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GINA FEBBRARO, MPHMATERNAL AND CHILD HEALTH UNIT
MANAGERCOLORADO DEPARTMENT OF PUBLIC HEALTH
COLORADO’S MCH PRIORITIES: MOVING FROM DATA TO ACTION
DISCUSSION OVERVIEW
MCH Program vision and direction
Identification of MCH priorities
State infrastructure and process
Local public health agency alignment and support
Feedback and next steps
COLORADO’S MCH MISSION
Optimize the health and well-being of the MCH population by employing primary prevention and early intervention public health strategies.
MCH STRATEGIC DIRECTION
Integrating MCH/CYSHCN efforts across the life course
Attention to primary prevention and early intervention strategies
Focus on population-based approaches to health
MCH INTERVENTION
STRATEGIES MCH Pyramid Here
COLORADO MCH
NEEDS ASSESSMENT
Occurred in 2010 for 2011-2015
Purpose to identify 7-10 specific priorities that could be measurably impacted in five years using public health strategies
Conceptual framework
MCH population – Integrated CSHCN
Life course model
Social determinants of health
NEEDS ASSESSMENT
PROCESS Phase I – Collection of quantitative/
qualitative data to identify potential MCH priorities.
Expert Panel Process
Health Status Report
Phase II – Stakeholder surveys
Phase III – Final prioritization, including identification of new priorities and State Performance Measures.
CRITERIA FOR ESTABLISHING
PRIORITIES
A clear MCH public health role exists.* Evidence-based or promising practices exist
to address the issue. Consistent with mission and scope of MCH
– alignment with MCH SOW. Efforts could achieve measurable results in
5 years.*Ability for MCH to impact.
Promote preconception health among women and men of reproductive age with a focus on intended pregnancy and healthy weight.
Promote screening, referral and support for pregnancy-related depression.
Improve developmental and social emotional screening and referral rates for all children ages birth to 5.
COLORADO’S MCH PRIORITIES 2011-2015
Prevent obesity among all children ages birth to 5.
Prevent development of dental caries in all children ages birth to 5
Reduce barriers to a medical home approach by facilitating collaboration between systems and families.
COLORADO’S MCH PRIORITIES 2011-2015
Promote sexual health among all youth ages 15-19.
Improve motor vehicle safety among all youth ages 15-19.
Build a system of coordinated and integrated services, opportunities and supports for all youth ages 9-24.
COLORADO’S MCH PRIORITIES 2011-2015
MCH PRIORITIES AND WINNABLE BATTLES
See Crosswalk!
MCH STEERING TEAM
Redefined role from needs assessment to implementation;
Members: Karen Trierweiler, Title V Director
Rachel Hutson, Children and Youth Branch Director
Esperanza Ybarra, Women’s Health Branch Director
Gina Febbraro, Maternal and Child Health Unit Manager
FROM MCH PRIORITIES TO STATE AND LOCAL PLANS
Developed a new state-level infrastructure that: Promotes a coordinated approach between
state and local MCH efforts;
Provides support and capacity-building among both state and local MCH staff;
Provides oversight and accountability to state and local-level work;
MCH IMPLEMENTATION TEAMS (MITS)
MIT formed for each MCH priority;
State program staff person with expertise in the priority area leading each team;
Teams (6-10 people) varied in composition: state, local stakeholders;
Teams were required to complete a team charter.
Required to engage local stakeholders for input/ feedback;
BROWNSON EVIDENCE-BASED PUBLIC HEALTH MODEL
Brownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:189
MIT WORK
Develop state-level logic models and action plans that guide the next 3 years of work.
Develop coordinated local-level logic models and action plans that guide the next 3 years of work.
TRAINING AND SUPPORT PROVIDED
Ongoing communication and consultation (Rebecca Heck and Kerry Thomson)
Collaboration and policy training
Logic model and action plan trainings
Will continue to identify and coordinate ongoing professional development opportunities for MITs and local MCH staff working on priorities.
ACCOUNTABILITY AND OVERSIGHT
MITs presented and discussed work with MCH Steering Team 2x each last year.
MCH Director, Unit Manager, and Generalist Consultants reviewed state and local level logic models and action plans and provided feedback to MITs.
Report on efforts and progress in annual Title V Block Grant report
AT THE SAME TIME…MCH LOCAL FUNDING POLICY
Revised local funding formula for MCH and HCP funding
2008 Public Health Act, MCH Priorities, Address some funding inequities that evolved over time
Intensive communication and stakeholder engagement, including LPHA workgroups
MCH LOCAL FUNDING POLICY RESULTS
Using the same, consistent formula for all 55 LPHAs (MCH population x poverty of MCH pop.)
