MCHB ALL GRANTEE MEETING

Training Grantees

October 4-7, 2004

LAURA KAVANAUGH: Again, I'm just so pleased to see so many of you here. I want to take a moment as we start to introduce the Bureau staff, and then because we're such a large group, rather than asking you to introduce yourselves individually, I'm going to introduce you by groups, if you wouldn't mind standing. Let me introduce my staff first.

Nanette Pepper, Captain Nanette Pepper.

Denise Sofka.

Denise, stand up for just a moment longer, please. Just stand up a moment longer. Thank you. Just long enough.

Madhavy Reddy.

Diana Ruhl.

And Vera Proctor. She's been running around. Is she in the room now? She's in a pink shirt. I'll point her out to you later. I also want to thank, in particular, for this preparation for the strategic plan and this meeting, we've been working very closely with the consultant Jean Athie. She also worked with me on the training evaluation plan. Jean.

And we have a logistics contractor working with us. AHCDI staff, Lannie Crystal.

To help us make this meeting happen. I'm sorry we're so tight but I'm excited that we're so tight that there's so many people here. Thank you very much.

Okay. Now, some of you I've never met before, and this has been a wonderful opportunity to meet you in person. We've probably been emailing back and forth, and we might have interacted that way. But I've never met you in person. And I'm very excited to get to know you better. I want to ask, what I'm going to do is just list the training program areas that we support, and when I get to your area, if you could just stand and look around and see who is in the group. I'm sorry we can't in this large group do individual introductions. When we get to the smaller work groups this afternoon, that I'll talk about in just a moment, we'll do individual introductions.

Also, you'll have an opportunity this evening, if you're able to attend the training reception and get to know one another a little bit there. We'll go alphabetically backwards, because LEAH always gets to go first. Social work. Social work training programs.

Where is Kathleen? Schools of public health.

See, now even you're seeing people you didn't know who were here. Pediatric pulmonary centers.

Pediatric dentistry.

Nutrition.

And they came from, the American Dietetic Association had a direct conflict with this meeting. Nursing.

And I understand nursing has a new acronym and the acronym is LERN. So we'll start referring to you as LERN.

MCH Institute.

LEND, Leadership Education and Neurodevelopmental Disabilities.

Graduate Medical Education.

Distance learning.

Developmental behavioral pediatrics. That's another group that had a direct conflict with their professional association meeting this week. I'm sorry.

Continuing education.

Communication disorders.

Collaborative office rounds.

Certificate in public health.

And last but not least, the Leadership Education Adolescent Health, LEAH.

To give you a flavor, every single category is represented. I'm so excited. I noticed, too, Ann snuck in over here. I heard you weren't going to be able to attend. Can you come up for just a second. I heard a nasty rumor somebody said you wouldn't be able to attend this meeting. This is Ann Drum, Director of Division of Research Training and Education, my boss.

ANN DRUM: Thank you very much. I'm sort of frantically down working on Powerpoints but I said I have to leave for a few minutes and say welcome and I hope to come back and join you as you go into your breakout groups later. And I don't know if Laura did this, but I say this with a great deal of sincerity. Sometimes it's overwhelming to realize the investment of training that the bureau supports. But I really would like to acknowledge the MCH training staff. It is a terrific team, and they do terrific work. And I really want to acknowledge their leadership as well. So could we give a big hand for your project offices?

It's been a very difficult couple of years. I'll be honest with you. And I think their tenacity during these very changing times is a real tribute to their spirit and their leadership. And I think it's also, I have to give you a lot of acknowledgment, because I know these have been tough years with so many changes and many changes to go.

But just remember, there's always a lot of forgiveness on this end. So let's do the best we can. Because I know with the performance measures and the way electronic, everything is changing so quickly and some of these systems have lots and lots of glitches. But we're going to work with you and we're going to make it work somehow, and you really have a strong team to help you through these land mines.

So anyway have a great leadership training meeting, and I look forward to popping in and out. I think you've done a lot already with your strategic planning. I think you're light years ahead of many other groups and categories, which is what is expected of all of our academic leaders. Thank you very much.

