Maternal And Child Health Leadership Research Articles

Grounding the Work of Grassroots MCH Leaders in Storytelling.

Our Grassroots Maternal and Child Health (MCH) Initiative works to build the capacity of individuals and organizations in zip codes with persistently high infant mortality rates to bring about systems change that will improve maternal and child health (MCH) outcomes. Foundational to the Initiative is the training and mentoring of local women to become Grassroots MCH Leaders. We greatly honor that these women possess community expertise, essential to the Initiative's success. Our training equips them with strategies they can use to bring about changes in social, economic, political, and/or cultural systems that underlie poor birth outcomes. One impactful strategy they learn is the use of critical narrative intervention (CNI). This approach, grounded in the crafting and sharing of stories, complements statistical, behavioral, and medical approaches to improve MCH outcomes. This article describes the impact of CNI within the Grassroots MCH Initiative. Drawing from 14 Grassroots MCH Leaders' narratives, we present five significant maternal traumas and influential supports in their surrounding contexts. We explore the leaders' reflections on the impact of story development and dissemination. Our findings reveal that situating CNI within the context of a grassroots initiative provides opportunities for leaders to use their stories to advocate for systems change. Personal MCH narratives provide a powerful and respectful approach to public health promotion, as they highlight important systems-level failures that need to be addressed to sustainability improve MCH outcomes.

Advancing Cultural Competency Toward Sexual and Gender Minorities: Innovation in Maternal and Child Health Pedagogy.

PurposeThe purpose of this project was to develop and disseminate an innovative teaching activity to increase cultural competency toward sexual and gender minority (SGM) populations within the maternal and child health (MCH) context.DescriptionOver 4.5% of the population (16 million people in the US) identify as SGM, and this population is an often-overlooked group within the traditional MCH context. SGM individuals have specific healthcare needs, including reproductive healthcare needs, that are currently left unaddressed. Given these gaps, the future MCH workforce should be prepared with cultural competency skills to address reproductive health inequities from many perspectives, including SGM populations. An innovative SGM activity was developed and disseminated to supplement the MCH and Reproductive Health curricula.AssessmentThe objectives of this SGM Reproductive Health activity were: (1) to understand SGM populations, terminology, culture, and health inequities within an MCH context; (2) enhance cultural competency and the communication skills appropriate for this population; and (3) develop culturally competent resources for practice. The teaching activity includes a lesson plan, lecture with script, recorded lecture, assignment description, and grading rubric, designed for a U.S. based curriculum. The activity was evaluated and modified based on feedback from students, and pilot tested in practice in a graduate-level reproductive health course.ConclusionFuture MCH leaders must have the skills to provide culturally competent care to the populations they serve, including SGM populations. Through teaching about SGM populations and cultural competence, educators can equip future MCH leaders with a culturally competent skillset to prepare them to work in cross-cultural situations.

The 'A' is the Weakest Link: What Local Health Departments are Doing to Improve Adolescent Health.

Although adolescence is a critical developmental period, there has not been coordinated effort to comprehensively address adolescent health within the field of maternal and child health (MCH). In order to inform future adolescent health efforts, MCH leaders in local health departments were asked to reflect on the greatest health challenges facing adolescents in their communities, the causes of these health challenges, the interventions currently implemented to promote adolescent health, and additional intervention needs. 15 interviews were conducted in 2018 with 13 city and county health departments and two community-based agencies (N = 19). Interviews were recorded and transcribed verbatim. Mutually agreed upon themes were determined by the research team and these themes were used to code the transcripts. Mental and behavioral health and sexual and reproductive health issues were perceived to be the greatest health challenges facing adolescents. Participants attributed these health issues to the social determinants of health and adverse childhood experiences. Although all health departments offered sexual and reproductive health interventions, few implemented mental and behavioral health interventions. Insufficient funding and collaboration challenges were the major barriers impeding the implementation of additional coordinated adolescent health interventions. Coordinated funding and technical assistance will be needed to enable MCH professionals in local health to realize their potential to improve the health of adolescents. Specific observations and opportunities were addressed in efforts to create conversation that would lead to an improvement in adolescent health services within local health departments, as well as communities and the field of MCH.

