AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
AMCHP 2005 ANNUAL CONFERENCE
VALERIE RICKER: I'm Valerie Ricker, and I'm the Title 5 director in Maine . I'm also the regional director for the AMCHP board, representing Region I, which is New England , being Connecticut , Rhode Island , Massachusetts , Vermont , New Hampshire and Maine .
My background is as a pediatric and women's health nurse practitioner, working many years in postpartum obstetrics in the Greater Boston area, and then for the last eight and a half years I've been the Title V director in Maine , taking responsibility for the family health‑related programs. And our other presenter today is Sally Kerschner, who also has a nursing background. Sally is presently employed by the Vermont Department of Health, Division of Health Improvement, working in maternal child health planning. She's worked in public health and maternal child health for over 25 years in a variety of practice settings, including inpatient community and public health organizations. She obtained her BSN from the University of Delaware in 1975 and completed her MSN in October of 2000 at the University of Vermont School of Nursing.
Tom Rice, from the National Center for Infants and Early Childhood Health Policy was also scheduled to be a presenter but unfortunately they had a rather significant grant that is due at the end of this week or the very beginning of next week and he needed to stay home and do his homework. So we're going to pitch in for Tom to the best of our ability.
It's very exciting to see so many people who have chosen this session. It's also a little nervous, makes me a little bit nervous in terms of the number of people who have joined.
What we're going to talk with you about is what started out as a brief informal discussion among a couple of us that has sort of grown it's way into a regional initiative.
Back in January of 2004, our region was presented with the opportunity to get some technical assistance in planning for the five‑year comprehensive needs assessment, and all of our representation from all of our region was at the meeting, as well as I believe region two was involved.
And at that workshop we started talking about what was included in the workshop was very helpful. But we also were looking for information about how did we assess the strengths of the systems with which we're responsible for so that as we're making these five‑year plans with the comprehensive assessment, we could include those in there. We also found at that time that several of our, actually all of our states were undergoing significant budget deficits at the state level. And we had the sense that they were going to be coming also at the federal level. And we felt that if we were, the timing of the comprehensive assessment and the budget deficits meant we were going to have to make some really tough choices and none of us wanted to make choices that in three to ten years we would be regretting saying we've slid backwards.
So that gave us more of a push to talk regionally in regards to how we included strengths in the general five‑year assessment. Through February of 2004 we continued to have some regional dialogs. In our region we have a monthly conference call of all the Title V Maternal Child Health and CHSN directors. And in that we would include some discussion about the philosophy of strengths and the assets in assessing populations. At the AMCHP meeting last year, we also continued to have more discussion about strength and asset measurements of population and started exploring the possibility of including a regional strength measure in the 2005 assessment.
In region one we are fortunate that we are geographically close enough to each other that we are periodically able to get together in person, and we have a bit of a history of doing some shared projects together. So from the needs assessment training in January of '04, and the AMCHP meeting in February, we continued as the facilitator for the monthly conference calls, I saw that we continued to have the strength addition continue as a part of our discussion about needs assessment.
As we were having these conference calls on a monthly basis, individual states continued to have dialogs in planning for their five‑year assessment.
And as we looked at, you know, well where do we start, we identified that maybe we could look at the guidance that comes with the Maternal Child Health Bloc grant and maybe we could identify some areas within that that we could add discussion of strengths, and we could make a template that every state in the region would use so that the reviewers would start to see some standardization as they read across our applications.
We also ‑‑ so that was the first step. And we have made two drafts of that. We also searched for the existence of strength‑based measures. Searched through the Title V information system on the web, as well as looking at other resources such as the Search Institute for information. And what we found was that the wording, one that we're really no performance measures in any of the 50 states or nine territories that were really a strength‑based measure. There was one in Alaska that was sort of. And then one in New Hampshire that possibly was. But we were finding that it was really taking the wording and turning a negative into a positive. And that that really for us was not indicating a strength measure.
As we continued our discussions and trying to figure out, okay, this is a huge area we're responsible for, how do we narrow it down, several of us, but myself and Bill Hollinshead in particular had been active in a state ‑‑ national initiative looking at the development of school readiness indicators. So we started to have a conversation about maybe we could take something from the school readiness indicators to use as a strength measure or a strength indicator.