LAURA CAVANAUGH: I'm going to briefly review the agenda. I know there's been some confusion about what's happening and how this meeting wraps around the larger meeting and where are you supposed to go and are you going to have a reception? Yes, you are. Are you going to have an opportunity to work in smaller groups? Yes, you are.

In your yellow packet is an agenda. It's purple, light purple. We'll start off today, I'll give you an overview of the training strategic plan that you've all contributed to. This afternoon we'll break out into five work groups based on the strategic plan in the area of MCH competencies, faculty and training and diversity, leadership training, cultural and linguistic competence and family‑centered care.

These were listed as priority areas for action steps to follow up on the training strategic plans. So we're going to take this opportunity when we're all here to meet in small groups and move it forward and start the implementation right away.

Most of you have signed up for work groups ahead of time. We've tried to give you your first or second choices, but we've also tried to make sure that we have spread out schools of public health between programs. We've spread out social work programs between work groups.

What is going to happen is this big ballroom divides into six smaller rooms. We're going to have ‑‑ once we take our break, when we leave the room, they'll pull these walls closed, and MCH competencies will come into Potomac Room 6. Faculty training diversity will be in Potomac Room 5. This is 6; this is 5.

Leadership training will be in 1 and 3, larger group. If you hang out in this little area back here, that will be where it will become, because they'll open up this wall.

Cultural linguistic competency will be in Potomac Room 4, which is this area here. Family centered curricula will be in Potomac Room 1. The other side of this wall. It's one that's set up as its own little work room. If you have any questions, ask us, the staff. We'll get you there. You get a half hour break to figure it out. Tonight there will be a reception with a cash bar and finger food just for you, just for the training programs. It's in the ‑‑ says on the agenda the Virginia room. I think what that means is the Virginia rooms on the third floor. Is that accurate? I'm looking for Crystal . There's no Virginia room that I see on the agenda. I think the Fairfax, Prince William and those on the third floor are called the Virginia rooms. We need more than one room to have this group in it. The Virginia room. That's really all of those little ones on the third floor, Prince William, Fairfax. Is that correct?

UNIDENTIFIED SPEAKER: (Inaudible)

LAURA CAVANAUGH: Okay. I'm pretty sure that's right. I looked on the agenda. I was looking for Virginia room. I didn't see anything marked that. I believe it's the third floor. We'll get confirmation before we break up today. That's available. I know some are taking a cruise. I apologize there's a direct conflict. We set up the reception and found out later that there was going to be a cruise. Enjoy the cruise if you're going on it. That will give you an opportunity to interact with one another more informally.

Tomorrow morning, during breakfast, from 7:30 to 8:10 in Washington Rooms A and B, which are the rooms right across from the Potomac rooms, right across the hall, there will be breakouts or breakfast round tables around topical areas of interest. And those are listed on the next page of the agenda. Those that are working on children with special healthcare needs transition to adulthood; you'll be meeting in this room, Potomac 6, because people asked for a separate room.

The rest of you will go to Washington A and B. And you'll, the areas that are available to you are technology to improve training, collaboration with state TITLE V staff and we've invited the TITLE V directors to join us for breakfast. Children's health, the nation's wealth, the IOM report, who will keep the public healthy. Emerging issues. If there's an issue of interest that you would like to sit around a table informally and discuss, there's some open tables for you. For those who have a new project office or for most of those it's Annette Pepper and Madhavi Reddy, they'll be at separate tables, if you questions related to the grants or grant process, they'll be happy to answer those questions.

We go back to the big HRSA meeting for all morning, tomorrow morning after the breakfast, and reconvene just as to the training program. We're providing lunch at noon outside of these rooms. And make sure you clearly say you're part of the training program. Otherwise you'll be tackled in the hall and your lunch will be ripped out of your hand.

Pick up your lunch outside the Potomac rooms, and we'll continue with our work groups in the same place. This is where we'll be this afternoon. Come back to the same place you were this afternoon.

I know you all have very busy schedules. I know people are coming and going. I'm so pleased so many are here today. I know not all of you will be here tomorrow. This session and the final report back session from the work groups will be webcast, and it will be available in an archive, so you can view it if you missed part of the report back or part of the session today, because we have some people who are coming later as well. Any questions about the agenda, the logistics part of the agenda? You're not allowed to have logistics questions, Nanette.

