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Title V MCH Needs Assessment

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Using the Q-sort methodology to rank priorities. Results of ... List of attendees and group assignments. Q-Sort Results (goldenrod) Q-Sort Needs Grid (blue) ... – PowerPoint PPT presentation

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Title: Title V MCH Needs Assessment


1
Title V MCH Needs Assessment
  • SETTING PRIORITIES
  • March 30, 2005

2
Agenda
  • Overview of Needs Assessment Process
  • Using the Q-sort methodology to rank priorities
  • Results of Q-Sort Data Analysis
  • National State Performance Measures
  • WI 2010 Health Priorities
  • Process for Setting Priorities
  • Consensus Building
  • Small group discussion
  • Overview and wrap-up

3
Handouts for Meeting
  • Agenda
  • List of attendees and group assignments
  • Q-Sort Results (goldenrod)
  • Q-Sort Needs Grid (blue)
  • Health Problem Priority Setting Worksheet (green)
  • Q-Sort Rank by population group (colored print)
  • Consensus Definition (yellow)
  • Enhanced Data Detail Sheets (20 top ranked)

4
Presenters
  • Linda Spaans Esten - State SSDI Coordinator
  • Randy Glysch - Research Scientist, Injury Program
  • Kate Kvale - MCH Epidemiologist
  • Elizabeth Oftedahl - CSHCN Epidemiologist
  • Murray Katcher - BCHP Chief Medical Officer
  • Susan Uttech - Chief, Family Health Section

5
Title V MCHNeeds Assessment
  • Federal Requirement
  • Title V of the Social Security Act
  • In 1935, President Roosevelt signed legislation
    into law to promote and improve maternal and
    child health
  • WI Dept of Health Family Services, Division of
    Public Health (DPH)
  • receives funds through the federal Maternal and
    Child Health (MCH) Services Block Grant
  • Required statewide needs assessment every 5 years
  • In 1990s greater sophistication in assessing
    unmet needs
  • Increased accountability in measuring program
    performance

6
MCH Needs Assessment Purpose
  • Direct decisions toward the most appropriate
    programs and policies that promote the health of
    women, children, CSHCN and their families.
  • Needs assessment is a fundamental element of
    program planning
  • Needs assessment is about CHANGE

7
MCH Needs Assessment is part of an ongoing cycle
  • Assess problems, needs, assets strengths
  • Develop and implement solutions
  • Evaluate activities
  • Monitor performance

8
Title V MCH Needs Assessment
  • We undertake needs assessment because
  • We recognize the dynamic nature of MCH
  • We wish to be good stewards of the publics trust
  • We must set priorities within limited resources

9
MCH Needs Assessment
  • Should be data driven and engage stakeholders
  • Process must bridge
  • Science and politics
  • Data and values of the community
  • Needs and the strategies for their solution

10
Stakeholders
  • Needs assessments must engage and involve the
    community of interest, the stakeholders
  • Understand the values of the community
  • Know the needs
  • Help to identify strategies and solutions

11
Who are the stakeholders?
  • Local Health Departments (LHDS)
  • Regional CSHCN Centers
  • Family Planning/Reproductive Health
  • Professional organizations
  • Advocacy organizations
  • Parents
  • Professional staff from hospitals/clinics
  • Minority health
  • Division of public health
  • Department of Public Instruction
  • University

12
Needs Assessment is data driven
  • Population based data
  • Census, Vital Records
  • Surveillance systems data
  • SLAITS, BRFSS, YRBS, PedNSS, communicable disease
    incidence
  • Survey data from Family Health Survey
  • Program and service data
  • Listening Sessions

13
MCH Identified Problems/Needs
  • 44 Identified Needs
  • 16 Listening sessions reaching 350 people
  • Federal MCH needs
  • State and local identified MCH needs
  • Developed data detail sheet for each need
  • Invited 200 people to participate as stakeholders
  • Distributed 90 packets of data detail sheets in
    November 2004
  • Held a stakeholder Q- Sort Training
  • Participation by 61 stakeholders in Q-sort
    process

14
Used Q Sort Technique to select priorities
  • Purpose To identify priorities among competing
    needs
  • Stakeholders have unique expertise, perspectives
    and passions about needs
  • All needs cannot be the highest priority for
    the state MCH program
  • Q Sort Technique is effective at getting
    information from people with different backgrounds

15
What should the table look like?
  • Create Nine Columns

16
Inserting Needs on the Q-Sort Priority Log
17
Completed Q-Sort Priority Log
Sixth Highest Priority
Seventh Highest Priority
Eighth Highest Priority
Fourth Highest Priority
Fifth Highest Priority
Second Highest Priority
Third Highest Priority
Highest Priority
Lowest Priority
18
Data Analysis
  • Look at the mean score of each need after
    gathering responses.
  • Scores will be assessed for their variability by
    using the standard deviation.
  • Some scores may be weighted if they are from
    under-represented fields or regions.

19
Q-Sort Results and Descriptive Statistics
20
Scoring and Standard Deviation
  • Health Insurance Coverage for Children has a mean
    score of 3.28 and had a very small (1.7) standard
    deviation, you know that most everyone agreed
    this was a high priority.

