Sunday, October 19,2003

1:20-3:00 PM

Cassie Lauver: Okay. I was hoping that I could say we’ve saved the best for last here, but Dr. Drum has usurped me by not being able to locate her slides, so I won’t be the last act for you today. Division of State and Community Health, that’s the division in the Bureau that has the primary oversight and responsibility for the block grant and working with the state, MCH and Children with Special Needs Directors around--primarily around the Title V Block Grant. And one thing that’s also part of our responsibility is to link with all of the other divisions and offices that have perhaps research or information or population based focus and link that into our work with the states. One thing that we are doing and this is a bit new, and since you’re new maybe it’s not all that helpful to go into it, but staff in the division actually are project officers for the block grants. Historically, people in the office or division of State and Community Health have had a role and have frequently had specific states that they’ve worked with, and at the same time there was a significant relationship with staff in the field offices, and with a more recent reorganization or refocus within HRSA, the staff within the division have taken over the primary role as Project Officers of the 59 states and territories. So one thing over the last several years is that staff have gone out and continue to do reviews with the states around the block grant in August after they’re due, and one thing that I tried to have staff focus on is some continuity with the state or states within a region and that way they can get to know a little bit about what goes on from year to year and have a better relationship and a more familiar contact point within the division and within the Bureau for the states around the block grant. One of the other focuses of the division has been around tracking state progress, and as you know, there are 18 national performance measures that are part of the block grant, as well as anywhere from five to 10, some states have more than that. State performance measures that they’ve identified based on their needs assessment in identifying their priorities that they focus state performance around. And while I think that the national performance measures are very helpful, particularly at the national level and having a focus and being able to tell a story about maternal and child health and knowing where we are relative to those performance measures, the set as a whole may not be the most relevant set of performance measures, and that, in fact, states are very diverse and have formulated state performance measures around their own priority needs, and one of the responsibilities that staff in the division have in working with states is seeing where states are in their progress in meeting not only the national targets, but their own state targets, which may be different than the national targets around performance, and we also have the responsibility to link that with technical assistance. And again, for those of you who have been around for more than six months or a year, if you’ve been in the programs for several years you know that you often had worked with your regional office staff around technical assistance. That now is a role that the project officers in the division have in working with the states. So form 15, that’s part of the maternal and child health block grant application, talks to technical assistance requests that you might have. And one thing that we’ve been trying to help states focus on is technical assistance as it relates to their performance, particularly around needs assessment, around national and state performance measures, but we’re trying to have a focus on technical assistance and strengthen the focus in how we can be helpful. I know Dr. Cogan mentioned this morning that they have availability of technical assistance resources in data and I know other division and office directors have access to technical assistance as it relates to their population areas, as well as our division having funds. So we try to maximize what we have and work with the other divisions, particularly around performance relative to children with special needs per say, or training or research, and work with the other divisions and offices in seeing if we can put together resources that will meet and match the technical assistance requests that the states have. And we’ve also been experimenting a little bit with some of the technical assistance opportunities and events that we’ve had. Last year, for example, we recognized that while states are really diverse, there are some commonalities, and we had a technical assistance initiative, or event, where we had the states with the nine largest populations come together and look at some of the issues that they have in common relative to the size of their populations. We have had a focus with some of our jurisdictions in the Pacific Basin as well as the Atlantic jurisdictions and looking at their data capacity and focusing on MCH Epi capacity in those areas. And so we’re also looking at where we might want to go in the future with that and how we can maximize what we’re doing and bring people together with technical assistance that more than one state or jurisdiction may have a need that we can develop a resource to help meet that. So if any of you have any ideas of that, please feel free to approach me or Jeff or any of the people in the division relative to your thoughts on technical assistance because we are, now that we have the new block grant application guidance out there, want to have a stronger focus on where we can look at performance and technical assistance. Another one of our responsibilities is this meeting. This is the division that has the responsibility for the annual grantee meeting, which is the federal state partnership meeting as well as this new leader orientation piece that we’re adding on to it. So again, please provide any suggestions or thoughts that you have around the meeting so we can help meet your needs and our needs at the same time. And, in addition, the division also administers the SSDI grants, the State Systems Development Initiative grants, and as you know those are grants that are companion grants to the block grant and the intent has been a bit evolutionary, but over the last several cycles of this grant, it’s focused on data capacity in the state, both from an infrastructure point of view, and in particularly in supporting the MCH data needs, and it focuses on the most current health system capacity indicator, 9A, looking at data linkages between MCH, WIC, PRAMS, Medicaid, some of those key data linkages, and it’s also been used by the states in their development of their needs assessment, their five-year needs assessment. So as you may or may not know, the law requires a needs assessment that’s done every five-years. The next time it’ll be due is in your submission not next August, but the following August, so that would be in calendar year ’05, the next needs assessment will be due. And so many states use the SSDI around that time to help focus their data capacity around needs assessment activities. The slides that you have in your handout you may already have, but wanted to give those to you again, and those are the staff in the division that are the project officers by region. So for example, in region one, Audrey Kurt-Viecci is the project officer. So for those states in federal region one, Audrey is going to be your primary contact. Unfortunately, we don’t have the ability to focus on one region, so most of us are sharing ourselves between more than one region, but we are available. I think email access is probably about as efficient as you can get, but I continue to want to--so we have the regions one through 10. I’m going too fast; I’m trying to get you out of here in a hurry. Dr. C. J. Wellington is the Project Officer in the division for the SSDI grant. Again, one thing that we want to do is we’re analyzing Title V performance data across states and within individual states across time and identify best possible practice. One thing that we’ve noticed when we’ve been doing the block grant reviews is that, one is that most states do something really well. They may not do everything really well, but they certainly don’t do everything poorly either. And that there are