MCHB ALL GRANTEES MEETING

Solos to Symphonies: MCH Partners Working

October 4-7, 2004

JOANNE CRAIG: Good morning. It’s our pleasure to be here with you and what we’d like to do is to open the doors to Pennsylvania and give you a look at who and what we are, the Pennsylvania Perinatal Partnership. Okay. This is Pennsylvania . The Title V and Healthy Start projects and the state department of health that comprise the Pennsylvania Perinatal Partnership as you can see are spread across the state of Pennsylvania . Primarily, in the largely populated areas on the western and eastern side of the state. What we’d like to do now is to tell you more specifically what Title V looks like in Pennsylvania and what Healthy Start looks like in Pennsylvania .

KATE MOSS: We’re going to feel a little bit like jacks in the box here, I think, upping and downing but so you’ll bear with us. Pennsylvania ’s a very interesting state. There are two big cities and a lot of area in between and we have an interesting arrangement for our public health service. We have a state health department and then a bunch of county and municipal health departments, so the areas that are not served by the county and municipal health departments are served by the state health department. It makes for a very complex system within which to try to get anything done, and in particular if you are one of the county municipal health departments, the challenge of figuring out how to have an impact at the state level where a lot of the decisions are made is very challenging and that had a great deal to do with the impetus as far as the Title V programs are concerned behind the formation of the Pennsylvania Perinatal Partnership.

JOANNE CRAIG: Title V and Pennsylvania . We are fortunate--I’m sorry--Healthy Start in Pennsylvania . We are fortunate and blessed in that we have six projects in the state of Pennsylvania . As Kate said, they tend to be along the eastern and western sides of the state where it is fairly highly populated. In Philadelphia , there is the west and southwest Philadelphia Healthy Start Project and then separately the North Philadelphia Project. In Delaware County , Pennsylvania , which is the very south eastern corner of the state, my project *Kroger Keystone Healthy Start healthy start, the city you probably know as Chester , Pennsylvania in the surrounding communities. Next to us is the Chester County Healthy Start Project and then far out to the western side of the state near the Ohio border, you have the Allegheny County Healthy Start Project and the Fayette County Healthy Start Projects. These projects are--they range in age. The Philadelphia project one and the Allegheny County Healthy Start Project were part of the demonstration phase of Healthy Start. My project--the *Kroger Keystone Project in Chester County came along during the replication phase and then Fayette County in North Philadelphia came along shortly thereafter.

So our Healthy Start Projects have a lot of experience to contribute to this partnership. The Maternal Child Health Bureau funds both Healthy Start and the Title V projects. A long time ago, I think about 1998 or ’99, MCH being mandated that Healthy Start and Title V MCH programs collaborate. And we had some discussions about this recently over dinner. The project directors in Pennsylvania seem to be fairly compliant. When you tell us to do something we take the marching orders and we march and we do what we’re supposed to do. It started off with a healthy start project a very long time ago now, about six years ago, deciding that we needed to get together in Pennsylvania, get to know each other as projects and as personnel and begin to explore areas for partnership and collaboration. And that pretty much came along at the same time as the mandate, so the good news is that the Healthy Start projects decided that they needed to just work together and it made it easy when a prospect came along to consider Title V in the state department of health. Pretty simple what we did.

I mentioned the Healthy Start projects were already communicating and working together and we basically asked if we could have a meeting with the Title V folks. It wasn’t quite that simple. The meeting part, scheduling it, having people come together, that was the easy part. The hard part was finding that common ground, figuring out what our purpose was, finding out if there would be value and true meaning for us and what we found is that we really had to build a relationship. No different than a marriage. We needed to learn about one another’s programs. We needed to truly develop relationships and really get to know people on a more personal level, not just that we were project directors or municipal MCH directors, but what we brought to this party, what we brought to the relationship. Many years of experience, working in the trenches, our commitment to the communities that we serve, and we needed to take all of that to help us to create a vision for collaboration. But again, I tell you, it wasn’t quite that simple. It was really quite a labor but I think it was certainly a labor of love.

