MCHB 2006 Federal/State Partnership Meeting
Charting a Vision for MCH - Part II
October 15-18, 2006
ELIZABETH MCGUIRE: --from a special health care needs. And planning, as we've heard, is perhaps the most important part of running a Future Search. So today in the second hands-on session, we're going to just dive into what planning a Future Search is all about. And we're going to look at how states and communities can be affected and also we want to learn how this is intertwined with MCH. So Dick Aronson and Eric Collier are going to lead us through this process and I'm going to turn this session over to them. Oh, all right, Cynthia Pitts, Bryant Pitts or Pitts Bryant?
CYNTHIA BRYANT PITTS: Bryant Pitts.
ELIZABETH MCGUIRE: Bryant Pitts, Liz Alperin Solms, and Marie McCormick are also all going to facilitate this session.
DICK ARONSON: Thank you so much Elizabeth and thank you all for hanging in here this afternoon. How many of you were at either of the mind map sessions today so we can just get a sense of that. Okay, great. Well, I will briefly--for those who weren't and could those who weren't just--sorry, raise their hands, okay. These are the two mind map, here is one of the mind maps that came from today and before we get going to the planning I want to again give you a bit of a context where we are in terms of this whole thing. Sorry for the distance here but, again, the four Future Search principles that apply to everything that we do in Future Search and the first one is getting the whole system in the room and the second is looking at the whole picture before acting on any parts. The third is focusing on the future in Common Ground and treating problems and conflicts as information but not to be worked on, and the fourth is self-managed learning and responsibility for action. And before we get started, does anybody have any questions or comments about those principles as we've been--this is now our, like it's our fifth or sixth session as we've been talking. I want to make sure that people have a sense of that. Okay, what I'd like to do is again, if we could just briefly introduce ourselves so we know who's in the room and then we'll get started, so--
DON SCHWARTZ: Don Schwartz from Vermont.
ANNE SWINFORD: Anne Swinford from Kentucky.
PATRICIE ONHEIBER: Patricie Onheiber from Wisconsin.
DR. ROSSALINA VALKRISSEL: Dr. Rossalina Valkrissel from Puerto Rico.
DR. JONES-HICKS: I'm Dr. Jones-Hicks from New Jersey.
TAMMY GALLOP-MILNER: Tammy Gallop-Milner from North Dakota.
BETH SCHOBER: I'm Beth Schober from Wyoming.
JUDY WRIGHT: Judy Wright from Nevada.
KAREN TRUWILER: Karen Truwiler from Colorado.
CATHY TUCCHI: Cathy Tucchi, New York.
ELIZABETH MCGUIRE: Elizabeth McGuire, local.
ELLEN FOLPEY: Ellen Folpey, MCHB.
ANN DRUM: Hi, Ann Drum, Maryland.
DENISE SOFGA: Denise Sofga, Maryland.
DICK ARONSON: Great, Okay. Planning for a Future Search. As we said yesterday as well as today, the planning for a Future Search is extremely important and if you can get through the planning the Future Searches is a breeze, and I really mean that. To get the stakeholders identified, to get a very clear idea of what the task is, what the issue is exactly that you want to address in you community, or your state, or your home organization, and to have agreement among the planning team is really key. What it takes to start--get this going is one or two people who are really energized about a particular issue in maternal and child health and want to work on it, and within the Future Search context and then get a group of about 8, 9, 10, 11, 12--8 to 12, 6 to 10 people. You want it to be small enough so that it can be a working group over several months, but you also want to really reflect the principle of the whole system in the room so that as you plan the Future Search you become enriched by the very experience of planning it. So planning itself becomes part of the Future Search experience. That's a really important point. So, what we're going to be doing today is, we're going to really give--and also, we really mean this self-management principle. I mean it's a different way of doing business at least from my own background in medicine and public health. This is where we really share the responsibility and everybody has the capacity to be a leader and to contribute something special to an issue. And I know we have some folks in the room who have been through some Future Searches and I would encourage you all to contribute to this. But we're going to go through a process now and I'm going to turn it over to Eric and we will move from there.
