Regional Training Needs Assessment: A First Look at High-Priority Training Needs Across the United States by Region.

CONTEXT: Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains. OBJECTIVE: The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions. DESIGN: The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling. SETTING: State and local health departments. PARTICIPANTS: Respondents from state and local health departments. MAIN OUTCOME MEASURES: This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ test and Rao-Scott design-adjusted χ test. RESULTS: Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community. CONCLUSIONS: Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

Achieving Public Health Standards and Increasing Accreditation Readiness: Findings From the National Public Health Improvement Initiative.

OBJECTIVES: During 2010-2014, the Centers for Disease Control and Prevention implemented the National Public Health Improvement Initiative (NPHII) to assist 73 public health agencies in conducting activities to increase accreditation readiness, improve efficiency and effectiveness through quality improvement, and increase performance management capacity. A summative evaluation of NPHII was conducted to examine whether awardees met the initiative's objectives, including increasing readiness for accreditation. DESIGN: A nonexperimental, utilization-focused evaluation with a multistrand, sequential mixed-methods approach was conducted to monitor awardee accomplishments and activities. Data analysis included descriptive statistics, as well as subanalyses of data by awardee characteristics. Thematic analysis using deductive a priori codes was used for qualitative analysis. RESULTS: Ninety percent of awardees reported completing at least 1 accreditation prerequisite during NPHII, and more than half reported completing all 3 prerequisites by the end of the program. Three-fourths of awardees that completed a self-assessment reported closing gaps for at least 1 Public Health Accreditation Board (PHAB) standard. Within 3 years of the launch of PHAB accreditation, 7 NPHII awardees were accredited; another 38 had formally applied for accreditation. CONCLUSIONS: Through NPHII, awardees increased collaborative efforts around accreditation readiness, accelerated timelines for preparing for accreditation, and prioritized the completion of required accreditation activities.

A Review of Public Health Training Needs Assessment Approaches: Opportunities to Move Forward.

CONTEXT: Assessing training needs of the public health workforce is crucial for creating professional development opportunities to improve knowledge, competence, and effectiveness of this workforce. DISSEMINATION: Regional Public Health Training Centers (RPHTCs) assess workforce training needs and deliver training based on identified needs. To determine training priorities, several needs assessment surveys have been administered by RPHTCs and national public health member organizations. EVALUATION: This study identified the types of training questions being asked to public health practitioners in the various assessment surveys implemented by RPHTCs and national membership organizations. Although the surveys measured similar overarching constructs, multiple approaches with limited consistency were used to measure training needs. DISCUSSION: Although successful in responding to the needs of their targeted constituents, the limited consistency among survey types makes generalization of findings difficult. Disseminating common metrics and aggregate survey findings would increase efficiency in determining workforce training needs and developing targeted training.

Quality improvement coaching to build capacity within health departments: reflections and recommendations.

CONTEXT: Strengthening the Community of Practice for Public Health Improvement is a 2-year initiative that facilitates the exchange of best practices and builds capacity among the nation's health departments to become accredited and conduct quality improvement (QI). Launched as the Public Health Accreditation Board opened its doors to receive the first accreditation applications from health departments, the Community of Practice for Public Health Improvement is the next stage in the National Network of Public Health Institutes' efforts to nurture and expand a community of practice focused on accreditation and QI. A key component of the Community of Practice for Public Health Improvement is the QI Award Program, which provides small grants and distance-based QI coaching to state, local, tribal, and territorial health departments. OBJECTIVE: To understand the efficacy of distance-based QI coaching. DESIGN: The QI coaching model was evaluated using Web-based satisfaction surveys along with programmatic data collected through progress reports, coaching logs, and meetings. SETTING: During 2 QI Award Program cycles, 60 health departments (30 departments per cycle) received $5000 and QI coaching to engage in QI projects that address locally identified priorities and connect to efforts to prepare for public health accreditation. PARTICIPANTS: Data in this article represent findings from the first 30 sites and 9 coaches who participated in cycle 1. MAIN OUTCOME MEASURE(S): QI coaching hours and methods, sites' impressions of QI coaching, sites' accomplishments due to coaching, and suggestions for coaching improvement. RESULTS: Approximately 80% of QI satisfaction survey respondents indicated that they strongly agreed or agreed that distance-based coaching is effective. Sites also reported increased experience with QI processes, initiation of QI spread within the health department, and additional activity within and beyond the project team due to the QI Award Program.

