4. Select Priorities

4. Select Priorities

Introduction

On Your Mark: Start Here with Grounding Concepts and the Evidence Base

In order to select priorities as step 4 of the needs assessment process, each Title V agency must examine the identified needs and match them to the desired outcomes, required mandates and level of existing capacity.  Agencies are guided to select seven to ten priority areas for targeted focus in promoting continued improvement and progress. 

Priorities identified should address areas in which the agency believes there is reasonable opportunity for a focused programmatic effort (e.g., new or enhanced interventions, initiatives, or systems of care) to lead to an improved outcome. Other factors to consider include: the availability and effectiveness of interventions, economic feasibility, community perception of the problem, and political issues related to the problem.

As part of this step, consider priority-setting methods used successfully by other states or jurisdictions (e.g., Delphi process, public opinion polls, advisory groups, focus groups, specialized research studies).

Importance of Selecting Priorities

Selecting priorities for the five-year needs assessment is a critical step in ensuring that limited resources are effectively allocated to address the most pressing issues within a community. The importance of this process lies in its ability to align identified needs with desired outcomes, adhere to state and local mandates, and conduct activities that fit within the agency's abilities, capacities, and strengths. By carefully matching these elements, Title V teams can maximize the impact of chosen evidence-based interventions through:

  • Alignment with Desired Outcomes. Selecting priorities is crucial because it enables Title V agencies to align their efforts with the desired health outcomes within the community. This alignment ensures that the resources and interventions are directed towards addressing the most pressing health issues. By matching identified needs with specific, measurable, and achievable goals, public health officials can maximize their impact and track progress effectively. This approach fosters accountability and demonstrates a commitment to improving the overall health and well-being of the population.
  • Compliance with State and Local Mandates. Title V agencies operate within a complex system of state and local regulations, mandates, and guidelines. Selecting priorities that align with these legal and policy frameworks is essential to maintain legal and regulatory compliance. This not only helps in avoiding potential legal issues but also ensures that the agency's work is recognized and supported by the broader community and government authorities. By adhering to these mandates, Title V can enhance their credibility and maintain the trust of their constituents.
  • Optimizing Health Department's Capacity. Title V agencies often face limitations in terms of staffing, funding, and infrastructure. The process of selecting priorities helps in optimizing the utilization of these limited resources. By focusing on priorities that can be realistically implemented with the available capacity, public health officials can ensure that their interventions are efficient and effective. This approach prevents the waste of valuable resources and ensures that the public health department's efforts have a meaningful impact on the health of the community.
  • Community Engagement and Support. When priorities are chosen carefully and transparently, it promotes community engagement and garners support from stakeholders. Community members and partners are more likely to rally behind initiatives that address the issues they consider most important. This not only bolsters the success of Title V programs but also strengthens the bonds between the agency and the communities it serves.
  • Data-Driven Decision-Making. Prioritizing needs assessment and selection based on data ensures that interventions are evidence-based and founded on objective assessments. This leads to more effective and scientifically supported solutions, which can be crucial for achieving the desired health outcomes.

Barriers to Selecting Priorities

Barriers to effective priority selection can arise from various factors, including:

  • Competing Interests Among Partners. Different partners may have diverse interests and priorities when it comes to public health. This can lead to conflicts and challenges in reaching a consensus on what priorities to address. To overcome this barrier, Title V agencies should engage in inclusive and transparent decision-making processes that involve all partners. Building a shared understanding of the most critical needs can help identify common ground and minimize conflicts.
  • Limited Funding and Resource Constraints. In many cases, Title V agencies face tight budgets and limited resources, which can hinder their ability to address all identified needs. To overcome this challenge, prioritization becomes essential. Agencies should conduct thorough cost-benefit analyses to determine which interventions will yield the greatest return on investment. Additionally, seeking additional funding sources, grants, or partnerships with other organizations can help bridge resource gaps.
  • Lack of Data and Information. Inaccurate or incomplete data can impede the identification and assessment of needs, making it difficult to set priorities. Title V teams should invest in data collection and analysis capabilities and establish robust data-sharing agreements with relevant partners to ensure they have access to comprehensive and up-to-date information. This helps in making informed decisions based on a solid understanding of the local health landscape.
  • Resistance to Change. Some partners or community members may resist changes or new priorities, particularly if they perceive them as disruptive or unfamiliar. Title V agencies can address this by providing clear and compelling communication about the rationale behind the selected priorities, their potential benefits, and how they align with community values and goals. Engaging with communities in a culturally sensitive and respectful manner is crucial for overcoming resistance to change.
  • Political and Bureaucratic Challenges. In some cases, political or bureaucratic obstacles can hinder the selection of priorities. Collaboration with policymakers and professional groups can help navigate these challenges. Title V teams should work on building relationships and influencing policy decisions that support public health priorities.
  • Short-Term Thinking. Prioritizing based solely on immediate needs may lead to missed opportunities for addressing underlying determinants of health and achieving long-term health outcomes. To overcome this barrier, agencies should consider a broader perspective, focusing on addressing not only symptoms but also the root causes of health disparities.

