AMCHP: A Guide for Senior State MCH

Managers Combined as One

Cathy Hess: Hi. I’m going to start talking. Even in advance of having the power points. In the old days we actually used to talk without power points. I’m the C Cathy, incase you couldn’t tell, Cathy Hess, and I’m glad to be here, and I’m half of the duo that produced a brand new product that will be coming out from the Association of MCH programs, AMCHP. I think they’re really going to unveil it at their annual meeting, coming up, is it March this year Deborah, or February? End of February this year. This product is a guide for new leaders, such as yourselves, many of you, who are coming into positions perhaps with a lot of experience from other places in your agencies, other programs, but are new to actually being a leader of a Title V program. And part of what the guide is going to talk about, what you’re going to see up on the overheads is what does that mean? What exactly is a Title V leader? That was probably one of the most challenging thins as we worked on this guide. We ended up calling it, I think you’ve got a copy of the overheads, “Leading State Title V Maternal and Child Health and Children with Special Healthcare Needs Related Programs: A Guide for Senior Managers.” And we got to that title, I would tell you, from input from a focus group. The process of developing this guide relied very heavily on pulling together a very small but very helpful group primarily made up of state leaders in Maternal and Child Health and Children with Special Needs programs, some of them relatively new. I think some of the people in the group had experience of less than a year, together with more veteran leaders, if you will, and a few folks that were not in state leadership positions but who worked closely with state programs and had been in positions prior to that, people like Donna Peterson, who many of you may know, who’s now at the University of Alabama at Birmingham, Holly Grayson who’s now at Johns Hopkins University. The impetus for putting together this guide came from I would say sort of a number of years of sheer concern as we saw a lot of turnover going on in the field. Turnover that actually in many respects is something that’s very healthy; it’s bringing in new perspectives into the program, there’s more of a diversity in the leadership of state programs, new knowledge coming in, all of that’s very positive. But at the same time, the fact that turnover’s happening much more quickly than it did--this is it, so we just don’t need our notes. The fact that that turnover is happening so rapidly just underscored the need to try and provide some common starting points, some common basis, knowledge base that would be useful to folks starting out in their leadership positions, regardless of where they came from. Because some of you have come from perhaps other state agencies, some of you have been in the Maternal and Child Health program or the Special Needs program for quite some time, but have moved up the ranks. Some of you are coming perhaps from private practice. This is the kind of diversity that we’re seeing in the leadership. So our attempt in putting together this guide and the direction we got from our focus group was to really try and cover a number of bases, and what we’re going to do today, we can’t possibly cover all the content that’s in the guide, but we’re going to kind of hit the highlights of what’s in the guide and talk to you about some of the key concepts. And we’re basically going to divide up this presentation as we did the work and putting together. Although, I have to now, as we get this up, give credit to my collaborator, Kathy. You know if you’ve studied leadership, that one of the key qualities of a good leader is a good sense of humor and I hope I have a good sense of humor, but I would say that Kathy actually is the one who is excellent at picking out graphic pictorial representations that hopefully will give you a smile at the end of the day because we know it’s been a long day. Well, I can’t really move over.

Unidentified Speaker: Yeah, we’re really locked in here, this thing (inaudible) locked us in here.

Cathy Hess: Do you want me to go somewhere else? I mean, move over to the table?

Unidentified Speaker: I think I’ve got it now. I think I’ve got it now.

Cathy Hess: You’ve got it?

Unidentified Speaker: As soon as I get this hourglass (inaudible) open it.

Cathy Hess: I can just keep working without it, but where do you--do you want me standing somewhere in particular? All right. We’re switching laptops.

Unidentified Speaker: (Inaudible). Do you have this program on something else? Do you have it on a disk or something?

Cathy Hess: Yes, we have it on a disk.

Unidentified Speaker: Okay because this disk is not going to work at all.

