MCHB ALL GRANTEES MEETING

MCH Training Program Closing Session

October 4-7,2004

LAURA KAVANAGH: Thank you very much. I know you've all been working so hard. And I'm looking forward to this report back session. We're going to have to just speak without a mic for right now in this room. What I'm going to do is call each group up individually, report back to the group. We're being taped. If you can't catch everything today at the very end of a very long four days, you can come back and view it later. Let's start with family centered curriculum. Are you ready?

SPEAKER 1: Family centered curriculum and curriculum workers. What we did yesterday was brainstorm. We have some printouts of things we talked about. We talked about what things each of us, each of the programs do in terms of family centered care. And then, secondly, what we did was try to distill down from that what we wanted to communicate to you about family centered care. I'm sorry, I'm (inaudible) from the LERN center. Leadership and education and research in nursing. It's the Center for Leadership in Pediatric and Family Care. So what we want to talk to you about today from our discussions are our guiding principles, a wish list and then how some advice we have when working with families.

Let's talk about guiding principles. You can see we had a lot of discussion about these terms. I'll tell you where we are now. These are guiding principles that we think should be encompassed in the curricula that we need to communicate to our trainees that the end users, and we defined the end users as children, youth and adults and families, that those end users are engaged in the programs at all levels; planning to implementation, to evaluation. So that the family is the center of the team.

The family is self‑defined. So that means that family is who they say they are, not who we say they are. We'd like families centered care came to come from a (inaudible) based perspective or asset‑based perspective, rather than looking at problems or deficits. We believe that family centered care should foster or promote family resilience. And we're looking for partnerships and collaboration with and among families and their communities, and family centered care.

A couple more guiding principles. We're looking to support and encourage empowerment in families. We believe that families should be, should be and are treated with dignity and respect, that the care embraces cultural and linguistic diversity. And that families should be equitably compensated to the extent possible. And I could clarify these if we have time and if you've got questions.

So then we created a wish list that we'd like from MCHB. It was a good opportunity. The first one, which is sort of small up here but it's really an important one, is family involvement in the processes, in this process and future processes, to look at family centered care and the other issues around training programs. To explore and/or gather programs about family centered care and family. There are lots of places where you can look for that. These are some examples of places. National Council on Family Relations. Both consumer and professional specialty groups. The Division of Nursing, which is within HRSA. And NIH.

There are lots more. It's not an exhaustive list, but it is a start. We also talked about on our wish list that we'd like a website, bulletin board, searchable database to communicate programs, grants, et cetera, and to have both internal and external input, so that it would be things grantees could put things up there. The Bureau could put things up there. But also people external to the grantee program and the Bureau could also contribute, if they've got a curriculum they're using or an activity or whatever.

We are asking for MCHB's financial support, money, for family and family centered care research. There is some of that, but certainly there needs to be more of that. And also MCHB money, support for research on the effects of family involvement on training and learning or curriculum evaluation. So, essentially, if we bring families in, how does that effect the training that the trainees get and what they go through. We also are asking for a self‑assessment tool or form for trainees, for programs and for faculty. You can see we had some other thoughts and then decided to take them off of there and put them under evaluation. So they're not on the wish list anymore.

And, finally, we wanted to convey after all of our discussions some advice to you, to the other programs, about working with families and training programs. First, to use or take advantage of existing models. Let's look for things that already exist. We believe there are already a lot of things that already exist rather than reinventing the wheel. To have families, to be members of the curriculum team, from planning, implementation and evaluation.

And finally, this is sort of a way to get started, is to make the commitment to family centered care. Start small and then build on those efforts. So we're not expecting that you're going to have a full‑blown, full implementation and integration of families. But that you'll begin to make steps towards that and work towards that goal. Any questions?

LAURA KAVANAGH: You did great. Thank you very much. Next up is cultural and linguistic competency and curricula (phonetic). Next is leadership training.

WENDY O’GRADY: I'm Wendy O'Grady from the University of Seattle program in pediatric dentistry. Almost I'm a developmental pediatrician. We took on the task of presenting to our leadership group the results of a conference that was held and sponsored by the Bureau in April this year in Seattle on leadership training and competencies. And I'm going to just very briefly summarize for you the output and the discussion we had in a few minutes. The executive summary and full report are on the MCHB website at this time and can be accessed. The group in Seattle actually identified a list of competencies which would include four core competencies and seven applied competencies, and we'll be interested in the discussion from the group on MCH competencies, because we expect there's a lot of overlap here.

