Table of Contents Meeting Summary  Background  Purpose  Participants  Meeting Overview  Breakout Group Reports and    Discussion  Review of Draft FCHDR Plan  Meeting Outcomes  Next Steps Appendices  A-1 - Meeting Agenda  A-2 - Meeting Participants  A-3 - FCHDR Road Map  FCHDR Home

MEETING SUMMARY

Meeting Sponsors

Office of Minority Health/Office of Public Health and Science,
U.S. Department of Health and Human Services

Office of Public Health Research, Office of the Chief Science Officer, Office of the Director, Centers for Disease Control and Prevention,
U.S. Department of Health and Human Services

Interagency Committee on Disability Research, National Institute on Disability and Rehabilitation Research,
U.S. Department of Education

August 2007

JUNE 14, 2007
WASHINGTON, DC
HOLIDAY INN CAPITOL

Meeting Summary

Background
On May 24, 2006, the Centers for Disease Control and Prevention (CDC), Office of the Director, Office of the Chief Science Officer, Office of Public Health Research (OPHR) in collaboration with the U.S. Department of Health and Human Services (HHS), Office of Public Health Science, and Office of Minority Health (OMH), held the first Federal Partners Meeting on Collaborative Research Efforts to Eliminate Health Disparities in Washington, D.C. This meeting was an outgrowth of broader HHS efforts including the 2006 National Leadership Summit to Eliminate Racial and Ethnic Disparities in Health and efforts to coordinate research and data, and CDC’s efforts to develop the Health Protection Research Guide, 2006-2015 and the Health Protection Goals, all of which emphasize health disparities elimination. Participants initially identified 165 potential areas for research opportunities. From these areas, participants selected 23 areas, including four top priority areas that they felt were promising for multi-agency collaboration: obesity, built environment, mental health care and co-morbidities.

A second meeting, Accelerating Collaboration on Health Disparities Research, which occurred on December 5–6, 2006, brought together subject matter experts and agency points of contact for each of the four areas identified in the May 2006 meeting. The purpose of the December meeting was to refine the four top priority areas that were identified in the first meeting, and recommend strategies for sustaining the collaboration. During this meeting, participants determined that the most important immediate next step was to develop an infrastructure for the collaboration in order to sustain the effort. While the four research areas identified at the May 2006 meeting are the focus of the initial effort, it is recognized that additional areas that would benefit from further research through interagency collaboration in the future. After the December meeting, CDC OPHR worked to add structure to these collaborative efforts and create a formal entity, the Federal Collaboration on Health Disparities Research (FCHDR). FCHDR is co-led by HHS OMH and the U.S. Department of Education’s (DoEd) Interagency Council on Disabilities Research (ICDR).

• work collaboratively on setting the direction of FCHDR
• develop a plan for establishing the FCHDR Steering Committee

• resources needed by the Steering Committee
• incentives for all (including partners) to stay engaged in FCHDR
• coordination with other FCHDR structural components (including Subject Matter Expert (SME) Workgroups for the four priority areas and Co-Leads)
• empowerment levels for the Steering Committee
• possible derailers for the Steering Committee

1. Development of a purpose statement for the Steering Committee

   The purpose of the FCHDR Steering Committee is to:

   • coordinate across and between federal agencies
   • promote inclusion of all stakeholders
   • make decisions regarding the FCHDR
   • provide leadership, oversight, guidance, and capacity
   • set priorities and milestones to ensure progress
   • conduct ongoing evaluations of critical needs and ensure necessary midcourse corrections
   • serve as a bridge between the Steering Committee Co-Leads and the SME Workgroups
   • avoid micromanagement of the SME Workgroups
   • conduct project management activities, including keeping minutes, reporting, and arranging interagency agreements
   • address issues related to funding by serving as a voice to the rest of the health disparities research world

2. Key deliverables of the Steering Committee

   One key deliverable of the Steering Committee is to produce regular progress reports and evaluations. Specific recommendations for reports and evaluations include an annual status report, a report card on how agencies are working synergistically to reduce health disparities, progress reports, and a summary of the current evidence-based practices in various settings.