NANETTE: (Inaudible).

LAURA CAVANAUGH: She'll tell you where to go.

UNIDENTIFIED SPEAKER (Inaudible).

LAURA CAVANAUGH: If you haven't been assigned a work group, you're not on the list in the yellow packet, which some of you aren't, see Nanette we'll figure it out in the half hour while they're pulling together all the walls, pulling across all the walls.

I'm going to take a brief, just a couple of minutes to talk about the state of the MCH training program and then move to an overview of the strategic plan as the basis for our discussions and work groups.

First of all, I want to congratulate you on terrific accomplishments over the course of just the three short years I've been here. It's been remarkable to see your accomplishments. You have drafted an MCH training strategic plan for the nation, and you've read and reread it and provided lots of comments, and we appreciate that. There are many people in here who participated in the work groups themselves, but then we got a lot of informal feedback as well as we sent it out via e‑mail.

We now have an MCH training website. In the center of your table is the URL for that website and a copy of the home page. I hope that you all use it and that you point your trainees to the website. I'm very excited about it. It includes a map of the United States . You can point and click to any region of the United States and find out all the training programs that are available in your region. You can also point and click by program area. So you can point your trainees or faculty members to see where all the programs in LEND and LEAH, in social work, nutrition and nursing.

As Peter mentioned just a little while ago, there's some hope that we actually might see an increase in funding in the TITLE V bloc grant this year. The last time it did happen, the training program did see a slight increase in funding as well. That happened two years ago.

I'm holding out hope that's a possibility. The house mark was level funded, but we'll see how that goes. We've had some tremendously successful collaborative projects. We had a leadership program in Seattle in April that has led to much of the work that we'll be doing in the leadership work group here. Many of you working together as never before around issues of transition and regionally you're working together. It's very exciting to see what has evolved out of collaborative efforts between the training programs. And I hope to see more of it and we certainly will be encouraging it and guidances in any other way we can.

Next year there will be an MCH training resource center that will be available to you to help bring together some technical assistance that you may require. They'll be populating the training website more and more as well. I hope they'll help us to do some of the follow‑up work that's going to be required for the training strategic plan as well, in terms of developing baseline data and tracking our progress overtime. It's another resource available to you and certainly another resource available to us at the central office.

I'll be telling you more about that as it comes about. Right now all it is is a line item in the budget for next year. I don't have a contract or anything. We're competing with next year. But the money is there.

Performance measures: We now have performance measures for the training strategic, the training program as a whole. Many of you have developed performance measures for your individual programs. You can actually see them on line as you apply for grant programs. There are three programs that are competing this year. Pediatric pulmonary centers, schools of public health and distance learning.

If you go upstairs next to the registration area there's a contractor there showing you the electronic, the new electronic application process. I strongly urge you to take a few minutes and stop by that room. Chris Dickton and staff are there to help walk you through the system in person and also the HRSA call center is available to you. And that's who answers. It's Chris and his staff who answer the phone to help you with that process.

As Ann mentioned, it's going to be, the first year is going to be interesting as we implement it. I hope there aren't land mines. But I think that I've been beta testing it over the course of last several months. I've seen several versions. It's a very good system. Finding it is not easy on the website, I have to admit.

Once you get into it, it's pretty straightforward, how you navigate the system. Those who aren't competing this year, my understanding is that your progress reports will be submitted electronically as well by SPRAN. So when you get the announcement from me, it's usually in January or so, that your progress reports are going to be due soon, my goal and my hope and what I've been told is you'll be doing it electronically as well. Even though you're not competing for submitting an application this year, take a moment and stop by the site because your progress reports will look similar to that as well.

All right. I'm going to skip some of this. Okay. Any questions before I move to the strategic plan which will be the ground work for what I hope we'll be discussing at our work groups.

Terrific. The national plan for Maternal and Child Health training. I hope you all have the handouts that's with this as well. First of all, I want to emphasize this isn't a bureaucratic exercise. I feel very passionately about the tenets of MCH training. I feel it provides a path and tools for measuring our success so that we can measure how successful we are in achieving our goals. So I think it's very important and it's not something that is going to sit on a shelf. Our staff have been using it already. You'll note that it's going to start appearing in guidances it's going to shape the future of what we want to achieve as part of the national training plan. So what do we hope to achieve through this plan? Well, first we want to raise awareness. In the process of laying out these goals and objectives, we identified some needs and some problem areas. Areas where we don't have data. Areas where we need to collect data over time. We hope that by clarifying goals for MCH training that we can help people understand what MCH training is and why it's important to the nation.

