MCHB 2006 Federal/State Partnership Meeting

Town Hall Meeting

October 15-18, 2006

JOHN NELSON:  This is our last session of this year's program.  I want to thank all of you for staying here.  I'm actually very pleased that as many of you remained as are here; although everybody seems to be, again, congregating toward the back.  I think we ought to have a rotating podium so we can all swing around behind and catch everybody by surprise.  This is the Town Hall session of the meeting.  It's an opportunity, really, for more interaction, although there has been certainly plenty of that over the last two and a half days.  It's a more focused opportunity and maybe to have that kind of interaction to ask questions of the leadership of the Maternal and Child Healthcare as well as AMCHP.  I don't think that any of the people at the front have an agenda, per se, although, I would note that at the end of the last session, we're handing out the summary statements of the four workgroups that were constituted two years ago that addressed, as you recall, six issues.  They were distilled down to four topics.  If that's an area, or there are areas of that that you would like to address, I think now is the opportunity to, although there will probably be ample opportunity to address those reports in the future.  But it might give you some thought and might spur some thinking and questions you might want to ask.  So, with that, I don't know if any of you have anything to lead into.  We can open it up now.  For those of you who have questions about--what?

CASSIE LAUVER:  Jamie's got a microphone.

JOHN NELSON:  And Jamie has got the microphone over here.  So raise your hands.  Please feel free to ask the kinds of questions that you've been hoping to be able to ask.  And, again, please do fill out those evaluation sheets.  There's a box as you go out of the anteroom here to put those in.  They are very useful and they help us focus what the programs that are going to be in the future.

UNIDENTIFIED SPEAKER:  I wanted to ask--and Peter, maybe this is a question for you--I wanted to ask how the strategic plan will be developed.  What will be the process?  And I'm assuming that the workgroups will feed into that but I'm assuming there are going to be other processes as well.  And so I wondered what that process would be like if there are other opportunities for others of us in the room to add in or just how that works.

PETER VAN DYCK:  The workgroup reports that began at the All Grantee Meeting in October of 2004, we have the summary on the table that you now have.  That was the first process and the feeding into the strategic plan.  We'd like to have our new strategic plan.  And by the way, the old one is in your notebook.  And there's a lot more there than you might think.  I mean, it relates the performance measures to each goal, and each strategy, and each action step that has values, mission, purpose, goals.  So it's really a fairly complete document.  We'd like to have the new one done for 2007 to 2011 by next summer.  And we will begin a process now using this as input using some of our new department strategic plan, some of the new HRSA strategic plan as input.  And we will form another several groups to feed into the process.  And then, as we did before, we will send out a draft strategic plan to everybody we can think of at some point for review and comment before it's finalized.  So there should be ample opportunity for input.  And that's really the strength of the strategic planning process is that input, so everybody can play a role in the input.

JOHN NELSON:  I don't think you can overstate the importance of it.  In our own discussions within the bureau, we're always looking at whether the new opportunities for funding, whether our SPRANS programs are consistent with the strategic plan.  And so it really does give us focus and it's often on the table as we proceed through the year.

PETER VAN DYCK:  I might add, we do work for the academy and we've worked closely with AMCHP, as well.  Not in parodying one another's strategic plan but to make sure we know where there are similarities and where we choose to differ.  And I think that's been an important process as well, and with other major organizations as well.  ACGs included as are others.

CATHY PEPPY:  Thanks.  Cathy Peppy from AMCHP.  Will the workgroups that are being set up for the strategic planning process be internal workgroups or do they include external folks, too?

PETER VAN DYCK:  No.  They'll include external folks as well.  We will have an internal workgroup but even the internal workgroup will include some representatives from outside.  But several of the groups will include almost exclusively outside folks.

CATHY PEPPY:  Thank you.

JOHN NELSON:  I think, Bill, in the back, you have a question as well?

BILL:  I'm actually just happy to bellow but I guess technology requires this.  I haven't, I apologize, had a chance to really parse the workgroup to communication recommendations but I think this is reasonably fit with them because I've had two or three conversations with different friends of Title V suggesting that this is a window of opportunity or critical moment to work on the framing and presentation of the Title V Agenda in a time of a rapid change.  I'd be interested in people's responses if they're comfortable doing so as to whether AMCHP might be the vehicle for some more sophisticated, social marketing research and maybe help in framing the nature and potential future roles of Title V in ways that candidates and other people might understand going forward.

JOHN NELSON:  And I think what Peter was saying was that our plans as well as the plans of other organizations, AMCHP included, and rather specifically, really do need to complement each other.  The kinds of activities that we can undertake within the bureau often are necessarily different.  We have more limitations maybe than the AMCHP and I think that's where we can work cooperatively.

PETER VAN DYCK:  Yeah, Bill, was your question, could AMCHP be a vehicle to disseminate or gather data or--?

