MCHB 2006 Federal/State Partnership Meeting

October 15-18, 2006

MARIE McCORMICK: Good morning everyone. How are you? We're glad you're here today. We hope we piqued your interest, I guess we piqued your interest a little bit yesterday with Future Search.

I'm going to ask you if you don't mind to work up here, because we'll be working as together on this which you'll learn in a few minutes called the mine map. If you can move up to these rows, that would be terrific.

As we mentioned I'm Marie McCormick a member of the Future Search network, as my colleagues. It's a nonprofit organization that does a methodology of two and a half day planning methodology called Future Search. Future Search has been done literally all over the globe and literally for every kind of organization and on every kind of issue you can imagine.

It's been done in nonprofit. It's been done in corporations. It's been done in communities. It's been done in northern Ireland and Africa. Really all over the world.

As someone said in the large group meeting, it seems to tap into something so basic to humanity that it allows us to talk and have conversations in a way that sometimes have been impossible.

And because of these heart felt and important conversations, it helps a group to move to action to acting together in ways that they haven't been able to do before. And so to get us started, Future Search, a core belief of Future Search is that what needs to be known is in the room, that you don't need experts to come. You can invite experts and that they bring a point of view and that everyone there brings an important perspective.

And so it's very participative, and we're not too large a group. What I'd like to do is pass the mic and just say your name and where you're from. The state, the organization, and this is quick. We're just going to pass it quickly so we get a sense of who is in the room. And I'll start.

DICK AARONSON: Oh boy, it's loud. Dick Aaronson from Maine.

CYNTHIA PITTS: Cynthia Bryant Pitts from Milwaukee.

UNKNOWN SPEAKER: Suzanne (inaudible) from Guam.

ELLEN VOLPEY: Ellen Volpey for the Division of State and Community Health.

UNKNOWN SPEAKER: Brian (inaudible) Texas.

UNKNOWN SPEAKER: Dr. Rosalinda (inaudible) from Puerto Rico.

MARY MOSK: Mary Mosk from Milwaukee, Wisconsin.

LUCILLE BARING: Lucille Baring from Milwaukee, Wisconsin.

ANN SWENFORD: Ann Swenford from Kentucky.

MARIE MANN: Marie Mann from the Maternal Child Bureau.

DON SCHWARTZ: Don Schwartz from Vermont.

KATHY TOUCHEY: Kathy Touchey of New York.

LORRIE COOPER: Lorrie Cooper from Virginia.

UNKNOWN SPEAKER: (Inaudible) from the Maternal Child Health Bureau.

ROBERT DILLON: Robert Dillon, Family Health State of Delaware.

ELIZABETH McGUIRE: Elizabeth McGuire from MCHB.

UNKNOWN SPEAKER: (Inaudible) Maternal and Child Health.

MARIE McCORMICK: And I want to remind us again of the principles that Future Search is based on and to say, to begin with, because this is an important message from us, is that Future Search is two things: It's a set of principles that you can go-- we know that you're already using in your work and that you can go back to your work and enlarge upon when you leave here today. So one thing is it's a set of principles about how we work with each other.

And the second thing it is, it's a two and a half day meeting.

And so obviously in this three-day session, with lots of other things, we can't do the whole two and a half day meeting. So you are not getting a full Future Search experience. And as it is a process, you certainly can't get the whole thing.

But what we wanted to do today is go again over the principles and then to take one piece of the Future Search, piece called the mind map, and have that experience together and then talk about it and talk about how it fits into the whole process.

So let me begin by just reviewing a few things. The first is that there are eight conditions for success and you'll recognize the first four because they're the principles that Dick talked about yesterday.

The first condition for success is whole system in the room. And what that means we know you can't really get the whole system in the room. But what you try to do is get around 64 people or eight groups of eight, more or less, that represent the various stake hold per groups that make up the whole system.

And there's a planning committee that works in advance of the Future Search so it isn't the consultants who decide what represents the whole system or who needs to be there. But this planning committee, which ideally is also representative of the system that says we need these groups and we need these specific people.

And then we'll have as best we can the whole system in the room to tackle the task, which is also defined by the planning committee. So the first condition for success is the whole system in the room.

The second is global context, local action. When we're doing Future Search we start big, we look at history over a 50 or 100 years. We look at trends in the world and it's not until the last day that we talk about and what are we going to do about it.

