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 April 7, 2009


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The Big Picture

By Mike R. Fraser, PhD    

Last week I had the good fortune of attending the National Association of Chronic Disease Directors’ (NACDD) Chronic Disease Academy in Seattle. The Academy is a three-day skills building conference that focuses on improving chronic disease program staff competency in several domains. It was a great event that included state and local chronic disease professionals from all over the country who took a few days to develop and hone their skills and proficiency in several important areas. During the Academy I attended several sessions, including a session on leadership development for chronic disease programs.  

During that session the facilitator shared a quotation with the group that I thought was particularly insightful. He said: “The biggest challenge impeding public health’s success is its focus on tactics.” What he meant was we often rush to tactics – of the “how” we’ll get the work done – and we spend too little time thinking about the “what” we should be doing to truly improve the health of the women, children, and families served by our programs. 

I knew what he meant but was still offended; at least at first. How dare he say that our tactics impede our success! Of course we focus on tactics: there are people to serve, things to do, issues to address and programs to develop. We are busy doing because there is so much to do. But, at the core, I knew he was right. In our rush to address, develop, implement and all the rest, we may forget the central reason we are doing all the work in the first place: the “why” we are here and the “who” we are serving. We are often so focused on the trees, we cannot see the forest. The “big picture” can be hard to imagine and so we rush to solve the bits and pieces in front of us. Often times this leads to stovepipes, silos, and other valiant attempts to improve the health of women, children and families that may not ultimately work because they are not sufficiently grounded in why we are doing the work we are doing and who all this work is supposed to be helping in the final analysis.  

Reflecting on the facilitator’s remarks I can certainly understand our rush to develop new programs, write new grant proposals and implement new interventions. But how often do we truly rush to contemplate why we are doing the work we are doing? Indeed, our tactics can cloud our thinking about strategy. How much of our work is truly strategic – i.e. moving our strategic goals forward – and how much of our work is just business – i.e. task oriented work that fills our day but may or may not be ultimately grounded in the reason we are all doing this work to begin with? How many meetings have you been in lately to revise and refresh the reason we are doing the work we are doing versus reviewing and planning the tactics necessary to get the work done? If you are like me you could be spending a lot more time on the why and the whom and less time on the how. Certainly that is what we as MCH leaders are called to do but more often than not that pragmatic, “doing” portion of our brains takes over and we end up designing yet another program, intervention, or other task to get the work done.  

As we move forward to address the maternal and child health issues affecting our states and communities, let’s not forget the reason we are doing the work in the first place: our shared vision of healthy children, healthy families and healthy communities. As we plan, develop, refine and implement, let’s make sure that we are grounded in an overall vision of where we want to go and not just how we want to get there. Keeping the “big picture” in mind is key to our success, and is just as crucial as the tactics we use to do our work.  

Over the next few weeks I urge you to take some time to step back and look at the big picture: Are the tactics you are using moving your work forward, or just filling your day with things that have to get done? With all we have to do how can we not afford to step back, analyze, and be strategic so that our tactics truly are a means and not just an ends? Let’s work to make sure that the vision we are trying to reach is clear, vivid and central to all that we do day in and day out. If we don’t we are indeed busy just for business’ sake and may be missing the big picture after all, and the work we have to do is too important to forget why we are doing it in the first place.

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AMCHP Continues Title V Funding Advocacy
With the FY 2009 Omnibus Appropriations bill completed, the Administration and Congress are turning their attention to the FY 2010 appropriations process. President Obama released an initial blueprint for a federal budget in March, but did not include detailed funding levels for individual programs such as the Title V Maternal & Child Health (MCH) Services Block Grant. The White House is expected to release a more detailed budget proposal containing more information on proposed program funding levels in early to mid May, but the delay has created some confusion on Capitol Hill where both chambers began work this week on their own non-binding budget resolutions. 