BILL:  I think those of us who have followed the model of Utah, among others, and made a real investment in communications expertise, starting with the market research piece, have come to recognize the value of that but also the cost and some of the sensitivities and it feels to me as though AMCHP might be the vehicle, if we could find the resources, perhaps through several partners to really dig much deeper than, perhaps, we have with some very sophisticated help as to how the public would best see Title V and how politicians might better see its roles by, perhaps, the spring of 2008.  And that would need a real investment.  And it feels as though AMCHP might be the agent for that.

JEFFREY LOBAS:  My hope is that with the regional calls that we do together with the bureau and with the effort we do originally with our board members to get information that we're trying to look at a standardized approach and do some looking at common themes and threads that we use as data.  My hope is that we could, in fact, be a very useful vehicle to be that feedback loop.  And, like I said in my talk, our function of liaison linkage connector, I think is a really important one because we're out there.  And I think we can do it; we have that infrastructure.  And my hope is that we could be looked at the valuable partners in that.

PETER VAN DYCK:  I wonder, Bill, and Jeff, and everybody in the room, we really can't do much beyond our strategic plan.  We almost have to market our strategic plan because that's part of our planning process.  So we have to try to make that document both efficient and effective and responsible inside but yet something that's readable and usable outside.  But it's really not a marketing document.  And I'm wondering, does AMCHP, I mean, they've done a nice strategic plan now, but does AMCHP need to go beyond the--and I think this is what you are getting to--beyond just the strategic plan itself and develop a separate marketing document that mirrors or mimics the content of the strategic plan or the bureau strategic plan or the commonalities in the strategic plan or whatever.  And I think that's an important discussion.

BILL:  (Inaudible) effort to take the document and make it matter and measure that.

JEFFREY LOBAS:  Yeah, I would think we need to do that.  We need to take it on the road and make it real and make sure that within our states, our planning process incorporates what our national vision is, too, and reflects it.  We've tried really hard for the AMCHP strategic plan to complement and reflect what MCHB's strategic plan was and thus, in turn, I would hope the states reflect both of those.  And I think we are the type of work division that could be that vehicle to really disseminate and build a cadre of support out there for us.  So I do think there's an important discussion we need to have. 

JOHN NELSON:  Where's the lively group?

CASSIE LAUVER:  It's time for the hard questions.

JEFFREY LOBAS:  Go out there.  Peter said he would sing if we had a lull.  That's all.

PETER VAN DYCK:  It's almost time for Good Night, Irene.

JOHN NELSON:  I'd be interested in hearing from another state or two that has a Children's Cabinet.  I'd be interesting hearing a little more about a state that's been successful with that.  Bill talked about the Rhode Island Cabinet.  Are there other--are there people here--

JEFFREY LOBAS:  Do you want failures, too?

JOHN NELSON:  Pardon me?

JEFFREY LOBAS:  Do you want failures, too?  Iowa has a Children's Cabinet and it simply is the department heads meet once a month and they have not engaged, really, the rest of the state, and many people are pretty disappointed in what the Children Cabinet was.  There's a real move now within through the academy to have a Children's Council, and we will see where that goes but our Children Cabinet has not functioned well.

PETER VAN DYCK:  I guess I'm just wondering, so you market and have a campaign or you develop a document or something.  I mean, it needs more than just taking it to everybody.  I mean, you need to be able to buy people into it that are targeted groups or targeted small groups, or targeted individuals that have an interest and are willing to then carry it on.  And if there's Children's Cabinets or other organizations or other state-wide places.  I'm just trying to determine if Children's Cabinet might be one of those or if there are others in the states.

JUDY:  Nevada has a governor appointed Maternal and Child Health Advisory Board.  We have parents, doctors, and so on like that.  We make a report to the legislature and they look at it and they approve things for us, and it's not really Children's Cabinet, but it's an advisory board.

PETER VAN DYCK:  And can the advisory board do advocacy?

JUDY:  I'm sorry?

PETER VAN DYCK:  Can the advisory board do advocacy to the legislature and things for you?

JUDY:  Oh, yes.  Oh, yes.  Yeah, yeah they do.  When we had, for example, they were trying to change immunization laws a few sessions ago and all of our eco-foreign folks came out just to drop the requirement for them, and the board rallied everybody and got letters in and  killed it right off the bat.  Last session we had an attempt to criminalize pre-natal substance abuse, and they got out on that, and that never got out of the bill draft stage.  So they have been, you know, when we get them rattled, they do good.

JEFFREY LOBAS:  Judy, how big is it, and how often do they meet?

JUDY:  It's 11 people.  Nine are appointed by the governor, and then we have a senator and an assembly person that's appointed by the legislative council.

JEFFREY LOBAS:  And do they meet quarterly or monthly?

