Tarrant County Public Health Workforce Readiness

State: TX Type: Promising Practice Year: 2014

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The public health issue being addressed is workforce competence. According to NACCHO,local health departments have a serious and urgent need for preparing new public health professionals and for upgrading the skills of current public health professionals. This is because the vast majority of current public health workers do not have formal public health training (Institute of Medicine 2003). Additionally in an article titled "The Public Health Workforce: An Agenda for the 21st Century", the U. S. Department of Health and Human Services express a similar concern.

Goal: Identify and deliver developmental activities that support training specific to public health competencies and developmental national accreditation efforts for TCPH.

  • Develop a set of cross cutting public health competencies that can be used for a training needs assessment based on the 2009 updated consensus competencies developed by the Council on Linkages Between Academia and Public Health Practice (COLBAPHP).
  • Ensure all TCPH staff complete an assessment to identify specific competencies to develop.
  • Develop and deliver trainings to staff addressing public health competencies identified by their assessments to increase their knowledge base of competencies.
  • Evaluate initiative for process and outcome results.
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Tarrant County Public Health Department
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Tarrant County Public Health Workforce Readiness
Tarrant County Public Health is located in Fort Worth, Texas. This initiative builds upon earlier work beginning in 2008,Tarrant County Public Health (TCPH) received a certificate of Promising Practice from the National Association of County and City Health Officials (NACCHO) for the "TCPH Workforce Readiness" initiative. The public health issue being addressed is workforce competence. According to NACCHO,local health departments have a serious and urgent need for preparing new public health professionals and for upgrading the skills of current public health professionals. This is because the vast majority of current public health workers do not have formal public health training (Institute of Medicine 2003). Additionally in an article titled "The Public Health Workforce: An Agenda for the 21st Century", the U. S. Department of Health and Human Services express a similar concern. Goal: Identify and deliver developmental activities that support training specific to public health competencies and developmental national accreditation efforts for TCPH. Objective 1: Develop a set of cross cutting public health competencies that can be used for a training needs assessment based on the 2009 updated consensus competencies developed by the Council on Linkages Between Academia and Public Health Practice (COLBAPHP). Objective 2: Ensure all TCPH staff complete an assessment to identify specific competencies to develop. Objective 3: Develop and deliver trainings to staff addressing public health competencies identified by their assessments to increase their knowledge base of competencies. Objective 4: Evaluate initiative for process and outcome results. In the fall of 2009 a workforce competency committee was formed to address the above goal and objectives. The committee was composed of representatives from various divisions across the department, chaired by the Workforce and Leadership Development Coordinator. The committee processed through the 2009 updated consensus competencies developed by the COLBAPHP and developed modified assessments for Tier levels 1 through 3.These Tier levels included; Tier 1 for general staff, Tier 2 for staff whose positions required a degree, certification, or license, and Tier 3 for the Expanded Leadership Team. The assessments were distributed electronically and hard copy format for those without electronic access. In the spring of 2010 all staff completed an assessment. Over the next three years TCPH partnered with the University of North Texas Health Science Center School of Public Health (UNTHSCSPH) to provide public health competency trainings delivered onsite. The trainings provided included all domains addressed by the COLBAPHP along with various on line trainings and previously developed public health 101, Epi 101, public health preparedness 101, health equity 101 and HIPAA 101 trainings. In the spring of 2013 all staff again completed their Tier level appropriate competency assessment, in order to identify their progress and continued opportunities for training and development. The goal and objectives were met for this initiative. Developmental activities that support training specific to public health competencies were identified. A modified set of competencies were developed into an assessment that all staff completed. Over the course of the initiative from 2009 - 2013 trainings were delivered to staff that addressed competency gaps identified by their assessments. There was an increased knowledge level as evidenced by the 2010 - 2013 assessment comparison (See the Evaluation section in this application). With this initiative TCPH is better positioned to meet the requirements set forth by PHAB in Domain 8 for national accreditation. Factors that supported success include; the TCPH Leadership Team buy-in and support, our relationship with the UNTHSCSPH, and the willingness of the division managers and their staff to be willing participants in this initiative.