Cathy Hess: Is there anybody in the room that was on our focus group? I think Jeanette Shae Ramirez might have been. Oh, Meg. Meg Booth from AMCHP was part of the group. I know Jeanette was on the list to be here; she might’ve been with us earlier. It was basically based on the input of that advisory group, and I guess I’m supposed to be by the mic, that advisory group. We did also collect and review and share with the advisory group similar manuals from other organizations. It’s actually, I think, a sign of the turnover that’s going on, the change that’s going on in general in the environment now that a lot of organizations similar to AMCHP were putting, had already put together or were in process of putting together very similar guides. The Association of State and Territorial Health Officials has a guide. I think the National Association of Substance Abuse, Substance Abuse Directors, basically, was in process of finalizing one. There were a couple of groups like the Association of State Lab Directors that were planning on putting one together. So once again, AMCHP has sort in the vanguard here, and we looked at all those tools. That was also part of our background research. And we did a little bit of homework following the advisory group on leadership concepts because that was another key point that the advisory group made, that they really wanted this to be based on the concept of leadership. In our discussions about who this was really aimed at, we had a lot of conversation about what a Title V Director was. The target group that the focus group really wanted us to aim at was the senior management team, understanding, and I think Cassie said this just a little while ago, understanding that titles, exact responsibilities, all that varies state to state. People felt it was important to capture whatever your title was, that this was the audience that we were aiming at and also understanding that it does take a team within a state, a management team. Okay, so now we’re on track. And I think I’ve pretty much covered this other than to say I mentioned that AMCHP is going to roll this out at their annual meeting. AMCHP is intending on this being a web-based publication. All right. Dennis Ribino was someone who wasn’t able to actually join us at the focus group, but we included him in reviewing a draft of the document. He’s a relatively new MCH in Delaware although he’s got a long track record I know in HIV programs. And we asked members of the group if there were some key quotes they could give us that would capture some of their thoughts about (inaudible) about being a director, and you can see Dennis’ quote here, that the common denominator--I was just talking about what is, you know, what is a director? What is there in common? Dennis really emphasized the commitment to the population. Millie Jones, if you don’t know Millie, you should get to know Millie. She’s one of the veteran directors who’s been a long time active in AMCHPs leadership. Millie is in Wisconsin. Millie, despite all her years, said that this guidance is one of the best support systems around. “If I can’t have one of the seasoned AMCHP experts in my back pocket, this guidance is the next best thing.” So that’s our testimonial. And here’s Kathy’s humor coming, this is the first time I’m seeing these. And I think the point here is that no matter, you know, where you sit in the bureaucracy, you actually do have power. You may not always feel like it, you may feel like you’re being dumped on, but in fact you’ve got power. Okay. So again, I covered some of these points, but who we’re aiming at are senior managers and state agencies. Just by virtue of being a senior manager you’ve got some power. That you’re responsible for some or all aspects of the Title V MCH Block Grant; that you address the needs of women, children, children with special healthcare needs, adolescents, or family health, even a broader area. And we want to underscore that this really puts you in position to make real a long-standing national commitment to women and kids. This is not just about managing a small piece of federal dollars. It’s about a much longer legacy of this program and a national commitment to the health of women, children, youth and families. So remember that you’re one of 59 teams, management teams, in the country with this kind of responsibility. I think, again, Cassie mentioned this, Title V is the infrastructure, the glue. We give it a lot of different names, but usually you’re going to be overseeing a broader range of programs like WIC, like the Family Planning Program, like Birth to Three. The unit you’re in could be called all sorts of things; it may be called MCH or Children with Special Needs, but it may also be called Family Health or Community Health. But you are responsible, your team, for the essential public health services for all, and we underscore all women, children, youth and families, including kids with