II. Grant Program Characteristics

Overview of Grant Programs

The five grant programs that are authorized by Part D, Sections 751 through 755 of the Public Health Services Act and that are under the purview of the Advisory Committee include:

• Area Health Education Centers (AHECs);
• Health Education Training Centers (HETCs);
• Geriatric-Related Education and Training;
• Quentin N. Burdick Program for Rural Interdisciplinary Training; and
• Allied Health Program.

While these programs focus on different constituencies, they all provide training for health professions students, medical residents and local providers in community settings. In addition, they provide a key link between the academic health institutions and communities.

Without the Federal support provided by these programs, communities of persons who are vulnerable and often ignored by our traditional health care system would be denied access to primary and preventive health care. These populations include the elderly, rural residents, inner-city minorities, and those with special needs who live in U.S./Mexican border areas.

While distinguished by their different target populations, these programs share the following common goals:

• To increase the numbers of health professionals who can function in an interdisciplinary and multidisciplinary community-based setting through the training of students in the health professions, education of faculty in academic health centers, and continuing education for health care practitioners.
• To promote a redistribution of the health workforce to underserved areas within our nation.
• To improve the health status of the most vulnerable of our citizens by providing them with health care professionals who are technically well-trained, culturally-competent in the care they provide, responsive to the needs of the communities in which they work, and comfortable providing that care as part of an interdisciplinary team.

The success of these interdisciplinary, community-based grant programs in meeting their goals is clear. In FY 2000, the 45 AHECs and 13 HETCs trained approximately 40,000 health professions students in community-based sites. These sites, in areas designated as health professional shortage areas, include migrant health centers, local health departments, and National Health Service Corps sites. Of the students trained, slightly over one-half are medical students. Reaching down into the potential health manpower pipeline even further, approximately 25,000 high school students participate each year in AHEC-sponsored health career recruitment activities.

The Allied Health Program plays a crucial role providing a rapid transition of students with a baccalaureate degree into the health-related sciences. Allied Health professions encompass about 30 percent of the total health care workforce and projections are that by 2010, 5.3 million new Allied Health workers will be needed. Already there are shortages in critical Allied Health fields. For example, clinical laboratories are experiencing shortages of all types of diagnostic scientists and technicians from the associate's degree level through graduate degrees.

In addition to student training, faculty development activities are an important part of these grant programs. The Quentin N. Burdick Program trains faculty in the economic and logistical problems associated with rural health care delivery. Geriatric Education Centers train academic and clinical faculty at 170 health-related schools and 550 affiliated clinical sites. Additionally, 33 Geriatric Academic Career Awards were funded in FY 2002 to train the next generation of academic geriatricians.

Continuing education is another major activity in all of the Interdisciplinary Community-Based Grant Programs. Over 200,000 health professionals in the community received continuing education programs sponsored by the AHEC, HETC, GEC, or Burdick program in FY 2000.

Encouraging health care professionals to continue to serve in medically underserved areas or with medically underserved populations is also an important goal of Part D programs. A recent national survey of graduates of the Quentin N. Burdick Program showed that 54 percent were employed in rural or frontier areas 3 years after training. Many of the health professions students and the community health workers who receive training by the HETCs in underserved areas ultimately remain there to continue their practice.

Thus, in combination, these programs provide important educational and clinical opportunities for a health workforce that will serve unserved or underserved populations in our Nation.

Characteristics of Individual Programs

Area Health Education Centers (Section 751)

Purpose

The foremost purposes of AHECs are to:

• Improve the recruitment, distribution, supply, quality, and diversity of personnel who provide health services in underserved rural and urban areas or to populations with demonstrated serious unmet health care needs;
• Increase the number of primary care physicians and other primary care providers who provide services in such areas and to such populations; and
• Increase health careers awareness among individuals from underserved areas and underrepresented populations.

Activities

AHECs carry out the following activities to achieve the purposes stated above:

• Recruitment and health careers awareness programs to recruit individuals from underserved areas and underrepresented populations into the health professions;
• Preparation of individuals to more effectively provide health services to underserved areas or underserved populations through 1) field placements, 2) preceptorships, 3) conducting or supporting community-based primary care residency programs, and 4) agreements with community-based organizations such as community health centers, migrant health centers, Indian health centers, public health departments, and others;
• Health professions education and training activities for students of health professions schools and medical residents,
• At least 10 percent of the clinical education required of medical students is conducted at sites remote to the primary teaching facility of the contracting institution; and
• Information dissemination and educational support to reduce professional isolation, increase retention, enhance the practice environment, and improve health care through the timely dissemination of research findings.