So we set a global context. We start big and then we move towards and what am I and what are we going to do together to impact this.

And please, if you have a question, just raise your hand. Feel free to. The third is common ground and future focus. I don't know about you but I go to a lot of meetings that I walk out frustrated because we've spent a good deal of the time talking about what we can't agree on. That ever happen to anybody?

Usually we get a chuckle on that. So what's different here is that we know there are differences. There are always going to be differences. But we make a conscious choice, instead of focusing on what's different to focus what we hold in common. Because if we understand what we agree on, then we can act together on what we agree on and maybe the things that we don't agree on will follow later and maybe they won't but we can start where they start. We start with what we can agree on. Self‑managed small groups.

When we're in a future group as I said there are eight groups of eight. And really the role of the facilitator is a very easy one we set up the task, we give instructions. The groups themselves they manage themselves they bring in the data they make sense of the data, they do the work.

And that is a foreshadow of when we leave the meeting that we trust the Future Search principle, that people have what it takes. They don't need a grownup telling them what to do, they have what it takes to get the job done. And so we start that during the meeting.

So there are the four you heard before. And the other four conditions for success are full attendance.

So what we mean by that is when we have a two and a half day meeting and we start talking to the planning committee and inviting people and people go two and a half days, I gotta go for 16 hours. I can come for four hours on the first day and two hours--; we say, thank you anyway. But do you know someone who can come for the whole 16 hours, because it's a process, and we need you there the whole time.

So that's what we mean by full attendance. So when you go to a Future Search, the 64 people pretty much are there from beginning to end, from the past to how are we going to act together.

Healthy meeting conditions. Then we're setting up a Future Search we look at the place we go to the room are there windows, are people going to be comfortable. If you're going to be there for 16 hours that's pretty important.

It's a three-day event. You sleep twice. I need to say something about that. I have been an organizational consultant for about 12 years. I use a lot of different methodologies in my work, I know all of us do.

I can tell you sincerely that Future Search, in its design, and I didn't design it, Marv Winesboard and Janice designed it, it is exquisite in that it sets up a space for people to really be able to hear each other and talk to each other and act together.

And so very intentionally the work is spread over three days. It's a half day--normally a half day, a full day, and another half day. And it is very intentional that there's sleeping time. So you can soak on it. So there's uncomfortableness you go home with.

Very intentional. So oftentimes Future Search people will say can we do it in one day, two days, can we do that? We really push back because the process, the time, the soaking all of that is important to help a group get to where they need to get to.

And the last condition for success is public responsibility for follow‑up.

Again in alignment with the philosophy of Future Search. People can do it. So they stand up and say here's what we're going to do in groups or individually. Here's the actions that we want to take to make pour dream happen. And it's very outloud.

So there are the conditions of the success of a Future Search.

So that's kind of the underneath part. So what do we do in this two and a half days? And we've mentioned this but I'm just going to go over it in a little more detail. We start with the past of where we've been, and I'm going to get real ‑‑ I'm going to paint pictures of what we do so you get a feel for this.

Imagine a room like this and all over the walls you see we like to use paper and flip charts. There are large strips of paper and people are sitting in their groups of eight. And we begin by asking people to look at the past in terms of the issue they're exploring, in terms of a global, in terms of an organization and a personal perspective.

And let's say we ask them to look back 50 years and everybody gets up within the very beginning of the meeting and starts writing on these time lines and filling in, creating the history of the organization, the world and themselves, as it relates to the task at hand.

And people walk away from the past saying, you know, we really have a lot in common. We're all in the same world. We're all dealing with a lot of the same things.

So we begin with the past, where we've been. And then we move into the present, where we are now. And we look at trends impacting our world. And that's the point I'm going to highlight this. This present is what we're doing today. We're going to build what's a mine map of trends impacting maternal and child health, leadership legacy and vision.

And where this piece fits in is it's part of the present exploration in a Future Search. So that's what we're going to do today. That's just a part of it.

After we've explored the present, we move into the future. What we want. And in a Future Search, groups of eight put on skits. And people go oh my gosh I hate skits. No, they love them. It's been my experience. I've done many Future Searches they wear costumes and crazy things and they sing and dance and write rap songs. But the important thing is that they depict the future that they want for the organization or for the issue, for the task at hand.

And each of the groups looks at the other groups and starts thinking to themselves you know we have that in common. We didn't have that in common, you're observing it's the beginning of seeing what do we all hold that we want for the future? And it's done through skits.

