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 From the CEO

Five Thoughts about the Future of State MCH Programs

By Michael R. Fraser, PhD, CAE

As I have previously stated in Pulse columns, if I could have one wish granted in my lifetime it would be my wish for a crystal ball. While having a crystal ball would certainly take some of the fun out of life, in times like these, I am willing to pay that price. The uncertainty and brinksmanship here in Washington is formidable and it seems like we are constantly laying out new plans for potential futures given all that could change and all that might happen to state MCH programs and our partners. Don’t get me wrong, we are always planning and adjusting those plans as we move our AMCHP work forward. But the sheer number of variables and the quantity of potential scenarios far exceeds what we normally deal with in our day-to-day work on your behalf. A little certainty is very welcome. A crystal ball sure would be handy.

Given the potential for change and the uncertain future for our work it is a tad foolish to lay out what I think might happen in 2013, but I think it is worth a try. Below, I share "five thoughts about the future," in the spirit of preparing for those things that will challenge and confront us this year, and those things that I know we will succeed at doing as your national association and voice here in Washington. So, here goes nothing!

We Must Make 2013 the "Year of Impact"
We talk about evaluating our work and demonstrating success a great deal. Indeed, many of us have full-time staff who are trained to measure, analyze and report on the outcomes of our programs on a routine basis. And we do an okay to good job sharing our success. But we need to do more; we need to be "great" at showing impact and we need to do it now. I am calling on all of us to make 2013 our "Year of Impact." We must succinctly demonstrate the impact our work has on MCH outcomes. It is no longer good enough to know that our work matters and that our programs do good things; we need to explicitly state our succeesses and share them with partners, policymakers and the public. What is the impact of your work? What convincing data and stories can you share with AMCHP to amplify our call for continued support for MCH programs? Let us know!

We Need to Definitively Connect Title V and the Work of State MCH to the Goals of the Affordable Care Act
There is a great deal more to Title V than publically financed health care – indeed many state MCH programs no longer provide support for direct medical services as part of their Title V MCH Services Block Grant activities. The degree to which Title V is a "direct service" or "safety net" program needs to be more clearly articulated and that is the job of all of us moving into 2013. We understand the various levels at which Title V operates, but we have experienced increased scrutiny as to why Title V is needed since the passage of the Affordable Care Act (ACA). A core piece of our advocacy and programmatic work in 2013 will be to clearly articulate the continued need for state MCH programs in light of the expansion of publically financed health care through the Affordable Care Act.

What is the Title V role in ensuring access? What is the Title V role in outreach and enrollment? How are state Title V programs complementing the work of clinical care and what gaps remain in MCH needs post-ACA? What is our work in quality assurance, equity and integration of programs that play a part in improving maternal and child health? Our value added is clear to us but we must make that known to stakeholders moving forward. A key challenge we all face now is making that value added clear as budgets tighten and tough decisions about future funding are made here in Washington and in state capitols nationwide.

We Must Prepare for the Uncertainty of Certain Cuts
I wish it were otherwise, but I am convinced that success for us this year will be maintaining level funding for the Title V MCH Services Block Grant and other MCH programs. And honestly, that is being optimistic. What is more likely is that the political pressure to reduce the deficit and control federal spending will lead to some kind of cut in federal funding for the work we do: what is uncertain is how much those cuts will be and how they will take shape in 2013. AMCHP has advocated for level funding in light of these challenges and for a balanced approach to cuts, should there be any. Many partners share this message. Exactly how all this will resolve remains to be seen and is one of the most urgent factors impacting all our work moving forward. Again, a crystal ball would be helpful now more than ever. We are watching, waiting, and doing all we can to share our message with policymakers and partners to minimize the impact of cuts, prepare for uncertain futures, and advocate for level funding even in this difficult reality.

States Will Start Preparing for the 2015 Needs Assessment
2013 marks the year that many of you will begin to plan (if you have not started already, and I know some of you have) for your statewide MCH needs assessments. This will be the first time a comprehensive MCH needs assessment will be undertaken since the passage of the Affordable Care Act. AMCHP wants to work with you and your partners to ensure that the needs assessment is a meaningful activity for your state MCH program, but also for our national work here in Washington. As such, we are excited to learn more about your state needs assessment process and to get that process started early so that it yields even richer and more valuable data that we can use to advocate on your behalf. With all we know about data, MCH outcomes, and the continued need for MCH services and supports, we are really looking forward to the planning and implementation of your statewide process. We hope to work with you, the Maternal and Child Health Bureau (MCHB), and other partners to do all we can to support your work in this area moving forward.

Leadership and Resiliency are Not Optional Attributes for State MCH Program Staff
I spend a lot of time thinking, speaking and writing about MCH leadership. What is our vision for MCH, and how can we inspire and motivate others around that vision? In times of challenge and constraint we need a clear vision – what we want to see in the world – and we need to get others excited about that vision too. Our AMCHP vision, "healthy children, healthy families, healthy communities" does not change with the shifting sands of funding and the politics of debt and spending. Our vision is a constant amidst a sea of change. Is yours? Can you share your vision and maintain or increase support for your work even if we see a cut in resources to some of our work or confusion about why we are needed in the first place? 2013 is going to be a time of trial for us as MCH leaders – and I think we will prevail. But our leadership, and our resilience, will be tested more than ever. We will work to support you in your MCH leadership roles and share resources and ideas that you can adopt to strengthen your MCH leadership competencies. I hope you will share ideas that you have and needs you would like to see filled this year, and always!

We have lots to look forward to and lots to be wary of as 2013 unfolds. Amidst challenge and change is the clear need for continued support for our work. The AMCHP board, our staff, and our partners are all deeply committed to the success of state MCH programs even in troubling and uncertain times. Uncertainly is not a reason for paralysis – the needs of women, children, and families in our states and communities remain. With thoughtful leadership and careful planning we can continue the long tradition that is state Title V programs. We can demonstrate success, document the difference we make in the world, plan for the various futures we might experience, illustrate the needs we face in our states, and lead by adapting, even in uncertain times. I look forward to hearing your thoughts and ideas about where we are headed, and working with you to support state MCH programs and provide national leadership on issues impact women, children and families.