11. Working with Communities and Systems


Improving the health status of MCH population groups is a complex process because so many factors influence the health of children, adolescents, and families. Therefore, solving health problems and improving health status requires the active involvement of many disciplines and an array of public- and private-sector jurisdictions. Reaching a goal of promoting health and preventing problems requires a broad-based systems approach, rather than a categorical approach, to the issues.

Systems thinking is the ability to appreciate complexity. This includes the ability to see the whole and the parts to understand the ways in which the parts interact and influence outcomes.

Collaboration is a mutually beneficial and well-defined relationship entered by two or more organizations to achieve goals and act as one to solve an agreed upon issue. Key to collaboration is the use of supportive and inclusive methods to ensure that those represented by the collaboration are included in the change process and share power. (Source: web.tc.Columbia.edu/families/TWC)

Constituency building depends on the core competencies of communication, self- reflection, critical thinking, and ethics and professionalism.

The successful MCH leader thinks systemically about the complexity of policy, practice, and research challenges. Personality characteristics and temperament that may aid in this competency include passion, persistence, self-motivation, optimism, flexibility, creativity, charisma, humility, and patience.

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Knowledge Areas

Through participation in this program, a participant will know:

  • Basic features and issues of health care systems and health economics.
  • Relationships between the mission, vision, and goals of an organization to its strategic planning, operations, and the community to which it belongs.
  • Basic business and administrative principles related to planning, funding, budgeting, staffing, managing, evaluating, and representing health care systems and organizations.
  • Principles of building constituencies and collaborations in communities and among organizations.
  • Principles of systems-thinking that describe the hierarchy of systems.

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Basic. Through participation in this program, a participant will:

  1. Participate in basic strategic planning processes such as developing a mission, vision, strategic goals, and activities.
  2. Develop agendas and lead meetings effectively.
  3. Identify community stakeholders and their extent of engagement in the collaboration process.
  4. Interpret situations systemically; i.e., identifying both the whole situation and the dynamic interplay among its parts.

Advanced. With more experience and building on the basic skills, MCH leaders will:

  1. Assess the environment to determine goals and objectives for a new or continuing program, list factors that facilitate or impede implementation, develop priorities, and establish a timeline for implementation.
  2. Manage a project effectively and efficiently including planning, implementing, delegating and sharing responsibility, staffing, and evaluation.
  3. Translate mission and vision statements for different audiences, understanding their different cultures, perspectives, and use of language.
  4. Use negotiation and conflict resolution strategies with stakeholders when appropriate.
  5. Maintain a strong stakeholder group with broad based involvement in an environment of trust and use an open process.

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Educational Experiences

  1. Outline the essential maternal child health services in a state, identifying the disciplines and organizations involved
  2. Identify current issues in the legislation and regulation of the US MCH system
  3. Map the organizational relationships in the delivery of health care in a community, including networks for addressing continuity of care
  4. Explain the roles of the public and private sector in meeting health needs and priorities
  5. Prepare a program budget for a project or program area
  6. Identify individual, organizational and community concerns, needs, assets and resources for public health interventions and programs
  7. Prepare proposals for funding from internal or external sources
  8. Solicit ideas and opinions from others in formulating and justifying a decision.
  9. Provide examples of visions, missions and core values for an organization and how they align or not align with that organization’s behavior or actions.
  10. Participate in a team project to plan, development, budget, and evaluate a community initiative within an organization
  11. Identify potential partners in a community health initiative and how they could be approached so that they would see that it would in their interest to participate.

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Resources/Assessment Tools –
11. Working with Communities and Systems

Key Documents

Senge, PM. 1990. The Fifth Discipline. The art and practice of the learning organization, London: Random House.

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Assessment Tools

Inclusion Criteria –

To be considered for initial inclusion in this web site, the materials had to meet several criteria:

  • the material needed to focus on one or more of the skills listed for a particular competency
  • the material needed to describe either a measurement instrument or theory that could support the creation of such an instrument
  • the material had to be publicly available, that is, where the item is not a commercial entity available for purchase
  • the material needed either psychometric information about its properties as a measure or, particularly in the case of material found only on the Web, a high degree of face validity

Copyright and Use Issues –

The materials initially described were identified for consideration by MCH interdisciplinary training programs. Many of these materials are copyrighted and thus, may not be copied, distributed, transmitted, or published without the express written permission of the copyright owner. It is the responsibility of each user to ascertain whether materials may be freely used or whether such permission is needed.

Competency Grid

Bracy Kalb et al. (2006) described the pilot testing of a competency-based tool developed for use with public health nurses. The tool, used as part of regular performance appraisal, specifically addresses issues of policy development and program planning. The behaviors identified are developmentally sequenced for staff levels in the agency that developed the tool. Thus, they move from novice (individual RN) to advanced (nursing supervisor). Adaptation of the tool for use with MCH inter-disciplinary populations could provide a useful way to address issues of policy and advocacy in training programs.

Information at:
Bracy Kalb, K., Cherry, N. M., Kauzloric, J., Brender, A., Green, K., Miyagawa, L., Shinoda-Mettler, A., Kulbok, P., & Reed, J. (2006). A competency-based approach to public health nursing performance appraisal. Public Health Nursing, 23(2): 115-38.

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Community Education Competencies Grid

The Community Education Competencies Grid is a tool created by the Tri-College University Educational Leadership Program to assess learner portfolios on skills and knowledge related to community education. Many of these items are closely related to the MCH leadership competency of Working with Communities and Systems and could prove useful in designing and assessing learning plans that focus on specific components of this competency.

Information at:

Directions for scoring the portfolios are also provided.

Information at:
Directions for SELF Scoring (DOC)

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Portfolios are collections of information that can be used to evaluate MCH knowledge in action.

Portfolios include materials prepared by a learner to demonstrate learning in response to a plan. There is increasing evidence of the utility of portfolios for assessment of learning and for competency assurance in health care.

For a portfolio to be effective, it should include:

  • a learning plan that contains specific goals and objectives
  • materials that demonstrate achievement relative to the learning plan
  • learner reflections
  • learner and faculty evaluations of the material

The ACGME, in its draft Toolbox of Assessment Methods, provides some information about the properties and uses of portfolios for assessment.

Information at:

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