It's fun and it's meaningful. There's a lot of meaning. The skits are remarkably creative and have a lot of meaning.

So after the future we come to the common ground, and for me this is where the rubber meets the road. It's what we all want.

So picture the whole group sitting in a fashion like this. Having listened to the skits, having pulled out themes and then having about a two hour conversation with 60 people and coming to agreement on these are the things that we all want for the future. These are the things that we believe we can make movement on together.

So there may be some things we can't yet ‑‑ that's our term, we don't yet agree. So we post them and we don't work them, but we acknowledge them.

But when we're done with the common ground discussion, we know what we all want. And then we move to action and in keeping with the philosophy of Future Search, people decide what they want to do.

So groups self‑organize around action steps that they made that will help realize the future that they've agreed on.

So as you can see, it would be a very interactive meeting. And there's work individually. There's work in the small groups. There's work, a lot of conversation in the large group.

And so that is a very brief kind of description of Future Search and what we're going to do today, which is the mind map that fits into the present.

Are there any questions before I move on, just clarification questions? Does that make sense?

Okay.

UNKNOWN SPEAKER: Just (inaudible) do you make them put away their Blackberries and phones and telecommunications devices antennas, et cetera

MARIE McCORMICK: That's not silly. Now, the really answer is that the planning committee. I mean yes. But everything is a decision of the planning committee. So the planning committee would decide how that exactly is given as an agreement to the group. But yes because it's full ‑‑ remembering full attendance is so important there has to be full attention as well.

Anything else?

All right, I'd like to move on to the mind map. And we're going to create a mind map together with the help of Dick and Cynthia who are going to be our scribes. And what a mind map is is a form of capturing brainstorming. It's a graphic depiction of, in this case it can be used for many things, but in this case trends that are impacting the present, the present trends that are impacting maternal and child health.

And there are some ground rules that I'd like to introduce. The first is this is a group brainstorm. No evaluation and no censorship. So someone names a trend and you think to yourself, that's not true. It doesn't matter what you think. So this we want to get the perceptions of everyone in the room. So we'll write that down.

And then you get your chance to raise your hand and say the opposite. So they know what they say is their point of view how they see the world.

The second is state it as a trend, an increase or something or a decrease in something, so you'll say I see an increase in use of technology for example and use those words I say I see a decrease or increase in because we're looking for trends.

The next rule is the person who names the trend or issue says where it goes. That's a little foggy at this point. But what that means is if you raise your hand and say a trend, you're going to say to me or to the scribes, either that's a new line, that's not one that's already up there, or you're going to say that comes off of the red line about technology.

And so you'll tell us that's where it goes. And the important point here is the person that names the trend says where it goes. So even if the rest of the room thinks it goes somewhere else, it's the person whose named the trend that gets to place it.

Opposing trends are okay. I think I've already mentioned that, and we may ask you to give examples. If we're not clear on the trend you're talking about exactly, we may ask you to expand a little on what the trend is.

So that's it. So when we're done we'll ask for trends. You'll raise your hand. I may use a deli system, one, two, three, four, five, to keep things moving. We'll write them on here and when we're done we'll have a beautiful colorful map on what's impacting maternal and child health and when together we'll make some sense of what's on the map.

Ready?

UNKNOWN SPEAKER: Dick: I wanted to make sure the folks who joined us introduce themselves.

UNKNOWN SPEAKER: Chris (inaudible) pediatrician, New York State Department of Health.

ERIC COLLIER: Eric Collier, Future Search Network.

MICHELLE PURYEAR: Michelle Puryear, Genetic Services Branch Maternal and Child Health.

PAT McMANUS: Pat McManus Coalition Wisconsin.

MARIE McCORMICK: Noted Cynthia highlighted, we're in the present. So who had a trend? And we're going to pass the mic. A trend or decrease in something.

UNKNOWN SPEAKER: We see an increase in the number of grandparents raising grandchildren.

MARIE McCORMICK: I'm going to pause a little to give time to our scribes.

UNKNOWN SPEAKER: Increasing number of non‑English speaking immigrants into this country.

MARIE McCORMICK: Is that on that line or a different line?

UNKNOWN SPEAKER: Going with the grandparents?

MARIE McCORMICK: It's probably a different line. I just want to get us in the habit.

UNKNOWN SPEAKER: No, it's a different line.

