AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
LORI REEVES: …the March of Dimes Florida chapter. And over the past couple of days what I've noticed is that issues and problems and challenges we've been facing in Florida over the past few years are certainly not unique, that I've heard the same stories told over and over again from other states as I've been here for the past two days.
And I'm going to be speaking a little bit about the whys of why we did a Perinatal Periods of Risk practice collaborative and expanded it in Florida . Debra Bara, my partner with Healthy Start, Pinellas County, will talk about how we did it and where we went with it but I want to go back a little time to the political situation in Florida to talk a bit about how we came to some of these issues; and we have Republican, House, Senate and Governor, as many states do now. And when Governor Jed Bush, the President's little brother took office, is it five years or six years now? Six years ago, one of the first things he did was emphasize that his policy was going to be tax breaks and spending cuts particularly reduction of government services in the state of Florida , making government smaller in Florida . And he gave the State Health Office, along with many other state agencies, an ultimatum that they were to reduce their spending five percent per year over a five‑year period of time. We knew when that happened we were going to be looking at budget challenges, program challenges. With increasing numbers of births every year, how are we going to respond to these issues with less money every year we turn around?
So I want to talk a little bit about defining political will and why political will is important when you're working with Perinatal Periods of Risk or any other project, how do you get from where you start, which in Perinatal Periods of Risk is the data analysis stage to where you want to go. If you think of it as a road trip, the data analysis stage is the starting point. And the action or systems change or improvement in maternal child health outcomes, that's your destination. I think of the planning part as the car. Political will is the gas. And without the political will, without the gas in your car you're not going to get to your destination, no matter how much planning you do you'll just sit in one spot and you're not going to progress.
So how do you get the gas in your car? We have to build support at a broad level to move from these concepts to the plan for action as I was just describing, and the reason that we want to do this is, in order to make progress, we have to be able to influence decision making and policy. We have to influence services and programs, and we have to be able to look at resource allocation in this world of budget cuts. In Florida that's particularly important because we knew that the state health office budget was going to be smaller by 5% every year. That was going to impact maternal and child health programs, how are we going to respond to growing needs in maternal child health with less money every year. So Perinatal Periods of Risk was an important tool to help us put some focus on this area.
There's a slide missing. Where did it go? Okay. Well, there's a slide on partnerships ‑‑ oh, here it is. Nope, not there.
There's a slide that's missing on partnerships. And I'll just do it on this one. I'm speaking from the perspective as a partner in this project not as the convener, Healthy Start really was the convener around the state. We had three Perinatal Periods of Risk projects in the first group of 12 projects nationally, which made Florida kind of unique that we had so many in one state. And they worked together from the beginning. I was on one of the teams, in a peripheral way as a partner not involved in the analytical part of it. So speaking from the partnership perspective is important to me. One of the things I want to say as a partner is partners can do things that you may not be able to do, particularly if you're a state agency, there are restrictions on ways you can spend money. There are restrictions on how you may be able to advocate for programs and these are things that partners can bring to the table that you may not be able to do. So coming in as a partner, that was something that March of dimes could do. We could advocate. We could provide funding for programs and services. We could provide funding for training. So speaking as a partner, this was something that we were thrilled to be able to participate in, and I'm going to let Deborah talk about the expansion to the seven different sites.
But the other thing is that organizations and agencies that can influence decision makers, when I talk about advocacy, the March of Dimes is a grassroots network. We're a volunteer led organization. We have thousands of volunteers in the state of Florida . I don't have any idea how many we might have nationally. But if we want to mobilize volunteers to respond to an issue, we can have hundreds of people in contact with the state Legislature very quickly. And this was great working with Healthy Start, because they also are a grassroots organization that has a lot of community contacts and a lot of advocacy networks. So when you put the two of us together, we can make a big difference in what legislators hear, think and believe about programs in Florida , the state health office as a partner can't do that. And, of course, all of this is really easy to do.
Talking a little bit about the multi‑level partnerships. We started CityMatCH organized the Perinatal Periods of Risk project and March of Dimes was a partner at the national level as well as at the state level in Florida along with the centers for disease control and HRSA, and I don't know there were probably others as well. So for local state partners in Florida the maternal child health coalitions in Florida we have a unique set up I don't know of another state that has the same thing Healthy Start programs and Florida has its own Healthy Start program and we have about 30 Healthy Start coalitions they get a contract from the state health did he thought and they run as an independent community‑based coalition that recruits members from maternal and child health organizations and other interested community members whether it be businessmen, local leaders, whoever that might be, that come to the table and work on issues related to maternal and child health from a community perspective. So it's a wonderful structure that allows us to get a lot of community impact on programs that are planned.
The county and city health departments were partners. I think one of the important things on the Perinatal Periods of Risk project was that every project had to have a county health department closely involved in it. And one of the things March of dimes has been fortunate with is we have a great relationship with our state health office in Florida , and is anybody here from the state health office today? Hi. Thank you.
We have worked with them for several years, and again and again they are able to bring things to the table that we can't do and together we're able to implement changes that neither of us could ever do by ourselves. So it's been a really wonderful relationship. And of course the March of Dimes Florida chapter, in addition to being a strong advocate, being able to speak on issues for maternal and child health, we can also bring some money to the table. Things we can do are the state can't provide funding at a meeting, for example, for food. If you're bringing together for a two‑day meeting you need to feed them. We can feed them. So that's something that March of Dimes has been able to do is provide money to feed people when they come to these meetings. An important thing.
Our goal in these partnerships, this has been discussed by Ohio and all the previous speakers, is really linking existing efforts together so that you can build that momentum, build that political will, tell your story to policy makers. Sell yourself to policy makers in the sense of creating an interest in a capacity for them to make a change. And sometimes you're fortunate enough in public health every now and then there's one of these great things that happens, a story makes national headlines and all of a sudden your local politicians call you up and say what's it like here? I want to know? I want to do something about this problem in our community. Well, you just got your political will there because of this national publicity. But in most cases we're not fortunate enough to have that to be the case. We have to generate it on your own in order to do that we bring in all these different partners and bring all their information, all of their resources together in order to have a strong impact on the change. So at this point I am going to turn it over to Deborah to talk specifically about how we expanded the Florida practice collaborative.