Framework and Tools

Framework and Tools

Introduction

Start Here with the Needs Assessment Process

Needs assessment is a systematic process to acquire an accurate picture of the strengths and weaknesses of a state or jurisdiction's public health system, and essential in identifying the most appropriate programs and policies to promote the health of women, children, adolescents and their families. MCH assessments are to be population-based and community-focused and serve as a fundamental element of any program planning activity.1

The needs assessment process includes the collection and examination of information about the state or jurisdiction's capacity and infrastructure, needs, and desired outcomes for the MCH population, and legislative mandates. This information is used to determine priority goals, develop a plan of action, and allocate funds and resources. The needs assessment is a collaborative process that should include the HRSA/MCHB, the full Department of Health, families, practitioners, the community, and other agencies and organizations within each state or jurisdiction that have an interest in the wellbeing of the MCH population.

Title V of the Social Security Act requires states to conduct a statewide Needs Assessment every five years with the primary goal of improving MCH outcomes and strengthening state, local and community partnerships.

This page presents a practical framework that illustrates the continuity of the Needs Assessment process and its relationship to the planning and monitoring functions of Title V and the population that is serves. It also pulls together all the tools presented throughout the website.

 

Putting all these steps into practice is a difficult balancing act. The following checklist, cited from AMCHP's Guide for Senior Managers, can provide a practical framework of activities to help you accomplish all steps along the way:

  1. Study the guidance and make a list of tasks to be completed.
  2. Put one person in charge of the needs assessment.
  3. Make a master plan:
    • Discuss with MCHB project officer; obtain technical assistance if needed.
    • Gather existing documents (e.g., last needs assessment, data updates, studies, reports, program evaluations, SLAITS data, etc.).
    • Assign every task to someone to complete by deadline.
  4. Develop a calendar of key assignments and due dates. Build adequate time into the needs assessment calendar for an advisory group to review the resulting data, trends and other information.
  5. Hold a stakeholders meeting for all interested parties (staff, family advisory, and coordinating programs both within and outside your agency) to review master plan; periodic meetings thereafter for steering needs assessment activities.
  6. Conduct an environmental scan early in the process to determine what data, program evaluations and other information you have readily available.
  7. Use learning materials and resources from this toolkit to help guide your efforts.
  8. Obtain new data and analyses.
  9. Use consultants as needed.
  10. Read draft report from front to back; edit.
  11. Share draft with stakeholders; conduct process to develop list of needs and priorities based on needs assessment findings.
  12. Share final needs assessment report, including listing of needs and priorities, widely - with state agency leadership, "sister" agencies, advocacy groups, legislature, governor's office, etc.
  13. Celebrate a job well done!

Read Chapter 9, The ABCs: State and Federal Grants, Budgets and Accountability, pp. 98 - 110 for detailed guidance on needs assessment.

Conceptual Framework

This Nine-Step Process is Detailed in the Links to the Left
Navigator Conceptual Model

Implementation Tools

The Right Tools at the Right Time

These resources help move you from knowledge to practice with your needs assessment work. A list of all tools are presented below; specific tools are also repeated on the corresponding Needs Assessment Step page. You can also access a list of tools by step on this summary page.

