Chapter 6: State and Federal Grants, Budgets and Accountability
This chapter offers basic information about managing the Maternal and Child Health Block Grant, such as the strategic planning process of the Title V application, accountability, performance measures, budgets and helpful tips from Title V leaders who have "been there, done that."
Thoughts About Successful Planning
The Maternal and Child Health Services Block Grant provides the opportunity to direct resources (human, fiscal and technical) to significantly improve the health of the target populations. The critical importance of having a thoroughly researched needs assessment and a strategic plan cannot be overemphasized. Without a well-documented plan and assignment of all resources to fulfill that plan, you will be unable to ward off inappropriate demands and requests for funding unrelated activities. Block grant funds are flexible but only within the parameters previously described in this guide. Because the funds are flexible, they can be targeted to "cover" budget shortfalls in other program areas that are unrelated to the MCH plan. Your best defense against inappropriate use of these funds is to update your strategic plan annually.
- Develop a strong management team to work closely with you in all aspects of block grant administration. An outstanding leader recognizes his shortcomings and recruits team members with expertise in those areas. Spend time developing strong working relationships and teamwork, preferably in off-site retreats. Meet with the management team regularly and listen to their recommendations before making final decisions.
- Visit local health agencies and providers of MCH/CSHCN services to see the programs in operation and become familiar with their issues.
- Include all stakeholders (staff, advocates, families, other agencies) in the block grant application, needs assessment and strategic planning process from the very beginning. It ensures their buy-in and improves the chances that the block grant will actually become a working document that staff use to guide their daily work.
- Build support for the Title V programs within your home agency as well as with other key stakeholder agencies and organizations. This means that you need to personally meet with and develop close working relationships with the leaders of key programs (e.g., SCHIP, Medicaid, early intervention, bioterrorism and emergency preparedness, prevention and primary care programs). Be sure you understand what other agencies do, and what they expect from Title V programs. Be an effective collaborator.
- Anticipate what the "hot" issues will be and secure the support of your agency's leadership before the plan is released to the public. State health officers do not like to be blind-sided. Respect their leadership position and give them the opportunity in advance to have their say about a controversial issue that may surface. Be proactive.
- Distribute the block grant widely. Remember that others don't know what your program does, and this is one way to share that information. It also helps to remind everyone of their assignments in carrying out the strategies in the plan.
- Be sure that you have built accountability into the plan. Program activities, performance measures and capacity indicators should have timeframes. Be certain that someone is assigned to each activity as well as to conduct a regular review of the plan's status.
- Allow for occasional deviation from the annual plan. Make note of the deviations for use in future annual reports.
- Evaluate the planning process by regularly getting feedback from those involved in the block grant application. Was the process adequate? What could be improved? Are enough resources being directed toward a performance measure or priority issue? These are all questions that will help you improve the next cycle of planning.
- Celebrate completion of the application and celebrate achievements. It may seem like a simple idea, but ignoring accomplishments can encourage staff apathy, skepticism or cynicism. Don't skip this step - make it fun!
Resources
- Maternal and Child Health Data
- Maternal and Child Health Bureau
- Preparation of MCH Block Grant - Title V Maternal and Child Health Block Grant to States Program Application and Annual Report Guidance
Needs Assessments
- New England SERVE
- Women's and Children's Health Policy Center, Johns Hopkins University (1995). Blueprint for a Needs Assessment: Contributing to a System of Care for Children with Special Needs & Their Families. A Technical Resource Brief. Henry T. Ireys. Available from WCHPC website at http://www.jhsph.edu/wchpc/ (publications).
- Child Health Needs Assessment: A Review of Data Sources to Measure Child Health Status. A Technical Resource Brief. (1995). Donna M. Strobino. Available from WCHPC website at http://www.jhsph.edu/wchpc/ (publications).
- Resource Guide to Concepts and Methods for Community-Based and Collaborative Problem Solving. (1999). Marjory Ruderman. Available from WCHPC website at http://www.jhsph.edu/wchpc/ (publications).
- Child Health Systems Primary Care Assessment: Community Self-Assessment Guide. (1995). Alyssa Wigton and Holly Grason. Available from WCHPC website at http://www.jhsph.edu/wchpc/ (publications).
- Applying Concepts and Data from the NHIS Child Disability Supplement to State CSHCN Program Planning. A Technical Resource Brief. (1997). Henry T. Ireys. Available from WCHPC website at http://www.jhsph.edu/wchpc/ (publications).
- Donna J. Petersen and Greg R. Alexander (2001). Needs Assessment in Public Health: A Practical Guide for Students and Professionals. New York, NY: Kluwer Academic/Plenum Publishers.
- Kotch, Jonathan, ed.(1997). Maternal and Child Health: Programs, Problems and Policy in Public Health. Gaithersburg, MD: Aspen Publishers.
- Delphi Method - Norman C. Dalkey (1969). The Delphi Method. Santa Monica, CA: Rand Corp.
- Nomin