Maternal and Child Health
Leadership Competencies
V E R S I O N 3 . 0












MCH Leadership Competencies Workgroup (Editors)


June 2009

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Table of Contents
Introduction ................................................................................................................................................... 1 
Who Are MCH Leaders? ............................................................................................................................... 1 
Use of the MCH Leadership Competencies.................................................................................................. 2 
Rationale for Development of MCH Leadership Competencies ................................................................... 2 
History of Development of MCH Leadership Competencies ........................................................................ 3 
Conceptual Framework for the MCH Leadership Competencies ................................................................. 4 
The MCH Leadership Competencies............................................................................................................ 6 
Next Steps..................................................................................................................................................... 7 
MCH Leadership Competencies ................................................................................................................... 8 
I.  Self .................................................................................................................................... 8 
II.  Others ............................................................................................................................. 12 
III.  Wider Community............................................................................................................ 19 
Appendix A: Time Line of Development of MCH Leadership Competencies ...........................................A-1 
Appendix B: MCH Pyramid .......................................................................................................................B-1 
Appendix C: MCH Leadership References and Resources..................................................................... C-1 
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Introduction
AN MCH LEADER INSPIRES AND BRINGS PEOPLE TOGETHER
TO ACHIEVE SUSTAINABLE RESULTS
TO IMPROVE THE LIVES OF THE MCH POPULATION.1
To be a leader in Maternal and Child Health (MCH) requires specific knowledge, skills, personal
characteristics, and values. The leadership competencies described in this document and drawn
from both theory and practice are designed to support and promote MCH leadership. The
document is targeted to MCH interdisciplinary training programs and practicing MCH
professionals. The document:

Defines MCH leadership.

Identifies core MCH Leadership Competencies.

Outlines the knowledge and skill areas required of MCH leaders.

Provides a conceptual framework for the development of an MCH leader.

Describes how MCH Leadership Competencies might be used by a variety of audiences.
Who Are MCH Leaders?
2
An MCH leader is one who understands and supports MCH values, mission, and goals with a
sense of purpose and moral commitment. He or she values interdisciplinary collaboration and
diversity and brings the capacity to think critically about MCH issues at both the population and
individual levels, as well as to communicate and work with others and use self-reflection. The
MCH leader possesses core knowledge of MCH populations and their needs and demonstrates
professionalism in attitudes and working habits. He or she continually seeks new knowledge and
improvement of abilities and skills central to effective, evidence-based leadership. The MCH
leader is also committed to sustaining an infrastructure to recruit, train and mentor future MCH
leaders to ensure the health and well-being of tomorrow’s children and families. Finally, the
MCH leader is responsive to the changing political, social, scientific, and demographic context
and demonstrates the capability to change quickly and adapt in the face of emerging challenges
and opportunities.3

1 Adapted from: George, B. (2006, October 30). Truly authentic leadership. U.S. News & World Report, 52.
2 Maternal and Child Health Bureau (MCHB). Strategic Plan, FY 2003–2007. Retrieved February 20, 2007, from MCHB Web site:
http://www.mchb.hrsa.gov/about/stratplan03-07.htm#1.
3 From the April 2004 Future of MCH Leadership Training Conference.