JUDY:  They meet quarterly and they have sub-committees around things.  I think that their last report is posted on our website if anybody went.  It's stated in our state law.  It's in our NRS that they operate.

JOHN NELSON:  Susan had her hand up.

SUSAN:  Thanks.  I just wanted to pick up on one thing that Renee said that I thought was, perhaps, useful to look towards the future, and that was the connection she made between healthy children developing into a healthy workforce.  And I think as we look to the future, we have to find ways to make the work that we do relevant to people who don't normally think it's their job or their responsibility or their concerns.  In the last few weeks, we've had meetings on the hill with members of the appropriations subcommittee to talk about our MCH dollars for next year, and there's a concern that the dollars are going the wrong direction and we are fighting to remain level-funded.  So looking to the future, I think we have to continue to think of ways to orient people to the importance of providing whatever supports are needed to turn healthy pregnancies into healthy babies and on up the line because the trend over the last few years for spending in these areas is not good.  And I think that that's something that we need to look at to figure out how to make those changes in ways that are going to work for everybody.  And people will feel comfortable simply presenting the information without a spin, without advocacy.  Just 'This is the information we have.  These are the data we have.'  And I would just be interested in any information that people have had at the state level if that has worked.

PETER VAN DYCK:  And I guess I'd be interested if there are ideas on if the bureau can do anything else or what additional we can do to help people get to that place.  I mean, are there things we can provide or try to provide?

SHUDBI ARMAD:  Shudbi Armad from California.  What we have in California, each county has an MCH director and they have their own executive committee and they meet three times in a year; two executive committee meetings, and one large, all-member participation.  And they do a lot of advocacy work at the local level.  We are also facilitating the AMCHP meeting of the MCH action, actually.  At the end of this month, Peter is coming to California to meet with them.  They write, like, letters to the senators, to the house members, and so and so on.

ELLEN SCHMIDT:  Hi, this is Ellen Schmidt from the Children's Safety Network.  I just wanted to go back to the Governor's Children's Boards or Committees, and I wonder if that might be a good question to put on the Ask An Expert AMCHP thing, and see if we can get some other experiences from states because not everybody is here, and knowing that they might want to chime in about how they've been effective or not effective.

JEFFREY LOBAS:  Not to dominate the discussion, but with the Rhode Island example we have been at it for a long time.  Two observations I'd make: ours is established in statute so that it is itself a legislative goal to have a Children's Cabinet, and might be worth pursuing in some states, and it mandates that the relevant state directors and a bunch of other people be at the table.  And the way it's been positioned, especially in the years when it's been most effective, it's not only been open as a forum in which many advocates and interested parties come and there's an opportunity for public dialogue with the Cabinet, but it's effectively been staffed by Rhode Island Kids Count, which is a very robust, well supported children's advocacy organization.  And of course, they are from time to time angry with the decisions that specific Cabinet members have made, and there's always that bit of tension.  But there is a perceived balance between the bureaucrats who sit behind the table and the Rhode Island Kids Count and other advocacy allies that are sort of doing a lot of the research and the staffing, and prep of the issues, and the like, and that actually works out quite well.  And one of the more dramatic examples was that the Cabinet actually approved our going in for successful start, the Early Childhood Initiative, as a collaboration between the state departments and Rhode Island Kids Count.  They were co-applicant and manager of this, at least the planning phase of the Early Childhood Initiative.  And that made it a sort of a shared vehicle that brought a bunch of recommendations back to the Cabinet, some of which have actually been happening.

JILL BRIGGS:  Hi, I'm Jill Briggs from Minnesota.  Two things: we have an advisory committee, an MCH Task Force Advisory Committee, and so a rich array of our folks we work with, but parents are on those committees, statutorily created.  There's interesting language that makes that group sunset, and we're making on trying to remove that and have had some indications we might have the sunset provision taken away.  I think what I would call necessary tension is our commissioner often reminds these folks that 'You advise me.  Thank you very much.'  So, as staff people, it gets difficult because you have a wealth of folks in our area that are supportive of our work.  They're advising our Commissioner of Health and that interplay that has to happen is just reality so we work with it and they are a good crew in our advisory committee.  The second thing, Peter, that I would offer is that I think to carry forward some of these strategic plans is that somehow we need to find some champions.  I'm the mother of some 20-year-olds and they're saying to me,"Mother, you guys are doom and gloom."  You know, we have interest in working in government, but you know, and I'm an optimistic gal and notorious for being the jokester and the lightness in the office, but how do we have fun?  Sometimes and in a real challenging area and who are our fun people?  My children consider me the fun-person of the family, not that that's important, but where is the energy, enthusiasm and spunk?  I had dinner, lastly, with my colleagues from Region 10, never met them, had a great time going out.  So building some of that and finding some champions, we're out here.