Accomplishments

• Since 1972, AHEC programs have trained more than 1.8 million students and residents in medicine, nursing, Allied Health, dentistry, pharmacy, public health, and other disciplines in areas designated as health professional shortage areas.
• As of 2003, the AHEC network consisted of 49 campus-based AHEC programs affiliated with 180 community-based AHEC centers. More than 60 percent of the centers are hosted by non-profit 501(c)(3) organizations. Community colleges and universities host another 19 percent, community hospitals 9 percent, community health centers 3 percent, and other host relationships account for the remaining 6 percent.
• The 49 AHEC programs consist of 33 Model (fully established) and 16 Basic (under development or expansion) programs. Each AHEC program consists of a program office and one or more remote centers. Model centers receive approximately $82,000 in Federal AHEC funds, making up the rest of their budget from State and local sources. The average AHEC center employs a full-time equivalent staff of about four.
• AHEC programs exist in all but seven states and Puerto Rico. Their annual impact is briefly summarized below:
• AHECs train approximately 31,100 health professional students in community-based sites per year. Of that total, slightly over half (17,000) are medical students; the rest are students from other health professions, including Allied Health.
• AHECs work with approximately 530 community or migrant health centers and 475 health departments, approximately 170 National Health Service Corps sites serve as training sites.
• Approximately 28,200 high school students participate each year in 20 or more hours of AHEC-sponsored health career enhancement or recruitment activities.
• More than 329,600 local providers receive AHEC-sponsored education on topics relating to locally defined needs and Federal priorities. Topics covered include bioterrorism and emergency preparedness, oral health, women's health, domestic violence, adolescent issues, diabetes, HIV, and mental health. Cultural competence is also a focus.
• Below are some examples of AHEC program leadership in bioterrorism training to health care professionals.
• Three AHEC programs, Oklahoma AHEC, California AHEC (UC-SF), and South Carolina Area Health Education Consortium (Medical Univ. of SC) are Bioterrorism Training and Curriculum Development Program (BTCDP) awardees, a Title III program in the Division of State, Community, and Public Health. Four other AHEC programs, Arkansas AHEC, Colorado AHEC, Connecticut AHEC, and the Virginia Statewide AHEC System, are collaborative partners with BTCDP awardees in their states.
• With extensive involvement using the continuing education resources and networks of these seven AHEC programs, an estimated 52,615 health care professionals will receive bioterrorism preparedness training.

Funding

In FY 2003, 49 AHEC programs received $31.6 million in funding, an amount essentially unchanged from the previous two years (FY 02: $32 million for 46 programs; FY 01: $31.6 million for 44 programs).

Health Education and Training Centers (Section 752)

Purpose

As their primary purpose, HETCs address persistent and severe unmet health care needs in States along the border between the United States and Mexico and in the State of Florida. They are also charged with the same mission in other areas, urban or rural, that have populations with similar needs.

Activities

To accomplish their mission, HETCs engage in the following activities:

• Training and education programs for health professions students in the assigned service area;
• Training in community-based health education services, including training to prepare community health workers; and
• Education and other services to health professionals practicing in the area.

In support of these activities, each HETC maintains an advisory board of health service providers, educators, and consumers from the designated area.

Accomplishments

In FY 2002, HETC's achieved the following:

• 16,000 health professional providers received continuing education;
• 3,677 health professions students and 1,226 preceptors served in medically underserved areas;
• 7,593 students in grades 9-12 participated in health careers awareness activities of 20 hours or more; and
• 681 community health workers (CHWs) received training that addressed a variety of topics including lead poisoning, indoor air quality, asthma control, environmental health, cardiovascular disease, building community capacity, rural health issues, and others.

Funding

In FY 2003, 13 HETC programs (5 border and 9 non-border) received a total of $4 million in funding, with half of that amount ($2 million) awarded to border area HETCs in Arizona, California, New Mexico, Texas and Florida. Average funding per HETC program in FY 2003 was $400,498 for border programs and $250,361 for non-border programs. The average for all HETC programs in FY 2002 and FY 2003 was $308,260, as opposed to $480,000 in FY 2001 when there were only nine HETC programs. With the total Federal investment remaining essentially constant over time while the number of programs increases, there is an insufficiency of funds for individual programs to address worsening health education and personnel training needs, particularly in the U.S.-Mexico border region.

