1. C OLORADO ’ S MCH
P RIORITIES : M OVING FROM
D ATA TO A CTION
G INA F EBBRA RO , MP H
M ATER N A L AND C HILD H EALTH U NIT M AN A G E R
C OLORADO D EPART M E NT OF P UBLIC H EALTH AND
E NVIRON M EN T
GINA . FE BB R A R O @ STAT E . C O . U S

2. D ISCUSSION O VERVIEW
 MCH Program vision and direction
 Identification of MCH priorities
 State infrastructure and process
 Local public health agency alignment and
support
 Feedback and next steps

3. C OLORADO ’ S MCH
M ISSION
 Optimize the health and well-
being of the MCH population
by employing primary
prevention and early
intervention public health
strategies.

4. MCH S TRATEGIC
D IRECTION
 Integrating MCH/CYSHCN efforts
across the life course
 Attention to primary prevention
and early intervention strategies
 Focus on population-based
approaches to health

5. MCH I NTERVENTION
S TRATEGIES
 MCH Pyramid Here

6. C OLORADO MCH
N EEDS A SSESSMENT
 Occurred in 2010 for 2011-2015
 Purpose to identify 7-10 specific priorities that
could be measurably impacted in five years using
public health strategies
 Conceptual framework
 MCH population – Integrated CSHCN
 Life course model
 Social determinants of health

7. N EEDS A SSESSMENT
P ROCESS
 Phase I – Collection of quantitative/
qualitative data to identify potential MCH
priorities.
 Expert Panel Process
 Health Status Report
 Phase II – Stakeholder surveys
 Phase III – Final prioritization, including
identification of new priorities and State
Performance Measures.

8. C RITERIA FOR
E STABLISHING P RIORITIES
 A clear MCH public health role exists.*
 Evidence-based or promising practices exist
to address the issue.
 Consistent with mission and scope of MCH
– alignment with MCH SOW.
 Efforts could achieve measurable results in
5 years.
*Ability for MCH to impact.

9. C OLORADO ’ S MCH
P RIORITIES 2011-2015
 Promote preconception health among
women and men of reproductive age
with a focus on intended pregnancy
and healthy weight.
 Promote screening, referral and
support for pregnancy-related
depression.
 Improve developmental and social
emotional screening and referral rates
for all children ages birth to 5.

10. C OLORADO ’ S MCH
P RIORITIES 2011-2015
 Prevent obesity among all children ages
birth to 5.
 Prevent development of dental caries in
all children ages birth to 5
 Reduce barriers to a medical home
approach by facilitating collaboration
between systems and families.

11. C OLORADO ’ S MCH
P RIORITIES 2011-2015
 Promote sexual health among all youth
ages 15-19.
 Improve motor vehicle safety among all
youth ages 15-19.
 Build a system of coordinated and
integrated services, opportunities and
supports for all youth ages 9-24.

12. MCH P RIORITIES AND
W INNABLE B ATTLES
See Crosswalk!

13. MCH S TEERING T EAM
 Redefined role from needs assessment to
implementation;
 Members:
 Karen Trierweiler, Title V Director
 Rachel Hutson, Children and Youth Branch Director
 Esperanza Ybarra, Women’s Health Branch Director
 Gina Febbraro, Maternal and Child Health Unit
Manager

14. F ROM MCH P RIORITIES TO
S TATE AND L OCAL P LANS
 Developed a new state-level
infrastructure that:
 Promotes a coordinated approach between
state and local MCH efforts;
 Provides support and capacity-building
among both state and local MCH staff;
 Provides oversight and accountability to state
and local-level work;

15. MCH I MPLEMENTATION
T EAMS (MIT S )
 MIT formed for each MCH priority;
 State program staff person with expertise in
the priority area leading each team;
 Teams (6-10 people) varied in composition:
state, local stakeholders;
 Teams were required to complete a team
charter.
 Required to engage local stakeholders for
input/ feedback;

16. B ROWNSON E VIDENCE - BASED
P UBLIC H EALTH M ODEL
Brownson, RC; Fielding JE; Maylahn CM. Ann. Rev. Public Health
2009.30:189

17. MIT W ORK
 Develop state-level logic models and
action plans that guide the next 3 years of
work.
 Develop coordinated local-level logic
models and action plans that guide the
next 3 years of work.

18. T RAINING AND S UPPORT
P ROVIDED
 Ongoing communication and consultation
(Rebecca Heck and Kerry Thomson)
 Collaboration and policy training
 Logic model and action plan trainings
 Will continue to identify and coordinate
ongoing professional development
opportunities for MITs and local MCH
staff working on priorities.