ERIC COLLIER: Hello again. So, here's the process, first thing we're going to do is brainstorm five or six different things that you all might see that you have applied Future Search technology to. And then we're going to actually form small groups just as you would if you were a planning team to actually flesh out the idea of the topic in terms of its underlying purpose, how it relates to your overall vision, and then you'll actually figure out which stakeholder groups you might need in order to deal with this topic fully, and then layout what next steps you would have for that. A planning meeting might last--any given planning meeting might last an hour-and-a-half to two hours. So you're going to have 30 minutes to discuss those things among yourselves and then we'll have report outs, okay? So for now--you're going to write? Good, then I could just hold the mic. For now, what we'd like to do is get topics from you that you would use Future Search to address. So think about what you've heard thus far about Future Search and if you participated in one of the other sessions, you got a flavor for what this is all about. So in your own experience, what do you think you would use Future Search to deal with? What would make a difference for you?
DICK ARONSON: Or another way is what do you want to work on too?
ERIC COLLIER: Yeah.
MARIE MANN: I'm Marie Mann from Maternal Child Healthcare and I guess, is this just from our work experience or some areas that we could see applying this--
ERIC COLLIER: Something that you would want to work on, so look into your own experience and say, what is it that I want to tackle here?
MARIE MANN: Okay. And actually, we've actually have talked about possibly applying this is, we're involved in newborn blood spot screening, and specifically there is, around the issue of long-term follow-up, and we're very much interested at the national level of better defining what long-term follow-up and what are the components of a long-term follow-up. Because there are certainly multiple stakeholders who would be involved and many of them have--we have done a preliminary survey of those stakeholders and they come from--they all have different ideas. And before we can design or make recommendations as to what--bringing some uniformity of what long-term follow-up should be, we need to hear what everybody's idea is and then define what those common elements. And it was this morning when I was hearing that this would be a useful tool, a process by which we could come together and identify, hopefully some common ground and from which then we can structure a program.
UNITENTIFIED SPEAKER: It's very profound you see what you dropped? Yes, right.
UNITENTIFIED SPEAKER: (Inaudible)
ERIC COLLIER: I think the earth actually moved. Okay, someone else?
UNITENTIFIED SPEAKER: We've done three different Future Searches, but I was seeing there thinking as we're looking at ways to implement our Early Childhood Systems Development Plan that the thing to do would be to have one to bring state-wide group together instead of just the 20 or 30 that were involved in that plan. But get involved the casinos, the faith communities, whoever we would need to bring to the table to really get it implemented.
ERIC COLLIER: So just to clarify, you've already done your state Early Childhood Plan? That's completed and now the next step--thank you.
UNITENTIFIED SPEAKER: We were thinking about in two different ways, one was with our next--because we start our Title V needs assessment process relatively early because we have a lot of parts to it. We really thought about this in terms of that when you have your stakeholders involved in the prioritization and collaborative planning phase of it, that this could be useful. And then from the special healthcare needs side, I'm thinking about a little bit in terms of some medical home planning and collaborative activities around that as well.
UNITENTIFIED SPEAKER: Wyoming would like to use this as we try to figure out the fair and equitable way to create a funding formula for our local communities that we fund with our MCH dollars.
DON SCHWARTZ: In Vermont, we're considering a system wide approach to the obesity issue and this sounds like a very good way to try to bring everybody together and determine where the opportunities and common interests are across the whole system.
UNITENTIFIED SPEAKER: This isn't something that I'm working on but I could see that this would be ideal for Future Search is the whole immigrant issue of how we treat immigrants. The volatile feelings of everyone and I could really see that we need to have some policies that work and I could just see--I mean it might be early, hopefully it wouldn't be a terrible experience but I think it has to be dealt with and I could see that in a community really focusing on that.
UNITENTIFIED SPEAKER: Okay, is there another one?
UNITENTIFIED SPEAKER: Yes. Two more.
UNITENTIFIED SPEAKER: Parenting connection as a strategy to prevent teen pregnancy, STD's, violence--what we deal in the morning with social connectedness.
UNITENTIFIED SPEAKER: Not just parenting and social commitment (inaudible)?