When we say MCH training, I mean this nationally not just the MCH programs that are sponsored by the MCH Bureau. Keep it in mind as you read the plan. It's a national plan. We hope to influence others, not just the dollars that come through the Maternal and Child Health Bureau.

Second, we want to foster greater collaboration for MCH training across a wide variety of groups. This is a national plan. And I want to make sure that in order for this plan to be successful, many organizations will have to work together to make it happen. You and others and many others will have to work together to make this work with the Bureau.

We also want to encourage, we're specifying national goals and measurable objectives, so we work toward common ends. We want to provide clarity in what we want to achieve to help us move forward. The aim of this plan is to be as clear as possible in delineating where we want to be five years from now.

And, last, to track progress. If we don't know where we are, it's hard to know if we're succeeding. We hope to use this plan as a way to assess our progress in moving toward our goals.

What is this plan? It's a national initiative to ensure that we have a quality work force to serve children, youth and families. And although the Bureau will be taking a leadership role in its implementation, it's national. We hope to have a scope that goes beyond the Bureau.

It's also a framework for action. As you'll see when I discuss the components of the plan, its structure lends itself to the identification to specific activities by a variety of groups. When you look at the plan the way it's laid out right now it's (inaudible) we have said that will be our activities that we're committed to completing in the next five years. I hope that each of you will take a look at this from your individual training program perspective but also with your professional associations and hope that it can serve as a road map as well around MCH training issues more broadly. You can see what activities you would fill in from your training program perspective or from your professional association perspective to contribute to this plan.

I hope it's going to be a catalyst for change, that the goals in here aren't new concepts. Several of you we got that feedback from the last version as well. But I still think we have a long way to go in terms of what we mean by leadership training, family centered care and cultural competence.

I want this to become more than a mantra. I want it to become something that we truly believe in and that we make happen, and that we train the next generation of MCH providers to understand and implement over time.

What the plan is not. Your greatest fears. That this plan is going to result in a new set of performance measures. New requirements. You're going to see it in guidances. But it's not going to be the sole thing that's going to be shaping guidance from now on, but you'll note even in the distance learning guidance, this year we refer this to the strategic plan as these are areas of action and changes we definitely want to impact in the short‑term.

For many of the objectives a baseline isn't even available yet. This is not going to become performance measures overnight, that's for sure. Most of the performance measures or most of the objectives in here are national, for us to achieve as a Bureau, for us to achieve as a nation. It's not for additional training programs to achieve.

And this is not a plan that's directed only at MCH funded projects, as I said before we see this as having more of a national impact.

Briefly. How do we develop this? Many of you were involved in this. We convened an ad hoc strategic planning group initially. We developed the goals, then we sent it out very widely for field critique, then we convened another strategic planning group to develop field objectives and another critique. It's been embedded within the bureau, within portions of the Centers for Disease Control, prevention, within the association for Maternal Child Health programs and others to get their feedback on it as well.

I presented the strategic plan to the AMCHP, which is the association of Maternal and Child Health Programs, the board of directors on Sunday. Their board has many common areas of interest with us. And I'm very excited about the possibilities of what will emerge already with that group.

The plan has four goals which are broad statements. The general purpose, just to guide our thinking around an issue: Strategies which are more specific, and it's a way to help us ensure the goal is attained. For example, the strategy for goal four: Develop effective leaders. The strategy is identify people who have potential to provide leadership in MCH and foster their development. Once we get to objectives, we're getting to observable/measurable. Which we're trying to be very specific to identify measurable milestones and targets. And activities, as I mentioned before, the version you have before you, just lists bureau activities, things we're committed to make happen in the short run.

The six goals: Number one, assure a work force that possesses the knowledge, skills and attitudes to meet unique MCH population needs. Goal two, prepare a work force that's culturally competent and family centered. Goal three, improve practice through interdisciplinary training in maternal and child health. Goal four, develop effective MCH leaders. Goal five, generate, translate and integrate new knowledge, to enhance MCH training, informed policy and improve health outcomes. And goal six is develop broad based support for MCH training.