Critical we thought were communication, sense of ethics and professionalism, critical thinking, the ability to have internal reflection, skills that require a special training and additional work in our program. In our leadership training programs once our trainees get there, include cultural competency, negotiation in conflict resolution, use of evidence‑based and translation, science to practice, constituency building, policy and advocacy skills. We then, we felt as a group, and there were some people in this discussion work group that had been at the MCH, at the meeting in Seattle and a number of people who had not. We felt as a group this was a generally useful classification and collection of competencies to be used as a tool for next steps. Not to be written and engraved in stone, but a useful tool.

The second thing we did was to also play around with the notion of we as leadership of training programs are training leaders for the future and the difficulty is that we don't know what the future holds for us. And so the notion of going beyond individual competencies that you might need today to think about actually individuals who have the capability of coming out, capability to move forward, and capability is to adapt to change, generate new knowledge and continue to improve performance.

So we like this idea that actually what we want is something very internal in our graduates that will allow them to respond to situations which we may not have anticipated in our training, our current training programs. We identified some key gaps in resources where we felt our faculty need additional work. One of these is around negotiation conflict resolution, around a core set of MCH knowledge, values and history that some trainees are getting a lot of and some trainees aren't getting a lot of, that we could provide something to the larger group, something should be provided to the larger group that all of our trainees could access, whether there's a web module or whatever.

We needed to do more work on the area of working with more organizations. One of our competency areas was management skills that we were not able to get to in Seattle working with organizations separately. We thought we oughta fill in that gap. And finally we thought ethics and professionalism was handled a bit spotty way in our programs and we could profit by more in depth work.

We then talked about how to start a philosophical discussion with what do 140 leadership training programs bring to the public? What is the value added? And the things that we came up with, while clearly interdisciplinary, not just interdisciplinary lip service, but actual participation, most of our programs, students doing hands on work with other disciplines, learning within those teams, understanding how within the (inaudible) of our interdisciplinary work, we actually influence others in other sectors and how as a team function evaluating ourselves and moving together.

We recognized that not everybody has, no one of us has all of what we thought were some of the important leadership competency areas. But somebody on your team ought to have it. How does the team then go about assessing what the strengths are and weaknesses are. How do you (inaudible) things and move to that level. Second important value added is a focus on vulnerable populations. The MCH work force, of which you're a part, there's more out there in the MCH work force, leadership training programs, feeding this MCH work force, we hope to create an enduring commitment to work with MCH populations.

And including the ability to move between a public health perspective and back to the individual clinical perspective and then back to the public health perspective and how to have the facility and ability to do that. We thought it rather force behind than again is ethical and moral underpinnings of our purpose, that is we hope that trainees lead with enduring commitment to MCH values and goals to improve populations for these populations ‑‑ improve health for these populations.

We thought that we have a preventive approach and an approach which really goes across the developmental and reproductive lifecycle; that not a lot of individually disciplined‑based or other public health programs necessarily have this MCH focus, developmental focus. It's a family, mothers, pregnant women and on focus. Infants, prenatal care focus. We felt that we have a lens through which we anticipate, analyze and respond to emerging opportunities and challenges to the MCH population. When a policy comes out, we think about how it affects children and families. And we thought that that's something that this work force does as a whole.

And then finally, we thought that we represent across our 140 leadership training programs and all the other team education programs, others, really an incredible infrastructure that communicates with each other and within our programs on MCH research, training, continuing education and outreach. And that's an incredible asset, we believe, to the public, and to public health. I won't go into them, but we identified a number of next steps. Referring to operationalize, test, field test and develop additional materials around some of these other areas to the (inaudible). So other comments from the leadership group?

(Applause)

LAURA KAVANAGH: Thank you. Next up, faculty and trainee diversity.

JEAN ATHEY: I'm Jean Athey. I'm a consultant with the Bureau. And our charge, we had actually two issues that we addressed that were quite related. One was to develop recommendations related to strategies for increasing faculty diversity and advancement. And the other was to identify innovative ways to recruit and to maintain trainees with diverse backgrounds. And in our group we actually divided up into two: One subgroup to talk about faculty and one subgroup to talk about trainees. But in fact as you might imagine, actually there was a great deal of coming out and discussion in these groups. Both groups actually felt that mentoring was incredibly important. Mentoring of faculty is important and mentoring with students was important, or trainees. And both groups identified the importance of having a receptive environment so that people felt comfortable where they were.

