Innovations for Aging

Chronic Disease Self-Management Education Program Grantee

1 of 2

Prevention and Public Health Fund 2022, effective May 1, 2022

Goals

The overall purpose of this three-year 

“Integrated Networks to Deliver and Sustain 

Evidence-Based Chronic Disease SelfManagement Education Programs” grant is to:

• Goal 1: Develop or expand capacity to 

significantly increase the number of 

older adults and adults with disabilities, 

particularly those in underserved 

areas/populations, who participate in 

evidence-based chronic disease selfmanagement education and selfmanagement support programs to 

empower them to better manage their 

chronic conditions.

• Goal 2: Enhance the sustainability of 

evidence-based chronic disease selfmanagement education and selfmanagement support programs 

through the implementation of robust 

sustainability strategies.

Strategies and Activities

The Juniper® network, a program of Trellis, and 

its partners will: 

• Scale program capacity to meet 

growing demand and increase program 

participation across Minnesota, 

including through blended class 

offerings that provide in-person, online, 

and telephone attendance options 

where allowed by program licensors;

• Compare outcomes based on 

participant method of attendance to 

identify differences in program 

participation by method of attendance, 

including impact to projected cost 

savings on a per completer basis;

• Deepen partnerships with healthcare 

providers, senior living communities, 

and the Minnesota Department of 

Health to promote referrals and 

contribute to local population health 

efforts;

• Integrate programming into care 

settings, including clinics and hospital 

locations where Juniper will insert 

community health workers (or a similar 

role) to offer social determinants of 

health screening, care navigation, 

health promotion programming, and 

referrals for other long-term services 
2 of 2

Prevention and Public Health Fund 2022, effective May 1, 2022

and supports in a communityintegrated health network model;

• Expand the geographical footprint of 

programs to match the reach of 

sustainability partners (health plans);

• Design quality measures and tracking 

systems that will capture program 

impact and illuminate return on 

investment for program participation; 

and

• Develop technology 

enhancements creating administrative 

efficiencies and operating cost 

reductions

Proposed Interventions

• Arthritis Foundation Exercise Program

• Living Well with Chronic Conditions

• Living Well with Diabetes

• Living Well with Chronic Pain

• Programa de Manejo de la Diabetes

• Tomando Control de su Salud

• Walk with Ease

• Wellness Recovery Action Plan

Partnerships

To achieve the goals of the grant, Trellis will 

collaborate with the following key partners:

• Arrowhead Area Agency on Aging

• HealthPartners 

• Minnesota Board on Aging

• Minnesota Department of Health

• Minnesota Indian Area Agency on Aging

• Minnesota River Area Agency on Aging

• Presbyterian Homes 

• Sanford Health 

• Solid Research Group

Anticipated Results 

Trellis and its partners propose to achieve the 

following results: 

• Partner with chronic disease selfmanagement education program 

providers.

• Engage 2,367 participants across all 

programs.

• Expand access to social determinants of 

health screening and referral through 

three clinic locations by engaging 900 

community members.

• Implement the Wellness Recovery 

Action Plan program

Contact:

Mark Cullen

Vice President of Strategy and Business 

Development for Trellis 

mcullen@trellisconnects.org

For more information: 

Administration for Community Living 

U.S. Department of Health and Human Services

Washington, DC 20201

http://www.acl.gov