JEFF:  Okay. Hard work. Is group one, Role Of Communication ready?  Here we come, Jean Emans.

JEAN EMANS: Thank you, our communication three-fold were an MCH leader is able to communicate effectively with multiple audiences through multiple modalities. An MCH leader is able to inspire others to be their best and under that is demonstrating respectful listening and sensitivity to non-verbal and verbal cues of self and others, and to articulate clearly organizational and personal vision. And, we spent a lot of time looking particularly at the first one in ways in which, for example, with communication, oral, public speaking, written, we wanted to put grants up there as one of those things that we got some brownie points for. And, then some of the newer modalities like e-mail, film, etcetera, and many of those we felt could be measured well during the training period, so, that they should be--have a curriculum and could certainly move forward during that time. At five years, we talked about using self-report and CVs to help us figure out how the faculty member or the post-trainee was doing after the training period. We did struggle a bit with the inspires others to be their best and articulate clearly, organizational and personal vision. We felt that those were things to address during the training period, but we weren't quite sure how to measure them at five and 10 years without doing 360 reviews or other much more complex ways of measure them, but we do feel they're really essential to leadership.

JEFF:  Okay. Group number two, Building Constituencies. Wendy again.

WENDY MOURADIAN:  We decided that Building Constituencies was a paradigm for mature MCH leadership. As we brought--brought it down, we determined that it included--we felt, every area that was addressed within another area, it required--it requires the kind of communicating that was just discussed, it requires negotiation, it requires critical thinking, cultural competency, mentoring, and therefore, we thought it was (inaudible) of what we were looking for in an MCH task. We tried to make it succinct.  I'll just give my--try--our try through it. Brings an MC--mature MCH coalition, builder brings a vision, enhances it with input from others. Builds and sustains relationships with diverse community by embracing and integrating differences. Continually identifies task holders. Assesses the environment with savvy. Has passion, commitment, persistence, is flexible and nimble in a changing world. Can bring or knows how to develop legitimacy for themselves, and has all of the relationship and communication pieces together. But importantly, we felt that even a graduating MCH trainee, who might, for example, be a physical therapist going out to provide for the first time, skill--training--care for children in a rural community would be able--would find it necessary to work within their own staff, to work with the MCH system in their community.

Other providers learn how to get to bill, work with a birth to three center and collaborate effectively with families and advocates. So, we felt that the (inaudible) of these skills would be--would need to be present from very early on, but that you would acquire maturity and development in it as you progressed in your career. We thought that it--we could assess in an MCH applicant, both either their ability to articulate something about the MCH practitioner as part of this larger system, or evidence that they had actually participated in it. So, we thought from a value-added perspective, MCH leadership training should provide the practitioner or other MCH--the MCH leader with an ability to understand and work in an environment that is much larger than they are, and can--and that it keeps this larger perspective.

JEFF:  Thank you, and group number three, Cultural Competency, Noah--NOAH CHAVEZ. Sound statements.

NOAH CHAVEZ:  Okay, sure, well, in a sense reflecting some of what we discussed yesterday, our group defined an MCH leader as someone who models, advocates for and supports, and motivates others to reach their own or move towards their own cultural competency. And, they're also able to integrate cultural competency into the organization or program, its philosophies, policies and activities, ad so that's how we define the cultural competence in that area. We divided up the--the--the--these particular attributes into three different categories, some of which we thought that a lot of people came with. Things like respect for others or having good interpersonal skills or self-motivated for change, and we had a whole list of things, some sense of social justice and fairness. We had another group of what we called reflective qualities, which would be things such as self-awareness and awareness of others, or being able to observe and assess people in the environment and integrate that information into the care that you provided or the program that you did. And, then we also had knowledges--knowledge and skills that we thought were things that could be worked on, that we could actually improve through the process of training. And, so, some of these were things such as the--the concept of family-centered programs or population-based programs that--a collaboration, enhancing listening and hearing skills.

Being a catalyst for change. Not making--you know, being not--less judgmental or tailoring what we do to meet the needs of the group or family, be it patient care or program development. And, so, those were the knowledge and skills in terms of how to assess some of these. They're very sort of self-assessment tools that are out there, a suggestion of looking at organizational assessment instruments that are out there that you could use to apply to a particular training program, having external stakeholder assessment of the program or the training, as well as by patients or former trainees or the like. At the process of recruitment, we could actually look at things such as the personal statement, interviews with--with potential applicants or faculty. Reference letters as to develop--to respond to particular things or ask them to reflect on their own experiences as they might relate to cultural competence.

