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Foundation for a Healthy Kentucky
Request for Proposal (RFP)
Creating a Culture of Health in Appalachia: Disparities and Bright Spots
April 2015
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1.
Introduction
1.1 Purpose
The Foundation for a Healthy Kentucky is collaborating with the Robert Wood Johnson
Foundation (RWJF) and the Appalachian Regional Commission (ARC) to invite proposals from
qualified research teams and consultants to document and examine health conditions in the 420county Appalachian Region. The research will:
1. Document disparities in health outcomes in the Appalachian Region and investigate the
causes for and variability of local and regional disparities;
2. Identify “Bright Spots,” or communities that have better-than-expected health outcomes
given their economic status;1
3. Profile Bright Spots, using social/anthropological approaches, and identify communitybased models and policy implications; and
4. Propose a findings dissemination strategy, complete with a communications plan to
accompany the research.
Appalachian Regional Commission
In the mid-1960s, at the urging of two U.S. presidents, Congress enacted legislation to address
the persistent poverty and growing economic despair of the Appalachian Region. This legislation,
the Appalachian Regional Development Act of 1965, established the Appalachian Regional
Commission as a regional economic development agency representing a partnership of federal,
state, and local government. ARC is composed of the governors of the 13 Appalachian states and
a federal co-chair, who is appointed by the president. Local participation is provided through
multi-county local development districts.
ARC invests in the health of the Appalachian Region via grantmaking, strategic partnerships,
research, and advocacy, both to improve individual and community health outcomes and to
1
See Pascale, Sternin, & Sternin. (2010). The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest
Problems. Harvard Business Press.
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strengthen the economic competitiveness of the Region. ARC is the only federal entity exclusively
devoted to the unique concerns of Appalachia. The Commission believes that a healthy
population is critical for the Region’s economic and community development; supporting a
healthy population is a key component of ARC's strategic goal of strengthening the capacity of
the people of Appalachia to compete in the global economy.
ARC has focused attention on regional health concerns since the agency’s inception in 1965. In
the 1970s, substantial resources were invested in infant mortality reduction, ultimately bringing
regional rates to parity with the rest of the nation. Another major initiative sought to make
primary care services available to every Appalachian, resulting in the construction and operation
of hundreds of rural hospitals and clinics.
Since 2000, a series of ARC-funded research projects has documented Appalachia’s health
conditions, identifying unique geographic disparities in chronic disease, substance abuse, mental
health, oral health, access to care, cost of care, and availability of health insurance. At present,
ARC’s health program activities include grantmaking and partnership activities that respond to
these health disparities in an economic development context. A small portfolio of grants targets
improved health care access and community-based public health initiatives, mostly in rural
communities. The agency manages long-term regional partnerships on diabetes and cancer
prevention, control, and treatment with the Centers for Disease Control and Prevention, and
advocates for Appalachian health issues among federal partners in Washington.
Foundation for a Healthy Kentucky
The Foundation for a Healthy Kentucky is a nonprofit, philanthropic organization with the mission
to address the unmet health care needs of Kentuckians. Founded in 2001, the Foundation’s
approach centers on developing and influencing health policy to improve access to care, reduce
health risks and disparities and promote health equity. Foundation staff have expertise in public
health, health policy, health systems and services, communications and program and grants
management.
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Since 2001, the Foundation has invested more than $24 million in grants, health policy research,
educational forums, and training.
Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation (RWJF) has worked to improve
health and health care. RWJF is working with others to build a Culture of Health where attaining
the best health possible is a fundamental and guiding social value that helps define American
culture. It’s an America in which all people—no matter what their background, heritage,