Meanwhile, the House of Representatives Labor, Health & Human Services Appropriations Subcommittee is already working to develop its version of an appropriations bill. AMCHP policy staff visited staff for 10 of the members of that committee, including the Chairman, Representative David Obey of Wisconsin and the Minority Ranking member Todd Tiahrt of Kansas. We asked each to include the Title V MCH Block Grant as one of their programmatic funding priorities for 2010, and at least five members of the House Subcommittee have tentatively agreed to do so. AMCHP’s Board President, Phyllis Sloyer of Florida was also invited to testify before the Subcommittee on the importance of the Title V MCH Block Grant. To download a copy of the testimony, visit here. 

Work now focuses on the Senate, where AMCHP has visited with appropriations staff of the Chair, Senator Tom Harkin of Iowa and Ranking Member, Senator Arlen Specter of Pennsylvania. We will be scheduling meetings with all the appropriations subcommittee members in the Senate and again asking them to make the Title V MCH Block Grant one of their key priorities.  

Congress goes on recess for two weeks starting on April 6. This is a great opportunity to check if your health agency leadership will have the opportunity to reach out to members of Congress who often return home during the break, and ask if funding for the Title V MCH Block Grant can be part of the agenda. A summary of AMCHP’s Title V Appropriations request is available here.  AMCHP encourages members to also consider inviting Congressional representatives to attend local events where they can hear about the importance of the Title V MCH Block Grant. Finally, we will be issuing a Legislative Alert in late April to ask for targeted advocacy on the Title V MCH Block Grant from all members who are able to do so. Please stay tuned for that information.

Health Reform Update
Congressional leaders have announced increasingly specific timeframes to introduce and mark up health reform legislation this spring and summer, with the goal of passing a bill by August. AMCHP continues to meet with Congressional staff and other public health partners to advocate for the strengthening of MCH and public health services in health reform, as outlined in AMCHP’s Principles for Health Reform. We expect a very busy spring tracking policy proposals and spreading our message about the need to dramatically increase investments in prevention and strengthen Title V programs as part of reform.

President’s Nurse Home Visiting Proposal
AMCHP continues to seek information on the proposal to develop a nurse home visiting program for first time mothers included in the president’s budget outline. While details remain sketchy, we did have an opportunity to meet with officials from the HHS Office of Planning and Evaluation and Administration for Children and Families (ACF) Office of Planning and Evaluation to begin a dialogue on the program’s policy development. The Administration is not releasing further details at this time, but we did advocate that state MCH programs be involved with the program development and implementation to assure a focus on improving the quality of home visiting services statewide, identifying areas of greatest need to guide replication of programs within a state, reducing duplication of services within a state or territory, and assuring interagency planning and linkages to other efforts and investments focused on promoting family health and optimizing early childhood development. We will continue to develop AMCHP’s response to this proposal, and provide more details on the Administration’s plans as they become available. 

EMSC Reauthorization Passed in the House, Now on to the Senate for Consideration
Reauthorization of the Emergency Medical Services for Children (EMSC) program was passed by the House of Representatives on Monday, March 30, 2009, by a vote of 390-6. The bill now goes over to the Senate for consideration. The bill is named for the family of Mary Wakefield, newly appointed Administrator of the Health Resources and Services Administration. Tragically, Mary lost her brother Tom and two of his children, Nicole and Mikal to a car accident in 2005. Her nephew Lucas narrowly survived, due in part to the excellent emergency care he received. The EMSC program provides grants to every state’s EMS office to support activities related to pediatric emergency care, in accordance with specific performance measures. In addition, EMSC provides the infrastructure for a research network that has produced groundbreaking studies on effective emergency care for children. AMCHP has joined with the AAP and other groups in support of the Wakefield Act and will continue to advocate for reauthorization of the EMSC program. 

Family Smoking Prevention and Tobacco Control Act Passes in the House
On Wednesday, April 1, 2009, the House of Representatives passed the “Family Smoking Prevention and Tobacco Control Act” (HR 1256), which was introduced by Rep. Waxman. A nearly identical bill also passed the House during the last Congress. AMCHP joined more than 1,000 public health, faith, medical and other organizations endorsing the bill (see list here.)  The bill will now move on the Senate for consideration.

This legislation would grant the FDA the authority and resources to effectively regulate the manufacturing, marketing and sale of tobacco products. Among other things, it would: 

  • Restrict tobacco advertising and promotions, especially to children.
  • Stop illegal sales of tobacco products to children.
  • Require larger, more effective health warnings on tobacco packages and advertising.
  • Ban misleading health claims such as “light” and “low-tar” and strictly regulate all health claims about tobacco products to ensure they are scientifically proven and do not discourage current tobacco users from quitting or encourage new users to start.
  • Require tobacco companies to disclose the contents of tobacco products, as well as changes in products and research about their health effects.
  • Empower the FDA to require changes in tobacco products, such as the removal or reduction of harmful ingredients or the reduction of nicotine levels.
  • Fully fund the FDA’s new tobacco-related responsibilities with a user fee on tobacco companies so no resources are taken from the FDA’s current work.

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Submit Your Best Practice Today!
AMCHP is seeking submissions of best practices in maternal and child health from around the country. Whether it’s an effective campaign to promote breastfeeding, an outstanding home visiting program, or a proven early intervention program for young children, get the word out about your best practice. AMCHP defines “best practices” as a continuum of practices, programs and policies ranging from emerging to promising to evidence-based. A best practice could focus on the health of women, adolescents, young children, families, or children with special health care needs. Best practice focus areas include preconception care, mental health, data and assessment, financing, program and system integration, workforce development, injury prevention, emergency preparedness, family involvement, or other public health issues. Contribute to AMCHP’s Innovation Station – a growing database of what is working in MCH. 

1) Click here to download a PDF of the submission form.  

2) When you are ready to submit, click here to start the survey. 

For more information on submitting best practices, please contact Darlisha Williams or call (202) 775-0436.   

Webcast on Protecting Families at Home
The Maternal and Child Health Bureaus (MCHB) will host a webcast on “Protecting Families at Home: Best Practices, New Products and Resources” on April 8 from 3 to 4:30 p.m. (EST). Learn about best practices in home safety, new programs, partners and resources. In addition, you will learn about program development taking into account the very important aspect of literacy. To register for the webcast, visit here 

Webcast on Preventing Exploitation of Children and Adolescents
MCHB will host a webcast on “Preventing Exploitation of Children and Adolescents on the Internet” on April 14 from 2 to 3:30 p.m. (EST). To register for the webcast, visit here 

Webcast on Improving Perinatal and Infant Oral Health
MCHB will host a webcast on “Engaging Providers to Improve Perinatal and Infant Oral Health: Innovative Strategies” on April 16 from 2 to 3:30 p.m. (EST). This Web cast will describe collaborative, early intervention activities to prevent oral disease between oral health grantees from MCHBs' Alliance for Information on Maternal and Child Health grant programs. To register, visit here. 

Webcast on Medical Homes for Children
MCHB will host this webcast on April 21 from 3 to 4:30 p.m. (EST). This webcast will highlight efforts to support the implementation of medical home across multiple stakeholder groups, including an overview of the medical home concept and an update on the activities of the American Academy of Pediatrics' National Center for Medical Home Implementation. To register, visit here 

Webinar on Youth in an Online World
The Youth Intervention Programs Institute and the National Institute on Media and the Family will present a webinar on the opportunities, dangers and impacts for "Youth in an Online World” on April 21 from 10:30 a.m. to Noon (EST). To register, visit here 

Webcast on Cyberbullying
Bullying prevention experts will discuss Cyberbullying: Tools and Tips for Prevention and Intervention during a Stop Bullying Now! Campaign webcast on April 22 from 3 to 4.30 p.m. (EST). To register for the webcast, visit here. For more information about the webcast, contact Nicolle Grayson 

Public Comment on Draft Voluntary National Accreditation Standards
The Public Health Accreditation Board (PHAB) is developing and implementing a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments. The deadline for the comment period is April 27. To review a draft of the voluntary national accreditation standards, visit here 

Call for MCH Case Studies
Maternal and Child Health projects of all kinds are needed (community-based/indigenous, public health, NGO, foundation-funded initiatives) to be used in the "International Case Studies in Maternal and Child Health," a textbook for health professionals. The deadline for submissions is September 30. Priority will be given to case studies written by, or in collaboration with, local voices. All questions and submissions should be addressed to the editor Ruth C. White, PhD, MPH, MSW.

