Maternal and Child Health Leadership Skills Development Series

1. Maternal and Child HealthLeadership Skills Development Series www.jhsph.edu/wchpc/mchlds Women�s and Children�s Health Policy Center Department of Population, Family and Reproductive Health

2. Leadership skills training modules that are: This series is being developed with funding from the Maternal and Child Health Bureau�s MCH Training Grant to JHBSPH. It�s offered free of charge over the web. It�s entirely web-based --- doesn�t mean that it�s a tool used entirely online, as an exercise between you and your computer. Rather, all of its components are available on the web, inlcuding a mix of resources that are used online, like streaming video, or downloaded for use on paper and in discussions. As the name suggests, it�s geared toward the MCH context and for practitioners and trainees working the MCH field. It�s self-directed, meaning that this isn�t a course you sign up for and take; it�s a set of resources you can use in the setting and time frame of your choice, It�s best used in a group, although there are components that lend themselves to individual study as well. Would like presentation to be very informal -- feel free to interrupt with questions or comments, and I�ll be asking some questions later that will hopefully lead to some group discussion.This series is being developed with funding from the Maternal and Child Health Bureau�s MCH Training Grant to JHBSPH. It�s offered free of charge over the web. It�s entirely web-based --- doesn�t mean that it�s a tool used entirely online, as an exercise between you and your computer. Rather, all of its components are available on the web, inlcuding a mix of resources that are used online, like streaming video, or downloaded for use on paper and in discussions. As the name suggests, it�s geared toward the MCH context and for practitioners and trainees working the MCH field. It�s self-directed, meaning that this isn�t a course you sign up for and take; it�s a set of resources you can use in the setting and time frame of your choice, It�s best used in a group, although there are components that lend themselves to individual study as well. Would like presentation to be very informal -- feel free to interrupt with questions or comments, and I�ll be asking some questions later that will hopefully lead to some group discussion.

3. Why another leadership training resource? Barriers to accessing or providing leadership training Application of general leadership principles to the maternal and child health context Recognition of the need to �groom� the next generation of public health leaders Leadership requires life-long learning Ask how many people have participated in a leadership training activity, either in their workplace or off-site. Ask group for examples of barriers to providing or accessing leadership training Barriers to providing or accessing leadership training Organizational culture that is not supportive of professional development Quote from an email I received a few days ago from an employee of an urban health department: �The environment where I work is generally not conducive to development and growth. I am more interested in your leadership program for myself and how I can use it to promote these ideas as an example. I feel a little bad and sad that I have little motivation to present your program as beneficial with the decision making individuals and structure here. Support would be little to none, or token support that writes up very nicely, with little application. I do see personal and professional benefit that could be applied to my current and future endeavors.� Limited resources--both cost and time can be barriers just keeping up with day to day work responsibilities can be draining, leaving little energy left for professional development. Can be expensive to hire facilitators or to send staff to leadership programs off site. Maybe your agency does send staff but only a handful can go Application of general leadership principles to the maternal and child health context Recognition of the need to �groom� the next generation of public health leaders Hoping to reach �deeper� into an organization to offer leadership training to greater numbers of people To bring colleagues together to create new energy and new ways of working together toward common goals Leadership requires life-long learning concept of leadership as a process of growth and learning; makes sense that it�s not a one-shot approach. May need �booster shots� throughout your career.Ask how many people have participated in a leadership training activity, either in their workplace or off-site. Ask group for examples of barriers to providing or accessing leadership training Barriers to providing or accessing leadership training Organizational culture that is not supportive of professional development Quote from an email I received a few days ago from an employee of an urban health department: �The environment where I work is generally not conducive to development and growth. I am more interested in your leadership program for myself and how I can use it to promote these ideas as an example. I feel a little bad and sad that I have little motivation to present your program as beneficial with the decision making individuals and structure here. Support would be little to none, or token support that writes up very nicely, with little application. I do see personal and professional benefit that could be applied to my current and future endeavors.� Limited resources--both cost and time can be barriers just keeping up with day to day work responsibilities can be draining, leaving little energy left for professional development. Can be expensive to hire facilitators or to send staff to leadership programs off site. Maybe your agency does send staff but only a handful can go Application of general leadership principles to the maternal and child health context Recognition of the need to �groom� the next generation of public health leaders Hoping to reach �deeper� into an organization to offer leadership training to greater numbers of people To bring colleagues together to create new energy and new ways of working together toward common goals Leadership requires life-long learning concept of leadership as a process of growth and learning; makes sense that it�s not a one-shot approach. May need �booster shots� throughout your career.

4. Guiding Principles We all have the capacity to exhibit leadership, no matter where we �sit� in the organizational hierarchy. Leadership is an evolving lifelong process, not a static state of being.

5. Modular Format Module 1: Tapping Into Your Leadership Potential Module 2: Creating Clarity and Shared Vision Module 3: Building and Supporting Teams Module 4: Managing Conflict Effectively Module 5: Organizational Change (late 2008) Module 6: Mentoring and Developing People (spring/summer 2009)

6. Relationship to MCH Leadership Competencies How many people are familiar with the MCH Leadership Competencies? How do you think you will/can use the competencies in your work? MCH Leadership Competencies are embedded in the MCHLDS modules. This crosswalk showing how they relate is somewhat subjective; if you looked at the details of each competency area and the content of the modules, you might come up with additional/different check marks. How many people are familiar with the MCH Leadership Competencies? How do you think you will/can use the competencies in your work? MCH Leadership Competencies are embedded in the MCHLDS modules. This crosswalk showing how they relate is somewhat subjective; if you looked at the details of each competency area and the content of the modules, you might come up with additional/different check marks.

7. Components Video lecture Discussion questions Group exercises Case study Interviews with MCH leaders Individual self-assessment Individual planning worksheet

9. Most of the registrants are from local or state health agencies--in about equal #s Others are from agencies other than health departments, medical centers or clinics, universities, nongovernmental agencies, and federal agenciesMost of the registrants are from local or state health agencies--in about equal #s Others are from agencies other than health departments, medical centers or clinics, universities, nongovernmental agencies, and federal agencies

11. Module 1 Mini-Lecture 15 minute video What are some barriers to leadership--either external or internal?What are some barriers to leadership--either external or internal?