System Support Mapping: A Novel Systems Thinking Tool Applied to Assess the Needs of Maternal and Child Health Title V Professionals and Their Partners.

The Maternal and Child Health (MCH) workforce aims to improve health outcomes for women, children, and families. The work requires coordination and partnerships that span disciplines and service systems. As such, workforce needs assessment requires an approach that is broad, flexible, and "systems-aware." To illustrate the use of System Support Mapping, a novel systems thinking tool that was used to guide participants through a structured assessment of their discrete responsibilities, key needs, and specific resources required for each. Thirty-four Title V MCH professionals and partners from 15 states or jurisdictions. Description and frequency of Title V MCH professionals' coded roles, responsibilities, needs, resources, and wishes. An aggregated map illustrating interconnections between identified codes is presented. State- and local-level MCH professionals reported a range of roles, responsibilities, needs, resources, and wishes. The most and least frequently reported roles, responsibilities, needs, resources, and wishes by state- and local-level MCH professionals are listed, as well as the most frequent connections between those responses. The most frequent responsibility reported in local maps was "link to or provide care or resources" (82%), whereas the most frequent responsibility reported in state maps was "system management" (65%). System management was indirectly connected to 3 wishes: "access to data or information," "funding or resources," and "collaboration, coordination, or support from community or other external organizations." System Support Mapping can be used to support needs assessment with MCH professionals. System Support Maps show not only the most and least frequently reported roles, responsibilities, needs, resources, and wishes of participants but also how those responses are connected and potentially interdependent. System Support Maps may be useful for MCH leaders determining how best to organize their teams to take on complex public health challenges and prioritize improvements that will better support their work.

Grassroots Maternal Child Health Leadership Curriculum

In the United States, Indiana ranks 43rdfor its infant mortality rate. Twenty-nine (of the 988) Indiana zip codes account for 27% of infant deaths. There is a need to train and mentor community members to lead local maternal and child health (MCH) efforts that address the priorities of community members as related to poor birth outcomes and facilitate the community’s solution strategies to this important public health problem. This community-centered approach coupled with local healthcare delivery helps thoroughly address local adverse birth outcomes. A comprehensive grassroots MCH leadership curriculum is needed for this training process. To meet this need we developed and solicited feedback on a curriculum designed to train community members situated in Indiana’s high-risk zip codes to be grassroots maternal child health leader (GMCHLs). The curriculum teaches GMCHLs the knowledge and skills to become self-reflective leaders who understand the causes and effects of adverse and inequitable birth outcomes, the negative health effects of chronic stress, and the protective power of the community. These GMCHLs will become skilled in the use of storytelling, Photovoice, policy development/advocacy and EvaluLead to build the capacity of their local community to support positive maternal and child health (MCH) outcomes.

Advancing Leadership Skills: A Multiyear Examination of LEND Trainee Self-Efficacy Growth.

PurposeThe current healthcare system requires Maternal and Child Health (MCH) professionals with strong interdisciplinary leadership competence. MCH training programs utilize a conceptual framework for leadership and 12 validated MCH Leadership Competencies. Examining Trainee Perceived Leadership Competence (TPLC) through the competencies has the potential to inform our understanding of leadership development. DescriptionFive cohorts of NH-ME leadership education in neurodevelopmental disabilities trainees (n = 102) completed the MCH Leadership Competencies Self-Assessment at three time points. Paired-sample t tests examined TPLC scores. A one-way analysis of variance tested for statistically significant differences in mean difference scores. A General Linear Model was used to examine the extent to which TPLC scores changed when controlling for specific variables. Assessment Statistically significant differences in mean scores between Time 1 and Time 3 were found. Cohen's d effect sizes fell in the moderate range. A one-way ANOVA demonstrated significant differences between groups in the spheres of self and others. TPLC mean scores between Time 1 and Time 3 in the sphere of wider community had the highest increases in four out of five cohorts. Age, discipline, experience, and relationship to disability did not contribute to the model. ConclusionOn average, cohorts began the year with very different evaluations of their leadership competence but finished the year with similar scores. This suggests participation in the NH-ME LEND Program consistently supported the development of leadership self-identity. Small sample sizes limit the ability to draw definitive conclusions from these results. Further study with a larger sample may reveal relationships between cohort characteristics and change scores.

Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University.

ObjectivesDespite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA's Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. MethodsA mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for PracticeThese results will be used to inform other MCH training programs and strengthen Tulane's CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.

Integrating Family as a Discipline by Providing Parent Led Curricula: Impact on LEND Trainees' Leadership Competency.

Background While the MCH Leadership Competencies and family as a discipline have been required elements of Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs for over a decade, little research has been published on the efficacy of either programmatic component in the development of the next generation of leaders who can advocate and care for Maternal and Child Health (MCH) populations. Objective To test the effectiveness of integrating the family discipline through implementation of parentled curricula on trainees' content knowledge, skills, and leadership development in family-centered care, according to the MCH Leadership Competencies. Methods One hundred and two long-term (≥ 300h) LEND trainees completed a clinical and leadership training program which featured intensive parent led curricula supported by a full-time family faculty member. Trainees rated themselves on the five Basic and Advanced skill items that comprise MCH Leadership Competency 8: Family-centered Care at the beginning and conclusion of their LEND traineeship. Results When compared to their initial scores, trainees rated themselves significantly higher across all family-centered leadership competency items at the completion of their LEND traineeship. Conclusions The intentional engagement of a full-time family faculty member and parent led curricula that include didactic and experiential components are associated with greater identification and adoption by trainees of family-centered attitudes, skills, and practices. However, the use of the MCH Leadership Competencies as a quantifiable measure of program evaluation, particularly leadership development, is limited.

Creating an MCH Pipeline for Disadvantaged Undergraduate Students.

To address minority health disparities in maternal and child health (MCH), increasing the diversity of the MCH workforce is an important strategy. Guided by the MCH Leadership Competencies, we developed an undergraduate pipeline program for disadvantaged students. Our target population is minority undergraduates who are interested in entering health professions but have academic challenges. We identify these students early in their undergraduate careers and expose them to the field of MCH through a 4-unit course, summer field practicum at an MCH community-based organization or agency, and volunteer experience in a student-run organization focused on helping children and families. We also provide academic advising and personal counseling by a faculty mentor and leadership training opportunities. Since 2006, 75 students have participated in our program, of which 36 are still enrolled and 39 have graduated. Among the graduates, three (8%) have completed graduate school and are working in a health field; 11 (28%) are enrolled in graduate school; and 13 (33%) are currently applying to graduate school. Of the remaining graduates, seven (18%) are employed in a health field, and five (13%) are working in an unrelated field. Pipeline programs should attempt to reach students as early as possible in their undergraduate careers to more effectively influence their academic trajectories. Many minority students face academic and personal challenges; therefore, intensive academic advising and one-on-one faculty mentoring are important components of pipeline programs.

Transformation of the title V maternal and child health services block grant.

This paper describes the transformation of the Title V Maternal and Child Health (MCH) Services Block Grant. The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability. State reporting burden is reduced by aligning and streamlining the needs assessment, annual report and application, reducing the number of forms States have to fill out, eliminating Health Systems Capacity Indicators, and prepopulating the annual report and application with State data using national data sources. State flexibility is maintained through the needs assessment process whereby State needs and priorities drive the selection of National Performance Measures and State-specific Performance Measures, and the development of State Action Plan and Evidence-based/informed Strategy Measures. Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation’s mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.

