LESSON 1: Everyone needs to stay on message during times of change. Don't change the message too often, even as you are working out the details. For the CBHI, the implication is that it is really important for them to control the message of change, especially during the "ramp-up" time, to keep things from taking on a life of their own.
Now the other problem was the way in which the message was interpreted in the 351 (or so) semi-autonomous school districts in the Commonwealth, a largely local option that depended on the strength of local health departments, the ability of the school nurses to have a voice in the systems, the sophistication of the parents, the relationship with the local medical community, and, most importantly, the leadership style of the superintendent. Ideally, this would be a collaborative relationship in which the DPH would bring information and plans that the other sectors of civil society would embrace and implement. Not so, in many cases. Implementing this should have been a discussion, but it more often reflected and amplified the local power imbalances that drive action at the local level. We heard stories of excellent collaboration and stories of serious conflict, as the needs of the schools for high MCAS scores were balanced against the need of the community for school closure. According to the office of the legal counsel, the health authorities should have had precedence in this matter. In practice, they often did not. This is the place where many saw a need for improvement.
LESSON 2: Implementing change requires buy-in from all of the parties, and will build on the relationships that were established in the past. Or not. For the CBHI, the implication is that forming the multidisciplinary teams, especially with doctors and educators, is going to be difficult. We need to invest in building relationships.
SO, HERE WE ARE IN DAY 2 OF THE BRAVE NEW WORLD OF THE CBHI. HOW'S IT GOING OUT THERE?