Open Door Adult Community Mental Health Expansion

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Executive Summary

Open Door Adult Community Mental Health Expansion is a nonprofit in Tennessee that expands access to licensed counseling for adults. We add therapists, offer appointments within a week and evening and telehealth hours, charge fees on a sliding scale, accept Medicaid and employ a care coordinator who helps clients reach medical care, housing and benefits.

Many adults struggle with depression, anxiety and trauma, and the system that is supposed to help has long waits and few places that take Medicaid or charge according to ability. Untreated mental illness affects work, relationships and health.

With this grant we will serve about 150 adults in Year 1 at 1 clinic. We are not an emergency room and our crisis plan names 988 and 911. We explain the limits of confidentiality at the first visit and we do not promise any outcome. We promise licensed care, respect and honest records.

Our Year 1 budget is about $263,500, growing to about $460,500 by Year 5 as we add sites, coaches and participants. Each year's budget is planned to balance, with a small surplus each year. We have 4 staff in Year 1 (an Executive Director, a Clinical Director, a Therapist and a part-time care coordinator) and 10 by Year 5.

We are asking the Volunteer State Mental Wellness Foundation for $70,000 for a Licensed Therapist and the sliding-scale fee subsidy. Our other income and startup support cover the rest. These numbers are estimates based on the assumptions listed at the end of this proposal, and we do not promise any result beyond what we describe.

Company Description

Open Door Adult Community Mental Health Expansion is a nonprofit organization in Tennessee. We are a registered charity with a volunteer board of directors, a written conflict-of-interest policy and a yearly budget the board reviews.

Our mission. Every adult should be able to see a licensed counselor close to home, whatever they can pay.

What we do.
- Provide individual and group counseling from licensed therapists on a sliding fee scale.
- Offer same-week intake appointments and evening hours.
- Provide care coordination to help clients reach medical care, housing and benefits.
- Offer telehealth for clients who cannot travel.
- Bill Medicaid and insurance where possible and subsidize fees for those who cannot pay.
- Train primary care and community partners in making warm referrals.

Our values. Respect for every participant, honesty with families and partners, safety first and a place for everyone who wants to belong.

What we do not do. We are not an emergency room. Our staff follow a written crisis plan that includes the 988 Suicide and Crisis Lifeline and 911. We explain the limits of confidentiality, including mandatory reporting, at the first visit. We do not prescribe medicine; we refer to prescribers. We do not promise any outcome. We follow the rules of our partner sites and our insurer.

How we got here. A group of counselors and a pastor began offering free counseling two evenings a week in a church office. The schedule filled within weeks and a waiting list formed. We kept simple records of who we saw and how long they waited. This proposal asks for support to move from two evenings a week to a steady program with paid, trained staff and the materials to match.

Problem & Opportunity

Many adults struggle with depression, anxiety and trauma, and the system that is supposed to help them has long waits and few places that take Medicaid or charge according to ability.

Cost. Therapy can cost more than a household can pay, and many insurance plans cover few visits.

Access. Wait times for community mental health appointments are often weeks or months, and many areas have too few therapists.

Safety and trust. Clients and funders want licensed clinicians, a clear crisis plan and respect for privacy.

Missed benefits. Untreated mental illness can affect work, relationships and physical health and can lead to crises that could have been prevented.

What we hear.
- A man says he called seven offices and none had an opening for two months.
- A nurse says her patients are waiting for care she can only describe.
- A mother says she cannot pay a copay and keep her lights on.
- A client says her first appointment was the first time anyone had listened.

We do not claim that a program can solve every challenge. We believe that timely, affordable care from a licensed therapist can help adults recover and stay well.

Products & Services

Open Door Adult Community Mental Health Expansion gives adults who need mental health care a safe, welcoming place to get timely and affordable counseling.

How the program works.
1. Intake. A client calls or walks in and is offered an appointment within a week.
2. Assessment. A licensed clinician completes an assessment and agrees on a plan with the client.
3. Counseling. Clients receive individual or group sessions, in person or by telehealth.
4. Care coordination. A coordinator helps clients reach medical care, housing and benefits and keep appointments.
5. Fees. Fees follow a sliding scale, and Medicaid and insurance are billed where possible.
6. Crisis plan. Every client has a written safety plan, and every staff member knows the crisis plan with 988 and 911.
7. Follow-up. We check in with clients who miss appointments.

What a typical session looks like. Participants arrive and check in with a staff member, settle in together, work on the day's activity in small groups and finish with a short talk about what went well. Staff praise effort, correct mistakes kindly and make sure no one is left out.

Staff. Our therapists are licensed clinicians who pass a background check, complete our training and are paid for their time. A clinical director supervises care.

Access and fairness. Programs are free. Care is available to every adult regardless of ability to pay. We offer sessions in English and Spanish.

Market Analysis

Who we serve. Adults ages 18 and older in our service area who need mental health care, with priority for those with Medicaid or no insurance. Eligibility is need for care and where a person lives, and no adult is turned away for inability to pay.

How we estimate need. We cannot count every young person who could benefit, so we plan from what we can see. In our evening hours we filled every slot and kept a waiting list. Primary care clinics told us that many more patients need counseling than the area offers. For Year 1 we plan to serve about 150 participants at 1 clinic locations. By Year 5, with more staff and sites, we plan to serve about 430.

Where participants come from.
- Primary care clinics and hospitals.
- Churches and social service agencies.
- Employers and community groups.
- Clients who tell a friend.

Who else benefits. Families gain a healthier adult. Primary care clinics gain a place to refer. Employers gain healthier workers.

What the numbers mean. Every number here is a person who got an appointment this week. We keep our early counts modest and honest so we can do the work well.

Competitive Landscape

What young people can find today, and how we are different.

1. Community mental health centers. Essential and often have long waits. We add capacity and shorter waits.

2. Private therapists. Effective and costly, and many do not take Medicaid. We offer sliding-scale care.

3. Hospital behavioral health. Treat crises and are not set up for ongoing counseling. We provide the next step.

4. Employee assistance programs. Help those with employers who offer them. We serve those who do not have one.

5. Online therapy apps. Convenient and not for every client or every condition. We offer in-person and telehealth care.

What makes us different.
- Appointments within a week.
- Sliding-scale fees and Medicaid accepted.
- Evening hours and telehealth.
- A care coordinator for every client.
- A written crisis plan for every client.

Why this gap matters. Existing programs do good work, and most serve people who can already pay or who live close to them. The people we serve are the ones left over: they live in the wrong neighborhood, have the wrong schedule or have no one to ask. We are built to reach them.

We have spoken with primary care clinics, community mental health centers and other counseling programs to make sure we are filling a gap and not duplicating services. Their letters of support are in the attachments.

Marketing & Sales Strategy

How young people and partners will find us.

Reaching young people.
- Primary care clinics and hospitals. We will give staff a short referral form and a named contact.
- Churches and social service agencies. We will leave flyers and talk with leaders.
- Employers. We will offer a talk and a flyer.
- Social media and local radio. We will share clear information on how to get an appointment.
- Word of mouth. Clients tell friends.
- A simple website and a phone line with a text option.

Reaching staff and sponsors.
- Recruit therapists through universities, licensing boards and clinical networks.
- Offer an orientation, a background check and training in safety, privacy and respectful practice.
- Give partners a short report each quarter with counts of participants and what they said.

How we decide who joins. We use a simple sign-up form and enroll participants in the order received, with priority for those with the greatest need and for people new to the program. We keep a waiting list when the program is full.

What we watch. Sign-ups, attendance, clients seen, wait times and how many participants return for a second season.

Operations Plan

How the program will be carried out.

Timeline for Year 1:
- Months 1 and 2 (July and August): Hire the staff, buy equipment and materials, finalize the waiver, consent form and privacy policy with our attorney and sign site agreements.
- Month 3 (September): Hire therapists and open expanded hours.
- Months 4 to 10: Provide counseling and care coordination year-round with monthly clinical supervision.
- Months 11 and 12: Survey clients and referral partners, report to funders and plan Year 2.

Space. Counseling is provided at our clinic and by telehealth, with a private room for every session.

Safety and privacy.
- Every staff member is trained on the written crisis plan, which names 988 and 911.
- Therapists follow licensing rules and mandatory reporting laws and explain confidentiality limits to every client.
- Every staff member and volunteer passes a background check and completes safety training.
- Staff work in pairs or in view of others whenever participants are minors or in a vulnerable situation.
- We keep an emergency plan at every site, and participants complete an emergency contact form.
- We keep records private, share them only with a participant's permission or as the law requires and follow a written policy.

