Promising and Proven Strategies for State MCH Partnerships with Academic Colleagues

Holly Grason: Good afternoon. And I'm really delighted to be here and to see you all. Can we go forward?

Lauren Kavanaugh: Sure

Holly Grason: And we can go forward again. Thank you. Okay. So quickly, I just wanted to go over what we're about today. Our intent is to explore with you some of the synergies of state and academic problem solving partnerships in order to realize public health goals. And as I'm sure all of you know from your various years of professional experience, there are many problems in the problem solving partnerships and we wanted to share with you some of the strategies that we've evolved in working together over the years and in collaborating with others around the country to hope to sort of stimulate further thinking and glean from your ideas and to share some ideas with you all about how we can do more of it and better of what partnering we do do. Identifying short- and long-term prospects for developing and maintaining partnerships and then to get, again, to begin a dialogue to inform design of future efforts. So how we're going to go about doing this is I'm going to spend a few minutes describing the Women's and Children's Health Policy Center at the Johns Hopkins Bloomberg School of Public Health, which I am very privileged to be a part of, as just one example of a group of faculty who have organized themselves with various partners to try to achieve the aims of interfacing with the practice and the policy community. So with that as background then, I've co-opted some state partners and federal partners, as usual. That's where I think I do spend most of my time as director of the center, sort of co-opting people to engage in these activities with me. Sally Fogerty is going to talk about evolving a national strategy through a federal, state, and academic partnership and that was in Charting the Course for the Future of Women's and Perinatel Health, something that we were working on over the past actually five to seven years and it continues in its various forms and derivatives now. I'm going to talk for a little bit, I was unsuccessful, the Colorado folks were so popular this afternoon they had to be in many places. So I'm going to speak on behalf of a group of family planning directors in Region Eight, and talk about how some regions can come together around shared problems and work with academic centers perhaps to attack some very real challenges that often states and programs are faced with. And then Susan Panny is going to talk about a partnership that evolved in Maryland with her program, Title V Program, in the Maryland Health Department. And I know many of you are familiar with one of these strategies or another but hopefully we can give you a flavor. Laura is going to talk a little bit about some more examples from around the country. Again, we're just sort of one such group that does this kind of work in working with states and the federal government to try to translate and apply research and policy and also to take practice-based problems, practice-based experience and bring it into the research and academic arena. So Laura will share some more examples. And then we're hoping to have some time to actually brainstorm with you and problem solve with you. We've passed out index cards and if you haven't already, if you can think about some specific kind of challenges that you think such partnerships could be formed around, the ones that you know of personally. Laura will take the cards up towards the end and we'll discuss it as a panel and with you. So that's how we're going to go about the next hour or so. So anyway, what is the Women's and Children's Health Policy Center? Well, this is our mission statement up here. I almost forgot to put it in and I thought I had to practice what I preach when I sort of go out and work in states. But our mission statement says that we draw upon the science base of the university setting to conduct and disseminate research to inform MCH policies and programs and the practice of MCH nationally. Some of the key words in there is we basically organize ourselves or do work that is of national scope primarily. That is not to say that we don't work with individual states, but we have, for the most part, worked on issues that are shared by a large number of states and over a long period of time. We usually engage in long-term agenda work, and I say that to distinguish our particular center with many other centers, which are also very key and very productive who work more in the Washington, Capitol Hill, state government, legislative arena, where there's a sort of fast short-term kind of response, analysis and so forth, and that's a little bit different kind of center than we are. And our specific orientation is towards the application of scholarship in MCH and the linking between them. I want to tell you just a tad about how we organize ourselves because we do it intentionally and systematically to address some of what I'm sure many of you are familiar with: traditional barriers of linking between academia and practice and policy in maternal and child health and in public health generally. Actually it was three years ago this month we had, with funding from the MCH Bureau and the Agency for Healthcare Research and Quality, Quality and Research, Research and Quality, convened a conference also called Building Bridges, where we brought together--some of you were here, were at that meeting with Health Services Researchers, with foundations, with other federal agencies in talking about what some of the barriers and opportunities were. And the traditional ones, we in the Ivory Towers tend to be very slow at what we do. I think states have a reputation of being slow-moving and universities have a reputation of being even slower, behind the elephants or at the tail of the elephant chain. We move slowly. We very often are not really familiar with your daily schedules, with your daily challenges, with your real needs, and what the constraints and the parameters are of implementing maternal and child health programs of developing policies, of promoting advocacy agendas, on a day-to-day basis. And so very often what we do in terms of research and teaching can easily become disconnected. Most academic faculty are not experienced or trained in the field. And also the incentives in academics and in state government and in local government or federal government are very different. And so the incentives, for example, from where I work now are not necessarily to be here today quite frankly. Well, put it this way: the personal incentives are great, which is why I'm here despite the employment disincentives for academic faculty. So the incentives are very different in government and in policy arenas and in academia. And then on the state