   The Steering Committee should:

   • create a federal-wide strategic plan for FCHDR
   • identify additional research gap areas
   • create Memoranda of Understanding (MOU) between Federal Departments and Agencies
   • develop communication links, including a website
   • develop a plan for the dissemination of research findings
   • maintain detailed minutes of Steering Committee meetings
   • develop a governance plan that describes how the Steering Committee will interact with the SME Workgroups relative to program development and implementation, research announcements, interagency agreements, and policy development
   • ensure the creation of deliverables and functioning of the SME Workgroups
   • ensure both upstream and downstream communication between the Steering Committee and SME Workgroups

3. Comments on draft membership statement for the Steering Committee from the FCHDR Road Map

   Participants generally supported the draft membership statement included in the FCHDR Road Map (Appendix A-3). Several supported the idea that members of the Steering Committee should act as agency champions. Groups also supported the idea that SME Workgroup Co-Chairs serve as members of the Steering Committee. While some individuals liked the broad language of the membership statement, other participants expressed concern that a large Steering Committee may inhibit productivity. High level involvement and commitment from leadership is essential to success. Concern was expressed that without such support, Steering Committee members may not have the ability to attend meetings and devote adequate time to FCHDR. The need for equal agency partnerships and a public/private partnership are also important.

   In addition, it is important to ensure that the Steering Committee:

   • has broad representation and has a balance of producers and downstream consumers of research
   • includes senior and non-senior level representation
   • has the authority to make decisions and take action during meetings
   • includes principal policy makers
   • has a membership statement that uses language common to all agencies (e.g., the meaning of division varies from one agency to another)
   • clearly identifies its roles and responsibilities and those of the SME Workgroups
   • has a formal mechanism for rotation

4. Operational Issues
   1. Resources needed by Steering Committee
      Essential resources to the success of the Steering Committee include a clear articulation of support from each agency in the FCHDR, along with support from non-Federal partners and foundations. Communication tools, including a Web portal and Web page are important to promoting collaboration and increasing the visibility of FCHDR. Dedicated staff and administrative support are vital to the success of the Steering Committee. Finally, a budget line item dedicated to the Steering Committee is essential to the long-term success of the FCHDR.
      
      
   2. Incentives for all to stay engaged in FCHDR – what’s in it for non-Federal partners?
      Benefits to partners that are engaged in the work include the ability to create a federal strategic plan on health disparities research and the opportunity to leverage/conserve resources on common research priorities as incentives. In addition, it is important to recognize partners for their involvement.
      
      
   3. Coordination with other structural components
      Key structural components of the Steering Committee include the need for regular and consistent communication (i.e., quarterly reporting) and a collaborative process to ensure sustainability and individual commitment. In addition, the linkage of existing networks and provision of guidelines to agencies relative to the creation of collaborative announcements and opportunities to work together are important.
      
      
   4. Empowerment levels for Steering Committee
      The Steering Committee should be empowered to make principle decisions regarding SME Workgroups, deliverables, and process.
      
      
   5. Possible derailers for the Steering Committee
      Factors that could inhibit the work of the Steering Committee include concern about ensuring equal opportunities for contribution among agencies of varying size and budget. Support for FCHDR may fluctuate with changes in the political environment. The variations in organization structure, culture, priorities and goals, legal restrictions, and regulations between agencies may be an additional derailer. Buy-in from each agency, despite these variations, is essential to ensuring sustainability. Other potential derailers include lack of authority, accountability, and transparency.

• draft statements outlining the purpose of the FCHDR Steering Committee
• revisions to the membership section of the FCHDR Road Map
• key deliverables for which the FCHDR Steering Committee should be responsible
• identification of operational issues related to coordination, frequency of interaction, infrastructure, and resources

The next meeting, scheduled for September 17, 2007 in Alexandria, Virginia, will formalize the FCHDR Steering Committee.

