A Leadership Training Model

8/21/2019 A Leadership Training Model

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Infants Young Children

Vol. 18 , No , l , p p , 6 0 - 7 1

© 2005 Upp incott W illiams & Wilkins,

Inc.

Leadership Training Model

to Enhance Private and Public

Service Partnerships or

Children With Special

Healthcare Needs

Diane

L .

Magyary PhD ARNP; Patricia Brandt PhD ARNP

Healthcare in this nation and the na ture ofth e workforce are experiencing th e m ost dramatic trans-

formation in history. With healthcare reform, health professionals are increasingly being called

upon

to be

leaders

in

creating

a

wide variety

of

community partnerships

to

influence

and

doc-

ument accessible, high-quality, cost-effective service systems. In particular, community partner-

ships between private and public sectors of society need to be coordinated to achieve optimal

health

for

children with special healthcare needs,

and

their families

and

communities. Healthy

People 2010 objectives encourage new partnership development be tween the private-public sec-

tors of healthcare in collaboration with families and com munities. The reformulation of health-

care

and the

workforce likewise calls

for a

revision

of

professional education

to

produce lead-

ers who have the competency to create and engage in partnerships on behalf of children with

special healthcare needs. In this article, a nursing training grant's model of leadership is dis-

cussed that encom passes the full spectrum of private-public partn ersh ips using the M aternal Child

Healthcare Service Pyramid model, with p articular emphasis on th e interface among 4 serv ice lev-

els: (1) direct healthcare services, (2) enabling/advocacy services, (3) population-based services,

and (4) infrastructure-building services. An additional leadership dimension, cultural competency,

is identified as an essential aspect of leaders wh o engage in partne rship building with diverse com-

munities. Finally, the training grant's formative and summative evaluation process is discussed, and

illustrated by presenting data that illustrate culturally com petent leadership . Key words: children,

healthcare, leadership, nursing, training

From

the

Departments

o f

Psychosocial

and

Community

Health (Dr Magyary)

and

Family

and

Child Nursing (Dr Brandt), University o f

Washington, Seattle, Wash.

Funding or this training grant was provided by theMa-

temai and Child Health Bureau, Public Health Service,

US Department of Health and Human Services

grant.

Number 6 T80MC

00002-37.

Appreciation is extended

to many colleagues who have participated in the train-

ing grant over the years. Gratitude is extended tojody

Okam ura, the program coordinator who assisted in the

preparation of this manuscript

HEALTHCARE REEORM AND THE

CALL

FOR LEADERS

Healthcare in this nation and the nature of

the workforce are experiencing the most dra-

matic transformation in history (Pew Health

Professions Commission, 1995), With health-

care reform, professionals are increasingly be-

ing called upon to engage in leadership ac-

tivities to improve the accessibility, quality,

and accountability of the healthcare system.

Interdisciplinary leadership networks are in-


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A Leadership Training Model 61

teams of professionals (Committee on Quality

of Healthcare in America, 2001).

The reformulation of healthcare likewise

calls for a revision of professional education

to produce interdisciplinary leadership teams

to assure that the evolving healthcare sys-

tem provides comprehensive and coordinated

services that are evidence-based, accessible,

equitable, of quality, cost-effective and pro-

vide culturally competent care to all popula-

tions including the underserved (Committee

on Quality of Healthcare in America, 2001;

Pew Health Professions Commission, 1995).

Leadership competencies, attitudes, and val-

ues have a fundamental impact on the health-

care system (O'Neil, 1993; Shugars, O'Neil,

Bader, 1991). The Institute of Medicine Re-

port Health Professions Education: A Bridge

to Quality (Committee on the Health Pro-

fessions Education Summit, 2003) urges pro-

fessional education to instill attitudes, values,

and com petencies required to engage in inter-

disciplinary collaborative relationships with

diverse population of families, emphasizing

evidence-based comprehensive and coordi-

nated care that is culturally respectful and

competent.