Building relationships. Well you’ve heard, for those of you who know Teddy Pendergrass he talks about it being 50/50, 60/40, 90/10 in terms of a relationship. It’s a give and take. We brought that to the party, too, unfortunately in that we brought our own stuff with us in terms of trying to find that value and figuring out whether we really should be at the table. There was resistance to change. Many of us are used to working in silos and not working towards symphonies. We’re very territorial so we needed to overcome that. Certainly the fear of the unknown. For a lot of years we had worked in our separate corners of the state in our separate programs and not all of us truly understood, perhaps, what the long-term vision would and should be and what it is we are really setting out to do, and then the competing demands. Well, in this case we did get all the CEO’s or directors or chiefs in the room and that’s very important but better than that, we all were program directors in our own right with big responsibilities at home as well as the demands that we had for our programs, and it made it very difficult to consider the prospect of collaboration and partnership and then how are we going to get it all done? But I have to tell you my colleagues and I we were up to the challenge.

The level of commitment once we figured out that this was where we needed to be, beginning to build a relationship toward collaboration and partnership, I think we hit the ground running. We knew that you had a group of busy people that had a lot of responsibility and could make decisions in the room, but it took more than just that. Actually, it took more than just us. We needed to develop an infrastructure. We couldn’t just go on good intentions and commitment. The other thing is that takes money. Even just to find a place to meet in and if you were to simply have a sandwich and a cup of coffee, it cost us money to get there. We probably need to copy things so that we have materials for the meeting and so on. So we knew that we needed to contribute funds and I have to say that the bureau made it easy for us in the beginning, at least on the Healthy Start side because they actually made funding available to contribute toward the collaboration process. So, the Healthy Start Projects, and where possible the Title V Projects and the state department of health actually contributed funds to the Pennsylvania Perinatal Partnership.

I talked about needing to create an infrastructure. Well, again, very busy people trying to do one more thing. We decided to be realistic about what our capacity was and we knew that we couldn’t ask all of these directors to do one more thing and be successful with it. So we decided that we needed to find someone who could coordinate our meetings and help keep us on track, and we identified several people within the state that had a lot of experience working with the department of health Title V and Healthy Start. And what actually happened is that that individual became associated with a well-known organization and we were able to sub contract with the Family Planning Council of south eastern Pennsylvania to provide the, kind of, organizational support for the Pennsylvania Perinatal Partnership. We actually got a lot more value with that contract than we ever imagined.

The infrastructure leads us to setting an agenda. We created work groups and we established program and policy, priorities, and we continued to find common ground purpose and value beyond just the mandate that were given by MCHB. The infrastructure included operating principals. We developed organizational by laws, a mission statement that reflected Title V and Healthy Start’s values. We developed membership status. We have voting and non-voting members and we have a governance structure. Presently, we have to co-chairs, one each representing Title V and Healthy Start and I happen to be presently the secretary treasurer. The mission statement as you can read of the Pennsylvania Parental Partnership which is composed of Healthy Start, Title V, and other maternal and child representatives is to improve perinatal health outcomes in Pennsylvania--key words--through collaboration intervention, joint strategies, and advocacy.

KATE MOSS: So having created an organization, we had to determine what our program and policy priorities were going to be and we came up with three on which we’d been working since the inception of this outfit. Education advocacy and what we’ve called creating a presence. What we’re doing with regard to education began at home. It was important for us to learn about each other. We were very surprised. Philadelphia ’s a little bit different because the Healthy Start programs are located within the health department, which is also the Title V agency. But many of the Healthy Start programs have not Title V--have no local health department in their area or didn’t have a close, strong relationship and in addition because the parts of the state are very different, it was important for us to learn in the east what was going on in the west, all of the stuff that you would think we could perhaps have learned otherwise but we hadn’t.

We were concerned as everybody has been about sharing information among our projects and so we actually invited in a HIPAA expert to come talk to us about protected health information and what were going to be the limitations on our ability to share information. We looked at some of the critical issues going on in Pennsylvania . In particular right now for maternal and child health (inaudible) maternal and child health issues, one of which no stranger to anybody here is the medical malpractice crisis. We were experiencing a significant flight of OB ’s from Pennsylvania because it’s just too expensive to practice there given how much the malpractice insurance premiums are. And we took an opportunity to re-educate ourselves because many of us had had some exposure to this concept originally, but in this context it was useful to once again review the parinatal periods of risk approach to understanding infant mortality. We determined what some of our advocacy activities should be since part of the purpose of coming together as a group was to be able each to amplify the other’s voice and to have an impact in areas where none of us alone would have very much to say. So we’ve looked a number of areas now.