In addition, ICDR will be hosting a meeting with FCHDR external partners on September 17, 2007. The meeting will engage external researchers, professional associations, universities, non-governmental organizations, business and worker organizations, community groups, American Indian and Alaska Native tribal leaders and organizations, public health partners, and health professionals. Participants will help to identify priority health disparities research needs and discussion of how they can promote translation and dissemination of evidence-based interventions in order to accelerate the elimination of health disparities.

Appendices

A-1 - Meeting Agenda

Meeting Objectives

• Work collaboratively on setting the direction of FCHDR
• Develop plan for establishing FCHDR Steering Committee

Proposed Meeting Outcomes

• Buy in on value of FCHDR and need for Steering Committee
• Recommendations on operational issues (coordination, frequency of interaction, infrastructure, and resources)
• List of next steps
• Guidance for planning September 17 external partners scientific meeting on health disparities and disabilities

Agenda

A-2 - Meeting Participants

David Asch, MD, MBA
Robert D. Eilers Professor, University of Pennsylvania School of Medicine and the Wharton School / Executive Director,Leonard Davis Institute of Health Economics, University of Pennsylvania, / Co-Director, VA Center for Health Equity Research and Promotion
Department of Veterans Affairs
3641 Locust Walk
Philadelphia, PA 19104
215-746-2705
asch@wharton.upenn.edu

Peter Ashley, MPH, DrPH
Senior Environmental Scientist
Office of Healthy Homes and Lead Hazard Control
Department of Housing and Urban Development
451 7th Street SW
Washington, DC 20410
202-402-7595
peter.j.ashley@hud.gov

Tanya Pagan Raggio Ashley, MD, MPH, FAAP
Director, Office of Minority Health and Health Disparities
Chief Medical Officer,
Health Resources and Services Administration
Department of Health and Human Services
5600 Fishers Lane,
Room 6C-26
Rockville, MD 20857
301-443-8305
traggio@hrsa.gov

David Baquis
Accessibility Specialist
United States Access Board
1331 F Street, NW #1000
Washington, DC 20004
202-272-0013
baquis@access-board.gov

Ebony Bookman, MS, PhD
Chief of Staff, National Institute of Environmental Health Sciences,
National Institutes of Health
Department of Health and Human Services
111 TW Alexander Drive
Bldg 101, Room 240
Research Triangle Park, NC 27709
919-541-7758
bookmane@mail.nih.gov

Diane Boyd, PhD
Project Director
Cherry Engineering Support Services (CESSI)
6858 Old Dominion Drive
Suite 250
McLean, VA 22101
703-448-6155x235
dboyd@cessi.net

Richard Bragg, PhD
Coordinator, Minority Health Services Research,
Centers for Medicare and Medicaid Services
Department of Health and Human Services
7500 Security Blvd.,
MS C3-19-07
Baltimore, MD 21244
410-786-7250
richard.bragg@cms.hhs.gov

Sharunda Buchanan, PhD
Director, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention
Department of Health and Human Services
Chamblee Bldg 101, Rm 1122
MS F30
Chamblee, GA 30341
770-488-7362
sbuchanan@cdc.gov

Cecilia Casale, PhD
Senior Advisory for Minority Health
Agency for Healthcare Research and Quality
Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
301-427-1547
cecilia.casale@ahrq.hhs.gov

Jacqueline Chmar, MPH
Health Scientist, Office of Public Health Research, Office of the Chief Science Officer
Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS D-72
Atlanta, GA 30333
404-639-7404
jchmar@cdc.gov

Francis Chesley, MD
Director, Office of Extramural Research Education and Priority Populations,
Agency for Healthcare Research and Quality
Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
301-427-1521
francis.chesley@ahrq.hhs.gov

