Designing Technical Assistance For Successful Engagements
The federal government relies on technical assistance (TA) – a broad term referring to customized, hands-on expert advice and technical instruction – to build capacity among state agencies and other grantees.[1], [2] TA can help an organization understand policy developments and opportunities, analyze its operations, implement efficiencies, and develop staff knowledge and skills. Receiving TA is an ongoing, consultative relationship.
For TA to be effective, recipient organizations need to invest staff time, which is often a precious commodity, particularly for overstretched state public health entities. Abt and the TA funders whose technical assistance we evaluate use various approaches to position TA recipients to succeed:
- perform an evaluability assessment of the organization’s baseline capacity
- clearly describe and discuss the role and commitment of both the provider and recipient
- co-develop a scope of work that is feasible within the project timeline
- create agreed-upon benchmarks to evaluate progress
- have the TA recipient sign an agreement that it is committed to the process
- secure the organization’s leadership commitment of staff and resources to the project.
Abt has found that data analytics TA projects, such as helping states improve their Medicaid data management systems or helping Ryan White jurisdictions improve linkages between data systems, not only require a substantial amount of staff time, but also require an upfront investment of staff time before reaping skills and knowledge from the TA. Data analytics TA has three phases.
Phase 1: The TA recipient staff has to educate the TA provider about the organization’s information technology system – an investment of time with no immediate return. This task is made more complex by the fact that many state data systems layer new tools on decades-old software code and hardware.
Phase 2: The TA recipient staff and TA provider work together to identify a project that is feasible given the project’s scope and time period. This process is another investment with little immediate return beyond the project specifications.
Phase 3: Only after completion of these steps can the TA provider implement activities such as providing guidance on choosing software; offering training on data linkage tools, data visualization techniques, and other technical topics; and perhaps writing code. This step can yield great benefit to the state or other TA recipient through improved systems and better-trained staff. However, the time required for the first two steps may mean a TA recipient can’t complete the third step and may experience a net cost instead of a net benefit from the TA engagement.
Many factors are barriers to TA recipient organizations allocating sufficient time to reap benefits from data analytics TA.
First, TA recipient organization staffers have “day jobs” and rarely, in the TA projects we have evaluated, had dedicated TA time carved out. For example, the Centers for Medicare and Medicaid funded TA to help states integrate Medicare data with their Medicaid data for their dual eligible population so they could better understand the health status and healthcare utilization of this population. Of the five states that participated, just one assigned a staff person to the project, and it was the only state to implement data integration despite extensions to the project period.
Second, changes in the TA recipient’s leadership’s priorities often require staff to spend time on projects other than the TA. Even when leadership states its commitment to the TA in the application process, staffing, organizational structures, priorities, and even leadership itself can change during the TA period.
Third, the TA may simply require more time than anticipated as administrative tasks such as creating data use agreements may slow the delivery of more technically focused TA.
Abt’s TA projects respect the time commitment made by TA participants, and, as part of our TA work, we gather empirical data to help generate accurate estimates of participants’ time invested.
For example, Abt is evaluating TA to enhance data linkages between HIV, sexually transmitted infection, and Ryan White systems to improve identification of people with multiple conditions and engage people in care more quickly and continuously. During the evaluation, we are collecting data on time spent across five separate activity categories for multiple staff categories and placing this information in the context of the specific TA goals to support case studies. The result will be a better understanding of investment required to inform future TA recipients. In addition, Ryan White jurisdictions that are interested in future opportunities will have a guide to estimating the resources they will need to commit.
Abt’s TA to help hospitals improve referral to cardiac rehabilitation includes a set of 10 training modules. We will be posting recordings of the training sessions and supplemental Implementation Guides on a permanent website for other hospitals to use. To estimate required time, we will ask the TA recipients at two points in time how many hours per month they spent on TA activities. This information will be posted on the website to help other hospitals decide how to plan a self-timed training course and implement what they learn.
While we cannot control unexpected changes in TA recipients’ schedules, resources, or priorities, by understanding TA recipients’ time commitments, Abt can design TA initiatives that have a better chance of exerting downstream influence within organizations.
ENDNOTES:
[1] H.R.2740 - Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020. Accessed at https://www.congress.gov/bill/116th-congress/house-bill/2740/text, on January 182021. Dated July 10, 2019.
[2] Educational Technical Assistance Act of 2002. Accessed at https://www.govinfo.gov/content/pkg/BILLS-107hr3801enr/pdf/BILLS-107hr3801enr.pdf, on January 18, 2021. Dated January 23, 2002.
