Title V Needs Assessment Methods

 
 
 
 
 
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What you need to know

The overarching goal of Nebraska's MCH/CSHCN Needs Assessment is to produce a list of well documented priorities that will guide the work of the Title V Block Grant, DHHS, and its stakeholders over the next five years.

DHHS had two desired goals in conducting the stakeholder portion of the MCH/CSHCN needs assessment:

A) To conduct an objective process by utilizing rigorous public health methods and relying on data and evidence for decision-making whenever possible. 
B) To empower stakeholders to determine and commit to a list of ten priorities.

In 2004, Nebraska began to  utilize the planning methodology described by the Family Health Outcome Project (FHOP), University of California, San Francisco in “Developing an Effective MCH Planning Process: A Guide for Local MCH Programs" (September 2003). The FHOP process is adapted from assessment methods developed by the University of North Carolina School of Public Health as outlined in HRSA/MCHB's commissioned “Assessment of Health Status Problems" (1996, revised 2001), evaluation methods from University of Chicago Illinois School of Public Health, and logic model methods developed by the University of Wisconsin Extension. 

The FHOP planning methodology results in an ongoing process of assessment, strategic planning, implementing/monitoring and evaluation that has had a strong impact on Nebraska's Title V direction (short, medium and long term goals), resource/staff allocation, program development and activities, as well as performance measurement and accountability. 

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The following figure outlines the planning cycle that is followed:

Title V Assessment and Planning Cycle 


The Needs Assessment was conducted by the MCH Epidemiology Program, Lifespan Health Services Unit (LSHU), Division of Public Health, Nebraska Department of Health and Human Services.  The assessment process was began in July 2014. The stakeholder process was conducted between the October, 2014 Kick-off meeting and the May, 2015 Prioritization meeting.  In between the two meetings the stakeholder committee broke into the following five subcommittees: Woman of Childbearing Age, Infants, Children (1-9), Youth (10-19), and Children with Special Health Care Needs.  

 

The Process

The following describes the flow of the process and is followed by detailed description of each step:

Data Collection and Analysis

In July 2014 Nebraska employed a Needs Assessment Intern to assist with the collection and management of data. The data process began with a comprehensive review indicators relevant to Nebraska's MCH/CSHCN populations. The complete indicator list totaled 218 indicators plus demographics for five population groups.  Once the indicator list was established data were collected and formatted in the following forms (when available):

  • For years 2008-current (in most cases 2013);
  • By race/ethnicity and geography;
  • National rates
  • Healthy People 2020 objectives

A data factsheet was created for each indicator, showing (as available) time trends and significance, comparisons to national data and HP2020 goals, and disparities across sub-populations.

Stakeholder Process Kick-Off

The stakeholder process kick-off occurred on October 23, 2014 in Lincoln, NE with 86 participants. The process began with an orientation to the Title V Block Grant, the planning process and purpose of the Needs Assessment, as well as an introduction to the priority setting process specifically the development of criteria. The five population groups to be assessed were introduced and were able to self-select and meet with their sub-committee prior to the end of the day.

Stakeholders Develops Criteria

The stakeholders developed criteria to prioritize health problems/needs of Nebraska's MCH/CSHCN population through a facilitated process.  These criteria were developed to objectively assess the health problems/needs, such that the group could determine if a given problem was more or less important compared to other problems.  The criteria are the direct means of determining the list of 10 priorities and as such the selection of criteria prior to discussion of specific health problems is an essential element to the process.

The discussion generated during the criteria development workshop was meant to stimulate critical thinking about the stakeholder's values as a community.  The group was given time to thoroughly discuss the proposed criteria and assure each member had a common understanding of each criterion. At the end of the discussion the group voted and selected the following five criterion:

  1. The Problem is Worse than the Benchmark or Increasing 
  2. Disparities Exist Related to Health Outcomes 
  3. Strategies Exist to Address the Problem/An Effective Intervention is Available
  4. Societal Capacity to Address the Problem
  5. Severity of Consequences

Stakeholders Determine Weights for Each Criterion

Not all of the criteria developed are of equal importance; each was weighted using a points system.  For example, using a scale of 1 to 3, a criterion is given a weight of “1" if it is considered important but not as important as other criteria, “2" if more important than some criteria but not as important as other criteria and a “3" if of very great importance.  The weighted score for each criterion was agreed upon and determined by voting. The following criteria and weighting was developed:

  1. The Problem is Worse than the Benchmark or Increasing (Weight = 1)
  2. Disparities Exist Related to Health Outcomes (Weight = 1)
  3. Strategies Exist to Address the Problem/Effective Intervention is Available (Weight = 3)
  4. Societal Capacity to Address the Problem (Weight = 2)
  5. Severity of Consequences (Weight = 2)

Staff Finalizes Definitions and Develops Rating Scales for Criteria

Staff drafted expanded definitions for the five selected criteria and developed a rating scale particular to each criterion.  A rating scale is a way to assure that each participant is using the same, agreed upon definitions for scoring.  The rating system was used to capture the degree to which a problem met a criterion on a 5-point scale.  The following is an example:

Severity of Consequences

Definition: This means that the problem identified could result in severe disability or death. Even though some health indicators may have improved due to effective interventions, these interventions must be sustained to avoid severe negative outcomes. An example of this would be the importance of sustaining an effective immunization program to avoid the reemergence of vaccine-preventable diseases.

Criterion Weight:  2

Rating Scale: 

1= Problem is not life threatening or disabling to individuals or community
2= Problem is not life threatening but is sometimes disabling
3= Problem can be moderately life threatening or disabling
4= Problem can be moderately life threatening and there is also a strong likelihood of disability
5= Problem has a high likelihood of death or disability

Full list of Criteria

Subcommittee Meeting 1:  Provide Orientation, and Present Data

There were five stakeholders who volunteered to chair a subcommittee (women, infants, children, youth, and CYSHCN), the chairs were supported by 7 staff members who provided for meeting logistics, communication and organization.  During the first meeting the Needs Assessment Coordinator provided an orientation to the sub-committee scope of work/tasks to complete, reviewed and sought approval of the draft criteria definitions and rating scales, and presented the data factsheets and identified requests for additional data.

Subcommittee Meeting 2: Review Data, Identify List of Needs, and Determine Top 3-5 Needs per Population Group

During the second subcommittee meetings the members reviewed additional data, identified a preliminary list of issues, and utilized the criteria to narrow their list to three -five issues to propose to the larger group. There were a total of 22 issues identified across the five subcommittees.

Subcommittee Meeting 3: Write Problem Statements, Draft Issue Briefs, and Determine Presenters

Between the second and third/final subcommittee meeting the members wrote problem statements for their chosen indicators, began to draft issue briefs.  The issue briefs contained a problem statement and detailed information addressing each of the five criteria, the averaged three pages in length. The subcommittees spent their third meetings reviewing/editing the issue briefs and began to plan their presentation. 

Presentation of Identified Problems by Subcommittees to the Entire Stakeholder Group

After the third subcommittee meeting the issue briefs were finalized and published to the DHHS website. A total of 22 Issue Briefs were developed.  Each stakeholder attending the final meeting were asked to read the briefs prior to the meeting. At the final meeting the subcommittees presented their findings and made their case to the larger group.

Use Weighted Criteria to Score Problems

Following the presentations and prior to voting five issues (Overweight/obesity in women, children, and youth and Sexually transmitted diseases among youth and women) were combined to make two, reducing the number of issues from 22 to 19. Stakeholders scored each of the 19 problems individually utilizing the rating scales of weighted criteria.  Staff provided a copy of the prioritization tool (scoring sheet) and instructed participants in the use of this tool illustrating with an example and answering questions.

Sum Participant Scores/Rank Problems

The results of the individual scoring of each problem were validated by staff and entered in a summary table that showed the sum total of the weighted individual scores and the rank order of each problem.  The total scores were ranked from the highest, priority 1, to the lowest (19).  Results of the ranking were then presented to the group. 

Discuss and Confirm Ranked Results

After review of the scores and ranking the stakeholders discussed and at their tables then documented their comments and suggestions to DHHS.

Finalize List of 10 Priorities

Following the final meeting staff analyzed and refined the recommendations then presented to the leadership within DHHS for final approval. Once approved the list was disseminated to back to the participants through e-mail the and published for public input on the DHHS website.