Joan P. Cioffi

A research agenda for public health workforce development.

In the past decades, public health research has focused on categorical rather than cross-cutting or systems issues. Little research has been carried out on the infrastructure required to support public health programs. This article describes the results of an interactive process to develop a research agenda for public health workforce development to inform all those with stakes in the public health system. This research is defined as a multidisciplinary field of inquiry, both basic and applied, that examines the workforce in terms of costs, quality, accessibility, delivery, organization, financing, and outcomes of public health services to increase knowledge and understanding of the relationships among workforce and structure, processes, and effects of public health services. A logic model and five priority research areas resulted from meetings of expert panels during 2000 to 2003. Innovative public and private partnerships will be required to advance cross-cutting and systems-focused research.

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.

The MACH Model: From Competencies to Instruction and Performance of the Public Health Workforce

In A National Public Health Strategy for Terrorism Preparedness and Response 2003–2008, the Centers for Disease Control and Prevention (CDC) outlined the 11 imperatives for preventing death, disability, disease, and injury associated with urgent health threats.1 Imperative five, Competent and Sustainable Workforce, identifies four critical objectives: (1) increase the number and type of professionals who comprise a preparedness and response workforce; (2) deliver certification and competency-based training and education; (3) recruit and retain the highest quality workforce; and (4) evaluate the impact of training to ensure learning has occurred. The plan states: “Challenges that exist … include defining the role of certification, practicing quality assurance and performance measurement, developing customized standard competencies …”1 The MACH (Miner, Alperin, Cioffi, and Hunt) Model, developed at the Rollins School of Public Health, serves as a logic map that describes the associations among the objectives and challenges within this imperative. The MACH Model places into context the organizational and instructional theories that underpin workforce preparation and practice. It also accounts for the two general types of needs within public health: those of the employee with skill deficits for specific tasks, which can be met through training or other expert systems; and those of the institution with deficiencies in the work environment, which can be met through management practices and organizational priorities.

Credentialing the public health workforce: an idea whose time has come.

The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels since the landmark 1988 Institute of Medicine report. The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. The fact that the public health workforce is not a single profession, but rather a fabric of many professions dedicated to a common endeavor, creates challenges to any singular approach. This article explores the relationships among competency, certification, and accreditation and summarizes the expert panel dialogue on workforce development incentives, specifically regarding certification and credentialing. The authors challenge public health leaders to become actively involved in framing the issues so the best possible strategies can be developed.

Partnering for Preparedness: The Project Public Health Ready Experience

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The projects pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.

Are public health services available where they are most needed? An examination of local health department services.

Local health departments (LHDs) play a key role in the provision of public health services in the United States. Little is known about the extent to which LHD service availability varies by the socioeconomic characteristics of regional populations. This study merges data from the 1996 National Association of County and City Health Officials LHD profile survey and the Area Resource File system. The empirical analysis suggests that LHDs in low-socioeconomic background counties are more likely to provide services such as family planning. For other services, either LHD involvement is low across the board or the distribution of LHD services does not favor low-socioeconomic background counties. Thus, there is often room for improvements in service availability and targeting.

Preparedness and Emergency Response Learning Centers: supporting the workforce for national health security.

The importance of a competent and prepared national public health workforce, ready to respond to threats to the publics health, has been acknowledged in numerous publications since the 1980s. The Preparedness and Emergency Response Learning Centers (PERLCs) were funded by the Centers for Disease Control and Prevention in 2010 to continue to build upon a decade of focused activities in public health workforce preparedness development initiated under the Centers for Public Health Preparedness program (http://www.cdc.gov/phpr/cphp/). All 14 PERLCs were located within Council on Education for Public Health (CEPH) accredited schools of public health. These centers aimed to improve workforce readiness and competence through the development, delivery, and evaluation of targeted learning programs designed to meet specific requirements of state, local, and tribal partners. The PERLCs supported organizational and community readiness locally, regionally, or nationally through the provision of technical consultation and dissemination of specific, practical tools aligned with national preparedness competency frameworks and public health preparedness capabilities. Public health agencies strive to address growing public needs and a continuous stream of current and emerging public health threats. The PERLC network represented a flexible, scalable, and experienced national learning system linking academia with practice. This system improved national health security by enhancing individual, organizational, and community performance through the application of public health science and learning technologies to frontline practice.

Applying Instructional Design Strategies and Behavior Theory to Household Disaster Preparedness Training

Context: Interventions and media campaigns promoting household disaster preparedness have produced mixed results in affecting behaviors. In large part, this is due to the limited application of instructional design strategies and behavior theory, such as the Transtheoretical Model (TTM). This study describes the development and evaluation of Ready CDC, an intervention designed to increase household disaster preparedness among the Centers for Disease Control and Prevention (CDC) workforce. Objectives: (1) Describe the instructional design strategies employed in the development of Ready CDC and (2) evaluate the interventions impact on behavior change and factors influencing stage progression for household disaster preparedness behavior. Design: Ready CDC was adapted from the Federal Emergency Management Agencys (FEMAs) Ready campaign. Offered to CDC staff September 2013–November 2015, it consisted of a preassessment of preparedness attitudes and behaviors, an in-person training, behavioral reinforcement communications, and a 3-month follow-up postassessment. Results: Ready CDC employed well-accepted design strategies, including presenting stimulus material and enhancing transfer of desired behavior. Excluding those in the TTM “maintenance” stage at baseline, this study determined 44% of 208 participants progressed at least 1 stage for developing a written disaster plan. Moreover, assessment of progression by stage found among participants in the “precontemplation” (n = 16), “contemplation” (n = 15), and “preparation” (n = 125) stages at baseline for assembling an emergency kit, 25%, 27%, and 43% moved beyond the “preparation” stage, respectively. Factors influencing stage movement included knowledge, attitudes, and community resiliency but varied depending on baseline stage of change. Conclusions: Employing instructional strategies and behavioral theories in preparedness interventions optimizes the potential for individuals to adopt preparedness behaviors. Study findings suggest that stage movement toward household preparedness was not spurious but rather associated with the intervention. Therefore, Ready CDC was successful in moving staff along the continuous process of adopting household disaster preparedness behaviors, thus providing a model for future interventions. The TTM suggests factors such as knowledge, beliefs, and self-efficacy will differ by stage and may differentially predict progression towards behavior adoption. Thus, tailoring interventions based on an individuals stage of change optimizes the potential for individuals to adopt desired behaviors.