special needs, and you’ll find that word “all” in the Title V legislation. These are some tips we included in the very front of the guide. If you in fact are just starting out, some very basic things, obviously to understand the job, and I think we’re talking about understanding that from your state’s perspective, but also, again, from this national perspective. And I think the guide, when you get it, if you look over the first couple of chapters will help you get oriented to that national piece, as well as all this material from the Bureau. Ask your staff and ask your colleagues for briefing documents to get grounded in what the program does. Get to know your program staff early on. Become nationally involved through AMCHP. There’s lots of ways to do that, and I know Deborah Deitrich, the acting Executive Director is going to be talking later on in the meeting. I’m sure she’ll touch on some of the ways you can get involved in AMCHP. One of the important things that AMCHP makes available, in partnership with the MCH Bureau, is a mentorship program where newer leaders are paired up with more veteran leaders. So that’s one way that you can actually get to work with a colleague who is in a state with perhaps some similar characteristics to yours and learn hands-on about some of the nitty-gritty of this job. But we’re really emphasizing again, Title V is the foundation for your work. And so we’re talking a lot about, thanks again to Kathy, we’re talking not just about what’s above the surface there, what’s in the Title V statute, what’s in your state job description, we’re talking about sort of what’s underneath that, what doesn’t get talked about, what’s really critical for you to know about? I missed Dr. Van Dyck’s presentation this morning, but I assume he touched on a lot of this history, but our guide does cover some of it. If you know a little bit about it or if Dr. Van Dyck touched on it this morning, you know that the history of Title V actually starts before Title V in the Federal Children’s Bureau, and there was a strong emphasis on data, on the power of data to lead to action to improve health status. There was the Sheppard-Towner Act that proceeded Title V of the Social Security Act. That was the first time that there were federal grants and aids provided to states. It was the beginning of the federal state partnership, if you will, and of course it was in 1981 that we saw amendments that created the Block Grant. For those of you who were around at that time, you know that that was actually, despite some flaws in that legislation, that was a major victory to preserve a focus on women, children, youth, and families. The proposal at the time was for a much larger Health Block Grant, and interested parties mobilized and were successful in preserving something focused on women and kids. OBRA 89 brought some much-needed changes to improve accountability. We got the flexibility that you all needed in ’81, but there was a lot of concern about the lack of accountability; we got that in ’89. Dr. Van Dyck and his team have built on that with performance measures, etcetera. We cover in the guide some key conceptual frameworks. I’m not obviously going to be able to go through all of these. Some of these you’re going to hear a lot about over the course of this meeting, if you haven’t already. The MCH services pyramid that the Bureau has developed, the family centered comprehensive coordinated and culturally competent community based systems of care that the Children with Special Healthcare Needs Division, in particular, and Dr. McPherson have provided a lot of leadership for, and those concepts are now being adopted throughout maternal and child health programs. And essential public health services, going back to the top, which are really the overall public health framework, the 10 essential public health services which have been translated, if you will, into MCH terms by Johns Hopkins University. There is a framework available that kind of tailors those essential services to MCH. And the other thing I would just note about those is those are very consistent with the pyramid. If you look at what’s in that infrastructure, the very bottom base of the pyramid, that’s a lot of what we’re talking about with the essential public health services, is building that infrastructure. Other key concepts that we talk about: systems building. The fact that programs are not just responsible for filling gaps by providing services, but by really taking a number of different measures to try and improve the system of care available to women, kids, and families. That’s from needs assessment and planning functions, training, quality assurance activities, some research and demonstration activities, all of those help to build a stronger system. Family involvement has become, again, central. It started again with strong emphasis in the kids with special needs program. It is something that MCH programs are