Monthly Archives: August 2014

Many Proposals Are Swimming Against the Tide: An Example From HRSA’s New Access Point (NAP) FOA

Take a look at the laundry list of stuff that HRSA wants New Access Point (NAP) applicants to somehow improve (the quote comes from page 38 of the 101-page FOA):

Diabetes, Cardiovascular Disease, Cancer, Prenatal Health, Perinatal Health, Child Health, Weight Assessment and Counseling for Children and Adolescents, Adult Weight Screening and Follow-Up, Tobacco Use Screening and Cessation, Asthma – Pharmacological Therapy, Coronary Artery Disease (CAD) – Lipid Therapy, Ischemic Vascular Disease (IVD) – Aspirin Therapy, Colorectal Cancer Screening, New HIV Cases With Timely Follow Up, Depression Screening and Follow Up, and Oral Health.

Improving almost all of those metrics really starts with behavior, not with care. The real way to better health can be reduced to a couple things: 1. Eat better. 2. Get some exercise.* 3. Avoid the obvious drugs. 4. Brush and floss.

But those things have been public health goals for the last 50 years, and in the meantime Americans have gotten fatter and by most metrics less healthy—except, curiously, for longevity. We’ve built cities and suburbs that are actively unhealthy because they force everyone to drive everywhere all the time. Smoking rates have fallen, but they’re still stubbornly high and have been hovering between 20 and 25% for years. Cancer and heart disease look like eternal public enemies who can no more defeated than drug traffickers or superheroes.

Changes can’t and thus aren’t going to come from a bunch of doctors and nurses telling their patients—yet again—to lay off the McDonald’s and the soda and instead hit the gym for squats. HRSA knows this to some extent, and whoever sees the evaluations for NAPs in a couple years is going to know that opening one new primary care health clinics is equivalent to chucking a pebble in the river of behavior and culture. It is true that the federal government also subsidizes big agriculture in various ways that make eating well relatively harder and more expensive than it should otherwise be, but a lot more people could swim against that tide than actually do.

People who get and stay in shape do so because they realize it makes them feel better and because it dramatically increases their mating market value. Until they get sick and tired of being sick and tired—or, rather, until they get sick and tired of being the butt of jokes—no one is going to make them change. Pressure from external sources, like doctors, rarely does it. Treatment will never be as effective as prevention, but prevention can’t be mandated from above. It has to emerge from below. It would be interesting to see a study of the health behaviors of HRSA bureaucrats compared to the general population and a population of their peers.

The other night I was hanging out with a bunch of doctors and almost all of them were smoking cigarettes outside a bar. These are doctors. No one knows more about how dangerous smoking is. But they wanted drinks to take the edge off and for the usual reasons having a cigarette or three helped the relaxation process. I’m not even going to start into the unprotected sex stories—commonly referred to as “raw dogging” among today’s urban 20- and 30-somethings. As usual the stories may be exaggerated, but some episodes may also not bubble up into even impolite conversation.

(By the way, these same doctors like to note how infrequently patients take their standard advice: stop smoking, drink less, lose 20 pounds. To them medicine often feels like a futile endeavor.)

We’ve noticed one other thing, which isn’t related to the main point of this post but is likely to be hilarious to the right audience. CHCs—sometimes called Section 330 providers—must have community-based Board of Directors. At least 51% of these Boards must be composed of “consumers,” and the board is supposed to “Approve the selection/dismissal and conducts the performance evaluation of the organization’s Executive Director/CEO.” HRSA requires that NAP applicants say as much, and say that the Board has control over the Executive Director. This is saying the applicant will certify that the sun rises in the East.

The bylaws of every nonprofit typically state that the executive director/CEO serves at the pleasure of the board. Who else would hire, evaluate and, if necessary, fire the CEO? While some CHC CEOs can come from the clinical side, like a physician, they are often a health administrator type or general purpose nonprofit manager. More importantly, they are often the founder and/or prime mover in the organization.

