Executive Summary – Leadership Summit

New England Tuberculosis Consortium

May 14-15, 2009, Salem, MA


TB Heroes Award Ceremony, 2008 Consortium Summit, 2009

Mark Lobato, MD: “Where we’ve been, where we’re going”

Comments on the Consortium:

The Consortium is more than a collaboration—it is transformative. It changes how people look at things and helps them confront and accept differences. We work as a living system, responding to the changes occurring around us. What’s driving this Consortium is the consensus process and goal setting we do.

Regionalization works because

* Authority is vested at the local level thereby empowering stakeholders

* Local decision-making provides greater flexibility and faster responses to change

* Increased involvement translates into improved commitment to shared goals and objectives

* Self-actualized action promotes accountability

* As agents of change, capacity is built andlearning is enhanced

* Shared outcomes results in a community of practice

Activities:

Reflection on all we’ve done and are doing: Public Health Law project, genotyping, leadership, education, TB Heroes Award.

Challenges:

Common challenge is dwindling funds and infrastructure being eaten away. The Consortium needs more resources, trying to get a PHPS fellow. Looking forward, will examine a regional role for Program Collaboration and Service Integration (PCSI).

Kathy Hursen, RN, MS: Regionalization Strengthens Education

Long history of communication and education within New England, going back to at least 1992. New England TB Training Consortium created to expand training efforts and have better communication. Lots of education activities states wanted to do, and with help from others through the Consortium they could do them. Easier if you need to create a policy quickly, because you already have the background and relationships with other states.

2005: RTMCC places an on-site educator. This person is able to be at the meetings, hear what the problems are, understand and anticipate what will be needed. Can tailor trainings to observed needs.

Mark’s arrival tightened up looking at education and what’s happening on the ground, did more materials sharing.

Maureen Wilce: CDC Evaluation of the NETB Consortium

Synergy exists between the 6 states, lots of similarities and good interpersonal communication.Creating smaller regional groupings enable extensive interaction andrelationshipsto develop.

Dissemination of the evaluation results is up to us—we can work on writing them up and getting them published.

Many of theindividuals involved in this areare strong leaders and have extensive skills. Other states with less “strong” leadership might be able to use our process as a template, so they don’t have to be as strong initially.

We have made progress on the action steps identified in the evaluation a year ago.

Dan Ruggiero: 2010 Cooperative Agreement

Changes in the TB cooperative agreement. New funding announcement in June, needs to be submitted in Aug. New formula, strong emphasis on evaluation, PCSI section consolidated.

Discussion:

Q: Can the states seekunsolicited proposals to support regionalization activities andenhance collaboration and integration with other programs i.e., HIV, STD?

A: Programs can solicit in the Cooperative Agreement a request in caseadditional money becomes available.States can also put forthan unsolicited proposal to CDC for funding regionalization and PCSI although there is no guarantee of funds given level funding.

Q: Asked about thoughts on regionalization.

A: CDC is looking into defining areas for regionalization.

Q: Can “Seek new opportunities for program integration” include regionalization?

A: programs can put in co-ag that if additional money becomes available, it will go towards supporting regionalization or PCSI. Can also put forth non-solicited proposal to NCHHSTP for funding regionalization or PCSI.

Carol Pozsik, RN, MPH: The NTCA Experience

No one else is like us in the respect that they’re formally organized like we are. But some other regions ARE working together:

  • The Southeast region has been working together for 30 years. Has annual meeting, committee work. It’s natural for this region to work together, especially during natural disasters to track patients. They support each other, seek advice, etc.
  • California is organized, and their TB controllers make policy for the entire state.
  • 4 corners states: Have an annual conference with 250-300 people, including tribes
  • Midwest region—smallest and newest, includes OH, IN, MN, KS, Nebraska
  • CO, WA, OR, ID: Rocky Mountain region
Lee Reichman, MD, MPH and Nisha Ahamed: The Northestern RTMCC

Lee: The RTMCC highly values the work of the New England health educator. The model used by the Consortium has been effective in TB education. The RTMCC has decided to not renew the contract for supporting an onsite educator in New England because of added costs and the fact that some programs complained that they do not have similar support.

Nisha: We are committed to continuing to serve the New England TB Programs and to be flexible and open during the transition period while relocating the health educator position

GTBI utilizes a collaborative process in planning and implementing training and education activities; we work directly with programs to develop tailored off-site trainings to meet programmatic needs and gather programmatic input through mechanisms such as the RTMCC Advisory Council and conference calls with training focal points and nurse consultants

Discussion:

The on-site educator is able to be at the meetings, hear what the problems are, understand and anticipate what will be needed. Can tailor trainings to observed needs.

