MCHB ALL GRANTEE MEETING

Critical MCH Issues and Recommended Strategies

October 4-7, 2004

TERRY COVINGTON : Now! That was a great segue into Yellow, I tell you! Thank you! We really have to tell you we haven’t seen these Power Points, so we’re earning some prizes up here for this one! Oh, goodness. Anyways, I was the team leader for Yellow, and I want to first thank our facilitators and our recorders, and especially the people who came twice into some tight, closed, very crowded rooms and spent a lot of energy and really gave a lot of time. So to all the Yellow people out there, thank you. And what I’m presenting is only a very small capsule of the discussions. We had about 135 people, so you can imagine where we went and we had many, many, many layers of thinking that we just can’t capture here in a short presentation, so what I do present, I hope I get it right for you. We actually thought we had a pretty tough IOM area. It was called Systems of Accountability: Assuring Quality and Availability, and I actually had to call Doug Patterson, our Title V director in Michigan and say, “Doug, what does this mean?” It was really tough for me to sort of think through it, because there’s three areas there.

There’s accountability, there’s quality, and then there’s access, and we really were wondering how we were going to manage this in a very short time. But our teams took off really quickly and what they did end up really focusing on was Systems of Accountability. I think it was real clear across the board that everybody really knew what good quality care was, or good quality services were, and we all knew what access meant, and so we focused on systems of accountability in relationship to grantees, partners and consumers, and our relationship with HRSA. But before I describe our three strategies, I want to make sure that you sort of get a flavor of the discussion, because there were a number of recurrent themes that kept coming up across the three groups, and our teams thought that a futures-oriented accountability system to measure our performances should be developed with input from multiple levels, and not be a top-down-developed system.

Capture the qualitative richness of our work. I heard someone say, “I just don’t think that what we have today tells the true stories of the intangible impact we’re making with families.” Be flexible enough to not stifle creativity. Recognize that one size doesn’t fit all, and that there’s different types of projects, different types of systems, there’s projects, there’s portfolios, there’s research, there’s services, there’s training, there’s dissemination, and they were looking for a system that would help address all of those. That the federal and our state partners would model the kind of accountability behavior they wanted us to have at the local level. That there be strong leadership linking the data systems across systems. An accountability system would foster strong collaborations within and across MCH and other sectors (which I thought was interesting). That’s really where all of our teams ended up.

The title of this conference is, “The Power of Partnerships,” and all three of our teams ended up spending most of their time talking about how to build partnerships for accountability systems. So I’m going to talk about our strategies now. Let’s see. Yellow Team One, the facilitator was Imelda Rocha, and the recorder was Laura Bray and they worked really well together. Their strategy was to create a high-quality system of cross-communication among MCH projects and potential partners, and they took that way beyond MCH, and all areas in the resolution of the issues around equality and availability. Some of the strategies that they suggested was: A block grant-like reporting system that would address a lot of other programs and services coming out of HRSA. That we look at something called international classification function, which is an accountability system, which I don’t know a lot about, but they encouraged us to look at it.

There’s more peer consultation and technical assistance available for people trying to measure their performance; that there’s better development of quality improvement tools; that there’s much more consumer participation, not only in measuring our performance but in developing those measures and that that include individuals with disabilities; that there be a whole heck of a lot more MCHB site visits to programs to help in our measurements. That there be more external reviews for quality improvement above and beyond the MCHB rules, and that we involve other partners in that; and that there be more communication and data-sharing, even above and beyond what we do within MCHB. I want to make sure I covered that, right. Okay. Another thought that they had was that there be more Internet options for communications. They really put a lot of work into this and they were thinking of things where you could do list search, where there’d be a search engine that would help integrate all the MCHB projects, so that people could start seeing what people are doing.

One of the thoughts that they talked a lot about was that what a lot of our programs and services do, we’re doing a lot of the same stuff and we have a lot of the same outcome measures), and how can you integrate that across programs and how can we learn from each other?

Okay. Yellow Team Two was Missy Fleming and Ivy Vetamuthu, so than you for your work. They focused on something that, you know, we’re not surprised it’s there, the issue of inadequate resources, including funding, training, personnel power, to really do good-quality accountability and to address systems analysis and development, program and project evaluation, cultural competency, etcetera. Some of their strategies: That there be increased demonstrated federal partnerships across agencies; that we try to streamline the accountability measures that are currently in place across agencies and do a little bit of economy of scale there and save some money. That there be more of a focus on US state and territorial priorities rather than more global priorities. That we think about developing a strategic communication fund. This ties into the first group, looking at how people can do a better job working with each other so that there’s better communication across accountability measures.

And then, finally, of course, that there be star leadership to increase the agency budget for Title V and other MCH programs, something we would all love to see. Yellow Team Three, they really got into the nitty-gritties about collaboration, and their strategy was that there currently is inadequate collaboration and consensus among systems and providers serving the MCH population, and they gave a list here. Not just including public health, but medical care providers, behavioral, educational and social services, etcetera. And they felt that there’s a real lack of linking of data systems and that because of that, funding may drive competing practices: We have definitions that are different, there’s different quality standards, etcetera, so what are we all really measuring when it comes right down to it? Some of their suggestions were to develop better collaboratives, same like the other groups, at the federal, state and regional levels, across systems. That there be more involvement of key policy makers, and more involvement of diverse policy makers. That there be development across systems of a common mission vision and trust.

There was a lot of discussion about those different agencies that are out there, even at the local, state and federal level where we really don’t know what we’re all doing but we think we’re doing the same thing. That there be much more involvement of families in developing and building an accountability system. That this will lead, and hopefully will lead to the integration of services and an ability to identify and address gaps in services. They talked a lot about linkages between and among the entities that might be included in this giant collaborative and what that might involve, and we have more detail on that in writing. Some people were describing some of the models that we’ve all heard about: One-Stop Shopping. You see that in some programs but you don’t see it in others, and they felt that we really need to explore that and see where that can work for other programs. And then, ultimately, that would be an integration of data systems and a reduction of duplication. Cost-savings for services so funds can get out where needed. That’s it? I think that’s it. Thank you.