Let me repeat that: they are the driving force behind the organization. That isn’t true in the largest organizations, but in small ones the Executive Director usually controls the board, no matter what the bylaws nominally say, because taking away the key person who built the organization usually kills the organization. It’s like “firing” the donor keeping the organization alive. It rarely happens in small- or medium-sized organizations. Nonetheless, in the proposal world the patients represented on the board have all the power. Among most actual NAP applicants, the real power isn’t likely to reside in the non-experts who can be rounded up to sit on the Board.


* I’ve become a much more regular lifter since reading “Everything You Know About Fitness Is a Lie,” and to a lesser extent Starting Strength and Arnold: The Education of a Bodybuilder. The last one is admittedly not very good yet I like it anyway.

GWC Goes to the Movies Part Deux: Young Frankenstein, In the Heat of the Night and the Ferguson, MO Riots (or is it Rebellion?)

In Mel Brooks’s hilarious 1974 send-up of classic Universal Pictures 1930s horror films, Young Frankenstein, the incredibly goofy Kenneth Mars (as Inspector Kemp) says to the mob with pitchforks and torches: “A riot is an ungly thing . . . und, I tink that it is chust about time ve had vun.” I thought of this scene as I watched the chaos in Ferguson. From a grant writing perspective, I agree with Inspector Kemp. The human tragedies and political/police incompetence are hard to watch. Having an urban riot televised endlessly in the new 24-hour news cycle will, however, eventually generate lots of grant opportunities for nimble nonprofits. Simultaneously, a nice riot enables grant writers like us to continue the urban mythology of economic despair and violence lying just below the false calm of many urban and suburban streets that are home to large African American populations. This is the stuff of which compelling needs assessments are made. Riot anecdotes and allusions should be larded throughout.

I remember reading Life magazine, which was the Twitter of its day, about the 1965 Watts Rebellion.* Over the years, variations on the Watts theme have played out across America: white cop arrests/shoots/kills unarmed African American, an urban riot ensues, the police/national guard overreact and the community in question is left without grocery stores. I’m surprised that this ritual racial drama still occurs in 2014. As noted above, the Ferguson Rebellion will be a boon for urban nonprofits and grant writers, as the government response will be, as it always is, more grant programs—which is sometimes termed the “do something disease.” As Bob Geldorf, of “We are the World” fame and professional do-gooder, once said: “Something must be done, even if it doesn’t work.”

Since the feds and State of Missouri can’t do much of anything else about the immediate situation except blame the obviously incompetent and probably racist Ferguson PD, they’ll make it rain grant dollars on Ferguson and other perceived African American communities, like amateur night at a strip club. I say “perceived,” because it turns out that while about two-thirds of Ferguson residents are African American, the rest are white.

Although the community has been trending African American for decades, Ferguson is hardly all African American. Also, at $37,517, the median household income isn’t all that much lower than the state median of $47,333. There’s a wine bar, craft brewery, several chain restaurants and retailers, and even a weekly Farmer’s Market and outdoor concert series in the summer. There’s a Starbucks right across the city line in Jennings and a Whole Foods nearby. What I didn’t find when looking at Ferguson Census and social indicators were the “Cliff’s You Buy We Fry” fish markets and the Mr. Jones Rotten Fruit and Dented Can stores typical in low-income African American communities. Ferguson, one of several similar first-tier suburbs north of St. Louis, is hardly a place of urban despair.

If one watches CNN, however, all one sees are relatively small groups of angry African American faces and the unfortunate image of the very white and not too articulate Police Chief, Thomas Jackson, looking like Rod Steiger in In the Heat of the Night. The media presents the situation using classic urban riot tropes. That’s fine with me, as this is exactly how we write proposals for clients in actual economically devastated and African American places like North Philly or South Chicago, as well as ones that are perceived as African American. For example, Watts, the original poster city for riots, is actually now only one-quarter African American and 73% Hispanic.

We’ve written lots of proposals for projects in Watts, including some in which the City of Los Angeles was our client, and, through the magic of grant writing, we always make it seem that it’s still 1965 in Watts. See this NYT article for a good example of writing the ghetto myth, not the reality. Just as we harken back to 1965 in many grant proposals, the author of this piece goes all the way back to the early 50s to somehow rationalize what is going on 60 years later.

