Greater Kansas City Food Handler Training Reciprocity Agreement

State: MO Type: Promising Practice Year: 2014

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The food handler requirements in Missouri are addressed at a local level. The food handler subcommittee is comprised of local health agencies from Missouri. The agencies include 4 counties (Cass, Clay, Jackson and Platte) and two cities (Independence and Kansas City). The combined population served by the EHWG agencies, according to the 2010 Census, is 1,085,795. Prior to the food handler reciprocity agreement, the jurisdictions had differing minimum food handler training requirements for food service employees working within each local jurisdiction. Each jurisdiction required training courses. The trainings were in six different locations, with associated and separate fees. The different training requirements and fees caused concern for the food service industry in the Kansas City Metro area. A local chapter of a nationally recognized association for restaurant owners and food service workers expressed their concerns about the undue financial burden placed on food service workers that hold positions in multiple jurisdictions. Members of the association began lobbying elected officials to change the food handler requirements. In response, the EHWG established the food hander subcommittee. The solution to the expressed concerns was found with collaboration facilitated by the EHWG food handler subcommittee. The six agencies’ willingness to collaborate resulted in a reciprocity agreement to accept food handler certifications from each of the participating jurisdictions. The EHWG food handler subcommittee provided the platform for the agreement to be reached. The agreement accommodates different training mediums, methods and even finances. During the process, the agencies worked together to standardize food handler training amongst each of the jurisdictions.

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Kansas City Health Department
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Greater Kansas City Food Handler Training Reciprocity Agreement
The Mid-America Regional Council (MARC) Environmental Health Work Group (EHWG) resides in Kansas City, Missouri. The EHWG is comprised of local health agencies from the state of Kansas and Missouri. However, there are currently no food handler training requirements in Kansas. The food handler requirements in Missouri are addressed at a local level. The food handler subcommittee is comprised of local health agencies from Missouri. The agencies include 4 counties (Cass, Clay, Jackson and Platte) and two cities (Independence and Kansas City). The combined population served by the EHWG agencies, according to the 2010 Census, is 1,085,795. Prior to the food handler reciprocity agreement, the jurisdictions had differing minimum food handler training requirements for food service employees working within each local jurisdiction. Each jurisdiction required training courses. The trainings were in six different locations, with associated and separate fees. The different training requirements and fees caused concern for the food service industry in the Kansas City Metro area. A local chapter of a nationally recognized association for restaurant owners and food service workers expressed their concerns about the undue financial burden placed on food service workers that hold positions in multiple jurisdictions. Members of the association began lobbying elected officials to change the food handler requirements. In response, the EHWG established the food hander subcommittee. The solution to the expressed concerns was found with collaboration facilitated by the EHWG food handler subcommittee. The six agencies’ willingness to collaborate resulted in a reciprocity agreement to accept food handler certifications from each of the participating jurisdictions. The EHWG food handler subcommittee provided the platform for the agreement to be reached. The agreement accommodates different training mediums, methods and even finances. During the process, the agencies worked together to standardize food handler training amongst each of the jurisdictions. Each agency’s training has to meet certain specific food safety requirements while still allowing for the flexibility to teach jurisdictionally specific regulations, codes and policies. The reciprocity agreement was formulated over a period of one and a half years. The agreement was reached over a series of meetings beginning in December 2012, which included pragmatic evaluation of each jurisdiction’s food handler training requirements, baseline food safety standards, food safety educational costs, potential financial impacts on the participating organizations and feasibility of the reciprocity agreement being accepted by six different health agencies. The evaluation included challenges of shared implementation. The potential positive and negative impacts of implementation were weighed. The food handler reciprocity agreement went into effect in August of 2013. Each jurisdiction signed the agreement and prepared to start accepting the food handler cards from the other participating jurisdictions. For most jurisdictions it was as simple as recognizing the agreed upon food handler cards in the field as part of food handler audits during the inspection process. Restaurant owners were notified of the policy changes when permit renewal applications were mailed. Additionally, Public Health Investigators informed restaurant managers during routine inspections. The intended impacts of implementing the food handler reciprocity agreement were to ease the financial burden for area food handlers and establish baseline food safety training requirements for the region. The evaluation of each jurisdiction’s food handler training course materials ensured that the baseline food safety educational requirements were being met. The acceptance of food handler cards from each of the agreed upon jurisdictions ensured that food handlers were not experiencing the added expense and time commitment to get separhe agreement was met with resounding praise by the local chapter of a nationally recognized association for restaurant owners and food service workers and the food service industry workers themselves. The assurance of standardized food safety training is expected to create food service workers throughout the region empowered by knowledge that will help them understand the public health impacts of their work. Along with the increase in regional food safety knowledge, the cost burden of jurisdictionally specific food handler training requirements has been eliminated for food service workers who work in multiple jurisdictions. Milestones: Getting the Stakeholders to the Table- Six Health Departments (December, 2012), Financial implications and evaluations of the agreement (December, 2012), Establishing a baseline for food safety training requirements (January, 2013), Food safety training program evaluations (January, 2013), Memorandum of Agreement is drafted (March, 2013) Agreement is finalized (August, 2013) ate food handler cards.
Prior to the food handler reciprocity agreement, each local jurisdiction had differing minimum food handler training requirements for food service employees working within the different jurisdictions. The trainings were in six different locations, with associated and separate fees. The different training requirements and separate fees caused concern for the food service industry in the Kansas City Metro area. The local chapter of a nationally recognized association for restaurant owners and food service workers expressed their concerns about the undue financial burden placed on food service workers that hold positions in multiple jurisdictions. The concerns were expressed to elected officials in the form of lobbying. Describe the Community: The six local health agencies involved are Cass County, Clay County, Jackson County, Platte County, City of Independence Health Department and Kansas City, Missouri Health Department. Together, the health agencies serve the Missouri side of the Greater Kansas City area. The populations served range from rural to urban with different demographics. The total population served is approximately 1,085,795 according to the 2010 census. Winnable Battles: This agreement addresses the Center for Disease Control (CDC) Winnable Battle’s Food Safety Initiative. According to the CDC, Foodborne diseases affect tens of millions of people and kill thousands in the United States each year. They also cause billions of dollars in healthcare-related and industry costs annually. With additional effort and support for evidence-based, cost-effective strategies that we can implement now, we will have a significant impact on our nation's health. Easily accessible and cost-effective food safety education is expected to have a positive impact on foodborne illness in the Greater Kansas City Metro Area. Cass County: According to the 2012 American Community Survey 1-Year Estimates, Cass County has 2,701 arts, entertainment, recreation, and accommodation and food service workers. As of July 2011, Cass County’s population was 100,052 people. Sixty-eight percent of the County’s population is urban. Thirty-two percent of the County’s population is rural. Racially, Cass County is comprised of 89.5 percent White, 4.0 percent Hispanic or Latino, 3.5 percent Black Non-Hispanic, 1.7 percent two or more races 0.6 percent Asian and 0.5 percent American Indian and Alaskan Native. The median household income of Cass County is $59,382. There are currently 4,999 active food handler cards issued by the County. Clay County: According to the 2012 American Community Survey 1-Year Estimates, Clay County has 10,623 arts, entertainment, recreation, and accommodation and food service workers. As of July 2011, Clay County’s population was 225,161 people. Ninety percent of the County’s population is urban. Ten percent of the County’s population is rural. Racially, Clay County is comprised of 84.1 percent White, 5.9 percent Hispanic or Latino, 5.1 percent Black Non-Hispanic, 2.1 percent two or more races 2.0 percent Asian and 0.5 percent American Indian and Alaskan Native. The median household income of Clay County is $57,794. There are currently approximately 4,500 active food handler cards issued by the County. Jackson County: According to the 2012 American Community Survey 1-Year Estimates, Jackson County has 28,049 arts, entertainment, recreation, and accommodation and food service workers. As of July 2011, Jackson County’s population was 676,360 people. Ninety-six percent of the County’s population is urban. Four percent of the County’s population is rural. Racially, Jackson County is comprised of 63.3 percent White, 23.7 percent Black Non-Hispanic, 8.4 percent Hispanic or Latino, 2.4 percent two or more races 1.6 percent Asian. The median household income of Jackson County is $45,886. There are currently 11,067 active food handler cards issued by the County. Platte County: According to the 2012 American Community Survey 1-Year Estimates, Platte County has 4,013 arts, entertainment, recreation, and accommodation and food service workers. As of July 2011, Platte County’s population was 90,093 people. Eighty-four percent of the County’s population is urban. Sixteen percent of the County’s population is rural. Racially, Platte County is comprised of 84.1 percent White, 5.8 percent Black Non-Hispanic, 5.0 percent Hispanic or Latino, 2.3 percent Asian, 2.0 percent more than one race and 0.4 percent Native American or Alaskan Native. The median household income of Platte County is $64,497. There are approximately 2,400 active food handler cards issued by the County. City of Independence: According to the 2012 American Community Survey 1-Year Estimates, the City of Independence has 3,794 arts, entertainment, recreation, and accommodation and food service workers. As of 2012, the City of Independence population was 117,270 people. Ninety-nine percent of the City’s population is urban. One percent of the City’s population is rural. Racially, the City of Independence is comprised of 82.2 percent White, 7.7 percent Hispanic or Latino, 5.4 percent Black Non-Hispanic, 2.5 percent more than one race, 1.0 percent Asian, 0.5 percent Native American or Alaskan Native and 0.07 percent another race alone. The median household income of the City of Independence is $41,487. There are currently 21,474 active food handler cards issued by the City. City of Kansas City, Missouri: According to the 2012 American Community Survey 1-Year Estimates, Kansas City, Missouri has 22,293 arts, entertainment, recreation, and accommodation and food service workers. As of 2012, the Kansas City, Missouri population was 464,310 people. Racially, Kansas City, Missouri is comprised of 59.2 percent White, 29.9 percent Black Non-Hispanic, 10 percent Hispanic or Latino, 3.2 percent more than one race, 2.5 percent Asian, 0.5 percent Native American or Alaskan Native and 0.2 percent Hawaiian or Pacific Islander. The median household income of Kansas City, Missouri is $56,401. There are currently 21,736 active food handler cards issued by the City. Target Population: The target population for the food handler reciprocity agreement is the food service workers which work in each jurisdiction of the agreeing agencies. The jurisdictions distributed approximately 66,176 total current food handler cards. Although, each jurisdiction expects the number of food handler cards issued to decrease, each operator is still meeting the educational requirements for food safety. The drop in cards issued is not expected to affect the percentage of people who are receiving food handler education, only the amount of money each food handler has to expend to receive the training. Past Initiatives: In the past, food handler educational training was addressed individually by each of the six jurisdictions. There was not a shared baseline for meeting food handler training requirements in the Greater Kansas City Metro Area. Each jurisdiction provided their version of the training. A shared standard had not yet been developed in the Greater Kansas City Region. The food handler reciprocity agreement is in place to ensure that minimum food safety requirements are being met, while providing food handler education at a reasonable cost. The ability to utilize a single food handler card throughout the Greater Kansas City Metro Area has saved some food handlers up to $25.00. The $25.00 is a significant amount of money to some food handlers in the area. The collective financial savings has yet to be evaluated. Innovation: Other municipalities such as Austin, Texas and Tulsa, Oklahoma accept food handler’s training from multiple sources but still require a transfer of the food handler card to the specific jurisdiction for a fee. Our practice is innovative and new to the field of public health because the food handler reciprocity agreement cuts out the need to transfer the food handler card from jurisdiction to jurisdiction. The subsequent food handler card transfer fee is eliminated. The EHWG food handler reciprocity agreement is the first to not require a transfer card. Because this is an innovative practice, there is not currently data to consider this practice evidence based. The evaluation methods should facilitate the data in order for this to be considered an evidence based practice in the future.  
Food Safety
Goals: Establish a baseline for food safety educational requirements while easing the financial burden on food service workers. Objective: Reach an agreement that allows for acceptance of food handler training from each of the six jurisdictions. -Steps Taken: -The agreement was reached August 1st, 2013 outlining acceptance of the food handler reciprocity agreement for each of the six local public health agencies. -Milestone Meetings: -Getting the Stakeholders to the Table- Six Health Departments (December, 2012) -Financial implications and evaluations of the agreement (December, 2012) -Establishing a baseline for food safety training requirements (January, 2013) -Food safety training program evaluations (January, 2013) -Memorandum of Agreement is drafted (March, 2013) -Agreement is finalized (August, 2013) Objective: Create baseline food service requirements for food handler educational training in the Greater Kansas City Metro Area. -Steps Taken: -Each of the local public health agencies agreed upon minimum food safety educational requirements. -Pragmatic Analysis of Food Handler Training Programs in each jurisdiction. Objective: Ease the financial burden placed on food service workers in the Greater Kansas City Metro Area. -Steps Taken: -Elimination of transfer fees for verified food handler training cards. -Elimination of need to take training courses from each of the local public health agencies. -Evaluation of financial impact to local health agencies. -Evaluation of financial impact to food handlers. The people who are affected by the food handler reciprocity agreement are food service workers that work in multiple jurisdictions. The food handler reciprocity agreement is in place indefinitely. The food handler reciprocity agreement was developed over the course of 1 and a half years. The process involved many stakeholders. The local chapter of a nationally recognized association for restaurant owners and food service worker were able to express concerns to each of the local health agencies via elected officials. The EHWG food handler sub-committee is made up of representatives from six local health agencies to address the concerns of the Greater Kansas City Area Restaurant Association. Addressing the concerns has facilitated an environment that allows for open dialogue between the private sector and public sector around the common goal of food safety. The local health agencies are Cass County, Clay County, Jackson County and Platte County, along with the City of Independence and the City of Kansas City, Missouri. Each health agency played a role in formulating the agreement, evaluating food handler training requirements from each jurisdiction, agreeing upon minimum food safety standards and completing financial impact assessments for their jurisdiction based on a reduction in transfer card fee collection. The collaborative nature of the food handler reciprocity agreement project has fostered additional opportunities for the involved health agencies. A “just in time” training video for emergency responders and food service volunteers was created by the same EHWG. The “just in time” training video is just one of many regional collaborative efforts that the food handler reciprocity agreement creation process has helped facilitate. Additionally, the EHWG provides a platform for free flow of information to tackle environmental health problems that may arise in the area. In-Kind Costs/Start-Up Costs (Budget Document): Although the MARC EHWG total operating budget was $88,000, the food handler reciprocity agreement project was developed completely in-kind. Most of the $88,000 was spent on other regional environmental health projects and trainings. There were meetings once a month for the MARC EHWG, with food handler subcommittee meetings following. The food handler subcommittee had approximately 6 people at each meeting. The hourly salary for each of the people at the meetings is $30.00 plus benefits at $9 per hour. Each meeting lasted around an hour with an additional hour of driving time for the meeting attendees. The approximate in-kind cost for labor in the food handler reciprocity agreement meetings is $5,616. Additional labor time for drafting the agreement and evaluating food handler certification numbers is 20 hours. This equates to approximately $780 additional dollars. The total approximate in-kind costs for this project were $6,396.
Each local health department currently tracks the number of food handler educational certifications issued each year. The number of food handler educational certificates issued by each jurisdiction is expected to decrease. The number of transfer cards is expected to become negligible. Tracking of food handler educational certificates will continue. The City of Independence is the only jurisdiction which tracks the number of transfer cards issued. The transfer cards issued in Independence for 2012 are 420. The 420 transfer cards issued make up approximately 6.2 percent of the total food handler cards issued. Extrapolated over the combine total of food current food handler cards issued, 66,176 the total transfer cards would be approximately 4,117. Multiplied by a $5.00 transfer fee, the total amount saved by the food handler reciprocity agreement by food service workers is approximately $20,585.
The food handler reciprocity agreement is a sustainable practice. The start-up costs for this program were mostly in-kind costs, approximately $6,396. The remainder of the cost was funded through the MARC EHWG. Costs such as, meeting space overhead, minor printing and meeting facilitation were funded through MARC. The program is expected to be sustained with existing food handler training revenues through each of the local health agencies. The health agencies will continue to operate their food handler educational programs with the reciprocity agreement in place. Each agency involved is fully committed to the continuation of the food handler reciprocity agreement. The continuation of the food handler reciprocity agreement means that there will be a continuation of the MARC EHWG food handler sub-committee. Each agency will meet regularly on an every-other-month schedule to discuss the positive and negative aspects of the agreement. These meetings will allow for analysis of collected food handler data, which should further the affirmation that the agreement was positive for the targeted community and the involved agencies. The cost-benefit analysis suggests that the approximate cost to the local health agencies, $6,396, is far less than the $20,585 that is saved by the food service workers. While the MARC EHWG plans to continue meeting, the meeting frequency is less than prior to the food handler reciprocity agreement. The cost incurred by the local health agencies will continue to decrease as the savings for the food service workers will be reoccurring every three years. Multi-agency collaborative efforts require vision and willingness of each agency to adapt accepted practices for the greater good of the target population. The food handler reciprocity agreement shows that these efforts are not only possible, but practical and sustainable. The needs of the targeted community were met, while still meeting basic food safety educational requirements for each of the health agencies involved because of the collaborative spirit fostered by MARC EHWG. The food handler reciprocity agreement has been met with reaffirming praise by the local chapter of the nationally recognized association for restaurant owners and food service workers, restaurant owners and food handlers alike. The praise has been bolstered by restaurant managers to inspectors in the field. The evaluation methods should show that the agreement has been beneficial to both food handlers and food safety outcomes in the Greater Kansas City Metro Area.
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