The quantitative story behind the quality improvement storyboards: a synthesis of quality improvement projects conducted by the multi-state learning collaborative.

CONTEXT: The Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement (MLC) brought state and local health departments in 16 states together with public health system and national partners to prepare for national voluntary accreditation and to implement quality improvement (QI) practices. OBJECTIVE: The MLC has collected the single largest repository of qualitative public health QI data to date. A preliminary study was conducted to explore the potential merits of further mining data sets of this size and scope and examining them quantitatively. DESIGN: We addressed the following research question: What characteristics of QI projects/mini-collaboratives make them more or less likely to attain their stated objectives? Qualitative MLC data were modified and coded as quantifiable measures using categorical or Likert scale measures analyzable through quantitative methods. Descriptive and inferential statistics were calculated. RESULTS: Of the 156 mini-collaboratives with complete data, chronic disease was the most commonly selected target area. Among the 4 dependent variables, results varied somewhat by outcome. There was support in 1 or more analytical models for a positive relationship between aim statements that included target objectives, time frames, measurable goals, and well-defined processes. The degree to which the intervention was logically aligned with the aim and the comprehensiveness of the QI project were also positively associated with 1 or more outcomes. The large number of statistical tests conducted may have led to type I errors for some comparisons. CONCLUSIONS: Quantitative analysis and modeling of public health QI activities are feasible and desirable. It may provide critical information leading to incremental improvement in QI performance within public health practice. This work can inform the nascent national accreditation program and the developing QI in Public Health Practice Exchange.

Promoting quality improvement and achieving measurable change: the lead states initiative.

Along with the development of a national voluntary accreditation program for public health departments that holds quality improvement as its core goal, the application of quality improvement in public health has been gaining momentum. The 16 states participating in the Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement (MLC) represent best practices in these activities. The MLC brings together partnerships in 16 US states to prepare for accreditation and implement quality-improvement practices. The grantee states are managing quality-improvement teams of local and state health department representatives and other partners. These teams, called mini-collaboratives, are working collectively to implement quality-improvement techniques to make measurable change on identified public health issues, or target areas. The work of the MLC seems to show that state and local-health departments and their key partners have the leadership, will and interest to apply quality improvement tools, and methods to solving public health problems and to raising the standard of public health practice. This article describes the history, current status, and lessons learned from the work of the MLC.

Voluntary rapid human immunodeficiency virus (HIV) testing in jails.

OBJECTIVES: To provide human immunodeficiency virus (HIV) rapid testing to persons in jails, identify previously undiagnosed cases of HIV infection, and refer HIV-infected inmates to care, treatment, and prevention services. DESIGN: Four state health departments (Florida, Louisiana, New York, and Wisconsin) collaborated with jails to implement stand-alone voluntary rapid HIV testing programs. Inmates requested or were referred by medical staff for rapid HIV testing. HIV testing was provided by the health department, correctional facility, or a community-based organization. Inmates whose rapid test was reactive were offered confirmatory testing, medical evaluation, prevention services, and discharge planning. RESULTS: From December 2003 through May 2006, rapid HIV testing was provided to 33,211 inmates, more than 99.9% of whom received their test results. Most of the inmates tested were male (79%), black (58%), and less than 35 years of age (60%). A total of 440 (1.3%) rapid HIV tests were reactive, and 409 (1.2%) of the results were confirmed positive. The testing programs identified 269 (0.8%) previously undiagnosed cases of HIV infection. In the multivariate analyses, new HIV diagnoses were associated with race/ethnicity, report of risky behaviors, and with no report of HIV risk behavior. Almost 40% of diagnoses were for inmates whose only reported risk was heterosexual contact. CONCLUSIONS: Rapid HIV testing in jails identified a considerable number of previously undiagnosed cases of HIV infection. Rapid HIV testing should be available to all inmates, regardless of whether inmates reported HIV risky behaviors.