Title V MCH Needs Assessment

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Title V MCH Needs Assessment

• SETTING PRIORITIES
• March 30, 2005

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Agenda

• Overview of Needs Assessment Process
• Using the Q-sort methodology to rank priorities
• Results of Q-Sort Data Analysis
• National State Performance Measures
• WI 2010 Health Priorities
• Process for Setting Priorities
• Consensus Building
• Small group discussion
• Overview and wrap-up

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Handouts for Meeting

• Agenda
• List of attendees and group assignments
• Q-Sort Results (goldenrod)
• Q-Sort Needs Grid (blue)
• Health Problem Priority Setting Worksheet (green)
• Q-Sort Rank by population group (colored print)
• Consensus Definition (yellow)
• Enhanced Data Detail Sheets (20 top ranked)

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Presenters

• Linda Spaans Esten - State SSDI Coordinator
• Randy Glysch - Research Scientist, Injury Program
• Kate Kvale - MCH Epidemiologist
• Elizabeth Oftedahl - CSHCN Epidemiologist
• Murray Katcher - BCHP Chief Medical Officer
• Susan Uttech - Chief, Family Health Section

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Title V MCHNeeds Assessment

• Federal Requirement
• Title V of the Social Security Act
• In 1935, President Roosevelt signed legislation
  into law to promote and improve maternal and
  child health
• WI Dept of Health Family Services, Division of
  Public Health (DPH)
• receives funds through the federal Maternal and
  Child Health (MCH) Services Block Grant
• Required statewide needs assessment every 5 years
• In 1990s greater sophistication in assessing
  unmet needs
• Increased accountability in measuring program
  performance

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MCH Needs Assessment Purpose

• Direct decisions toward the most appropriate
  programs and policies that promote the health of
  women, children, CSHCN and their families.
• Needs assessment is a fundamental element of
  program planning
• Needs assessment is about CHANGE

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MCH Needs Assessment is part of an ongoing cycle

• Assess problems, needs, assets strengths
• Develop and implement solutions
• Evaluate activities
• Monitor performance

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Title V MCH Needs Assessment

• We undertake needs assessment because
• We recognize the dynamic nature of MCH
• We wish to be good stewards of the publics trust
• We must set priorities within limited resources

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MCH Needs Assessment

• Should be data driven and engage stakeholders
• Process must bridge
• Science and politics
• Data and values of the community
• Needs and the strategies for their solution

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Stakeholders

• Needs assessments must engage and involve the
  community of interest, the stakeholders
• Understand the values of the community
• Know the needs
• Help to identify strategies and solutions

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Who are the stakeholders?

• Local Health Departments (LHDS)
• Regional CSHCN Centers
• Family Planning/Reproductive Health
• Professional organizations
• Advocacy organizations
• Parents
• Professional staff from hospitals/clinics
• Minority health
• Division of public health
• Department of Public Instruction
• University

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Needs Assessment is data driven

• Population based data
• Census, Vital Records
• Surveillance systems data
• SLAITS, BRFSS, YRBS, PedNSS, communicable disease
  incidence
• Survey data from Family Health Survey
• Program and service data
• Listening Sessions

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MCH Identified Problems/Needs

• 44 Identified Needs
• 16 Listening sessions reaching 350 people
• Federal MCH needs
• State and local identified MCH needs
• Developed data detail sheet for each need
• Invited 200 people to participate as stakeholders
• Distributed 90 packets of data detail sheets in
  November 2004
• Held a stakeholder Q- Sort Training
• Participation by 61 stakeholders in Q-sort
  process

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Used Q Sort Technique to select priorities

• Purpose To identify priorities among competing
  needs
• Stakeholders have unique expertise, perspectives
  and passions about needs
• All needs cannot be the highest priority for
  the state MCH program
• Q Sort Technique is effective at getting
  information from people with different backgrounds

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What should the table look like?

• Create Nine Columns

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Inserting Needs on the Q-Sort Priority Log
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Completed Q-Sort Priority Log
Sixth Highest Priority
Seventh Highest Priority
Eighth Highest Priority
Fourth Highest Priority
Fifth Highest Priority
Second Highest Priority
Third Highest Priority
Highest Priority
Lowest Priority
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Data Analysis

• Look at the mean score of each need after
  gathering responses.
• Scores will be assessed for their variability by
  using the standard deviation.
• Some scores may be weighted if they are from
  under-represented fields or regions.

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Q-Sort Results and Descriptive Statistics
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Scoring and Standard Deviation

• Health Insurance Coverage for Children has a mean
  score of 3.28 and had a very small (1.7) standard
  deviation, you know that most everyone agreed
  this was a high priority.

