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GO: Promising Practices and Implementation Resources

Having been introduced to needs assessment on the Ready page and acquired trainings and tools on the Set page, you are now ready to focus on utilizing implementation tools in your state or jurisdiction.

Use the links below to access state-based programs and resources, a checklist for conducting your needs assessment, and other implementation resources:

Examples Applicable Across Steps

  • Arizona: Needs Assessment Timeline. This timeline shows the process from January 2018 through December 2020 of the 5 stagaes of Arizona's needs assessment process: (1) planning and design, (2) data collection, (3) data anlaytics, (4) priority setting and report writing, and (5) dissemination.
  • Arizona: Overall Approach. This presentation shows Arizona's approach and process related to their overall timeline.
  • California Family Health Outcomes Project: Title V Needs Assessment Resources. California has developed a compilation of information of links and resources that the University of California, San Francisco, has developed for the Title V Needs Assessment.
  • Colorado: Project Team Charter Checklist. This document establishes goals and devliverables, membership, checkpoints, a mechanism for feedback, boundaries, and a process for decision making. The resources and time needed are outlined as well as an overall timeline
  • Indiana: List of Planned Needs Assessment Activities and Processes. To engage stakeholders and collect needs, Indiana plans to survey the Indiana Perinatal Quality Improvement Collaborative (IPQIC) members, a group of almost 400 statewide professionals,  and use them to vet overall needs assessment findings. They also plan to hold focus groups with the state and federally funded programs at their all grantee gatherings, survey MCH conferences such as the annual infant mortality summit and breastfeeding conference, and utilize the statewide pregnancy mobile app to offer surveys to assess community needs. In addition, Indiana will partner with the state hospital association to conduct patient focus groups, and survey parent and family organizations. In order to leverage resources and support capacity, Indiana plans to onboard a program evaluator to support the needs assessment process. Contact for more information about the proposed strategies.
  • Minnesota’s Title V Needs Assessment Website. This website includes an overview of the needs assessment process, links to their needs assessment plan, and information on webinars that share the results of Minnesota’s Discovery Survey. The site also includes links to health equity specific resources, including the state’s Health Equity Report.
  • Oregon: Overview of Title V Needs Assessment (2015). This document contains a brief narrative summary of the components of the 2015 Oregon 2015 Title V Needs Assessment, including stages of the process and key staff roles.
  • Oregon: 2015 Flowchart of Title V Needs Assessment (2015). This is a graphic which displays the relationship between the key components of the methods used during the needs assessment. These components included a community themes and a strengths assessment, a health status assessment, and a MCH health system and forces of change assessment. The results of these assessments then fed into the prioritization and planning process.

Examples Related to Step 1: Engage Stakeholders

  • Colorado: Needs Assessment Design Overview Visual. Colorado has used a visual such as this one in multiple assessments to organize and communicate about the design of the MCH Needs Assessment. It helps partners understand all of the elements of the assessment as well as the general timeline.
  • Oregon: Partner Voices Key Questions. These are the key questions that were used in a survey of partners in Oregon, to both gather information and to engage partners in the work. The modes of data collection included an online survey of partners, listening sessions with key stakeholders, discussions with core partners including local health departments and tribes, and regional listening sessions with community organizations and agencies.
  • Oregon: Youth Engagement on Surveillance and Assessment Tools. As part of Oregon’s effort to design better assessment and surveillance tools, Title V engaged youth in focus groups, surveys, and informational interviews to find out what health topics are most important to them, whether or not the survey speaks to those topics, and how the state can better design assessment to speak to their needs and strengths.
  • Oregon: Contracts for Culturally Responsive Data Collection
    The mission of the Oregon Center for Children and Youth with Special Health Needs (OCCYSHN) is to improve the health, development, and well-being of all Oregon’s CYSHCN. Understanding the experiences and needs of all CYSHCN and their families, including those of non-dominant race/ethnicities, is essential to achieving this mission. Limited data exist that describe the Oregon CYSHCN population generally; data are even more limited if a child is a member of community of color. For example, generalizable data for the percentage of Oregon CYSHCN who identify as Black do not exist. Family members who responded to OCCYSHN’s 2015 needs assessment surveys were overwhelmingly Caucasian (77%) and relatively well-educated (46% reported a Bachelor’s degree or higher). In an effort to learn more about subgroups of CYSHCN about which less is known, OCCYSHN is contracting with culturally-specific organizations to conduct culturally responsive data collections with families of CYSHCN in the communities they serve. They will share information gleaned, and work with OCCYSHN on effective strategies to better serve those communities. These example Request for Proposals (RFPs) can serve as examples of how to seek organizations to co-develop culturally-appropriate surveys:
  • Oregon Key Stakeholder Panel Discussion for Needs Assessment Specific to Children and Youth with Special Health Care Needs. OCCYSHN invited professionals representing a wide range of organizations and institutions that serve CYSHCN (e.g., Coordinated Care Organizations, pediatric provider member organizations, county Developmental Disability, providers that serve CYSHCN) and representatives of families of CYSHCN to participate in a facilitated discussion on December 10, 2014. The discussion focused on the needs of CYSHCN and the capacity of Oregon’s system of services to address those needs. Participants also recommended priority areas of focus for OCCYSHN for the next 5 years. We included these recommendations in our priority area data tools used for our state prioritization process. Contact Alison Martin at, 503-494-5435 for information.