Let me return to Young Frankenstein. In the movie, Gene Wilder, as the scion of the mad doc family, starts the movie by trying to run away from his myth-filled heritage. Eventually fate intervenes and he decides to live the myth by building his own “monster.” The monster, played by Peter Boyle, turns out to be rather more charming than menacing, but still generates the angry mob with pitchforks that started this post. This lesson applies to grant writing: it’s important to honor the mythology of the past, while creating a new bogeyman that can only be overcome with grants.


* When writing proposals about communities that have been rocked by large-scale urban disturbances, like the Watts Riot or the chaos in LA following the Rodney King trial, never refer to a “riot”—only use terms like “rebellion” or “disturbance.” This fits in well with the proposal mythology that low-income folks are not actually out of control, but rather are understandably rebelling against the dominate power structure. Think Public Enemy’s “Fight the Power.”

EDIT: Commenter James observes that this post is cynical even by our standards, but we’ll point out that we’re assuming the voice and thoughts of politicians and policy makers. Think of this as a nonfiction version of what James Wood’s description of point of view.

GWC Goes to the Movies: Casablanca and a WSJ Opinion Piece on the Wobegon Illinois Neighborhood Recovery Initiative (NRI)

Faithful readers know I love movies, and this is the first in a new series: “Grant Writing Confidential Goes to the Movies.”

Today, let’s talk about perhaps the best film ever made, Casablanca,* and Claire Groden’s recent opinion piece in the WSJ, “An ‘Antiviolence’ Boondoggle in Murder-Plagued Chicago.”

Groden recounts the disappointing impact and sad tale of woe surrounding the Neighborhood Recovery Initiative (NRI), a $54 million grant program sponsored by Illinois Governor Pat Quinn. NRI was supposed to reduce the astounding level of youth violence in the state, and in particular in Chicago, where dozens of young people are killed every weekend. Not only did violence rise during the program implementation, but one of the at-risk youth employed in the program allegedly shot and killed a second employed youth while the two were passing out anti-violence pamphlets in the community.**

Groden is apparently surprised that NRI didn’t work, which reminds me of the scene in Casablanca when Captain Renault says to Major Strasser, “I’m shocked, shocked to find out that gambling in going on in here [Rick’s],” as a croupier hands him a pile of winnings. Programs like NRI rarely achieve their lofty public goals—which is one reason evaluation sections are unintentionally hilarious—but they may achieve other, less obvious ones. Just because NRI didn’t do much to curb crime doesn’t mean it’s a “boondoggle.” In Casablanca terms it’s more like Captain Renault saying “Round up the usual suspects.”

While we haven’t written any NRI proposals, the program looks to me like a fairly standard Walking Around Money suspect, about which we’ve blogged many times. Lots of grant programs are really a means to funnel money into certain neighborhoods via nonprofits. It’s also clear to me, if not to Groden, that NRI is mostly a jobs program—in this case, the idea is to hire gang bangers as Peer Outreach Workers, with the assumption that if the youth have some money, perhaps they won’t feel the need for mayhem. In this instance the theory didn’t work so well, as one of the employed kids shot another one in the head. (This could be an argument for a higher minimum wage, but I digress).

Many grant programs are really jobs programs in disguise. My favorite example is Head Start, on which billions of federal grant dollars are spent annually, with over a million kids enrolled. While there are lots of conflicting studies on whether or not Head Start actually has any lasting impact on enrolled kids, it certainly succeeds as a jobs program—tens of thousands of low-skilled, low-income women, are employed as Head Start “teachers.”***

Interestingly, most Head Start teachers also have or have had kids enrolled in the program, which means the same women who seemingly fail to educate and socialize their kids in their own home are somehow supposed to help similar kids learn in the classroom. Head Start has been around for almost 50 years and, by now, there must be lots of third-generation Head Start kids. Since the family has to be low-income to be in Head Start, if three generations are still in poverty despite Head Start—including moms and grandmothers who were Head Start teachers—one can assume that the program doesn’t improve long-term family self-sufficiency (free proposal phrase here). It does, however, keep lots of low-skill women employed at an average annual salary of $21,000, which is probably around what they could make at Wal-Mart but also includes implicit childcare subsidies.