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Use of the MCH Leadership Competencies
The MCH leadership competencies can be used in a variety of ways to support and promote
MCH leadership. These include the following:
1. Frame training objectives for the MCH Leadership Training Programs. It is the
responsibility of MCH leadership training programs to ensure that program graduates
have the foundation necessary to work within a variety of professional settings to
contribute to the health and well-being of our Nation’s most vulnerable population groups
and to inspire others to do likewise. The core leadership competencies can be used by all
academic MCH training programs to help frame their own training objectives.
2. Measure and evaluate leadership and training for leadership. MCH leadership
competencies can be used to initiate and guide discussion about the measurement and
evaluation of MCH leadership and of quality training.
3. Cultivate and measure competencies within the current MCH workforce. MCH leadership
competencies can be used as a tool to strengthen the leadership abilities of the existing
and future MCH workforce. The framework provided by the MCH leadership
competencies can assist local and State MCH agencies in orienting new employees
without MCH backgrounds to the goals and methods of MCH. The leadership
competencies can also guide ongoing continuing education efforts to promote the
knowledge and skills necessary for effective leadership.
4. Sustain and grow MCH leadership throughout the health care system. The MCH
Leadership competencies allow State and local health agencies and organizations and
graduate MCH training programs to assess and promote leadership capacity.
Rationale for Development of MCH Leadership Competencies
It is often said that a Nation’s health is best measured by the health of its most vulnerable
citizens: its children. Promoting and ensuring their health and wellness requires the strong
presence of MCH leaders at the national, State, and local levels. These are individuals with the
vision, expertise, and skills to provide the leadership needed to design and implement policies
and programs to assure that children grow into competent, independent, nurturing, and caring
adults.
The importance of MCH leadership is emphasized in the strategic plan for the Maternal and
Child Health Bureau (MCHB) and throughout the MCH Training Program. For many years,
MCHB and the MCH Training Programs have had an interest in defining MCH leadership better
and measuring whether those trained through the program became leaders.4 The need for MCH
leadership competencies was also emphasized in the development of the MCH Training

4 See Appendix A for a detailed listing of MCH Leadership Activities.

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Program’s 5-year strategic plan, the National Plan for MCH Training, 2005–2010.
Representatives from both the MCH academic and practice communities recommended that the
MCH Training Program develop MCH Leadership Competencies as one of its strategic goals.
History of Development of MCH Leadership Competencies
The development of the leadership competencies has been thorough, comprehensive, and
inclusive. The following summarizes steps used in this process.
6

April 2004. At a conference entitled Future of MCH Leadership Training, held in Seattle,
Washington at the University of Washington, representatives from many of the MCH
Training programs came together to draft MCH Leadership competencies, the critical
knowledge and skill areas that they felt were necessary to develop MCH leaders.

Fall 2004. The draft competencies developed in Seattle were further refined later that year
at the MCHB All Grantee Meeting in Washington, DC.

Early 2005. The MCH Competencies Working Group was formed, composed of
individuals representing MCH training programs, Association of Maternal and Child
Health Programs, and CityMatCH. This group refined the competencies and developed a
revised draft.

Fall 2005–spring 2006. The revised draft was shared at grantee meetings throughout this
period and all MCH training programs were asked to provide comments about the MCH
Leadership Competencies.

Winter 2007. Comments from the field were reviewed by the Workgroup. This document
reflects the suggested changes from the field and subsequent meetings with the
Workgroup.7
The result of this work was 94 competencies, clustered in 12 domains. In the spring of 2008, a
method of expert consensus, known as a modified Delphi Technique, was conducted to begin the
process of validating the competencies. The Delphi technique relies on the opinions of experts to
determine how important particular items are to a construct or domain of interest. The goal of the
technique is to achieve consensus, or agreement, about items that are considered to be important
or very important. A panel of MCH experts was identified by MCH leadership. These experts
were contacted via e-mail and asked to participate in the two-phase validation process. Forty-

5 Maternal and Child Health Bureau (MCHB). National MCH Training Strategic Plan. Retrieved February 20, 2007, from MCHB
Web site: http://www.mchb.hrsa.gov/training/strategic_plan.asp.
6 Maternal and Child Health Bureau (MCHB). (2004). MCHB Conference Webcasts. Retrieved February 20, 2007, from Center
for the Advancement of Distance Education Web site: http://www.cademedia.com/archives/MCHB/leadership2004/
7 Workgroup members are Gwendolyn Adam, Mary Balluff, Karen Edwards, Anita Farel, Al Hergenroeder, Colleen Huebner,
George Jesien, Laura Kavanagh, Kathy Kennedy, Mark Law, Crystal Pariseau, Virginia Reed, Greg Redding, Karyl Rickard, and
Phyllis Sloyer.