Pamela Costa, MA
Acting Director, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS E-88
Atlanta, GA 30333
404-498-3027
pcosta@cdc.gov

Roscoe Dandy, DrPH
Health Resources and Services Administration
Department of Health and Human Services
18172 Parklawn Building
Rockville, MD 20857
301-443-6582
rdandy@hrsa.gov

Jane Daye, MA
Chief of Administration and Program Director, Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health
Department of Health and Human Services
6116 Executive Blvd.
Suite 602
Rockville, MD 20892
301-594-5946
dayej@mail.nih.gov

Hazel Dean, ScD, MPH
Acting Deputy Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention,
Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS E-07
Atlanta, GA 30333
404-639-8002
hdd0@cdc.gov

Frances Ferguson, MD, MPH
Program Director, National Institute of Diabetes and Digestive Kidney Disease, National Institutes of Health
Department of Health and Human Services
2 Democracy Plaza, 6707 Democracy Blvd., Room 648A
Bethesda, MD 20874
301-594-9652
ff54t@nih.gov

Shirley Gerrior, PhD, RD, LD
National Program Leader, Human Nutrition, Cooperative State Research, Education, and Extension Service
United States Department of Agriculture
1400 Independence Ave. SW
MS 2225
Washington, DC 20250
202-720-4124
sgerrior@csrees.usda.gov

Garth Graham, MD, MPH
Deputy Assistant Secretary for Minority Health
Department of Health and Human Services
Office of Minority Health
1001 Wootton Pkwy, Suite 600, Rockville, MD 20852
240-453-2882
garth.graham@hhs.gov

Milton Hernandez, PhD
Director, Special Populations Research and Training, National Institute of Allergy and Infectious Disease,
National Institutes of Health
Department of Health and Human Services
6700B Rockledge Drive
Room 2101
Bethesda, MD 20892
301-496-3775
mh35c@nih.gov

Laura House, PhD, MSW
Public Health Advisor, Substance Abuse and Mental Health Services Administration
Department of Health and Human Services
One Choke Cherry Road
Room 1142
Rockville, MD 20857
240-276-1625
laura.house@samhsa.hhs.gov

Suzanne Heurtin Roberts, PhD, MSW
Special Advisor on Policy Research, Office of Minority Health, Division of Policy and Data
Department of Health and Human Services
1101 Parkway, Suite 600
Rockville, MD 20852
240-453-2882
sheurtin@mail.nih.gov

Daniel Hutch, MA
Economist, Office of Policy, Economics and Innovation
Environmental Protection Agency
1200 Pennsylvania Avenue N.W., (1807-T)
Washington, DC 20460
202-566-2844
hutch.dan@epa.gov

Melissa Mau
Summer Intern, Office of Minority Health
Department of Health and Human Services
1101 Wootton Parkway
Suite 1000
Rockville, MD 20850
240-453-8222
melissa.mau@hhs.gov

Robert Mays, PhD, MSW
Acting Chief, Mental Health Disparities Research Program, National Institute of Mental Health, National Institutes of Health
Department of Health and Human Services
6001 Executive Blvd.
Neuroscience Center
Room 8125
Bethesda, MD 20892
301-443-3017
rmays@mail.nih.gov

Ron McCuan, DMD, JD
Public Health Analyst, National Institute of Corrections
Department of Justice
320 First Street, NW
Suite 5007
Washington, DC 20534
202-307-0147
rmccuan@bob.gov

Helena Mishoe, PhD, MPH
Director, Office of Minority Health Affairs, National Heart, Lung, and Blood Institute, National Institutes of Health
Department of Health and Human Services
6701 Rockledge Drive
Room 9080
Bethesda, MD 20892
301-451-5078
mishoeh@nhlbi.nih.gov

Julie Moreno, MHS
Senior Public Health Analyst
Office of Minority Health
Department of Health and Human Services
1101 Wootton Parkway
Suite 600
Rockville MD 20850
240-453-2882
julie.moreno@hhs.gov