DILLIANA:  Hi, Dilliana from Hawaii.  Hawaii has something called the Inter-departmental Council, which is established in state statute, and it has an overwriting objective to look at.  The vision is all children shall be healthy, safe, and ready to succeed.  The make up of the group are the cabinet members across the state.  And in addition to that, one philanthropic representation and then someone from the business sector as well.  The focus has been primarily on the Ready to Succeed side promotion of Universal Preschool Incentives for quality in preschools; however, we have adopted 18 measures across those three areas, so that we are tracking some of the health measures as well.  The focus on health has been more on healthcare insurance, so, again, expansion of SCHIP activities.  And safety, again, has been more on prevention of child abuse.  And it's been viewed more as a vehicle to look at how can we break down barriers across departments to move an agenda forward?

JEFFREY LOBAS:  I want to say something about joy.  I couldn't let that go.  Because I do think a lot of this conference has been around difficult issues, has been around DRA and all these things that may be happening to us or at us and I do think it's easier to get doom and gloom and I meant to put in my side as I talked about coaching that I try to do it joyfully.  And to me, the idea of then it's so important to have meetings like this, meetings like the AMCHP annual meeting, regional meetings, because to get through difficult times, I think that the idea of a community is really important and connectedness is really important.  We can't ignore there's some serious issues out there, but we can do it joyfully with each other.  And I always come away from meetings like this feeling invigorated and that there is hope.  But I do think it's an important piece to look at what the end product is and it's children and women and the families that are healthy and that's joyful, joyful work.  So it's important to continue to build that social connectedness and come together on a regular basis so thank you for making that comment.

VALERIE RICKER:  I'm Valerie Ricker from Maine.  And Maine does have a Children's Cabinet.  It was formed about 12 years ago under our prior governor, Angus King.  It is composed of the five departments that are primarily working with children and young families, so it's Department of Corrections, it's the Department of Health and Human Services, Labor, Education and--remember what the fifth one is?  It's there somewhere, I can't remember right at the moment.  Oh, Public Safety.  And under our current governor, Baldacci, the Children's Cabinet had developed something called the senior staff, which is key staff members from the various departments who meet on what used to be on a weekly basis, it's now moving to two times a month, to talk about what are the issues that have come up in the Children's Cabinet and actually trying to get the work going that needs to be done to resolve those issues that have been raised.  Our Children's Cabinet, I think that the biggest challenges are when you change administrations and one administration may not readily see the benefit to continuing something that was started under a prior administration.  It does help to have it in statute that it should be there.  The other is finding somebody in that administration that will carry the banner.  We're very fortunate, our governor's wife, before becoming a governor's wife, was a WIC director, nutritionist, and a kindergarten teacher so, she understands the importance of children and she currently chairs our Children's Cabinet.  Our Children's Cabinet has taken the leadership on developing a number of initiatives that are designed to positively impact the youth in Maine.  And a couple of those initiatives are the Maine Youth Suicide Prevention Program was developed out of the Children's Cabinet's concern about suicide rates in Maine.  Our Taskforce on Early Childhood is a subcommittee of the Children's Cabinet and, again, the First Lady chairs that.  And that has provided the groundwork for the development of our early childhood state plan, and really was a key element in getting people from my perspective, and Dick may disagree, but I think they were really key in getting the buy in for people to come to the future search related to early childhood.  In the last couple of months there's been a slight reorganization of our Children's Cabinet so that at the Children Cabinet's meeting, it's just the Commissioners, the First Lady, and then each department has one executive staff who is designated to be the liaison between the senior staff and the commissioners to bring them up to date of what's going on in preparation for the monthly cabinet meetings.

UNIDENTIFIED SPEAKER:  Well, as one of the members of the Region Ten Fund Committee, I'm not sure I have a fun solution but perhaps I have a unique solution from Alaska.  And it's one that we actually started about ten years ago as a result of the strategic planning around developing the Children's Hospital at Providence.  We found that we couldn't necessarily rely upon our political representation because it ebbs and flows so dramatically sometimes you can't figure out sort of who's on first.  So we joined together with the hospitals, the four primary hospitals in the State of Alaska, again, none of them being owned by, you know, corporations that were based out of Alaska.  To some degree, they had a little bit more independence as a result, and also included our Medicaid director, at that time our Title V director, and the head of Municipal Health for Anchorage, which is actually the only municipality in the State of Alaska.  Everyone pitches in money, including the Department of Defense, who pitches in kind for space and services, we've hired a part-time executive director and she kind of keeps the caps moving in one direction.  And we have an agenda every year and we utilize those folks, especially those of us who are in government, to forward our agenda.  Probably one of our shining successes was moving ahead in the SCHIP program called Denali's Kid's Care Program, and really promoting that throughout the state.  The second initiative, I think a big success, was getting funding, general funding for our immunization registry.  And we continue to work on several items with outcomes that are published on an annual basis, including work on obesity and trying to get the vending machines, not so much out of the schools, but changed with healthier snacks.  And we've worked on kind of a number of issues.  So, again, looking for unique partners is what it's about in Alaska and I have found this to be very, very successful in really raising the awareness of children's issues sort of beyond what a traditional public health model has been. 

