To ensure the success of this recommendation, the committee suggests that the NCIPC work with other relevant federal agencies (e.g., NHTSA, MCHB, NIOSH, CPSC) to implement the training recommendations of the National Plan (NCIPC, 1993). Additionally, to ensure a trained work force to conduct injury research, NCIPC should initiate a formal program of individual and institutional training grants for pre-and postdoctoral candidates.

Building State and Community Infrastructure

NCIPC has fallen short of expectations for building state and local injury prevention programs. The formation of such programs nationwide was a major force behind the placement of an injury center within CDC. In its 1988 report, the NRC recommended CDC as an opportune location for a federal injury program because of its long-standing and durable relationships with state and local health departments. The NRC envisioned a constellation of programs in every state and community, with the CDC as a focal point for financial and technical assistance. CDC was seen as pivotal to moving injury prevention research into practice (NRC, 1985, 1988). More broadly, the need for vigorous federal efforts to shore up state and local health programs was described in a landmark report (IOM, 1988).

NCIPC's shortcomings in cultivating state and local programs are a function of three factors: resource constraints, its policy decision (noted earlier) to steer away from capacity building and towards more focused injury surveillance and interventions (through cooperative agreements); and greater reliance by Congress on earmarked funding for state and local activities. NCIPC estimates that $15 million of the $19 million it disbursed through cooperative agreements in FY 1997 was directly or indirectly related to Congressional earmarks over the past several years (M. Scally, NCIPC, personal communication, 1998). From the point of view of the state and local programs, NCIPC's role does not sufficiently satisfy their needs for technical assistance and is overly prescriptive.

With respect to technical assistance, NCIPC has no formal office serving state programs. Most other federal agencies seeking to build state programs have entire offices whose mission is devoted to state and local assistance. The technical assistance should transcend the technical aspects of program design and implementation. It should also entail assistance in identifying and accessing funding from NCIPC as well as other federal and private sources. This report outlines the daunting array of possible funding sources in multiple government agencies. The complexity can be overwhelming even to aficionados of federal injury programs. It is imperative for state and local programs to receive help in identifying an array of potential sources of funding, in both the public and the private sectors, with which to build comprehensive injury programs.

The conversion to cooperative agreements is a relatively new development. The transformation of more flexible grants into more circumscribed cooperative



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