Examples Related to Step 2: Assess Needs and Identify Desired Outcome and Mandates

  • Oregon CYSHCN Family and Youth Surveys. OCCYSHN administered electronic and paper surveys in English and Spanish to families of CYSHCN between the ages of birth and 26 years, and to young adults between the ages of 12 and 26 years with a special health care need. Because the population of each of these groups is not known, and therefore cannot be sampled from, OCCYSHN used a snowball sampling approach in which OCCYSHN’s contacts were asked to complete the surveys or, in the case of organizational partners, disseminate the surveys to the organization’s constituency. This resulted in a convenience sample. Results cannot be used to generalize to these populations, but do provide useful information about the types of existing needs, and about similarities and variations between stakeholder perspectives on needs. Of the 675 family surveys received, 554 were usable (83%), and of the 116 youth surveys received, 109 were usable (94%). Alabama’s Title V CYSHCN program let us use items from their youth survey for ours, and we used or adapted other items from the NS-CSHCN and CAHPS. The incentive for participating was the opportunity to be one of 5 randomly family survey participants and one of 5 randomly selected youth survey participants to receive iTunes gift cards. OCCYSHN will share copies of any of these surveys with other Title V CYSHCN agencies. Contact Alison Martin at, 503-494-5435 for information.

Examples Related to Step 3: Examine Strengths and Capacity

  • Wisconsin: Staff Capacity Survey. This anonymous survey is used to assess staff capacity at the Wisconsin Department of Health Services Maternal and Child Health Program.
  • Oregon: Capacity and Forces of Change Questions for Online Discussion Forum. These are the questions that were used in an online discussion forum to solicit feedback from stakeholders on capacity and forces of change in Oregon. Partners included in these discussion forums included Coordinated Care Organizations, Early Learning Hubs, and community agency partners.

Examples Related to Step 4: Select Priorities

  • Colorado Prioritization Criteria List. Colorado researched and compiled a list of possible criteria to use in the prioritization process and frequently references this document.  
  • Louisiana Criteria for Group Discussion: Lens for Group Discussion of Selection of Priorities. A tool to crosswalk whether ideas are supported by data, address a Title V domain and NPM, are consistent with agency capacity, addresses disparities, and other essential considerations.
  • Oregon Title V Needs Assessment Data Tools. These were the summary data tools that were shared with the stakeholders during the prioritization process, in order to facilitate selection of priority areas. These data tools included information in the following categories; performance measure data, other health status data, significance of each priority area, context for the priority area in Oregon, stakeholder input, and alignment with partners.
  • Oregon Snapshot on Adolescent Health Title V. A tool specific to the Adolescent population that is used to highlight needs, strengths, and disparities for community consideration in prioritization.

Examples Related to Step 5: Set Performance Objectives

  • Colorado: HP 2020 Comparison Table. Colorado used this table to compare how the state was doing in areas of interest, in reference to national targets. This was one quantitative data product, among many considered by decision-makers, but served as a helpful tool in determining areas to work on. (Note: this is an Excel file).

Examples Related to Step 6: Develop Action Plan

  • MCH 2020: Kansas Maternal and Child Health Needs Assessment. This document provides an overview of the 2016-2020 Title V Needs Assessment in Kansas. It provides an overview of many of the steps in the needs assessment process. Appendix L of the document is the Statewide Strategic Action Plan.

Examples Related to Step 7: Seek and Allocate Resources

  • Colorado: State and Title V Needs Assessment Coordination. In Colorado, the Title V needs assessment and the state health department's five-year health and environmental assessment are coordinated, leading to more efficient processes and better informed results. To date, the MCH needs assessment project manager has participated on the steering and advisory committees for the statewide assessment, and the MCH program has provided funding for community members and rural partners to join the advisory committee.  The MCH and state assessment teams have also shared resources, methods and tools to implement best practice assessments.  In the future, the MCH Team will use the quantitative data compiled through the statewide assessment as well as priority issues identified to further explore the impact and relevance among MCH.

Examples Related to Step 8: Monitor Progress for Impact on Outcomes

Examples Related to Step 9: Report Back to Stakeholders

  • Colorado: Data Briefs. Colorado's MCH program has developed this approach to compiling quantitative data in an easy-to-digest format both as part of the MCH needs assessment as well as for staff and partners to learn and communicate about key issues affecting the MCH population.
  • Colorado MCH Needs Assessment Summary. This is a document used to share the design and results of the needs assessment with partners throughout the five-year needs assessment cycle.

Putting all these resources 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:

  • Study the guidance and make a list of tasks to be completed.
  • Put one person in charge of the needs assessment.
  • 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.
  • 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.
  • Hold a stakeholders meeting for all interested parties (staff, family advisory, and coordinating programs both wihin and outside your agency) to review master plan; periodic meetings thereafter for steering needs assessment activities.
  • Conduct an environmental scan early in the process to determine what data, program evaluations and other information you have readily available.
  • Use learning materials and resources from this toolkit to help guide your efforts.
  • Obtain new data and analyses.
  • Use consultants as needed.
  • Read draft report from front to back; edit.
  • Share draft with stakeholders; conduct process to develop list of needs and priorities based on needs assessment findings.
  • 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.
  • Celebrate a job well done!

Read the entire chapter on needs assessment.