They're--the training opportunities that we outlined provide various opportunities to assess how people are moving along the continuum, and then we could also build this more into professional competencies that--that trainees and--and faculty do. And, then we could ask trainees to evaluate each other or perhaps faculty on presentations or program designs or evaluation instruments, those sorts of things to see how they had moved towards making whatever that entity was more relevant and appropriate for--for that particular group or individual. And, then things to look for, you could actually go through and do an organizational assessment of the trainee, who's in the leadership position, which we could see as being somewhat cumbersome, but you could do it both internally and externally to the organization and have people where they were--where we had somebody in the leadership role have them do an internal and external assessment. You could do--add things to the follow up survey of graduates that we did. We could take different--you know, we could ask more questions about the types of--not just their job title, but the types of positions that they had and where they provided leadership and cultural confidence and those sorts of things, and that's about as far as we got.

JEFF:  All right, group number four, Negotiation and Conflict Resolution. We got Penny and Rebecca.

PENNY:  Okay, so, I--we made quite a run-on sentence here, but I'm sure you'll forgive me for that. And, we were trying to address both knowledge, behavior and attitudes of--of the MCH leader in the area of negotiations. So, first, we--we think an MCH leader should have knowledge of group dynamics, communication theory, negotiation skills, decision making theory, and understanding the context of an issue. And--and the behavior that they would have in the context of those--that knowledge is behavior that would foster teamwork, a quiet brain, which we sort of like that term, because to us, that means it's available for other information. It's open to suggestion and working with others in those areas. Learning--the ability to learn from failure. And adapt to--to those things. And, the process of risk taking and aligning yourself with the--with those processes. And modeling evidence-based leadership for your trainees, and then self-reflection, with attitudes that involve collaboration being open and engaged. Again, the quiet brain we felt spanned both behavior and attitude having a resilience, so that you can deal with failures that you might have. And, a vision that's--we sort of had vision and mission together, so, a vision and mission-oriented, and--and a value of evidence-based learning. And, overriding all of that which you may be able to see, we thought it was important for there to be passion that was not just random passion, that passion that is focused, informed and courageous. And, I think the--the final point that we also thought about was that, you know, we're--we're planning all these things for our trainees, but actually, there are a lot of us in the faculty could benefit from all of these things as well. And, I think faculty maybe should be involved in this training process along with the--the trainees, because we're teaching it, but we need to learn it, too.

JEFF:  Very good. Okay. Seeing a good bit of interesting overlap as we go here, number five, Mentoring and Modeling, who's up?  Mentoring and Modeling, here comes Louise, I was looking for Louise.

LOUISE:  Let's see, I was (inaudible) back there and our mentoring group actually had along discussion and this is what we felt, we felt that an MCH leader is going to be someone who is recognized as a--a leader, who is an active advocate in academia in the community, and who's dedicated in that role in nurturing and guiding in the path towards the benefit of our maternal and child health population. We felt that was very significant that it would be an immediate recognition, this would be an active and dedicated process, but particularly targeted to MCH. In terms of our trainees, we felt though, in--at--at--because mentoring is a--a long-term process, that perhaps we should wait to see outcomes at the five or 10-year level. But it became clear from our discussions that no, it's--it's the repetition of reinforcement that's important, so, in evaluation, the decision was that whatever that unit of time when the introduction and the curriculum is given, there should be a point where some reflection, exit interview, pre and post (inaudible) or something to say that they kind of got it after they left the immediate curriculum. And, that what we would expect at five or 10 years out that they would provide us that they have been a mentor, that hopefully that they are mentoring in the MCH targeted populations and that would be sort of the outcomes that we would be looking for.

JEFF:  Thank you Louise, group number six, Translating Science and Evidence to Practice, Peter Bosco.

PETER BOSCO:  Well, we felt incomplete--did not have enough time. And, what I went through is frankly a mess, but I'll try to distill it for you, Wendy. We like the title, so the domain--this domain of MCH Leadership Translating Science and Evidence Into Practice was a good title, and we define that as the ability to find, analyze, apply and communicate scientific evidence to different audiences. The--we reconfigured our capacities or skills, we had seven that--that we presented yesterday, we reconfigured those to five, resource finding or gathering, excuse me, experience and knowledge, number two, attitude, number three, evaluation of science, four, and translation to policy or practice, five. And, let me just go through kind of the themes that ran through our measures, because they--they really crossed over quite a bit, but the themes that came out from attempting to measures these processes were, for example, research projects or program development, the concept being, for example, using research project. And, if you took a research project from start to finish, ideal literature search, methodology, dah-dah-dah-dah-dah, all the way to presentation and publication, you really cross through a lot of domains that covered a lot of ground. Easier things, measurement to measure attendance at courses, at lectures, attendance at various conferences and seminars, and some of the seminars, for example, a journal club, there's an evaluation piece that can go with that, so, you can specifically evaluate the trainee's performance at a journal club.

Continuing education activities, that is to say down the line the delivery or the presentation at continuing education conferences would be an ongoing measure of this commitment. Performance evaluation in the clinic, that's an easy one. Another one, service on boards, panels, committees, as a measure of this domain, also being asked to serve on boards or--or various panels. And, then the last one, when we got back to attitude, we couldn't come up with any measures for attitude, but we felt a lot of the measures was kind of inferential. If you're publishing five and 10 years later in respected journals, one could infer that you're committed to the scientific method. That you're asked to serve on the board of organizations one could infer that maybe you've got the right attitude. That's it.

JEFF:  All right, group number seven, Policy and Advocacy Skills, Bruce Shapiro.

BRUCE SHAPIRO:  Well, first let me thank the organizers of the course because we did have somebody from the University of Washington with us today.

WENDY MOURADIAN:  That doesn't let you off the hook.

BRUCE SHAPIRO:  Okay. The policy and advocacy group met and--and we dutifully tried to pull together the definitions of what somebody--a leader in maternal child health should be able to do, and we ran into difficulty with that, because we kept on saying, well, that should be done by this group, that should be done by that group, and that should be done by the other group. And, we're coming up with very little, and so, we basically spent a little bit of time and end up rethinking the paradigm, and what we came up with--it's not something that you're going to be able to read, but basically, we came up with four or five dimensions through which leadership could be expressed, and that included things such as policy and advocacy, and we needed to make work for ourselves. Clinical or evidence-based practice and then we talked about academic and we went back and forth on whether to split research and training from each other, and administration. And, then what we did on the vertical column was to talk to different processes, and these were the--the work of most of the other groups and things included communication, constituency building, cultural competence, negotiation, conflict resolution, mentoring management, we did some renaming personal development, critical thinking and ethics. And, then we began thinking about, well, how were these processes related specifically to policy and advocacy. So, for an example, under communication we spoke to the idea of being able to develop an argument that would present a particular point of view.

Being able to use media to advance your agenda. Being able to listen well and translate the differing agendas of the various stakeholders in a fashion that would be useful. Under constituency, we talked about identification of stakeholder and building of linkages, for example, so, there were a number of these kinds of things that we spoke to. We--we--we--we had less time as a consequence to spend talking about how we would evaluate it, other than to say that there are--are--are basically two kinds of broad approaches. One is the kind of the bean counter approach, we would do things like, you know, count the number of pieces of legislation you had your name attacked with within five years of graduating one of these programs. Or, you know, testifying or strategic planning or starting a new program or--or--or--or those kinds of things. And--and--and the other was--was a much softer, in the sense of, you know, and this was one that Laura spoke to yesterday in terms of storytelling and speaking to the activities and how those--how--how--how did your training experiences move in that direction. We then got into a discussion of how we would train these things, and--and I think that at that point we simultaneously ran out of time, and ran out of steam, and decided to hold that discussion at a later time.

JEFF:  Thanks. Okay, we're up to group--the combination of eight--the original eight and nine, Management Skills and Working With Organizations, Joel Berg.

JOEL BERG:  Okay. Well, the questions aren't there anymore, the first--we--we tried to answer the--two questions, not the third, we felt we did that yesterday, so, okay. So, the first question was an MCH leader should--and this is in the realm of management/dealing with organizations and systems. There were--yeah, four things that we came up with we think are in the management domain, and the first was it was sort of a compilation of a lot of things we discussed yesterday, and that is, they should be a capable business manager, because if somebody's a leader and they're being distinguished from someone who's not, one of the most important skill sets is this whole package of things related to managing something, and therefore, the skill set should include some competencies in planning, budgeting, financial management, contract negotiation, marketing, human resources management, employee development, which includes evaluation and mentoring. So, all those aspects of managing an organization must be included in a program, and leaders should be evaluated on the basis of their capability in that regard, we felt that was pretty important.

The second is visioning/systems thinking, logical reasoning, and that's my interpretation of our discussion, to look at--to--the ability to look at an organization as a whole. The picture that Judy showed this morning of looking at the corner of the big picture, to make sure they're really looking at the big picture, and that and you can kind of by--I think, by setting the target of trying to measure somebody's capability to do that, looking at them in that way it's easier to determine whether they've achieved that.