Groden makes a common mistake by confusing the grant program—NRI—with the funding agency—the Illinois Violence Prevention Authority (IVPA). Since NRI has gotten a lot of bad press, the program may see reduced funding, becoming a grant mummy waiting for more tana leaves. She implies that this means the end of IVPA. Wrong. IVPA has been around for years. I know, because we’ve written many funded IVPA proposals for a variety of programs, albeit not NRI. IVPA is a vehicle for federal pass-through funding, with similar agencies existing in each state. While IVPA and the Illinois governor may put temporary brakes on NRI, IVPA will continue to churn out grants for lots of other programs.

As Dooley Wilson sings, “The fundamental things apply, as time goes by.

Much of the Casablanca plot centers around missing Letters of Transit. These are never explained because they’re just a plot device, called a MacGuffin by Alfred Hitchcock and often used in both screenplays and grant proposals. Examples of common MacGuffins in proposals are imagined community needs assessments (e.g., vaguely described informal task forces), case planning documents (e.g., Individual Service Plans), referral linkages, and so on. Since most proposals have severe page limitations, it’s often not possible to go beyond MacGuffin references to move the proposal narrative along, so we might randomly stick in “informal planning task force” or “referral for wraparound supportive services” every few pages. After a while, the reader thinks they know what an informal planning task force is or what the referral mechanism is just as a Casablanca viewer eventually buys into the Letters of Transit device.


* When I worked for L.A. Mayor Tom Bradley in 1974, one of volunteers in the Mayor’s Office was Kitty Curtiz, daughter of Micheal Curtiz, director of Casablanca. Kitty was a delightful woman who’d been a teen on the set when Casablanca was being filmed at Warner Brothers in Burbank. She had lots of anecdotes about the filming and confirmed that no one knew (spoiler alert) Rick would end up with Louie, not Ilsa, at the end of the movie, until it was shot.

** This is called “street outreach” in the grant writing biz and is a standard component in the outreach/engagement section of most human services proposals. Once again, round up the usual suspects.

*** A comprehensive 2011 Head Start Study by DHHS itself found that, while Head Start produces “brief learning gains,” such gains fade quickly and have little or no impact on ultimate education and income outcomes. Judge for yourself.

Lots of Crap Required in an Early Head Start (EHS) Proposal, but Here’s What’s Missing: Shit. Literally.

The latest Early Head Start FOA is blessedly shorter, in both FOA and the required narrative, than it used to be. But it’s still astonishingly detailed. Applicants must discuss attitudes towards discipline, staffing plan minutia, approved curricula, snacks, parent contact, daily plans, transportation, and on and on.

One conspicuous point that should be obvious to anyone who has spent time around very little kids is absent, however. If you have dozens of kids under the age of three, the primary staff activity isn’t going to be reading or counting or structured art or whatever. It’s going to be making sure the kids haven’t had an “accident.” Basic bodily issues will disrupt many of the best-laid Pre-K plans conceived by Washington D.C. early childhood education thinkers.

Earlier today Isaac and I were talking about the first time he walked into a Head Start classroom, back around 1978. The first thing that struck him was the relatively huge bathroom and its many, many toilets. Every one of them had a little kid occupying it. He mentioned that to the teacher, who rolled her eyes and walked away. Keeping the attention of a group of neonatal to 36-month-old kids is hard enough; keeping them clean is going to consume more time than any other activity apart from sleeping and eating.

In the Early Head Start and Head Start proposal world, however, these issues don’t exist. It would be funny to add details about potty training, or lack there of, to a narrative, and ideally to describe the issue in great, exquisite detail, and perhaps to add a validated curriculum (which we would invent, of course). Not funny enough that we’d ever do it, but definitely funny enough to contemplate the response of the reviewers. They would what—shit their pants?