As we talked about school readiness. We also realized that that could connect with our early childhood comprehensive systems activities. Now, I realize, as I talked with my counter parts in New England , that not everybody was as informed about the school readiness indicator project as Bill and I were fortunate to be. And I also realized, talking to my counter parts in the nation, that they also were not as aware of this. This was an initiative funded by the Packard and Ford and Kaufman Foundations. They funded 17 states which happened to include all six states of region one for the development of a comprehensive set of school readiness indicators that could be used to inform public policy for young children and their families. It was to be a three‑year initiative. States would work individually on developing a set of readiness indicators that they would report on in their state. And we would take from those we would look for where was the commonality across the 17 states and come up with what we called a core set of readiness indicators. The population we were looking at from the prenatal period three to five years of age and most of the indicators were looking at child outcomes as well as system outcomes.
The indicators were to reflect state policy goals and state investments in programs and policies for young children and families, as well as the outcomes.
So we started saying, well, maybe these could provide a foundation for Region I strength‑based measure indicator. Last week on the 16th of February the Rhode Island Kids Count released the list of the core national school readiness indicators. Rhode Island 's Kid Count was the convener of the national effort. And you can go to their website, which is rhodeislandkidscount.org and look for the toggle switch that talks about the school readiness indicators and you can get a whole list of those. We also have a highlight of those in the hand outs that we provided.
Most of you, I think, are aware of The State Early Childhood Comprehensive Systems Initiative, which was funded by Maternal Child Health Bureau starting in 2003. Its purpose is for Title V to initiate the development of early childhood systems plans with the goal that children who are healthy and ready to learn at school entry. There are five critical components to the Early Childhood Initiative: Access to health insurance and medical homes, mental health and social emotional development, early care and education, child care, parent education and family support.
So we had some initiatives that we were all involved with to one degree or another. And started looking at how we might use the strength and needs assessment and the desire to develop a regional performance measure or performance indicator that was strength‑based. We said okay how we are going to get ourselves all organized. And fortunately, through the Maternal Child Health Bureau we had been approached by the center at UCLA about doing a early childhood learning collaborative. And so through our ongoing monthly conference calls, we decided that this was something that we'd like to participate in and use that to inform our work around strength‑based measures or indicators.
The purpose of the learning collaborative is to develop at least one asset‑based indicator to measure early childhood systems, include indicators in the state early childhood comprehensive systems grant strategic plan, and you see there core participants are, the six states, the early childhood coordinators the Title V director and CHSN director, and fortunately I don't think we have anybody who fits all three of, the one person who fits all three roles. But there are a couple of states where one person is covering at least two roles. We started our discussion in the fall of 2004, and we will end the latter part of the spring of this year. And Tom Rice from the National Center For Infant and Early Childhood Health Policy is providing most of the staff for this initiative.
In doing this learning collaborative, it's to be a cyclical process among the groups with similar interests, a common goal in mind, and implementing similar strategies that can more easily overcome obstacles. This collaborative is unusual in that it is focused on agency planning effort rather than a detailed set of practice changes. And in terms of the goals for the initiative, it is to divine a measurable early childhood indicator or indicators and the indicators will help states to track their state's outcomes, determinants or systems performances. They will provide additional information to maintain the public and policy focus on early childhood, promote adoption of this indicator, hopefully by other states and regions. And may be an initial step toward building a robust network of indicators that can be better meeting the informational needs for public policy.
The framework that's been developed around the learning collaborative is that looking at any of the school readiness domains, which are health, early care and education, social and emotional health and development, parenting education and family support. And you look at those domains and then there are four levels of systems or services, and those go from the individual family community and system level. And each level responds to the level below and creates incentives for the level above to respond. I can also show how an asset at one level can leverage assets in another level. And then there are three types of measures. We had a lot of discussion back and forth between indicators and measures. One is prevalence, which is a simple measure of the presence or absence of an asset. Performance measure. It's the simple measurement of the quality with which an asset is used. And then type three, which is interconnectivity. And the three types allow for the creation of a more complete picture of what is occurring, why and how. At the systems level, measures examine how systems operate at a large scale and ultimately contribute to localized activities, processes and outcomes.
System measures can create incentives for community level structures, processes and outcomes, which can be measured as well.
In terms of our initiative, the next steps will be to develop and finalize a prioritization of indicators based on this framework that we're using here. We will complete the final indicator selection and develop a collection and reporting strategy. And we will promote indicator selection and processes as options for other states and regions when it's finished.
Now I'm going to turn the presentation over to Sally