MARIE McCORMICK: Thank you.

UNKNOWN SPEAKER: New line. Public funding for Maternal Child Health issues is decreasing.

UNKNOWN SPEAKER: Access to gaps and barriers to accessing healthcare particularly for oral and mental health.

MARIE McCORMICK: Can you repeat that?

UNKNOWN SPEAKER: Gaps and barriers to accessing healthcare particularly for oral and mental health services.

UNKNOWN SPEAKER: Increasing or decreasing.

UNKNOWN SPEAKER: Increase in gaps and barriers. Thank you.

UNKNOWN SPEAKER: And that was gaps in ‑‑

UNKNOWN SPEAKER: In accessing healthcare in general but we're seeing much more particularly for oral and mental health services.

UNKNOWN SPEAKER: An increase in teen pregnancy.

UNKNOWN SPEAKER: Where would that go?

UNKNOWN SPEAKER: Since a lot of them are unmarried, I would be inclined to sort of group it in with the grandparents raising children but others may feel differently

MARIE McCORMICK: You get to name it.

UNKNOWN SPEAKER: I'd put it in with the grandparents raising children.

UNKNOWN SPEAKER: As the geneticist, I have to say this: Increase in the anticipation of the use of genetic technology

MARIE McCORMICK: Increase in the anticipation of the use of genetic ‑‑ new line?

UNKNOWN SPEAKER: New line

MARIE McCORMICK: Thank you.

UNKNOWN SPEAKER: Increase in STDs on the same line as teen pregnancy.

MARIE McCORMICK: Same line as teen pregnancy.

UNKNOWN SPEAKER: And that was S ‑‑

UNKNOWN SPEAKER: STDs.

UNKNOWN SPEAKER: Increase in overweight and obesity and at the same time decrease in physical activity.

MARIE McCORMICK: Where would that go, Elizabeth.

UNKNOWN SPEAKER: Out of the central

MARIE McCORMICK: New line?

UNKNOWN SPEAKER: Right.

MARIE McCORMICK: I'll start giving numbers. One, two, three.

UNKNOWN SPEAKER: This goes into the increased gaps and this would be a sub ‑‑ a line off of that in accessing service for oral and mental health.

It would be decreasing number of providers trained to deliver services in oral and mental health.

UNKNOWN SPEAKER: Increase in violence against children in schools.

MARIE McCORMICK: Where would that go?

UNKNOWN SPEAKER: I think it stands by itself

MARIE McCORMICK: So increase in children ‑‑

UNKNOWN SPEAKER: In violence against children in schools

MARIE McCORMICK: Okay thank you. I'm sorry.

UNKNOWN SPEAKER: I see an increase in homeless parents

MARIE McCORMICK: Where would that go? Homeless parents.

UNKNOWN SPEAKER: And children. I don't know where it would go. I guess on the grandparents

MARIE McCORMICK: Thank you.

UNKNOWN SPEAKER: Following up with what Marie said because it's more of a general problem, there's a decreased number of subspecialty providers period

MARIE McCORMICK: Where is that?

UNKNOWN SPEAKER: New line. I mean it's going to be related to that but it's not about oral health. It's about subspecialty care, period

MARIE McCORMICK: Do you have it Cynthia or do you need to say it again.

UNKNOWN SPEAKER: I don't have it

MARIE McCORMICK: Would you mind repeating that.

UNKNOWN SPEAKER: A decrease in the number of subspecialty providers

MARIE McCORMICK: Decrease in the number of subspecialty providers.

UNKNOWN SPEAKER: Increase in uninsured.

MARIE McCORMICK: Increase in uninsured. Where would that go?

UNKNOWN SPEAKER: With teen pregnancy. I'd make it a new one.

MARIE McCORMICK: Okay.

UNKNOWN SPEAKER: Decrease of uninsured.

UNKNOWN SPEAKER: There's an increase in the disconnect linguistically with a lot of the immigrants not being fully fluent in English. So there's a communication problem even when they're receiving medical care of communicating what's wrong.

MARIE McCORMICK: Does that go under the increase of ‑‑

UNKNOWN SPEAKER: I think it would go under the increase number of nonspeaking immigrants as an off shoot.

MARIE McCORMICK: Thank you. Number two.

UNKNOWN SPEAKER: Decrease in national leadership.

MARIE McCORMICK: Where would you put that?

UNKNOWN SPEAKER: I think it's a new line. Because I don't think it's always related to the funding.