Connie Pledger, PhD
Executive Director, Interagency Committee on Disability Research
Department of Education
400 Maryland Ave., S.W.
Washington, DC 20202
202-245-7480
connie.pledger@ed.gov

Amy Pope
Facility Security Officer
Maximum Technology Corporation (MTC)
P.O. Box 11817
Huntsville, AL 35814
256-864-7630 x 109
apope@maxtc.com

Beth Rasch, PT, PhD
Staff Scientist
Clinical Research Center Rehabilitation Medicine Department, National Institutes of Health
Department of Health and Human Services
Building 10, CRC, Room 1360, 10 Center Drive, MSC 1604, Bethesda, MD 20892
301-594-3090
rasche@cc.nih.gov

Jamila Rashid, PhD, MPH
Team Leader, Research Agenda and Promotion, Office of Public Health Research, Office of the Chief Science Officer, and Senior Advisor for Special Populations, Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS D-72
Atlanta, GA 30333
404-639-4658
jjr5@cdc.gov

Rochelle Rollins, PhD, MPH
Acting Director, Division of Policy and Data, Office of Public Health and Science
Office of Minority Health
Department of Health and Human Services
1001 Wootton Parkway
Suite 600
Rockville, MD 20852
240-453-8222
rochelle.rollins@hhs.gov

Marc Safran, MD, MPA, DFAPA, FACPM
Senior Medical Officer, Senior Psychiatrist, Mental Health Council Chair, Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS E-44
Atlanta, GA 30333
404-639-3130
msafran@cdc.gov

Etta Saltos, PhD
National Program Leader, Human Nutrition, Cooperative State Research, Education, and Extension Service
Department of Agriculture
1400 Independence Ave. SW
MS 2241
Washington, DC 20250
202-401-5178
esaltos@csrees.usda.gov

Elizabeth Skillen, PhD, MS
Health Scientist, Office of Public Health Research, Office of the Chief Science Officer
Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS D-72
Atlanta, GA 30333
404-639-4784
eskillen@cdc.gov

Adrienne Smith, PhD
Public Health Advisor, Office on Women’s Health, Office of Public Health and Science, Department of Health and Human Services
200 Independence Ave, SW, Room 733E, Washington, DC 20201
202-690-5884

Philip Smith, MD, MPH
Division Director, Planning, Evaluation and Research,
Indian Health Service
Department of Health and Human Services
801 Thompson Ave.
TMP 450
Rockville, MD 20852
301-443-4700
philip.smith@ihs.gov

Robert Spengler, ScD
Director, Office of Public Health Research, Office of the Chief Science Officer
Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS D-72
Atlanta, GA 30333
404-639-4621
dje9@cdc.gov

Shobha Srinivasan, PhD
Health Disparities Research Coordinator
National Cancer Institute, National Institutes of Health
Department of Health and Human Services
6130 Executive Blvd, 6126
Rockville, MD 20892
301-435-6614
ss688k@nih.gov

Mark Swanson, MD, MPH
Team Leader, Disability and Health Team, National Center on Birth Defects and Developmental Disabilities,
Centers for Disease Control and Prevention
Department of Health and Human Services
1600 Clifton Road NE
MS E-88
Atlanta, GA 30333
404-498-3076
cfu9@cdc.gov

Francisco Sy, MD, DrPH
Chief, Office of Community-Based Participatory Research and Outreach, National Center on Minority Health and Health Disparities, National Institutes of Health
Department of Health and Human Services
6707 Democracy Blvd.
Suite 800
Bethesda, MD 20892
301-496-7074
syf@mail.nih.gov

Steven J. Tingus, MS, C. Philosophy
Director, National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services
Department of Education
400 Maryland Ave., S.W.
Washington, DC 20202
202-245-7549
steve.tingus@ed.gov