UNITENTIFIED SPEAKER: We reached the number eight.
UNITENTIFIED SPEAKER: The integration of health and human services data beyond just the health department.
ERIC COLLIER: Okay, so we have nine you all see those. So what we'd like to do right now is have you all form into two groups of eight. We have 16 people in the room, so whoever the last person who has showed up thank you very much for making us two complete groups of eight. And given the law of averages it's not likely that two groups will pick the same one, but, so I want you to self manage now, and get yourselves into two groups of eight around two of the tables, so eight and eight. I think we'll have them choose a topic. Okay, so here's the task that you all have to perform. First thing is that you need your self-management role so you need a discussion leader. The discussion leader is the person who makes sure everyone talks, or everyone has the opportunity to talk. We don't make people do anything in Future Search unless they don't want to participate. And there's a timekeeper, so you'll have 30 minutes from the time we start, so someone needs to keep track of the time, so that you complete the task, and someone to take notes, and someone to give the report, okay? Now, so that's what you have to do first, and then you choose a topic. So, which ever one you like, I suppose it doesn't matter that much if you all choose the same one, but maybe something that the group has some energy around that you all can discuss amongst yourselves and reach consensus about. And then, so then you want to--once you've selected your topic, you want to make sure that or you brainstorm, what's the underlying purpose of this topic. And then explore the--why it is important within the context of MCH Title V Leadership and Partnerships? Develop a list of eight stakeholder groups, so these are the people that you would need that are connected to the task that you would need in the room to complete the task. And then decide on next steps within your group as to what you need to do the complete the planning for the Future Search, okay? I'm going to give you some paper to deal with that.
DICK ARONSON: What I want to--just pick up on it. I sense some real energy about some very specific issues from individuals here, so I would encourage you, if possible, to choose a real live topic that you would in fact would like to and want to work on, and would take that back with you, because there was some great energy in that discussion, so turn this into a real experience.
UNITENTIFIED SPEAKER: It's an exercise but--
DICK ARONSON: Yeah.
UNITENTIFIED SPEAKER: --It's time for kind of a real--any questions about anything?
DICK ARONSON: And then, how much time?
UNITENTIFIED SPEAKER: Thirty minutes.
DICK ARONSON: Thirty minutes, and at the end of 30 minutes, we'll report out from each group, and then we'll have a dialogue.
UNITENTIFIED SPEAKER: All right.
DICK ARONSON: Thank you. I know that we--usually we spend more time--okay, okay. Okay, okay, we're ready to go. All right. Please, just a sec, okay? We're ready to go now. Okay, what I'd like is that for each group to report out and again what we're reporting is what you agreed to be the theme or some statement of what this Future Search Conference is going be about, what the theme of this is going to be about, in a way that people will understand. And then the stakeholder groups that you've identified in your conversation. And then we'll have a dialogue among all of us are about this. So who would like to go first?
UNITENTIFIED SPEAKER: Okay the topic that we choose was parenting connections. How to improve parent to teen relationships. We want to establish a program to strengthen the bond between parents and adolescent children to prevent and reduce risky behaviors such as pregnancy, violence, STD's, suicide, early sexual activity, gangs, and substance abuse. Because research has said that if we have a better connection between parents and their kids, there are going be less risky behaviors, or risky--the kids will involve less in the risky behaviors. So we thought about the stakeholders groups to be parents, youth, faith-based organizations and community organizations, experts on the positive youth development model, youth organizations, educators, health professionals, social services, judicial law, business, and researchers.
UNITENTIFIED SPEAKER: That was pretty good. And she just wants to escape. Who's the girl that's going to go?
UNITENTIFIED SPEAKER: One of the few lone public health MCH men. We talked about gathering interlinking data and using it to improve child outcomes and life span. So essentially we broke this down into eight stakeholder groups, of course the reason we want to link data is to help us to understand better how Early Childhood outcomes can effect later adolescent health morbidities, which of course cost us more money. To hopefully using this kind of data warehouse, we can demonstrate, return our investment and make the business case for those of us who like the business case. We found eight stakeholder groups, at least need the major state agencies, anyone who'd be inputting data into the data warehouse, so as to the major payers will also be there. We need IT, legisla--
UNITENTIFIED SPEAKER: What's IT?