The Tarrant County Public Health (TCPH) Department is located in Fort Worth, Texas. TCPH serves a county with 41 municipalities, including the Dallas / Fort Worth International Airport located in North Central Texas. TCPH serves a diverse population both urban and rural of approximately 1.8 million residents. The public health issue being addressed is workforce competence. According to NACCHO,local health departments have a serious and urgent need for preparing new public health professionals and for upgrading the skills of current public health professionals. This is because the vast majority of current public health workers do not have formal public health training (Institute of Medicine 2003).Additionally in an article titled "The Public Health Workforce: An Agenda for the 21st Century", the U. S. Department of Health and Human Services express a similar concern. The target population of this internal initiative included all TCPH staff. There is approximately 385 full time staff covering all disciplines of public health, half of which are professional and the other half non-professional. All of the target population participated in this initiative. All staff completed an individual assessment and all attended trainings. Prior to this initiative in the summer of 2006 a general needs assessment was developed. There were two versions; one for management and the other for general staff. In the fall of 2006 assessments were completed. The assessments were completed in both electronic and hard copy formats (for those without access to a computer). The data was gathered in aggrerate form. The goal was to obtain a general overview of training needs for staff. From the discussion with the Leadership Team, the data and the needs of the health department staff, several courses were recommended for development including; Public health 101, Epidemiology 101, and Community Collaboratin 101. These courses were developed and staff completed them along with online public health trainings and general communication and leadership trainings offered by the County. While this was a good start to begin to address workforce development, more needed to be done to get at individual staff competency development. In the fall of 2009 the Workforce Development Coordinator along with the Leadership Team determined there was a need to identify development activities that support training specific to public health competencies and developmental national accreditation efforts for TCPH.The goal was to develop a set of cross cutting public health competencies that could be used for a training needs assessment based on the 2009 updated consensus competencies developed by the Council on Linkages Between Academia and Public Health Practice. This initiative improves and expands the previous efforts prior to 2009 addressing workforce development by specifically addressing each staff and providing opportunities for staff to complete training they have identified from their assessments. This initiative was innovative and new in the following ways. In 2009 the Council on Linkages Between Academia and Public Health Practice had only published the updated public health competencies and had not yet developed assessments to identify gaps for public health professionals. When our workforce Competency Committee processed through the competencies and developed a modified assessment for Tier 1 - 3 levels, the Council on Linkages Between Academia and Public Health Practice had not yet developed or published their assessments. The Committee modified the competencies assessments in two ways; one they reduced the number of competencies to be used for the assessment to make it more manageable for our staff while still addressing all domains for competencies and secondly the Committee modified some of the wording of a few competencies in order to better fit our Tier 1 level staff.
