Chapter 5: Title V as a Foundation for Family Health
If You Don't Know Where You Are Going, You Will End Up Somewhere Else!
In The Wizard of Oz, Dorothy lamented her fears, "Lions! And tigers! And bears! Oh, my!" Planning and managing resources may seem fearsome, but they don't have to be so overwhelming. This chapter offers basic information about family involvement, the strategic planning process, leadership, budget administration and strategies for managing scarce resources.
Family Involvement
When the chair of a policy level group of professionals invited the new parent representative to offer her views and perspectives on issues under discussion at her first advisory meeting in the 1980s, she said, His behavior demonstrated respect for my opinion, made me feel welcomed and supported, and specifically created the opportunity for my comments. - Betsy Anderson, director, National Parent Resource Center, Boston, Mass.
As raised in the first chapter of this guide, CSHCN programs provide leadership for promoting family involvement in Title V programs. Family involvement in the planning, development and evaluation of all aspects of maternal and child health programs is important to assuring program effectiveness and accountability. National surveys have shown that, increasingly over the last decade, programs are hiring family representatives on staff. Most serve their organizations in more than one area, but nationally there continue to be fewer family representatives in MCH programs, particularly immunization and prenatal care.
One approach to securing family involvement is to develop a parent advisory committee. Staff and parents should mutually set meeting agendas and hold meetings on a regular basis. During meetings, families can help review new policies, brochures and literature to be used by families, and annual report accomplishments. The council may discuss policies that parents find problematic, help develop the strategic plan, participate in the needs assessment, help develop the block grant application and provide advice on the budget. Besides policy making, families can participate in outreach work and training activities for both professionals and families.
For parents to be effective in their role as advisors to Title V programs, they must be provided with education about the block grant and their role. Take the time to ensure they are oriented completely so they feel comfortable and able to participate fully. They should receive information about the work of the advisory committee, the culture of the organization, and the "dos and don'ts" of their new role. A mentor program where seasoned parent advisors and professional staff provide training to new parent advisors is an excellent approach. It might be especially effective to use the experienced parents of CSHCN to assist in engaging families from other Title V programs. Listen to what parents say about the importance of their input. They need to feel welcomed at meetings, including understanding any jargon or acronyms. More than anything, parents want to feel that they are truly making a difference. When you hear someone make a great comment at a meeting, tell her so.
Figure out how to pay for parents to be involved in Title V programs. In some states, you may be able to use the agency contracting process to reimburse parents for their expenses. In others, you may need to secure an administrative rule or even special legislative approval to pay parents for their participation in an advisory capacity. Explore avenues within your system that might be used, develop a proposal and get clearance from agency leadership.
Including families from the beginning of program planning is the right thing to do! Smart businesses have known for decades that consumer input is invaluable to develop goods and services that the public will buy. Health care can put those same marketing principles to use in planning services and allocating scarce resources. We can ensure that our services are targeted to best meet family needs without wasting funds on unnecessary frills or errors in judgment about what we think families want and will use. Families can be our programs' target marketers who know where and how to reach under-served families. Remember that families are better able to use services if they are educated and aware of their options.
Expand your definition of parent involvement. Parents can be members of task forces, advisory board members, program evaluators, co-trainers of pre-service or in-service training sessions, paid program staff, paid program or policy consultants, mentors for other families and professionals, grant reviewers, participants in the needs assessment process, reviewers of the block grant application, and much more. The unspoken value of parents familiar with the Title V programs is their ability to strongly advocate for programs that serve them well. Parents who know how to interact with legislators should be your new best friends. The old adage "make your friends before you need them" definitely applies here! Once families understand the impact of budgetary decisions upon their families, they can be eloquent and powerful.
Framework for Strategic Planning and Management
The primary reason to plan is to have a clear purpose and direction for your program; decide how to use available resources; identify the resources that need to be developed; and translate the plan's priorities, goals and performance measures into work assignments for staff. Planning intends to answer these questions:
(1) Where is the organization now?
(2) Where does it want to go?
(3) What does it have to do to get to where it wants to go?
Performing the activities needed to answer these questions is a continuous and cyclical process.
There are many types of plans and a host of planning methods. The annual MCH Block Grant application can, and should, be the annual strategic plan for the program, but even that needs translation to a more functional work plan for each program and staff member.
A quick review of one type of planning process may be useful to a new Title V leader. There are numerous references available for a more in-depth look at planning strategies. If you are unfamiliar with planning, or your skills are rusty, you may want to spend time refreshing your knowledge in this area. You may also find that your state has designated employees to help guide managers through a strategic planning process.