trying to adopt now across the board. We’ve got some information on that. And the concept of the program being population based, that actually, despite the program having a lot of roots in child welfare. This is a program that is really aimed at improving the health of all, not just poor, although it focuses on those that have special needs or are at risk, have problems with access; it’s really aimed at the entire population. Now what that population is is actually one of the key questions for the future, this focus on women, the focus on men and fathers. So what are the boundaries now of the MCH population? And one of the key questions I think that are being debated in talking about the future of the program. Title V at national and state levels is another major section of the report. I’m only going to touch briefly on the state level because this meeting is all about helping you get oriented to the federal component. And again, I think that Cassie Lauver touched on some of these points, but just to reiterate, there is incredible variation state to state. You already know that or you’re learning that as you talk to your colleagues at this meeting. There are some common denominators; the program must be in a state health agency, although these days, with a lot of massive reorganizations going on at the state level, it’s a little bit even hard to tell sometimes what the state health agency is. But the Title V program must be administered, or it must supervise the administration; the state health agency must supervise the administration of the Title V program. The structure that’s a broader family and community health emphasis is becoming more common. Structure across the states, and I think that’s been documented in some AMCHP survey work. There are still major agency reorganizations going on that raise questions and issues. It’s been said that in some states it’s difficult to find the focal point on women, kids, and families that MCH is all about. So that’s something to watch and to make sure. I think the bottom line in the years that I was involved with AMCHP was to make sure there was in fact that focal point, there was expertise, there was a database to plan specifically for the needs of women, kids, and families. There’s also a lot of variation in the function and the emphases of the program, so there’s a sort of a common range. But in terms of where programs put their emphasis, where their resources go, that’s going to vary state to state. Some of that varies still by historical patterns. For example, the south has tended to be an area where there’s been a lot of direct provision of healthcare services because there are large numbers of poor in those states. Some of the states that are perhaps in the northeast, or northwest, on both coasts where there were more providers, perhaps were earlier on doing some of the other core functions more extensively and were contracting out their services, a trend that we’re seeing more across the country, and that is all changing as managed care evolves, as coverage expands. There’s also variation, you just look at the participant lists here, in leadership and staff backgrounds. Again, some of you are coming in with clinical backgrounds, some of you are career administrators, but there needs to be attention to in fact where are those next leaders coming from and what are those core capacities and skills that we need in place in programs. That’s partly what this guide is about. It’s partly what some of the support that Ann Drum’s division gives to the training programs to produce those future leaders. So speaking of leading, we discussed some ways to lead. Even though you may be, again, far down that totem pole, and even though your budgets may be relatively small, say, compared to Medicaid, you still have power. There actually are some leverage points in Title V, not just in the legislation itself, but in other pieces of federal legislation that give you a little bit of a hook as you try and work with some of your other agency and program colleagues. There are specific provisions in Medicaid that address Title V. If you don’t know those, you should look into those; you should research those. Those provide the basis for having interagency agreements with Medicaid. There are some exceptions that Title V falls into. For instance, Medicaid can still reimburse services that are offered for free if there are Title V support for those services. Medicaid otherwise is not able to reimburse if the services are offered for free. That particular provision often comes in handy in setting up school-based health programs if the school based clinic does not want to have to bill insurance for every single kid coming in, and if there’s Title V money in that program, they don’t have to do that. Those kinds of things are handy to know. There was an exception made for children with special healthcare needs in more recent Medicaid managed care amendments. There’s sort of a complicated definition of kids with special needs, but the Title V definition is part of that. The SCHP, State Children’s Health Insurance Program, legislation: I think we would’ve liked to have seen more language in there, but there is some language that in evaluating that program there does need to be some evaluation of coordination with MCH. An old provision, but one that’s still important is there is a requirement that SSI programs are to provide their lists of kids that are enrolled to Children with Special Healthcare Needs Programs, and this can be an excellent way to reach out to those kids and make sure that they are in fact linked to the system, provide them with care coordination if they need it. This is a provision that came in very handy at a time in federal history when a lot of those kids were getting cut off the rolls and Title V was able to reach out and make sure that those kid’s eligibility was being determined properly. And most recently, when Healthy Start was authorized there was language in there to require coordination with state programs. Use the vision thing. Now this is a general leadership concept, as you know. Actually in the guide we have the more complete statement of AMCHPs vision of healthy families and healthy communities. The Bureau has a very nice vision statement that’s included in the guide. But think about your vision, be able to communicate it frequently, get it in 30-second sound bites, if you’ve studied communication skills. But your passion, back to Dennis Ribino’s quote, your commitment to the population can get you far. Tips for building partnership are in there. I’m not going to go through all of these, but a lot of this is about making connections with key stakeholders; some of that can be done by joining groups. Making that overture to your state chapter, the Academy of Pediatrics, for instance, is something that that link used to be common. It may not be as common anymore. Forming task forces and advisory groups, finding ways to involve all of your different constituent groups. And some of these tips are verbatim from our focus group. The more difficult the relationship the more important it is to meet face to face. Never, ever, burn your bridges. And then the complete quote from Donna Peterson, be a good listener, always be willing to meet people halfway. Do not be afraid to help someone get their needs met first. And build your reputation as someone who’s trustworthy and honors their commitments. Okay, Kathy says the moral of this cartoon is, be the dog, not the cowboy. Okay. We do talk about education and advocacy as a way of exerting influence. Advocacy I know sometimes in state government is sort of like a verboten word. But education, in fact, is one of those essential public health services, it is part of your job, and advocacy is simply education that’s coupled with a call to action, which really is also an essential public health service; it’s part of the policy leadership called for in those functions. Lobbying, I didn’t even want to put up here on an overhead, but really, lobbying has to do with really acting on a specific piece of legislation. That’s the specific meaning of lobbying. If you’re not out there saying pass HR whatever, or oppose senate whatever, then you’re not lobbying. If you’re trying to educate policymakers about what the needs of women and children are, that’s education, and if you tell them that a new program is needed to address some of those needs, that’s advocacy. And there’s a variety of ways within your position that you can do that. As we talk in the guide, it’s very important to know what the rules are in your state and what the bounds are, but sometimes often there’s a lot more room than you think there might be, until you start looking around and asking. Some of the ways that you can really educate and advocate are through again your data, your information, having effective analyses that you get out to stakeholders. You could hold briefings and conferences. Invite key policymakers to those events. You could host site visits for policymakers, have them come visit your programs. You can be in task forces, advisory committees; it can mean coalitions. Making sure, again, that you get information out. I know sometimes you get done with a report and it seems like you’re done, and that piece of actually making sure you’re communicating effectively and disseminating it widely, sometimes doesn’t get as much attention as the actual content of what you’re doing, so make sure that you’re marketing effectively, you know, using easy to understand graphics, maps, maybe spend a little bit of money on having it look like a professional document and making sure that you’re not just presenting data, but you’re telling stories with that data. And families can come in at that point and really be effective working with you in telling the story. And I’m going to turn things over to Kathy Peppe now.