Equipment. We buy about $8,000 of equipment once at the start: laptops and telehealth equipment for therapists ($3,000), therapy room furnishings ($3,000), locking file storage and printers ($2,000). Later years replace or add a few items.

Staffing. In Year 1 I serve as Executive Director. The Clinical Director, a licensed clinician paid $66,000 a year, supervises care. The Licensed Therapist, paid $58,000, sees clients. A part-time care coordinator, paid $26,000, helps clients. We add therapists as demand grows.

Management & Organization

Dr. Marcus Whitfield, Executive Director. I lead the organization, report to the board and am responsible for budgets, partnerships and reporting. I came to this work as a counselor who saw how long people waited. I will complete the training we require of our staff so I understand the program from the inside. (Replace this paragraph with your own background.)

Staff. The Clinical Director, a licensed clinician, supervises therapists, licensed therapists provide care and a part-time coordinator helps clients. Each passes a background check. These positions are part of our grant request.

Board of directors. Our volunteer board includes a licensed counselor, a primary care physician, a client, a banker who serves as treasurer, an attorney and a pastor. The board meets every other month, approves our budget and reviews our safety plan. No board member is paid, and members with a conflict of interest step out of related decisions.

Advisory partners. A psychiatrist, a clinic director and a social worker give guidance twice a year.

Staffing and pay in this plan: Executive Director, paid $54,000 a year; clinical Director, paid $66,000 a year; licensed Therapist, paid $58,000 a year; care Coordinator (part-time), paid $26,000 a year.

Milestones Narrative

Our goals, how we will measure them and when we plan to reach them.

Year 1 outcomes (July 2027 through June 2028):
- Serve about 150 participants at 1 clinic locations.
- Run at least two full seasons and a summer session.
- Have at least 85 percent of participants attend most sessions.
- Have at least 80 percent of participants return for a second season.
- Receive positive feedback from at least 90 percent of families who answer our short survey.

What we count and how.
- Participants enrolled, sessions and games attended, from our records.
- Skills learned and goals met, from the coach's checklist.
- Equipment issued and returned, from our log.
- Participant and family feedback, from a short, confidential form.
We report what we find, including what did not work, and use it to improve.

Growth over five years.
- Year 2: About 220 participants at 1 clinic locations.
- Year 3: About 290 participants at 2 clinic locations.
- Year 4: About 360 participants at 2 clinic locations.
- Year 5: About 430 participants at 3 clinic locations.

Learning along the way. At the end of each quarter, the director and the board review the numbers and decide whether we are on track. If we are behind, we will adjust our outreach, our sites or our schedule before asking for more money.

After the grant. By Year 5, grants make up about 45 percent of our budget, down from about 64 percent in Year 1, as partners and donors give more. We will keep building those relationships every year.

Funding Request

What we are asking for, and how the money will be used. Our request: $70,000 from the Volunteer State Mental Wellness Foundation for a Licensed Therapist and the sliding-scale fee subsidy, for July 2027 through June 2028.

The request is spread across these budget lines:
- Personnel: Licensed Therapist salary, $58,000.
- Other: Sliding-scale fee subsidy, $12,000.

Other money in the program. This request is about 41% of our Year 1 grant income. Other grants and the income lines below pay for everything it does not cover.

Year 1 budget: about $263,500, planned to balance with a small surplus (about $10,900 after the yearly wear on equipment). Year 1 money coming in: Grant Revenue $169,500; state Mental Health Funding $60,000; medicaid and Insurance Reimbursement $24,000; individual Donors $10,000. Year 1 costs: executive Director $54,000; clinical Director $66,000; licensed Therapist $58,000; care Coordinator (part-time) $26,000; clinical Supervision and Consultation about $8,000; sliding-Scale Fee Subsidy about $12,000; health Record and Telehealth System about $8,000; crisis Plan Training about $3,000; outreach about $4,000; administration and Insurance about $12,000; about $3,600 a year for the wear on equipment.

One-time startup costs. Startup costs of $18,500 are paid once from startup money, not from the yearly budget: $3,000 for laptops and telehealth equipment for therapists; $3,000 for therapy room furnishings; $2,000 for locking file storage and printers; $3,000 for attorney review of the consent form, confidentiality policy and crisis plan; $1,800 for signs, flyers and a simple website; $2,200 for staff training and background checks; $3,500 for first insurance payment.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($18,500), the cash the program uses before it balances (about $0) and a cash cushion of about $62,800, which is about three months of Year 1 costs. In all, that comes to $81,500. We start with $8,000 from our founding board and $76,000 in startup support from a community foundation and a hospital partner, $84,000 in all, which covers that amount with room to spare.