Geriatric Education and Training Projects (Section 753)

This section of the legislation, designed to improve the training of health professionals in geriatrics, consists of three components:

• Geriatric Education Centers (GECs);
• Geriatric Training for Physicians, Dentists, and Behavioral/Mental Health Professionals (GT); and
• Geriatric Academic Career Awards (GACA).

Geriatric Education Centers

Purpose

The GEC Program is the only federally-funded program dedicated solely to the interdisciplinary geriatrics education and training of all health professionals. By its very nature, geriatrics health care requires a team approach. The elderly tend to have multiple health problems and quality health care for these individuals requires an interdisciplinary team approach. The GEC Program provides funding to strengthen interdisciplinary education and training of all health professionals in the diagnosis, treatment, and prevention of disease and other health problems of the elderly. GECs provide services to and foster collaborative relationships among members of the health professions educational community.

Activities

Projects supported by the GECs offer interdisciplinary training involving four or more health professions disciplines. The interdisciplinary approach of the GECs fosters an interdisplinary team approach among partners and enables this team of health professions partners to work together in ways that would not otherwise be utilized to achieve a statewide approach. Through, for example, interactive videoconferencing and other state-of-the-art distance learning technologies, each project is afforded the opportunity to establish regional sites through any given State, thereby equipping each GEC to be an effective and efficient way to reach target populations, particularly those in rural/underserved areas. Since 1983, GECs have worked to:

• Improve the training of health professionals in geriatrics by providing geriatric residencies, traineeships, or fellowships;
• Develop and disseminate curricula to health professionals on the treatment of health problems of the elderly;
• Support the training and retraining of faculty to provide instruction in geriatrics;
• Support continuing education of health professionals who provide geriatric care; and
• Provide students with clinical training in geriatrics in nursing homes, chronic and acute disease hospitals, ambulatory care centers, and senior centers.

Accomplishments

These activities have produced the following accomplishments:

• Since inception in 1983, the GECs have provided geriatric training to over 400,000 health professionals in 27 disciplines and to 2,700 academic and clinical faculty at 170 health-related schools and 550 affiliated clinical sites.
• All GEC grantees have collaborated and established linkage relationships with the State and local organizations that deliver health care to increase or enhance the services provided to underserved communities and populations.
• Each GEC works with primary and secondary schools that have a high percentage of minority and disadvantaged students to increase their interest in health professions careers and in order to expand the pool of diverse and culturally competent qualified applicants for the health professions workforce.
• The National GEC Network (NGN) has developed and continues to develop a continuum of audiovisual media for presenting educational content. The interaction continuum ranges from television with full-motion video and audio interaction to interaction with either visual or audio media. The midpoint of this continuum is the use of computers as an interactive medium for learning.
• To encourage continued collaboration between centers and avoid redundant development, the GEC Clearinghouse Web site, http://coa.kumc.edu/gecresource/loginMain.asp, was established by the GEC at the University of Kansas Medical Center. The Clearinghouse is a depository of resources developed by GECs across the country. GEC resource information maintained in the Clearinghouse is searchable by title, keywords, descriptions, or authoring organization. Access to the GEC Clearinghouse is available to health professionals and the public at large.

Funding

It is important to note that over the last few years, funding for establishing new GECs has been scarce (i.e., 15 new GECs were funded in FY 2000, 14 in FY 2001, 12 in FY 2002, and five in FY 2003 with Alaska and Maine representing states with GECs for the first time). Forty-six (46) GECs received $16.8 million in FY 2003, with an average first-year award of $200,000 for a single institution and $400,000 for a consortium of three or more. Despite ongoing efforts, the goal of establishing a minimum of one GEC within each state has yet to be realized.

Geriatric Training for Physicians, Dentists, and Behavioral/Mental Health Professionals

Purpose

The goal of the GT program is to train physicians, dentists, and behavioral/mental health professionals to become experts in geriatrics in order to serve as faculty for other trainees in their respective health professions. Training must be based in a graduate medical education program in internal medicine or family medicine or in a department of geriatrics or behavioral or mental health. This program consists of two options:

• A 1-year retraining program in geriatrics for current faculty members; or
• A 2-year internal medicine or family medicine fellowship program, with emphasis in geriatrics, for physicians, dentists, and behavioral or mental health professionals who have completed graduate medical education or post-doctoral training.