The Relationship between Interprofessional Leadership Education and Interprofessional Practice: How Intensive Personal Leadership Education Makes a Difference

The Relationship between Interprofessional Leadership Education and Interprofessional Practice: How Intensive Personal Leadership Education Makes a Difference

Family leaders and workforce leadership development.

Family members can become leaders who are a voice not only for their own family, but also as part of a collective voice to advocate for changes in services, programs, policies, and organizations that benefit all families. Family leadership is important because family leaders can keep the focus on the family experience, providing their own and other family stories, experiences, and perspectives to provide first hand feedback on the best ways of meeting the needs of families and the barriers and challenges that families face along the way. Strong family leaders not only have an impact on Maternal and Child Health (MCH) leadership, they represent a vital part of the MCH workforce. In the past, family leaders ‘‘emerged,’’ either by their own initiative and efforts or from other sectors such as education and early childhood program spheres (special education, Head Start, etc.). Family leaders are a valuable resource to MCH; therefore, as MCH identifies strategies for building the leadership capacity of the current workforce and developing the next generation of leaders, it is essential that the role of family and family leaders be infused in all aspects of MCH leadership development. In addition to family leaders, youth and young adults acting as self-advocates play an important role in MCH programs and policy development. Family leaders have become a vital part of the workforce and will be integral in providing a family-driven response to the changing environment, opportunities and realities that MCH will face in the future. This will require that MCH directors recognize the need to ensure family leaders have the knowledge, skills, confidence, and experience to represent the family perspective. Further, MCH as a field will need to cultivate an environment within programs and practices that embraces family leaders and youth/young adult self-advocates as vital members within the MCH workforce.

Transforming LEND leadership training curriculum through the maternal and child health leadership competencies.

The purpose of this article is to describe how the Maternal and Child Health (MCH) Leadership Competencies (v 3.0) were used to examine and improve an MCH Leadership Education in Neurodevelopmental and Related Disabilities (LEND) training curriculum for New Hampshire and Maine. Over 15% of the nation's children experience neurodevelopmental disabilities or special health care needs and estimates suggest 1 in every 68 children is diagnosed with an autism spectrum disorder. Across the Unites States critical shortages of qualified MCH professionals exist, particularly in poor and rural areas. A continued investment in training interdisciplinary leaders is critical. The MCH Leadership Competencies provide an effective foundation for leadership training through identification of requisite knowledge, skills, and dispositions required of MCH leaders. This paper describes a three-step process, which began in 2010 and included utilizing the MCH Leadership Competencies as a tool to reflect on, develop, and evaluate the NH LEND leadership curriculum. Curriculum development was further supported through participation in a multi-state learning collaborative. Through a series of intentional decisions, the curriculum design of NH LEND utilized the competencies and evidence-based principles of instruction to engage trainees in the development of specific MCH content knowledge and leadership skills. The LEND network specifically, and MCH leadership programs more broadly, may benefit from the intentional use of the MCH competencies to assist in curriculum development and program evaluation, and as a means to support trainees in identifying specific leadership goals and evaluating their leadership skill development.

The MCH training program: developing MCH leaders that are equipped for the changing health care landscape.

This article examines the success of the Maternal and Child Health (MCH) Bureau's MCH Training Program in producing the next generation of MCH leaders, equipped with interdisciplinary, leadership skills necessary for the changing health care landscape. A secondary data analysis of performance measure data (2007-2011) collected through the discretionary grant information system was performed. Grantees were grouped by grant program (n = 10) for this analysis. Outcomes of interest 5 years post-program completion included: (1) the percentage of long-term training program graduates who demonstrate field leadership; (2) the percentage of long-term trainees (LTT) who remain in MCH, work with underserved and/or vulnerable populations, or work in a public health agency/organization; and (3) the percentage of LTT working in an interdisciplinary manner to serve the MCH population. Summary output data on the number of LTT reached was also calculated. The number of LTT participating in the MCH Training Program increased between 2007 and 2011. Over 84% of LTT demonstrate field leadership 5 years after program completion, while 78.2% of LTT remain in MCH work and 83% are working with underserved or vulnerable populations. At 5-years post-program completion, over 75% of LTT are working in an interdisciplinary manner to serve the MCH population. The MCH Training Program has produced well-positioned leaders. Continued investment in the MCH Training Program is critical to ensure a well-trained pipeline of health professionals equipped to address the special health needs of MCH populations in an evolving health system.