The third is collaboration, all the skills related to proactive collaboration, and there are a variety of sub-skills that are important for leaders in the area of management, having to do with collaboration. The first is defining who you are in order to collaborate, you have to know yourself and how you would interact with others. Then understanding of systems once again, relating to that other one, the ability to affect change within those systems, communication skills, of course, articulation, one of the training elements that we felt was necessary and we've talked about that in our program, but haven't implemented it yet, would be to provide a--a--some kind of material related to evaluating how we articulate how we speak to present in front of others and have us critique each other, look at how well we can articulate in the presence of a collaboration situation. And, the training should be individual in this regard because some of had some--have had more experience than others. And, the last one is inspire active lifelong learning. And, leaders are those who inspire others to do that. So, in order to do that they have to live it themselves, so to asses the individual as a leader, one element of that assessment as a manager of others who are going to be lifelong learners would be to inspire lifelong learning.

And, then finally, the second question was how do you assess that at the conclusion of the program and then five years out?  Regarding the--the time of conclusion of the program, the challenge some of our folks brought up was maybe there needs to be a determination of who should be nurtured further as a leader at that point. In other words, maybe it's determined at that point that some of the people in the program are going to be wonderful individual contributors as clinicians or whatever they may be doing, but they aren't necessarily going to be leaders. Don't force the issue at that point, just because they made it through the program of trying to continue to make or assume everybody will be a world-class leader. So, make some kind of identification of who we intend to focus on thereafter, and then having done that, look five years out at things like lifelong learning, is that happening, affecting change in their community, MCH interaction, interaction with the program and the intentions of this organization, are they--are they living up to what the intent of the MCH leadership training was all about?  And, then there are the more obvious measures of management expertise, such as, are they heading up something, are they chairing something, are they active in their local professional society, not just active by response, but proactively, are they leading something in that organization? And, are they fostering collaborative relationships proactively?  And, I think the key word we came up with was that it's a proactive--are they doing things proactively as opposed to reactively?  And, that's--that's a big difference, because a lot of people get begged into doing things, and they may be very good at it, but that doesn't mean that they're a leader, and I think one identification of a leader is the one who proactively seeks to do it and challenges others to follow. So, that's it.

JEFF:  Thanks Joel, let's see, number 10, Internal Process, Becoming A Leader, Gail Kikifor.

GAIL KIKIFOR:  Well, many of the things that we've said--that you've all said, we identified probably because internal processes go through all of the things you've talked about, I'm going to go through a few things. We tried really to go through all seven of the criteria we talked about, so, some of the things we said that a leader would use critical thinking skills to foster one's own and one's trainees reflections, they would have and use--their own mentor, they would use listening skills on a repetitive basis. They'd celebrate their own and other successes, and reflect upon those for the future successes. They would understand and use change processes frequently. They would know one's own style and be able to articulate the why of that, why they're using that style in any particular situation, and also the why of why they are changing that style. They would go back and relearn, retrain where they felt inadequately prepared. They would be able to market effectively the vision of MCHB, and how their own personal vision fit with that, aligned with the MCHB mission. They'd have the ability to discuss their own leadership trajectory and how that trajectory was fitting with their personal mission for the future. And, they'd be able to help someone else do that. They would develop a yearly short reflection plan, a written plan for where they are and where they're going. And, they would take and create opportunities for themselves and for others to discuss the why, the how and perhaps even the why not they didn't take some opportunity, because as some people have told us here, there are sometimes when your vision isn't in alignment with the organizational vision, and that's fine.

Three things that ran through, many of us felt that the selection criteria maybe shouldn't be applied to the trainees, because many of us felt we wouldn't have been selected as trainees had they been applied, but perhaps openness to some of these internal processes could be articulated. And, then someone else--when we talked about evaluation, end of program five years and 10 years, we really again applied the developmental trajectory that perhaps at one year the trainees are able to do the things we've talked, at five years they're modeling for other people, but truly, at 10 years what they're doing is that they are actually bringing other people along and giving these skills to others because we felt in terms of internal processes, it's really critical that by 10 years they are caring who carries on the vision after they're gone. And--and so that would be important. We really did say this is going to take time in training. That because you're dealing potentially with internal conflicts and weaknesses, and this is difficult for us all, and I think I'll end. We've got much more written.

JEFF:  Thank you. Thanks very much. Group number 11 Critical Thinking and Problem Solving. Here we go.

