Presentation is loading. Please wait.

Presentation is loading. Please wait.

“So What?” History and Currency of Needs Assessment in MCH as an Agent for Change AMCHP Data Skills Session MCH Epidemiology Conference December 7-8, 2008.

Similar presentations


Presentation on theme: "“So What?” History and Currency of Needs Assessment in MCH as an Agent for Change AMCHP Data Skills Session MCH Epidemiology Conference December 7-8, 2008."— Presentation transcript:

1 “So What?” History and Currency of Needs Assessment in MCH as an Agent for Change AMCHP Data Skills Session MCH Epidemiology Conference December 7-8, 2008 Atlanta, GA

2 Public Health: MCH Public health is what we do collectively as a society to create those conditions in which we can be healthyPublic health is what we do collectively as a society to create those conditions in which we can be healthy Maternal and child health is a fundamental component of public health efforts worldwideMaternal and child health is a fundamental component of public health efforts worldwide Maternal and child health in the US seeks to promote the nation’s interest in improving the health and well-being of all children and their familiesMaternal and child health in the US seeks to promote the nation’s interest in improving the health and well-being of all children and their families

3 Public Health: MCH Focus is on the POPULATIONFocus is on the POPULATION Emphasis is on PREVENTIONEmphasis is on PREVENTION Orientation is toward the COMMUNITYOrientation is toward the COMMUNITY Efforts are directed at SYSTEMSEfforts are directed at SYSTEMS Overarching role is one of LEADERSHIPOverarching role is one of LEADERSHIP

4 Public Health Assessment As fundamental public health programs, MCH programs engage in the core functions of public health, as applied to these efforts to promote the health of MCH populations:As fundamental public health programs, MCH programs engage in the core functions of public health, as applied to these efforts to promote the health of MCH populations: –Assessment –Policy development –Assurance

5 Public Health Assessment “It is the responsibility of every public health agency to regularly and systematically collect, assemble, analyze and make available information on the health of the community, including statistics on health status, community health needs and epidemiologic and other studies of health problems”“It is the responsibility of every public health agency to regularly and systematically collect, assemble, analyze and make available information on the health of the community, including statistics on health status, community health needs and epidemiologic and other studies of health problems” IOM 1988 The Future of Public Health IOM 1988 The Future of Public Health

6 MCH Essential Services 1. Assess and monitor MCH to identify and address problems 2. Diagnose and investigate health problems and hazards 3. Inform and educate the public and families about MCH issues 4. Mobilize community partnerships between policymakers, health care providers, families, the general public to identify and solve MCH problems 5. Provide leadership for priority-setting, planning and policy development to support community efforts

7 MCH Essential Services 6. Promote and enforce legal requirements 7. Link women, children and youth to health and other community and family services and assure access to comprehensive, quality systems of care 8. Assure the capacity and competency of the public health and personal health work force 9. Evaluate the effectiveness, accessibility and quality of personal health and population-based services 10. Support research and demonstrations

8 MCH Leadership We share the mission of public health but in many ways our task is both more intensive and more diffuseWe share the mission of public health but in many ways our task is both more intensive and more diffuse We are responsible, in some way, for every public health aspect of the lives of a large and often vulnerable population groupWe are responsible, in some way, for every public health aspect of the lives of a large and often vulnerable population group Our successful advocacy and action for this population group can affect everyoneOur successful advocacy and action for this population group can affect everyone

9 MCH Leadership MCH programs, with their tremendous responsibility and sweeping scope, must be meticulous in determining the best strategies for achieving the greatest outcomes with the fewest resourcesMCH programs, with their tremendous responsibility and sweeping scope, must be meticulous in determining the best strategies for achieving the greatest outcomes with the fewest resources This means that program leaders must pay close and serious attention to each element of the assessment and planning process and monitor its progress and its successThis means that program leaders must pay close and serious attention to each element of the assessment and planning process and monitor its progress and its success

10 MCH Assessment State Title V agencies are required to conduct comprehensive needs assessments every five years, to identify state MCH priorities, to arrange programmatic and policy activity around these priorities, and to develop state performance measures to monitor the success of their effortsState Title V agencies are required to conduct comprehensive needs assessments every five years, to identify state MCH priorities, to arrange programmatic and policy activity around these priorities, and to develop state performance measures to monitor the success of their efforts MCH assessments are to be population-based and community-focusedMCH assessments are to be population-based and community-focused

11 MCH Assessment Assessment is not at all new to MCHAssessment is not at all new to MCH 1912 charter establishing the Children’s Bureau states as its mission:1912 charter establishing the Children’s Bureau states as its mission: “...to investigate and report upon matters pertaining to the welfare of children and child life among all classes of people...” “investigate and report” = assessment!“investigate and report” = assessment!