The MCH navigator: tools for MCH workforce development and lifelong learning.

Maternal and child health (MCH) leadership requires an understanding of MCH populations and systems as well as continuous pursuit of new knowledge and skills. This paper describes the development, structure, and implementation of the MCH Navigator, a web-based portal for ongoing education and training for a diverse MCH workforce. Early development of the portal focused on organizing high quality, free, web-based learning opportunities that support established learning competencies without duplicating existing resources. An academic-practice workgroup developed a conceptual model based on the MCH Leadership Competencies, the Core Competencies for Public Health Professionals, and a structured review of MCH job responsibilities. The workgroup used a multi-step process to cull the hundreds of relevant, but widely scattered, trainings and select those most valuable for the primary target audiences of state and local MCH professionals and programs. The MCH Navigator now features 248 learning opportunities, with additional tools to support their use. Formative assessment findings indicate that the portal is widely used and valued by its primary audiences, and promotes both an individual's professional development and an organizational culture of continuous learning. Professionals in practice and academic settings are using the MCH Navigator for orientation of new staff and advisors, "just in time" training for specific job functions, creating individualized professional development plans, and supplementing course content. To achieve its intended impact and ensure the timeliness and quality of the Navigator's content and functions, the MCH Navigator will need to be sustained through ongoing partnership with state and local MCH professionals and the MCH academic community.

Incorporating Life Course Theory and Social Determinants of Health into the LEND Curriculum

The goal of this paper is to describe strategies for revising LEND curricula to incorporate a stronger focus on life course theory and social determinants of health (LCT/SDOH). The Maternal and Child Health Bureau (MCHB) includes a central focus on LCT/SDOH and states that a goal of Maternal and Child Health (MCH) training is to "Prepare and empower MCH leaders to promote health equity…and reduce disparities in health and health care." Two LEND programs engaged in a comprehensive process to strengthen LCT/SDOH in their curricula that included choosing content and themes and developing instructional strategies congruent with MCH Leadership Competencies and with the learning needs of LEND trainees. We describe: key elements of LCT/SDOH; the relationship of these to children with disabilities and to the MCH Leadership Competencies; LCT/SDOH resources for the LEND curriculum; a collaborative curriculum revision process for faculty; and LCT/SDOH content and themes for the LEND Curriculum and strategies for incorporating them. We present the results of our work in a format that may be used by other LEND programs undertaking curriculum revision to incorporate LCT/SDOH.

Bringing it All Together: Effective Maternal and Child Health Practice as a Means to Improve Public Health