UNITENTIFIED SPEAKER: The--yeah, the computer guys. Legislators, major insurers--From a state level, we need to have our local and regional partners. University Research Community, legal, because we have HIPPA issues, health insurance portability. But at some point, acronym is not an acronym. I mean, HIPPA is not an acronym, it's like CDC. Epidemiology, folk representation from your pre-epi bureau or branch. Advocates of the family, privacy advocates, I think I said legal and then you want to get into the hospitals, the doctors, the providers, that kind of group. So those of you did end up like the State Medical Association, the AAP, that kind of group. So those would be our major stakeholders, we have to whittle that down to eight, so we can get down to 64.
DICK ARONSON: So let's open it up to discussion and questions. And how much more time do we have Marie? It's 4:30
UNITENTIFIED SPEAKER:
ERIC COLLIER: Thank you. Others wait hold on, okay.
UNITENTIFIED SPEAKER:
ERIC COLLIER: Okay, that's a really good question.
UNITENTIFIED SPEAKER:
DICK ARONSON: Thank you. Yeah, good question. It's a really good question, and to answer that I want to go back to one of the flip charts, which is the agenda for a Future Search Conference. Remember we talked about a Future Search Conference is a two and a half day event that you guys are going to be planning for. It's going to take several months for you to get to the point of actually holding the conference. The number of months and the time depends on various factors. One of the factors is having enough lee time to make sure that you have all the people in the room that you want and need to have in the room. And in such--and for that you need to have a certain amount of lead time because you're asking for a commitment over two and a half day period. You also need enough time, as a planning group, to come to an understanding of what you really, really want to do with this Future Search. What do you want to see, yeah, come out of it. What do you really want, yeah, what do you want see come out of it. And then the Future Search itself consists of five parts. The first is an examination of the past, where we've been, and we have timelines going back 50, 60 years, that everybody fills out in three areas. The global timeline, the personal timeline, and the issue at stake, so in your group it would be connecting parents of teenagers, with teenagers, and your group would be the data linkage system. Then you move in to the present. And today, we had two sessions, in which we did one aspect of the present that you do in a Future Search, which is called a Mind Map. Up there on the wall is one of the mind maps that came out of today's session. And that's where everybody, together contributes a share picture of what the present looks like. And then you move into the future of putting yourself, five, 10, 15 years into the future and acting as if what you really want to have happened has occur. And you come up with ways to express that. And that's where your creativity can be used. You can use all kinds of different ways to express that. And then the final part is--the final two parts are the keys. The common ground, as Marie said, that's where the rubber hits the what? And the rubber meets the road. This is where, as a group, as a community of 60 to 70 people, you have a dialogue among yourselves and you decide based on what has come before in your Future Search, what are the things that everybody in the room can agree to, can buy into, and is willing to work on. And now there will be things that are not agreed upon, and those go up on a separate list.
Under the common ground it's extremely important, so I was really interested to hear the observation about the language from this group. In the common ground dialogue, it often happens that people maybe using the same terms but mean something different. And so one of the key aspects involved in the common ground dialogue is to really get statements that clearly describe what the common ground is. And when we talk about common ground, we're talking about themes, principles, propositions, that everybody can agree to. We are not yet talking about specific strategies, programs, and actions. That's where the final part of the Future Search occurs, which is based on the common ground, based on the themes that the group agrees to. Then, we decide and we begin to work on it. And we may identify eight or nine things that people want to work on and they start to meet actually in the conference, and then go from there. So the planning itself is not--the purpose of the planning is not to come up with programs and strategies to address this issue. The purpose of the planning is to create a structure for the future search to really work well. And it works well when the group is as diverse as possible. It works well, and these are the conditions for success, and I wonder what happened to that one. We had one of the conditions for success. It works best when you have a whole system in the room. It works best when--thank you--when everyone is considered an expert. And here we have our stakeholder. We don't have--again to understand this, there's no way we can do a Future Search Conference here, and there's no way that you guys could be the planning committee for a Future Search Conference. Does everybody understand that? Okay. So, the next step is going to be to get a planning committee that is as representative as possible of the stakeholder groups that you've initially decided upon. Now you may, as you continue to evolve in your planning, you will continually ask yourself, who else should be at the circle, who else should be at the table. And you will likely, in my experience, you will increase the number of stakeholders that you want to have included. And that's okay. That's good. But you need to reach a point where you're going to decide, "Okay, these are our stakeholder groups. These are the people that we want to have at the conference" and then you want to start reaching out to them, and inviting them to come, but you're not really during the planning, you can talk about strategies among yourselves, but that's not really the purpose of the planning of the Future Search. Questions about that?