12 MCH Assessment The nature of the mission of MCHThe nature of the mission of MCH “... to assure the health of all mothers and children...” requires that MCH programs engage in ongoing monitoring and assessment of trends in population characteristics, health status indicators, risk factors, health system attributes, and the availability and accessibility of quality services for MCH populations

13 Get to Know your Tablemates First Question: Where were you in 1981? And why is that year significant in the context of this discussion on needs assessment?Where were you in 1981? And why is that year significant in the context of this discussion on needs assessment? Second Question: Where were you in 1989? And why is that year significant in the context of this discussion on needs assessment?Where were you in 1989? And why is that year significant in the context of this discussion on needs assessment?

14 1981: Block Grants In the spirit of state’s rights and “get the federal government off our backs” the old formula MCH funds were “blocked” with several MCH- related categorical programs and funds were awarded to each state based on its proportional share of the total amount of funding less 25%, because state’s were expected to make better decisions about how to spend their money In the spirit of state’s rights and “get the federal government off our backs” the old formula MCH funds were “blocked” with several MCH- related categorical programs and funds were awarded to each state based on its proportional share of the total amount of funding less 25%, because state’s were expected to make better decisions about how to spend their money

15 1981: Block Grants Because state’s were making their own decisions, there was no need for any federal interference or oversightBecause state’s were making their own decisions, there was no need for any federal interference or oversight So reporting requirements were removed as was the need for any real applicationSo reporting requirements were removed as was the need for any real application So... add up the reduction in funds with the removal of any requirement to report data or submit a plan and what happened?So... add up the reduction in funds with the removal of any requirement to report data or submit a plan and what happened?

16 The 1980’s: The Dataless Decade No data, no problems!No data, no problems! The primary source of any population data was vital recordsThe primary source of any population data was vital records –Little surprise that the 1980’s was also the decade of infant mortality reduction efforts Child advocates and an increasingly vocal group of parents of children with special health care needs demanded that this changeChild advocates and an increasingly vocal group of parents of children with special health care needs demanded that this change

17 OBRA 89 Major revision of the Block Grant legislation from 1981 to what you know and love todayMajor revision of the Block Grant legislation from 1981 to what you know and love today –Restored annual reporting requirements –Restored the application (plan) process –Specified how funds were to be used –Required a comprehensive assessment of need every five years –Etc, etc, etc

18 MCH Assessment Needs Assessment in MCH is essential to direct our decisions toward the most appropriate programs and policies to promote the health of women, children, adolescents, and children with special health care needs, and their familiesNeeds Assessment in MCH is essential to direct our decisions toward the most appropriate programs and policies to promote the health of women, children, adolescents, and children with special health care needs, and their families Needs Assessment in MCH is a fundamental element of any program planning activityNeeds Assessment in MCH is a fundamental element of any program planning activity Needs Assessment in MCH is about changeNeeds Assessment in MCH is about change

19 MCH Assessment and Planning Good!Good! Because MCH planning is also about changeBecause MCH planning is also about change –Changing direction –Changing efforts –Changing staffing –Changing resources –Changing outcomes –Changing lives

20 MCH Assessment and Planning Needs Assessment is part of an ongoing planning cycle that enables us to 1. assess problems, needs, assets and strengths 2. develop and implement solutions 3. allocate resources 4. evaluate activities 5. monitor performance 6. begin anew, back to #1

21 MCH Assessment Needs assessment is an inextricable part of planning and both are ongoing processesNeeds assessment is an inextricable part of planning and both are ongoing processes The five year needs assessment provides a point in time at which the process is revisited, constituents are re- engaged, plans and strategies are reassessed and a new course is charted based on newly analyzed informationThe five year needs assessment provides a point in time at which the process is revisited, constituents are re- engaged, plans and strategies are reassessed and a new course is charted based on newly analyzed information The plans that evolve from your assessment should also include focused assessment activities in the intervening yearsThe plans that evolve from your assessment should also include focused assessment activities in the intervening years

22 MCH Needs Assessment We undertake needs assessments NOTWe undertake needs assessments NOT –because “we have to” –to justify our current efforts –if we do not intend to act on the results We undertake needs assessmentsWe undertake needs assessments –because we recognize the dynamic nature of MCH –because we wish to be good stewards of the public’s trust –because we must address priorities within limited resources

23 MCH Assessment Needs Assessments are data-driven because MCH, as part of public health, is science and evidence-basedNeeds Assessments are data-driven because MCH, as part of public health, is science and evidence-based BUT, in recognition of the politics of policy- making, program development and resource allocation in public health, needs assessments must also engage and involve the community of interest, the stakeholdersBUT, in recognition of the politics of policy- making, program development and resource allocation in public health, needs assessments must also engage and involve the community of interest, the stakeholders