socioeconomic status or current state of well-being happens to be—have an equal right to live
longer, healthier lives.
1.2
Background
Appalachia
The Appalachian Region, as defined in ARC's authorizing legislation, is a 205,000-square-mile
region that follows the spine of the Appalachian Mountains from southern New York to northern
Mississippi. It includes all of West Virginia and parts of 12 other states: Alabama, Georgia,
Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina,
Tennessee, and Virginia. Forty-two percent of the Region's population is rural, compared with 20
percent of the national population.
The Region's economy, once highly dependent on mining, forestry, agriculture, chemical
industries, and heavy industry, has become more diversified in recent times, and now includes a
variety of manufacturing and service industries. In 1965, one in three Appalachian residents lived
in poverty; during the 2008–2012 period, the Region's poverty rate was nearly 17 percent.
Approximately 70 percent of Appalachian counties (295 of 420) were considered high poverty in
1960 (at least one and a half times the U.S. average); during the 2008–2012 period, that number
went down to 107.
These gains have transformed the Region from one of widespread poverty to one of economic
contrasts: some communities have successfully diversified their economies, while others still
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require basic infrastructure such as roads, clinics, and water and sewer systems. The contrasts
are not surprising in light of the Region's size and diversity—the Region includes 420 counties in
13 states, extends more than 1,000 miles from southern New York to northeastern Mississippi,
and is home to more than 25 million people.
1.3 The RFP Process
All organizations or teams interested in pursuing the scope of work outlined below are invited to
respond with a written outline of their proposed approach, methods and data sources, including
existing databases to be used (include source, authorization of access if applicable, and most
recent year for which data are available); credentials of the principal parties to be preparing the
information, reflecting experience in the preparation of similar studies and reports; timeline for
project completion with appropriate milestones; proposed costs; and at least three professional
references. More detailed instructions for submitting materials are provided in Section 3.
An advisory committee of informed regional and subject-matter expert stakeholders will work
with the Foundation, ARC and RWJF to review proposals and select the contractor for this multiyear study. The advisory committee will remain involved in this study as needed, to provide
guidance and feedback to the research team. The selected research contractor will be expected
to present to the advisory committee twice per year, following submission of the progress and
annual reports and to incorporate advisory committee feedback and guidance into the study
process and deliverables as appropriate.
2.
RFP Submission Information
2.1
General Terms and Conditions
Documentation submitted in response to this RFP will be distributed to members of an advisory
committee and RWJF, Foundation, and ARC staff. Submissions will remain in the control of this
group and will not be used for other purposes without prior written consent of the applicant.
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Please note that the selected research team will be asked to release the contents of their
proposal. Proprietary and confidential information must not be submitted under this request.
The successful applicants will be required to enter into an Agreement with the Foundation for a
Healthy Kentucky. This Agreement will define programmatic administration, project participant
responsibilities and, by signing the Agreement, the participants will agree to work with the
Foundation and ARC towards the objectives of the project. The Foundation anticipates a single
yearly award (with disbursements based on agreed upon timeline and deliverables) for
accomplishment of a mutually agreed scope of work, to be conducted over the study period.
2.2
Scope of Work
This multi-year study includes quantitative and qualitative methodologies as well as the
development of a robust communications plan and making the information gained webaccessible to various audiences. The scope of work requires a qualified team with expertise to
effectively complete all project objectives. The selected team will have an established, successful
record of conducting rigorous socioeconomic research focused on rural areas, and engaging local
communities in participatory research.
This team will include professionals with expertise in a number of areas, including but not limited
to:

economists and data analysts with expertise in health research;

sociologists, anthropologists, or other social science professionals with experience in
conducting in-depth qualitative analyses, including community profiles and case studies;

professional writers and editors, including local journalists, with experience in making
technical information accessible to a broad audience;

geographers or others with GIS and mapping expertise; and

a professional communications team to work with RWJF, the Foundation for a Healthy
Kentucky, ARC and the profiled communities to ensure the successful dissemination of
project findings
and the replication of policy solutions. Although developing and
producing a web site is not a deliverable, part of the communications plan will include
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planning for a web site, which should include mock-ups or examples using current web
sites. Web professionals including an information architect and a graphic designer will
need to be part of the communications team to ensure deliverables could be seamlessly
integrated into either an existing web platform or one that would be designed.
Additional Information
Existing research that teams may find useful includes the following:
Robert Wood Johnson: Culture of Health
http://www.rwjf.org/en/blogs/culture-of-health.html
Appalachian Regional Commission: Health-Related Research
http://www.arc.gov/research/ResearchReports.asp?F_Category=13
Foundation for a Healthy Kentucky:
http://healthy-ky.org/
http://www.kentuckyhealthfacts.org/
http://inequality.org/inequality-health/
Objectives
There are four main objectives to this major research project:
Objective 1: Document and assess health disparities, and identify “Bright Spots” through a
positive deviance framework.
Using currently available data sources and accepted research methods, the research team will
compile standardized, baseline information necessary to document and assess health and
economic disparities in the Appalachian Region, and investigate the causes and variability of local
and regional disparities. The research team will analyze economic and demographic data
compiled by ARC and others, along with health data such as County Health Rankings, the
Behavioral Risk Factor Surveillance System (BRFSS), and the Centers for Disease Control and
Prevention’s Community Health Status Indicators.2 Health data will include rates of various health
2
See http://www.countyhealthrankings.org/, http://www.cdc.gov/brfss/ and
http://wwwn.cdc.gov/CommunityHealth/home.
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conditions (such as cancer rates, heart disease, mental health conditions among others) and
other key health indicators such as disability, insurance coverage, and access to health care.
While the focus will be on health data for the 420-county Appalachian Region, national-level
statistics will also be necessary, in order to provide context to the disparities findings. Where
possible, analyses should examine changes in health conditions and key indicators over time.
As part of the economic data analysis, researchers should note and assess poverty rates, income
distribution, and degree of disparity between the highest and lowest income brackets in each
studied community.
This economic equity gap should be noted in data findings for all
communities studied.
In addition to disparities, the research will identify Bright Spots, using a positive deviance
framework to identify regional Bright Spots—counties and communities in the Appalachian
Region that show positive health outcomes despite economic hardship and other determinants
associated with negative health outcomes—as well as the converse set of counties where
negative health outcomes prevail, despite positive economic measures.
Positive deviance is a strength-based approach which is applied to problems requiring behavior
and social change. Pascale, Sternin, and Sternin (2010) note that it is based on the following
principles:

Communities already have the solutions. They are the best experts to solve their
problems.

Communities self-organize and have the human resources and social assets to solve an
agreed-upon problem.

Collective intelligence. Intelligence and know-how is not concentrated in the leadership
of a community alone or in external experts but is distributed throughout the community.
Thus the PD process’s aim is to draw out the collective intelligence to apply it to a specific
problem requiring behavior or social change.

Sustainability as the cornerstone of the approach. The PD approach enables the
community or organization to seek and discover sustainable solutions to a given problem
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because the demonstrably successful uncommon behaviors are already practiced in that
community within the constraints and challenges of the current situation.

