The Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement is managed by the National Network of Public Health Institutes and funded by the Robert Wood Johnson Foundation. Assuring A Competent Public Health Workforce Clark and Dubois Counties Indiana Local Public Health Workforce Development Mini-Collaborative

B ENEFITS OF L OCAL A SSESSMENT AND T RAINING  Identify critical public health issues  Bridge and strengthen communication  Enhance system dynamics  Improve partner relations and increase rapport  Facilitate collaboration  Increase capacity to provide public health services  Foster creativity and reflective thinking

I NDIANA C OUNTIES P ARTICIPATING IN P UBLIC H EALTH QI A SSESSMENTS  PHSQIP Year 1 Counties ( )  PHSQIP Year 2 Counties ( )

I NDIANA G AINS  Discovery of new and existing information to increase awareness of community services and enhance effectiveness in contributing to public health.  Exploration of others’ perceptions in order to enhance effective communication and support collaborative relationships.  Improvement of public health practice using national public health performance standards.  Participation of over 600 public health and public health system partners in Indiana in the assessment process.

The Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement is managed by the National Network of Public Health Institutes and funded by the Robert Wood Johnson Foundation. Assuring A Competent Public Health Workforce Clark and Dubois Counties Indiana Local Public Health Workforce Development Mini-Collaborative

A SSESSMENT  Recently completed NPHPSP, LPHS Assessment, Version 2.0  Revealed significant areas for improvement related to Essential Service 8: Assure a Competent Public Health and Personal Healthcare Workforce, most notably in the following areas:  Model Standard 8.1 Workforce Assessment, Planning, Dvpt ; Composite Scores 30% and 24% for Clark and Dubois, respectively  Model Standard 8.3 Life-Long Learning Through Continuing Education, Training and Mentoring ; Composite Scores 62% and 50% for Clark and Dubois respectively  Model Standard 8.4 Public Health Leadership Development Composite Scores 42% and 41% for Clark and Dubois respectively

P ROBLEM S TATEMENT Clark and Dubois counties lack a comprehensive and sustainable local public health workforce development program that:  aligns with the mission and goals of their local public health agencies  supports the implementation of public health services within the framework of the ten essential services  ensures that population health needs are addressed by staff in the ever-changing landscape of public health

G OAL S TATEMENT Clark and Dubois counties will have a comprehensive and sustainable program for education and workforce development to:  Build knowledge and skills the staff need to support public health practice  Serve as a foundation to improve delivery of public health services to promote population health  Prepare for national voluntary accreditation

E SSENTIAL S ERVICE 8  Understand who we, the local public health workforce, are.  Identify important factors that impact our practice.  Build our capacity.  Maximize our retention and professional growth.  Market ourselves!!

FUTURE STATE MAP B UILDING A F OUNDATION T O A SSURE A C OMPETENT P UBLIC H EALTH W ORKFORCE LeadershipRecruitment Training & Education PartnershipRetention Training & Education: build and sustain the skills/competencies of staff to enable them to practice effectively in an evolving public health environment.

5 W HY ’ S 1. Why do the counties lack a workforce development program? The health departments have not had the resources necessary to build a sustainable program to promote workforce development of all staff within the framework of the ten essential public health services; and, no formal state-level workforce development program exists as a resource. 2. Why hasn’t the health department had the necessary resources? Coordination of workforce development has previously occurred, informally and effectively, through the collaboration of individuals within each health department. Consequently, there was no need to invest, more resources. Local health departments have not previously had a need to consider meeting national standards until the new voluntary accreditation program was developed, nor was there a need to formally educate staff on the ten essential public health services as they were only recently developed. 3. Why hadn’t the health department been aware of the ten essential public health services? The assessment process for evaluating the integration of the ten ES was only started in only Indiana two years ago and the 10 ES developed less than five years ago. Until implementation of the Indiana State Public Health System Quality Improvement Program, utilization of this framework was not promoted by the ISDH for public health practice in Indiana. 4. Why weren’t the 10 ES promoted for public health practice in Indiana? 4A. The ten essential services are a recent development as a framework for public health practice in state and local health departments. 4B. The economic environment of local public health in Indiana is challenging, with focus primarily on delivery and sustainable funding for basic public health services, and there is a lack of public health as a priority for funding by local county government. 5A. Why is there a lack of public health as a priority at the local county level? There are many more visible areas of communities where funding is considered a greater priority. Public health is often invisible until a public health emergency arises. There has previously been no similar mechanism to quantitatively communicate the work of public health in this manner at the system, agency, or staff level to elected officials.

No accreditation structure previously No time to participate Staff turnover Pressure to meet job demands No value in participation No funding to support program development Changes in economic trends is barrier for program development No coordinated effort among key state public health stakeholders Lack of leadership for such an effort Changing demographics PH lack of priority to elected officials PH invisible to public PH resources unknown to partners Pop w/poor health indicators Lack of agency vision for standardization / accreditation Not a requirement of staff Informal orientation process No incentive for workforce dvpt Cause and Effect Diagram

E VALUATING P OSSIBLE S OLUTIONS

L IST P OSSIBLE S OLUTIONS : ( insert Prob. Statement here ) 1. Increase staff funding for cont ed programs7. Integrate state workforce initiative into local program 2. Online education programs8. Employ staff with higher qualifications 3. ISDH LMS9. 4. Create incentives for individual ed efforts Create internal workforce ed program Educate local government officials12.