UNIDENTIFIED SPEAKER:  Well, I wanted to say that in Massachusetts we think very nostalgically back to the days when we had our Office for Children led by Jack Leiderman.  That was quite an incredible time back in the '70s.  But I was thinking even before moving out, and I think the idea of Children's Cabinets is a very intriguing one, and I don't know if people from New Mexico are here, but I've heard some things that they do, but I was also wondering if this is a goal of the Bureau, and maybe even more specifically, of MCHP to kind of think about starting at home, and what are we doing even within our MCH programs, within our Title V programs, what kind of advisory and other groups exist, and how robust are they?  How do they draw people in and actively engage people right there, and then how can we kind of move out what would be the right ways to do that?  Finally, I just wanted to mention in another sphere, I think in some academic areas, they are thinking in some different but a similar kinds of veins.  I know that, for example, top universities set up a kind of children center because they were aware that the School of Medicine was dealing with children and one way over here, the School of Education was doing something across the river over there, and the School of Government and Social Welfare, and all these different academic pieces were not together in terms of kids.  So I think we're not the only ones kind of thinking about this, although how effective in what ways people are doing it might vary.  But I'd really like to ask maybe the panel or other people about that starting at home business, and thinking about what we can do to really draw people in and engage people right from Title V.

PETER VAN DYCK:  I was trying to get some feeling for the extent that people use Children's Cabinet or if they even existed.  Although I had some idea, it was helpful to hear because Renee Jenkins did seem to put some priority on it in her talk.  And as we're in the development of a strategic plan process, and we have the questions about marketing strategic plans, and MCHP has strategies that include better communication and marketing, I'm just trying to get a feeling for where this fits in, and if the Academy is going to put some effort into this, then we have to decide where we play or how much we play or in what way we play.

JEFFREY LOBAS:  In our state it's kind of interesting.  We have a very fragmented approach to advising.  You know, we have an Early Intervention Advisory Group, we have an MCH advisory group.  We have an Oversight Committee for Children's Mental Health, which is in an advisory group, and we're kind of all over the place.  And there's an effort through the Academy of Pediatrics to move to some children's council, and it's been a little fragmented in this approach.  And I think just in this discussion, I need to go back to our chapter president, and really help her engage with these other advisory groups, and not be so scattered and be more focus.  And Title V is on every one of these other ones, and I do think we could be a real force in maybe pulling together a more unified approach to it, so that we're at least all talking to each other.  But I do think Title V could, in fact, help pull a lot of it together.  A lot of this has been driven by the Academy of Pediatrics and had been really nice place of overlap for Title V and state chapters to start working together in a real, real way.  Like I said earlier, in our state we work together closely because I'm an officer of the Academy, but there's a huge variability.  But this would be a neat project for those two to meet each other and are pulling together the common focus around children.

JOHN NELSON:  And it might be that we could have some influence with Renee just starting here before she becomes president for a year in developing what the structure or form that this effort between Title V folks and whatever Cabinet or Advisory Committee or what else they might choose on forming.  We might have some say in the structure of that perhaps.  And it might be a way to foster, as you say, the relationship between Title V and the local academy.

JEFFREY LOBAS:  It's just so interesting to me.  I had conversation out in the hall with one of the state directors, who's fairly new, just how people still don't know what Title V is.  If he wore a button that could say Title V, they'd think he was in a cult or something in his state.  Yeah, we wear one, it's 'live long and prosper'.  It really behooves us to market it, to put words to it, to have people understand it, and the academies don't understand us very well.

The other player, I will mention just being from a rural state, is the Academy of Family Physicians.  In our state, 65 percent of pediatric care is done by family physicians, and to ignore family physicians as primary care providers, and the Nurse Practitioners Association, I think, isn't going to get us anywhere.  It only adds to fragmentations.  So those are the players that need to be involved in Children's Councils, Cabinets.  But I think this would be a nice dovetailing of effort between academies and Title V.

UNIDENTIFIED SPEAKER:  The Florida chapter of the American Academy of Pediatrics is actually proposing a Children's Cabinet and are working with some of the key legislators to better flesh out that idea.  We are at the table with them and they've actually asked us for some input on what they think might be beneficial in the Cabinet.  There is a document that has been produced by the National Governors Association that outlines the Children's Cabinets that exist in each state.  And I know our academy sent us the site so that we could look at that, but it might be something that people want to take a look at.

