Facilitator’s ReportBinational Health Council (BHC)Strategic Planning Workshop

Presidio-Ojinaga BHCApril 23-24, 2008

Prepared by:Ruth E. Andersen, Ph.D.Inclusive Insights Consulting

Austin, Texas Translated by: Gianna Martella, Ph.D.

Alecto Translations Submitted: 05-15-2008

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I. WORKSHOP BACKGROUND

A. Planning Phase: A short planning meeting was conducted in Ojinaga with some of the workshop’s potential participants about six weeks before the workshop. Organizers of the workshop (from TDSHS/OBH) had already developed the plan of a two-day workshop timeframe for completing the workbook-based strategic planning process. At the planning meeting, the rationale for the strategic planning process was explained by the selected workshop facilitator, Ruth E. Andersen, Ph.D., (hereinafter WF), of Inclusive Insights Consulting, Austin, Texas, a private sole proprietorship owned by the WF. Potential objectives were addressed, the workbook to be used at the workshop was distributed, a date and place for the workshop were set, and some logistical aspectswere discussed. The workshop organizers also met with the WF briefly to consider logistics and other aspects. In addition, Dr. Fernando Gonzalez and the US-Mexico Border Health Association provided helpfulinformation and materials for the WF during the workshop preparation process.

B. Logistics: At the planning meeting, potential workshop participants (hereinafter WPs) decided to meet inPresidio the first day and Ojinaga the second day, primarily because a binational location for the meeting was felt to be supportive of the BHC’s binational mission. Luncheons and snacks for the workshops were coordinated by Bea Martinez of (TDSHS/OBH) with local providers and paid for by the facilitator as host on the first day of the workshop and by the interpreter as host on the second day. City health departments of the two host cities respectively provided appropriate and very commodious meeting facilities, one for each day ofthe workshop.

C. Interpretation/Language Use: At the initial planning meeting, simultaneous interpretation with headsets was utilized. The WF identified some difficulties with this interpretative technique, including distraction and distancing of participants from each other and from the group; interactive challenges such as the difficulty of attending to kinesic and proxemic cues and behaviors while attempting to listen to input from headsets; and equipment failure (some headsets did not function properly). As a result, the WF proposed the use of consecutive interpretation for the upcoming strategic planning workshop. The proposal was accepted and Gianna Martella, Ph.D., owner of Alecto Translations, was secured as interpreter for the workshop on a sub-contract basis using available project funds. As a result, the workshop was conducted bilingually using a subcontracted professional interpreter hired by Inclusive Insights Consulting. The interpreter also functioned as translator for the some of workshop materials and post-meeting materials.

D. Agenda & Materials: The agenda for the meeting was prepared by the WF based on specifications provided by the workbook and the workshop organizers and is attached at the end of this report. The WF also produced a vision worksheet for use at the workshop and oversaw translation of various workshop materials.

E. Process and Limitations: The technique used for the workshop is known as “facilitated discussion.” The expectations for the two-day workshop as set forth in the workbook provided were extremely substantive and included a number of lengthy worksheets for participants’ use. In this case, WPs were unable to complete and use all of these forms in the allotted time, especially given the challenges of limited preparation time for the workshop and limited time within the workshop framework itself. A recommendation for future events of thistype might be to distribute the workbooks to invitees prior to the workshop and ask that they complete certain portions and bring them to the workshop for use in group activities. Under the circumstances, the WF and WPs worked together and did the best they could to accomplish as much as possible. They were aided greatly in theirendeavors by Dr. Manuel Acosta, BHC Co-President from Ojinaga. Besides his cordial and informative

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greeting and closing remarks, Dr. Acosta provided a great deal of leadership and ensured that the workshop was ultimately appropriately conducted as well as productive. Unfortunately, the group had just recently suffered the loss of the Co-President for Presidio, Dr Miguel Escobedo, owing to a conflict in professional responsibilities that made it impossible for him to continue to serve in that capacity.