Formulation of nursing training

grant in response to the call for

leaders in healthcare

In response to the challenge of educat-

ing professional leaders for the 21st cen-

tury, we developed a project focused on

the enhancement of clinical and leadership

competencies in the graduate preparation of

nurses who have a specialty with emphasis

on providing family-centered, culturally com-

petent, and evidence-based comprehensive

healthcare to ethnically diverse and under-

served populations of children with special

healthcare needs (CSHCN), within the con-

text of their families and communities (Mag-

yary,

2003;

Magyary Brandt, 1998). CSHCN

population

was generally defined as infants

(Office of

State

and Comm unity

Health,

1997,

p. 114). Educating leaders to advance health-

care for CSHCN is particularly important for

the following reasons:

• The prevalence of CSHCN has signif-

icantly increased (Children's Defense

Eund, 2001; Collins, 1997; Office of State

and Community Health, 1997; Simpson,

Bloom, Cohen, Parsons, 1997).

• Families and com munities are faced w îth

enormous service and fiscal challenges to

enhance CSHCN optimal health and qual-

ity of life (Children's Defense Fund, 2001 ;

Ireys,

Anderson, Shaffer, & Neff, 1997;

Newacheck Taylor, 1992).

• CSHCN often do not receive services that

place emphasis on health promotion or

the emotional and behavioral aspects of

health (Community Tracking

Study,

1997;

Ireys, Grason, & Guyer, 1996; Office of

Disease Prevention and Health Promotion

[ODPHP], 1997).

• Families have difficulty negotiating and

coordinating a patchw ork of different ser-

vice systems, including health, education,

and social/welfare (Blancquaert, ZvaguHs,

Gray-Donald, & Pless, 1992; Cartland &

Yudkowsky, 1992; Community Tracking

Study, 1997; Ireys et al., 1996).

• Primary care providers in managed care

plans are increasingly challenged to pro-

vide direct care and case management ser-

vices to CSHCN, and yet these providers

often overlook early detection of CSHCN

and subsequently miss the opportunity

for early intervention. Moreover, man-

aged care emphasis on cost containment

often deters the provision of community-

based comprehensive care by primary

care providers (Chrvala & Bulger, 1999;

Health Resources and Services Adminis-

tration, 1999; ODPHP, 1997).

N E WL Y D E F IN E D P R IV A T E PU B U C


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62

INFANTS

YOUNG CHIUDREN/JANUARY-MARCH

2005

family-centered interdisciplinary healthcare

services for the CSHCN population highlights

the need for leaders to generate creative so-

lutions across the entire spectrum of health-

care, inclusive of the private and public sec-

tors of healthcare services. The formulation

of creative partnerships between the private

and public sectors of healthcare provides a

seamless interdisciplinary infrastructure to

assure that the day-to-day clinical practice

incorporates evidence-based best practices

for

CSHCN

pop ulations, and their families and

communities. Newly defined private-public

sector partnerships will benefit CSHCN

populations through enhancem ent of optimal

health and quality of

life,

and also benefit pri-

vate and public healthcare systems through

cost sharing and containment. Prominent

professional and governmental reports are

urging leaders to advance private-public

sector healthcare partnerships. The 1997

Improving Health in the Community report

(IOM) emphasized the need for personal

direct healthcare services and public health

activities to be coordinated and directed

toward improving the health of the entire

community within a socially and politically

responsible con text (Durch, Bailey, & Soto,

1997). Healthy People 2010 action plan takes

into consideration that new relationships will

be defined between public health depart-

ments and healthcare delivery organizations

(ODPHP, 1997).