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Frequency by Geography
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Frequency by Agency

• Birth to 3 (1)
• Central Office (16)
• Clinic (1)
• CSHCN Regional Center (7)
• DPI (2)
• Hospital (3)

• LHD (8)
• Managed Health Services (1)
• Private Non Profit (8)
• Regional Office (9)
• University (5)

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Frequency by Specialty Area
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Q-Sort Rank byPopulation Group

• Women and Infants (14 problems/needs)
• Children and Adolescents (14 problems/needs)
• CSHCN (9 problems/needs
• Note the overlap between the groups
• color coded

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Reach Consensus and Set Priorities

• Size of problem
• Seriousness of problem
• Potential for prevention

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Size of the Problem

• Mortality
• Number
• Rate
• High-risk sub-populations age, gender, race,
  geography, income, co-morbidity, setting

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Size of Problem, cont..

• Prevalence- number of cases in a given
  populations at a specific time
• Lifetime
• Current (point)
• Incidence- the rate of occurrence of new cases in
  a populations over a period of time

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Size of Problem, cont..

• Comparison to Healthy People 2010 and Healthiest
  Wisconsin 210 goals
• Comparison to U.S. and to other states
• Trends over time

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Seriousness of the Problem

• National data defining the problem
• If available, data to define the cost of
• Death or YPLL (years potential life loss)
• Hospitalizations/Disability
• Social and economic consequences

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Potential for Public Health Prevention

• Is the problem or need prevented or changed by
  known interventions ?
• What are the health consequences of not
  addressing the problem or need?
• Is there current demographic disparity for the
  problem or need?
• Do other providers identify this as problem or
  need?
• Are the problems precursors to other problems?

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Potential for Public Health Prevention, cont..

• Can the problem/need be measured and evaluated?
• Are their reasonable approaches/strategies for
  addressing the problem?
• Provide services directly or contract
• Regulate the activity
• Educate public and providers
• Systems development
• Data system improvements

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Priority Setting Worksheet

• Health Problem/Need
• A Size of Problem (rate 1-5)
• B Seriousness of the Problem (rate 1-5)
• C Potential for Prevention (rate 1-5)
• Priority Score (A 2B) C
• Rank based on priority score

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Priority Setting Processby Population Groups

• Read and discuss the 1st assigned data detail
  sheet
• Individually rate column A, B, and C (1-5)
• Review the individual results
• Facilitator/assistant will determine the
  frequency or mean score
• Facilitator will ask Is this score acceptable
  that everyone can agree to support it?

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To Reach Consensus

• Each person will hold up a colored ticket
• Green I agree to support it
• Yellow I think I can support it but want more
  discussion
• Red I cannot support it
• Individuals present additional opinions and data
  to help decision making
• Group must reach consensus at the end

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EXAMPLE
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What is Consensus?

• A collective decision arrived at by a group of
  individuals working together under conditions
  that permit communication to be sufficiently
  open--and the group to be sufficiently
  supportive--for everyone in the group to fell
  that he/she has had his/her fair change to
  influence the decision!!

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Consensus is a Process

• It is NOT Conformity
• Acceptable enough that everyone can live with it
  and agree to support it
• Not everyone must be completely satisfied with
  the outcome
• Total satisfaction is rare

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Consensus How to make it work

• Pooling opinions
• Effective listening
• Discussing ideas and differences
• Not getting all you want
• Agreement to the point you can live with it
• Support of the final decision

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Consensus and Conflict

• Not good or bad - only indicates disagreement
• Is normal the whole group benefits by exchange
  of opinion
• Group can experience intense disagreement as long
  as there remains an assumption of cooperation

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Consensus Breaking an Impasse

• Take a break or go on to the next problem
• Review criteria and standards
• Review the data
• Inject humor to break the tension

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Next Steps(to bring a method to the madness)

• Review the ranking for each group
• Identify solutions and strategies to
• Determine whether or not we can do anything about
  the need and what precisely it is we can and wish
  to do.

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Generate possible solutions related to a priority

• Compare the priority to strategies such as
• Provide service directly
• Contract with others to provide service
• Provide education to public and/or providers
• Systems development
• Data system improvement

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Generate possible solutions related to priority

• Then ask the following questions for each
  strategy
• How effective would this solution be?
• Low, medium, high
• How efficient would this solution be?
• Low, medium, high
• How acceptable would this solution be?
• Low, medium, high

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Determine Wisconsins Title VState Performance
Measures

• Compile results and internally finalize
  recommendations for
• State Performance Measures
• Program Direction
• Resource Allocation
• Present findings to Department
• Include final recommendations for annual Title V
  Block Grant Application