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Is your CYSHCN department interested in learning more about transitioning from a direct services model to a community based approach? Please reply to Brynn Rubinstein.


Lisa Bujno, Administrator, Maternal and Child Health Section, in the State of New Hampshire and Sharron Corle, Associate Director for Adolescent Health at AMCHP were featured speakers on a recent webcast sponsored by the Maternal and Child Health Bureau (MCHB). The webcast, “Setting State Health Priorities in Tough Budget Times,” highlighted state efforts as a result of participation in a two and a half day invitational seminar, “Using Limited Health Dollars Wisely: What States Can Do to Create the Health System They Want.” The seminar is designed to foster collaboration among state policymakers, helping them identify specific steps they can take together in their own state to improve the health status of women and children within the context of broader health issues. The project is a collaboration between AMCHP, the National Conference of State Legislatures, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, the National Governor’s Association, and CityMatCH. AMCHP has been a key planning partner in the project since 2005. Lisa and the New Hampshire team participated in the 2007 meeting in New Orleans, Louisiana. The webcast is archived here.

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Children’s Health 

CHIP Tips Series
A new series on specific provisions of the CHIP law produced by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and the Center for Children and Families at the Georgetown University Health Policy Institute help explain what the law does, key dates and choices for states. Look for upcoming topics in the series including the new citizenship documentation option, coverage opportunities for legal immigrant children, and new financing rules. The first two briefs on the Medicaid Performance Bonus can be downloaded here 

Adolescent Health

Study on Proximity of Fast Food Restaurants and Obesity in Children
A recent study, “The Effect of Fast Food Restaurants on Obesity,” published by the American Association of Wine Economics and conducted by researchers at Columbia University and the University of California-Berkeley, links proximity to fast-food restaurants with increased obesity rates among children and pregnant women. The study assessed obesity rates among 3 million ninth-grade students in California and more than 1 million pregnant women in Michigan, New Jersey and Texas. To download the study, visit here 

Research Brief on Percentage of Females who Become Teen Mothers
According to a new Child Trends research brief, "Estimated Percentage of Females Who Will Become Teen Mothers: Differences Across States," an estimated 18 percent of females nationwide will become teen mothers. The brief also finds that states vary widely in the estimated percentage of females who will have a baby before the age of 20, ranging from eight percent in New Hampshire to 30 percent in Mississippi. To download the brief, visit here.

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Interventions for Youth and Young Adults with Fetal Alcohol Spectrum Disorders
Deadline: April 9
The purpose of this funding opportunity announcement issued by the CDC is to support innovative research to identify and evaluate components of a systematic intervention for youth and young adults (aged 16 to 25 years old) with a Fetal Alcohol Spectrum Disorders and their families. This program is a directive within the Children’s Health Act of 2000 to develop and scientifically evaluate interventions for children and adolescents affected by Fetal Alcohol Syndrome (FAS) or other conditions resulting from prenatal alcohol exposure. To learn more, visit here 

Special Project Grants to WIC States
Deadline: April 13
The USDA Food and Nutrition Service (FNS) expects to have approximately $500,000 in fiscal year (FY) 2009 funds available for Special Project Grants to WIC state agencies. Grant funds will be available only to the 90 WIC state agencies responsible for administering WIC in the states, territories, and Indian Tribal Organizations (ITOs). FY 2009 WIC Special Project Full Grants are open for consideration from all WIC- related program areas and may focus on either the general WIC population or specific segments of the WIC population. Grants should be used to help states develop, implement and evaluate new or innovative methods of service delivery to meet the changing needs of WIC participants. To learn more, visit here 