Kathy Peppe: Thanks Cathy. I’m Kathy Peppe. I’m the Kathy with a K, and I’m sure you can tell that by the pronunciation, right? The second half of this guide is sort of the perspective of how do things really work at the state level. Cathy’s portion talked a lot about sort of the history, the foundation, the roots, and so on, of the Title V program. The take home thought I want to give you here is you’re not alone. You don’t need to feel like there’s nobody who understands the job functions that you’ve got, the stressors that you experience at work, and the joys that you find in your job. They do. There are other folks who are interested in the same things that you’re interested. They are in your state. They are your peers in other states and at the national level. This chapter of the guide gives you tips on how to find those people. It starts with a quick review of the legislative process at the national level and the state level; does a quick comparison of how they differ from each other and how they’re similar, and it sort of gives you a little primmer on, for example, how a bill becomes a law. Now I know you’ve had that, but it’s been a long time for most of us, and this just gives you the real deep, you know, the nitty-gritty. It talks about budgets, how they’re established at the federal level, how that differs, again, at the state level, and it gives you clues to things such as what’s the difference between an authorization level and an appropriation level, important things for you to know. It talks about the federal partners, not only the Maternal and Child Health Bureau, but some different program areas from Centers for Disease Control, the Primary Care Bureau, Medicaid, all of the various programs that come under that part of HHS and so on. And last but not least, it talks about the resources available to you from the Association of Maternal and Child Health Programs. There are regional counselors out there who should be in touch with you, especially since you’re new in your program area. They’ll welcome you into the association, they’ll be there to answer questions for you and to help you find other folks who have the same questions you do or who have found the answers to those questions, even more importantly. Excuse me. It gives you tips, again, I’m not going to go through them, but that are applicable at the national or the state level. Such things as keeping one page simple descriptions of each of your programs available so that when a legislator calls and says, “What’s with this children with special healthcare needs program? What does it do anyway?” You can give them the quick thumbnail sketch: how many kids have been served in your state, how much it’s cost, and so on and so on. Keep those things on hand because you never have enough time when somebody asks for it to develop that sort of material. So those are some of the kinds of tips that the guidance gives you. Then we go into planning and managing resources for effectiveness or for results. This section of the guide focuses on the basic information on working with families, strategic planning processes, leadership skills, budget administration, and strategies for managing scarce resources. In the family involvement, Cathy’s really talked about how this is already a key concept of the guide, and we consider families to be integral to the planning and management processes that go on in Title V programs at the state level. There have been national surveys that have shown over the last decade that increasing numbers of parents are involved in our programs and that’s a good thing. As a new Title V leader, this guide will give you some tips for how to identify who the parents are that are already involved in the programs, how to identify parents who aren’t yet involved but need to be involved, and helps you find ways to surmount the barriers that every state system and every territorial system puts in the way of including families. Such things as how do you pay them for the time that they’ve spent? How do you pay for childcare? How do you pay for their travel expenses and so on? All of those are barriers within our state systems that you’ll have to learn ways to overcome to help parents be involved in our programs. It gives tips, again, as we’ve mentioned, and then goes on to talk about strategic planning processes. It explains the difference between strategic planning and long range planning that’s more traditional nature. Strategic planning really has six stages: the environmental scan, evaluation of the issues, which gives you a description of what the current state of affairs are; talks about forecasting so that you have a desired point that you want to reach and then helps you with goal setting to get you to that desired point. And then of course you’ve got implementation of the strategies, and then last but not least, monitoring to help you figure out whether or not what you’re doing is going to get you to your goal or to the desired point. Talks a little bit about the logic model, and that is a methodology that is becoming increasingly popular to help you generate the questions that are useful for evaluation of your programs so that you know whether or not what you’re doing is effective in helping you reach your goal. And then finally gives you some discussion about the decision making process and why that’s important. If you don’t make decisions, things will definitely come to a screeching halt and it will become increasingly more difficult to make a decision if you’re fearful of making a decision. So the guide kind of gives you that little courage or that little push to go ahead and make the decision. Think it through, but make the decisions. John Hurley, who’s one of the folks that’s taken a look at this guide for us and participated on the focus group that Cathy was talking about, gave us a quote that said, “Be tolerant of ambiguity but by all means, organize, prioritize and closurize,” not close your eyes, but closurize, “and if you don’t do that you may be the cat that ends up inside the birdcage instead of the bird.” The guidance material also talks about how to manage your resources, talks about various leadership styles, helps you try to identify what your leadership style is. Talks a little bit about how do you win your staff over. You’re new on the job. Obviously somebody was there probably before you because these programs have been around for a while. How do you avoid the pitfalls of, “Well, so and so never did it that way,” or “We used to do X, but you’re asking us to set that aside.” Well, that all takes leadership skills in helping to win over your staff, not just their minds, but also their hearts, and so we talk a lot in this about this. But again I think the take home thought here is always guard and protect your reputation for honesty and credibility. If you lose that, you’ll never get it back. So whatever it is that you’re doing, be sure that you’re