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seven individuals responded, indicating that they would participate. Of these, 38 completed
Phase 1 of the process and 35 completed Phase 2. Complete details of the validation process and
the resultant analysis and recommendations may be found in the report: Validating the MCH
Leadership Competencies: Results of a Modified Delphi Procedure8.
During the two phases of the modified Delphi Technique, participants noted that the number and
lack of distinctiveness of many of the competencies was problematic, commenting in particular
that the current number of competencies was larger than could be used practically. Thus, a
decision was made in consultation with MCH leadership to decrease the number of
competencies, focusing on those lacking consensus as targets for elimination. Applying the
criteria described in the report, 19 items were eliminated, reducing the number of competencies
to 75. Three additional items were eliminated due to redundancy. Thus, the Version 3 set of
MCH Leadership Competencies consists of 72 items clustered in 12 competency domains.
These competencies are the result of an iterative and inclusive work-in-progress that was based
on the literature on leadership (from the business, military, and social science contexts),9 and the
wisdom and experience of current MCH participants and leaders.
Conceptual Framework for the MCH Leadership
Competencies
An early task of the groups was to determine what concepts should frame the development of the
competencies. Many conceptual frameworks for leadership have been described in the literature,
and while these are undeniably useful, Workgroup members emphasized the importance of the
following concepts in understanding MCH leadership.

Leadership in health care is contextual in nature.

MCH leaders must address an array of issues that are specific to the MCH population
groups.

Leadership should be viewed as a developmental progression of increasing influence.
A wide array of factors influences both the health status of individuals and groups and the ability
of leaders to affect health policies, programs, and outcomes. These factors can include the health
practices of individuals and groups, the availability of health care resources, and competing
social and political priorities.

8 Reed, Virginia A. (April 12, 2009). Validating the MCH Leadership Competencies: Results of a Modified Delphi
Procedure. http://leadership.mchtraining.net/
9 See Appendix C for leadership references and resources.

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The developmental progression of leadership is of particular importance to those involved in the
professional and continuing education of MCH health professionals. Leadership ability grows as
the knowledge, skills, and experience of the individual expands and deepens. The Figure 1
graphic illustrates the widening circles of influence that leaders experience as they develop –
from self to others to the wider community.

Self. The leadership process begins with the
focus on self where leadership is directed at
one’s own learning through readings,
instruction, reflection, and planned and
serendipitous experiences. Individuals
increasingly learn to direct their actions and
growth toward specific issues, challenges, and
SELF
attainment of desired goals.

Others. The next sphere is labeled others where

leadership extends to coworkers, colleagues,
OTHERS
fellow students, and practitioners. The behavior
and attitudes of others are influenced and
WIDER COMMUNITY
possibly altered through the actions and
interactions of the individual. Leadership and
Figure 1.
influence can remain at this level of impact for
long periods of time. There are wonderful examples of how teachers have affected the
life course of students or how clinicians or public health workers have affected the lives
of children and families.

Wider Community. Leadership also can extend to a broader impact on entire
organizations, systems, or general modes of practice. These wider areas of impact and
influence require additional skills and a broader based understanding of the change
process and the factors that influence change over time. Examples of this level of
leadership are MCH professionals mobilizing communities to improve the local system
of health care for pregnant women or influencing policy at the State level to improve
reimbursement to MCH providers.
The following leadership competencies are presented in a progression from self to wider
community which demonstrates the widening contacts, broadening interests, and growing
influence that an MCH leader can experience over a professional lifetime.
Also important to the framing of the competencies is the understanding that (1) leadership can be
developed through learning and experience; (2) leadership can be exerted at various levels within
an organization or agency and at the local, State, or national levels; and (3) leadership
opportunities change over time. Finally, it is understood that MCH leaders build their expertise