Technical Assistance Center for Mental Health Promotion and Youth Violence Prevention Grant
Deadline: April 23
The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting an application to supplement and expand grant activities funded under the Technical Assistance Center for Mental Health Promotion and Youth Violence Prevention (TAC-MHPYVP) cooperative agreement. The available funds will extend technical assistance services to Project Linking Actions to Unmet Needs of Children’s Health (Project LAUNCH) grantees who will be newly funded in FY 2009. The TAC-MHPYVP will continue to provide an array of technical assistance services that will improve the effectiveness, efficiency, and sustainability of all Project LAUNCH grant funded projects, not just those funded under the FY 2008 cooperative agreement. To maximize and ensure that technical assistance services are uniform in design and intent, and to ensure effectiveness and efficiency, eligibility is limited to the current grantee (Education Development Center Inc.). Project LAUNCH supports a vision of communities in which families participate in a seamless set of local programs, supports, and services that promote healthy early childhood development and supportive family environments. To learn more, visit here 

DHHS Request for Proposals for its Healthy People 2020 Project
Deadline: April 27
The Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services (DHHS) is pleased to announce a Request for Proposals for “State Action: Evaluating the Healthy People 2020 Disease Prevention and Health Promotion Agenda” project. This evaluation project will fund state, territory, and tribal governments to conduct innovative and participatory strategic planning activities, with an emphasis on multi-sector collaboration, using the Healthy People 2020 framework and population health improvement concepts (i.e., Healthy People 2020 mission and overarching goals; social, physical, and environmental determinants of health; and health equity). Up to 12 projects, taking place between July 1, 2009 and June 30, 2010, will be funded. To download the request for proposal forms, visit here. For more information, please contact Ann Loeffler or call 1-800-839-0934. 

Upcoming FY2009 Autism Research Funding Opportunities at MCHB/HRSA
Deadline: May 15
R40 MCH Autism Intervention Research Program will support up to four (4) two-year research projects ($400,000 per year) on evidence-based practices for interventions to improve the health and well-being of children and adolescents with autism spectrum disorders (ASD) and other developmental disabilities. Consistent with HRSA’s mission as the access agency to provide services to underserved populations, applicants are particularly encouraged to propose research studies that address the needs of underserved populations, as well as barriers to receipt of interventions. Examples of research topics of interest to MCHB include but are not limited to the following:

• Family well-being, coping, resilience and social networks;

• Variations in access to services affecting family functioning in diverse populations;

• Transition into adulthood, including employment and healthcare issues; and

• Service systems and infrastructure.  

To learn more, visit here

Cooperative Agreements for Linking Actions for Unmet Needs in Children’s Health Grant
Deadline: May 20
The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services is accepting applications for fiscal year (FY) 2009 for Cooperative Agreements for Linking Actions for Unmet Needs in Children’s Health (Project LAUNCH). The purpose of Project LAUNCH is to promote the wellness of young children, birth to 8 years of age. Project LAUNCH will award cooperative agreements to states, territories and tribes, each of which will select a locality within the larger jurisdiction to be a partner in Project LAUNCH. States, territories and tribes will bring together child-serving systems to develop a vision and a comprehensive strategic plan for promoting the wellness of all young children, and will develop policies, financial mechanisms and other reforms to improve the integration and efficiency of the child-serving system. States, territories and tribes will identify and work closely with a locality that will engage in infrastructure reform, and will use Project LAUNCH funds to enhance and expand the delivery of services and practices that promote the wellness of young children and their families. To learn more, visit here 