II. WORKSHOP EVALUATION

A. Methodology: Evaluation questionnaires were distributed following the second day of the workshop. The forms used a four-point Likert scale to measure participants’ satisfaction with, and reactions to the workshop and its various features and aspects. The Likert scale evaluation methodology measures respondents’ opinions by offering for respondents’ consideration one or more items, each of which is a statement. The respondent must react to each statement by choosing one of several responses, which on a five-point Likert scale are as follows: Strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree. Unlike the five-point scale, where each item offers the respondent the choice of the “neither agree nor disagree” response, the four-point scale omits this neutral option, thus forcing the respondent into a type of bipolar reaction formation. This approach has the potential ofskewing responses, since it eliminates the neutral possibility. It is possible to assume that if the item is leftblank, neutrality is indicated, but that is not a certainty. Sixteen participants completed the workshop evaluation questionnaire. The WF tabulated responses to the questionnaire and obtained totals for all questions. Comments were divided into three categories: “favorable,” “unfavorable,” and “mixed,” and tabulated accordingly. Remarks written in the space for “Suggestions for improving interpretation” were divided into categories appropriate to their content and tabulated accordingly. Tabulated results appear on the chart on the following page:

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EVALUATION StronglyAgree

Agree Disagree StronglyDisagree

Item leftblank

Workshop and Materials1. The workshop content satisfied my expectations. 1 9 4 2 02. The workshop examples or activities helped me to learn. 3 8 3 1 13. The workshop materials were useful. 5 9 1 1 04. The audio/visual aids enhanced the workshop. 5 8 2 1 05. The presentations demonstrated were useful. 5 6 4 1 06. The facilities where workshop took place were appropriate. 4 9 2 1 0CommentsFavorable: 1 Mixed: 1 Unfavorable: 3 Item left blank: 11

Facilitator 7. The facilitator demonstrated knowledge in the topic. 4 4 5 3 0CommentsFavorable: 2 Mixed: 1 Unfavorable: 7 Item left blank: 6 8. The facilitator encouraged participation, solicited input from all participants, and managed the group discussion well. 4 3 3 4 2CommentsFavorable: 0 Mixed: 1 Unfavorable: 5 Item left blank: 10

Interpretation for Workshop 9. Was the interpretation useful? 4 2 4 2 410. Suggestions to improve interpretation? Very good, patient: 1 Good but some problems: 2Prefer simultaneous: 3 Not useful/functional/fast enough: 4 Item left blank: 6 CommentsFavorable: 1 Mixed: 0 Unfavorable: 1 Item left blank: 14

Overall Satisfaction 11. Overall, I was satisfied with this workshop. 3 6 5 0 2CommentsFavorable: 4 Mixed: 0 Unfavorable: 4 Item left blank: 8

AGGREGATE SCORES StronglyAgree 38

Agree 66

Disagree 33

StronglyDisagree 16

Item leftblank 9Satisfaction Items

Comments Favor-able 8

Mixed

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Unfavor -able 20

No comment (item left blank) 49

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III. SUMMARY

As shown on the table above, overall responses to the workshop were positive, with positive responses (Strongly Agree + Agree) totaling 104 and negative responses (Disagree + Strongly Disagree) totaling 49. Some of the favorable write-in comments regarding overall satisfaction indicated that something new was learned about the communities of Ojinaga and Presidio, that it was helpful to have a new focus regarding existing resources, and that the experience was enriching. Aggregate scores on the evaluation fleshed out with the write-in comments appear to indicate that participants in general seemed to find the workshop appropriate, useful, and valuable to some extent, but saw problems with the facilitation, interpretation, and organization. Key accomplishments of the workshop include:

Face-to-face networking and interaction with others on the core and virtual regional/binational publichealth teams.

Review of up-to-date epidemiological information from the Presidio-Ojinaga border region, which served and will continue to serve as an effective foundation for evidence-based planning by the BHC.

Formulation of new, well-written vision and mission statements, which should prove useful in the recruiting process for new BHC members as well as in maintaining direction in future endeavors.

Identification of five top priorities for binational focus and future action. Definition of some gaps in the current public health response and formulation of some proposed projectsto address these gaps.

Development of a workplan for the coming months and years.

IV. CONCLUSION The usefulness of the strategic planning process on behalf of this BHC was evident in the accomplishments ofthe participants in spite of significant challenges they faced, all of which can be attributed to circumstances beyond their control, such as perceived quality of workshop facilitation, interpretation, and organization. Theirenergy and enthusiasm in the face of these challenges as well as their obvious dedication to shared values and a common binational agenda were an inspiration to the workshop facilitator. It is hoped that this energy, enthusiasm, and dedication will prove to be equally inspiring to the BHC in the months and years to come as itsmembers join together to address the important work of improving the health outcomes of the people of the Texas-Mexico border. ■

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2008Office of Border Health

Presidio/OjinagaBinational Health CouncilStrategic Planning Workshop

April 23-24, 2008

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Workshop Overview The two-day workshop will address Phases II through IV from the workbook.

Phase II activities: Present overviews of principal public health issues within each jurisdiction. Co-presidents (and/or their representatives) will present a summary of the results of Phase I in a PowerPoint presentation at the outset of the workshop.