21
Frequency by Geography
22
Frequency by Agency
  • Birth to 3 (1)
  • Central Office (16)
  • Clinic (1)
  • CSHCN Regional Center (7)
  • DPI (2)
  • Hospital (3)
  • LHD (8)
  • Managed Health Services (1)
  • Private Non Profit (8)
  • Regional Office (9)
  • University (5)

23
Frequency by Specialty Area
24
Q-Sort Rank byPopulation Group
  • Women and Infants (14 problems/needs)
  • Children and Adolescents (14 problems/needs)
  • CSHCN (9 problems/needs
  • Note the overlap between the groups
  • color coded

25
Reach Consensus and Set Priorities
  • Size of problem
  • Seriousness of problem
  • Potential for prevention

26
Size of the Problem
  • Mortality
  • Number
  • Rate
  • High-risk sub-populations age, gender, race,
    geography, income, co-morbidity, setting

27
Size of Problem, cont..
  • Prevalence- number of cases in a given
    populations at a specific time
  • Lifetime
  • Current (point)
  • Incidence- the rate of occurrence of new cases in
    a populations over a period of time

28
Size of Problem, cont..
  • Comparison to Healthy People 2010 and Healthiest
    Wisconsin 210 goals
  • Comparison to U.S. and to other states
  • Trends over time

29
Seriousness of the Problem
  • National data defining the problem
  • If available, data to define the cost of
  • Death or YPLL (years potential life loss)
  • Hospitalizations/Disability
  • Social and economic consequences

30
Potential for Public Health Prevention
  • Is the problem or need prevented or changed by
    known interventions ?
  • What are the health consequences of not
    addressing the problem or need?
  • Is there current demographic disparity for the
    problem or need?
  • Do other providers identify this as problem or
    need?
  • Are the problems precursors to other problems?

31
Potential for Public Health Prevention, cont..
  • Can the problem/need be measured and evaluated?
  • Are their reasonable approaches/strategies for
    addressing the problem?
  • Provide services directly or contract
  • Regulate the activity
  • Educate public and providers
  • Systems development
  • Data system improvements

32
Priority Setting Worksheet
  • Health Problem/Need
  • A Size of Problem (rate 1-5)
  • B Seriousness of the Problem (rate 1-5)
  • C Potential for Prevention (rate 1-5)
  • Priority Score (A 2B) C
  • Rank based on priority score

33
Priority Setting Processby Population Groups
  • Read and discuss the 1st assigned data detail
    sheet
  • Individually rate column A, B, and C (1-5)
  • Review the individual results
  • Facilitator/assistant will determine the
    frequency or mean score
  • Facilitator will ask Is this score acceptable
    that everyone can agree to support it?

34
To Reach Consensus
  • Each person will hold up a colored ticket
  • Green I agree to support it
  • Yellow I think I can support it but want more
    discussion
  • Red I cannot support it
  • Individuals present additional opinions and data
    to help decision making
  • Group must reach consensus at the end

35
EXAMPLE
36
What is Consensus?
  • A collective decision arrived at by a group of
    individuals working together under conditions
    that permit communication to be sufficiently
    open--and the group to be sufficiently
    supportive--for everyone in the group to fell
    that he/she has had his/her fair change to
    influence the decision!!

37
Consensus is a Process
  • It is NOT Conformity
  • Acceptable enough that everyone can live with it
    and agree to support it
  • Not everyone must be completely satisfied with
    the outcome
  • Total satisfaction is rare

38
Consensus How to make it work
  • Pooling opinions
  • Effective listening
  • Discussing ideas and differences
  • Not getting all you want
  • Agreement to the point you can live with it
  • Support of the final decision

39
Consensus and Conflict
  • Not good or bad - only indicates disagreement
  • Is normal the whole group benefits by exchange
    of opinion
  • Group can experience intense disagreement as long
    as there remains an assumption of cooperation

40
Consensus Breaking an Impasse
  • Take a break or go on to the next problem
  • Review criteria and standards
  • Review the data
  • Inject humor to break the tension

41
Next Steps(to bring a method to the madness)
  • Review the ranking for each group
  • Identify solutions and strategies to
  • Determine whether or not we can do anything about
    the need and what precisely it is we can and wish
    to do.

42
Generate possible solutions related to a priority
  • Compare the priority to strategies such as
  • Provide service directly
  • Contract with others to provide service
  • Provide education to public and/or providers
  • Systems development
  • Data system improvement

43
Generate possible solutions related to priority
  • Then ask the following questions for each
    strategy
  • How effective would this solution be?
  • Low, medium, high
  • How efficient would this solution be?
  • Low, medium, high
  • How acceptable would this solution be?
  • Low, medium, high

44
Determine Wisconsins Title VState Performance
Measures
  • Compile results and internally finalize
    recommendations for
  • State Performance Measures
  • Program Direction
  • Resource Allocation
  • Present findings to Department
  • Include final recommendations for annual Title V
    Block Grant Application
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