MARIE McCORMICK: Decrease in national leadership.

UNKNOWN SPEAKER: (Inaudible) an example of that.

MARIE McCORMICK: Can you give an example of decrease in national leadership?

UNKNOWN SPEAKER: I can say there are not as many spokespeople at the national level who can articulate the needs of the uninsured, for example, or needs for coverage and oral and mental health.

MARIE McCORMICK: So spokespeople about maternal and child health issues, leaders.

UNKNOWN SPEAKER: Yes, of national ‑‑ actually, I think it's both. I think it's national and local.

MARIE McCORMICK: It's not limited? Okay. Thank you.

UNKNOWN SPEAKER: Under the increased uninsured, there's also increased cost for insurance and decreased coverage.

MARIE McCORMICK: That two separate ones?

UNKNOWN SPEAKER: Put that as two separate ones.

MARIE McCORMICK: So just say it one more time.

UNKNOWN SPEAKER: Increased cost for insurance and then a decreased amount of coverage service, decrease of covered services.

UNKNOWN SPEAKER: I have one more question, this is all maternal and child health, do you talk about sort of the elephant in the room. Because we're talking about the present. We're in a war.

MARIE McCORMICK: Certainly. If it's a trend that is in the world that impacts in some way maternal and child health, then absolutely.

UNKNOWN SPEAKER: Okay. We're in a war.

MARIE McCORMICK: So the increase is ‑‑ trend is.

UNKNOWN SPEAKER: Increasing wars.

UNKNOWN SPEAKER: New or connected to any of these?

UNKNOWN SPEAKER: I think it's a new one.

MARIE McCORMICK: Deserves its own line.

UNKNOWN SPEAKER: Increased use and dependence on technology and so like computer, it's more than electronic technology, I guess, television computers, electronics.

MARIE McCORMICK: Is that a new line or is that ‑‑

UNKNOWN SPEAKER: I think it's a new line.

UNKNOWN SPEAKER: Linked to obesity and lack of exercise?

UNKNOWN SPEAKER: I would think that obesity and physical activity would come ‑‑ it's as a cause. It could be a potential cause of just like it could be a cause of increased violence, but it's not ‑‑ I don't see it as a ‑‑ I don't know how you relate ‑‑

MARIE McCORMICK: Remember that. Sometimes we'll make a connecting line and remember that every line is connected by the circle in the middle. So it assumes that they impact each other. But if you see one that impacts something else so strongly then we'll connect them. Then you would say connect that with.

UNKNOWN SPEAKER: Do they hear a connection?

UNKNOWN SPEAKER: Yes, I see a connection with the increased obesity decreased physical activity as well as the increased violence against school, children in schools or something.

UNKNOWN SPEAKER: Increase.

UNKNOWN SPEAKER: Did we capture that right. I'll give numbers again one, two, three, four. Elizabeth.

UNKNOWN SPEAKER: So connected to the increase in wars, a decrease in awareness of current events around the world and current political activities either in the U.S. or around the world.

UNKNOWN SPEAKER: Thank you. Mass media, communication affecting adolescent behavior.

MARIE McCORMICK: Increase or decrease.

UNKNOWN SPEAKER: Increase.

MARIE McCORMICK: Increase in mass media affecting adolescent behavior. Where would you put that one.

UNKNOWN SPEAKER: Maybe a new one connected to violence and teen pregnancy.

MARIE McCORMICK: Okay on that one. The first one was increase in mass media affecting what?

UNKNOWN BEHAVIOR: Adolescent behavior. Thank you.

UNKNOWN SPEAKER: Decrease in education.

MARIE McCORMICK: That's connected to violence? And anything else?

UNKNOWN SPEAKER: (Inaudible)

MARIE McCORMICK: Thank you.

UNKNOWN SPEAKER: Decrease in education of our children.

MARIE McCORMICK: Where would you put that?

UNKNOWN SPEAKER: I guess violence against children

MARIE McCORMICK: Violence against children in schools. So it's decrease of the education of our children. Thank you. There was a number three.

UNKNOWN SPEAKER: Decrease in the value of preventive services. I think this fits in around the uninsured and that cost breakout

Decrease in the value of preventive services and coverage of preventative services.

MARIE McCORMICK: Does that need clarification of that or was everyone okay with that? Was there a number four?