24 MCH Assessment MCH Needs Assessments bridge: The science and the politicsThe science and the politics The data and the values of the communityThe data and the values of the community The needs and the strategies for their solutionThe needs and the strategies for their solution All within a comprehensive planning process that leads to change

25 MCH Data for Decision Making Essentially four sources of data for needs assessments:Essentially four sources of data for needs assessments: –Population-based data (vital records, census) –Surveillance systems and survey data –Program or service data –Public forums or focus groups Assessment activities include identification of needs, assets and resource capacities across the stateAssessment activities include identification of needs, assets and resource capacities across the state

26 MCH Data for Decision-Making Population-based Data CensusCensus Vital RecordsVital Records –Births –Deaths –Fetal Deaths –Abortions –Marriages, divorces, adoptions

27 MCH Data for Decision-Making Surveillance or Survey DataSurveillance or Survey Data –Behavioral Risk Factor Surveillance System –Youth Risk Behavior Survey –SLAITS (children with special health care needs) –PRAMS –Communicable Diseases –Registries –FIMR, Child Fatality Review –Specific surveys conducted for this or other purposes

28 MCH Data for Decision-Making Program and Service DataProgram and Service Data –MCH programs that provide services have data bases for program management purposes that can still provide important information for this needs assessment –If services are funded via contract, contracted agencies are collecting service data that may be of interest –Other sister programs and agencies will have data that may extend to a larger population that can be informative

29 MCH Data for Decision-Making Program and Service DataProgram and Service Data –Children with Special Health Care Needs –Newborn Screening –WIC –Family Planning –School-based Clinics –Prenatal Clinics –Well-baby Clinics, Immunization Programs –Lead Poisoning Prevention Programs

30 MCH Data for Decision-Making Program and Service DataProgram and Service Data –Disease Control –Chronic Disease Prevention –Injury Prevention –State Lab –Primary Care –Minority Health –Environmental Health –Facilities and Professional Licensure

31 MH Data for Decision-Making Program and Service DataProgram and Service Data –Medicaid –SCHIP –Education (special ed, lunch and breakfast programs, graduation rates, enrollment, etc) –Social Services (child abuse and neglect, adoption, foster care, child care, etc) –Mental Health and Substance Abuse –Justice (adult and juvenile) –Housing, Planning, Urban Affairs, Transportation, etc

32 MCH Data for Decision-Making Public Forums and Focus Groups Town Meetings and Public ForumsTown Meetings and Public Forums Public HearingsPublic Hearings Focus GroupsFocus Groups Anecdotal DataAnecdotal Data –Concerned citizens, complaints –Media reports, “Focusing” events –Elected officials

33 But is it Data? Yes, MCH is data-driven but because it is public health it must involve the community of interest because their wishes matter, sometimes more than the data!Yes, MCH is data-driven but because it is public health it must involve the community of interest because their wishes matter, sometimes more than the data! What stakeholders bring to the process is the reality check – what really matters to them?What stakeholders bring to the process is the reality check – what really matters to them? The assessment will have no credibility if it does not reflect what affected constituencies believe is importantThe assessment will have no credibility if it does not reflect what affected constituencies believe is important

34 Needs as Values Needs are value judgments that suggest that problems exist for specific population groups or in specific communitiesNeeds are value judgments that suggest that problems exist for specific population groups or in specific communities Needs, as reflections of our values, are subject to disagreement and debateNeeds, as reflections of our values, are subject to disagreement and debate For needs to be useful in policy and program planning there has to be agreement that they reflect real and important problemsFor needs to be useful in policy and program planning there has to be agreement that they reflect real and important problems –Data and politics...

35 Involving Stakeholders Who are “stakeholders”? Anyone representing a group with a particular interest in the process and its outcomesAnyone representing a group with a particular interest in the process and its outcomes Anyone with a “stake” in the process and its outcomes, anyone with a vested interest (beware the conflicts of interest that will arise...)Anyone with a “stake” in the process and its outcomes, anyone with a vested interest (beware the conflicts of interest that will arise...) As needs assessment is about change, lots of folks will have something to say about the process and its outcomes...As needs assessment is about change, lots of folks will have something to say about the process and its outcomes...

