How to Apply

Step 1: Watch THE Informational Webinar (Optional)

Watch the Informational Webinar to hear a detailed description of the learning collaborative and listen to some questions and answers. The slides from this webinar can be found here and a detailed FAQ can be found here

Step 2: Apply Online

Your proposal and budget must be submitted online by Thursday, April 30, 2020 by 5pm.

Applications should include the following:

  1. Application Submission Form 
  2. Application Narrative: Includes responses to the nine questions listed below. 
  3. Budget Template
  4. Tax Status Documentation
  5. Letter of Leadership Support: This letter should demonstrate organizational commitment to ACEs screening and response. This includes dedicated time for the core team to fully participate in program convenings, activities, and implement changes at the clinical and organizational level. The letter should be submitted by either the CMO, COO, or CEO.
Application Narrative Questions

Please limit responses to a maximum of 6 pages, using at least 11-point font and 1-inch margins.

  1. Timeliness and Alignment: Why is it important for your organization to address this topic at this point in time? How does this learning collaborative align with your broader organizational goals?
  2. Organizational Commitment to Trauma-Informed Care: What past or current work has your clinic engaged in to understand and implement trauma-informed care? What training has your staff undergone in this area? What are 1-2 lessons that you have learned about what it takes to build a trauma-informed organization?
  3. ACEs Screening: How do you currently assess for trauma and ACEs at your organization? What improvements would you like to make to your current screening processes?
  4. ACEs Treatment and Response: If a patient screens positive, what are the ways your organization responds to identified ACEs? What are the options available for treatment or referrals, both internal and external? 
  5. Resilience and Protective Factors: What are you currently doing to promote resilience in your patient population? Are resilience and protective factors integrated into care? If so, how?
  6. Site Selection: What site will you start piloting ACEs screening and response (in alignment with ACES Aware) and why did you select this particular site? What are some key characteristics about that site (for example, number of patients, number of providers, and prior trauma-informed care work)? What other sites (up to four additional) will you plan to spread to within the timeframe of the learning collaborative? 
  7. QI Experience: Please describe a clinical improvement project you implemented in your organization. What data (outcome measure, processes measures, balancing measures) did you collect and how often? What is an example of one change you made based on what you learned from the tests and/or data?
  8. Data Reporting Capabilities: Please describe your current ability to collect and report on data regarding ACEs screening and response/referral. How are data currently collected? How are data used? If not currently collected or if collected manually, what is the process for creating new reports on clinical quality metrics?
  9. Looking Ahead: What challenges would you expect to face in participating in this program? What challenges do you foresee impacting your ability to implement ACEs screening and response? What can CCI do to help address these potential constraints? For example, what resources might you need to implement your work (i.e., expertise, coaching, technology or other outside partners)?

California ACEs Learning and Quality Improvement Collaborative (CALQIC) Application Submission Form

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.


Upload and submit all application materials via this form by Thursday, April 30, 2020 at 5pm. Decisions will be made by mid- to late- April, with formal award letters and announcements sent Monday, June 15, 2020.

Organization Information















If Applicable: Fiscal Sponsor Information









Patient Demographics 






Grant Information and Current ACEs Screening Practice 





CALQIC Program Agreements 

Please answer the following questions:


Is your team willing to align your organizations' ACEs screening and response efforts with the ACEsAware Initiative, including:




CEO Contact 




Grant Manager Contact 






Project Team Members

Please list the contact information for each member of your anticipated team. At least 4 individuals, including the project lead, are required to be committed to the program. Your team can have up to eight individuals participating in core program activities. Please see the RFA for suggestions regarding appropriate roles to have on your team.


To add another Team Member, click "Add another Team Member" in the bottom right corner.

Project Lead Contact






Team Member 2





Team Member 3





Team Member 4





Additional Team Members





Application Components




Next Steps

CCI and our learning collaborative partners will review applications. Our intent is to select an engaged group of up to 15 organizations representing at least 50 sites that have already started their journey toward ACEs screening and response and are committed to leveraging this support to advance their efforts. Priority will be given in order to ensure geographic diversity in the final cohort as well as to ensure a mix of organizations focused on screening pediatric and adult populations. The cohort will be announced via email by Monday, June 15, 2020.

 

Download RFA as PDF