| IV.
Concluding thoughts about the technical
assistance process through leadership
workshops
We believe these workshops had an impact
in creating dialogue and a stronger working
relationship between Title V programs
and their counterparts in State-financed
health care
delivery programs. The availability of
the TA provided through MCTAC served as
a critical
catalyst for dialogue in each of the States
– dialogue that clearly would not
have happened
without external facilitation. The measure
of success, in part, is that MCH leaders
in four out of
five states used their workshops as a
springboard to continued action and policy
development.
While all the relationships among the
public and private players in maternal
and child health
programs were improved as a result of
the workshop, these five States began
with varying
“baselines” in terms of the
level of the MCH-Medicaid-SCHIP collaborations.
While each
workshop identified a “follow up”
agenda, some States could have benefited
from further
“nurturing” of the collaborative
relationship than a 1 or 1.5-day workshop
format would permit.
Based on our experience with the five
States we visited for technical assistance,
we have
identified several elements of the process
that are potential predictors of success
for this kind of
technical assistance effort. We suggest
they become the basis for determining
either “eligibility”
for technical assistance workshops of
this kind and/or the level of effort that
might be a
requirement for such an intervention to
be most successful. These elements are:
-
States must express interest (i.e.,
volunteer) for a technical assistance
workshop.
-
A State must have its own “catalyzer”
who has the authority and/or credibility
to bring the
relevant players to the table. External
facilitation is necessary, but not sufficient,
as a
catalyst. The catalyzer can be from
within one of the government programs
or can be a
leader from one of the community organizations
working with State government on MCH
issues.
-
A State must meet a “threshold”
test of being able to organize a planning
committee for the
workshop that is reflective of all of
the key constituencies concerned with
financing maternal
and child health services in the State.
This is both a test of the seriousness
of the players and
a measure of the State’s ability
to follow up on the recommendations
or conclusions of the
workshop without further external facilitation.
-
From beginning to end, the workshop
must be designed around finding “common
ground”
among the participants. If any participants
perceive the workshops as attempts to
hold a
particular player accountable, the motivation
for the workshop will be questioned
and frank
and full participation will be limited.
The more successful workshops avoided
this pitfall,
and thus more creative avenues for follow
up could be identified.
-
To maximize benefit, the workshops must
be tailored to the needs of the individual
State.
While the Little Rock experiment in
2001 was successful in creating a common
baseline of
information for the participating States,
focusing on key issues that were on
the agendas of
some if not all of the players in a
State increased interest and active
participation by a
broader range of participants. As Table
3 (above) shows, there was great overlap
among the
States regarding the content of the
workshops. However, the particular motivating
factors
that caused States to request workshops
ranged from pay-for-performance in Kansas
to child
welfare issues in Wisconsin.
-
To maximize participation by higher-level
officials, workshops must be held in
State. This
not only solves barriers created by
restrictions on out-of-State travel,
it also increases the
likelihood that higher-level officials
will participate in at least part of
the workshop. In
almost every State, we had senior officials
(e.g., Governor’s office, legislature,
program
directors) participating. Their presence
(often for the entire workshop) conveyed
seriousness
of purpose to those who would be responsible
for follow up.
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