UNITENTIFIED SPEAKER: Well, I have a question and a comment about Future Search, and about your guidance, because I know at least as I understand it, you give a lot of freedom to the people planning it, and then attending it, to define the issues, but have you thought about helping the group be more specific about their issues. And I guess the reason I'm saying that is because Milwaukee picked infant mortality was constant victim for mortality, and everyone wants to see outcomes and we can't say that today that the infant mortality in African-American community is better. And I wouldn't really have expected that either. So, could we have better defined what we wanted to accomplish out of that Future Search, back you know, how many years now, 10 years ago. Or has Future Search thought about that? Because it's almost like, what can groups expect to come out of it?
ERIC COLLIER: Our role is the process, and the process is engineered, designed to focus energy on an outcome that you all want. So, if there's-if you're trying to show tangible results, I mean, what I'm hearing is we really haven't been able to show tangible results from this. I mean in other words, the objective it hasn't gone down.
PATRICIE ONHEIBER: It probably depends how it was defined like, I think we were real specific here. So I could see that out of a Future Search Conference maybe a program like this could be developed. But if you say you want to reduce infant mortality, how are you going to say that Future Search can bring infant mortality down? So, that's my question about Future Search. Is there a way to help better define?
ERIC COLLIER: Yeah, Future Search is a process. So, what happens inside the process is that the people come to grips with the things that they see that need to happen in order to bring whatever the objective, or whatever the future is that they want into being. Now, we do participate in the planning process. So, we will have planning meetings, and the extent to which we support the process that you're engaged in is to ask questions, to continually have you peel back to support your peeling back the layer of the onion. Okay? So, I mean, it's really your show, in terms of what it is that you want to accomplish. So, to the extent that you define it, I mean, even in terms of infant mortality, it's very complex. Yes, so maybe, your time horizon is too short. Maybe, the reality of that is--and so, if you look underneath the covers you might see some other things that have occurred, that are just as important, that the metaphor we use is that if you're going to moon, all right? Then when you launch, and this actually happened, this is how Apollo got to the moon, so when we launch--shortly after launch there are hundreds--perhaps thousands of title course corrections in order to hit the target. It's a long trip and if you're a silly millimeter off course at launch, when you get out in space, whoops, there it is. It's over there. Oh, we got--make a hard left and spend a lot of time and a lot of money.
UNITENTIFIED SPEAKER: Given the complexity of the issue of infant mortality, perhaps you're going too, and you're still in that stage of making course corrections, and then so with follow up process perhaps -
ERIC COLLIER: You know maybe it's time for another Future Search around the issue to see where you are to move it along. But you're sort of in the process of getting there. Anybody else have anything to add to that?
TAMMY GALLOP-MILNER: And I'm trying to walk through this, given--if you have identified--the planning group identified infant mortality and brought together the people to address it, but in the process of identifying other themes, when it comes to coalescing as to what the common ground issues are, they come to the conclusions. There's to say insufficient information to say, "Decrease infant mortality in African American", because that's not well understood yet. What's the basis for that? But for certain groups, maybe pre-term births or something -- everybody agrees these are the causes. And then can you narrow it at that point? So that your action steps becomes just targeted to what those themes that people have--can agreed upon, and so what you've done is sort of narrowed it down what you originally. Because in the beginning you were talking about decreasing infant mortality, say in Milwaukee, but in the process when you've--is that--can you do that?