12. Tackling Childhood Obesity:A Case Study in MCH Leadership Learning Objectives: Break a complex task into steps and identify barriers to change. Understand how the process may affect the results. Apply leadership principles in a collaborative group process, by: using data strategically, addressing the context for collaboration, creating energy around a shared vision, maintaining momentum toward change, articulating the framework and strategies for change to policy and funding decision makers. The following case is designed to help practicing professionals and trainees in public maternal and child health (MCH) efforts think strategically about how to address difficult issues related to leadership, developing a shared vision, and shaping and supporting teams. The case study centers on the issue of childhood obesity, a high-profile public health issue, but one that does not lend itself to straightforward approaches or answers. Moreover, designing comprehensive approaches to combating childhood obesity requires public health systems to integrate their efforts with other systems that may have different organizational cultures, protocols, and perspectives. Background: State must respond to an RFP for a grant to fund a collaborative childhood obesity prevention initiative As often happens in the real working world, the protagonist of this case study, Gloria Browning, must step in after the fact�in this case, a disastrous first meeting�and try to understand and reconcile diverse opinions, approaches and territories. Although the reasons for the failure of the first meeting are relatively clear, the steps necessary to make the second meeting productive and successful are less so. Gloria must decide how to lead the team and make strategic decisions. She must decide what she needs to do and what tasks she should assign to others, so that all the team members have ownership of the final approach, even if it is not the one they would have initially taken. Gloria must also decide how to use the data from her program, the data available from other team members, and the data she needs to collect from this project to her best advantage in order to develop a shared strategic vision. Gloria will need to carefully consider her approach to engaging members of the group, including the language she uses to frame the tasks before them. She will have to be strategic and realistic in determining how to assess the team�s progress. The First Meeting Dr. Helen Fielding, the retiring section Director, planned and led the initial planning meeting two weeks ago. As incoming Section Director, Gloria Browning attended but did not help plan the hastily and loosely formed agenda. The goal of the meeting was to agree on a basic strategy to address childhood obesity in the state. Unfortunately, the invitations were sent out only 8 days ahead of time, and participants did not receive an agenda until they attended the meeting. The agenda itself included only four items: 1) introductions of participants, 2) description of the grant requirements, 3) discussion of the problem, and 4) next steps. Due to the last minute notice, the Education Department was able only to send the Commissioner�s deputy, Sandra Ivey; the Section Chief for Child Nutrition Services, Suzanne Childs, was participating in long-planned site visits with regional staff. Luckily, Superintendent Ray Johnson, invited by the Education Department, was able to attend at the last minute. Other participants included State AAP Chapter Chair Bill Lyons, Anna Alva, Director of Child Nutrition Services in the Health Department, Sharon Cresser with the State PTA, and Mary Owens from the University. Donald Harris, Chair of the State School Boards, was unable to attend. After initial introductions and a brief discussion of the grant requirements and deadlines, Mary Owens made a brief presentation on the problem of obesity, using adult data. After the presentation, AAP Chair Bill Lyons decried the lack of evidence-based practices for tackling childhood obesity, leading to an unproductive discussion about both the causes of childhood obesity (parental behavior, TV and video games, reduction in physical activity, school lunches and vending machines, the fast food industry, media messages) and strategies to address the issue. Lyons raised State PTA President Sharon Cresser�s ire when he said that �weight control is the parent�s, not the pediatrician�s, responsibility� and that he doesn�t see a role for doctors beyond noting BMI during well-child visits. Anna Alva acknowledged the problems but said she cannot commit her nutritionists to more time beyond the WIC program. Dr. Fielding insisted that stricter nutritional standards for school and more physical education time are the best solutions. Fielding blamed the Education Department for not funding school breakfast programs throughout the state, angering Sandra Ivey, who was skeptical about how $100,000 spread across the state could allow schools to do much of anything. Central City Superintendent Ray Johnson said schools simply don�t have the energy or the facilities to add yet another program. Because of the lack of time to prepare for the meeting, neither the Health Department nor the Education Department had a sense of what is currently going on in the state or if any model programs already exist. The meeting ran one hour over schedule and concluded with a whimper as the various participants begged off for other appointments and gave only lukewarm commitments to attend another meeting. What Next? Shortly after Gloria returned to her office, she received a call from Sandra Ivey, who threatened to pull out of the collaboration. Ivey said she felt blind-sided by the meeting, which �appeared to be simply an opportunity to make it look like educators don�t care about children�s health.� Gloria apologized to Sandra and insisted that the next meeting would be better. After hanging up, Gloria put her head in her hands and tried to brainstorm about her next steps. The next meeting is slated to take place in a month, which only leaves about three weeks after that to write and submit the application and gather letters of support. Participants must agree on an approach at this next meeting if the state wants to pursue the funding, which the Governor is insisting they do. Gloria Browning�s leadership�and job�are on the line. Module 1 exercise: Draft a memo or letter setting the stage for the second meeting of this initiative and inviting participants to collaborate. As you draft the memo, consider the following questions: ? Who was missing from the first meeting? Are there key stakeholders who should be brought in now? ? How can you persuade the participants that they will benefit from participation in the collaboration (e.g. help them understand ?what?s in it for them?)? ? How can you encourage invitees to think about the strengths and resources that they can bring to the table? ? What specific phone calls need to be made, in addition to the memo? ? Are there specific ways you can engage key participants prior to the meeting (e.g. asking them to gather or analyze specific data that will be used in the meeting)? Module 2 exercise: Role play the second meeting as the group develops a shared vision. Assign group members different roles (e.g. nutrition, education, public health). After the role play, answer the following questions: ? What struck you about this process? ? How was it similar or dissimilar to your own professional experiences? Would this process succeed in your own work setting? ? What leadership skills did you (or would you, in real life) draw on? ? What will need to happen in order to make progress toward the vision or to meet expectations about results? ? What do you think will happen now? Module 3 exercise: Draft an agenda and general plan for the second meeting. Include an outline of the data, information, and materials that will be provided in advance or during the meeting, and how they will be used. Create a plan for organizing participants to get the work done (e.g., team member tasks and roles, timelines, team structures). As you plan for the meeting, answer the following questions: ? What are the specific challenges you will face in creating an effective working environment for this group? ? What are some strategies