The MCH Evidence Center has reviewed the literature to find strategies for selecting priorities:

Learn What Works

Get Ready: Immerse Yourself in Effective Strategies and Learn More

Selecting priorities is a pivotal step in translating the findings of a needs assessment into actionable public health initiatives. This step involves identifying and ranking the most critical health needs and issues within the community. The process should consider factors like severity, feasibility, potential impact, and equity to ensure that the selected priorities align with the overall goals and resources of the public health department. Key to this process are the following considerations:

  • Establish clear criteria for prioritization. Develop a set of clear and measurable criteria to guide the prioritization process. These criteria should be based on the community's health needs, the potential impact of interventions, and the feasibility of implementation.
  • Utilize a scoring system. Assign weights to each criterion and develop a scoring system to evaluate each identified need. This scoring system can help to objectively compare different needs and identify those that are most significant.
  • Involve partners in the prioritization process. Engage community partners, healthcare providers, public health professionals, and policymakers, in the prioritization process. Their input can provide valuable insights and help to ensure that the selected priorities reflect the community's needs and priorities.
  • Consider equity and social justice. Prioritize interventions that have the potential to reduce health disparities and promote health equity among vulnerable populations. This may involve addressing the underlying social determinants of health that contribute to inequities.
  • Be transparent and accountable. Communicate the prioritization process and the selected priorities to the community and other stakeholders. Be transparent about the rationale behind the decisions and accountable for the implementation of the selected interventions.
  • Prioritize health equity. Ensure that selected priorities aim to reduce health inequalities and improve the well-being of vulnerable and underserved populations. Use equity impact assessments to evaluate how each priority may affect different demographic groups.

These trainings have been collected by the MCH Navigator:

Tools to Try

Get Set: Use these Tools to Move from Knowledge to Implementation

These tools and examples have been developed by the National MCH Workforce Development Center or collected by the MCH Digital Library:

  • Concept Mapping. A tool used to help stakeholders identify areas of consensus and priorities that are important and actionable.
  • Causal Loop Diagramming. A tool used to help stakeholders identify leverage points/priorities to shift the entire structure and not simply treat the “symptom” of the problem. This tool will help your stakeholders understand the forces shaping the problem, uncover assumptions about the problem, identify unintended consequences, and identify strategies to influence the system.
  • Guide to Prioritization Techniques. NACCHO has developed a prioritization technique that provides a structured mechanism for objectively ranking issues and making decisions, while at the same time gathering input from agency-wide staff and taking into consideration all facets of the competing health issues. 
  • Prioritization Matrix. The last phase of the CAST-5 Process highlights selecting priorities. This document provides an overview and tool for Prioritizing Needs.
  • Title V Prioritization Process Tool. This tool (Word format) used by the National MCH Workforce Development Center asks Title V agencies to consider if: (1) they have the capacity (or get the capacity) to carry out (or contract out) selected activities?; the selected activities be acceptable to local and state partners?; (3) there is momentum/interest in the selected areas?; and if the selected activities align with planned Title V goals/NPMs and current activities?
  • Impact Matrix. A tool to help groups identify and achieve agreement on activities that can be implemented with maximum impact given the effort invested. This is an easy-to-facilitate tool that can be used when a team (or a group of stakeholders) has many ideas about potential courses of action and wants to consider the impact of all potential solutions before deciding on a course of action.

These resources have been collected by the MCH Digital Library:

Title V Tools and Examples

Go: Learn from Your Peers Across the Country

These tools have been collected by AMCHP and the MCH Evidence Center:

Stories and Strategies for Peer-to-Peer Learning

These stories and strategies have been collected by AMCHP and the MCH Evidence Center related to Step 4:

  • Hawaii: Conducting quantitative/focus groups partnering with community organizations. Finding good consultants to help analyze - qualitative data, assist with planning.
  • Kentucky: ID strengths, weaknesses, assets. How do you do this? ID partners. 1. funder. 2. convener. 3. informed. 3–4 sessions for small states. 3. Strengths and capacity. 4. Select priorities. What I'm doing! 1. coordinating the needs assessment activities in my MCH division, Meetings, communication, partners/stakeholders, outside consultants, etc. 2. Communicating progress of our various steps along the way. Why am working! 1. Set a plan and stick to plan! 2. Be clear and concise as the steps you are following or want to follow. There are so many ways to go about this.
  • Hawaii: Utilizing a resource/effort/importance matrix to help with prioritizing in addition to crossing with partner ranked priorities for proposed strategies. This would also be informed by class aggregated demographic data.
  • North Dakota: The state health assessment is complete. Developed the MCH stakeholders survey. Compiled and preparing other data for analysis.
  • Wyoming: Utilize contractor for the data collection pieces of the needs assessment. Especially if you're a state with small staff capacity.
  • Wyoming: I'm actively involved in developing the structure and written report, managing a contractor that is collecting and analyzing community data, and developing a performance management framework to guide us through the next five years. These processes are helping us keep the whole picture in mind and strengthening the links between assessment and action.
  • Utah: Sharing info about NPM's with partners, so when partners are engaged, they can share feedback about which NPM's have alignment, or could be prioritized based on family input. Our Title V and CSHCN partners have been fantastic at involving our F2F HIC.
  • Be upfront with engaging partners and communities about the capacity /what MCH is usually able to do/deliver via Title V.
  • Commonwealth of the Northern Mariana Islands: Utilizing network and existing partners to assist with the needs assessment and selecting MCH priorities. Providing expertise and intersection activities to develop the action plan.
  • Commonwealth of the Northern Mariana Islands: Include CYSHN and families with lived experiences in the action plan. Having all MCH managers involved in the needs assessment. It will address more domains.
  • Delaware: Boot camp: putting together in-person, all day internal stakeholders to examine strengths/capacity and select partners using state developed ranking sheet.
  • Mississippi: We are mining the contact/partner list from programs, not directly or traditionally, or historically involved in the MCH needs assessment to add a minimum, leverage those organic relationships to increase stakeholder feedback and access the population(s) they serve.
  • Idaho: Forming internal advisory team. Conducting external stakeholder meetings (in person and virtual) to help prioritize and identify new partners for the work ahead. Working with contracted facilitator for meetings and small team strategy work.
  • Commonwealth of the Northern Mariana Islands: Partner engagement. Ensure population representation. Keep partners in the loop (informed) of every stage of the NA process.
  • Wisconsin: Created a needs assessment data collection monitoring dashboard. Allowed us to monitor our overall progress, but more importantly, if we were reaching (pre-determined) priority populations (some MCH domain specific, but also BIPOC, AI/AN, Spanish-speaking, Hmong, youth, LBGTQIA). This allowed us to shift efforts, adjust communication strategy, increase outreach efforts, etc. Also pointed out some pretty glaring gaps, Re: partnerships.
  • Oregon: We are developing topic, specific data tools that bring together needs assessment, data collected across a variety of communities, partners and methodologies. They will reflect needs assessment findings in both the NPM topic areas and community identified needs. The data tools will be used by our partners and community reps who come together to weigh the needs assessment findings and develop priority recommendations based on those.
  • Washington: Working with partners to determine priorities and assess needs. Present quantitative and qualitative data to partners (local health departments, families, providers, others) and having them prioritize areas and determine programs to influence, impact, and address equity.
  • Texas: 1. Capacity survey. 2. Meeting with stakeholders to select priorities. Examples on mchneeds.net are useful, especially for us, a new team with the needs assessment. Helpful to see what other states have done.
  • California: 1. Engaging, local, MCH, and other stakeholders in our action planning. 2. Working across domains to build more cohesion and shared language use/structure to improve our systems and reporting.
  • Oklahoma: 1. Form partnerships. 2. Systems mapping.
  • Virginia: We are thinking regionally: Broad strategies that will allow for regional activities that are more aligned with unique populations/cultural needs. We are reading out to nontraditional partners: • We hope to see other state Title V programs as our partners! Shared regional strategies to address, deep, generational issues. • We are hoping to find a new relationship with our state chapter of National Association of Social Workers. They are definitely conduits to work around SDOH.
  • Florida: Maybe a map or list with contact info by state and/or national or county of available partnership or entities that are categorized by NPMs and NOM's. For example: Infant Mortality --> March of Dimes.

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