Activities

• The GT program provides full-time, intensive training in a 1- or 2-year program for physicians, dentists, and behavioral and mental health professionals in geriatrics who plan to become faculty members. The GT program provides a minimum of 2,080 hours of training in a 1-year program and 4,160 hours in the 2-year fellowship.
• Each program has a core curriculum for all fellows and specialized training in each discipline.
• The core curriculum addresses teaching, research, administration, and clinical training.
• The programs provide fellows exposure to elderly patients in various levels of wellness and functioning and from a range of socioeconomic and racial/ethnic backgrounds.
• Service rotations include geriatric consultation services, acute care services, dental services, geriatric psychiatry units, day and home care programs, rehabilitation services, extended care facilities, geriatric ambulatory care, and community care programs for elderly persons with mental retardation.

Accomplishments

The GT program is unique in the country. It is an integrated program that is not limited to one hospital and has flexibility in affiliations and in curriculum. The number of clinical sites is broad and includes day and home care programs, geriatric psychiatry units, rehabilitative services, extended care facilities and community care programs for elderly persons with mental retardation. The program is the only program in the U.S. that trains faculty in postdoctoral geriatric dentistry.

Between 1989 and 1999, 334 fellows were trained. The seven projects scheduled to end in 2005 will train 87 fellows. Two projects, one at a historically Black college/university (HBCU), are projected to train an additional 30 fellows by the end of the program in FY2007. Three new projects scheduled to end in 2008 are projected to train an additional 45 fellows.

Funding

In FY 2003, $6.5 million was awarded to 12 geriatric training programs for physicians, dentists, and behavioral/mental health professionals.

Geriatric Academic Career Awards

Purpose

The GACA Program was established in 1998 by the Health Professions Partnership Act to increase the teaching of geriatrics in medical schools. The purpose of the Geriatric Academic Career Award is to support the career development of geriatricians in junior faculty positions who are committed to academic careers teaching clinical geriatrics.

Activities

• GACA recipients are required to provide training in clinical geriatrics, including the training of interdisciplinary teams of health care professionals.

Accomplishments

• The first competition for the GACA was held in 1999. The accomplishments of these junior faculty members are impressive and diverse. All are providing interdisciplinary training. Many are providing training in community-based settings in addition to hospital and medical school-based training. Their activities include curriculum development, various administrative duties at their medical schools; providing care and teaching in a wide range of clinical settings; clinical research; participating in educational programs to build their own skills; and providing continuing education to already practicing health professionals and working with other sponsored health education programs.
• In a single year (FY 2002), the 13 funded GACAs from FY 1999 provided training to over 4,800 health professionals including medical students, residents, fellows, physicians practicing in the community, nurses, nurse practitioners, social workers, physical and occupational therapists, dentists, psychologists, respiratory therapists, ethicists, health administrators, case managers, pharmacists, community workers including police personnel, informal caregivers, and community dwelling elderly persons.
• In FY 2002, 20 GACAs were awarded.

Funding

In FY 2003, $6.8 million funded 73 Geriatric Academic Career Awards, 29 continuations and 41 new awards.

Quentin N. Burdick Program for Rural Interdisciplinary Training (Section 754)

Purpose

The purpose of the Quentin N. Burdick Program for Rural Interdisciplinary Training is to support the interdisciplinary education and training of health professional teams to enter into practice and/or remain in rural areas. The interdisciplinary training projects are designed to:

• Use new and innovative methods to train health care practitioners to provide services in rural areas;
• Demonstrate and evaluate innovative interdisciplinary methods and models designed to provide access to cost-effective comprehensive health care;
• Deliver health care services to individuals residing in rural areas;
• Enhance the amount of relevant research conducted concerning health care issues in rural areas; and
• Increase the recruitment and retention of health care practitioners from rural areas and make rural practice a more attractive career choice for health care practitioners.

Activities

To accomplish these goals, Quentin N. Burdick programs carry out the following major activities:

• Provide all health-related students an interdisciplinary learning experience designed to enhance the understanding of the contribution that each discipline brings to the solution of health problems.
• Conduct workshops and education activities in rural communities for rural health professionals and the community.
• Provide information and awareness activities for K thru 12 grade students concerning career opportunities in the health professions.
• Funds are also used to purchase or rent transportation and telecommunication equipment where needed.

Accomplishments

• Since 1990, over 13,000 health care providers, teachers, and students in 23 disciplines and 31 states have been trained through Quentin N. Burdick programs.
• The retention aspect of the program is impressive. Over 50 percent of the graduates of these programs were, according to a recent nationwide survey, employed in rural or frontier areas 3 years after training.