Grant Writer as Ghost Writer: The Man Who Shot Liberty Valance Conundrum

At our most basic level, we grant writers are nothing more than ghost writers. Ghost writing is sometimes referred to as the world’s second oldest profession, and there’s probably some truth to that. While ghost writers haunt (sorry about that) every strain of writing, ghost writing is largely veiled from the real world. Andrew Crofts’s new book, Confessions of a Ghostwriter, provides a rare glimpse into the profession.

Like me, Crofts has spent about 40 years writing under other writers’s bylines and toiling in the shadows while making a tidy living and seemingly enjoying his anonymous vocation. Crofts points out correctly that his clients view him as ranking “somewhere between a valet and a cleaner.” In my view, our clients actually view us more in line with the purveyors of world’s actual oldest profession, but his point is well taken: when someone wants a grant writer/ghost writer/valet/hooker or some similar service, they want it right now and they probably don’t want to be reminded that they felt compelled to use the particular service.*

While we don’t worry about not having our writing attributed to us, our anonymity presents some challenges when we’re asked for references. Since we’ve been in business for 21 years, we have lots of potential references, except for a few minor issues. One is anonymity: as mentioned in the footnote, not every client wants others to know that they did not write a particular proposal and may decline to provide a reference or even deny our involvement. Crofts points out the reality: clients who hire ghost writers don’t necessarily want to be public about it.

Hillary Clinton just released her state department memoir, Hard Choices, which has been widely panned by reviewers as a real snoozer, but at least Hillary admitted to the Washington Post that this tome was actually written by her “book team” (I wonder if the team had matching t-shirts). This is better than President Kennedy, who accepted a Pulitzer Prize for Profiles in Courage, which was largely written by Theodore Sorenson without attribution. Interestingly, Sorenson also wrote Kennedy’s stirring Inaugural Address, once again without public credit.

To return to our own story, we’ve also been around so long that we’ve outlived many of the contact people we worked with, who retire or move on to new jobs. There is little institutional memory in most nonprofits. For example, about 15 years ago, we wrote several large funded proposals for a small nonprofit that oddly used arts education to provide English as a second language (ESL)** instruction to immigrant children. As a result of these funded proposals, they became a much larger organization, but for whatever reason they stopped hiring us. About five years ago, I received a call from the new executive director of this same nonprofit inquiring about grant writing assistance.

The old executive director had left some time before and the new guy was amazed when I told him that we’d written the original funded proposals that launched them into nonprofit glory. He was skeptical, so I emailed him a proposal we’d written about ten years earlier. He declined to hire us and the organization eventually sunk back beneath the nonprofit waves again. They couldn’t effectively write proposals. Nonprofits that can’t write winning proposals or find some other way of funding themselves die.

Talk about ghost writing reminds me of one of my favorite John Ford Westerns, The Man Who Shot Liberty Valance. Told in flashbacks, the storyline is that Jimmy Stewart’s righteous, nonviolent lawyer character Ransom Stodard (called “Pilgrim” by John Wayne’s laconic and quick with a gun rancher character, Tom Doniphon) is forced by circumstance to face down and “shoot” the local desperado, Liberty Valance, played with snarling fury by Lee Marvin.

Or did he? As “the man who shot Liberty Valance,” Stodard becomes famous and is elected a senator. It turns out, of course, that John Wayne’s character actually shot Liberty over Stodard’s shoulder. In effect, John Wayne was Pilgrim’s “ghost shooter.” When Jimmy Stewart finishes telling the true story to the local newspaper editor in real time at the end of movie, he says to the editor, “you’re not going use the story?” The editor replies, “No, sir. This is the West, sir. When the legend becomes fact, print the legend.”

Like all ghost writers, we grant writers just print the legend.


* This is one reason why we don’t list past clients on our website and always disguise them when we mention one in a post. We don’t just sell grant writing; we sell discretion.

** “ESL” is actually a somewhat archaic term in grant writing these days. The newer term is English language learning (ELL), making the the students ELLs. Now you know. In a couple years the nomenclature will probably change again, for no reason apart from fashion.