PATRICE ONHEIBER:  Patrice Onheiber, Wisconsin.  I'm sorry if I've missed it, but in addition to this strategic alliance between ourselves and the AAP, has there been some thinking about where we could go with APHA?  With Deborah Klein Walker being there, it seems like an opportune time.

JOHN NELSON:  That's a good point, I think.

PETER VAN DYCK:  That's a good comment.  Go ahead.

JEFFREY LOBAS:  Yeah.  It just seems that confluence of a number of events are pretty amazing.  With Debbie taking over there, the MCH section will become stronger and she really knows those.  And, boy, I think we have to hit it while the iron is hot, and really start immediately working with her about how do we get an agenda that she was talking about for children, and women, and families going.

PETER VAN DYCK:  Do we have some other MCH Section Council people in the room?  Laura, are you on the Section Council now?  Do you see any advantage with Debbie being APHA president?

LAURA KAVANAGH:  Oh, absolutely.  Absolutely.  I think if we want to initiate work with APHA, I'd recommend we do it along two fronts, both through the MCH Council and directly with Debbie as the incoming president of APHA.  We were thrilled when she became the president.

PETER VAN DYCK:  Do you have ideas on how we can affect the Council, influence the Council?

LAURA KAVANAGH:  I mean, we are going to be meeting in two weeks in Boston.  I would recommend that--do you mean the Bureau or do you mean the AMCHP?

PETER VAN DYCK:  I just mean the community--

LAURA KAVANAGH:  The community.

PETER VAN DYCK:  --the MCH community in general, AMCHP Bureau.

LAURA KAVANAGH:  Right.  To be honest with you, I've had some frustration in working with the MCH Section Council of APHA.  I think that the advocacy issues around child health have not been as prominent in my short experience with the Council.  You have a much longer experience in working with the section, so I'd like to hear your thoughts as well.

Right now, Weingrad Smith is the head of the MCH Section Council.  I think she's interested in becoming much more active.  I don't know if Kaye is still here, but Kaye has been definitely very active around advocacy issues more recently.  So, I think that as Jeff mentioned, I think this is a prime time to be coming before them with an advocacy agenda.  In my short experience with the section, I don't think it has been as prominent as it could/should have been.  But I'm in this weird position as a Fed now, too, so.

PETER VAN DYCK:  Are there other things that you think that Bureau can--oh, I'm sorry.

SALLY FOGERTY:  I'd like us to take Title V and (inaudible) invited the rest of the Council on Sunday evening, am I right?  Is it meeting Sunday evening?  So, if there are particular issues or things you would like me to say is as a state Title V director, let me know.

JOHN NELSON:  Is this part of a bigger agenda, Sally?  Or is it just a--?

SALLY FOGERTY:  Actually, whatever state is sort of represented or wherever they are, they have frequently asked people to come and they asked Debbie Allen to put together part of the agenda.  And so Debbie called me about a week ago--this is Debbie Allen, not Debbie Walker--to talk about Title V and the importance of Title V and as SCHIP in some of the other issues.  So I'm more than willing to carry any message people would like.  So if there are particular issues you'd like me to raise, our issues are pretty similar, e-mail me.

JOHN NELSON:  Yeah, I would think it'd be an opportunity to try to find similarities between MCHB's strategic plan or the Bureau's strategic plan and the section's priorities, whatever they are.  I'm not sure what they are but Laura, I mean, someone can certainly fair those out for you. 

PETER VAN DYCK:  And I would hope, too, that at the end of it, there's a next step, is it the end of it, or how should we plan together to create an agenda around children and women?

UNIDENTIFIED SPEAKER:  (Inaudible) that we, together, raise some issues on Sunday (inaudible).  I mean, if we could just also meet again in connection with AMCHP meeting (inaudible) opportunities rather than (inaudible)?

SALLY FORGERTY:  And I actually think we're going to be together at ATMCH on Sunday afternoon.  Are you coming to ATMCH?

UNIDENTIFIED SPEAKER:  Oh, yes.

SALLY FORGERTY:  Okay.  So, maybe the two of us could work together as to what we bring to the Council.

JOHN NELSON:  Yeah, it might be, if there is something around the Annual AMCHP Meeting, maybe we should meeting with them like we did, you know, we're starting with ATMCH regularly to talk about similar issues and interests.

SALLY FORGERTY:  I also know that one of Debbie's priority areas that she really wants APHA to be involved in is SCHIP reauthorization.  So we might want to think about how we raise issues in regards to that.

UNIDENTIFIED SPEAKER:  I have a question on a separate topic.  What has been our relationship historically with the American Academy of Family Physicians?  In many of our smaller states, we don't have a large group of pediatricians.  I have a total of 75 in the state of Alaska.  The majority of the children are cared for by family physicians and mid-level providers.  Have we reached out to them to also sort of put together a joint agenda around children's health?