I'll review each of these goals in a little more detail and talk a little about the strategies. Goal one is ensuring a work force. We have two strategies under that. They come under quality, and for the most part the feedback that we've got from those who participated in the process was they felt that a way to achieve a level of quality was through competencies. And we'll discuss that in much more detail in our work groups today.

Strategy B is a relatively new one for MCH. We tried, in the past, to sort of separate ourselves as not solely a work force development program, but as a leadership development program.

We also sit within an agency that is to ensure access to all. Our mission as the Maternal Child Health Bureau is to ensure access for all. We'll be working hard to talk about access issues and the quantity of providers available as well as the quality.

Goal two, prepare and support a diverse work force. Goal two addresses two issues: Diversity among faculty and trainees and assurance that providers are both culturally competent and family centered. And it has four strategies. The first two of the strategies are designed to ensure that MCH faculty and the MCH work force reflect the diversity of the nation. Partly the desire for a diverse work force comes out of a belief in social justice. The recognition that historically certain Americans have been deprived of the ability to participate in some fields and it's time to rectify that.

In addition, we realize that diversity brings richness to our professions and promotes cultural understanding of our population. The populations that we serve often feel more at ease when the treatment team includes someone from their cultural group and that can translate into a better relationship and will hopefully result in better outcomes.

Goal three, improve practice through interdisciplinary training. Interdisciplinary training is widely recognized as the gold standard in the field, but it's also quite expensive. I think we need to spend some time documenting what we're achieving through interdisciplinary training. And I think that in times of increased financial pressures, providing this type of training continues to be even more of a struggle. With goal three, we're aiming to increase the opportunities for interdisciplinary training and also to ensure that training that we do offer is of the highest quality possible.

Goal four, develop effective MCH leaders. We still struggle with this concept of leadership. We're working hard to better define it so we can measure it and seeing if we're achieving our goal of producing leaders in the field of maternal and child health.

We'll always need leaders and MCH people to advocate for children who can't advocate for themselves, people who understand that children's clinical needs are different from those of adults. Teacher with fire in their bellies to inspire a new generation, with passion to serve children; researchers who are committed to solving very difficult problems. You are leaders and I know that you are producing leaders as well, but we need to document that.

This integration between research and training is one that is particularly needed I think right now as well. It includes regularly assessing work force needs, and I hope that we'll be doing this very regularly with the Bureau of Health Professions within HRSA, expanding the knowledge base about what we know, and making sure that whatever we know is translated rapidly into policy training and with practice.

We've already developed some innovative programs with the MCH research program, and I hope over time more with ARC, with the National Institute of Child Health and Human Development as well.

Goal six, develop broad based support for MCH training. This goal is incredibly important. As you all know well, the financial constraints under which MCH training has been conducted. You've been dealing with level funding when you're trying to increase your stipend levels, increase the support for your faculty and we're getting level funding. We're not going to meet the goals of this plan if we don't figure out a way to increase the pie.

Some assumptions: We hope this plan provides a focus and a greater opportunity for success that data collection will have, some policy implications, and that the outcome will determine future directions and where we are five years from now.

We're going to review our progress as we go along that begins with collecting some baseline data and looking at our progress over time.

Finally, I think this plan is an extremely powerful tool. It's also very ambitious. And to be honest with you, when my staff and I sit down to look at it together, it's a little bit frightening. It's very ambitious. But I think the only way we can achieve what we need to in MCH training is to be visionary, to be looking forward, and that's the way we're going to make a change. It's going to require your partnership. I look forward to working with you in meeting these objectives, and also in how we can tweak it to change to engage with different partners and those sorts of things in the future.

That's it for the plan. I'm going to take any questions. It could be about the strategic plan or anything else as well for right now.

We're not going to introduce ourselves. But when you do the question, would you stand up and introduce yourself to the group so they know.

UNIDENTIFIED SPEAKER: (Inaudible) because (inaudible) do you have a definition that describes us (inaudible).