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10
upon a base of specific disciplinary knowledge and MCH knowledge that includes
understanding and applying the overall mission and vision of MCH. A useful framework for
thinking about the MCH mission and types of MCH services and systems that an MCH leader
can impact is presented in the MCH Pyramid, Appendix B.
The MCH Leadership Competencies
Twelve MCH leadership competencies are presented here and organized into the three categories
described in the conceptual framework. These categories include:
I. Self

1. MCH Knowledge Base
2. Self-reflection
3. Ethics and Professionalism
4. Critical
Thinking
II. Others
5.
Communication
6. Negotiation and Conflict Resolution
7. Cultural
Competency
8. Family-centered
Care
9. Developing Others through Teaching and Mentoring
10. Interdisciplinary Team Building
III. Wider Community

11. Working with Communities and Systems
12. Policy and Advocacy
Each of the 12 competencies includes a definition of the competency, knowledge areas, and basic
and advanced skills for that competency.

10 Each MCH discipline (e.g., public health social work, pediatrics, public health, nutrition, nursing, psychology, pediatric dentistry,
etc.) has defined its own discipline-specific competencies through its professional organizations and accrediting bodies. These
may overlap, in part, with this list of 12 competency areas.

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Next Steps
Since the initial release of MCH Leadership Competencies 2.0 , the competencies have been
disseminated at Training Program grantee meetings and made available on the on the MCH
Leadership Competencies Web site, www.leadership.mchtraining.net.
The MCH Leadership Competencies Web site will continue to house the Competencies and
serve as a place for you share your comments and experiences. The Web site offers the
following:

Bulletin board. Here you can comment on the usability, clarity, and functionality of the
competencies. You also can provide your own examples of training mechanisms and
resources.

List of the Competencies. This includes definitions, knowledge, and skill areas.

Training Experiences. Available is a list of training opportunities and a place where
grantees and others can add their own suggestions.

Measurement Section. Included here are suggestions for how to create measures, a
resource section, leadership literature review, and many more helpful items.
It has been evident through the MCH Training Program annual progress reports that efforts have
been undertaken by programs across the nation to determine how best to use the competencies to
improve the quality of our training programs and of our practice in MCH. We hope that you will
share with us how you are using the MCH Leadership Competencies in your work and your
thoughts on the revised Competencies . Examples of how the Competencies could be used
follow:

Current MCH training programs could choose to focus on one competency per year as
they assess their curriculum.

Local health departments could use the competencies to orient new staff members or to
incorporate into job descriptions.

Faculty members or practicing MCH professionals might use the competencies to
identify areas in which they would like to receive continuing education.
Finally, this document represents the continuation of a dialogue regarding MCH leadership
competencies and MCH leadership. We look forward to your continued involvement.

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MCH Leadership Competencies
Twelve MCH leadership competencies are presented here, organized into three categories: Self,
Others, and Wider Community. Each of the 12 competencies includes:

A definition of the competency.

Knowledge areas for that competency.

Basic and advanced skills for that competency.
I. Self
MCH Leadership Competency 1: MCH Knowledge Base
DEFINITION
MCH is a specialty area within the larger field of public health, distinguished by:

Promotion of the health and well-being of all women, children, adolescents, fathers, and
families, especially in disadvantaged and vulnerable populations

A life cycle approach to theory and practice. The life cycle framework acknowledges that
there are distinct periods in human development that present both risks and opportunities
to intervene to make lasting improvements.11
MCH focuses on individuals and populations, on health promotion and prevention, and on
family-centered systems of care in communities.
KNOWLEDGE AREAS
Through participation in the training program a participant will know:

The history and current structure of the key MCH programs serving women, families and
children.

The core values and strategic objectives that necessitate a special focus on the MCH
populations. These core values and strategic objectives include a focus on prevention,

11 World Health Organization. Life-cycle approach: A framework to identify vulnerabilities and opportunities. Retrieved February
1, 2007, from World Bank Web site:
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTCY/0,,contentMDK:20243956~menuPK:565264~pagePK:148956~pi
PK:216618~theSitePK:396445,00.html

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