JOHN NELSON:  David, are you in the room and does that relate to the PIC stuff at all?  Are they part of that group?  Oh, here you are.  I know you can't.  That's right I forgot that you can't talk.

JEFFREY LOBAS:  Can you sign, David?

JOHN NELSON:  What an impediment that must be for you, David.

JEFFREY LOBAS:  Oh, wow, whoa.  Write it down.

DAVID HEPPLE:  I think we have attempted to get AAFP involved in the past, not as successfully as we would want.  I think Chris with the Bright Futures' effort and Ann, who may be able to talk, who's in the back, we did include that.  So there's a start and there's a recognition that there's an empty chair at the table, but we're not there yet.

JEFFREY LOBAS:  No, I would say the empty chair we just put out there within the last year or two.  I don't know that we've been terribly inviting to family physicians, and I think the Academy of Pediatrics, I think, is finally realizing these are our partners.  In the Medical Home area, the Academy of Family Physicians have really put Medical Home as one of major priorities and we're working, actually, the director of our Medical Home Project in Iowa is the executive director of the Iowa Chapter of Family Physicians.  And so we've actually made some inroads with their national leadership around Medical Home, but we need to do more.  I think we have the connections now, and if we have agenda, I think it'd be easy to get it to them to see and ask them through, at least, some of our connections in the Medical Home Project.

DAVID HEPPLE:  Yeah, just one defensive thing, we have done the model benefits plan that the National Business Group on Health is putting out, that's going to be piloted by AOL and Marriott.  The advisory committee--I know I'm more articulate than I've ever been, right?

JOHN NELSON:  And we're listening more closely.

DAVID HEPPLE:  Yeah.  On that advisory committee, we were very careful that Joe Hagan is representing AAP.  But we also have an AAFP rep and it's made a big difference in how things are moving.

JOHN NELSON:  Anne or Chris, are you at the back table there?  You want to--because I know they're involved in Bright Futures some.

UNIDENTIFIED SPEAKER:  They are involved in Bright Futures too, as much as (inaudible) him an (inaudible) to be involved and they are, but it is limited.  It doesn't seem that since they do reportedly take care of half of the kids in the country that they're never much at the table from much of anything that I've been involved with in my time with MCH, so I think we certainly, all of us could make them work in certain effort there.

JOHN NELSON:  Right.  That's a good comment.  We do include them in the newborn screening.  Hereditary Disorder Advisory Council of the Secretary, they have a place and attend regularly.  But it sounds like our efforts could be more universal.  Laura, was that your hand?

LAURA KAVANAGH:  Actually, this is a different question.  I don't want to--if we're still in the groove of the AAFP--

JOHN NELSON:  Okay.  Why don't we wait just a second?

JEFFREY LOBAS:  They are involved as regular members of the Friends of Title V and come regularly to those meetings.  We probably need to be more thoughtful about what we want from them and get clear because I think they're willing partners for sure.

PETER VAN DYCK:  Good comment.  Go ahead, Laura.

LAURA KAVANAGH:  Okay.  Are there any comments about AAFP?  I want to change gears for just a second.  Since workforce development has emerged as a priority for both AMCHP and the Maternal and Child Health Bureau, could you reflect on your plans and hopes and dreams around succession planning for the field, not personally, and how that relates to, or does it relate to mentoring and those sorts of issues?  Thank you.

JEFFREY LOBAS:  Let's see.  Well, my hopes and dreams, as I've said earlier, is that we don't get in a situation where everybody retires at the same time and where there's nobody left.  And so, which means we have to begin engaging the pool of people who might come into the field early on in their training.  And to me that this is part of what we're all working on, how do we do that.  And I think we have to develop a model or a best practice around that area.  I think it's going to be multifaceted.  As we have said, with ATMCH the other evening, you more and more, you don't have people out in the field coming to get their MPH.  You get people, who right out of an undergraduate go, they have no life experience.  And many of them want to go to work for foundations and places that, frankly, just pay better.  And I think, to me, the multifaceted approach becomes one of offering relevant internships.  I think going to the source, we've gone to our nursing school.  I try to talk to our pediatric residents.  I try to get our College of Public Health to be open to give experiences.  But what I have seen is by offering relevant internships, and we use the LEND Program a lot with the school social work, and so we really cast a wide net, and I think it's possible for all of us to look at what's work and find what those best practice models are of engaging the next generation and disseminate it, and give technical assistance on it, and help each other find that.  I can imagine that there aren't young people who if they saw what we do wouldn't get excited and become passionate about it.  And so we need to show that to them.  So my dream would be one of a process that comes up with this, a true effective strategy, which is multifaceted.

PATRICK VAN DYCK:  Is that question to me, too, Laura, that you asked?  Well, I hired you, Laura.