RTMCC is one size fits all, but regional model is more responsive. All the other federal training centers cover smaller areas than the RTMCCs.

Analysis of Strengths, Weaknesses, Opportunities, and Threats

Strengths:

1st) Designated CDC and RTMCC coordinators/facilitators

2nd) Support and learning from each other/experiences of other members

3rd) Do more with less/added value

Opportunities:

1st) Apply for money

2nd) Marketing opportunities

3rd) Better use of advocates

Weaknesses:

1st) Sustainability

2nd) Outreach and identifying partners (labs, National training centers, PCSI)

3rd) Self-promotion and promoting the model

Threats:

1st) Loss of regional designees

2nd) Loss of infrastructure and budget cuts

3rd) Lack of discussion at CDC regarding regionalization

Moving Forward

Information gathering:

  • Find out the actual # of people trained and trainings done in New England each year. How does this compare to northeast? (Please send statistics about state-sponsored educational activities with which the Consortium has assisted)
  • We don’t know which programs were complaining, or what they said. Find out # of programs that complained, what they said (“we want this, we need more support” vs “that’s a waste of your money)
  • Identify and apply for money
  • Foundations
  • Government

Advocacy (including ACET, NTCA, NTNC, NSTP, Southeastern region):

  • Write a letter about why the model is successful, what it does, and what would be lost. Suggest that this model be expanded, not deleted. Our letter should go to Kashef and DTBE leadership.
  • Get endorsements from MACET, CT advisory group. Send these letters to CDC.
  • Develop a letter of support we can take to these and other interested parties.
  • STOP TB needs to become a partner. Start with David Debiasi. Approach them with the regionalization part of the TB Elimination plan, try to figure out how to market the plan.
  • Set up meeting at NTCA: Ask to meet with Ken and Kashef. Good to meet face-to-face.
  • Reach out to consortia for other diseases who are organized regionally. Get Consortium on STD group agenda (Heidi). Propose to STD group in New England that we work on PCSI stuff together and with HIV programs
  • Broaden our support within CDC by identifying supporters
  • Approach the person in charge of PCSI and let them know our successes  PCSI as an opportunity to grow the model

Co-operative agreements:

  • Joint proposal with our co-ags to keep regional person in New England, so that we’re on the list of proposals to consider if there’s extra funding. This will be done through the MA co-ag, and the other states can sign on.
  • States can add a “regional collaboration” section to their grants, reports, co-ag, etc.

Marketing the model:

1) promote the consortium, and 2) promote regionalization in other regions

  • Strengthen the on-site support piece of the new TB Elimination Plan.
  • TB Notes: have an article about the Consortium. Think of other places we can publish.
  • Sharon drafting journal article about the Consortium. Need to show achievement and impact.
  • Sue and Carol going to arrange to talk about regionalization on the next Southeastern Region conference call.
  • Create a handout that will be available at NTCA, NTNC, STOP TB meetings.
  • Might need to update work plan, partially for us and partially for marketing, so other regions have an idea what we do.
  • Next year at NTCA, we need to organize a breakout on regionalization.
Attendees

New England TB Consortium:

Connecticut – Heidi Jenkins, Lynn Sosa

Maine – Kathy Gensheimer, Diane Brookes

Massachusetts – Sue Etkind, Kathy Hursen, Sharon Sharnprapai

New Hampshire – Jill Fournier, Lisa Roy

Rhode Island – Two persons denied travel

Vermont – Susan Schoenfeld

RTMCC – Nickolette Patrick

CDC representative – Mark Lobato

Facilitated by: Tony Palomba, Program Director, Massachusetts Medical Society

Welcome: Kevin Cranston, Director, Massachusetts Bureau of Infectious Disease

Prevention, Response and Services

Invited guests:

Carol Pozsik – Executive Director, National Tuberculosis Controllers Association

Lee Reichman – Executive Director, Northeastern RTMCC and the NJ Global TB Institute

Nisha Ahamed – Program Director, Education and Training, Northeastern RTMCC

Maureen Wilce (phone) – Health scientist, Evaluation Team Leader, CDC

Dan Ruggiero (phone) – CDC Team Lead, field Services and Evaluation Branch, DTBE, CDC

Acknowledgement:

We thank DTBE, especially Karyn Mitchell and Kashef Ijaz, for their support without which this meeting could not have taken place.

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