Both groups talked about the need for a clearinghouse of resources. These resources might include tools to do a cultural competency assessment of the faculty or to do, to understand what are the reasons that students or trainees are not staying if they aren't in a particular program. What are the retention issues. We also talked about in the group on trainees the issue of problems and accrual. That is if there weren't enough trainees, students who had the requisite initial training, how they could improve that. So we talked about the need to go earlier and earlier and earlier. And I think in fact fourth grade was the age we thought they should be (inaudible). We felt that it is important collaboration and that there were a number of groups that we should collaborate with, professional associations, minority‑serving institutions, groups that are culturally specific groups such as the NAACP; that all of these groups had something that we could work with them on. And the idea that came out was that there should be top‑down collaboration, such as MCHB working with these groups, but there should also be bottom‑up; that these are local, often have local affiliates in terms of organization and that we need to do both.

There was a great deal of interest in research: Why are students or trainees not staying in a particular program. We need to find that out. There were a number of ideas that were suggested in our groups, in both of our groups, and really just as one example we thought there should be workshops on how one could be a better mentor, a better helper, and that ideally it would be students or trainees who have gone through the process quite recently who would be the best teachers in such a workshop.

We kind of went back and forth between change the world strategies to more finite kinds of things. And one of the changing the world strategies was we needed to change our universities so that instead of only recognizing research as something that would link to promotions, that service and mentoring would also lead to that. We have, as I said, a number of recommendations, a number of really wonderful ideas. And so when we thought about what do we do with this, where do we go next, our group felt that we needed to further flesh these out, so that it would be helpful if we had a small group to work further on some of these ideas and that we would need to prioritize them as well both in terms of what's the most important to do and perhaps also what is it that we can most likely achieve.

(Applause)

LAURA KAVANAGH: Next up, MCH competencies.

MARK BROWN: Hi, I'm Mark Brown. I'm with the Bureau of Education (inaudible) from Tucson . We had the MCH core competency group. We were charged with five questions: First was what is meant by MCH core competencies and how would these differ from and/or complement disciplinary competencies? What MCH competencies already exist and how can we build on them? What's the process for developing the competencies? How should the draft competencies be tested and evaluated? And how do programs prepare trainees for achieving core competencies? And how are our outcomes from training reflected in leadership competencies after graduation? Pretty extensive list of questions to answer.

We had very good discussions centered around those questions. And what I'm going to present to you now is the synthesis to the answers to those questions, not necessarily the answer to those questions themselves, but some key concepts we came up with that we thought would help guide us in developing core competencies for MCH training programs. First is the competencies in general are very dynamic, developmental and integrated skill and information and knowledge sets and attitudes that any graduate from the MCH program should have to (inaudible) program. We also thought there was a need for several different conceptual frameworks or models of the core competencies that include the integration of various areas of the different competencies within them, because they're interrelated.

We started off with a pyramid, much like the MCH pyramid. There was some discussion, well, that reflects that a certain base is more important than the other or maybe it's the apex that's more important than the base, what do you do with that. We went to (inaudible) which is sort of a circle with pies in it, and iteration, and we have a web. What we decided then we need various models because the one model isn't going to be valuable to every program or to every individual within every program. So that we need to develop models that could be useful across the spectrum of training programs and professionals, that convey the same information, the same philosophy of core competencies.

When it got down to the definition, we concluded that core competencies are those that are applicable to all training programs that are to be expected of any MCH training program graduate. But the expectation is going to vary depending upon the particular program, the particular discipline, the trainee's educational and experiential base when they reach the program, the goals of the training and the length of the trainee's program. No, I won't say that again.

The final consensus we reached was that when we're developing these competencies, the core competencies, we can't do it in isolation; that there's a tremendous need for integration of the core competencies with competencies from other groups, particularly the leadership group. Because while the leadership competencies certainly are going to be core, that's their charge to deal with those. And we didn't need to try and do that as well. We need to come up with a set of core competencies that integrate it with what the leadership group develops.