This initiative builds upon earlier work beginning in 2008,Tarrant County Public Health (TCPH) received a certificate of Promising Practice from the National Association of County and City Health Officials (NACCHO) for the "TCPH Workforce Readiness" initiative. Goal: Identify and deliver developmental activities that support training specific to public health competencies and developmental national accreditation efforts for TCPH. Objective 1: Develop a set of cross cutting public health competencies that can be used for a training needs assessment based on the 2009 updated consensus competencies developed by the Council on Linkages Between Academia and Public Health Practice (COLBAPHP). Objective 2: Ensure all TCPH staff complete an assessment to identify specific competencies to develop. Objective 3: Develop and deliver trainings to staff addressing public health competencies identified by their assessments to increase their knowledge base of competencies. Objective 4: Evaluate initiative for process and outcome results. In the fall of 2009 a workforce competency committee was formed to address the above goal and objectives. The committee was composed of representatives from various divisions across the department chaired by the Workforce and Leadership Development Coordinator. The committee processed through the 2009 updated consensus competencies developed by the COLBAPHP and developed modified assessments for Tier levels 1 through 3.These Tier levels included; Tier 1 for general staff, Tier 2 for staff whose positions required a degree, certification, or license, and Tier 3 for the Expanded Leadership Team. The assessments were distributed electronically and hard copy format for those without electronic access. All staff were informed of their responsibility to complete training to address competencies identified by their competency assessments. This responsibility was addressed by each manager in the "Additional Criteria: Goals and Objectives" section in each staff's annual appraisal. In the spring of 2010 all staff completed an assessment. Over the next three years TCPH partnered with the University of North Texas Health science Center School of Public Health (UNTHSCSPH) Training Center to plan and deliver public health competency trainings to be delivered onsite. The UNTHSCSPH Training Center worked with the workforce competency committee to identify training topics along with specific objectives for the trainings. The trainings provided included all domains addressed by the COLBAPHP along with various on line trainings and previously developed public health 101, Epi 101, public health preparedness 101, health equity 101 and HIPAA 101 trainings. Other trainings provided included Leadership and Succession training provided by the County training department.There is also a public health Toastmasters Club where public health staff can work on and improve their public speaking skills, as well as, develop leadership skills. Along with partnering with internal management and staff for this initiative TCPH collaborated with several external partners for both planning and delivery of competency trainings. TCPH contracted with the University of North Texas Health Science Center School of Public Health (UNTHSCSPH) Training Center to provide faculty to deliver on site public health competency training in 2011 at a cost of $2,500. In 2012 TCPH again contracted wit(UNTHSCSPH) Training Center for faculty to provide public health competency training on site at a cost of $1,600. TCPH also contracted with The University of North Texas Office of Professional and Continuing Education(UNTPACE) for the provision of Continuing Education Units (CEUs) for staff completing public health competency and medical staff trainings. The contract details follow: TCPH and UNTPACE for provision of CEUs from July 2009 - July 2010 for $1,000.  TCPH and UNTPACE for provision of CEUs from July 2010 - July 2011 for $1,000. TCPH and UNTPACE for provision of CEUs from September 2012 - September 2014 for $2,000. TCPH also partnered with the Texas Board of Nursing to plan and deliver update trainings to the TCPH medical staff. Another partner to assist with the delivery of training for TCPH staff was the Public Health Informatics Institute. In addition, TCPH partnered with the Tarrant County Training Department to deliver Leadership and Succession training to the staff. TCPH has a long standing and good relationship with UNTHSCSPH and this relationship contributed greatly to the success of this initiative. TCPH values the relationships with community and State partners as well, and the previously established partnership with the Texas Board of Nurses greatly contributed to the success of this initiative. TCPH workforce development staff have participated jointly with the Tarrant County Training staff to provide training to the staff of Tarrant County in the past and this relationship contributed to the successful collaborative efforts for the delivery of Leadership and Succession training to our staff. In the spring of 2013 all staff again completed their Tier level appropriate competency assessment, in order to identify their progress and continued opportunities for training and development. See the progress and comparison results in the Evaluation section of this application. In addition to the collaboration of partners to plan and accomplish the objectives of this initiative, TCPH also shared the results of this initiative with other health departments including; Denver Public Health, Plano Texas City Health Department, New Mexico Department of Health - Southeast Region, Gila County and Emergency Services, Panhandle Health District - Idaho, Cuyahoga County Board of Health - Ohio and Austin-Travis County Health and Human Services. The Austin-Travis County Health Department has developed their workforce development program using this initiative as a guiding model.