Conceptualization of leadership across

the private public spectrum of

healthcare o n behalf of CSHCN

For the purposes of our project, leader-

ship was conceptualized to encompass the

fuU spectrum of leadership competencies re-

quired to generate, disseminate and imple-

ment evidence-based best practices at the in-

dividual level as well as at the aggregated

community health level, and thus ultimately

advance partnerships between private and

and public sectors of healthcare. The 4 health-

care service levels, namely, direct health-

care services, advocacy (enabling) services,

population-based services, and infrastructure-

building services (Office of

State

and Commu-

nity Health, 1997), are interrelated and coor-

dinated to advance the health of the entire

community (Fig 1).

Each healthcare service level and the inter-

face among the service levels are essential to

advance community-based, comprehensive,

coordinated, family-centered healthcare for

CSHCN, and their families and communities.

The definitions of leadership competencies

associated with each of the 4 healthcare ser-

vice levels w^ere revised and expanded upon

to identify specific clinical and leadership ac-

tivities on behalf of the CSHCN population

(Brandt & Magyary, 1999). It is rare to find a

graduate healthcare program that emphasizes

the interface across all 4 healthcare service

levels. For example in nursing. Nurse Prac-

titioner graduate programs typically empha-

size direct healthcare and advocacy services;

in contrast. Comm unity Health Nursing grad-

uate programs typically emphasize aggregate

focused population-based and infrastructure-

building services. The cross-fertilization of

strengths from each program enhances lead-

ership development across the entire health-

care service spectrum that are interrelated

through private and public healthcare part-

nerships. The nursing training grant offered

students a unique opportunity to engage in

cross-fertilization-type activities. Nurse Prac-

titioner students with Community Healthcare

students jointly engaged in training grant

activities designed to cultivate appreciation

for the entire spectrum of the 4 healthcare

service levels that are interrelated through

private-public partnerships.

Culturally competent leadership

An emerging challenge for the 21st cen-

tury is the formulation of private and public


4/13


DIRECT

HEALTHCARE

SERVICES

Examples:

Interdisciptinary

Basic Heatth Services,

and Health Services for CSHCN

ADVOCACY SERVICES

Examples:

Transportation, Translation, Outreach,

Respite Care, Heatth Education, Famity

Support Services, Purchase of Health Insurance,

Case Management, Coordination with Medicaid,

WIC, and Education

POPULATION BASED SERVICES

Examples:

Newborn Screening, Lead Screening, Immunization,

Sudden Infant Death Syndrome Counseling, Orat Heatth,

Injury Prevention, Nutrition and Outreach/Public Education

INFRASTRUCTURE BUILDING SERVICES

Examples:

Needs Assessment, Evaluation, Planning, Policy tDevetopment,

Coordination, Quatity Assurance, Standards Development, Monitoring,

Training, Apptied Research, Systems of Care, and Information S ystems

Figure 1. MCHB pyramid m odel encom passes 4 interrelated hea lthcare service levels. From Background

and framework of Title v Block Grant Gu idatice, the HSRA Perform ance M easurem ent Systems. by Office

of State and Community Health, 1997.