end--and as a former state employee myself, it's almost like we have the wealth of too much information coming from all sorts of sides and then limited access to other information. So in terms of actually translating research into your daily work schedules, into your daily plans, what you do with your staff, with your partners and with your constituents and so forth, you have very limited resources and very often, major challenges or mountains of paper to get through to sort of sift out and think about what it is that all this means in terms of what you need to do for the population. So we organize ourselves where we have a multidisciplinary faculty, and I mean that in the traditional sense in terms of public health disciplines, and most of our faculty are traditionally academically trained but we also have practice experience faculty like myself and we hope to grow that. I'll talk about that a little bit later. So we have not only people who are traditionally trained but people with experience in the field who are there working in tandem all the time to be able to inform each other's work. And I think that's one of the key things that has been very helpful. We have a core stable staff and some of them are here today, Gillian Silver, who many of you know, who has been very important to the work of faculty, to the work of the states in terms of use of research, to have folks who are there all the time who can be externally oriented where faculty cannot always be. They're sort of torn between teaching, research and practice. The staff are there to be that constant link between people in the practice field and the faculty. We have instituted links with national organizations in several different ways, and we'll talk more about some of them. We have, as a center, what we call the state cluster group, which is a group of six or seven state MCH leaders like yourselves and Sally's been one of them for a long time. And let's see if anyone else is in the room. I guess none of our other ones are in the room. As well as national organizations, the Association of MCH Programs represented on that group as well as some of the professional organizations, Academy of Pediatrics and the ACOG. And these folks are our lifeblood in terms of conducting our work in ways that hopefully are making sense to folks in the practice field. So we have our state cluster group that we work with very closely and there'll be some more examples of that. For some of our health services research projects in particular, we have national expert research advisory boards that are a mix of state people and academic faculty and policy makers. We have links with partnerships for information and communication, the national membership executive branch and legislative branch. Organizations such as the National Governor's Association, ASTHO, NACCHO, National Conference of State Legislatures and so forth, the MCH Bureau organizes this group of organizations. They meet regularly and we are very honored to be able to meet with that group--and Laura actually used to run that group--and to be able to sort of have that kind of ongoing dialogue with policy makers and administrative executives and as well as other links with national professional organizations. So through a number of venues it's very important for us to have those kinds of institutionalized links, to be able to always have our ears open, and to be able to continue a dialogue. I think one of the things that we need to constantly fight against in an academic setting is the isolation that happens even when you're in close proximity to where the national policy is made or where folks think they're making national policy. And then lastly students and we'll talk about that more. And we engage with students in a number of ways but I think most importantly our commitment is to make sure that the students that come through our program in the Department of Population and Family Health Sciences to the extent that we can give good exposure to maternal and child health practice in the field by working with us on projects in whatever way that fits with their academic goals. And many logistical issues with that but we try very much to help make that workable, and I don't see our new one but we have one of our MHS students--oh, she's staffing the exhibit. So I hope you'll stop by our booth out in the hallway and meet one of our current students who's working on a project with us. Laura? Okay. Here are some of the core principles that I think will surface in a number of the discussions. We have a fundamental belief or testament that we collaborate with states from the inception through implementation of various projects or products that we develop on behalf of states. I spend a lot of time talking with my colleagues about they can't understand why no one sort of cites their work or uses their work or whatever and that's because nobody knew about it until it got into a journal and maybe there was a press release or something got picked up on it if they were lucky and it got in a newspaper or someone happened to go to a certain conference where their work was presented. But rather we work with folks from the beginning in terms of designing our research and so forth so that it's going to be applicable in the end and hopefully used. We engage federal and national stakeholders throughout the process and this is, again, a fundamental tenant of what we do regardless of the specific topic or project. And the reason for that being to fundamentally strengthen infrastructure activities nationally that will support what the states do. And just as states are very important in what they do on an ongoing institutionalized basis to community and local projects, it's important for, at the national level, there be recognition and embracing of what states are doing. And so it's also a key partner to have along the way. We strategically sit down and talk about what are the benefits and rewards for the academic, the state, and the federal and national partners in any given project we want to do. So that people aren't doing each other favors, if you will. That there are actually, in each step of a process as we work with states in a particular area to address a health problem, conundrum, or need, there's something in it for everyone and it's not just money because we all know none of us make a whole lot of money, so let's just get that off the table. And we have to look at what are the incentives in it. Well, we'll give out some examples of that. And then lastly we device and pursue companion activities to defuse and sustain the work in the field. So these are the four sort of principles we keep in mind as we go about our work. So Gillian, our wiz at bringing us into--bringing me into technology here developed this little--yeah, you have to keep--there we go. Laura knows how to work it.

