Promising and Proven Strategies for State MCH Partnerships with Academic Colleagues

Holly Grason: Okay. One of the things I just wanted to mention, and I'll talk about the Region Eight work we've done very briefly, was to make really clear sort of what my interest in this session--I think it was Laura, and probably Cassie (inaudible) both asked me, "Well, why do you want to give this session? Why do you want to take the time to do it and so forth?" And I think what I said and I truly believe is to sort of create demand. There's different ways to move things forward. As we know, you can pay people to do it. You can force them to do it with legislation or with grant guidance or various tools we all have to make things happen and I think the one that I'm probably least familiar with and certainly wasn't schooled in, that is creating demand. And I think you as consumers of academic public health services that if you can demand and ask for certain things, very often folks realize they have it in them to do they just don't know how to get started. And so really the intent here is not to talk so much about what we've done but to really hopefully get you interested and excited about the possibilities so that, as Sally said, you will go back and ask folks who are in your neighborhood or accessible to you otherwise to sort of consider ways in which you can sort of create some synergies together. Another just brief example, again, Laura, can you sort of go forward, is the family planning directors in Region Eight, which is the Rocky Mountain area, had some specific needs and developing performance indicators and this was in the late '90s I think. And they said in a casual conversation, "Well, we really need to do a better job in monitoring the quality of family planning services. And the state of the art is getting better, the state of the field and we've been doing quality monitoring as Title X grantees for ever, chart audits and so forth but we really don't feel like we're with it in terms of the field, so we really want to take a look at that again." They had new performance reporting requirements, which you all are familiar with on your own bailiwick that they needed to address through their reporting. So their current mechanisms for quality assurance and for data and reporting weren't meeting the sort of performance measurements, targets, and needs that they had. They wanted to be able to compare their family planning programs across states within the region because they've identified, they worked together as a region for a long time and of course as everybody knows the family planning programs are actually administered via regions as opposed to the Title V Block Grant so they wanted to be able to compare their states and sort of create this kind of collegial competition that they'd always had. And they wanted to be able to use data developed or collected through a new indicator set to sell their program to policy makers. They were just feeling like what data they had on family planning issues was not making the case, was not convincing to folks that they needed to sell the program to. So they came to us and they said, "Okay, these are things we want to do." Okay. And they said, "And we want to be credible." And we said, "Well, you know, you can do all that. You folks are very experienced professionals." And they said, "Yeah, but they think we're prejudiced to our programs and we have axes to grind and everything and they want listen to us so we need some credible, scientific kind of aura to put on this and so we want Johns Hopkins or Harvard or whoever to do this for us and to really ground it in science to that our QA is actually better. There's actually higher quality QA activities and so actually that it has the kind of credibility that will be assistive in terms of telling our story, making the case with the public and policy makers." So some of the specific challenges we addressed with them were there are new frameworks for assessing quality in family planning programs, but none of them even most of the ones that were done on the international--and most of them were in international public health field, not domestic work. And they hadn't been operationalized in to data collection systems, so there were some new, exciting ideas and ways to go about it but not yet put to use. We had to meld what the current thinking was in terms of these new frameworks with ongoing data collection because obviously you're not going to go in and put in an all new data system and have it actually kicked off in the next 20 years probably if you're lucky. So we had to meld it with what was possible in terms of ongoing data collection and another third challenge was that the data was highly variable within the states, across the states in terms of definitions used and data qualify. So what we did was basically work very closely initially with the six family planning directors to clarify their goals and specify where they wanted to go with this activity. I think that's a really time well spent and a meeting supported because very often when you have consultants come in if you're a state person or wherever you are having consultants come in, probably the biggest pitfall in my mind is not clarifying what you want out of it and not having everyone at the same place so the product that you end up with as a purchaser ends up being what it is you wanted and meeting your needs. So spent a good deal of time about their thoughts about uses for an indicator set. They wanted no more than 20 indicators that was going to do all these things I told you about before. We researched the frameworks and indicators and we presented to them in synthesis form. As Sally mentioned, that's the kind of activity that your colleagues in schools of public health and other academic graduate schools can be very helpful. It fits very well with their culture and time and resources and expertise. We surveyed and compared current data collection processes and instruments so basically being grounded in what they were doing, specifically in that region. The people who were going to use the indicators and measures, looking at what they had to offer and not necessarily just beyond internationally or nationally in other states and presented indicator sets and options and narrowed the strengths and weaknesses. So again, I feel like most of whatever we do is try to make other people's jobs easier for them. And so doing whatever we could to make it easy. And this is just an example. The content is not as important but in terms of working with folks to meet their multiple needs, they wanted to be able to tell a story. Okay. So that was one of the needs. They had certain data collection that was ongoing. They were sort of stuck with some of these processes because they're embedded in Title X legislation, the performance measures, they get some Title V money so they have to have big broad indicators for performance measurement. They have teen pregnancy rates and vital statistics, so we had all these givens but they wanted to be able to tell a story. Well, we had presented some frameworks that were more theoretical initially and along with it was this particular one. And basically this made sense to them in terms of telling the story. We had inputs, okay this is the money that policy makers in the public give us--staff, money and facilities--so they can count that, have data on that. These are the things that we do. We hand out contraceptives. We have patient follow up and counseling. We offer tests. So we have numbers in counts of that. That translates into outputs in terms of what's received by the clients so they have counts of that. And then we know--and I'm going to jump for a minute over to effect, unattended pregnancy rates--this is the other set of data we have. And so what they were saying to us was, "We can't seem to convince people that what we do has any connection to or lack thereof to the unattended pregnancy rates and abortion rates and so forth." And so what we did is actually additionally work with them on developing impact measures and measurement to be able to put together the whole story of what data was there. To skip quickly, this was how we used the same framework then to look at their specific data that would marry personal health data, clinic data, and population-based data. So we identified what was in their instruments already that could be pulled out and used in a separate indicator set. We drafted an instrument to collect data not otherwise available, a very parsimonious follow-up survey that they could implement. They worked with us closely to review and refine that draft instruments and then they we prepared them guidance. Okay, here's your indicator set, here's your instruments and then what are some feasible sampling methods, what are some periodicity for fielding surveys and putting this data together that's going to be usable for you, that you can do within your means. So we developed some empirically grounded guidance in that regard and then what we lastly passed the baton to, as many of you know, the Region Ten system has TA contractors in each of the regions and so we had engaged the Region Ten, John Snow, I think is in Region Eight, TA contractor along the way, and they sort of sat in on all of this and then they became the follow-up support for implementing this data indicator set. So there's a different model when there's a group of states who are sharing in a problem and working with us