It is easier to change behavior by practicing it rather than knowing about it. “It is easier
to act your way into a new way of thinking than think your way into a new way of acting.”
Objective 2: Profile Bright Spots and identify community-based models and policy implications
The Bright Spots identified in Objective 1 will be the basis for the research team’s exploration of
why positive deviance exists and whether these outcomes might be replicated in other
communities. The qualitative analysis will involve local community members throughout its
design and implementation, and will include a series of participatory methods to identify causes
of regional and local disparities, explain why certain communities exhibit positive deviance, and
explore how these outcomes might be replicated. Social scientists will work closely with local
community leaders, health professionals, and economic development officials to identify the
dimensions that contribute to the quantitative findings and, with communications professionals,
communicate in an accessible manner the incidence of Bright Spot communities to a broad
audience.
In the case that a sufficient number of Bright Spots are not found in the analysis, it is expected
that research teams will explore alternatives. These could include identifying communities with
positive health status and those with the greatest improvements in health outcomes in the
Appalachian Region and assess common traits, practices, and policies employing both
quantitative and qualitative methods. Research teams are encouraged to briefly discuss
alternative research options in their proposals.
Objective 3: Identify and recommend practices and policies that support and nurture Bright
Spots.
This objective involves identification of promising practices and supportive policies that foster
and sustain the Bright Spots. The research team will work closely with the local communities to
inform and recommend policy options to RWJF, ARC, and other key stakeholders to promote and
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expand a culture of health in Appalachia. A literature review of relevant practices and policies
will be included as part of this objective, with special attention to literature providing case studies
in rural communities.
Objective 4: Disseminate findings to initiate change
Finally, research teams will outline how to initiate change by promoting Bright Spots, specifically
through the dissemination of information from the quantitative and qualitative research as well
as recommended policy options. Research teams must propose a comprehensive
communications plan to identify key messages, determine target audiences, and propose
strategies to best convey information. Other key components of the communications plan
include strategies for engaging local residents in efforts to improve health outcomes in their
communities, as well as information on how communities can successfully implement promising
practices. The communications plan will also include recommendations for the development of
a web site, including data and interactive maps, as well as a GIS-based tool to allow users to select
datasets and view them in a variety of graphical forms, displaying relationships, patterns, and
trends. Ideally, the GIS layers would include datasets assembled in the quantitative analysis, and
overlay economic, social, and health factors. The web site recommendations and
communications plan will be thoroughly integrated with the quantitative and qualitative
elements of the project. The selected contractor team will incorporate planning for the
communications and Web site-ready elements in all phases of the work.
The research project is expected to begin in July 2015, with a planned release of the final
research findings in December 2017.
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Deliverables
The expected deliverables are:
1. A database containing all data and analyses associated with Objective 1.
2. All complete transcripts and reports for qualitative methodology efforts.
3. Written reports for Objectives 1, 2, and 3, and monthly progress reports.
4. A communications and findings dissemination plan.
5. Recommendations for a Web site, with data and GIS-based user tools to aid in mapping
and visualizations, as well as highlighted research outcomes and community profiles.
Proposals may include plans for integrating findings into either an existing web platform
or one that would be designed.
6. A comprehensive executive summary highlighting research results and providing policy
implications and implementation recommendations.
7. At minimum, two in-person meetings: a kick-off meeting and a presentation of final
results, in addition to periodic presentations to the advisory committee, and RWJF, ARC
and Foundation staff. Contractors should propose additional in-person meetings to
coincide with appropriate milestones and budget accordingly.
The report(s) will relate the narrative discussion to descriptive statistics, analyses, graphs, maps,
and tables where appropriate, yet the information should be written in a manner that is be
accessible to a non-technical audience. Technical details, data tables, and details regarding
methodology must be presented in appendices. ARC will provide the selected contractor with
formatting guidance documents for all reports. Consideration should be given as to how tabular
and graphic information will be integrated into the narrative structure of the report.
Results should include all 1,070 counties in the 13 Appalachian states where possible, or in the
case of limited data, just the 420 counties in the Appalachian Region. Results should be