Funding

Since1990, $51 million has been spent to fund a total of 99 Quentin N. Burdick interdisciplinary training projects. In FY 2003, $6.7 million was awarded to 22 projects.

Allied Health and Other Disciplines (Section 755)

Purpose

Section 755 has several purposes. In addition to a major emphasis on increasing the supply of individuals trained in the Allied Health professions, this section of the legislation authorizes support for:

• Preventive and primary care residency training of podiatric physicians;
• Collaborative demonstration projects involving chiropractors and physicians and the treatment of spinal and lower-back conditions; and
• Graduate programs in behavioral and mental health practice.

Activities

Allied Health

To meet the goal of increasing the supply of Allied Health practitioners as effectively as possible, the programs and activities funded under this Section focus on:

• Professions with the greatest shortages or whose services are most needed by the elderly;
• Programs that provide rapid transition training into an Allied Health profession for students with baccalaureate degrees in health-related sciences;
• Community-based programs linking academic centers to rural clinical settings;
• Career advancement training programs for Allied Health professionals in practice;
• Programs that develop curricula involving prevention and health promotion, geriatrics, long-term care, home health and hospice care, and medical ethics;
• Programs that seek to expand or establish clinical training sites in underserved or rural communities;
• Interdisciplinary training to promote the effectiveness of Allied Health practitioners in geriatric care; and
• Demonstration centers that apply innovative models to link Allied Health practice, education, and research.

Podiatric Medicine Training Grants

These grants are used to support training programs that encourage primary care, especially for underserved, minority, and elderly populations and for persons with AIDS.

Chiropractic Demonstration Grants

In addition to emphasizing collaborative efforts between chiropractors and physicians, a major focus is placed on the development and application of research protocols that will significantly expand documented research in the field.

Behavioral and Mental Health Training Grants

Activities conducted in connection with these grants include: increased training in residential care, faculty support for training and/or retraining, continuing education for certified/licensed paraprofessionals, and clinical training of students in senior centers and ambulatory care settings.

Accomplishments

Allied Health

Since inception, a total of 163 Allied Health projects have been funded. Currently, there are 38 Allied Health grants in place, training large numbers of students and serving people throughout the Nation.

• Allied Health programs provide access to health professions education and training to students in both minority and disadvantaged populations. For example, 95 percent of student recruitment and retention activities in Allied Health Special Projects have been offered to students from these populations.
• Grants have been awarded to academic institutions, hospital-based education programs, and consortia involving 42 different allied health disciplines in 22 states and the District of Columbia, with 26 percent of these awards going to Hispanic Serving Institutions and Asian Americans and Pacific Islanders Serving Institutions. Student recruitment and retention activities have affected more than 9,080 individuals, with 95 percent of these students being minority, disadvantaged, or both.

Podiatric Medicine Training Grants

At present, there are three grants for training students in podiatric medicine.

Chiropractic Demonstration Grants

Since 1994, more than 9,000 patients have received chiropractic care through grants with schools of chiropractic. Chiropractic care is provided to research participants at no cost to the patient.

• Since 1994, 13 grants have been awarded and have supported institutions and practitioners in the states of California, Iowa, Illinois, Minnesota, and Oregon. Grantees have provided chiropractic care to more than 9,000 patients.
• Chiropractic demonstration research grants are designed to improve the quality of chiropractic care by developing and testing new models for interdisciplinary medical and chiropractic care for the alleviation of pain and to increase mobility among back pain sufferers. This results in the continual improvement of the quality of patient care and service delivery. Grantees provide chiropractic care to research participants at no cost to the patient.

Behavioral and Mental Health Training Grants

In FY 2002, a new Graduate Psychology Education Program was instituted. Fifty-two (52) grant applications were approved and 15 were funded. In addition, work began on 3 new geropsychology projects, emphasizing the behavioral and mental health needs of the elderly. In FY 2003, 25 new graduate psychology education projects were funded. Also, a new Graduate Geropsychology Education Program was instituted in FY 2003. Twenty (20) applications were approved and seven were funded.

Funding

In FY 2003, funding under this section of the legislation was as follows:

• Four new Allied Health projects were funded and 34 projects received continuation funds, for a total of $4.2 million;
• The three podiatric medicine awards totaled $160,432;
• Three new chiropractic demonstration projects totaled $1.2 million; and
• Total funding for behavioral/mental health training was $4.9 million. Twenty-five (25) new graduate psychology projects were funded and 17 projects received supplemental funds for a total of $3.7 million. Seven new Graduate Geropsychology Education grants totaled $1.2 million.