C OLORADO ’ S MCHP RIORITIES : M OVING FROMD ATA TO A CTION G INA F EBBRA RO , MP H M ATER N A L AND C HILD H EALTH U NIT M AN A G E R C OLORADO D EPART M E NT OF P UBLIC H EALTH AND E NVIRON M EN T GINA . FE BB R A R O @ STAT E . C O . U S
D ISCUSSION O VERVIEW MCH Program vision and direction Identification of MCH priorities State infrastructure and process Local public health agency alignment and support Feedback and next steps
C OLORADO ’ S MCH M ISSION Optimize the health and well- being of the MCH population by employing primary prevention and early intervention public health strategies.
MCH S TRATEGIC D IRECTION Integrating MCH/CYSHCN efforts across the life course Attention to primary prevention and early intervention strategies Focus on population-based approaches to health
MCH I NTERVENTION S TRATEGIES MCH Pyramid Here
C OLORADO MCH N EEDS A SSESSMENT 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
N EEDS A SSESSMENT P ROCESS 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.
C RITERIA FOR E STABLISHING P RIORITIES 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.
C OLORADO ’ S MCH P RIORITIES 2011-2015 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.
C OLORADO ’ S MCH P RIORITIES 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.
C OLORADO ’ S MCH P RIORITIES 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.
MCH P RIORITIES AND W INNABLE B ATTLESSee Crosswalk!
MCH S TEERING T EAM 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
F ROM MCH P RIORITIES TO S TATE AND L OCAL P LANS 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 I MPLEMENTATION T EAMS (MIT S ) 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;
B ROWNSON E VIDENCE - BASED P UBLIC H EALTH M ODELBrownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health 2009.30:189
MIT W ORK 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.
T RAINING AND S UPPORT P ROVIDED 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.
A CCOUNTABILITY AND O VERSIGHT 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 S AME T IME …MCH L OCAL F UNDING P OLICY 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 L OCAL F UNDING P OLICY R ESULTS 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
A LIGNMENT OF L OCAL MCH F UNDING <$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;
A LIGNMENT OF L OCAL MCH F UNDING >$50,000 FY13 LPHA MCH/HCP Funding Expectations HCP Care Coordination Other MCH Priorities and Action Plans Includes costs associated with Medical Home Priority 10% One example of what HCP care coordination costs may be. 40%The parameters of the"Other" work are similar to HCP SpecialtyMCH funding parameters Clinic Fundingnow. Efforts are determinedby LPHA. 50%
R ESOURCE R OLL -O UTMCH 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
R ESOURCE R OLL -O UTMCH 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
A ND T HE S URVEY S AYS …
A ND T HE S URVEY S AYS …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 Brownsons model and the MCH Pyramid” “Action plans” “Partnership building” “Best practices for MCH work”
A ND O UR PARTNERS S AY … “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
R EFLECTIONS F ROM MIT S : W HAT W ORKED ? 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
R EFLECTIONS F ROM S TEERING : W HAT W ORKED ? 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
R EFLECTIONS FROM MIT S : W HAT C OULD W E I MPROVE ? 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.
R EFLECTIONS FROM S TEERING : W HAT C OULD W E I MPROVE ? Developing process and infrastructure in real time; created tight timelines – be more planful in the future; Modify structure to meet needs; Check-in routinely Value of sponsor role? Sponsor = supervisor Communication strategy overall and specifically related to stakeholders
N EXT S TEPS – A CTION TO O UTCOMES 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
T HANK YOU AND Q UESTIONS !GINA . FEBBRARO @ STATE . CO . US303 692 2427