honest with everyone that you come into contact with. Talks about the basic management skills, gives a little information about these, but most importantly, directs you to other resources where you can find out lots more information than this simple guide will. So if you’re interested, for example, in learning a lot more about how you coordinate resources, we refer you to reference material for that. Since this is going to be a web-based publication, we’re also hopeful that AMCHP will be able to do hyperlinks so that it will take you to those. So if you’re wanting to know more about the Maternal and Child Health Bureau’s Guidance, there should be a hyperlink that will take you directly to that guidance material. It also talks about how to survive reorganization in your agency, and that’s no small undertaking, believe me. It’s nerve racking, it’s scary, it acknowledges that these things happen, they happen at the federal level, they happen at the state level, it’s going to happen to you sooner or later if you stick around long enough, but it talks about some survival skills for that. It goes on and talks about grants, budgets, and accountability. This is really the last chapter, and again gives you the basics in this area. It describes the relationship between the State Health Plan that exists in your area and the Title V programs. It gives tips for organizing your staff and obtaining public input into the Title V application. It does not repeat what’s already available to you in your Title V Guidance document. I think we tried to be scrupulous about staying away from duplicating what’s already there and available. Consider this to be a companion document to that guidance. It tells you how the states and other states and other territories, what things they’ve done to organize themselves to get that application done. Such things as a checklist is included in this document. This gives you the tools to help you think through the really nitty-gritty, the basics of how am I going to get this application done for heaven’s sakes and how am I going to do it by the deadline date when it has to be turned into HHS. And knowing full well that you have to get it through clearance within your system before it ever leaves your hands. It’s a big job. Once you’ve accomplished it, we’re advocating that you take the time to celebrate the accomplishment of this job with your staff members. It may be a little pizza party over lunch, it might be taking folks out for a night on the town. You know, whatever rows your boat, but the point is, take the time to celebrate the accomplishment of this; it is no small task. Joan Whitekin talks about if you don’t know where you are you’re not going to know where to go next. A needs assessment is a great starting point. And this one says, maybe next time you’ll try a little sunscreen. So do a needs assessment to know where you want to be. We’ve done a checklist here as well. Every five years the Maternal and Child Health Block Grant requires that you go through a needs assessment. Again, we’re not repeating what’s available to you in the guidance material. We’re giving you tips such as put one person in charge. Give them the power to be the czar for your needs assessment. Make a master plan, that’s starting with reading the guidance document and making a list of all of the tasks that have to be done, gather all of the existing documents into one place, and so on, so that you can figure out what has to be done, what the timeframe is, who’s in charge, and so on, who’s responsible and who’s going to ride herd over the people who you’ve divided that out into. Even in small locales where you may be the only person doing that needs assessment, you will have other folks that you will be asking questions of and it helps to have a calendar to know what you have to do by when. One of the most important parts of your job is getting mastery of your budget. If you don’t know how much money you have, you’re going to be at everyone’s beck and call, and you will be taken to the cleaners by others in your agency. If they quickly find out that you are on top of your budget, that you know where you’ve got money, you know where you’re out of money, you know what the restrictions are on that spending, you know what the state policies are related to the use of that money, then you’re not going to get taken to the cleaners by other programs or other people that you work with, well meaning as they may be. It gives you some ideas for having maybe a little bit of money so that if your state agency director comes to you and says, “I’ve got this legislator who is on my neck and they need to have a prenatal program set up in, you know, Podunk,” you may have just a little bit of money to get some seeds started and planted there. So it gives you those kinds of helpful advice. Most of all, the thing to remember is when you’ve gone through that needs assessment process and developed your priorities for your needs for the block grant, you’ll know whether or not you’re achieving that priority by taking a look at where your money is going, so this is your opportunity to put your money where your mouth is. If you’ve gone through the prioritization process and the bulk of your money is not going to your, let’s say, top five priorities, then why not? It’s your time to really take a look at it. You need to understand your state budget process. You need to know what your budget calendar is. It differs from state to state. You need to know what your legal responsibilities are as the fiscal steward for the block grant funds and for all of the other grant funds that you get in your state that come under your scope of responsibility. You need to be able to prepare support materials so that when you’re asked what does the Maternal and Child Health Program need out of the state budget, you know what it needs, you can document that you’ve got a need, you can demonstrate exactly where you would put that money and to what use, and to what benefit. And it advocates, for example, participating in meetings where the budget is being discussed. Now this guide sounds like the answers to all of your prayers, doesn’t it, as a new person? Well, this actually is a real place, and coming from Ohio, we don’t often, this time of year especially, mention the word Michigan, but there is a *Hell, Michigan and AMCHP promises to you that this guide will be available to you soon, before hell freezes over. Okay. That concludes the presentation. Any questions for Cathy or I about the guide? If not, I think Deborah Deitrich is going to be talking about that tomorrow maybe--Wednesday, in her presentation, and she may have a little bit better handle on exactly when this may be available, but look for it soon on the AMCHP website. Okay. I'm sorry? It’s www.amchp.org. And Cathy and I are doing a roundtable Tuesday afternoon and we’ll be talking further about the guide. So with that, thank you very much.