AMCHP began developing this guide for new state MCH and CSHCN leaders in March 2003. AMCHP, responding to the increasing turnover of leadership positions in the field, views this guide as complementing other initiatives, such as AMCHP's mentor program for new directors and CAST-5, as well as the federal Maternal and Child Health Bureau's New Leaders orientation meeting and Partnership meeting. To author this guide, AMCHP contracted with two senior consultants with state Title V experience. Kathy Peppe, RN, MS, is former director of Ohio's Division of Family and Community Health Services and past-president of AMCHP. Catherine Hess, MSW, is former AMCHP executive director and previously was policy director for Massachusetts' Division of Family Health Services. A focus group of newer and more seasoned Title V leaders, academic and family representatives also assisted in developing this guide.
As the first step in developing this guide, the authors contacted 25 associations representing public officials or administrators, primarily at the state level, to determine if they had developed similar guides for their members. The associations that we contacted included:
- National Governors' Association (NGA)
- National Conference of State Legislatures (NCSL)
- Association of State and Territorial Health Officials (ASTHO)
- 16 associations of state health agency component programs or disciplines (ASTHO affiliates)
- National Association of County and City Health Officials (NACCHO)
- American Public Human Services Association (APHSA) that includes welfare, child welfare and Medicaid directors
- National Association of State Alcohol and Drug Abuse Directors (NASADAD)
- National WIC Association (NWA)
- State Family Planning Directors' Association (SFPA)
- State Adolescent Health Coordinators' Network (SAHCN)
Additionally, we reviewed some of the materials from the two continuing education institutes funded by MCHB to develop the knowledge and skills of state Title V staff - the CSHCN Continuing Education Institute (that ended a number of years ago) and the MCH Leadership Skills Training Institute. The latter continues to provide two institutes annually, one focused on planning and one on systems. Neither of these institutes has produced formal, written material specifically designed to orient new directors to their positions, but they have produced some very relevant resources.
Finding means to orient new personnel in state leadership positions struck a common chord throughout the 25 organizations that we contacted. In addition to AMCHP, 11 of the 25 organizations responded that they had developed either orientation or mentoring materials or programs for new leaders. Five of these organizations actually have developed formal written materials (ASTHO, SAHCN, NCSL, NGA and the National Association of EMS Directors). One organization (NASADAD) was preparing a written guide for new state substance abuse directors at the time of our contact. Two additional organizations have plans to develop guides in the near future, and two more organizations have prepared informal materials (e.g., case studies) for use during orientation training sessions. Finally, one organization, the Association of State and Territorial Dental Directors, developed a new director mentor program modeled on the AMCHP mentor program. The AMCHP program looks to the mentor and new director to shape specific learning objectives for a two-day site visit using the MCH core functions as a framework.
The scan we made of other similar organizations' efforts to orient new state leaders was extremely useful to us in informing the content for this guide. The findings from the half dozen associations that shared written material with us fell into six main categories:
- Understanding the position and what is the same and what varies across states
- Tips on key challenges and issues that arise
- Skills needed for positions
- Content knowledge needed for positions
- Key players and how to work with them
- Resources for further assistance
Generally, materials designed for higher level elected and appointed officials tended to focus on tips, addressing skills and key players at very general levels. Materials for program managers tended to provide more skill and content knowledge and were more specific about key players and resources.
The information gleaned from the first step in the process of developing this guide was shared with a focus group that we invited to participate. Eleven persons agreed to be members of the group, representing a mix of Title V leaders with less than 3 years experience in the job, Title V leaders with 5 or more years experience in the job, a family representative and two academic representatives with previous state Title V experience and AMCHP leadership experience. Besides the 11 able to participate in a meeting, three new Title V leaders agreed to provide feedback through electronic communication. The final list of participants provided a nice mix of representation from MCH, CSCHN, many of the HHS regions, and the AMCHP Board of Directors. A list of focus group participants is in the appendices of this guide.
We conducted a focus group meeting in Scottsdale, Ariz., on April 29, 2003. All 11 focus group members and a staff member from AMCHP attended the one-day meeting. The purpose of the meeting was to discuss the need for a guide for new state Title V leaders, its possible use and format, and potential content. Prior to the meeting in Scottsdale, we shared a copy of the results of our analysis of all similar guides obtained from other associations. Participants were asked to read this material prior to attending the focus group meeting. We also shared hard copies and presentations of materials from other organizations with focus group participants during the meeting.
During its meeting, the focus group reached consensus on the target audience for the guide, the primary uses of what it decided to call a "toolbox," the major content categories, and related suggestions for the MCH Bureau and AMCHP. The group recommended that:
- The target audience consist of the senior managers responsible for Title V MCH and CSHCN, which will vary state by state
- The material be conceptualized as a "toolbox" that might be part of a "leadership library" that MCHB or AMCHP might consider building
- The material be disseminated and marketed not just at completion of the tool, but on an ongoing basis through existing channels such as MCHB and AMCHP meetings and regional structures
- The content be organized around major leadership roles. Some major leadership roles were suggested with the understanding that we would investigate common categories used in the leadership literature.
The focus group confirmed and validated the perceived need and value of this tool for new leaders in Title V. A number of participants in the group commented that the meeting led them to rethink how they approached their positions and had generated new energy for tackling the challenges at home.
Following the focus group meeting, the authors prepared a draft document that was shared with AMCHP staff and the focus group members. On September 4, 2003, a conference call was conducted to review the draft document and receive suggestions for improving the final product. Additionally, tips and quotes were obtained from focus group members to sprinkle throughout the text of this guide. We have purposefully kept the tone of the document informal and friendly because we wanted to impart to the reader the feeling that this guide is friendly advice from those who have walked the same path. Most of all, we wish the new senior managers of the Maternal and Child Health Block Grant great success in their mission to wisely administer these vital public health programs.