Musings and advice re: your project design and writing your proposal

Jennifer Christian MD

What a DELIGHT to hear that some of you are now starting to move into the program design and proposal writing phase!   Here are some musings and some personal advice that I hope will help you think about how to approach the issue program design – and describe it in your proposal.  


Reassuring words:   Do not despair if you have to write a proposal that is fuzzy on a lot of details.   This demonstration program is VERY unusual, is NOT in anyone’s area of comfort today -- and thus includes several unusually knotty leadership/policy/operational/technical issues that will need time to figure out.   Realistically, it is UNLIKELY that ANY team is going to submit a proposal with ALL questions answered in detail given the CRAZY SHORT TURNAROUND TIME.   AND it’s unlikely the Feds will cancel the whole thing.  The fact that the 8 winners are going to get $1 million and 9 months to make preparations before you start your teeny weeny pilot test is an ACKNOWLEDGEMENT by the Feds that it is going to TAKE TIME to work all of the details out.


I’ve heard through the informal grapevine that in the past, the Feds have accepted the “best available” bids despite weak or half-baked plans.   As I understand it, they tend to accept  bids from GOOD groups of solid and committed people from states with a reputation for doing high quality work and actually getting things done.  After award, the Feds then relied on the Technical Assistance process to help strengthen the plans. 


So, I encourage you to write about your team members, the professional capabilities and strengths they are bringing to the team, those who are familiar with the dynamics of the SAW/RTW process, with working in a multi-stakeholder environment, with collaborating across traditional boundaries, who have a track record of commitment to workers, to improving outcomes, to preventing needless work disability -- whatever is relevant.  And point to their track record of accomplishing what they set out to do – and your state’s record with prior demonstration projects (if any).  


Also lay out:

  • Your understanding and agreement with the FED’s goals for the RETAIN Demonstration: to take a model that has been shown to reduce entry onto SSDI and adapt it as necessary to your state’s situation while staying true to as many of the key features as possible so it doesn’t lose its effectiveness.  
  • Your awareness and agreement with the unusual features of this project:
    • The new-to-you target population of working people with brand new and common everyday illnesses or injuries (especially musculoskeletal ones) who are NOT AWARE they might need help AND whom none of us would “deem” disabled (yet)
    • The multi-agency / multi-sector / public-private ACTIVE collaboration that will be required to deliver the interventions required to make the right things happen during that window of opportunity
    • The urgency and short time-window in which action needs to occur (preferably the first few WEEKS after onset of work disruption, going longer (up to 6 months) only in unusual cases
  • Articulate the GENERAL APPROACH you plan to take; persuasively convince the reader that you are really taking on a multi-stakeholder approach to the project leadership and management; describe  how you will conduct the program; demonstrate your awareness of the “hardest parts” and “critical success factors” of the project; describe the WAY you will be approaching the challenges and problems.  

With regard to your program design itself, I believe the Feds want to see the COHE program’s brilliant community positioning and simple clinical and SAW/RTW interventions duplicated as closely as possible given your state’s realities.    Therefore, I would think you would want to

  1. Describe your understanding of the key features of COHE that you believe were instrumental in delivering the result (different from “the norm”) so that you want to preserve / enhance as much as possible in your project.
  2. Describe your realities in some detail (to display your understanding of the facts AND dynamics of the actual situation on the ground in your geographic area),
  3. Discuss the rationale for each of the modifications to the COHE program’s design that you are making.
    • (I would caution against making modifications based on your team’s professional beliefs or preferences or philosophy (because the COHE model is the thing that has actually proven to be effective in reducing long-term disability and SSDI entry.  Thus, modifications should be required by your situation.)
    • Explicitly lay out the reasoning for why you think the COHE model –-- will not be diminished, and may even be enhanced by the changes you are making.
    • Explain why and how any additional interventions (over and above the basic COHE model) that are going to be provided by COHE staff or community physicians, the workforce agency or VR or whatever – whether actual services or subsidies or incentives -- will make your program even MORE LIKELY to reduce duration of work absence, job loss, and subsequent entry onto SSDI.


Jennifer Christian, MD, MPH

President / Chief Medical Officer

Webility Corporation

95 Woodridge Road

Wayland, MA 01778

Office:  508-358-5218 (preferred)

Mobile:  617-803-9835

Email: jennifer.christian@...