Cynthia Waisner, MBA, SPHR
Managing Partner
Catalyst Consulting Partners, LLC
1136 N. Linden Circle
Wichita, KS 67206
877-400-3283
cwaisner@ccpmail.com

Valerie Welsh
Public Health Analyst
Office of Minority Health, Office of Public Health and Science
Department of Health and Human Services
1101 Wootton Parkway
Suite 1000
Rockville MD 20850
240-453-8222
valerie.welsh@hhs.gov

A-3 – FCHDR Road Map

Federal Collaboration for Health Disparities Research
Road Map for Future Collaboration

Proposed Name:
Federal Collaboration on Health Disparities Research (henceforth referred to as FCHDR)

Background:
Health disparities have been documented for more than a century, yet efforts to eliminate them have been unsuccessful in many instances. Healthy People 2010, a comprehensive, national health promotion and disease prevention agenda developed by the U.S. Department of Health and Human Services (HHS), identified eliminating health disparities as a national goal. , In an effort to hasten progress, Centers for Disease Control and Prevention, Office of Public Health Research, Office of the Chief Science Officer and Office of Minority Health, Office of Public Health Science, HHS brought together a wide range of federal partners to explore the complex nature of health disparities and the role research could play in accelerating impact on many of the long standing health disparities. From this initial effort, federal partners are working together to explore need and opportunities for pooling scientific expertise and resources to conduct, translate, and disseminate research most needed to accelerate the elimination of health disparities.

Purpose and Scope:
The purpose of FCHDR is to engage a wide range of federal representatives to identify and support research priorities for cross-agency research collaboration to hasten the elimination of health disparities. Such a coordinated effort can lead to greater improvements in the health of populations disproportionately affected by disease, injury and disability, including, but not limited to, racial and ethnic minorities, women, children, immigrants, rural populations, people with disabilities, and the elderly.

FCHDR is designed to be a highly flexible structure that promotes informal and formal collaboration and partnerships on health disparities research. Although it will focus on specific topic areas, FCHDR recognizes the need to look at the complexity of health disparities in new and different ways. Thus, a systems thinking approach will be utilized. Such an approach will encourage participants to think differently, structure relationships and initiatives differently, and to consider alternative solutions that represent multiple perspectives and needs. Building on the directive included in the P.L. 106-525—Minority Health and Health Disparities Research and Education Act of 2000, FCHDR provides an opportunity to help “ensure that health disparities research is conducted as an integrated and inclusive field of study, rather than as an aggregate of independent research activities occurring in separate research domains”.

Expected outcomes:
Because of the wide ranging and complementary activities occurring at agencies across the federal government, FCHDR will not only focus on specific tangible outcomes (e.g., collaborative funding opportunity announcements) but will also serve as a primary vehicle for uniting initiatives with similar goals across the federal government. In addition to defined activities, such as funding research initiatives, FCHDR will facilitate communication among agencies and government workgroups which will lead to greater understanding of the wide range of missions and strategic activities being conducted. This understanding will lead to greater efficiency and effectiveness when working together to identify strategies to eliminate health disparities. Expected outcomes of FCHDR include:

1. Strengthened coordination and networking across federal departments and participating agencies
2. Development and funding of cross-agency collaborations on research initiatives
3. Increased cross-agency support for existing initiatives
4. Increased production of the evidence-base for use by federal agencies, researchers and other partners
5. Increased awareness across executive branches for the importance of health disparities research
6. Enhanced capacity to address health disparities
7. Enhanced network of internal and external partners that educate and raise awareness of the need for new resources to support research for the elimination of health disparities, and participate in the promotion and diffusion of important research findings

Incentive and commitment to work together:
Federal agencies are facing staffing and funding shortages. FCHDR presents an opportunity for agencies to work more collaboratively to make the most of limited resources. While each agency has its own mission and focus area, an agency participating in FCHDR may have an interest in the same health disparity concern as another participating agency. Making a commitment to work together introduces participating agencies to cross-agency subject matter expertise, a venue to dialogue before planning initiatives, and earlier notification of opportunities to collaborate before initiatives are finalized. By pooling scientific and programmatic expertise and resources across disciplines and organizations to identify, support, and implement common elements of research plans and priorities through joint research initiatives, FCHDR will accelerate the application of remedies more quickly and effectively.

