MCHB ALL GRANTEES MEETING

Response to Highlights of Critical MCH Issues Town Meeting with HRSA Deputy Administrator/ MCHB Associate Administrator

October 4-7, 2004

PETER VAN DYCK: I want to thank Dennis for being here and taking the time to listen. He had a choice, I might add. I gave him a choice. Do you want to come early and hear the results of these work groups, or do you want to come and take questions, and he said, “No, I want to come, I want to come early, and I want to hear the results of the work groups.” When I have to go to him, and to Betty, to Dr. Duke, trying to get actions started on some of the suggestions you’ve made, we’ll have someone who’s at least heard the passion and the feeling and the depth of discussion that went into generating these ideas and Dennis I want to thank you for taking the time. I had trouble putting my thoughts down because the presentations were so articulate and so good, I didn’t want to put my head down and write notes. I wanted to listen. But, clearly we need to collect and publish the richness of these groups so we can share it with all, and you can then continue to give us feedback. We need to establish some priorities from what we will eventually write down and the richness that was collected, and then, I think we need to probably clearly establish work groups around some of those issues and report back perhaps in six months or a year on our success in getting some things started. So, that’s part of the process I see.

But a few highlights caught my attention as I went through and again, there are just a few highlights that caught my attention. They are not things I necessarily want to do or don’t want to do, they’re just as we went through. But they need to be embellished with a richness of what came out and by us looking at it seriously. It’s very difficult to do this in a very short period of time. We need to broaden our thinking beyond just medical to include new morbidity, social and behavioral aspects. I’ve been hearing that more and more as I speak around and meet with more of you and get around your groups, a very important issue, I think. And we need to think about it throughout data and marketing and all the other issues. For change to take place, and this was said very early on, better marketing, tailoring or targeting the marketing, bold leadership and accountability. Analyze training needs. Increase MCH into the other disciplines in the training field. Get other disciplines to understand what it is MCH does and forge a partnership at that level: Incentives for rural training; change from disease to preventive emphasis; and foster leadership, help create a leadership that understands this increased emphasis in prevention and knows how to discuss it and talk about it. Increase awareness of the health needs of the MCH population, both in general and specifically related to legislatures, legislative staff, administration, I assume too. By doing this, it will help establish an environment of ownership in these folks, including parents and those we serve. We need to try to help create this feeling of ownership.

There was some discussion about needing more guidance from the Feds on each of our respective roles in how to market. There was a discussion about should we include, and these things were repeated throughout, how do we or should we include a communications plan or even a requirement for a communications plan as perhaps we do data, in all our RFPs for grantees to respond to? We need to increase the communication within the MCH community, including understanding better cost efficiency or cost-benefit effectiveness and perhaps use health economists more. And I’ve noticed, as I’ve gone through this, that Dennis and I have shared, actually picked out, some of the same areas: Sharing with others these economic approaches. Sharing data across HRSA bureaus; interdisciplinary work force; cultural competence—think about retention strategies for the work force that we’ve put so much effort into training; working in MCH field and then leaving for better pay or because of disappointment or disenfranchisement, or for a better job, frankly, or perhaps a more paying job.

How do we make the jobs exciting and keep people retained once we’ve put them through the training. The work force should model community make-up. It should reflect the community. The community where the service is being delivered, not the community of some higher level. We need to establish a core set of competencies for cultural diversity that we all can practice from and train to. And perhaps we should develop some guidelines for community engagement. And how do we work on this community engagement? Actually, it’s the first time in a large meeting I’ve heard the words used of community engagement in this much discussion about it, other than in small groups. Increasing the length or period of grants. Thinking about diverse leadership, making it a requirement in the grants that we talk about how to engage the community. I thought there were some interesting concepts here and want to read more about it. Mal-distribution of resources, which can lead, or perhaps does lead, to a decrease in community engagement. We need to continue and work with the disenfranchised individuals in communities to work on this broad theme of community engagement. When we get to accountability, systems, we heard several times, systems should be flexible, creative, networked among MCH as well as outside MCH, and we need to be the best we can do, we need to be as good as we can about capturing what MCH really does, the nuances of MCH, and try to capture that in our data and data analysis. Perhaps a system like the block grant should be developed for other grantees. We need to look at the international classification of disability.

I only say that and it caught my ear because we happen to be doing that currently in the last month or two, and in fact may include, we have in the pilot of the new Children’s Special Health Care Needs survey questions around the international classification of disability included in the pilot, with an idea towards including them in the second round of the survey that will be next year. That’s something we all should learn more about. Increased site visits for MCHB. Think broadly across more MCH partners and across federal agencies. Can we do more at the federal agency, thinking more broadly to incorporate ideas, accountability ideas, data from other federal partners, and can you do the same at the state or the community level. Think more of a networked plan for both our program’s horizontal integration, as well as at different levels vertical integration: federal, state, community, etcetera. Interesting theme, and a couple of times I heard, do we develop a strategic communications plan that we all work from? Fed, state, community. Data should be used well, to improve programs, improve outcomes, and shall be used by all levels of the system. How do we best use the data we generate? How do we help one another use it? Are there enough dollars for data and evaluation for grantees and technical assistance?

Do we need to include specifically in RFPs or in our grants, money for data and evaluation, as well as earlier I mentioned communication? How does evidence-based thinking fit into this gestalt of MCH that we have? Where does it fit? How does it affect me? How is it applied? How do I understand it better? What are the levels of evidence-based research? Will it impede what I do? Will it impede my ability to do the things that I’ve done all my life and think will work for families? There should be a more integrated sharing of data and reporting of data across programs. Communication: Better define MCH now, but MCH with the future in mind as well. Again, marketing, and I thought the distinction brought up in the last set of questions about marketing or social marketing were important. Involve families in all ways. Perhaps think about regional meetings to increase communication, like this meeting where people get together. I’ve heard this several times as I’ve walked around the meeting in the last couple of days. Think about electronic newsletters for communicating. Do we require communications strategies in our grants? And we need to increase communications by getting grantees together, such as this meeting, which was a nice comment to hear after the work that was put into this meeting. So these are kind of the highlights I pulled away. There’s a lot of similar themes. It will be very interesting to read the transcripts that come out, and we really look forward to collating those and to begin a process that involves you in setting priorities for how we take the next step. Thank you very much.