states out there when we look at performance measures, within a region, or across large states, or even across the national cohort of states that we’re looking at, may do something, maybe addressing and showing very good results in their performance and we’re trying to identify that. In fact, we have a contract with a group from NC Chapel Hill helping us look at the states and the performance measures, helping us to try to identify best practice, and I know some of your states have already been contacted and asking you questions about your result. Is it the data sources that you’re using for your data or have you really found something that is really working and may be helpful to other states and that we can build into our technical assistance program? Over the years, most of the states have told us for technical assistance one thing that is really helpful to them is state-to-state technical assistance. We still have the ability to identify national experts in the field, but for the most part, states are wanting us to link them with other states who are addressing a particular performance item and doing very well to learn what’s going on in other states and that’s something that we’re trying to do as well is to identify what might be a possible best practice in a particular area and again coordinate technical assistance around those events. Over the last year and a half, I’ve actually been a part of the Maternal and Child Health Bureau for three years now and I think I’ve spent most of the time there working on many things, but one of them included revising the Block Grant Guidance. The Block Grant Guidance requires clearance by ONB, and that was my first experience in working with that kind of process and found it a very interesting process that took certainly more than a year to get a package through. And actually we had an excellent package to work with, a guidance to work with, but we knew, as anything, improvements can be made, and we were also looking at state of the art web based submission which was part of this year’s package that states submitted on, and so we developed a new guidance. We formed a committee of state directors, folks from academia, family groups, people who have a vested interest in the block grant. We made revisions, we got feedback in terms of the areas that states would like to see revisions around or where we knew we could improve, we got the feedback from the states, and we got final approval for the Block Grant Guidance in May. So, as many of you know, that application is due in August and we were at least fortunate enough to have a very solid draft out back in February and that, in fact, when it was finally approved, there were no changes from the draft that ONB asked us to make, which may be a record, I’m not sure. But at any rate, we also worked with Science Application International Corporation, or SAIC, who are our electronic, our technology consultants around the web based application. So even though web based submissions is going to become the standard for HRSA, we were bit out in front of that with the block grant application and the folks--and many of you know Chris Dickton, you spoke to him by phone, and helped people walk through the block grant application, and other people, Stephanie Olson, will be here at the meeting through the week and we’ll have a table out there. We’re still wanting to collect feedback on this year’s application so we know how we can continue to improve the process. We’ve established a call center and, oh, how do you go back on this? No, you don’t know. Well, you have it out there, there’s the blank screen. And many of you know the call--the back key. Chris Dickton is the key person that you’re going to reach with the go for HRSA 877 number and we received a lot of very positive feedback about Chris and being available and helping people work through the web based submission. Actually, the feedback that we’ve gotten to this point is that in fact the forms piece has worked very well. The narrative piece, which had to be uploaded and was done differently than the form section, probably still needs to have some work, particularly on the length of the section and how much information can go into those sections, and so we’re still wanting to get feedback on that. But basically, what you see in the new application is an overall reduction in the redundancy and hopefully a more seamless narrative. We’ve converted many of the core health status indicators into something called health system capacity indicators that are reported annually. The developmental status measures are still very important, but perhaps don’t see as much change in those on a year-to-year basis, and so we’ve asked you to report on those with the needs assessment. So a state can choose to report them annually, but at least to report them with a needs assessment. We looked at using a three-year moving average. Many of the states had small population, even some of the larger states had small numbers on some of the performance measures and suggested that states look at using a three-year moving average, that there is a stand alone needs assessment, which has been by report helpful to states to have a document that they can actually use, but in actuality that wasn’t really what the motivating force was in doing it because many graphs and charts were used and it really wasn’t conducive to a web based submission, that the needs assessment actually is an attachment. Elimination of types of services and the ability to develop and have an annual report created basically through an electronic navigational tool through the application itself. Just a little bit about the review. We continue to have face-to-face reviews with the states in August. We find it very helpful to be able to go out and have that kind of interaction. The state is probably the one opportunity other than this meeting and the AMCHP meeting that we can go out and focus with the states and hope to continue doing that. It’s also an opportunity to look at needs assessment opportunities or desires while we’re out there. And just to quickly go through here because I’m being told I’m out of time. Two things: one is that many of you may be anxious to hear about your block grant application, whether there were any requirements, any recommendations, when you might be expecting your first payment for the year. As you know, we actually mailed out the approvals, whether there were any requirements or recommendations, this past week. So they should be waiting for you when you get home from this meeting. All in all, they were excellent applications, and I want to applaud all of the states for providing such excellent information and data to us. The reviews went extremely well. We really tried to refocus the reviews from an editorial review of a document to really an interactive discussion on what states priorities are, how you’re doing in reaching those performance measures that you’ve set for yourself, and what we can do to help you. And all of the feedback that I’ve had from our staff, the other outside reviewers, the family reviewers that went out, were really very excellent, and so I really want to commend you on your applications. One, considering how late you actually got the guidance and that it was a web based submission, so I think a lot of kudos are there. And then finally, just because you are new, one thing that I think is important for you to keep in mind is that your state is really--you see one state Title V program, you see one state Title V program and you may think that they all run the same and it’s really not true. State organizational structures are different. The programs that you have responsibility for outside of Title V such as WIC, Family Planning, (inaudible), all of these programs vary from state to state, and so I really encourage you while you’re here to get together with other states and talk to them about how their systems run. I think that there’s a lot of information that you can share. And we’re also trying to provide, tomorrow, an opportunity since you are new, that we’ve organized lunch tomorrow around regions, and I think hopefully that will be helpful for new folks here so you’ll know who to go sit with and talk to over lunch tomorrow and have the opportunity to have a regional meeting around lunch. So I’ll stop there and see if there are any questions. Thank you.