UNKNOWN SPEAKER: There's an increase in, I don't know how to say this, it's almost like an increase in the amplitude of natural disasters, and you know that causes a federal response tore an expectation of a federal response.

Katrina is a good example and then I don't know where to tie it in, but that eats up budget dollars that would be otherwise allocated for other resources and you know it's like a hamster in the wheel, and it ties in, it's going to be like an ugly spider web when I get done with this explanation. I think it's its own line but it will connect to several other things, because the dependence on technology, you know if you talk to anybody who is in Louisiana after Katrina, the problem with the cell phones is the power grid is at ground level and you wind up with the cell phones not working. So the PDAs don't work. And so if radios don't work, so they can't get the emergency medical services people where they're needed, the hospital's basement is flooded, that's where the power generator was, because nobody figured the city would fill with water now the hospitals don't have light, heat, oxygen, they don't have telephones, and the communication grid totally crashed for the first three days.

UNKNOWN SPEAKER: What is the first thing?

UNKNOWN SPEAKER: The first thing it's an increased ‑‑ increase in natural disasters. That triggers a response.

MARIE McCORMICK: Do you want those responses coming off that line?

UNKNOWN SPEAKER: Yes, you would have to respond emergency medical services.

MARIE McCORMICK: Increase in emergency medical services.

UNKNOWN SPEAKER: Right.

MARIE McCORMICK: I don't want to put words in your mouth.

UNKNOWN SPEAKER: And as we saw in Katrina, you wind up sharing emergency medical services from other areas, vis‑a‑vis EMTs, ambulances fire trucks, whatever, things were so bad in New Orleans and not to diminish Mississippi but other states had to come to the aid of that particular region.

MARIE McCORMICK: Okay.

UNKNOWN SPEAKER: So that taxes the entire infrastructure. It's kind of like it almost becomes like a domino theory.

MARIE McCORMICK: Increase in that taxing, federal disasters or disasters taxing the federal system.

UNKNOWN SPEAKER: That's correct.

UNKNOWN SPEAKER: Reduced resources in other states that had natural disasters at the same time.

MARIE McCORMICK: Okay. So does that capture pretty much what you said.

UNKNOWN SPEAKER: Yes, I think. And it will be added to in further discussion. I wanted to get it on the table.

MARIE McCORMICK: Did I call everyone who had a number. Let's go here and there.

UNKNOWN SPEAKER: Increased and I don't know if this is the right word, but variety of families. So it's what constitutes family is more variations. So it would be connected to increased grandparents ‑‑ look at that. Raising children.

UNKNOWN SPEAKER: Writing a book.

MARIE McCORMICK: Cynthia, do you have that? Decrease in ‑‑

UNKNOWN SPEAKER: It's an increase.

MARIE McCORMICK: Increase in the variation of families. So there's more kinds of families. More makeups of families.

UNKNOWN SPEAKER: The structure.

UNKNOWN SPEAKER: That's right.

MARIE McCORMICK: Family structure.

UNKNOWN SPEAKER: This is a separate line. Decrease in social connectedness.

MARIE McCORMICK: Decrease in social connectedness. Then I'm sorry I can't see your name.

UNKNOWN SPEAKER: Decrease ‑‑ decrease. Thank you. You have to keep us honest. You can imagine my job is easy. This is the tough job. This is the tough job here.

UNKNOWN SPEAKER: We also have an increase in hunger.

MARIE McCORMICK: Where is that?

UNKNOWN SPEAKER: What do we have up there? Maybe that's a new one.

UNKNOWN SPEAKER: The decrease in social connectedness, I think, relates to the increase in or potentially an increase in violence against children in schools. And then there's a whole series of things that can relate to that amplitude of natural disasters, because children's lives get disrupted. Families are on the move. Children also were living in mass concentrations where they were exposed to possible pedophiles and other things of that sort.

So that whole area of natural disaster has a lot of things that can go on to it.

MARIE McCORMICK: Let's make sure we capture what you said. Start from the top. So the first one is ‑‑

UNKNOWN SPEAKER: The first one I said there's a connection between the decrease in social connectedness and the increase in violence against school children.

MARIE McCORMICK: Okay. And then the next thing they are ‑‑ lines off of this?

UNKNOWN SPEAKER: No, I think something is added to the amplitude of natural occurrence of natural disasters. And that would be the disruption of the lives of children and exposure of children to hazards, which can be defined in many ways.