C LARK AND D UBOIS MLC3 L OCAL M INI -C OLLABORATIVE P ROJECT Phase 1: Creating the Vision of a Competent Local Public Health Workforce Phase 2: Educating Indiana’s Local Public Health Workforce for the 21 st Century Phase 3: Evaluating to Demonstrate the Impact of Education and Training Phase 4: Improving Local Public Health Practice Phase 5: Sustaining Workforce Education to Improve Population Health

Local Public Health Workforce Development Mini-Collaborative C LARK AND D UBOIS C OUNTIES What is Your Vision of Public Health?

I NSTITUTE OF M EDICINE, 1988 P UBLIC H EALTH I N D ISARRAY !!  Chronic underfunding  Lack of resources  Outdated technology  Weakened local public health infrastructure

I NSTITUTE OF M EDICINE, 2003 T HE F UTURE OF P UBLIC H EALTH  Focus on the Core Functions of Public Health  Assessment  Policy Development  Assurance  Have a Vision, a Purpose, and use the 10 Essential Services to guide delivery of your public health practice.

T EN E SSENTIAL S ERVICES IN E VERYDAY E NGLISH ES #1 Monitor health status to identify community health problems.What’s going on in my community? How healthy are we? ES #2 Diagnose and investigate health problems and health hazards in the community. Are we ready to respond to health problems or threats in our county? ES #3 Inform, educate, and empower people about health issues. How well do we keep all segments of our community informed about health issues? ES #4 Mobilize community partnerships to identify and solve health problems.How well do we really get people engaged in local health issues? ES #5 Develop policies and plans that support individual and community health efforts. What local policies in both govt. and the private sector promote health in my community? How effective are we in setting local health policies? ES #6 Enforce laws and regulations that protect health and ensure safety. When we enforce health regulations, are we technically competent, fair and effective? ES #7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Are people in my community receiving the medical care they need? ES #8 Assure a competent public health and personal health care workforce. Do we have a competent public health staff? How can we be sure that our staff is current? ES #9 Evaluate effectiveness, accessibility, and quality of personal and population- based health services. Are we doing any good? Are we doing things right? Are we doing the right things? ES #10 Research for new insights and innovative solutions to health problems.Are we discovering and using new ways to get the job done?

T HE T EN E SSENTIAL S ERVICES OF P UBLIC H EALTH Essential Service 8

A SSURE A C OMPETENT P UBLIC H EALTH AND H EALTHCARE W ORKFORCE Essential Service 8

W HY S TART W ITH E SSENTIAL S ERVICE 8?  Understand who we, the public health workforce, are.  Identify important factors that impact our practice.  Build our capacity.  Maximize our retention and professional growth.  Market ourselves!!

ES 8 M ODEL S TANDARDS  MS 8.1 Workforce Assessment, Planning, and Development  Establish a process to periodically determine competencies, composition, and size of local PH workforce.  Identify and address gaps  Share what is learned with local public health system partners

ES 8 M ODEL S TANDARDS  MS 8.2 Public Health Workforce Standards  Maintain licensure/certification requirements for all personnel.  Develop, maintain, and use written job standards and/or position descriptions for all LHD employees.  Conduct annual performance evaluations for all LHD staff.

ES 8 M ODEL S TANDARDS  MS 8.3 Life-Long Learning Through Continuing Education, Training, and Mentoring  Identify education and training needs and encourage opportunities for workforce development.  Provide opportunities for all staff to develop core public health competencies.  Provide incentives for staff to pursue education and training.  Provide opportunities for staff to engage in mutually enriching practice/academic partnerships.

ES 8 M ODEL S TANDARDS  MS 8.4 Public Health Leadership Development  Provide formal and informal opportunities for leadership development.  Promote collaborative leadership within the local public health system.  Assure staff have opportunities to provide leadership in their areas of expertise.  Provide opportunities for development of diverse community leadership to assure sustainable public health initiatives.

W HAT IS INCLUDED IN E SSENTIAL S ERVICE # 8 ?  Education  Training  Credentialing  Performance Evaluation  Workforce Assessment  Life-long Learning  Workplace development programs  Partnerships with academia  Leadership development

G OALS OF E SSENTIAL S ERVICE 8  Develop plans for education  Provide continuing education  Assess the number of PH and health care workforce  Recruit and sustain a diverse workforce  Focus on enhancing skills  Assure competency through increased knowledge and functioning

W HAT A CTIVITIES IN O UR LHD S UPPORT ES 8? Discussion

LHD A CTIVITIES I NCLUDED I N E SSENTIAL S ERVICE 8  Learning Management System  Regional Preparedness meetings  Drills and TTXs  Certification in Environmental Health  PHSQIP Project  Provide PHN experiences for nursing students  Environmental Health Specialist  Staff meetings  Contact hours in nursing  ISDH Conference Calls  Public Health and Medicine Partnership Conference  MARPHLI

W HAT A RE Y OUR P ROFESSIONAL G OALS ? Discussion

H OW D O W E I MPROVE A S T HE W ORKFORCE OF T HIS L OCAL P UBLIC H EALTH A GENCY ? Discussion

INDIANA MLC-3: G ETTING S MART A BOUT P UBLIC H EALTH I N C LARK C OUNTY  S – we will be specific by planning one ES Brunch & Learn presentation each month.  M – we will measure what we understand and learn by completing individual online surveys after each Brunch & Learn.  A – We will be committed to accepting our responsibility to support our agency vision. We are a team…..  R – we must be realistic – we are, after all, very busy people – we will make time to come together monthly for a Brunch & Learn.  T – we will establish a timeline to complete all 10 Brunch & Learns by December, 2009.

E SSENTIAL S ERVICE 8 S URVEY AND D ISCUSSION

I NDIANA P ARTNERS Clark County Health Department Dubois County Health Department Indiana State Department of Health Indiana Public Health Association Purdue Healthcare Technical Assistance Program