Laura Kavanaugh: Do you want me to go do the whole thing or just do one at a time?

Holly Grason: Well, one at a time. Okay. So initially we started out with states identifying issues and questions to be addressed. We talked about that. Okay. All right, states participating in design of project and research instruments along the way. The state cluster group that I mentioned, we have met with them at least twice a year for any number of years and say, "Okay this is an area that you want to have work in. How do we sort of organize ourselves? What are the kinds of things we need to know? How to we get that information out? Who should be involved and not just who's on our particular faculty, but who else in the country, who else in the university do we need to bring into this particular endeavor? What other states do we need to consult in this or federal agencies?" So we basically design our projects with our state cluster group, for example. So we go and do our sort of faculty thing for a while and people go back to the states and run the states and make MCH better and as work begins to progress and we have some preliminary findings emerging, we meet again usually to craft implementation and translation strategy so we don't wait until the end and say, "Okay, well, how do we make this make sense in terms of usable information?" So we come back to our state cluster group. Then usually when we have crafted sort of almost finished documents, we go through another sort of iteration and this varies from project to project but usually bringing in a broader range of reviewers and input into our process because quite often I fear my state cluster group, or whatever advisory board we're working with on a particular project has, by then, been very much co-opted by us and will like what it is because they have been a part of developing it. So we go a step broader usually in terms of getting input from people who have never seen this before and we say, "Okay, does this make sense to you?" Disseminating interim findings and reports, and this was actually something that came to mind--as some of you know I worked at AMCHP for quite a while before I was at Hopkins and the frustration of being able to have material to use when you know it's being developed, it's being developed, it's all most done, in meantime you legislature is meeting and is this report coming out. And so we have very much made a commitment to as soon as we have something that can be put into even a brief web format or a handout format or whatever, put together findings in ways and get them into states hands and then we work on sort of smoothing out the rough edges and getting the rest of the publication and product development things in order. So trying to get things out to folks quickly and timely to make them relevant. Incorporating public health MCH students in our efforts. Again, a major commitment to workforce development and hopefully, being able to entice some folks who are going through MPH programs and doctoral programs to want to spend their careers in public maternal and child health, in government service, and in national policy endeavors. And so giving them exposure, and exposure that's supported. I know when I was working in the states, I did have some students from the same place where I work now, but I had very little time and guidance. You're all very, very much pressed in many ways and so to have that sort of person on the other end to be able to mentor them and to support their academic needs are met while they are getting exposure to the very hairy life of MCH practice and government is important but time consuming. States jointly develop publications. I think very few of our publications are something that we put out ourselves. And again this goes back to the something for everyone, not only states jointly developing publications, but other organizations. For example, the MCH functions framework was a publication of ASTHO, CityMatch, AMCHP, NACCHO, The Federal MCH Bureau, and the Johns Hopkins Women's and Children's Health Policy Center. We do most of our work in tandem, which helps encourage dissemination and use in terms of people having ownership of the products and tools. We work with our federal partners along the way. As I mentioned this before, building an institutional policies and practices, an example of that, and this is something I haven't articulated much but I think I need to work on articulating is early on in the mid 1990s we were doing some work for the MCH Bureau on primary care systems, systems of care for children. And so one of the things we did was evolve a definition of primary care for states to use because those of you who were around in the late '80s remember, there was new terminology in the Title V statutory language around primary care and everyone says, "Well, what does this mean?" Not primary care per se, but primary care systems and so forth. So the Bureau asked us to do some thinking, literature review, and so forth on that and we've developed some frameworks and then those frameworks were built in to the Block Grant, needs assessment guide, and in to the reporting guides and in to other materials, some of SPRANS Grants that were let out, so that it was something that came part of the lexicon and it was supported at the national level as well as what you were doing in the states. Collaborative dissemination and customized packaging. Again, I think this is something that more and more university centers are learning, but you can't just sort of put out your journal articles are your research briefs, that you actually need to come and sort of explain to people how they can use that information, how it's a benefit. And so we spent a good bit of time on that. Devising and disseminating related teaching tools. Again, back to the building the workforce. Much of our work can be used in teaching and not just where we are working on daily basis but also our colleagues, and so we try to share those applications with other schools of public health, other MCH programs, around the country so that, again, we have a common understanding of MCH research and practice and can be having more productive discussions and future workforce. Is that the last one? And then lastly ensuring a structure is in place for TA support for state use and implementation. And this will take different forms in different projects. And actually I think they pretty much will be revealed in our discussions, but it's been important to us. For example, in Past Five for those of you who are familiar with the capacity assessment for state Title V programs, tool, this capacity assessment tool that we worked with AMCHP and the Bureau to develop because there was no ongoing sort of source of funds for resources for supports to states. What we did was use our last bit of federal funding to provide two-day training workshop for people around the country, both state folks, academic folks, and some independent consultant to be resource colleagues. So even though there was an ongoing set center where you could call and have some one come out and be a TA, expert, there may be some one in the state next to you or in your state or whatever who could in one way or another make arrangements with you to provide assistance and support. So that's sort of the process that we use on an ongoing basis. And next slide; I don't remember what's there. So at this point I'm going to ask Sally to sit in my seat perhaps. We'll switch things. And she's going to talk about some of her experiences in one of these projects that we mentioned the charting the course for the future of women's perinatal health.