PURPOSE OF THE NEEDS ASSESSMENT

The U.S. health care system has seen major changes over the last decade and has become increasingly complex. Resultantly, innovative policy, programmatic and service approaches will be essential to assure that there are adequate services and well-trained service providers available to meet the needs of the maternal and child health (MCH) population. In order to address the training needs brought about by these changes, the Maternal and Child Health Bureau (MCHB), HRSA, DHHS, currently allocates approximately $35.8 million annually to support training in a variety of areas relevant to the educational needs of professionals responsible for the MCH population in the United States. Graduate education (GE) programs receiving funding from MCHB support both uni-disciplinary and interdisciplinary studies in academic, clinical, and public health practice areas. In addition to conference-based training sessions, short-term continuing education (CE) efforts supported from MCHB include distance-learning and technology-based courses.

The Maternal and Child Health Bureau, supporting its strategic plan related to long-term graduate and short-term continuing education of the MCH workforce, asked the MCH Leadership Skills Training Institute (MCH-LSTI) to conduct a national assessment of graduate and continuing education needs. The purpose of this assessment was to provide current and critically needed information to help guide future strategic decisions regarding MCHB training initiatives. In an attempt to assure input from agencies and organizations focusing on MCH populations, information compiled for this needs assessment included responses to questions regarding the importance of and need for supporting training in specific skill and content areas and the preferred modalities for training. A copy of the needs assessment data collection form used for this project is provided in Appendix A.

METHODS

With the guidance of MCHB, the MCH-LSTI assembled an Advisory Committee for the project and organized a meeting of the committee in December of 1999. The Advisory Committee was convened to guide the project in:

1. Determining the target audience(s) for MCH continuing and long-term graduate education and, by extension, this assessment of those needs;

2. Planning for and developing needs assessment forms designed to assess the MCH continuing and long-term graduate education needs of each target audience;

3. Assessing current MCH-related CE and GE efforts;

4. Interpreting the results of the surveys; and,

5. Developing recommendations for a strategic plan for continuing and long-term graduate education in MCH.

In addition to MCHB representatives, the committee included representatives of public and private agencies, organizations and professional disciplines involved in MCH-related activities at the local, state and national levels, e.g., AMCHP, NCEMCH, ATMCH, MOD, local and state public health departments, NACCHO, CityMatCH, etc. Representation also reflected managed care and other health care plan organizations, health care providers, advocacy groups, special education, day care and families/consumers of MCH services. The agenda for the Advisory Committee meeting and a list of committee members are provided in Appendices B and C.

After reviewing alternatives, the Advisory Committee concluded that soliciting information directly from the wide range of professional specialty groups involved in MCH-related agencies was not feasible, given the resources available to this project. Instead, it was decided that the needs assessment should focus on soliciting information from the major employers of MCH professionals, rather than soliciting information directly from the individual professionals themselves. Therefore, the main target of this needs assessment was the directors of state MCH and CSHCN agencies and the MCH-related program directors of Medicaid programs and local public health departments. Input from state March of Dimes agencies was also seen as desirable in order to better understand the training needs of private, non-profit MCH-related organizations. Once the information from the above groups has been compiled and analyzed, Children’s Hospitals and managed care organizations are also seen as possible future target respondents for any subsequent phase of this needs assessment.

During the early months of 2000, further input toward the development of the needs assessment form and methodology was obtained through the conduct of telephone interviews with MCH experts, who were identified by the Advisory Committee. Once the needs assessment methodology was approved in the early Spring 2000, work started on the development of the needs assessment form. In order to allow for temporal comparisons, a decided effort was made to include questions contained in a previous MCH training needs assessment survey form used by the Association of MCH Programs’ Committee on Professional Education and Staff Development in 1992. A copy of their report on continuing and long-term graduate education needs, entitled "Meeting Needs - Building Capacities: State Perspectives on Graduate Training and Continuing Education Needs of Title V Programs, is provided in Appendix D.

The draft needs assessment forms were distributed for comment in the Spring of 2000 and finalized for use in May 2000. The distribution of the needs assessment forms was delayed until Summer 2000, in recognition of the pressing deadlines and workload faced by states related to their MCH Block Grant applications. The needs assessment forms were sent to the following MCH-related agencies:

While the HRSA Regional Offices and March of Dimes key informants were included in our information-gathering phase, the data collected from these groups are not included in this report, as the responses were not seen to necessarily be representative of their respective organizations or agencies. Therefore, all results presented in this reflect the following four respondent categories: local health departments and State MCH, CSHCN and Medicaid agencies. A twenty percent random sample of all local health departments (Local) was selected by NACCHO, who then provided MCH-LSTI with contact information for each local health department contained in the sample. The State MCH and CSHCN contact information was obtained from the AMCHP membership list. HRSA Regional Office contact information was provided by MCHB. The national office of the March of Dimes identified several key informants at the state level. These key informants were sent the needs assessments forms by their national office, which collected the responses and then provided them to MCH-LSTI.

Each individual needs assessment form was marked with a unique identifier, with the numbers grouped according to agency type. All needs assessment forms were mailed in August 2000. In order to increase the response rate, State MCH, CSHCN and Medicaid agencies received follow-up calls after 6 and 10 weeks.

STUDY LIMITATIONS

As will be indicated in the following Results section, the response rate from Local health department agencies was low (24%) and represents a major limitation to this study. Although the response rate is not atypical of mailed surveys and would be difficult to increase without a substantial investment, the Local respondents may not be representative of local health departments in general.

The data provided in the next section will also reveal that the response rate for the State MCH agencies was the highest among the agency types. After taking into account the predominance of missing responses from territorial offices, the MCH agency response rate probably does reflect a close representation of MCH agencies in general. The response for State CSHCN agencies was lower than that of MCH agencies and was more variable across the regions. Regions III, IV and IX were conspicuous in their low response and generalizing these results to those regions should be undertaken with due caution. Similarly, lower response rates from Medicaid offices in Regions VIII, IX, and X limits generalizability to those regions.

RESULTS