PUBLIC HEALTH PUBLIC HEALTH WORKFORCE WORKFORCE

DEVELOPMENTDEVELOPMENT

LOUIS ROWITZ, Ph.D

MID-AMERICA REGIONAL PUBLIC HEALTH LEADERSHIP

INSTITUTE

The Public Health Workforce The Public Health Workforce (PHS)(PHS)

All those providing essential public health services, regardless of the nature of the employing agency.

Promotion of individual and organizational excellence is the only standard acceptable to the public and decision makers who play a vital role in realizing the vision of Healthy People in Healthy Communities.

The Professional The Professional Obligations (Curry et al.)Obligations (Curry et al.)

All professionals are obligated to both acquire and maintain the expertise needed to undertake their professional tasks and all are obligated to undertake those tasks that are within their competence.

Competence is a professional Competence is a professional and and moralmoral obligation oriented obligation oriented to the highest standards of to the highest standards of performance and not to a low performance and not to a low minimal one.minimal one.

The determination of high The determination of high performance standards as performance standards as well as the minimal ones must well as the minimal ones must be determined by the public be determined by the public health professions, the policy health professions, the policy makers, community needs, makers, community needs, and societal values.and societal values.

The Public Health Worker’s The Public Health Worker’s Social ResponsibilitySocial Responsibility

Throughout the public health system, the social and moral responsibility of all individuals involved in the promotion of the health of the public is to put learning and experience into future practice.

This is what competency concerns are all about.

Educators and Educators and TrainersTrainers

Give the Public Health Worker the tools but the worker must take the responsibility of using these tools

Competency = Competency = Knowledge + Knowledge +

Understanding + Understanding + PracticePractice

Public Health leaders need do Public Health leaders need do be held to the highest be held to the highest

standards of competencystandards of competency

National Public Health National Public Health Leadership NetworkLeadership Network

Created in 1994 Funded by CDC and housed at St. Louis

University School of Public Health Supports the growth of state and regional public

health leadership development opportunities in all 50 states

Provide formal mechanisms for academic and practice to work together to promote leadership at all levels of the public health system

The Leadership CompetencyThe Leadership CompetencyProjectProject

Began in 1994 Ongoing Identification of competency requirements for

public health leadership due to multidisciplinary nature of public health

Competencies are tied to performance standards Built upon the core public health

functions/essential public health services

Four Major Leadership Four Major Leadership Competency areas were Competency areas were

defined by NLNdefined by NLNTransformational competenciesPolitical competenciesTransorganizational competenciesTeam Building Competencies

Core Transformational Core Transformational CompetenciesCompetencies

VisionarySense of MissionEffective change agent

Core Political CompetenciesCore Political Competencies

Understanding of political processNegotiationEthics and PowerMarketing and education

Core Transorganizational Core Transorganizational CompetenciesCompetencies

Understand organizational dynamics

Interorganizational collaborating mechanisms

Social forecasting and marketing

Core Team Building Core Team Building CompetenciesCompetencies

Develop team oriented structures and systems

Facilitate development with teams and work groups

Serve in facilitator and mediator role

Estimated 500,000 individuals Estimated 500,000 individuals currently employed by a range currently employed by a range of organizations involved in of organizations involved in public health practice and public health practice and providing the ten essential providing the ten essential services services

Public Health Workforce

Workforce CompositionWorkforce Composition

89

66

42

36

32

27

0 20 40 60 80 100

Nurses

Adminstrators

Sanitarians

Environmental HealthSpecialists

Dietitians/Nutrionists

Public InformationSpecialists/Helath

educators

Percentage

Percentage of local health departments having at least one full-time employee in the listed job classification, U.S., 1992-1993

An estimated 80% of the An estimated 80% of the workforce has no formal workforce has no formal training in public healthtraining in public health

GAPGAP

Current capabilities and future needs continue to widen

WHO IS MISSING ?WHO IS MISSING ?

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Present SOC Public Health Present SOC Public Health OccupationsOccupations

Public Health PhysicianPublic Health NursePublic Health DentistPublic Health Dental WorkerPublic Health VeterinarianPublic Health NutritionistPublic Health Pharmacist

Standard Occupations Standard Occupations ContinuedContinued

Public Health Laboratory Scientist Public Health Laboratory Technician and

Technologist Public Health Attorney or Hearing Officer Health Information System/Computer Specialist Public Relations/Public Information/Health

Communications/Media Specialist Biostatistician

New Recommended SOC New Recommended SOC Public Health OccupationsPublic Health Occupations

EpidemiologistEnvironmental EngineerEnvironmental Engineering Technician and

TechnologistEnvironmental Scientist and SpecialistEnvironmental Scientist Technician and

Technologist

ContinuedContinued

Occupational Safety and Health Technician and Technologist

Health EducatorPublic Health Policy AnalystHealth Service Manager/Health Service

AdministratorPublic Health and Community Social

Worker

ContinuedContinued

Mental Health and Substance Abuse Social Worker

Psychologist, Mental Health ProviderAlcohol and Substance Abuse Counselor,

including Addiction CounselorMental Health Counselor

BARRIERSBARRIERS

Inventory of the workforce does not existNo consensus on the competencies or

curricula needed for the workforceIntegrated delivery system for lifelong

learning does not existInadequate incentives for participation in

training and continuing education

BARRIERS(2)BARRIERS(2)

No uniform approach or commitment to evaluation

Financing of workforce development is unclear as well as a coherent training policy

PROBLEMS IN PROBLEMS IN ENUMERATIONENUMERATION

Lack of clear public health professions classification/schemes

An absence of consistent public health credentialing requirements

A professional workforce educated in specific disciplines but without formal public health training

ENUMERATION(2)ENUMERATION(2)

Standard occupation classifications based on population-based occupations

HRSA Action StepsHRSA Action Steps

National LeadershipState and Local LeadershipWorkforce CompositionCurriculum DevelopmentDistance Learning

National Leadership Action StepsNational Leadership Action Steps

Organize national forum of key stakeholders to examine human resource allocation and public health trends

Develop Leadership modules for training to assess roles in a changing public health environment

Involve frontline practitioners from all sectors in training

State and Local State and Local Leadership Action StepsLeadership Action Steps

Ensure that workforce planning takes place in all appropriate jurisdictions

Work with other health professionals in the jurisdiction to achieve mutual goals in public health workforce development

Develop partnerships with the State to quantify the supply and demand of public health personnel

Workforce Composition Workforce Composition Action StepsAction Steps

Identify lead agency to provide leadership in determining workforce needs for implementing the essential services of public health

Examine methods used by professional organizations to classify their respective workforces. DON’T REINVENT THE WHEEL

Workforce Composition(2)Workforce Composition(2)

Develop a standard taxonomy based on essential services to qualitatively characterize the public health workforce

Use the SOC to track shifts in the movement of the workforce in the public, private, and voluntary sectors

Ensure cultural and ethnic diversity in the workforce

Curriculum Development Curriculum Development Competencies(Action Steps)Competencies(Action Steps)

Verify that identified competencies are necessary for efficient and effective P.H. practice

Identify competencies critical to all P.H. practice and those critical to practice in specific settings

Improve long range planning to update competencies

Curriculum Action StepsCurriculum Action Steps

Ensure that the practice community has a substantial role in curriculum development

Determine the current status of competency of the workforce

Develop measurable performance indicators for identified competencies

Survey P.H. training centers to ensure that competencies are part of the curriculum

Curriculum Action Steps(2)Curriculum Action Steps(2)

Conduct analysis of competency statements and make revisions in curriculum

Identify gaps between high priority competencies that are needed and those already present in the workforce

Translate competencies into discrete didactic and field-based learning experiences

Curriculum Action Steps(3)Curriculum Action Steps(3)

Create a matrix of addressed and unaddressed competencies based on public health organizational needs

Support a curriculum development process that is sensitive to the needs of the local community

Recommend to CEPH that competency-based approaches be included in academic programs

Distance Learning Distance Learning Action StepsAction Steps

Utilize DL in training, education, and communications

Directly link DL systems and program development

Routinely gather input from key partners regarding training needs and technological capabilities

Distance Learning (2)Distance Learning (2)

Develop agency expertise in DLProvide access to information about public

health DL programsOrganize a mechanism for pooling and

accessing resources and expertise on DL across all of public health

CDC/ATSDR STRATEGIC CDC/ATSDR STRATEGIC PLAN FOR WORKFORCE PLAN FOR WORKFORCE

DEVELOPMENTDEVELOPMENT

VISIONVISION

A competent workforce able to perform the essential public health services

PremisePremise

Use the essential services as a framework for identifying workforce competency requirements

Assume a multidisciplinary, multisector, diverse and geographically dispersed public health workforce

Premise(2)Premise(2)

Design a cohesive learning system to develop and deliver a comprehensive P.H. practice curriculum which build basic, cross cutting(core) competencies and technical skills

Six Strategic System Six Strategic System ElementsElements

Monitor workforce compositionIdentify competencies/Develop curriculumDesign integrated learning systemUse incentives to assure competencyConduct evaluation and researchAssure financial support

Implementation(Guiding Implementation(Guiding Principles)Principles)

Build upon existing resources of CDC and partners

Focus on the needs of the front line public health worker

Strengthen competency certification and credentialing system

Focus AreasFocus Areas

Centers for Public Health PreparednessGlobal training development and delivery

system using state of the art technologyCertification and credentialing systems in

public healthApplied research and evaluation

KNOWLEDGE IS THE KNOWLEDGE IS THE SECRET TO FUTURE SECRET TO FUTURE

SUCCESSSUCCESS