aggregated and reported for these geographical areas: United States; Appalachia; five
Appalachian subregions; 13 Appalachian states; Appalachian and non-Appalachian portion of the
13 Appalachian states; ARC’s five economic status designations for the current fiscal year
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(distressed, at-risk, transitional, competitive, attainment); five metro status designations (large
metro, small metro, large metro adjacent, small metro adjacent, rural), and 73 multi-county local
development districts (LDDs). Geographical classification of ARC and U.S. counties are provided
by ARC.
Given the complex and evolving geographic boundaries of the Appalachian Region during the
past 50 years of development, mapping of findings will be essential to summarizing and
presenting the research results. All maps should be accompanied by well-documented
supporting databases.
The report’s executive summary must be professionally written, edited, proofread, and designed;
and must be produced for offset printing and for online publishing using either Adobe InDesign
or Quark Xpress publishing software. All work must be at the highest level of quality. Production
of the summary will require coordination between ARC, the report authors, writers, graphics
designers, and print vendor.
The executive summary must be written for a general audience, and edited for clarity, accuracy,
readability, and consistency. Charts, graphs, maps, and tables must have clear and consistent
titles and labels. Drafts must be produced in Microsoft Word with text and images submitted
separately. Maps, charts, graphs, and tables must be supplied in native files.
Proofreading for grammar, typographical errors, and inconsistencies in text, charts, maps,
graphs, and design elements will be required at every stage of production.
The executive summary must be visually appealing and designed for a general audience. The
summary will be approximately 24 pages and will include photos, maps, charts, tables and graphs.
Design services will include: 1) one meeting with ARC to establish design requirements; 2)
creation of two sets of comps showing two different design directions 3) production of a
minimum of four to five rounds of page proofs; 4) specifications for offset printing; and 5)
preparation of files both for offset printing and for online publishing.
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Print management, including procuring cost estimates, scheduling, working directly with the print
vendor, and reviewing printer’s proofs will be required. Contract manager must approve printer
selection. Deliverables for the executive summary must include: final native files for maps,
graphs, charts, and tables; page proofs for approval by contract manager; final page layout files
(InDesign or Quark Xpress); high-resolution PDF of final page layout files; PDF of final page layout
files, optimized for online viewing; 3,000 copies of the offset-printed executive summary.
A printed copy of the reports(s) and all electronic files for the reports must be submitted upon
completion of the project. Files must be in Microsoft Word and Adobe PDF formats. These should
be accompanied by an Excel workbook or Access database of all relevant data and analyses
compiled during the study. The contractor will provide metadata (field name description,
definition, source, sourced date, and equation if computed) for all raw and computed data fields.
Geographic information system mapping databases, map images, and map documents
developed for the project should also be provided to ARC. A PDF optimized for Web viewing will
be required. The PDF must include bookmarks and other recommended accessibility features.
2.3
Submission Instructions
To be considered complete, an application must include all information requested in Section 3,
below. The proposal should be typed in black, 12-point font. PLEASE KEEP YOUR PROPOSAL TO
TEN (10) PAGES OR LESS TOTAL INCLUDING THE COVER PAGE.
2.4
How to Submit
Proposals must be received no later than 5 PM EDT on June 8, 2015, at [email protected],
and please copy [email protected].
All proposals must be submitted electronically. Hard-copy submissions will not be accepted.
Applicants are also encouraged to register for the applicant webinar (Thursday, May 7, 10:00
am EDT) for an overview of the proposed project and an opportunity to ask questions about the
project and the RFP. To register, email Alexa Kerley at [email protected].
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2.5
Questions
Questions should be directed to Vice President of Policy and Program, Gabriela Alcalde at
[email protected] or Susan Zepeda, CEO/President at [email protected].
1640 Lyndon Farm Court, Suite 100
Louisville KY 40223
Phone: (502) 326-2583
2.6
Reimbursements
The Foundation will not reimburse applicants for any costs incurred in connection with preparing
proposals in response to this RFQ.
2.7
Schedule
The following table details the events and activities associated with this RFP:
RFP Issued
April 10, 2015
Applicant webinar (Register by emailing May 7, 10:00 am EDT
Alexa Kerley at [email protected])
RFP Responses Due
June 8, 2015 by 5:00 pm EDT
Selected Recipient Notified
Early July 2015
Kickoff Teleconference or Meeting
Late July 2015
Project start date
August 1, 2015
Disparities Draft
July 15, 2016
Bright Spots draft completed
September 30, 2016
Community profiles/case studies
June 30, 2017
completed
Reports finalized
September 30, 2017
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3.
Proposal Format and Content
3.1
Proposal Outline
Elements of the proposal should be presented in the following order:

Cover Page (Use form provided)

Overview

Scope of Work

Budget

Staff Credentials

References
Each of these Sections is described below.
3.2
Cover Page
Provide the name(s) of the applicant organization(s) and point of contact information. Teams
should list all team members and point of contact information for each (to include name, title,
organization, street address and P.O. Box if any, e-mail address and telephone number, with
extension if any). When submitting point of contact information, please provide both a
business/financial and technical point of contact, if they are not the same person. If additional
space is needed to list multiple project applicant team members, an addendum to the Cover Page
may be attached and will not be counted as an additional page.
Overview
3.3
Provide an introduction to the contents of your proposal, the proposed approach and its benefits.
Scope of Work
3.4
This section should include:

Policy significance of study

Objectives and activities
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
Methodology and sources. In this section, please describe your proposed methodology
and data sources and approach to reporting each of the proposed data elements and
analyses (including those identified in Section 2.2 of this RFP). Clearly identify any barriers
to obtaining information from the source(s) named, and how these will be overcome,
including the anticipated time-lag between data collection and availability of the data to
the researchers

How study progress and findings will be reported to the Foundation (twice per study year,
for three years, in addition to more regular reporting of a smaller sub-set of measures
submitted in the form of infographics)

The research will be managed by ARC; the research team will be required to submit
monthly progress reports and coordinate with ARC regarding all aspects of the research
3.5
Budget
The contract awarded for this research project will be a FIRM FIXED-PRICE CONTRACT not to
exceed $715,000 (ARC is providing funds of $250,000). As part of your proposal, please provide
a detailed budget and budget narrative for your proposed effort, including data gathering, data
analysis, project management, communications, report preparation, travel, and so forth. If
different functions are performed by staff compensated at different rates, please clearly indicate
the hours of effort to be provided on the project by each staff member. Administrative overhead
may not exceed 10 percent of the contract. Please begin this section on a new page so that it
can be separated from the main body of your proposal.
3.6
Staff Credentials
Provide resumes or curricula vitae for each of the principals on this project. For other personnel
who may be retained to assist on the project, please specify the minimum qualifications required
in terms of education and experience/proficiencies. Please address specifically past experience
with relevant mixed methods research; health policy research; and experience with proposed
methodology and data sources. The research team must have demonstrated competency and
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experience in the proposed methodology, data sources (including experience with rural data
issues), and subject matter of the study.
3.7
References
Provide a minimum of three professional references, for whom you have completed similar
projects. For each indicate:

Contact name and title

Organizational affiliation

Address, current telephone number(with extension, if any), e-mail

Brief description of the project completed for that organization

Duration of project; year of project completion
3.8
Proposal Review
All proposals will be evaluated based on the following criteria:

Complete, clearly articulated, logical study design, and technically competent
methodology;

Qualifications, relevant prior experience, command of existing research on health and
regional development issues, and ability to present findings in a useful manner;

A credible management proposal for staffing, and the capability to carry out and support
the project in a timely fashion;

The quality of interviews, focus groups, surveys and/or case study protocols proposed;

The quality of the proposed communications and findings dissemination plan, including
the web site to be used or developed;

The cost effectiveness of the proposal.
Members of the advisory committee will review proposals and make recommendations on
selection of a contractor research team based on the criteria above.
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Creating a Culture of Health in Appalachia:
Disparities and Bright Spots Proposal
Due: June 8, 2015
NAME OF LEAD ORGANIZATION:
STREET ADDRESS:
CITY, STATE, ZIP:
BUSINESS CONTACT NAME & TITLE:
PHONE/EXT.:
EMAIL:
TECHNICAL CONTACT NAME & TITLE:
PHONE/EXT:
EMAIL:
FAX:
WEB: http://
ANNUAL OPERATING BUDGET: $
EIN:
Other, please describe on line below 
501(c)(3)
TAX ID NUMBER:
PROJECT TITLE:
PROJECT TIME FRAME (m/d/y – m/d/y):
ESTIMATED PROJECT BUDGET:
PROJECT DESCRIPTION ( 50 words):
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