ERIC COLLIER: Is that what you want to do? Look at this--
TAMMY GALLOP-MILNER: Well, no. I don't--
ERIC COLLIER: When you're in that place in a conference, perhaps what you see, what the common ground that you reach is, you know, we set this target over here, infant mortality among African-Americans, what we can see that we can do right now that will put us on the way to that are these reasons. And you get some energy around that, and so in a sense, you have narrowed the focus, but perhaps you haven't given up that target.
TAMMY GALLOP-MILNER: Right.
ERIC COLLIER: You're just taking the step that you can take right now to get there. And if we're looking for results that would enroll others in the process of moving resources to this problem, then that's something that you would very definitely want to report on. As you move towards the larger target.
PATRICIE ONHEIBER: I guess my question was what kind of--maybe examples of action steps that people come out of Future Search with?
DICK ARONSON: Okay, here's an example. The original, the first Future Search that we had on infant mortality in Milwaukee 1994, one of the strategies or actions that emerged from that was to make sure that the fetal infant mortality review process--people familiar with fetal and infant mortality review, it's a systematic way of reviewing infant deaths. To make sure that that program in Milwaukee would be community based, it wouldn't just be a bunch of people from outside, so called, experts coming in and reviewing the deaths, but it would truly be a community driven, community rooted process of infant mortality review. So, that was a specific action that came out of a Future Search that really did happen. As a result of the Future Search, people were committed to making that process, that infant mortality review process, truly be community rooted, and that has endured throughout this past 12 years.
Now, the infant mortality rate among African-American has not, as we've heard, has not declined. Although there's been one-year, recently where it went down a little bit, but you never can say anything from one year. So the point that Patrice is making is well taken. Just to get back, another very specific example would be the Deputy Director of Medicaid was at one of the Future Search Conferences. She listened to the families who were having extreme frustrations in terms of signing up for the Medicaid enrollment, the expansion of Medicaid. Out of that came a group that worked on simplifying the enrollment process for the State of Wisconsin, and that worked, that happened. Now, it hasn't resulted in infant mortality being reduced 12 years later, but as Eric's saying, it set the stage for moving along there.
So then, one of the things that you'll do as a planning group, along the line is, you're going to need to develop these worksheets for the past, the present, the future, the common ground, and the action steps that you're going to actually use. And we, as the facilitators, help you do that, but when you come to the part that's called, "the future scenario", you need to have something very specific in there. You need to decide as a planning group, put yourself how many--you're going to need to decide first of all how many years do you want to go into the future for this ideal scenario? And then you need to define what is the ideal scenario that you're going to invite the group to do. Cynthia?
CYNTHIA BRYANT-PITTS: And that's to do research on population not just a plan.
DICK ARONSON: Right. The planning committee just defines the number of years out, and also, what kind of-- what the central question is. So maybe I think the flaw that we had in 1994 was that we said, "Okay, imagine 10 years into the future, 2004, Milwaukee has achieved the lowest infant mortality rate in the
DON SCHWARTZ: Be gentle on yourself because there's no guarantee that even this group of 64 people is going to come up with the right answer. So, it sounds to me like 10 years out, if you didn't achieve your goal it may be it wasn't achievable or it may be that the wisdom that was gathered in some way wasn't sufficient, but does not an indictment of the process. Because you're chances of getting the right answer are 64 times greater than relying on yourself.
DICK ARONSON: Thank you very much.
ERIC COLLIER: One of the things about this is that when Future Search is generally used to deal with big problems, so, I mean, the reason we're dealing with this because it ain't easy, and we don't know what's going to happen 10 years from now. Really, we're actually taking the bold step to create the future, but you create the future by action in the present. So, one of the things--in some great sense, it takes a great deal of vulnerability to be bold enough to make a statement about the future right now. I mean after all, the future is uncertain. Yes, it hasn't happen yet. So, being vulnerable to not making it-there's also you have to be open to what Max Dupree, one of my favorite leadership brother says is a beneficial surprise. It is that some of those unintended, non-expected consequences are things that you didn't think about happening, like, the simplification of enrollment process for Medicaid. I mean, perhaps no one thought about that going into it. So things happen. When you deal with big questions there are lots of other questions that form, that are subsets of that big question and some of those have significant impacts, and so one of the things we see happening after the fact and the future is, sort of, this storm surge if you will, of a Future Search is that people go often do things based on ideas that they got inside the Future Search that make a difference in the community where they're at, and those things, more than likely wouldn't have happened had they not had that shared experience in the partnership with the people that they experienced that with.