2009 Family Planning Research Cooperative Agreement
Deadline: May 26
This announcement seeks applications from public and non-profit private entities to conduct data analyses and related research and evaluation on issues of interest to the family planning field. Many persons have observed that gaps exist in the array of data and analyses needed by administrators, planners and researchers in the field of family planning. The need for such data is likely to increase. Therefore, funds available under this announcement are for projects to increase the availability of data and research-based information which will be useful to family planning administrators and providers, researchers and officials of local, State and the Federal government, including OPA, in order to improve the delivery of family planning services to persons needing and desiring such services. To learn more, visit here 

Funding Available for Male Involvement in Child Maltreatment Prevention Programs
Deadline: Open
The CDC’s National Center for Injury Prevention and Control solicits research applications that will help advance knowledge of effective strategies for engaging the participation of fathers and male caregivers in evidence-based parenting programs that may prevent child maltreatment. Specific proposals are being sought to take an evidence-based parenting program (that is, a program that has been evaluated using a randomized- or quasi-experimental design with evidence of positive effects on parenting and/or child behavior outcomes) and develop systematic adaptations to the delivery structure, content, and/or materials to target father or male caregiver involvement and engagement in the program. Furthermore, the applications should seek to conduct pilot evaluations of the effects of the adapted programs on participant involvement and engagement in the program; parenting behaviors and male caregiver-child relationships; and child behavior outcomes. To learn more, visit here. 

Changes in Health Care Financing and Organization Funding Alert
Deadline: Open
HCFO supports policy analysis, research, evaluation and demonstration projects that provide policy leaders timely information on health care policy and financing issues. This call for proposals is intended to support projects that 1.) examine significant issues and interventions related to health care financing and organization and their effects on health care costs, quality and access; and 2.) explore or test major new ways to finance and organize health care that have the potential to improve access to more affordable and higher quality health services. To learn more, visit here 

Health and Wellness
Deadline: Ongoing
PepsiCo Foundation’s mission in Health and Wellness is to advance and encourage healthy lifestyles and positive behavior change. Initiatives of particular interest are those which address one or more of the following focus areas: community activation, minority communities, school drop-out prevention, and health professionals. For more information, visit here.


AMCHP is Recruiting for an Associate Director for Women’s and Infant Health
The Associate Director is accountable for the development, implementation and evaluation of program activities related to women’s and infant health, maternal and child health, data and assessment through cooperative agreements and other funding sources. The Associate Director leads the Women’s and Infant Health Team and contributes to the advancement of MCH programs. This position leads the tracking, analysis, and reporting on federal and state programs impacting women’s and perinatal health and plays a critical role in fund development for women’s and infant programmatic efforts. To download the job description, visit here. For additional information, please contact Lauren Ramos.

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American Thyroid Association Symposium and Research Summit
April 16-17
Washington, DC

Empowering the Majority: Increasing Access to
Family Planning National Conference
April 26-29
Bethesda, MD 

Coalition for Juvenile Justice Annual National Conference and
25th Anniversary Celebration: Unlocking the Future of Juvenile Justice

May 2-4
Arlington, VA  

Family Voices 2009 National Conference
May 3-5
Washington, DC

National Day to Prevent Teen Pregnancy
May 6

American College of Nurse-Midwives 54th Annual Meeting & Exposition
May 21-27
Seattle, WA 

National WIC Association’s Annual Conference
May 24–27
Nashville, TN 

36th Annual International Conference on Global Health:
New Technologies + Proven Strategies = Health Communities

May 26-30
Washington, DC 

The Bill & Melinda Gates Institute's 7th Annual Summer
Institute in Reproductive Health & Development

June 1-12
Baltimore, MD 

Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health Scholarship and Practice
July 20-22
Oakbrook, IL

Health Forum and the American Hospital Association's 17th Annual Leadership Summit
July 23-25
San Francisco, CA  

World Breastfeeding Week 2009 -
Breastfeeding: A Vital Emergency Response
Are you ready?
August 1-7

National Conference on Health Communication, Marketing and Media
August 11-13
Atlanta, GA 

CityMatCH 2009 Urban Maternal and Child Health Leadership Conference
August 22-25
New Orleans, LA

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