When I started, there were a lot of people who wanted to get into the field because of the potential and excitement and the personal interest, and I don't want to say commitment because you're not necessarily committed before you start, but you become committed soon, and I think we have to be ready to capture that interest and excitement by having programs that create the ability to foster that commitment and excitement.  And we have to have created jobs and environments where people can exercise that commitment through leadership in the states.  We have to be not just in the states but in other areas where the graduates go.  So we have to be opportunistic, we have to be hopeful, we have to energetic, we have to be creative, and we have to be thoughtful in how we do that.  I frankly think the Bureau has done a wonderful job in creating that kind of environment and developing a strategic plan and if people haven't seen training strategic plan, I'm sure they can get to it from our website.  But we do have a vision for the future on training and I think it's visionary and useful and hopeful.

JEFFREY LOBAS:  Jane, you've been really even as effective as anybody I've seen in attracting people.  You've always got, what, five interns running around and many of them stay, if not most of them, stay in public health.  And that may be a best practice and I don't know if you're just like paying them huge bucks or what, but I'm always impressed with the number of interns we have at the Health Department.

JANE:  Well, thank you, Jeff.  Thank you for putting me on the spot.

JEFFREY LOBAS:  What else are friends for?

JANE:  It really began as a matter of economic necessity.  We had all these projects we wanted to do and we didn't have any positions or any money to do it with.  And we are able to network, first, with the Regents institutions to bring in interns and the sort of the rule of thumb is if you need academic credit, you work for free.  And if it's my project and you're not getting credit for it, then we can talk about some kind of a small stipend.  And the credit really goes to my staff then for building the energy once they get here.  And I thought that Jeff was going to say they all stay in Iowa.  No, they don't.  Some of them are here in Washington.  Once they get sort of bitten by the bug they have to go to the next level and see if they can really make a difference.  And I guess it's pretty ironic that when we started with the internship program, we didn't have a school of public health.  That's our next area to work on.  We're not really attracting very many MPHers.

The other part of the internship is that we moved away from some of the traditional preparation and nursing and social work, and have really engaged community health education curriculums in what we're doing.  And most recently, some Econ majors.  And we use a heavy reliance on the interview process in our selection as opposed to previous academic success.

And the other lesson learned is we don't take anybody who hasn't had a real job.  You might have run a cash register, whatever, but we don't teach role of employee because that slows down the rest of them.  So, I don't know.  Was that what you're going for, Jeff?

JEFFREY LOBAS:  Yeah.  Thank you.

JUDY GANZER:  Hi, I'm Judy Ganzer from Indiana.  I think this idea of having a best practices site for bringing up the next generation is really important.  One thing that we do is we have medical students who come for a month's rotation in public health and preventive medicine and their eyes are really opened to something they haven't seen at all.  And they also help us because they are great researchers and they do a lot of background work for projects that we are unable to do.  So I don't know exactly what you're talking with ATMCH but one of the things I've been wondering is are they still preparing people to work in MCH Departments because there aren't too many of those.  And we kind of have to prepare people to work in the world where they are and we also have to kind of grab the opportunities where we can to show people what is going on.  We developed a School of Public Health in Indiana, but there is no MCH Department.  So to introduce them to that, we kind of have to bring them to the field.

PETER C. VAN DYCK:  I think some of the discussions with ATMCH are pretty exciting.  We're talking about doing some joint planning, developing some mentorship type of programs ongoingly.  And I think committed to regular dialogues several times a year.  And so I think we're starting to move that agenda forward and there's a lot of good energy around that.  So I'm pleased with what's happening with that.

JEFFREY LOBAS:  I think how much convergence we can deal with over the next few years, I'm not sure, but there is a lot in this domain, too.  I can't resist but some of you have heard, and I think it comes from Cathy d'Angeles that the pediatricians, at least, have finally agreed with her that training community pediatricians in the academic medical centers is like training forest rangers in a sawmill.  And it just doesn't accomplish what the community actually needs.  And if you look at the new training statement that comes from the guild, from the Board, and from the chairs of pediatrics, it's a very different model of pediatric training than what we have at the moment.  And that's just been published.

The stuff that Ed Shore has been publishing; he certainly understands Title V.  Also, there's lots of common ground for this.  And if you delve into the family physician's philosophical approach to the world, it actually fits pretty well at Title V.  It's like Christianity.  We need to try it sometime.  But there are ways in which we could put this all together, but it falls to us to be sure that the public health piece of it, the Title V piece of it, our side of the pyramid, gets reflected.  So the internships and the other opportunities that actually work pretty well with some traditional models of professional training need to be there and we can almost certainly generate that part.

JOHN NELSON:  Okay, if there are no more questions, we can end this session.  I appreciate everybody for being here.  Cassie Lauver would like to have a few words.