CAROLINE:  Okay, as far as critical thinking and what should all MCH leaders do or be, we came up with quite a laundry list and I'm only going to highlight some of those. One is to be introspective, reflective, curious and flexible. To be able to question everything, one's own assumptions as well as the assumptions of others. Some of this we talked about yesterday. Analyze, learn from mistakes, create, foster, nurture thinking, reflective environments, that is environments where people can take the time to understand other people's perspectives in context. Use the lens of other folks and their perspectives, especially when it comes to issues regarding culture and community. Be able to acquire information from multiple sources. Leaders should be able to seek out various cultural perspectives, actually seek them out, rather than just be aware of. Understand one's own perspective and be self-aware. Effectively communicate about the complexity of evidence. Leaders should also--also affirm the process of critical thinking in others. And, this is part of the training piece, model critical thinking and actual--and actually label that as they do. And, in working with trainees, teach trainees how to prepare and how--how important preparation, for example, for testimony or other--anticipate other types of situations like that. The one thing about training that we talked about was--and this came from yesterday, too, but that we are doing this, we need to be much more transparent with our trainees and much more explicit in what we are doing. We need to label that we are teaching critical thinking and what critical thinking is.

Finally, as--as far as the measurement piece, that's where we began to run out of time and we struggled with this more, but we did discuss it somewhat. One of the issues we discussed was how do you screen for or recognize individuals as they come into the program, in terms of critical thinking, are these folks who are going to--are critical thinkings or will be able to learn how to be critical thinkers. And, we had a different--difference of opinion here, some--some folks felt that people who are outspoken, who can ask questions early on and challenge early on might be the folks that would turn out to be good critical thinkers. Other folks recognize that there might be some cultural differences in terms of how people ask questions or whether not they ask questions, and so, the issue of willingness to learn and openness to learning was something that--a characteristic that we thought was important. The issue of how to evaluate or know whether or not we've trained people in critical thinking, some folks talked about talking to employers after people graduated and started working in positions to find out how they were working out, scholarly products or case studies at the end of training where people could demonstrate their critical thinking. And, I think that's where we got bogged out. Thank you.

JEFF:  Thanks CAROLINE. Number 12, Ethics and Moral Commitment, Professionalism. Glen Dear and company.

GlLEN DEAR:  Yes, I'm back. Does anyone have a mirror I could borrow I think I have the word sucker written across my forehead.

UNIDENTIFIED SPEAKER:  Or leader.

GlLEN DEAR:Well, I think sucker. Yesterday we talked about--we pretty well laid out what we saw as the knowledge, skills and attitudes, so, we're not going to go over that today, we'll just build on what we talked about yesterday. And, in terms of assessing these things, there were a couple of things that--that seemed to really strike a cord with the members in our group, one was using portfolios and then from that, looking at--at whether they're meeting these various competencies, and I think that's probably one that would apply to a lot of the different categories, and not just hours of efforts and professionalism. And, then another one that we talked about, one of the best ways to assess professionalism is talk to peers and one possibility would be getting commendations and concern cards from the other people in the training program, to begin to identify early individuals that might have problems with their professional behavior. So, those were a couple of--of things that really seemed to sort of carry some weight with the group. Let me quickly go over things that we discussed in terms of assessing what they should know, using exams while they're in the program.

Faculty observations, having the trainees do self-assessments and portfolios or reflective journals fits in here. And, then after five years, again we might do exams or have them do a case-based assessment. Survey the trainees about the gaps they saw in the program and things that we might do better based on the experience they've had and then also employ--surveying employers or possibly even employees, people they're working with to get their view of their professionalism. In terms of what they--the trainees should do, again, doing self-assessments through portfolios, case analysis, looking at ethical decision-making. Having faculty observations as a part of the assessment and using performance-based assessments, things like (inaudible) as a way to do that. After five years, asking whether or not the--the trainee is licensed in their profession, and whether they're in good standing with their licensing board, and also, to find out if they have done continuing education in ethics. And, in terms of what a trainee should be, this may be one of the hardest ones to--to measure, it's a little less behavioral, although I think we can see some behavioral evidences of that.

Again, using faculty observations and surveys, asking patients and families to--to give their assessment of the attitudes that the trainee has--has demonstrating, using journals portfolios again personal assessment of attitudinal growth. Asking the trainee themselves to assess themselves on that. And, also whether there have been commendations or absence of incident reports. And, then after five years, again, a self-report on their commendations, employer surveys--surveys, trainee satisfaction with their career path, and professional assessment of moral development, and then finally a record of advocacy activities they've done to improve the world. Then the only thing we need to do is to bring all the trainees in for a 24-hour marathon to do all the assessment that all of us have talked about. Thanks.

JEFF: Yeah, gives yourselves a bigger hand that was hard work. Everybody obviously was putting a lot in now. Let's see, I'm sure there are a few other wrap-ups. We certainly want to make sure we collect evaluations from everybody. I'll say that one more time. And, the--let's see, we still have the box lunch activities. I think Wendy's grabbing a list here. Yeah.