Effective maternal and child health (MCH) practice requires skillfully combining a number of theoretical models and frameworks to support systems addressing the health needs of women, children, and families. This paper describes three perspectives relevant to current MCH practice: the federal Maternal & Child Health Bureau's Pyramid of MCH Health Services [1], Frieden's Health Impact Pyramid [Frieden in Am J Public Health 100(4):590-595, (2010)], and life course theory [Halfon in Milbank Quart, 80:433-79, (2002); Kotelchuck in Matern Child Health J, 7:5-11, (2003); Pies (2009)], an emerging conceptual framework that addresses a number of pressing maternal and child health issues including health disparities and the social determinants of health. While developed independently, a synthesis of these three frameworks provides an important analytical perspective to assess the adequacy and comprehensiveness of current public health programs and systems supporting maternal and child health improvement. Synthesizing these frameworks from the specific vantage point of MCH practice provides public health practitioners with important and dynamic opportunities to promote improvements in health, especially for state and local governmental health agencies with the statutory authority and public accountability for improving the health of women, children, and families in their jurisdictions. A crucial finding of this synthesis is that significant improvements in MCH outcomes at the state and local levels are the result of collaborative, integrated, and synergistic implementation of many different interventions, programs and policies that are carried out by a number of stakeholders, and administered in many different settings. MCH programs have a long history of coordinating disparate sectors of the health care and public health enterprise to create systems of services that improve maternal and child health. Future improvements in MCH build on this legacy but will come from a "paradigm shift" in MCH practice that blends (1) evidence-based interventions and best practices that improve the health of individuals, communities, and populations, and crosscuts health service settings with (2) public policies that promote and improve maternal and child health needs at the local, state, and national levels, and (3) supports MCH leadership to implement such changes in MCH systems nationwide. As such, the challenge presented by this synthesis is not merely technical, i.e. having the scientific and organizational capacity to address identified MCH needs. Instead, a more pressing challenge is providing effective leadership in the coordination and integration of these frameworks and using them in practice to develop a vision that guides programs and policies to improve maternal and child health nationwide.

Future Directions in Leadership Training of MCH Professionals: Cross-Cutting MCH Leadership Competencies

Leadership in Maternal and Child Health (MCH) requires a repertoire of skills that transcend clinical or academic disciplines. This is especially true today as leaders in academic, government and private settings alike must respond to a rapidly changing health environment. To better prepare future MCH leaders we offer a framework of MCH leadership competencies based on the results of a conference held in Seattle in 2004, MCH Working Conference: The Future of Maternal and Child Health Leadership Training. The purpose of the conference was to articulate cross-cutting leadership skills, identify training experiences that foster leadership, and suggest methods to assess leadership training. Following on the work of the Seattle Conference, we sub-divide the 12 cross-cutting leadership competencies into 4 "core" and 8 "applied" competencies, and discuss this distinction. In addition we propose a competency in the knowledge of the history and context of MCH programs in the U.S. We also summarize the conference planning process, agenda, and work group assignments leading to these results. Based on this leadership competency framework we offer a definition of an MCH leader, and recommendations for leadership training, assessment, and faculty development. Taken as a set, these MCH leadership competencies point towards the newly-emerging construct of capability, the ability to adapt to new circumstances and generate new knowledge. "Capstone" projects can provide for both practice and assessment of leadership competencies. The competency-based approach to leadership that has emerged from this process has broad relevance for health, education, and social service sectors beyond the MCH context.

Our legacy for leadership in MCH.

The history of Maternal and Child Health (MCH) in the United States provides some important lessons for us today. Emerging from the child labor abolition and progressive reform movements of the late 1800s, the basis of MCH in the United States can be traced to fundamental concerns regarding how our society should protect children from a host of threats, including abuse, the adverse practices of childhood labor, disease, and the ill effects of unclean milk and water, poor sanitation, and an unsafe environment. These and additional concerns about how to assure that children and families have access to adequate healthcare and to health and social systems that understand the special developmental needs of children persist to this day. A review of the history of MCH fosters an appreciation of the many accomplishments made by early MCH leaders during some very difficult times in this country. Today, with the advent of war and an unclear economic forecast, to say nothing of continuing health care reforms and the reinvention of the roles and purposes of public health, it may offer modest comfort to know that our predecessors faced grim circumstances too and prevailed. As MCH continues to evolve in response to the major social events of the times, there is an ongoing need to revisit and reflect upon the role and purpose of MCH in the society. Our inherited legacy of leadership in MCH both inspires and challenges us as we strive to responsibly advocate, align constituencies, build and use data capacities for need assessment and evaluation, question our premises, identify and courageously confront pressing health and social issues, and continue our efforts to formulate and articulate a vision for the future of MCH.