estimating to comprise

40%

of th e US popula-

tion. And yet, typically in the United States,

professionals are no t racially or culturally rep-

resentative of the people they serve, or have

developed knowledge and experience using

culturally competent approaches (Committee

on Ways and Means, 1992; Smedley, Stith,

& Nelson, 2003). Racial and ethnic minority

populations including CSHCN typically have

more negative developmental and health out-

comes in comparison to Caucasian popula-

tions (Smedley et al., 2003). This disparity in

health outcomes is due to

a

variety of reasons

such as lack of access to quality and culturally

sensitive h ealthcare (Com mittee on Quality of

Healthcare in America, 2001; Cross, Bazron,

veloped, and evaluated during the student's

course of study. Cultural competency is con-

ceptualized as a necessary leadership quality

for the successful implementation ofth e

4

lev-

els of healthcare services. Culturally compe-

tent care

is

defined

as

the provision of services

to families and communities that honor dif-

ferent beliefs, values, and interpersonal styles

and behaviors within the collaborative pro-

cess of partnership building and the incor-

poration of multicultural professionals, com-

munity leaders, and lay representatives in the

policy development, administration, and the

provisions of services within the collabora-

tive process of partnership building (Office

of

State

and Com munity Health, 1997). Inher-


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64

INFANTS

YOUNG CHILDREN/JANUARY-MARCH

2005

building is more likely to b e successful and ef-

fective if completed in the context of cultur-

ally sensitive interactions. An evolving body

of research substantiates that better health

outcomes occur if the family participates in

the decision-making process with culturally

sensitive professionals (Association of Amer-

ican Medical Colleges, 1999; Committee on

Quality of Healthcare in America, 2001). Fam-

ilies and communities included in health-

care planning and policy development en-

hance the cultural sensitivity and quality of

healthcare services (Barger, 1997; Bournes &

DasGupta, 1997).

The past 2 decades have -witnessed a

strong evolving emphasis on collaboration

among families, communities, and profes-

sionals. Several significant laws and policies

emphasize collaborative partnership building

between families with CSHCN and systems of

healthcare as well as public education (Healy

et al., 1989; Shelton

Stepanetk, 1994). The

Washington State Health Care Policy Board

(1997) endorsed partnership networks

among families, communities, health provi-

ders, and health plans as the primary way to

promote access to high-quality, affordable.

culturally competent services for CSHCN.

The National Institute of Nursing Research

Expert Panel on Community-Based Health-

care (1995) emphasized the critical nature

of community partnerships to advance

healthcare as highlighted by Barger (1997),

stating, comm unity-based care is founded

on partnerships between consumers and

providers of care and through these partner-

ships, services are developed and promoted

that are both sensitive and relevant to the

cultures and mores of the individuals, fami-

lies, populations and communities to which

care is directed (p. ll ).T he complexity of

developing successful and effective private-

public healthcare collaborative partnerships

with families and communities across the

4 levels of healthcare requires professional

leaders who are culturally competent and

sensitive. The training grant's culturally com-

petent leadership model encompasses the

dimensions of (a) multicultural competency,

(&) complexity of human development and

diversity, and (c) social-political responsibility

and activism (Magyary and Brandt, 1999).

Figure 2 illustrates the training grant's

culturally competent leadership model.

MULTICULTURAL COMPETENCY

Congruency

Attitudes/Beliefs/Values/Knowledge/Skills

COLL BOR TIVE

PROCESS

P RTNERSHIP BUILDING

WITH

F A M I L I E S ,

C O M M U N I T I E S , A ND PROFESSIONALS

COMPLEXITY

HUMAN DEVELOPMENT AND DIVERSITY

Person-centered Knowledge

SOCIAL -POLITICAL

RESPONSIBILITY A ND ACTIVISM

Active Stance Against Oppression


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A Leadership

Training

Model

65

Multicultural competency

Multicultural competency is a way of think-

ing and interacting that requires ongoing

learning. A culturally competent profes-

sional has been defined in many ways; how-

ever, a consistent definitional theme high-

lights the notion of congrueney in one's

attitudes, beliefs, know ledge, and skills in ac-

tively dem onstrating culturally sensitive care.

Sue,

Arredondao, and McDavis (1992) identi-

fied 3 congruency dimensions that character-

ize a culturally compete nt professional. These

dimensions we re adap ted to apply to both in-

dividual and systems of care.

• Individual and institutional aw^areness of

one's oŵ n assumptions about human be-

havior, values, biases, preconceived no-

tions,

personal limitations, and so forth

(Sue e t

al.,

1992, p . 75).

• Individual and institutional understand-

ing of the worldview of culturally differ-

ent clients/populations without negative

judgment (Sue et al., 1992, p. 75).

• Individual and institutional development

and delivery of appropriate, relevant,

and sensitive interventions/programs and

policies in working with culturally differ-

ent clients/populations (Sue et al., 1992,

p.

75).

Complexity of human development

and diversity

ImpUcit in multicultural competency is the

recognition that human beings are complex

and multidimensional. Multiculturally sensi-

tive and competent healthcare providers are

required to consider th e interplay betw een in-

dividuals and collective units. One's socially

constructed identity is influenced by one's

age, socioeconomic class, race/ethnicity, gen-

der, sexual orientation, religion, health con-

dition, disability, etc. For example, a child's

definition of self and the meaning ascribed

to life experiences are socially constructed

propensities such as temperament and cog-

nitive and emotional disabilities interact w ith

environmental socialization processes within

the family and the broader community. This

complex developmental process has been re-

ferred to in the literature as a transactional

ecological developmental perspe ctive.

Given the complexity of developmental

proce sses, consideration of both culture-

centered collective knowledge and person-

centered individual knowledge enhan ce

appreciation for the complexity of human

diversity. Sasao and Sue (1993) c onceptualize

cultural complexity at 2 levels, the indi-

vidual level and the larger collective level.

Taking into consideration these 2 levels of

complexity, cultural competency entails the

interface between 2 types of knowledge.

Culture-centered collective knowledge is

understanding how a child or a family, or

both, perceives itself as being similar to its

identified social-cultural unit. This type of

knowledge requires an understanding about

com mo nalties that characterize social-cultural

groups. Person-centered individual knowl-

edge is understanding h ow a child or a family,

or both, perceives itself as being different

from its identified social-cultural unit. This

type of knowledge requires an understanding

about individual variations often referred to

as w^ithin-group differences. Som etimes,

individuals may perceive them selves as being

positioned outside the group norms, thus

being a minority who may be marginalized

even within their own cultural group. In

addition, generational differences and levels

of acculturation often exist within social-

cultural groups or even within a faniily that

holds m ultiple perspectives and values.

Two competency skills that incorporate

the notion of person-centered knowledge

and culture-centered know ledge is scientific

mindedness and dynamic sizing, as pro-

posed by Sue (1998). Scientific mindedness

requires professionals to explore and check


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66 INFANTS

YOUNG CHILDREN/JANXJARY-MARCH 2005

Dynamic sizing requires professionals to un-

derstand when to generalize behaviors that

reflect a collective sense of identity versus

knowing w hen to individualize behaviors that

reflect an individualized sense of identity that

is different from one's social-cultural group.

The competency skills of scientific minded-

ness and dynamic

sizing

becom e critical w hen

professionals are trying to understand how

CSHCN and their families view^ their social-

cultural identity as well as the ir individualized

sense of self and of family.

Social political responsibility

and a ctivism

Multicultural competency that embraces

the complexity of human diversity protects

against stereotypical thinking, prejudices, and

discriminatory behaviors directed toward dif-

ferent collective social-cultural groups and in-

dividuals within those groups. As profession-

als develop collaborative partnerships with

families and communities, they cultivate an

understanding of socioeconomic and politi-

cal influences on health disparity. Over time,

this understanding is translated to the de-

velopment and promotion of programs, poli-

cies,

and legislation that validates an orien-

tation to strengthen assets and protective

factors within families and communities. Pro-

fessional, com munity, and family par tnership s

created to advocate on behalf of CSHCN have

advanced quality, comprehensive, accessible,

and culturally competent healthcare over the

years.

EVALUATION O F TRAINING GRANT

An essential component of the training

grant was the implementation of an eval-

uation model to document, evaluate, and

enhance the grant's achievement of perfor-

mance outcomes—in particular, the educa-

tion and socialization of culttarally competent

nursing leaders who advance healthcare for

uative data after th e graduate program of stud-

ies. For the purpose of this article, examples

of formative and summative evaluation will be

presented to illustrate the translation of the

leadership and the culturally competent con-

ceptual model to actual educational experi-

ences and outcomes.

Formative evaluation during

graduate studies

Leadership portfolio

Each student documents their evolving

mastery of leadership and cultural competen-

cies by completing on a quarterly basis the

training grant's Web-based Leadership Port-

folio (Brandt & Magyary, 1999). The Lead-

ership Portfolio template is based on the

training grant's conceptual pyramid model

of leadership service levels (infrastructure-

building services, population-based services,

advocacy/enabling services, and direct health-

care services), with the addition of cultural

competencies. Each student describes their

leadership activity for the quarter, articulates

how the leadership activity interfaces with

the specific leadership and cultural compe-

tencies, and plan their ongoing developmen-

tal leadership goals for the future. Particular

emphasis is placed on the development of

leadership competencies that advance health-

care services for CSHCN, and their families

and communities. Leadership competencies

are advanced through nursing and inter-

disciplinary coursework, scholarly projects,

fieldwork, clinical leadership practicums,

community-based partnership-building activ-

ities, and clinical scholarly projects, theses,

and dissertations.

Cotntnunity-catnpus partnerships

As students think about their leadership

goals and evaluate their advancement in lead-

ership competencies through completion of

the Leadership Portfolio, innovative inter-

disciplinary collaboration with families and


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fostered by the Comm unity Campus Partner-

ships for Health for Creating Healthier Com-

munities, an interdisciplinary organization

that (a) strengthens partnerships between

health professionals, educational institutions,

and communities, including service agencies

to address unmet health needs and improve

the health of comm unities;

(fo)

instills an eth ic

of community service and social responsibil-

ity in health professions schools, students,

and faculty; and (c) equips the next genera-

tion of health professionals with community-

oriented leadership competency (Seifer &

Conners, 1997). One of the training grant's

process goals measured on a quarterly basis

was the involvement of faculty and students

in campus-community partnership-building

activities.

An example of one of the training grant's

campus-community partnership projects in-

volved the collective effort by faculty, stu-

dents, community-based clinicians, and lay

representatives jointly engaged in a process

to develop, test, and refine a Decision Tree

and Clinical Path for the Assessment and Treat-

ment of Children with self-regulatory disor-

ders such as Attention Deficit and Hyperactiv-

ity Disorder (Magyary & Brandt, 2002). The

collaborative effort Ulustrates how the 4 lead-

ership levels of the MCH Pyramid Model are

encompassed within the ADHD collaborative

project.

The first level of the MCH Pyramid Model,

infrastructure building, involved a clinical re-

search process that began with a community

needs assessment asking pediatric-oriented

professionals to identify gaps in their clinical

expertise. Professionals from a wide variety

of healthcare systems (primary care clinics,

mental health clinics, school health clinics,

and public health departments) expressed

concerns about their expertise in behavioral

assessments, with special notation placed on

the assessment, diagnosis, and treatment of

young children challenged with ADHD. Given

Hyperactivity Disorder (Magyary & Brandt,

2002; Magyary, Brandt,

Kovalesky, 1996).

The second MCH Pyramid Model lead-

ership level, population-based services, in-

volved explaining to administrators the cost-

benefits of systematically incorporating the

ADHD

Decision Tree and Clinical Paths in th e

healthcare program for high-risk clinical pop-

ulation groups. The third

MCH

Pyramid Model

leadership level, advocacy/enabling services,

involved dem onstrating how to use

the ADHD

Decision Tree and Clinical Path educational

materials for case management, service coor-

dination, and family empowerment services.

Special emphasis is placed on cultural sensi-

tivity by assuring that the family's personal

health and cultural beliefs, knowledge, atti-

tudes, and response patterns are understood

and respected. Finally, the fourth MCH Pyra-

mid Model leadership level, direct healthcare

services, entailed assisting professionals to

systematically incorporate the ADHD Deci-

sion Tree and Clinical Path in their daily clini-

cal practice in collaboration with families.

Dissemination of the ADHD Manual has

occurred through in-services, workshops,

courses, and distance-learning modalities

involving more than 1000 professionals

representing a variety of disciplines. Ongoing

feedback from professionals and families

identify the urgent need to detect and treat

self-regulatory disorders, including ADHD

expressed earlier in life. As

Arons,

Katz-Leavy,

Wittig, and Holden (2002) state, Whereas

great progress has been made in diagnosing

and treating children with ADHD, scientists

and physicians are still struggling to un-

derstand the disorder among preschoolers

(p . S58). The high prevalence of disruptive

behaviors in very young children, aged 1-4

years, has generated theory development and

empirical investigation in the early expression

of self-regulatory developmental disorders

that involve mood/affect, motor-sensory,

attentional, physiologic, and behavioral

systems (Thomas & Clark, 1998). The Zero


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68

INFANTS YOUNG CHILDREN/JANUARY-MARCH

2005

Center for Clinical Infant Programs, 1994)

offers a useful way to conceptualize and

operationally define self-regulatory disorders

within the dyadic parent-child relationship.

Currently, an interdisciplinary team of faculty,

students, and community-based professionals

with families are engaged in developing a

clinical research protocol based on the Zero

to Three Diagnostic Classification System

that will be used in primary care settings

for the early detection and treatment of

self-regulatory disorders expressed by infants,

toddlers, and preschoolers.

SUMMATIVE EVALUATION

P OS T GR A D U A T ION

For the purposes of this article, examples

of postgraduate leadership activities will be

highlighted illustrating h ow graduates are per-

forming culturally competent leadership ac-

tivities across the levels of the MCHB Pyra-

mid Model of Care on behalf of children

and adolescents with special healthcare needs

and the ir families. Data were collected on 39

master's-level nursing graduates who had en-

rolled during the 2-year curricular grant pe-

riod from Fall 1998 to W inter 2003 (Magyary,

2003).

Employment

The Graduate Questionnaire consisted of

10 close-ended questions designed to obtain

employment information with respect to po-

sition, responsibilities, location, and popu-

lations served. Master's prepared graduates

competitively engage in the hiring process be-

cause of their clinical competencies to com-

bine primary and specialty care for CSHCN

and because of their leadership competency

to conceptualize healthcare across the entire

private-pubUc spectrum ofthe 4 service levels

as

depicted

by the MCHB

pyramid model. The

consistent theme demonstrated by the major-

with leadership functions. The newly cre-

ated nursing roles are implemented within the

context of interdisciplinary collaborative part-

nerships with families and communities to

advance healthcare for children/adolescents

with special healthcare nee ds, and their fami-

lies and communities.

The majority of master's prepared grad-

uates have found employment as certified

nurse practitioners or clinical nurse special-

ists ŵ ho integrate advance prac tice with lead-

ership responsibilities. The nurse p ractitioner

students have obtained advanced practice

certification at the national level as pediatric

nurse practitioner or psychiatric nurse prac-

titioners. AU of the employed graduates are

providing services and leadership activities

on behalf of chUdren/adolescents with spe-

cial healthcare needs that include physical,

developmental, neurobiological, and/or

psychological conditions often coupled with

environmental risk/protective factors. Eighty-

seven percent of the employed graduates

provide services to populations who are

medically underse rved as defined by

a

short-

age of health professionals and/or healthcare

services directed to both private and public

agencies with families who are underinsured,

homeless, residents of public housing, and/or

recipients of welfare. These populations were

also characterized by a large percentage of

ethnic minorities. Graduates tended to be

employed by inpatient hospitals, outpa-

tient hospital clinics, community clinics,

government-related health facilities, public

health departments, home care facilities,

and child developmental centers. The geo-

graphic location of employment included

rural, inner-city urban, urban, and suburban

areas.

The 4

MCH

core leadership functions were

incorporated into graduates' job responsibil-

ities with a designated average percentage

of time devoted to infrastructure building

(21%),

population-based services (17%), en-


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A

Leadersijip Training

Model 69

evaluated through self-analysis as well as sys-

tem and policy analysis.