UNITENTIFIED SPEAKER: I guess the comment is it's exciting to think about big outcomes and I think that's an important part but it's also important to think about how you're going to measure progress along the way. Because you talk about correction. What information are you using to make those midterm corrections, so I think that's a critical part of this.
UNITENTIFIED SPEAKER: I think you started seeing what I was thinking. I had my hand raised. There was a slide that was presented to us, I believe it was on yesterday, and I think that stuck on my mind that if you never take the risk, you'll never have the failure, and when you risk and have failure you can be forgiven, at least you did something. But I think the other part of that slide is that those that never risk, never have failure are already a failure in their whole being. At least, to say to try to do is better than to do nothing at all, and I'm relatively new to the MCH. I think three years, but one of the things I found and I was telling doctor here that, it's so frustrating we keep reinventing the wheel and keep attacking the problem. Why don't we just get off and do it? Just make it and do it. I'm just from a different school, like I used I have to kick it out, and I was laughing because if my mother was a Future Search in her whole idea with running her household. She always had her-- this agenda or had a strategy and she always had the stakeholders which is my brother and sisters, all the little kids, and we try to tasks, and we were to perform and meet back at the end of the week, to make sure those task were accomplish and because of it, every last one were be less one way educated, and we can say we were a success because she attacked. There is no such thing that we could not do it. So I'm really pleased to be part of this. I believe that the conditions for its success are already there. You have to try and if you fail, try again. You can always change in the middle of a plan. If it didn't work, have plan B. Try something different. So I think the stakeholders are only as much as a part, as is much as a whole and I think I've learned that that the parts had become at the table as much as a whole.
DICK ARONSON: Thank you.
UNITENTIFIED SPEAKER: I learned a lot.
DICK ARONSON: Thank you. We have just a few minutes left and I want to make sure that everybody has a chance to speak who would like to. Anybody who's actually had an experience with the Future Search that would like to share a bit.
JUDY WRIGHT: We had two Future Searches in Nevada because we had a very not well-known public health system, and the first one was just to bring everybody together and say, "Here we are and you need to pay attention to us." So, the State Health Division put it on, had a contractor come in to help us with the planning and the facilitating, but brought in our local--we only have two at that point, local health districts but they were Reno and Las Vegas, so they have 80 percent of the population brought them in. Legislators came, our advocates came, our community health people came and what that one accomplished was really getting public health into the minds of the people in the state, and that first one was I think '96, something like that. And since then, what also came out of that was we decided we need to develop a Nevada public health foundation, and that happened. And our state administrator and our deputy--our attorney general got together and decided we need to do something about teen pregnancy, so that happened and between that partnership we've gone from being number one to being number 12 within the country in 10 years, so that's a little bit of a gain for us. And, the second one, again, brought the partners together to look at public health and we have--if you look at Nevada we've got terrible outcomes. And, for the first time, the state has the money that this coming session we have been invited to ask for money to do things. And I think the only reason that happened is because we've laid the groundwork through Future Search, got the partners to the table and said, "You need to do X, Y, and Z if we're going to be at all successful and pretty--and not being the fattest state of binge drinkers or the whatever, in the nation." So--
JUDY WRIGHT: (Inaudible)
DICK ARONSON: Yeah. Thank you very much, Judy. And, thank you to all of you for your wisdom and the dialogue that we just had is an example of really a Future Search dialogue. Before we finish, could we please make sure that everybody does--there was a sign up sheet going around so we can be in touch with each other, and could those who came in later, if you could be sure to add your name to the list so that we can be in touch and we will see you hopefully tomorrow for our final wrap up at eight o'clock. Thank you very much.