LAURA CAVANAUGH: Good question. We did provide, I hope the version you got had a glossary at the end. Did it? The question was: Did we provide a definition of interdisciplinary. And there should be a glossary at the end. I hope my version is not different than yours. On mine it's page 20. On yours it's page 18. And it can use some work. And we're welcome to suggestions as well. Like leadership, it's an area that we've been struggling with for many, many years.

UNIDENTIFIED SPEAKER: (Inaudible).

LAURA CAVANAUGH: Yes. For some of it we have baseline data. From the MCH training evaluation that occurred in terms of leadership outcomes, those sorts of things. In other areas we hope that through partnering through agencies like the Bureau of Health Professions around work force issues, for example, will have some base lines there.

For others, we'll do our best to develop proxy measures or get as close as we can to some measures that make sense for us. And for most of the areas that's the case. We'll be working with Jean, with the bureau staff, with you and with this resource center to help do some better data collection as well. Partners are going to have to ‑‑ it's not all going to be done out of central office, as well. Some of it will come from your performance measures that you'll be reporting on, the leadership attainment, five years postgraduate, some cultural competency measures within our training program. But we also want to look beyond our training program where the data is not as accessible. So it's going to be partnering with professional associations and looking at a good deal of proxy measures there.

Other questions? This group is so quiet. I'm just shocked. You're exhausted. Yes.

UNIDENTIFIED SPEAKER: (Inaudible) North Carolina . What's the next step for this and how much do you put in the various training programs to facilitate your effort to drive the plan forward?

LAURA CAVANAUGH: Thank you. A terrific question. I hope the work groups that we have are in some of the strategic areas that we knew we needed immediate action on around MCH competencies, leadership development, faculty training and diversity. I'm sorry, I'm blanking. Cultural competency. I thought I already said that. Family centered care. Thank you.

Those areas we felt as we laid out the plan were areas that immediately we could use your input. You'll need to get it here to start formulating a plan for how do we move forward.

HCDI, who is a partner in putting together this meeting, also has resources to pull you together again after this meeting in smaller groups. We have resources to do some white papers, if that's necessary. We try to put in conference calls and a variety of things. So in person meetings, conference calls. From a logistics standpoint, white papers are included in their contract language so we can move forward with what we need. If you need to ‑‑ if you feel like you need to convene together as a group again, if you can handle it via conference calls, but what I envision is we'll end up with some smaller work groups based upon your interest expressed at the work groups here. They might splinter off into smaller work groups as well. If you have a particular expertise in ‑‑ we need a lot of help around work force assessment because that's not an area of expertise that our staff has. That would be something we would welcome any help.

UNIDENTIFIED SPEAKER: Time frame?

LAURA CAVANAUGH: Pardon?

UNIDENTIFIED SPEAKER: Your time frame for rolling this thing out?

LAURA CAVANAUGH: It's officially rolled out. This is the official draft. It will always say draft because ‑‑ turn off the mic. It's not going through the Office of Communications. So it's always going to say draft on it. Now it's committed to film.

UNIDENTIFIED SPEAKER: (Inaudible)

LAURA CAVANAUGH: In the next several months my goals are meeting with who are outlined as critical partners here. The Association of Maternal and Child Health programs. We've initiated that process. The National Conference of State Legislators and others. National Association of City and county Officials and others to start talking about how can we come together to develop the plan.

It does have a five‑year time horizon. We hope to achieve all these objectives in five years. It's ambitious. But if you look at the sequencing in terms of when we're going to achieve baseline data and the objectives, I think for most of them we can do it. It's ambitious but we can get it done, but it's a five‑year plan. And 2010 is just a tidy end date. Other questions, areas of clarification? Okay.

UNIDENTIFIED SPEAKER: (Inaudible).

LAURA CAVANAUGH: Okay. The reception tonight, most importantly, the reception tonight, which starts, we're going to do our work first, but the reception tonight I was going to get clarification, thank you very much, is from six to eight, and on your agenda it says Virginia room. There's no room that has that title. On the third floor of this hotel there's the Prince William, Fairfax , they're actually counties in this area. The Virginia rooms are on the third floor. So that's where the reception is. Okay. We are way far behind. Actually, are we?

UNIDENTIFIED SPEAKER: No.

LAURA CAVANAUGH: We're not. We have caught up. I planned it that way.