MARIE McCORMICK: Thank you. Could you pass it there, please.

UNKNOWN SPEAKER: There's an increase in entrepreneurial philanthropy.

MARIE McCORMICK: Where would that go?

UNKNOWN SPEAKER: New line.

UNKNOWN SPEAKER: Increase to exposure to infectious diseases.

MARIE McCORMICK: Where is that?

UNKNOWN SPEAKER: New line.

MARIE McCORMICK: I'll stop for a minute to catch up. Increase to exposure to infectious diseases.

UNKNOWN SPEAKER: Can you give me an example?

UNKNOWN SPEAKER: Did you say philanthropy or entrepreneurial ‑‑

UNKNOWN SPEAKER: We're a global world now so diseases are global. So when they start talking about just natural disasters, sort of (inaudible) increase in exposure to ‑‑

UNKNOWN SPEAKER: And managing.

UNKNOWN SPEAKER: But it's new and present and emerging diseases.

MARIE McCORMICK: Thank you. Let's take just about three more and then move on. You can see this could go on for a very long time. Let me say anyone who has one right now raise your hand we'll take you and then we'll stop.

UNKNOWN SPEAKER: I have a question. We're getting, and I don't know do you worry that this is very pessimistic, very cynical?

MARIE McCORMICK: It often is. So if you think that there are things that are optimistic that we're missing, make sure we say them. Make sure we include them. That's how the room is seeing the world right now as it relates to maternal and child health.

UNKNOWN SPEAKER: Disruption in the family planning, decrease in the family structure.

MARIE McCORMICK: Where would that go?

UNKNOWN SPEAKER: I guess that would go under (inaudible).

MARIE McCORMICK: The variation of family structure, is that what you're talking about. There's one that says an increase in the variation of family structure, would it be related to that or no?

UNKNOWN SPEAKER: Yes.

UNKNOWN SPEAKER: Because it (inaudible) maybe there.

MARIE McCORMICK: Is it a new line? You tell us.

UNKNOWN SPEAKER: Whatever you say.

MARIE McCORMICK: Whatever you say. It's whatever you think.

UNKNOWN SPEAKER: New line because family structures are being destroyed nowadays.

MARIE McCORMICK: Thank you.

UNKNOWN SPEAKER: Increase in the flatness of the world.

MARIE McCORMICK: Can you tell us what you mean by that?

UNKNOWN SPEAKER: That systems are interconnected. It ties in with technology but more than that people are more connected as a result of technology, things are shared globally a lot quicker. Good things and bad things.

MARIE McCORMICK: Where would that go?

UNKNOWN SPEAKER: New line.

MARIE McCORMICK: New line. I'm going to start over this side and work over one last sweep.

UNKNOWN SPEAKER: Well, increased people caring for others.

MARIE McCORMICK: An optimistic.

UNKNOWN SPEAKER: That's a new one.

UNKNOWN SPEAKER: Increase in unsafe food supply.

MARIE McCORMICK: I'm sorry?

UNKNOWN SPEAKER: An increase in an unsafe food supply.

MARIE McCORMICK: Where would you put that?

UNKNOWN SPEAKER: It's a systems issue. But I'm not ‑‑ maybe a new one. It might connect.

MARIE McCORMICK: Increase ‑‑ I'm missing the word ‑‑ unsafe food supply. Thank you.

UNKNOWN SPEAKER: An increase in MCH research.

MARIE McCORMICK: Where would that go, Elizabeth?

UNKNOWN SPEAKER: New line.

UNKNOWN SPEAKER: There's an increase in medical procedures. It's very positive. They're operating on infants and even babies in the womb now taking care of heart valves and situations which, you know, 25, 30 years ago, almost certainly would have resulted in an infant mortality.

So I mean medical procedures have improved probably 100 fold. So there's a wonderful opportunity if people can get to the hospital and get medical help that they're going to be saved where in the past you know they would have been part of the bureau of statistics.

MARIE McCORMICK: Where would you put that?

UNKNOWN SPEAKER: I would say that's probably either a new line ‑‑ I would say it's a new line, because it's not really dependent on technology. It's technology‑driven but there have been vast improvements in medical procedures, life saving.

There's equipment in the hospital now that can monitor things before that were life threatening that used to go unnoticed.

So I think that that's a positive from a technology standpoint.

UNKNOWN SPEAKER: Under social connectiveness I'd like to have a line for an increase in the gap between the very rich and the very poor.