that can be applied? ? What specific outcomes should be expected from this meeting? What kind of follow up will be required to move the proposal forward? ? Where do you expect to face the greatest resistance? How can you overcome this resistance? ?The following case is designed to help practicing professionals and trainees in public maternal and child health (MCH) efforts think strategically about how to address difficult issues related to leadership, developing a shared vision, and shaping and supporting teams. The case study centers on the issue of childhood obesity, a high-profile public health issue, but one that does not lend itself to straightforward approaches or answers. Moreover, designing comprehensive approaches to combating childhood obesity requires public health systems to integrate their efforts with other systems that may have different organizational cultures, protocols, and perspectives. Background: State must respond to an RFP for a grant to fund a collaborative childhood obesity prevention initiative As often happens in the real working world, the protagonist of this case study, Gloria Browning, must step in after the fact�in this case, a disastrous first meeting�and try to understand and reconcile diverse opinions, approaches and territories. Although the reasons for the failure of the first meeting are relatively clear, the steps necessary to make the second meeting productive and successful are less so. Gloria must decide how to lead the team and make strategic decisions. She must decide what she needs to do and what tasks she should assign to others, so that all the team members have ownership of the final approach, even if it is not the one they would have initially taken. Gloria must also decide how to use the data from her program, the data available from other team members, and the data she needs to collect from this project to her best advantage in order to develop a shared strategic vision. Gloria will need to carefully consider her approach to engaging members of the group, including the language she uses to frame the tasks before them. She will have to be strategic and realistic in determining how to assess the team�s progress. The First Meeting Dr. Helen Fielding, the retiring section Director, planned and led the initial planning meeting two weeks ago. As incoming Section Director, Gloria Browning attended but did not help plan the hastily and loosely formed agenda. The goal of the meeting was to agree on a basic strategy to address childhood obesity in the state. Unfortunately, the invitations were sent out only 8 days ahead of time, and participants did not receive an agenda until they attended the meeting. The agenda itself included only four items: 1) introductions of participants, 2) description of the grant requirements, 3) discussion of the problem, and 4) next steps. Due to the last minute notice, the Education Department was able only to send the Commissioner�s deputy, Sandra Ivey; the Section Chief for Child Nutrition Services, Suzanne Childs, was participating in long-planned site visits with regional staff. Luckily, Superintendent Ray Johnson, invited by the Education Department, was able to attend at the last minute. Other participants included State AAP Chapter Chair Bill Lyons, Anna Alva, Director of Child Nutrition Services in the Health Department, Sharon Cresser with the State PTA, and Mary Owens from the University. Donald Harris, Chair of the State School Boards, was unable to attend. After initial introductions and a brief discussion of the grant requirements and deadlines, Mary Owens made a brief presentation on the problem of obesity, using adult data. After the presentation, AAP Chair Bill Lyons decried the lack of evidence-based practices for tackling childhood obesity, leading to an unproductive discussion about both the causes of childhood obesity (parental behavior, TV and video games, reduction in physical activity, school lunches and vending machines, the fast food industry, media messages) and strategies to address the issue. Lyons raised State PTA President Sharon Cresser�s ire when he said that �weight control is the parent�s, not the pediatrician�s, responsibility� and that he doesn�t see a role for doctors beyond noting BMI during well-child visits. Anna Alva acknowledged the problems but said she cannot commit her nutritionists to more time beyond the WIC program. Dr. Fielding insisted that stricter nutritional standards for school and more physical education time are the best solutions. Fielding blamed the Education Department for not funding school breakfast programs throughout the state, angering Sandra Ivey, who was skeptical about how $100,000 spread across the state could allow schools to do much of anything. Central City Superintendent Ray Johnson said schools simply don�t have the energy or the facilities to add yet another program. Because of the lack of time to prepare for the meeting, neither the Health Department nor the Education Department had a sense of what is currently going on in the state or if any model programs already exist. The meeting ran one hour over schedule and concluded with a whimper as the various participants begged off for other appointments and gave only lukewarm commitments to attend another meeting. What Next? Shortly after Gloria returned to her office, she received a call from Sandra Ivey, who threatened to pull out of the collaboration. Ivey said she felt blind-sided by the meeting, which �appeared to be simply an opportunity to make it look like educators don�t care about children�s health.� Gloria apologized to Sandra and insisted that the next meeting would be better. After hanging up, Gloria put her head in her hands and tried to brainstorm about her next steps. The next meeting is slated to take place in a month, which only leaves about three weeks after that to write and submit the application and gather letters of support. Participants must agree on an approach at this next meeting if the state wants to pursue the funding, which the Governor is insisting they do. Gloria Browning�s leadership�and job�are on the line. Module 1 exercise: Draft a memo or letter setting the stage for the second meeting of this initiative and inviting participants to collaborate. As you draft the memo, consider the following questions: ? Who was missing from the first meeting? Are there key stakeholders who should be brought in now? ? How can you persuade the participants that they will benefit from participation in the collaboration (e.g. help them understand ?what?s in it for them?)? ? How can you encourage invitees to think about the strengths and resources that they can bring to the table? ? What specific phone calls need to be made, in addition to the memo? ? Are there specific ways you can engage key participants prior to the meeting (e.g. asking them to gather or analyze specific data that will be used in the meeting)? Module 2 exercise: Role play the second meeting as the group develops a shared vision. Assign group members different roles (e.g. nutrition, education, public health). After the role play, answer the following questions: ? What struck you about this process? ? How was it similar or dissimilar to your own professional experiences? Would this process succeed in your own work setting? ? What leadership skills did you (or would you, in real life) draw on? ? What will need to happen in order to make progress toward the vision or to meet expectations about results? ? What do you think will happen now? Module 3 exercise: Draft an agenda and general plan for the second meeting. Include an outline of the data, information, and materials that will be provided in advance or during the meeting, and how they will be used. Create a plan for organizing participants to get the work done (e.g., team member tasks and roles, timelines, team structures). As you plan for the meeting, answer the following questions: ? What are the specific challenges you will face in creating an effective working environment for this group? ? What are some strategies that can be applied? ? What specific outcomes should be expected from this meeting? What kind of follow up will be required to move the proposal forward? ? Where do you expect to face the greatest resistance? How can you overcome this resistance? ?