  • 30/30 Action Plan. (National MCH Workforce Development Center). A simple way to monitor progress and record future action steps in ongoing work. The idea is that the team meets for 30 minutes every 30 days to discuss progress over the past month. The progress, roadblocks and other relevant ideas are noted on the form, along with an action plan for the following month.
  • A3 Change Tool. (National Workforce Development Center). A tool designed for quality improvement and managing change. On the assessment side, it helps groups to frame their work together, uncover perspectives, find root causes, and establish measures of success for the change. On the action side it encourages learning, prototyping and testing. The tool is meant to be used longitudinally to track change over time.
  • Appreciative Inquiry. (National MCH Workforce Development Center). A tool that focuses on how to build on existing strengths and engage stakeholders to create change. This approach helps organizations identify what's working well, envision ideal futures, and develop actionable implementation plans.
  • Asset Mapping. (National MCH Workforce Development Center). A tool to help stakeholders examine assets and identify gaps within the maternal and child health system. Understanding existing resources will help stakeholders select priorities and take strategic action.
  • Balance of Petals. (National MCH Workforce Development Center). A tool used to clarify needs from and benefits to community partners. Knowing what you need from partnerships, as well as what each partner stands to gain from your initiative is an important part of allocating resources. Use this tool to identify which partners need to be engaged for success.
  • Birth Outcomes Action Plan. (AMCHP) An interactive map that describes urgent actions needed by specific system actors to address identified barriers to change. This tool helps Title V programs strategize their role in improving birth outcomes and identify high-impact actions while maintaining a systems perspective.
  • Capacity Assessment for State Title V (CAST-5). (AMCHP). A set of assessment and planning tools for examining organizational capacity to carry out key MCH program functions.
  • Causal Loop Diagramming. (National MCH Workforce Development Center). A tool used to help stakeholders identify leverage points and priorities that shift entire systems rather than just treating symptoms. This approach helps stakeholders understand forces shaping problems, uncover assumptions, identify unintended consequences, and develop strategies to influence the system.
  • Concept Mapping. (National MCH Workforce Development Center). A tool used to help stakeholders identify areas of consensus and priorities that are both important and actionable through a structured visual approach.
  • Data Placemats. (National MCH Workforce Development Center). Tool to visualize data to help make decisions or report out findings, draw meaning from complex information, and effectively report results. Particularly useful for communicating current health status of sub-groups in an accessible format. (Note: this tool is also relevant for other steps (e.g., Step 4).
  • Data Resources:
  • Developing a Plan for Addressing Local Needs and Resources. (Community Toolbox). Part of a comprehensive process developed Center for Community Health and Development at the University of Kansas to develop a plan for community assessment to guide efforts to better understand community needs and resources.
  • Developing an Action Plan. (AMCHP). The final step of the Capacity Assessment for State Title V (CAST-5) tool, this step provides an action plan worksheet to help organize implementation activities and timelines.
  • Developing an Action Plan. (Community Tool Box). Web portal that provides instructions, a checklist, examples, tools, and training for effective action planning with practical guidance for implementation.
  • ESM Review & Resources: National Summary. (MCH Evidence). This report serves as a conversation starter as we learn how to strengthen our strategies, work with the Evidence Center, and look toward the next iteration of block grant applications and work. 
  • Evaluation Resources:
    • Evaluation Learning Bundle. (MCH Navigator). This training spotlight uses the CDC framework as a conceptual model to organize learning opportunities. It presents introductions to the six steps of program evaluation in short video podcasts. You can also download materials from the CDC about each step. After reviewing the introductory material, you can access additional learning opportunities to gain knowledge and skills related to each step of the framework.
    • Evaluation Toolkit. ( MCH Digital Library). This deep-dive resource contains an evaluation primer, a collection of key resources, and an interactive Choose-and-Use tool to assist users in finding instructions on how to conduct evaluations and examples of successful evaluations from the field.
  • Federal Resources:
  • The Five Rs. (National Workforce Development Center). A tool used to break down elements of a complex problem.  It consolidates stakeholders’ perspectives on the system supporting MCH.
  • Guide to Prioritization Techniques. (NACCHO). A structured mechanism for objectively ranking issues and making decisions, while gathering input from agency-wide staff and considering all facets of competing health issues.
  • Health Communication Playbook. (CDC). Guides for communication strategies focused on consumers, media, and professionals.
  • Hexagon Tool. (NIRN). This planning and evaluation tool guides the selection of the appropriate, evidence-based/informed strategies through a six-step exploration process. It can be used in collaboration with your partners to better understand how a new or existing program fits into your existing work, context, and health outcome priorities.
  • How to Engage Stakeholders Tool. (Cottage Health). This tool provides practical strategies, background information, case studies, and step-by-step methods for effective stakeholder involvement in community health initiatives. This tool is part of the Engage Stakeholders page within the Cottage Center for Population Health's evaluation toolkit, offering valuable guidance for community engagement.
  • Individual + Policy, System, and Environmental (I+PSE) Conceptual Framework for Action. (MCH Navigator). This framework focuses on identifying needs and aligning programs by integrating direct service initiatives with policy (organizational/ public), system (simple/complex) and environmental (built/natural) approaches.
  • Impact Matrix. (National MCH Workforce Development Center). A tool to help groups identify and achieve agreement on activities that can be implemented with maximum impact given the effort invested. This easy-to-facilitate approach is ideal when stakeholders have many potential courses of action to consider.
  • Keep, Adapt, Let Go, Create. (AMCHP). This tool (in editable Word format) asks a series of questions to (1) examine the future state of work that could benefit from Title V resources; (2) determine what is being done currently that could be kept, adapted, let go, or created; and (3) plan for what could, should, and will be done.