36 Stakeholders as Partners Many of the needs you will identify “belong” to other agencies who may not share your population-, prevention-, systems philosophyMany of the needs you will identify “belong” to other agencies who may not share your population-, prevention-, systems philosophy Part of your leadership role is engaging other partner agencies to assume their own leadership roles with these issues – difficult to doPart of your leadership role is engaging other partner agencies to assume their own leadership roles with these issues – difficult to do Part of your job is figuring out who should take the lead on what issuePart of your job is figuring out who should take the lead on what issue Engaging them early and often can helpEngaging them early and often can help

37 Involving Stakeholders Stakeholders are essential in multiple areas: Helping identify the full scope of needsHelping identify the full scope of needs Helping interpret available data or collect newHelping interpret available data or collect new Helping sort out prioritiesHelping sort out priorities Helping identify and select solutionsHelping identify and select solutions Helping build awareness of your programHelping build awareness of your program Helping to build consensusHelping to build consensus Helping advocate for needed changesHelping advocate for needed changes Supporting the overall efforts of the larger programSupporting the overall efforts of the larger program

38 Needs Assessment and Planning Needs assessment is not done until the priorities are established, the strategies have been identified, the program has been planned (with measurable objectives), the resources are allocated, and the state performance measures have been determinedNeeds assessment is not done until the priorities are established, the strategies have been identified, the program has been planned (with measurable objectives), the resources are allocated, and the state performance measures have been determined It is NOT sufficient to “complete” an assessment of need, bind it, and put it on a shelfIt is NOT sufficient to “complete” an assessment of need, bind it, and put it on a shelf You might as well have not done it at allYou might as well have not done it at all Remember, needs assessment is all about changeRemember, needs assessment is all about change

39 Performance Measures The data you have gathered through your needs assessment, from which you determined your priorities, provides critical information from which to set measurable program objectives, which then allow you to evaluate your effortsThe data you have gathered through your needs assessment, from which you determined your priorities, provides critical information from which to set measurable program objectives, which then allow you to evaluate your efforts State Performance Measures are one important tool we use to document our intent and ultimately evaluate our successState Performance Measures are one important tool we use to document our intent and ultimately evaluate our success

40 Resource Allocation The data you have gathered through your needs assessment, from which you have determined your priorities, also provides the basis from which to allocate resources, either to localities, if you have such a structure, or through any grants or contract mechanism you employThe data you have gathered through your needs assessment, from which you have determined your priorities, also provides the basis from which to allocate resources, either to localities, if you have such a structure, or through any grants or contract mechanism you employ Per county? Per capita? Based on level of need? Based on capacity?Per county? Per capita? Based on level of need? Based on capacity?

41 Organizational Structure and Work The priorities you identify from the needs assessment will shape your agenda for the next several yearsThe priorities you identify from the needs assessment will shape your agenda for the next several years This should also cause you to consider changes in the nature of the work done within your offices and may necessitate structural changes in order to achieve the change desired in health status and outcomesThis should also cause you to consider changes in the nature of the work done within your offices and may necessitate structural changes in order to achieve the change desired in health status and outcomes The data can help you do this as wellThe data can help you do this as well

42 Evaluation The monitoring and evaluation strategy should be designed at the time you are devising the program strategyThe monitoring and evaluation strategy should be designed at the time you are devising the program strategy Measurable objectives for each area of activity and level of effort must be developedMeasurable objectives for each area of activity and level of effort must be developed –Specific, time-framed and measurable Data systems are needed for monitoring process, intermediate outcome and ultimate outcome objectivesData systems are needed for monitoring process, intermediate outcome and ultimate outcome objectives Establish timeframes for evaluation reportsEstablish timeframes for evaluation reports

43 “So What?” Basing our efforts on the evidence is part of our heritage and one of the great legacies left us by the leaders of the Children’s BureauBasing our efforts on the evidence is part of our heritage and one of the great legacies left us by the leaders of the Children’s Bureau Seriously engaging the data AND the community provides you incredibly important “strength in numbers”, both of which can help you realize your vision and bring your plans to realitySeriously engaging the data AND the community provides you incredibly important “strength in numbers”, both of which can help you realize your vision and bring your plans to reality

44 “So What?” As leaders in your states, you must manage this large planning effort in recognition of the inter- related nature of each of these effortsAs leaders in your states, you must manage this large planning effort in recognition of the inter- related nature of each of these efforts You can delegate tasks, but they must be managed collectively and with a great deal of communication, support and celebrationYou can delegate tasks, but they must be managed collectively and with a great deal of communication, support and celebration Needs assessment is not a data exercise, it is a leadership exercise (perhaps a survival exercise!)Needs assessment is not a data exercise, it is a leadership exercise (perhaps a survival exercise!) Maybe, needs assessment is about changeMaybe, needs assessment is about change

45 “So What?” It is to be expected that you will need resources, authority, direction from your legislatures and perhaps even internally within your agency to effect the change you seekIt is to be expected that you will need resources, authority, direction from your legislatures and perhaps even internally within your agency to effect the change you seek It’s very hard to argue with the powerful combination of data and public advocacyIt’s very hard to argue with the powerful combination of data and public advocacy Good needs assessments can set you free to succeed!Good needs assessments can set you free to succeed!


Download ppt "“So What?” History and Currency of Needs Assessment in MCH as an Agent for Change AMCHP Data Skills Session MCH Epidemiology Conference December 7-8, 2008."

Similar presentations


Ads by Google