MCHB ALL GRANTEE MEETING

Q & A and Closing Remarks

October 4-7, 2004

PETER VAN DYCK: Thanks Jack. It’s great to see so many of you still here. You know they say 30 or 40% of administrator’s responsibility is personnel issues, now you know why. I am always impressed by our staff when they get up and talk and by the people I get to work with, they are wonderful people, they do a wonderful job. They’re fun to be around most of the time. And, I just couldn’t work with better staff, let’s give them all a hand. We don’t want to prolong this, but I would like to invite you to ask questions of anybody that was here, me, or for our most recent panel. And, give you a chance to do that before you leave. Any questions? I’d like to say that--okay, please walk to a microphone, while--okay, please. Just try shouting. Yes, that’s on.

PETER GLASCO: Is that on. I’m Peter Glasco I’m a-

PETER VAN DYCK: No, it isn’t?

PETER GLASCO: Is that on?

PETER VAN DYCK: Just talk loud and I’ll repeat your question

.

PETER GLASCO: I’m Peter Glasco, I’m a lend director from the program in Oregon —

PETER VAN DYCK: Peter Glasco, who’s a lend director from Oregon .

PETER GLASCO: And, my question is about performance measures.

PETER VAN DYCK: I think we can hear now.

PETER GLASCO: Okay. The issue is, you know, being held accountable to some generic performance measures that cut across all programs is fine. And, I don’t think any of us have any problem with that. The thing that makes me a little uneasy about the issue is each program does some unique things. Some of which are pretty spectacular. And, my fear is that that’s lost if the only thing you’re looking at is generic measures that cut across all programs and don’t really take into account some of the unique aspects of what we do.

PETER VAN DYCK: The question was or the comment was performance measures are great, generic measures applied across all programs may not, however, catch special characteristics and some of the really fantastic things that individual programs or families of programs get. And, I think that’s true. And, that is one of the reasons why I think you’ve heard us say, families of grant programs, such as the Lend grantees, do have the ability as states do to write some performance measures of their own, three or four or five or six that relate specifically to what they do. States have used these effectively. States are able to write performance measures related to their own specific priorities that the governor may have or the legislature may have or the MCH director, or the Health Director may have. So, I think we’ve tried to address that responsibly, let’s see how it works for a year, and everybody is going to, I’m sure, feedback to us and let us know and we’re more than willing to accept wonderful ideas from you as grantees on better performance measures or performance measures that may report on your program more exactly or succinctly. So, good comment.

JIM MCCRAY: And, if I could just answer that in terms of performance reviews, part of the reason why the framework is (inaudible) and hopefully it’s pretty commonsensical is that we really did want the tool to be able to adapt to each particular program, each particular grantee so that we could capture not just those performance measures that cut across all programs, the ones that you need to report on, but also could capture, as Dr. Vandyke said, the specific ones that you all have identified and also capture some of those best practices. One of the real benefits we see of doing this is actually being able to share some of those innovative, creative ideas that you all have had to be able to share with other folks who are struggling with similar issues or concerns.

PETER VAN DYCK: Any other comments or questions? Yes, well, he’s just fixing the mikes.

UNKNOWN SPEAKER: No, yes, this one does work; I’m interested in what are considered outcome measures. We, in Maryland, have the Managing For Results System for our budget and we find for many of our programs it’s extremely difficult to come up with what our consultants consider real outcome measures, especially if you are starting a new kind of inter prevention. Sometimes it takes quite a number of years before you have anything that’s really an outcome measure. And example of this would be our Infant Hearing Screening Program. We can tell you how many kids we screen, we can tell you how many kids we diagnose before age three months, we can tell you how many kids we get into special services before six months, but I can’t really tell you what their language quotients are going to be until they hit school. Okay. And, the whole idea was that we were going to have kids who had much less language delay and hopefully not any language delay, and who were going to achieve in school and that, in fact, the intensity of the special services that they would need through school was going to be less. And, those kinds of things cannot be manufactured in a year. The process stuff can if you have a good data system and you work your tail off, but the outcome stuff really has to do with the natural history of the process, whatever it is.

PETER VAN DYCK: That’s a good comment and deciding what’s an outcome measure when we went through this in ’95 and ’96 and ’97, OMB basically forced us to our outcome measures, which you saw me list on the right-hand side of my scheme, infant mortality, child mortality, neonatal mortality, difference between Black and White infant mortality, perinatal mortality, that was the outcomes. We had suggested, perhaps those, but things like, well, if you take infant mortality, what’s the predecessor precedes infant mortality, well, pre-maturity. Well, what’s the number of low birth weight babies, or the percent of low birth rate babies, or the percent of pre-term birth babies? What about infants into prenatal care? How well do we get mothers into prenatal care?

What about just identifying women who are at high risk? Well, you can back up all these steps and what we said was, if there is scientific evidence that shows that these are natural steps in a progression leading to reduction in infant mortality, let us back up a couple of those steps and consider those outcome measures, they said no. But we put those measures into our set of 18 national performance measures anyway, and many of them are there. So we recognize that there is a gray zone between what a real process, what are perhaps intermediate between pure process and outcome, and what are outcome. And, I think when Jack says OMB want outcome measures, they try to force us more and more toward outcome measures. And, we try to make stronger and stronger arguments that there are evidence based near outcome measures that should count for outcomes.

So, we recognize this as an issue. We have a mix of outcome and process measures. We think process measures are important. Some process measures may be appropriate for three or four years, and then you get rid of them because most people have achieved them and you move on to something that’s a little farther towards outcome. So, bear with us on this and give us ideas, we’re willing to accept ideas. I don’t think you’ll ever see from us a grid that says which of our measures are process and which are outcome, because that’s not to our benefit. WE think they all lead towards eventual outcome and splitting the division between them doesn’t serve us well. Any other questions? Questions for the panel? I’d like to make one announcement before we end for our IOM recorders those of you in the room or facilitators for the rest of the meeting there is a meeting in Potomac One Room at 5:15 tonight with Ann Drum for training and questions and ideas on how to make this work. I want to thank again for you for staying and being so attentive, and for all of our presenters today and for you folks coming in on Sunday, we appreciate that. Thanks very much, have a good day the rest of the meeting.