After that discussion, we came up with a set of action items so that we can proceed. And the first one, and these are sort of in the order of which we would perceive them. The first one is we would communicate with other working groups within the long‑term training programs, within all training programs, that are in some way developing competencies. So that we don't end up duplicating efforts. We're coming out with different sets of competencies that aren't congruent with each other.

As part of that, we thought it would be important to assemble a glossary of terms and definitions to be sure we're all speaking the same language, that we've got accurate and clear communication. A nice phrase has been thrown out in this conference is MCH 101. Within our group we discovered they were very different concepts of what MCH 101 was. So before we start talking about we're going to deal with MCH 101 we all need to make sure we're all talking about the same thing. We also thought it was important to communicate with stakeholders, and by this we mean the end users of our product. And our product is our trainees. We can develop competencies and train our trainees and get them very, very competent in these areas. But if those aren't the areas that the end users, the public and private health agencies and other people that are going to hire them, then they're meaningless for what these people will be doing.

So there needs to be some communication with the end users as to what they need from us in terms of training for their workplace. Again, we then thought, based on that, we could develop our conceptual framework and models from which we would then inventory existing core curricula from different programs, different studies, maybe even outside the MCH training environment, to look for commonality within those curricula, and that would help us identify what are truly the core competencies that seem to be uniform throughout the various training programs. I would invite anybody in the group to add or clarify things that I've said. If there are questions, I can try and answer them quickly. Thank you.

LAURA KAVANAGH: And cultural and linguistic competency (inaudible).

SPEAKER 2: Hello everyone. (Inaudible) I'm Denise (inaudible) I'm participating in the last two days in this particular session. We did numerous different things in the discussion. First, yesterday (inaudible) we discussed what it is cultural competence, looking again to the organizational reference and any reference to definition (inaudible) how it applies to specific areas, looking at case studies. Then we discussed ways that cultural competence could be assessed with recommendations to MCHB, which is what Cora is going to discuss.

SPEAKER 3: We spent a really rich two days (inaudible) two days worth with some wonderful faculty from across the country. I just want to thank them for spending the time with us. We shared lots of experiences, and these are some outcomes or recommendations for the MCHB. We covered a lot of ground. We want to reflect maybe on a number of salient issues that came up during those two days. One is something that's fairly significant when we're looking at what are programs currently doing as relates to integrating cultural linguistic competence into curricula, training, research, et cetera. And we were going down the path that people really wanted to talk about some of the barriers and some of the institutional barriers. And I think it's a really important conversation. And part of those barriers were that people within those departments weren't really wanting to hear the discussion about cultural barriers to competence. They didn't get support for cultural linguistic competence; that the funding from the MCHB that comes in with creating the grants, not the equivalent of NRH grants, and there's not a great degree of collaboration; and that they can't get buy in.

Really we're talking with some significant institutional barriers, and I think they merit issue here. So these are just some recommendations that came out. And those I think came from a colleague in the state of Maine who looked at, when you're collecting data specifically to race and ethnicity, that many times, looking in that community, lumping all white people together is a problem. And that people don't get a chance to self‑identify, and how can we begin to collect data that gives cultural identity, not just race and ethnicity. And some of these are things to think about, things to work on and perhaps work groups, et cetera. Another was looking at ways to evaluate cultural linguistic competence, how is it included in the curricula and could there be such strategies as it relates to that. The guidance, and there are colleagues here who may just want to share, if I'm not getting it exactly how it was stated: Guidance from MCH data that would look at (inaudible) rather than compartmentalizing. In other words, you might have this which is the cultural competence plan as opposed to ways we can think of this in a more seamless way, look at this relevance across the board.

And I think that this mirrors that in terms of looking at the different aspects of culture and how that is needed to identify within the scope of work. And I'll get ‑‑ this recommendation came up as well. It's an occupation from one set of groups they thought that MCHB needs to model cultural diversity, and it was stated in relationship to this meeting ‑‑ and I don't know if I'm putting anyone on the spot to expand about that ‑‑ but that would be a statement, apparently some discussions have gone on within ‑‑ so some discussions have gone on.

SPEAKER 2: Discussions and presenters and things of that nature. (Inaudible).