UNKNOWN SPEAKER: Increase in the need for people to be informed and making their own healthcare decisions.

MARIE McCORMICK: Where would you put that?

UNKNOWN SPEAKER: I think that's a new line.

MARIE McCORMICK: So just say it one more time.

UNKNOWN SPEAKER: Increase in need for people to be informed and able to make their own healthcare decisions.

MARIE McCORMICK: So I'm going to stop there. And what I want you to do next, what I want us as a group to do next is to begin to make some sense of these trends. What are they telling us about what's going on in the world impacting maternal and child health.

And in order to do that we have the made and the normal Future Search the planning group would decide what the eight stakeholder groups are. Because this isn't a real Future Search Dick and I made these this morning to our best knowledge and we came up with four stakeholder groups that we think are in the room. Federal, state MCH, state CSCHN and community family and others.

Does everyone in this room see themselves, does it make sense in one of those four groups?

Yes?

UNKNOWN SPEAKER: What are the others?

MARIE McCORMICK: Others are if there's something we haven't thought of and you don't really see yourself fitting somewhere else.

UNKNOWN SPEAKER: I'm there. But what about the professional organizations or nonprofit organizations.

MARIE McCORMICK: Are there in this room a number of people who are professional, from professional organizations or nonprofit? I'm asking. So in a regular Future Search that would probably be a stakeholder group. In this, if it makes ‑‑ if it's okay with you ‑‑

UNKNOWN SPEAKER: That's fine.

MARIE McCORMICK: Then we're putting it in other, just so you can sit with other people and have a conversation. So we tried to make as much sense as we could with the people in the room.

Okay. So you'll see that there are colored dots next to each of these, and Cynthia has the colored dots. And so we're going to be standing here with the each of the packets of the colored dots. If you would come to us and get it's a strip of seven dots corresponding to the color of the stakeholder group that makes most sense to you. And what we're going to ask you to do with those dots is to come up and look at the map and ask yourself the question: Which trend or trends do you think have the most impact on MCH leadership legacy and vision, which are the most important trends from your perspective. And then you'll use the dots to say where you think the importance is.

So you can put one dot on seven different lines or seven dots on one line, or anywhere in between. And usually we get the question, should it be on a particular spot? If there's a sub line that you really think is important.

So put it on the line that you really think is important. Whether it's the major one or whether it's the sub line. So you each get a strip of dots. Come up, take a look at things and then vote with your dots as to what you think are the most important trends impacting maternal and child health.

Directions clear?

UNKNOWN SPEAKER: Directions are clear. However, in looking at the mind map, maybe ‑‑ I'm looking for one of the lines and I just need a clarification. When do you do it.

MARIE McCORMICK: Doing it now.

UNKNOWN SPEAKER: Increased care taking care of others, what do we ‑‑ caring for somebody or people emotionally caring.

UNKNOWN SPEAKER: It could be broad. You could care for people that need mental health. Could you care for children that needs to survive in an EQ area. You could care for all of us care for the health.

MARIE McCORMICK: Is that what you mean?

UNKNOWN SPEAKER: But also like public health service, care for the whole nation health. It could be direct versus public health service.

UNKNOWN SPEAKER: You mean there's more care than there used to be more people caring for other people.

UNKNOWN SPEAKER: More people caring for people in different ways.

UNKNOWN SPEAKER: More people fighting for services ‑‑

UNKNOWN SPEAKER: Caring. Like here we all care about the care of our nation so there's more people caring, versus what he says about the technology, there's more technology for ‑‑

UNKNOWN SPEAKER: So we are more concerned.

UNKNOWN SPEAKER: We could say that.

MARIE McCORMICK: Answer your question? Then come up and get your dots.

UNKNOWN SPEAKER: You need to identify your stakeholder group.

UNKNOWN SPEAKER: We need a sense of the numbers. How many of you are in this group? How many in the state MCH. Children with special health needs? And families and community.

MARIE McCORMICK: Would you feel comfortable going with the other stakeholder group.

UNKNOWN SPEAKER: Because then everybody will know what my thoughts are. Can't be anonymous.

MARIE McCORMICK: So federal is green. State is red and families community and others is yellow. So come on up, get to your dots.

MARIE McCORMICK: Now I told everyone to sit down and now I'm wondering if you can see the dots from where you are. Can you? Were you able to see? Are there a lot of dots?