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Two specific pieces of your RETAIN proposal - preliminary thoughts

Jennifer Christian
 

You may have already figured this out, but one group asked me to think with them about two parts of the proposal:   (1) Project Logic Model to illustrate Theory of Change  and (2) Organizational Chart.

Here is my very first whack at these pieces – generating some ideas that might be helpful in getting you started.  Some of you are WAY more experienced in writing up proposals and project plans than I am -- but very FEW of us are accustomed to having so many disparate entities involved.   Discussing these things with others would probably improve these ideas and cause better ones to emerge.  But here’s at least some preliminary thoughts.   

1.   Project Logic Model to Illustrate Theory of Change.  Five minutes of Google searching was very worthwhile.   I Googled these words:  Project Logic Model Template, and then clicked on Images.    Instantly clarified the basic nature of the work product.  And then I think you will get a lot out of looking at some of the non-image items.  University of Wisconsin looks like it has very useful stuff.    Attached is an excel template for a logic model worksheet from the University of Arkansas Agricultural something or other. 

Here is how I see it:  Fundamentally, for RETAIN a project logic model should tell a graphical story about your main idea:  what you are going to to improve outcome with a pithy explanation of how/why each thing contributes to the whole.  It must be a highly simplified graphical depiction of the chain of events you are putting in place that are intended to improve AGGREGATE outcomes of MANY INDIVIDUAL CASES, each box annotated with pithy little statements.   So your Logic Model should spell out the specific change that each major interaction the project staff is going to have with the key stakeholders will accomplish – HOW and WHY it will avoid an unfortunate outcome or increase the likelihood of a good one.    

Please do remember this:   most of the risk factors that create NEEDLESS work disability actually reside in the BRAINS / MINDS of the stakeholders:  the emotions, memories, knowledge, beliefs, expectations and intentions they have as well as the  decisions they make.   Here are two examples:  A doctor who doesn't even THINK of (and/or doesn't KNOW HOW or is UNWILLING to take the time) to provide practical guidance to patients on the specific activities they should / can be doing during recovery may unwittingly send a message to his/her patient that working in his/her condition is unsafe and the patient has to sit around until he/she gets all better.  An employer who refuses to provide light duty is usually doing it because they have never even heard of or considered the idea, do not know that working during recovery will benefit their worker, do not know they have an obligation to abide by FMLA or make reasonable accommodations or how to play their role,  have competing priorities, bad past experience, lack of know-how, lack of awareness that a practical solution exists, or lack of money, 

So, your project logic model should probably explicitly state that the ACTIVE INGREDIENTS in your staff’s activities include the transmission of knowledge, perspective, encouragement, know-how, confidence, etc.  as well as problem-solving skills, simple workarounds or technical solutions, or money.  

For example, your statement that you are going to recruit, train and coach physicians/healthcare providers and pay them to deliver best practices would read:  

RECRUIT, TRAIN, PAY & ON-GOINGLY REMIND MEDICAL PRACTITIONERS WHEN AND HOW TO DELIVER 4 SPECIFIC BEST PRACTICES .  THIS  WILL INCREASE THE NUMBER OF WORKERS IN THE DESIGNATED AREA WHO

(a) RECEIVE TIMELY AND APPROPRIATE GUIDANCE RE: FUNCTION & SAW/RTW AT ONSET OF WORK DISABILITY, AND

(b) RECEIVE A REFERRAL TO THE COHE FOR SAW/RTW COORDINATION SERVICES FROM THEIR CLINICIAN WHEN WORK ABSENCE EXCEEDS 2 WEEKS.

I've attached two documents that might be useful: 

(a) the How to Mitigate Risk Factors flow chart from the report on Improving Pain Management and Support for Workers with Musculoskeletal Disorders and

(b) the table showing specific Gaps that Create Work disability (Lucky vs. Unlucky People)  that is Appendix ii in our original proposal for a Community Focused Health & Work Service.      

2.  Organizational Charts:    My first impulse is to imagine three versions, each of which shows a different level /nature of detail:

a.  Describe administrative relationship among entities: one box for State DOL (shown as grant fiscal authority/ project with name of designated lead individual);  with dotted line to one box for Leadership Team with a list of organizational members and individual names) :  (c) dotted line to one box for Advisory Board (with same kind of details as Leadership Team), (d) straight line to contracted project management entity (if any) overseeing (e) contracted COHE-equivalent, and contracted ER-services entity, and any other direct service delivery entities.   And dotted line to TA contractor and Evaluation contractor.

b.  Delegation of functions to, among, and within  entities - i.e. overall Federal project management, overall project operations and direction;  budget/fiscal accountability;   bill payment and incentive payment for services delivered;   information handling, data capture, and IT infrastructure management;  clinical / medical oversight;  direct delivery of clinical/medical best practices;   delivery of telephonic RTW Coordinator services;  delivery of more intensive functional rehabilitation or vocationally-related services to individuals;  worksite-site delivery of employment support services;  medical community relations; employer community relations;

c. Relationships among named individuals in the involved entities who play key project roles - perhaps color coded by the entity that houses them.    

So, for example, the Grant Manager (who manages the cooperate agreement / demonstration project and interfaces primarily with US DOL) might be located in the State DOL.

The Program Operations leadership team that oversees / integrates the entire service delivery side of the program may be located elsewhere.  The service delivery side has THREE ARMS:  those delivered by (a) community physicians, (b) the RTW Coordinators (with their medical /clinical back-up) and (c)  by the employment services sector – either through public agencies or through contractors.   The composition of the Demonstration Program Operations team might be the Operations Director (team leader) who has general management expertise; a Clinical Director, a Program Medical Advisor, an Employment Supports Director, a Director of Administration, and the Grant Manager.   

If a separate entity is being set up to house the RTW Coordinators and their clinical back up (which I personally recommend), that entity will require its own operations director and medical director.  Part of their responsibility is to liaise with the Demonstration Program Operations Director / Clinical Director / Program Medical Advisor.