Combining both MCH and HCP funding in order to provide more flexibility for LPHAs and due to integrated nature of priorities
3-year transition/mitigation plan
Aligning contract expectations with priorities and HCP program direction
ALIGNMENT OF LOCAL MCH FUNDING <$50,000
Administered through Office of Planning and Partnerships – LPHA per capita contracts
41 LPHAs / Total of $410,000
$1500-$15,000 and $15,000-$50,000 Levels
HCP Model of Care Coordination with data entry in CYSHCN Data System (Required for higher level);
MCH priorities by implementing part or all of a state-developed local action plan related to an MCH priority;
Community health assessment process and public health improvement planning process;
ALIGNMENT OF LOCAL MCH FUNDING >$50,000
40%
50%
10%
FY13 LPHA MCH/HCP Funding Expectations
HCP Care Coordination Other MCH Priorities and Action Plans
Includes costs associ-ated with Medical Home Priority
One example of what HCP care coordination costs may be.
HCP Specialty Clinic Funding
The parameters of the "Other" work are similar to MCH funding parameters now. Efforts are determined by LPHA.
RESOURCE ROLL-OUT
MCH Conference
150 LPHA and State staff (MCH, PSD, OPP)
2 days that included a variety of Plenary Sessions
State MCH strategic direction
State and regional MCH data overview
Brownson’s Evidence-based Public Health Framework
Importance of population-based approach to health
RESOURCE ROLL-OUT
MCH Conference
MCH Priority Break-out Sessions (most priority session offered 3 times each)
Background and data on priority issue
Brief intro. to state logic models and action plans
Focus on local logic models and action plans
Interactive sessions highlighted local partner input
AND THE SURVEY SAYS…
AND THE SURVEY SAYS…
What is one thing you learned at the conference that you are excited to apply at the job?
“Almost plug and play action plans, logic models, and the stats”
“Utilization of Brownson's model and the MCH Pyramid”
“Action plans”
“Partnership building”
“Best practices for MCH work”
AND OUR PARTNERS SAY…
“I just wanted you to know how useful it has been over the last weeks to have the priority areas, each with workplans, logic models, etc. I have met with our WIC director about ECOP (and preconception), and have promoted Teen Motor Vehicle with some injury folks. Although we are not likely to undertake ABCD per say, the information has helped us so much with Medical Home Systems Building planning, and of course we are full on with Youth Sexual Health in many arenas and are using that material broadly. All though I could not articulate what is was I exactly needed when I took on this role, this body of tools fills multiple needs for Denver and I would like the staff who spent so many hours developing the information to know how useful it has been, even beyond its official purpose.”
--Denver Public Health MCH Program Manager
REFLECTIONS FROM MITS:WHAT WORKED?
Communication: Expectations for MITs were clear and flexible; MIT quarterly meetings; learning and sharing from other MITs was very helpful
Aspects of process helpful for accountability and moving the work forward: Assigning 1 lead per MIT; Sponsor and Steering Team check-in meetings
Support, resources and tool: Logic model and action plan templates; devoted EPE point-person; EPE infrastructure specifically for LM and AP consultation; MCH Generalist Consultant support
REFLECTIONS FROM STEERING:WHAT WORKED?
Steering Team check-in meetings – accountability and quality control
Creation of support infrastructure for MITs, including resourcing individual to support MITs
Continuity and intentionality from needs assessment through to implementing plans
REFLECTIONS FROM MITS:WHAT COULD WE IMPROVE?
Communication: more time for Steering Team check-in’s at the beginning of the process; increased sharing, mentorship, and lessons learned among the MITs during the development of LMs and APs; more frequent MIT lead meetings during ‘busy decision making time’ and prior to MCH conference; common communication platform for the MITs to access
More time: From to digest feedback and adjust LM and AP prior to MCH Conference; Between LM and AP trainings and the due date for the LMs and APs.
REFLECTIONS FROM STEERING:WHAT COULD WE IMPROVE?
Developing process and infrastructure in real time; created tight timelines – be more planful in the future;Modify structure to meet needs; Check-in routinelyValue of sponsor role? Sponsor = supervisor Communication strategy overall and specifically related to stakeholders
NEXT STEPS – ACTION TO OUTCOMES
Dissemination of Work and Resources
CoPrevent / MCH web site
Presentations (conferences/webinars/podcasts) and Publications
Ongoing and Enhanced Communication (internal and external)
Ongoing MIT/LPHA support and capacity-building
Oversight and evaluation of state and local work plans