Prioritize binational pubic health issues. Workshop participants will discuss and then prioritize public health issues within the context of the jurisdictional overviews presented.

Perform Gap analysis. Workshop participants will identify and analyze the gaps and deficiencies existing between the priority binational public health issues identified under Activity 6 and the current and future programs identified under Phase I.

Phase III activities: Develop Strategic Plan. Workshop participants will then propose answers to the following questions: a. What are the public health priorities and objectives for the BHC Region? (describe the vision of the future)

b. What is the role of the BHC in facilitating actions required to reach the objectives in the binational setting? (describe the vision and mission of the BHC)

c. What are the objectives proposed for the BHC over the next three years in response to the answers to questions a. and b. above?

Phase IV activities: Develop structure of BHC (overall mode of operations). Develop and adopt BHC by-laws on how the BHC should operate.

Develop work-plan to accomplish objectives described in Phase III

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DAY ONE – April 23, 2008 – Presidio, Texas Introductory Activities

Welcome & call to order by host agency: Office of Border Healt9:00 - 10:30 am 9:00 - 9:10 am h,

Texas Department of State Health Services 9:10 - 9:30 am Workshop objectives; introduction of facilitator & interpreter

Adriana Corona - Texas Dept. of State Health Services, Office of Border Health, Health Service Region 9/10 Ruth E. Andersen, Ph.D., Owner, Inclusive Insights Consulting Gianna Martella, Ph.D., Owner, Alecto Translations

9:30 - 10:00 am Self-introductions - All participants 10:00 - 10:30 am Session guidelines & ice-breaker exercise - Facilitator & Interpreter 10:30am - 12:00 noon Update: U. S. Mexico Border Health Association; History and

Operation of BHCs; Our Accomplishments, Vision, & Mission 10:30 - 11:00 am Background review: USMBHA, History & Founding of BHCs,

Participants’ Recollections - Facilitator, Interpreter, & Participants 11:00 - 11:40 am Our Business Plan: Review BHC structure, guidelines, and

operational model. Adopt guidelines as by-laws if desired; discuss meeting schedule/calendar, fiscal capacity and management.

11:40 - 12:00 noon Worksheet Synthesis: Our vision for public health in general and our vision for the health of area residents (facilitated group discussion)

12:00 noon - 1:00 pm Luncheon on the premises hosted by workshop facilitator 1:00 - 1:40 pm Describe our vision for the BHC and the BHC’s mission and role in

working toward our public health vision in the binational setting 1:40 - 3:40 pm Where Are We Now? Overview: Principal public health issues &

local public health systems in Presidio/Ojinaga area 1:40 - 2:30 pm Presenting for Ojinaga, Chihuahua: Dr. Manuel Acosta,

Co-President, Presidio-Ojinaga Binational Health Council 2:30 - 2:40 pm Interpreted summary and question & answer session 2:40 - 3:30 pm Presenting for Presidio, Texas: Saul Rivas, Regional Epidemiologist,

Texas Department of State Health Services, HSR 9/10 3:30 - 3:40 pm Interpreted summary and question & answer session 3:40 - 4:00 pm Preview of Day Two activities & conclusion

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DAY TWO – April 24, 2008 – Ojinaga, Chihuahua

9:00 - 10:00 am Introductory Activities & Prioritization 9:00 - 9:10 am Greeting & call to order by host agency: _________________,

__________________________________________________ 9:10 - 9:20 am Review of agenda, description of participant goals for Day Two

Facilitator & Interpreter 9:20 - 10:00 am Discussion: Based on the information presented on Day One, what

are the top 5 public health issues and priorities for the BHC region? 10:00 am - 12:00 noon Gap Analysis: What are the gaps between where we are and

where we want to be? 10:00 - 10:40 am Analysis: What systems and services are in place to address these

priorities? What degree of success are these achieving? 10:40 - 11:20 am Breakout groups: perform separate gap analysis by jurisdiction

11:20 am - 12:00 noon Discussion & synthesis: perform joint gap analysis for entire BHC 12:00 noon - 1:00 pm Luncheon on the premises hosted by workshop interpreter 1:00 - 3:45 pm How Will We Close the Gaps? – Binational Objectives 1:00 - 2:00 pm Brainstorming: Focusing on binational activities in the binational

context, develop 1-5 public health objectives for the BHC based on the 5 top priorities and existing gaps in systems and services.

2:00 - 3:00 pm Workbook and discussion: Develop functional model standards for the BHC’s public health objectives (3-5 Year Plan to address public health).

3:00 - 3:45 pm Discussion: Next Steps 3:45 - 4:00 pm Acknowledgements & Adjournment

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