SPEAKER 3: One colleague talked about (inaudible) retention being a significant challenge, depending on the geographic locale. And that while we look at what are the performance measurements, looking at the specifics in which you're able to improve and retain faculty members numbers, they may feel they're at a distinct disadvantage because the environment they're looking at is not conducive to getting people to stay. The example may be they may have that belief, but once within the university community and the city as a whole, but there's not a great degree of diversity within the city. People feel uncomfortable and that they often want to believe that things like it's a rotating door. This is a recommendation from a colleague in Virginia and felt that there should be something that is developed from MCHB for new grantees to help them move along the cultural competence, some kind of technical assistance or resources to help them in that aspect.

This may have been a spin off from that: Ways in which you can look at mentoring and linking with other institutions who really are moving along (inaudible) and to support other grantees and growth in this arena. And this is obviously now, this is the project from the School of Public Health in Berkeley, and we looked at a way in which the (inaudible) noted in California with funds from the California endowment and how public hospitals and I think health professions again at the University (inaudible) San Francisco begin to look at leadership training for linguistic competence for hospital teams and ways in which you're able to promote that. And each of the hospitals, that $50,000 to (inaudible) process.

There was a recommendation, strong recommendation that the MCHB strategic plan should reflect a central cultural (inaudible) competence throughout and not necessarily be limited to a particular objective. Let's see...this is (inaudible) recommendation or looking at programs starting with where they are. You may be at various stages along the continuum and that we need to be able to respect that and helping people along this from awareness to skills. There was a considerable discussion around (inaudible) protocols and looking at a way in which site (inaudible) protocol, there could be a way of addressing cultural linguistic competence and the (inaudible) improvement. But leverage was then, certain settings should be (inaudible) should not just go to the PI, but also to department chairs and CEOs of hospitals, so that those individuals in those positions can see how important it is to MCHB and be able to offer some support.

This is a problem with the overhead rate being a major impediment within certain institutions that (inaudible) grant from MCHB and other settings and just listening to the (inaudible) it's like who cares, they're not really the people who are paying the bills. There were some discussions about funding for evidence‑based practices from MCHB. That evolved into MCHB can serve as a way in which they can collect these evidence‑based data to help people describe rationale and why. And that they may be able to collate this data and make it available and accessible to the community so that people aren't searching all over to try and find what indeed is the most recent and evidence‑based as it relates to cultural and linguistic competence, improving patient outcomes and care.

Okay. This is a very concrete recommendation. This is again from a colleague in Virginia . And she said that for CEOs and others within their institutions, they needed something for folks with a short attention span. And while there were (inaudible) and other things that would be available, that she would like to have a two‑pager, in that two‑pager she would list or someone would list rationale, some specific rationale while cultural and linguistic competence would be important, business case and all that have listed succinctly and look back and look at all the accrediting bodies and other agencies that are really looking at this in terms of (inaudible) like one side is would be rationale and the other side is (inaudible). So I volunteered her to serve on that. She accepted. She would put that together.

And we did have a very interesting ending. We thought was very rich, because lots of people, there's not enough time, too much barriers, there's not enough money, there's not enough money, there's not enough money. So we asked people to talk about what they need to do tomorrow without another penny, and it was rich what came out in terms of discussions. One was looking at buy‑in. And it again was very interesting, that her frame of reference was that I just think it's the right thing to do and I've not been able to articulate a rationale why to elicit buy in because I haven't thought about it from that perspective. The other one is using the self‑assessment module that's available on the website and (inaudible) website would be able to integrate that into a couple of courses (phonetic).

Okay. This one was really looking at that sometimes when you're advocating for this, pushing for this within the institutions, you kind of get a brick wall or stones in the water, as Peter said this morning. And that this should be expected as part of the continuum looking at ways in which you can continue to get the flow going even though you have those barriers. Ways to integrate cultural and linguistic competence across the application as opposed to (inaudible). One person said that they have 22, manages a 22 ‑‑ okay. Has 22 list serves. And it's really around a national campaign for breast feeding. She's going to use this to post information as relates to cultural and linguistic competency.

Okay. This was a very interesting recommendation from a colleague in Virginia . And she said that they're really going to look at (inaudible) committees and ask questions in terms of (inaudible) you know how do we feel about cultural linguistic competency and be able to describe that in terms of their work. And then be able to push the whole notion of cultural and linguistic competence at the organizational level, not just at the individual level within the (inaudible). So those are the recommendations.

LAURA KAVANAGH: Thank you.