We did a presentation at a HRSA meeting in Philadelphia looking at managed care and cultural competency. We were able to draw in people from our Medicaid managed care plans, from state government, and all the project participated also, and learned some very interesting things. We brought in people from as far away as California to teach us about--in an area that’s even more culturally diverse than we are becoming--how they were coping with different languages and cultures. We recently held a round table at the state level involving people from a variety of state agencies on the Medicaid and SCHIP programs. Pennsylvania was one of the first children’s health insurance programs. We created a free-standing program and so rather than fold that in and just expand Medicaid which is what a number of other states have done with their SCHIP programs, we continued to have two separate programs, separate benefit packages. In some cases, separate panels of providers but kids who move between them. It’s particularly difficult for families of children with special healthcare needs who’ve become dependent on a particular panel of providers and then change insurances because of the change in their income.

And on the ground, our projects were very aware of the kinds of challenges that family’s face, but had had very limited ability to have any impact on the people at the state level who actually make the policy. So this was a phenomenal opportunity for us. We were lucky enough to obtain some technical assistance from HRSA. There’s a group of people putting together purchasing standards for Medicaid for children’s health and so we had something new to bring to the table here. We were able to get our Medicaid partners and they really are our partners now. Medicaid and the SCHIP folks to the table and the governor’s policy office and people from the legislature to take a new look. That was a very challenging meeting. When you’re the new kid on the block because we’re a brand new organization, you have to tread lightly when you’re working with people who’ve been doing this work for a long time and that’s a whole other presentation. A few months ago now--actually it’s probably about a year ago we did a really exciting parinatal depression summit.

We were able to invite people from ACOG and a number of other national agencies to come talk to us about perinatal depression, the state of diagnosis, the state of services, and figure out where we wanted to go with that. And we have now been in touch with the governor’s health task force. Our new governor formerly the mayor of Philadelphia created a health office specifically to look at the healthcare crisis in Pennsylvania and we have--we wrote to them--her--and have had a private audience with her to make sure that she’s clear about some of the maternal and child health issues that are going to need her attention.

JOANNE CRAIG: I have to tell you that this has truly been a labor of love. I’m trying to decide where I’m the mother of triplets or I have three separate children but I actually have a seven year old and our Healthy Start project came along about a month after that, so definitely twins. But I feel like maybe I added the triplet about two years later in the form of the perinatal partnership. My colleagues in the state of Pennsylvania and I have truly embraced the notion of collaboration and partnership. There’s an incredible amount of communication. There’s an incredible amount of commitment and just plain old caring and nurturing for this partnership. Kate mentioned the perinatal depression summit but what she didn’t say is that we actually worked very hard to actually develop a partnership with ACOG and the state of Pennsylvania on perinatal depression. And you can’t see on the surface the number of additional partnerships that we’ve created related to some of the different focus areas that we’ve established.

We needed to create a presence in Pennsylvania for the partnership. Some folks know who Healthy Start, maybe a lot more folks know about Title V, but this Pennsylvania Parental Partnership thing--we weren’t really sure that people really grasped the concept. So in addition to building the relationship and coming up with organizing principals and establishing where the value is for all the partners, we really needed to create a look so that we could have a presence. While we have our separate identities, the partnership itself needed to have its own identity.

KATE MOSS: Hence the letterhead. So the work continues. We chose some initial things to do. We continued to work out the details of our relationships with each other and our continuing work includes--we hope--additional presentations to government officials. Again, very difficult for a local entity to have an impact at the state level where the decisions are made that have a huge importance for the lives of the families we work with. We’re beginning to look at work with related statewide organizations to create partnerships. There have been many fascinating discussions about who are we? What’s our niche? How are we different from the docs? How are we different from the social work organization? What is it that we do that is particular and that can be of importance--of value--to people at the state government level? We’re continuing to raise public awareness and support about the importance of improving maternal and child health outcomes. And again, this is something that we couldn’t possibly have done individually, but as an organization, as a combination of Healthy Start and Title V, we’re getting there.