This initiative builds upon earlier work beginning in 2008,Tarrant County Public Health (TCPH) received a certificate of Promising Practice from the National Association of County and City Health Officials (NACCHO) for the "TCPH Workforce Readiness" initiative. Goal: Identify and deliver developmental activities that support training specific to public health competencies and developmental national accreditation efforts for TCPH. Objective 1: Develop a set of cross cutting public health competencies that can be used for a training needs assessment based on the 2009 updated consensus competencies developed by the Council on Linkages Between Academia and Public Health Practice (COLBAPHP). Objective 2: Ensure all TCPH staff complete an assessment to identify specific competencies to develop. Objective 3: Develop and deliver trainings to staff addressing public health competencies identified by their assessments to increase their knowledge base of competencies. Objective 4: Evaluate initiative for process and outcome results.With the Leadership Team guidance the Workforce Competency Committee along with the managers and the department staff, began the process steps described below in order to accomplish the goal and objectives stated above: Objective 1: In the fall of 2009 a workforce competency committee was formed to address the above goal and objectives. The committee was composed of representatives from various divisions across the department chaired by the Workforce and Leadership Development Coordinator. The committee processed through the 2009 updated consensus competencies developed by the COLBAPHP and developed modified assessments for Tier levels 1 through 3. These Tier levels included; Tier 1 for general staff, Tier 2 for staff whose positions required a degree, certification, or license, and Tier 3 for the Expanded Leadership  Team. The assessments were distributed electronically and hard copy format for those without electronic access.  All staff were informed of their responsibility to complete training to address competencies identified by their competency assessments. This responsibility was addressed by each manager in the "Additional Criteria: Goals and Objectives" section in each staff's annual appraisal. Objective 2: In the spring of 2010 all staff completed an assessment. Objective 3: Over the next three years TCPH partnered with the University of North Texas Health science Center School of Public Health (UNTHSCSPH) Training Center to plan and deliver public health competency trainings to be delivered onsite. The UNTHSCSPH Training Center worked with the workforce competency committee to identify training topics along with specific objectives for the trainings. The trainings provided included all domains addressed by the COLBAPHP along with various on line trainings and previously developed public health 101, Epi 101, public health preparedness 101, health equity 101 and HIPAA 101 trainings. Other trainings provided included Leadership and Succession training provided by the County training department.There is also a public health Toastmasters Club in which public health staff can work on and improve their public speaking skills, as well as, develop leadership skills. In FY 2011 ninety six percent of all TCPH staff completed public health competency training. In FY 2012 ninety five percent of all TCPH staff completed public health competency training. In FY 2013 ninety seven percent of all TCPH staff completed public health competency training. Objective 2: In the spring of 2013 all staff again completed their Tier level appropriate competency assessment, in order toidentify their progress and continued opportunities for training and development. One Hundred percent of TCPH staff completed a public health competency assessment in 2010. One hundred percent of TCPH staff completed a public health competency assessment in 2013. In order to ensure all staff completion of an assessment, all new employees completed their initial assessment when onboarding at the public health new employee orientation. The goal and objectives to accomplish the goal, were all achieved and due to this initiative TCPH is better positioned to meet PHAB accreditation requirements listed in Domain 8 of the PHAB Standards and Measures. In order to the evaluate outcome results listed in objective 3 related to an increase in competency knowledge, a comparison of the responses on the 2010 assessments and 2013 assessment were analyzed. Approximately sixty six percent of the staff completing the 2010 competency assessments also completed the 2013 competency assessments. This is the group that was used for the comparison study. When staff completed their competency assessments they responded with with one of four choices: Unaware: not able to identify the concept or skill. Aware: able to identify the skill but limited ability to perform. Knowledgeable: able to describe and apply the skill. Advanced: able to synthesize, critique or teach the skill. For analysis scores were assigned to each response option. Unaware was assigned 1 point, Aware was assigned 2 points, knowledgeable was assigned 3 points and Advanced was assigned 4 points. Summary for Tier 1 2010 vs. 2013 assessment results: The most remarkable observations include; a thirty five percent increase in the group's response in the Knowledgeable category from 2010 to 2013 and a sixty nine percent decrease in the group's response in the Unaware category from 2010 to 2013. The group's scores increased in 11 of 14 competencies from 2010 to 2013 and the other three remained