Be tolerant of ambiguity, but organize, prioritize and closure(ize). - John Hurley, section manager, Children with Special Health Needs, Minnesota
The primary tasks of strategic management are to understand the environment, define organizational goals, identify options, make and implement decisions, and evaluate actual performance. Strategic planning aims to take advantage of new opportunities as yet unknown. This differs from traditional long-range planning that begins with a thorough analysis of the current situation. As time passes, the process of keeping this status report current is known as monitoring. Monitoring produces the kind of information contained in annual reports - numbers of people served, expenditures, number of staff members, number of diagnoses made or immunizations given, and so on. It provides a history of the program's key features up to the current moment. The focus of long-range planning is to project information about the current situation into the future.
The strategic planning process most often consists of six identifiable stages:
- Environmental scanning - scan the external environment for driving forces, emerging issues or major influences that might impact the program. This is a "taking stock" phase and helps to answer the question "Where are we now?"
- Evaluation of issues - analyze the current situation, looking for issues that may emerge and assessing their potential impact on the organization. During this stage, planners may use a "SWOT" analysis, an acronym for considering the strengths, weaknesses, opportunities and threats facing the program. This stage ranks the issues according to their importance to operations.
- Forecasting - develop an understanding of the expected future for the most important issues and trends, usually by extrapolating from historical data.
- Goal setting - define the desired future based on the issue analysis and overall mission of the program. Goals answer the question, "Where do we want to go?" and should build on strengths (to take advantage of opportunities). They should devote attention to building up areas of weakness while warding off threats.
- Implementation - implement specific strategies, such as policies and actions, designed to reduce threats and reach the goals. Strategies give consideration to what is practical, affordable and efficient, with a timeframe and leader responsible for implementation. Strategies designate the human and fiscal resources that will be assigned. They answer the question, "What do we have to do to get there?"
- Monitoring - monitor the effects of implementation on the achievement of the goals. This requires that the plan be organized and written into a document that is distributed to all staff and other interested parties.
Throughout the planning process, it is important that you keep in mind the overall mission of your program and the vision and values of what your program's ideal world will be if you are successful. This will help you to stay focused. If your Title V program does not already have statements of mission, vision and values, then develop them with a group of staff.
Throughout the planning process, it is important that you keep in mind the overall mission of your program and the vision and values of what your program's ideal world will be if you are successful. This will help you to stay focused. If your Title V program does not already have statements of mission, vision and values, then develop them with a group of staff.
Selected Tools for Planners
Strategic planning literature includes a number of tools to help incorporate accountability into the plan. As the plan evolves, think about how it will be evaluated from the very beginning. What data will be needed to determine the effectiveness and efficiency of the plan and its strategies? Where will you get that data? How will the program be evaluated? Who is responsible for conducting that evaluation? You are responsible for making many of these decisions even though the plan is developed by a larger group. You may find it helpful to use the following decision-making and evaluation models.
Managing Resources - Your Leadership Style
A cartoon recently making the rounds illustrates the power of leadership humorously. Sled dogs are running as a team behind a single lead dog. The caption reads, "Unless you are the lead dog, the view never changes!" That is the thrill of leadership…making the decision about where you will lead the program. Take the time to learn about your own leadership style and encourage your staff to do likewise.
Qualities of a Top Administrator
Embrace the qualities of a top administrator. Understand your job thoroughly, as well as your power, authority and control, and know how to exercise them wisely. Think on your feet. Cultivate the role of being spokesperson for your state's women and children. As you hone your spokesperson role, use your personal skills to best advantage but always guard and protect your reputation for honesty and credibility; your ability to influence others depends on these character traits. Practice your networking skills. Be able to field tough questions, identify problems and develop alternate solutions quickly, but be humble enough to seek advice before making informed decisions. It is extremely important for you to be able to articulate clearly and briefly the vision for maternal and child health in your state. In short, become recognized and respected as THE expert on the MCH and CSHCN programs, both within and outside of your agency; be the "go to" person for your agency's leadership and your staff when there is an issue or question about the program, its budget or services and its needs. Being an effective Title V leader means that you have successfully combined the cachet of your position with your own charismatic leadership traits.
Resources
Family Involvement
- Family Voices. Title V Toolbox for Family Participation!
- Florida Institute for Family Involvement and Institute for Child Health Policy. Making It Work: When Families that Represent a Service Population Become Employees. September 2002.
- Institute for Family Centered Care. Essential Allies: Families as Advisors Planning
- CDC's Six Steps for Evaluating Physical Activity Programs. Step 2: Describe or Plan the Program
- W.K. Kellogg Foundation . Logic Model Development Guide (2001) Decision-making
- Burke, W. W. (1994). "Diagnostic models for organizational development". In Howard, A., Diagnosis for organizational change: Methods and models (pp. 53-84). New York: Guilford Press.
- Winch, G. W. (1995). Developing consensus: Reflections on a model-supported decision process. Management Decision, 33 (6), 22-31. Administration
- Overview of the Incident Command System, April 1992, Emergency Management Institute, Federal Emergency Management Agency
- Martin Yate. Knock 'Em Dead 2003. Avon, MA: Adams Media Corp. 2003.