19. A CCOUNTABILITY AND
O VERSIGHT
 MITs presented and discussed work with MCH
Steering Team 2x each last year.
 MCH Director, Unit Manager, and Generalist
Consultants reviewed state and local level logic
models and action plans and provided feedback
to MITs.
 Report on efforts and progress in annual Title V
Block Grant report

20. AT THE S AME T IME …
MCH L OCAL F UNDING P OLICY
 Revised local funding formula for MCH and HCP
funding
 2008 Public Health Act, MCH Priorities, Address
some funding inequities that evolved over time
 Intensive communication and stakeholder
engagement, including LPHA workgroups

21. MCH L OCAL F UNDING
P OLICY R ESULTS
 Using the same, consistent formula for all 55
LPHAs (MCH population x poverty of MCH pop.)
 Combining both MCH and HCP funding in order
to provide more flexibility for LPHAs and due to
integrated nature of priorities
 3-year transition/mitigation plan
 Aligning contract expectations with priorities and
HCP program direction

22. A LIGNMENT OF L OCAL MCH
F UNDING <$50,000
 Administered through Office of Planning and
Partnerships – LPHA per capita contracts
 41 LPHAs / Total of $410,000
 $1500-$15,000 and $15,000-$50,000 Levels
 HCP Model of Care Coordination with data entry in
CYSHCN Data System (Required for higher level);
 MCH priorities by implementing part or all of a state-
developed local action plan related to an MCH priority;
 Community health assessment process and public
health improvement planning process;

23. A LIGNMENT OF L OCAL MCH
F UNDING >$50,000
FY13 LPHA MCH/HCP
Funding Expectations
HCP Care Coordination Other MCH Priorities and Action Plans
Includes costs
associated with
Medical Home Priority 10%
One example of what HCP
care coordination costs may
be.
40%
The parameters of the
"Other" work are similar to HCP Specialty
MCH funding parameters Clinic Funding
now. Efforts are determined
by LPHA.
50%

24. R ESOURCE R OLL -O UT
MCH Conference
 150 LPHA and State staff (MCH, PSD, OPP)
 2 days that included a variety of Plenary
Sessions
 State MCH strategic direction
 State and regional MCH data overview
 Brownson’s Evidence-based Public Health
Framework
 Importance of population-based approach to
health

25. R ESOURCE R OLL -O UT
MCH Conference
 MCH Priority Break-out Sessions (most
priority session offered 3 times each)
 Background and data on priority issue
 Brief intro. to state logic models and action
plans
 Focus on local logic models and action plans
 Interactive sessions highlighted local partner
input

26. A ND T HE S URVEY S AYS …

27. A ND T HE S URVEY S AYS …
What is one thing you learned at the conference that you are
excited to apply at the job?
 “Almost plug and play action plans, logic models, and the
stats”
 “Utilization of Brownson's model and the MCH Pyramid”
 “Action plans”
 “Partnership building”
 “Best practices for MCH work”

28. A ND O UR PARTNERS S AY …
 “I just wanted you to know how useful it has been over the
last weeks to have the priority areas, each with
workplans, logic models, etc. I have met with our WIC
director about ECOP (and preconception), and have
promoted Teen Motor Vehicle with some injury
folks. Although we are not likely to undertake ABCD per
say, the information has helped us so much with Medical
Home Systems Building planning, and of course we are full on
with Youth Sexual Health in many arenas and are using that
material broadly. All though I could not articulate what is
was I exactly needed when I took on this role, this body of
tools fills multiple needs for Denver and I would like the staff
who spent so many hours developing the information to
know how useful it has been, even beyond its official
purpose.”
--Denver Public Health MCH Program Manager

29. R EFLECTIONS F ROM MIT S :
W HAT W ORKED ?
 Communication: Expectations for MITs were clear
and flexible; MIT quarterly meetings; learning and
sharing from other MITs was very helpful
 Aspects of process helpful for accountability and
moving the work forward: Assigning 1 lead per
MIT; Sponsor and Steering Team check-in meetings
 Support, resources and tool: Logic model and
action plan templates; devoted EPE point-person;
EPE infrastructure specifically for LM and AP
consultation; MCH Generalist Consultant support

30. R EFLECTIONS F ROM S TEERING :
W HAT W ORKED ?
 Steering Team check-in meetings –
accountability and quality control
 Creation of support infrastructure for
MITs, including resourcing individual to
support MITs
 Continuity and intentionality from needs
assessment through to implementing plans

31. R EFLECTIONS FROM MIT S :
W HAT C OULD W E I MPROVE ?
 Communication: more time for Steering Team
check-in’s at the beginning of the process;
increased sharing, mentorship, and lessons
learned among the MITs during the development
of LMs and APs; more frequent MIT lead
meetings during ‘busy decision making time’ and
prior to MCH conference; common
communication platform for the MITs to access
 More time: From to digest feedback and adjust
LM and AP prior to MCH Conference; Between
LM and AP trainings and the due date for the
LMs and APs.

32. R EFLECTIONS FROM S TEERING :
W HAT C OULD W E I MPROVE ?
Developing process and infrastructure in real time;
created tight timelines – be more planful in the
future;
Modify structure to meet needs; Check-in routinely
Value of sponsor role? Sponsor = supervisor
Communication strategy overall and specifically
related to stakeholders

33. N EXT S TEPS – A CTION TO
O UTCOMES
 Dissemination of Work and Resources
 CoPrevent / MCH web site
 Presentations (conferences/webinars/podcasts)
and Publications
 Ongoing and Enhanced Communication
(internal and external)
 Ongoing MIT/LPHA support and capacity-
building
 Oversight and evaluation of state and local
work plans

34. T HANK YOU AND Q UESTIONS !
GINA . FEBBRARO @ STATE . CO . US
303 692 2427