Guiding Principles:
The FCHDR will be guided by seven essential ingredients of successful collaboration :

• Build sustainability
• Consider and understand the mission of partners
• Clearly define expectations and roles
• Encourage each agency to agree to support and contribute to the collaboration
• Keep in mind the purpose and the beneficiaries of the collaboration
• Clearly define the successes and the challenges
• Articulate and document the boundaries (what we are/are not doing)

Membership:
FCHDR membership will be comprised of representatives from each participating federal agency, HDC, ICDR, Offices or Centers for Minority Health, and other federal committees and workgroups as they pertain to the purpose and scope of FCHDR. Federal agencies that have a primary role, research effort, or interest in the elimination of health disparities are invited to participate in FCHDR.

FCHDR Structure:
The Structure of FCHDR includes four components: Co-Lead agencies, Steering Committee, subject matter experts (SME) Workgroups, and staff support. Specific activities and responsibilities for these components of FCHDR are outlined below.

FCDHR Co-Leads:
As the governing bodies of FCHDR, the Health and Human Services Health Disparities Council (HHS Disparities Council) and the Interagency Committee on Disabilities Research (ICDR) will serve as Co-Leads. FCHDR Co-Leads may identify staff to serve on relevant workgroups on their behalf. HDC and ICDR will work jointly with the steering committee to provide overall advice, direction and guidance for FCHDR. It is recommended that Co-leads will:

1. Provide guidance to the Steering Committee on the development of FCHDR mission, activities, infrastructure and governance
2. Encourage and support cross-departmental collaborations and joint activities
3. Promote and represent FCHDR's purpose and activities to leadership within the federal government, other related federal workgroups and committees to which Co-Leads belong, and to external partners
4. Identify and leverage resources for health disparities research
5. Identify and leverage resources to sustain FCHDR

FCDHR Steering Committee:
Membership of FCHDR Steering Committee will be comprised of identified agency champions (division level staff or higher) who are scientific decision makers with knowledge and expertise in health disparities or targeted health disparities focus areas. FCHDR Steering Committee also will include representatives of the HDC, ICDR, HHS Office of Minority Health, Offices or Centers for Minority Health and Health Disparities, and several staff from the organization unit where FCHDR will be managed, currently CDC's Office of Public Health Research (through September 2007). Members of the Steering Committee will support FCHDR in different ways. The lead staff person of the HHS-HDC and ICDR will serve as Co-Chairs of the FCHDR Steering Committee. Decisions on roles and functions of the FCHDR Co-Chairs can be decided once the steering committee is established. The functions, roles of members, and operations of the Steering Committee will be reviewed, revised as needed, and adopted by the Steering Committee once established.

FCHDR Subject Matter Expert (SME) Workgroups
FCHDR SME workgroups will be formed for four to six health disparities priority research topic areas. Currently these include Mental Healthcare, Obesity, Built Environment, and Co-morbidities.

As FCHDR evolves and other priority areas are included, the number of workgroups may increase, and workgroups may complete their work and be dropped or replaced.