13. Preparing for Conflict and Negotiation:A Case Study in Perinatal Depression Learning Objectives: Apply negotiation and conflict resolution techniques to a public health scenario by breaking the task into discrete steps and: Clarifying the role of the primary negotiator, Demonstrating how to prepare for negotiations by thinking strategically and tactically, and Applying negotiation techniques to an actual public health issue.

14. Show clip: The difference between management and leadership--stop at 2:13 How do you learn to be a leader -- and is it different from learning to be a manager? Maybe I really can be a cowboy How is leading a horse like leading people? How is it different? Give examples from your experience of leading with �whips and spurs� and leading with �only the gentlest touch.� What is the relationship between your personal vision and the vision of your organization as a whole? Engaging others to carry the MCH banner What are some of the challenges involved in Show clip: The difference between management and leadership--stop at 2:13 How do you learn to be a leader -- and is it different from learning to be a manager? Maybe I really can be a cowboy How is leading a horse like leading people? How is it different? Give examples from your experience of leading with �whips and spurs� and leading with �only the gentlest touch.� What is the relationship between your personal vision and the vision of your organization as a whole? Engaging others to carry the MCH banner What are some of the challenges involved in

17. Flexible and Varied Uses Staff meetings or retreat Local, regional or state MCH conference Workshops offered by the local health agency for its community partners Integrated into other professional development activities Individual study You tell us! However they use it, ask that they let us know via the feedback form. Ideas from the group? However they use it, ask that they let us know via the feedback form. Ideas from the group?

18. Sources MCH Leadership Competencies Turning Point�s Collaborative Leadership Modules Johns Hopkins BSPH faculty with expertise in leadership training, especially Ben Lozare and Ann-Michele Gundlach MCH leaders interviewed for the MCHLDS Advisory group

19. Advisory Group Cheryl DePinto, MD, MPH Maryland Department of Health and Mental Hygiene Lillian Gibbons, DrPH Public Health Consultant Cathy Hess, MSW National Association for State Health Policy Laura Kavanagh, MPP Maternal and Child Health Bureau Lucia Rojas-Smith, DrPH RTI International Nan Streeter, MS, RN Utah Department of Health Karen VanLandeghem, MPH Independent Consultant? Kimberlee Wyche-Etheridge, MD, MPH Nashville-Davidson County Health Department

20. www.jhsph.edu/wchpc Women�s and Children�s Health Policy Center Department of Population, Family and Reproductive Health Johns Hopkins Bloomberg School of Public Health? 615 N. Wolfe Street?Baltimore, MD 21205 For questions about content or using the MCHLDS: Marjory Ruderman 434-244-2921 or mruderma@jhsph.edu For technical help with the website: Lauren Zerbe 410-502-7474 or lzerbe@jhsph.edu