relatively constant.The total average scores for the group increased by sixteen percent. Summary for Tier 2 2010 vs. 2013 assessment results: The most notable observations include; a thirty two percent increase in the group's response in the Knowledgeable category from 2010 to 2013 and a fifty two percent decrease in the group's response in the Unaware category from 2010 to 2013. The total average scores for the group increased by twelve percent from 2010 to 2013. Summary for Tier 3 2010 vs. 2013 assessment results: For this group the biggest improvement came in the Knowledgeable category for the following Domains; Community Dimensions, Financial Planning, Communication, and Leadership and Systems Thinking with an average increase of fifty six percent in the knowledgeable category from 2010 to 2013. Another notable finding for the Tier 3 group was seen in the Unaware category having no scores in the Unaware Category for five competencies that had scores in the 2010 assessments, the Domains in which these competencies were found include; Analytical Assessment, Policy Development and Program Planning, Community Dimensions, Financial Planning, and Leadership and Systems Thinking. The total average scores for the group increased by three percent. Although three percent may seem insignificant, this group had relatively high scores in 2010 as one may expect given this group's education and experience level. In general all Tier groups showed an overall increase in competency ratings, indicating an increase in knowledge base of  identified competencies. The biggest gains were seen in Tier 1 and Tier 2 groups moving out of the Aware and into the Knowledgeable categories. Given the success of this initiative future training opportunities will be developed to meet the needs of the staff based on the results and gaps identified by the staff competency assessments.
The lessons learned were many and included the following:Because this was a new initiative involving assessment and training for all staff using a set of public health competencies that many were not familiar with, there was a big need for buy-in from all staff at all levels. This buy-in had to start with the Senior Leadership Team. It was important to make them aware of the commitment and the process that would be involved if this initiative was to be successful. Once there was buy-in from the Senior Leadership Team we had to get buy-in from our Expanded Leadership Team which includes our division managers. The awareness education for this group took place multiple times in order to get consensus buy-in. In order to get buy-in from the entire staff our division managers along with the Workforce Development Coordinator provided multiple awareness activities. Because this type of initiative was new for many staff, as mentioned above,it involved a change in culture for our department. The staff needed to move from focusing solely on training only on job specific training to completing training specifically related to a general set of public health competencies. It was important to explain why there was a need for this initiative and this included conversations about National Accreditation which they were not familiar with as well. Once all the initial awareness and education activities were complete it was only then that we got thier buy-in. Another lesson learned involved the value of relationships and collaborations. It was critical to the success of this initiative to have already been in partnership with the School of Public Health, the Texas Board of Nursing and our internal County Training Office.These established relationships required less time and energy spent on building the relationships and allowed more time for planning and implementing the initiative. Another lesson learned included the value of gaining new partnerships through sharing our experiences regarding both the process and accomplishments of the initiative with other health departments. We have many new relationships as we shared our experiences with others and others shared with others seeking to develop their workforce development programs. The Senior Leadership Team is committed to sustaining and expanding workforce development activities for the future. They have committed to applying for and going through the process of PHAB National Accreditation which includes workforce development activities detailed in Domain 8 of the Standards and Measures. They have budgeted for the Accreditation fee as well as the expenses needed to sustain and expand workforce development activities based on the expenses needed for past workforce development activities. TCPH is also in the process of hiring a new FTE to join the workforce development staff to assist with maintaining and expanding current workforce development activities. As mentioned previously in this application TCPH applied for Model Practice in 2008 for this initiative and received a Promising Practice award. Since 2008 this initiative has been expanded to include development of public health competency assessments modified specifically for our staff based on a consensus set of public health competencies. Each staff are able to identify specific competencies to develop and there are more training opportunities available for them to address specific competency needs vs. in the past when the assessments were general and had limited options for trainings. This initiative is also better as it has brought TCPH in line with national accreditation requirements for workforce development.
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