Each participating agency will assign one or more staff to serve as working members on the selected topic area workgroup(s) that closely align with its own mission and scope. Workgroup members will have scientific expertise for the selected health disparities area. SME workgroup members will:

1. Encourage and participate in cross-agency collaborations and joint activities that are relevant to the member's agency and the selected topic area
2. Promote exchange of information among participating agencies and offices
3. Work to ensure inclusion and implementation of related health disparities research in their respective organization's work
4. Educate others and promote awareness of FCHDR among internal and external partners
5. Represent FCHDR's purpose and activities to leadership within their agency, other workgroups and committees to which members belong, and external partners

FCDHR Steering Committee Work Process and Activities
Once established, FCDHR Steering Committee will undertake the following activities:

1. Meeting 1
   • Confirm membership and group norms
   • Confirm the work plan and decision making process
   • Confirm meeting frequency and times
   • Define the organization and deliverables for the SME workgroups
   • Begin work
2. All subsequent meetings
   • Establish and adjust priority areas (decide process for how priorities are evaluated)
   • Provide guidance to FCHDR SME workgroups on research planning and other activities, while working in partnership with the HDC, ICDR, and FCHDR workgroups
   • Explore the complexity of health disparities elimination to identify new or improved solutions (e.g., new and innovative breakthrough strategies, tailoring strategies to better address social and environmental determinants)
   • Review and track research activities across agencies
   • Identify opportunities for further collaboration
   • Define and resolve issues
3. Provide information and updates on FCHDR at key meetings and conferences
4. Write and publish joint articles and reports in journals and other print media, and on the Web
5. Review and provide feedback on reports to agencies and department heads

FCDHR Steering Committee Decision-Making Process: Five-Finger Consensus
The FCDHR Steering Committee will use five-finger consensus as its major decision process. Five-finger consensus is designed to encourage significant agreement without jeopardizing the quality of the solution. Five-finger consensus encourages a group to listen carefully when there is disagreement; and, in fact, encourages listening carefully twice if necessary. But the technique does not allow a solution to be watered down because a few disagree. Although there may be one or two individuals who do not like a proposal, five-finger consensus can help ensure that all are heard and heard well.

Five-finger consensus works in the following way. Once a proposal is proposed and discussed, and a group is ready to check for agreement, the steering committee meeting leader explains that on the count of three, each person should hold up between one and five fingers indicating the level of support for the recommendation on the table. 5 – Strongly agree 4 – Agree 3 – Can see pluses and minuses, but willing to go along with the group 2 – Disagree 1 – Strongly disagree and can't support

If everyone shows five, four or three fingers, consensus has been reached, and the group can move ahead. If there are any ones or twos, those who indicate such are given the opportunity to explain to the rest of the group why they gave the rating and make recommendations to change the proposal in order to make it acceptable to them. The originator of the proposal has the option to make the change or leave the option as it is and explains the decision to the rest of the group.

The meeting leader tests five-finger consensus again. If everyone shows five, four, three or two fingers, the decision is made, and the group can move ahead. If there are any ones, those who indicate such are given the opportunity to explain to the rest of the group why they gave the rating and make recommendations to change the alternative in order to make it acceptable to them. Once more, the originator of the proposal has the option to make the change or leave the option as it is and explains the decision to the rest of the group. In the final review, the majority will rule. The decision is made based on the majority of the participants.

FCHDR Staff Support:
Staff will be needed to carry out the work process and activities of the FCHDR with guidance and direction set by FCHDR Co-Leads. Staff support for FCHDR Co-leads, Steering Committee and SME workgroups will help ensure sustainability of this effort. Staffing needs and plans will be discussed at the June 14 meeting.

External Partner Engagement:
Once the Steering Committee is established and the governance structure is determined, nonfederal representatives may be convened for scientific input on priorities and to facilitate the dissemination of findings. The external partner groups from which to select include: researchers, state and local health departments, professional associations, universities, non-governmental organizations, business and worker organizations, community groups, American Indian and Alaska Native governments, tribal leaders and organizations, and the public-at-large. Any official advice sought from the private sector will be consistent with Federal Advisory Committee Act requirements.

Operations and other issues that need to be addressed:
Meeting schedules, communications, and other operational activities will need to be addressed during the planning meeting for the steering committee, currently scheduled for June 14, 2007. Ownership, accountability and commitments will also need to be further explored at that time.