Advisory Committee to the Director State, Tribal, Local and Territorial Workgroup Live Meeting/Conference Call Monday, March 21, 2011 David Fleming, MD, Chair 1

Conference call Objectives: 1) To agree on high-level recommendations to the ACD for enhancing CDC’s support to STLT health jurisdictions. 2) To determine a process for providing advice to the ACD/CDC on managing within budget reduction environment. 2

Agenda Welcome Dr. Fleming, Chair, STLT Workgroup Discuss process to advise ACD on impacts of budget reductions Dr. Fleming/Dr. Monroe Discuss recommendations to ACD John Auerbach/Carol Moehrle Wrap up 3

Recommendations to the ACD State, Tribal, Local and Territorial Workgroup Charge: to produce recommendations to enhance CDC’s support and maximize resources to develop needed capacity throughout the STLT community. 4

Categories of Recommendations Flexibility Outcome-focused and Accountable Substantial Engagement Technical Assistance 5

Recommendations: 1. CDC should request from Congress more flexibility in awarding of funds without categorical and other constraints 2. CDC should evaluate feasibility, and where possible, grant awards that are bundled or integrated rather than limited and categorical 3. CDC should enable funding and coordination of linked or common activities across multiple grants in a jurisdiction 6

Recommendations: 4. CDC should develop and implement a process to better define and fund both program-related and agency-wide infrastructure costs necessary for effective execution of categorical cooperative agreements. 5. CDC should encourage new cross jurisdictional approaches with unified funding such as collaboration between several states in a region or a group of counties, however this should not supplant current STLT funding. 7

Recommendations: 6. CDC should devise and implement a new mechanism for quickly resolving questions about expenditures of grant funding or other contracting related questions without fault or penalty 7. CDC should utilize cooperative agreements when contracting with States and Locals. 8. CDC should strive for a consistent cooperative agreement approach that maximizes interactive, open and innovative program implementation. 8

Recommendations: 8. CDC should create incentives and enable use of grant funds to address causal/social determinants that underpin specific program goals 9. CDC should develop consistent, agency wide guidance to balance the use of process as well as outcome metrics. 10. CDC should collaborate with STLTs to develop a unified set of governmental public health system objectives. 9

Outcome-focused and Accountable Recommendations: 11. CDC cooperative agreements should support evidence based activities as well as innovative efforts that are community-developed and culturally oriented. 12. CDC should support PHAB accreditation as a beneficial measure of infrastructure development. 10

Recommendations: 13. CDC should seek meaningful input of STLTs in matters of significance - such as making the business case, setting priorities, determining goals and objectives, selecting intervention & evaluations. 14. Remove this bullet Establish consistent principles related to the Cooperative Agreement approach 11

Recommendations: 15.CDC should ensure that project officers have expertise in both grants management and technical assistance 16. CDC should Hire/train project officers to have knowledge of current/emerging best practices and extensive understanding of the diversity of practice in the field 12

Recommendations: 17. CDC should consistently offer grantees access to programmatic expertise using external stakeholder organizations and contractors and not simply internal CDC resources 18. CDC should prioritize working with grantees in continuous improvement of program effectiveness 13