  • Key Driver Diagram (KDD). This tool documents the team’s theory about the changes needed to achieve the desired improvement; becomes the team’s roadmap for change; and elps to define what should be measured to best learn how your interventions are impacting your system.
  • Logic Models. (National MCH Workforce Development Center). Logic Models are simplified graphic depictions of a program, initiative, or strategy. They provide a map of the relationships between the resources, activities, and benefits or changes that result. Logic Models demonstrate the theory of change, and can be useful in program planning, management, communicating with partners, and needs assessment. This tool (downloadable as a Word document) contains instructions and an editable logic model template.
  • MCH Workforce Capacity Assessment Templates. (MCH Evidence Center). Two draft assessment tools focused on: (1) capacity related to MCH levels of service and (2) internal staff capacity. Users can adopt or adapt either or both tools to assess capacity and identify areas for growth.
  • MCHwork: The Hexagon Tool — A Budgeting Perspective. (National MCH Workforce Development Center and MCH Navigator). State and local MCH departments can utilize the Hexagon Tool in conjunction with a budget analysis to strategically allocate resources and enhance implementation readiness for new or re-imagined programs.
  • Measurement Tables. (National MCH Workforce Development Center). Tools to document an agency's plan to monitor progress toward goals over time. These can be used to further develop measurement strategies for activities described in logic models.
  • Measuring Population Health Management Return on Investment. (HITEQ Center). Toolkit that includes a conceptual model for measuring ROI and a Matrix Tool for ROI calculation.
  • Network Mapping and Analysis. A visual tool to identify existing partnerships and collaborations within the MCH system. This approach helps organizations discover potential gaps in their partnership networks and reveals strategic opportunities to engage new stakeholders for improved outcomes.
  • Nutrition Resources:
  • Plain Language for Public Health. (Public Health Communications Collaborative). Tips for providing accessible communication to help your audience understand public health issues.
  • Plan-Do-Study-Act Cycle. (National MCH Workforce Development Center). This MCH version provides video training and a structured way to plan how the test will be carried out, try it, observe and collect data, and adapt the strategy based on what is learned.
  • Policy Review TA Brief on Title V agencies that have conducted a policy review as part of their needs assessment.
  • Prioritization Matrix. (AMCHP). The last phase of the CAST-5 Process highlights selecting priorities. This document provides an overview and tool for prioritizing needs in a systematic way.
  • Prioritization Toolkit. (MN Department of Health). This toolkit guides choosing prioritization methods, engaging community members, and selecting effective strategies.
  • Public Health Reaching Across Sectors (PHRASES) Toolkit. (Aspen Institute). Tools to communicate with framing and language that can enhance understanding of public health and help build partnerships.
  • Resource Allocation Tool. (HEG). This tool presents nine actions to allocate resources to improve outcomes and includes related case studies for practical application.
  • Results-Based Accountability Tools: (MCH Evidence Center). A suite of tools designed to help agencies develop stronger Evidence-based Strategy Measures (ESMs) and implement effective measurement processes:
  • Return on Investment (ROI). ROI is a tool used to evaluate the efficiency of an investment or compare the efficiency of several investments. The use of ROI can help guide the allocation of resources. This guidebook is designed to assist local health department staff assess the value of their contributions, with a particular focus on population-based prevention interventions.
  • ROI Calculator for Partnerships to Address Community Circumstances Affecting Health. (The Commonwealth Fund). This calculator is designed to help community-based organizations and their health system partners plan sustainable financial arrangements to fund the delivery of social services to high-need, high-cost (HNHC) patients.
  • Root-Cause Analysis (RCA) is a structured facilitated team process to identify root causes of an event that resulted in an undesired outcome and develop corrective actions. The RCA process provides a way to identify breakdowns in processes and systems that contributed to the event and how to prevent future events. The purpose of an RCA is to find out what happened, why it happened, and determine what changes need to be made.
  • Simulation. (National MCH Workforce Development Center). A tool used to predict outcomes based on formulas and selected variables and interventions. This approach allows stakeholders to "test" interventions virtually and understand their potential impacts before implementation.
  • Strategy Planning Tool. (MCH Evidence Center) A tool to help maternal and child health agencies develop strategic plans by using results-based accountability and root-cause analysis to improve health outcomes.
  • Successful Engagement with People who have Practical Experience. (National MCH Workforce Development Center). A detailed workbook providing step-by-step guidance for professionals seeking to authentically engage people with practical first-hand experience. This resource offers strategies for creating trusting relationships and meaningful involvement to improve policies, services, systems of care, and health outcomes.
  • System Support Mapping. (National Workforce Development Center). A tool used to understand the role, responsibilities, needs, resources, and wishes of individuals navigating or supporting the MCH system.
  • Title V Prioritization Process Tool. (National MCH Workforce Development Center). This tool (Word format) asks Title V agencies to consider if: (1) they have the capacity to carry out selected activities; (2) the selected activities will be acceptable to partners; (3) there is momentum/interest in the selected areas; and (4) the selected activities align with planned Title V goals/NPMs and current activities. structured planning and evaluation tool that guides the selection of appropriate, evidence-based strategies through a six-step exploration process.
  • Whole System Mapping. (National MCH Workforce Development Center). A tool used to capture a full picture of current services provided for maternal and child health, including where, by whom, and intensity of service. This tool provides an opportunity for stakeholders to see complementary system components and discuss how various parts could work together to address identified needs.
  • Youth Engagement: A collection of resources from multiple organizations demonstrating strategies for effective youth engagement: