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nity Health. It created a committee involving representatives from the State Maternal and Child Health and Children with Special Health Care Needs programs; academics in both public health and maternal and child health; staff of the National Governors Association; staff of the National Association of Maternal and Child Health programs; and staff of the Health Resources and Services Administration. This diverse and sizeable team determined a set of core performance measures states could use to show the progress of their maternal and child health programs.

The MCHB committee initially struggled over whether to start the process from the top down by setting national goals and then arraying state performance measures under them, or to start from the bottom up by amassing examples of performance measures from state maternal and child health programs as well as from academia, professional associations, and institutions and then developing national goals that reflected those measures.

Taking the latter approach, the committee collected maternal and child health measures and organized them by populations served, availability of data, and consistency of measures. The initial list of measures approached 300, with duplication as well as gaps. Next, the committee set criteria for paring down the list and filling in gaps, including the ability of the states to measure changes in the maternal and child health programs and the availability of desired data. Through its Office of State and Community Health, MCHB took the lead in guiding the committee to select a final set of 18 national performance measures that went into the new guidance to states.

One year after the committee began its work, draft measures were presented to all state maternal and child health directors for their review and comment. Once state comments were collected, a single document was compiled that outlined the process for capturing the data required by the Title V legislation, incorporated the revised performance measures, and allowed the states the flexibility to add their own performance measures based on their perceived needs. When the first draft was completed, 17 states volunteered to pilot test the new procedures.

During the pilot test, MCHB guided development of an electronic reporting system to allow the states to submit their applications and annual reports and to capture all the quantitative data necessary for performance measurement as well as qualitative programmatic information. All 59 jurisdictions in the program received intensive training in the new procedures. The guidelines and database on the MCHB block grant program has become a useful tool for a number of audiences including Congress, the



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