The next five years. Our budget grows from about $263,500 in Year 1 to about $460,500 in Year 5. Grants are planned at $169,500, $193,000, $157,000, $181,500 and $206,500 in Years 1 to 5. Other income grows: state Mental Health Funding from $60,000 to $100,000; medicaid and Insurance Reimbursement from $24,000 to $128,000; individual Donors from $10,000 to $26,000. Our surplus is planned at about $10,900 in Year 1, about $13,800 in Year 2, about $15,000 in Year 3, about $18,600 in Year 4 and about $22,400 in Year 5. We grow from 1 clinic locations to 3 by Year 5, adding a part-time coach for each new site.

Savings. We plan to keep several months of costs in savings. The lowest year-end balance in the plan is about $78,000, at the end of Year 1. Some grant payments and partner payments arrive after we bill, so we plan for about $10,540 owed to us at the end of Year 1.

Cost per adult. In Year 1, our total costs are about $1,684 per adult served, which includes setting up the program. By Year 5, with more adult served and a trained team in place, that falls to about $1,019 per adult.

After the grant. State mental health funding, corporate sponsors and individual donors grow every year, so grants become a smaller share of our budget. Participants and families share their stories, and businesses can sponsor a team or a season by name. We will look for partnerships with schools and the city that want a safe, free mental health option for every child.

Risks and how we will handle them:
- An injury. Certified coaches, proper equipment, groups matched by age and skill, a written emergency plan and insurance.
- A site is no longer available. We keep agreements with more than one site and a plan for bad weather.
- A coach leaves. We keep a list of trained backup coaches and share lesson plans.
- Low attendance. We adjust sites, times and rides based on family feedback.
- A privacy problem. We follow a written policy, use secure systems and train every staff member and volunteer.
- A grant ends. We keep savings and grow partner and donor support each year.

If you are just starting. A new organization can begin before it has its own 501(c)(3) status through a fiscal sponsor: an established nonprofit that receives grants for you and passes them to your program, usually for a fee (commonly around 5% to 10% of the grant, sometimes more; ask before you agree). Another way is to start smaller: one neighborhood, a handful of adults and a small team, tracked carefully. Strong results from a small start make larger grants easier to win.

Appendix Notes

Documents to attach with this proposal:

- Your IRS 501(c)(3) determination letter, or your fiscal sponsor agreement.
- Your most recent financial statements and your current year budget.
- A list of your board members and what each one does.
- Signed letters of support from partner schools, agencies and sites.
- Your site agreements and your insurance certificate.
- Your consent, waiver and privacy policy.
- Your safety plan and background check policy.
- Your program outline and schedule.
- Quotes for equipment and materials.
- Resumes for your Executive Director and key staff.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers (change them in the Financials section to match your own):
- Grant Revenue: $169,500 in Year 1, growing to $206,500 in Year 5.
- State Mental Health Funding: $60,000 in Year 1, growing to $100,000 in Year 5.
- Medicaid and Insurance Reimbursement: $24,000 in Year 1, growing to $128,000 in Year 5.
- Individual Donors: $10,000 in Year 1, growing to $26,000 in Year 5.
- Pay (a full year, per person, including payroll taxes and workers' compensation): executive Director $54,000; clinical Director $66,000; licensed Therapist $58,000; care Coordinator (part-time) $26,000.
- Other yearly costs in Year 1: clinical Supervision and Consultation $8,000; sliding-Scale Fee Subsidy $12,000; health Record and Telehealth System $8,000; crisis Plan Training $3,000; outreach $4,000; administration and Insurance $12,000. These grow between 4% and 6% a year.
- Equipment: $8,000 at the start, then $2,000 to $3,000 a year.
- Startup costs: $18,500, paid once from $84,000 in startup money.
- Participants served: about 150 in Year 1, growing to about 430 in Year 5. Sites: 1 in Year 1, growing to 3 by Year 5. The clinic is open year-round, with evening hours three days a week.
- About 4% of each year's income is still owed to us at year end.
- Tax: none, as a nonprofit.
- Every dollar amount is an estimate. Replace them with your own quotes and real budget.

Startup Costs