Phyllis Sloyer, RN, PhD, PAHM, FAAP
Division Director, Division of CMS
Florida Department of Health
Kimberlee Wyche-Etheridge, MD, MPH
Chair, CityMatCH Board of Directors
Director, Family, Youth and Infant Health
Metro Nashville/Davidson County Public Health Dept
This month’s Pulse features the topic of state and local collaboration. We asked the leaders of AMCHP and CityMatCH to share their thoughts on a few questions related to partnership and collaboration between state and local MCH programs.
Q: From your vantage points, what works in promoting successful state and local collaboration?
Kim: Three things are critical if state and local public health agencies are going to collectively advance the health of women, children and families. First, and most critical, we must remind ourselves and explicitly state our shared aim of improving health and wellness. Regardless of turf wars, clashing personalities, population differences, budgetary conflicts, or divergent objectives, we all strive for the same thing: Mothers and children, fathers and families that live healthy and productive lives. We want our communities to thrive. Second, we must keep the lines of communication open. When communication ceases, too often assumptions, and one sided expectations begin to define relationships between state and local health departments. These assumptions and expectations draw lines in the sand, erroneously pitting local agendas against those of the state, and vice versa. When this happens, critical collaborations morph into defensive maneuvers that are not beneficial to either entity. Regular and open communication is the surest way to safeguard against this constant threat. Finally, we must be willing to see, and respect each others’ points of view. Differences should be expected, accepted, and used as opportunities. It's our ability to find mutuality in our differences that yields creative solutions and innovative programs.
Phyllis: First, an understanding of the respective constraints and roles and responsibilities and second a recognition that local is where the heart of services are. I believe it is the behavioral competencies that make a difference here, over and above knowledge. Strong networking and consensus building skills are necessary. Often I use a team where one or two individual possess the behavioral competencies necessary to establish a collaborative environment and others who possess the technical and knowledge competencies needed to outline effective implementation of a strategy. This is hard work and takes a commitment to clear your calendar so that you have the time to work on collaboration. I also think the agency's values set the tone for this as well as senior leadership’s commitment to a partnership model. I have also found low turnover and consistency has improved collaboration. The changes in workforce and shorter tenure in a position will create new challenges for us in the future.
Q: How can AMCHP and CityMatCH promote state and local partnerships?
Phyllis: We both have a national presence and have, in part, common members. We can and should develop a shared vision and implementation steps toward fulfillment of that vision. I believe we have begun this process and have a lot of work to do to keep each other informed and find common activities we can work on to advance maternal and child health, whether at a state or local level.
Kim: I believe AMCHP and CityMatCH have already created an effective approach for this. The State/Local Practice Collaborative model provides the opportunity for multidisciplinary teams to work within, and across states for improved effectiveness. Team members work as equal partners with shared goals and routine communication. The experiences and skills these team participants master stretch individuals to embrace new ideas and enhanced ways of “doing” public health. If you have not had the opportunity to participate, I highly recommend it.
Q: What are some sticking points that we have to work together to address as state and local MCH leaders?
Kim: Although the ultimate goal is the same for both state and local entities, the steps to get there can often be very different. Again, the solutions to this challenge are readily available: recognizing shared aims, communicating regularly, and seeing each other’s perspectives. We need only to be willing to use the tools we have available.
Phyllis: I think dwindling resources develops a perception of the state transferring risk and responsibility without sufficient resources being transferred to the local level, not unlike the states' complaints about the new federalism. Furthermore, our governance structures may create competition for the same resources. Sticking points can also be created by changes in leadership in the executive and legislative branches and changes in perception about the value of our services.
Q: What have been past challenges in local and state collaboration from which we can learn?
Phyllis: We too often do not document the structural, policy, and other frameworks that led to success. It is important to catalogue the strategies used in creating success or in avoiding failure. I am also a firm believer in recruiting and molding successful leaders with the competencies necessary to create and sustain an effective environment. Never believe that function follows form! Question and listen to those who have been successful at building state and local partnerships and make a point of making it a top priority in our job! At the state level, our customers are as much the local health departments or local provider networks as are the women and children who are the foundation of our mission.
Kim: Two areas in particular come to mind, and I suspect these two issues are among the most daunting for most local maternal and child health workers. First, budget concerns. Often times we don't understand why or how state resources are divided among locals. Urban areas often feel short changed due to far more clients needing service while at the same time, rural areas may feel that appropriations are uneven or unfair also. When dealing with an ever-shrinking resource pot, state, urban and rural health agencies far too often leave the table disillusioned, and this erodes the relationship dynamics. Come time to sit at the table the following year, expectations are low, and willingness to give, even a little is even lower. The second challenge in state/local collaboration that is specific to maternal and child health has to do with the needs assessments conducted every five years. We as state and local representatives must do a better job of collaboratively completing this assessment. This kind of mutuality at this level can be the first step in assuring that what results from the assessment will potentially set the stage for positive partnerships.