System Capacity for Adolescent Health: Public Health Improvement Tool

Overview of the System Capacity Project and Tools
What is the System Capacity Tool?

The System Capacity Tool identifies six areas of capacity that must be in place in public health agencies, specifically maternal and child health programs, to provide the 10 essential public health services to support effective state adolescent health programs.

The intended outcome of this tool is an assessment of a program’s existing capacity and the organizational and environmental supports needed to improve that capacity around adolescent health.

From a public health perspective, assessment leads to action and action leads to quality improvement. Documenting capacity also allows for a historical record of where a program started to provide consistency for staff and partners and establish a baseline for measuring system improvement over time. And finally, assessing MCH program capacity in the context of other state level adolescent health efforts can also help define the role of the MCH program and the adolescent health coordinator as a vital piece of the network necessary to improve adolescent health.

The primary audience for this tool is state and territorial MCH program staff, including MCH and children with special health care needs (CSCHN) directors, adolescent health coordinators, and other program managers. However, the concepts presented within this tool, and the process of documenting capacity to plan for quality improvement, will prove useful to a wide variety of audiences no matter what level of capacity or effort they are starting with.

Frequently Asked Questions and Lessons Learned

In 2004, the System Capacity Tool was piloted in three states (Tennessee, Utah and Wisconsin). Following are some of the most frequently asked questions about using the tool, and lessons learned from the three pilot states.

Question: Should we ask for group evaluation comments at the end of assessment or hand out the evaluation form at end to solicit individual feedback?

Lessons Learned:

  • Individual feedback through the form will be most useful as participants can be honest and more in depth about personal experience with the process.
  • Group feedback at the end of the assessment meeting is useful for general process questions (how did this go, what worked or didn’t).

Question: If a two day assessment has different people on each day, how should we orient participants coming and going at different times?

Lessons Learned:

  • Send out orientation materials in advance for participants to read.
  • Hold brief orientation call prior to face to fact meetings to give general overviews of project.
  • Give brief introduction both days.
  • Give introduction first day then give one on one abbreviated introductions to new participants during breaks or lunch as needed.

Question: We have not defined certain terms amongst participants or facilitators. How should we present terms that we have not come to consensus on?

Lessons Learned:

  • Different participants and programs will have different terms, and different definitions even for the common words. Facilitators or meeting planners should agree on what they mean when they use certain terms or words and present it as such. For example, “For the purposes of this meeting, when we say ‘outcome’ we mean….. you may have different organizational definitions but for this conversation we want to make sure everyone understands what we mean when we say it.”
  • Agreeing on the kinds of examples you give to describe concepts might also be useful so that all involved have a common understanding of the appropriate examples for your work (despite differing definitions of terms across programs or agencies).

Question: We have a lot of capacity and efforts in place for other populations, but not for adolescents. How do other efforts figure into our adolescent system capacity rating?

Lessons Learned:

  • Even capacity in other areas can constitute system capacity that benefits adolescent health efforts. Capacity and experience with other programs, populations, and issues can contribute model practices and strategies for working in certain venues, with families, with health care providers. While system capacity for adolescent health specifically may be low or non-existent, MCH programs have a long history of expertise in areas such as data collection and evaluation, the administration of a variety programs affecting families, as well as strong collaborative relationships with providers, families and others. These experiences should be considered assets when thinking about system capacity for any population, including adolescents.

Question: Do we need a facilitator to conduct the adolescent health system capacity tool with a group?

Lessons Learned:

  • The tool can be used in many ways, with and without a facilitator. However, using a facilitator to help conduct the assessment with a group can be very helpful.
  • Assessment participants can be more engaged in the process, instead of one or some minding the clock and the agenda.
  • A facilitator can also help a group stay on track, make connections between similar conversations, and make suggestions for how to process discussions or thoughts.

Question: Some ideas and concepts overlap multiple capacity areas, is it necessary to assess all capacity areas?

Lessons Learned:

  • While assessing all capacity areas are not necessary to benefit from the tool, you should read through all capacity areas before making a final decision on which areas to assess. The capacity areas, concepts, and questions presented are designed to build on each other to provide a comprehensive assessment of system capacity for adolescent health.
  • The use of the tool should ultimately meet your needs. There may be concepts that overlap multiple capacity areas, but are reflected differently in each capacity area. If a review of all areas determines there is a concept throughout you want to assess, a slight adaptation of the tool might be useful to pull out the pieces you want to focus on.
  • And although assessing all capacity areas is not necessary to benefit in some way, the Commitment to Adolescent Health capacity area should ideally be assessed first no matter what other areas you are assessing. This capacity area assesses overall focus and commitment to adolescent health in your program or division and sets the stage for the other capacity areas.

Question: Is it necessary to complete the Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis while assessing capacity areas?

Lessons Learned:

  • Using the SWOT analysis simultaneously as you discuss capacity area questions and rate capacity is strongly recommended.
  • Assessments conducted over time or even over a few days can be intense. Using the SWOT analysis as you proceed through each capacity discussion will help you recall, even in the short term, will be useful when you reach the end of your process and look back at your discussions to help you prioritize areas for action.
  • This process will also be helpful in documenting opportunities and strengths that will be useful if you move into action planning.

Staff Contacts

Sharron Corle
Associate Director, Adolescent Health
Region VIII Liaison
x109, (202) 266-3036

Lissa Pressfield, MHS
Program Manager, Adolescent Health
Region VII Liaison
x119, (202) 266-3037