So what has it taken to get us to where we are now? And I have to say this is a work in progress. It sounds like this is, kind of, a done deal and we’re all real comfortable with each other and we’re clear about our agenda going forward and there are some things we’re very clear about and we’re pretty trusting at this point of each other, but the work of collaboration, a much overused word, continues. So what it took was a shared vision which took some time to articulate and common purpose. It doesn’t mean that we share the same point of view on every issue, but there’s enough that we share that we were able to identify some common vision and common purposes. It’s taken a lot of time. Pennsylvania ’s a big state. That means if you live in the western part of the state and the meeting is in the eastern part of the state, you fly in or you drive five and a half or six hours and you can’t, you know, this work doesn’t get done in a half a day a year and we’ve been meeting quarterly now, I guess, since we began and that’s a big chunk of time out of the schedule--out of my schedule, out of Joanne's schedule, but I think that what we’re realizing is that it just takes that much time.

It’s taken a great deal of patience. I mean even when other people in the room are being entirely unreasonable, it was important to, you know, take a deep breath and remind ourselves what the common vision was, what the purpose was here. She probably didn’t really mean it that way and to be able to, sort of, come back to the table. Its taken leadership. We’ve been fortunate in having elected for ourselves, people who had a tremendously strong commitment to making sure the organization would function and frankly, the entity with whom we contracted--the Family Planning Council--and our executive director have been phenomenal in supporting us. They do the work. They get the minutes out. They get the meeting organized. They buy the food. They keep us on track with, okay this is what happened at this meeting, this is what you were committed to do. Okay, now here’s the email telling you what your job is now.

Okay. We’re continuing to work on our structure. I think we’ve talked about most of this. A big issue for us now is the possibility of expanding membership. So are we meant to be just Healthy Start and Title V or could it be that we would want to invite some other people in who are, sort of, unaffiliated but interested. Or do we develop liaison relationships with other entities at the state level. That’s a topic currently under discussion at the moment. So what have learned? We’ve certainly learned about the difficulties involved in collaboration but that it is doable. I would say we’ve also learned that it’s really important to make friends with people who are friends with the people you want to be friends with. So if you don’t know the people--if you don’t have a relationship with the people whom you need to influence, find somebody who does and who shares a common purpose with you and then work through them. I think that’s how we’ve been able to establish a lot of what we’ve done. Autonomy is also very important. It’s been very important for the development of trust to assure people that they’re not giving up their ability to do what they need to do for their organization, but we can come together and work on these joint strategies. And I’m an old community organizer and one of the things they taught me in graduate school was if you want an organization--an effort to succeed--pick an issue.

Pick an issue you can win on, bring everybody together around the issue, get your win, make sure everybody knows that you won and so they feel good about it and then you’ve got energy to build out from there, and that’s what we’ve been doing so far.

JOANNE CRAIG: Joint strategies is another big part of the lessons learned. This is a collaboration between Title V Healthy Start and the state department of health and while, yes, now we have common performance measures and we certainly have some common interest and common vision, we needed to take that and develop the strategies that would keep us in sync together. The advocacy piece is very important. Can’t tell you--as Kate said--making friends with the people who have the friends that you want to be friends with. It’s really about who you know initially, especially when you’re the new kids on the block and you don’t have a real identity, but you have some very important information to contribute to the overall effort. Advocacy is incredibly important absolutely for the populations that we’re serving and the work that needs to be done.

We kept our eyes on the prize and we had to keep reminding ourselves of that through the ups and downs and through the, kind of, long drawn out process. But we did have those plans, those visions, the outcomes that were anticipating and we had to keep focusing on it. We had to be willing to take risks but they were calculated risks. We weren’t just going to, kind of, jump off the side of the building and see what happened. And they were managed and again, I attribute that to the folks around the table, to the individuals that run the Healthy Start programs and the Title V programs who brought their expertise to the table and have contributed to this. And the intention that we were going to survive, that we are going to come out in the right place on the other side contributed and we certainly walked away with those lessons learned. Thank you very much. You have our email addresses, I’m sure in the program booklet, if you’d like to know anything more about the Pennsylvania Perinatal Program.