Leadership examples

The Graduate Profile form consists of 20

open-ended questions asking graduates to de-

scribe specific leadership activities and how

their leadership activities affect healthcare

for CSHCN, and their families and commu-

nities. Graduates described participation in

leadership activities that encompass the 4 ser-

vice levels of the MCHB Pyramid Model, of-

ten requiring an interdisciplinary collabora-

tive effort in partnerships with families and

communities. The following is a compila-

tion of those leadership activities (Magyary,

2003):

• 33 clinical studies and dem onstration

projects

• 12 community-based assessment projects

• 52 healthcare service program evaluation

projects or quality assurance projects

• 19 leadership roles in care coo rdination/

case management activities

• 26 interdisciplinary and/or interagency

partnership-building programs

• 18 advocacy service activities

• 20 standards of care activities

• 45 mem bership or leadership roles in na-

tional professional organizations

• 13 participant roles on advisory board/

council

• 8 publications in peer-reviewed journals

• 3 study guides for Reagents CoUege

exams

• 9 presentations at regional conferences

• 35 continuing education/in-service guest

lecture presen tations and university-level

lectures

• 19 family health educational materials/

produ cts developed and disseminated

The following are selected descriptive

examples of graduate leadership activities

and how these leadership activities have af-

fected healthcare on behalf of CSHCN, and

pilot interdisciplinary service program

for substance-abusing mothers and their

infants.

Quality assurance activities resulted in

the development of interdisciplinary-

team pain control protocols and stan-

dards including young children; modifica-

tion of the pain management services to

be more responsive, available, and stan-

dardized; the development of pain con-

trol educational materials and the provi-

sion of community outreach educational

and in-service programs.

Community needs assessment resulted

in an interdisciplinary transition ser-

vice whereby NICU discharge service

is coordinated with primary care and

community-based early intervention ser-

vices as one seamless program.

Community needs assessment and pro-

gram development activities resulted in

the adaptation of a tuberculosis teaching

kit to enhance therapeutic adherence and

decrease the potential spread of tubercu-

losis among east African refugees' families

who have a child newly diagnosed with

tuberculosis.

Community partnership-building ac-

tivities resulted in interdisciplinary

consultant service between a neurode-

velopment center and a state-supported

day care that serves infants and young

CSHCN.

Program planning activities in collabora-

tion with African American families re-

sulted in the development and evalua-

tion of comprehensive inpatient and out-

patient services for children with sickle

cell and their families, including com-

munity and school outreach educational

programs and the annual summer camp

program supported by state funds for

genetics.

Program development activities in collab-

oration with the community expanded


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70

INFANTS

YOUNG CHILDREN/JANUARY-MARCH

2005

• Initiation of a case management program

resulted in timely coordinated access

to comprehensive primary and spe-

cialty outpatient services for infants and

CSHCN.

• Chart review on breast-feeding rates re-

sulted in the collaborative development

of a lactation support program with

Hispanic mothers in a primary care site.

• Advocacy building with mental health-

care agencies created avenues for timely

referrals and access to mental health ser-

vices,

including young children.

SUMM RY

The MCH pyramid model on healthcare ser-

vice levels coupled with a cultural compe-

tency conceptual framework proved to be

useful in training nursing leaders with an em-

phasis on leadership activities that interface

the private and public sector within the evolv-

ing healthcare system. Culturally competent

leadership development through collabora-

tive campus-community partnership building

was emphasized across the entire healthcare

service spectrum (direct healthcare, advo-

cacy, population-based programs, and infras-

tructure building). The interdisciplinary edu-

cational process enriched the nursing training

grant's emphasis on famUy-centered compre-

hensive and well-coordinated healthcare ser-

vices involving teams of different disciplines

and ethnically diverse teams of healthcare

providers. Ultimately, interdisciplinary collab-

oration ŵUl result in a well-coordinated and

comprehensive delivery of healthcare that

better serves CSHCN, and their families and

communities.

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