Tracking Public Health Workforce Retention: Observations From CDC's Public Health Associate Program.

Objectives. To describe the career trajectories of 1 cohort of US Public Health Associate Program (PHAP) alumni over 3 years since completing PHAP.Methods. We distributed a Web-based survey at 3 time points between 2014 and 2017 (response rate = 76%). We calculated descriptive statistics in SPSS.Results. At all time points, most alumni were employed. Of those, the percentage employed in public health was 100% at program completion, 86% at year 1, and 68% at year 3.Conclusions. Most alumni were employed in public health jobs at each time point. At the 3-year mark, approximately a third of the alumni had left public health employment, which is in line with documented rates of turnover within the broader public health workforce.Public Health Implications. Service learning programs like PHAP are effective at recruiting early career professionals into public health. The extent to which PHAP is effective at retaining workers in public health after the program appears most promising immediately following the program or in the short term after the program concludes. The extent to which workers are retained in the longer term requires further study.

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 intervention's impact on behavior change and factors influencing stage progression for household disaster preparedness behavior. DESIGN: Ready CDC was adapted from the Federal Emergency Management Agency's (FEMA's) 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 individual's stage of change optimizes the potential for individuals to adopt desired behaviors.

Early Evaluation Findings From a Federally Funded Training Program: The Public Health Associate Program.

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) created the Public Health Associate Program (PHAP) to establish a continuous source of public health professionals who can deliver frontline services at the federal, state, tribal, local, and territorial levels. The article describes preliminary evaluation findings for PHAP. DESIGN: The evaluation's primary purposes are to assess the quality and effectiveness of PHAP, determine its value and impact, and provide information to continuously improve the program. Because the evaluation is both formative and summative and focuses on aggregate outputs and outcomes of PHAP, the methodology is complex and builds over time as different cohorts cycle into and out of the program. Results presented are outcomes of various Web-based surveys and reporting systems. PARTICIPANTS: Four PHAP cohorts, consisting of 579 individuals, participated in 1 or more of the evaluation activities described in this article. RESULTS: The majority of participants report satisfaction with their PHAP experiences, and 74% of recent graduates indicate they are continuing their careers or education in public health immediately after program completion. Seventy-eight percent of recent PHAP graduates who accept a job in public health are employed by the federal government. One year post-PHAP, 74% of alumni report that PHAP has been influential in their careers. CONCLUSION: CDC's investment in PHAP has increased the capacity and capabilities of the public health workforce. Results presented are early indicators of program quality, effectiveness, and impact. Today's public health workers are asked to do more with less, in the face of a dynamic array of complex public health challenges. PHAP offers public health agencies assistance in tackling these losses and challenges.

Service Learning in Public Health: Exploring the Benefit to Host Agencies in CDC's Public Health Associate Program.

The "learn by doing" approach to training is common in the public health field and is a core component of service-learning programs. Trainee satisfaction, learning, and application of learning have been studied. What is less understood is the perspective of the agencies that host trainees. This study aimed to identify whether and how the Centers for Disease Control and Prevention's Public Health Associate Program (PHAP) adds value to the agencies that host trainees during 2-year field assignments. An exploratory, qualitative study design consisting of 9 semistructured telephone interviews with PHAP host agency supervisors was used. Results suggested that PHAP increased host agencies' capacity by assigning capable trainees to host agencies. Trainees made quality contributions that led to agency- and/or community-wide improvements and positively affected the agencies' culture. Further evaluation of the host perspective is necessary; as coupled with the trainee's perspective, it will provide a more holistic understanding of program value.

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 public's 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.

The Preparedness and Emergency Response Learning Centers: advancing standardized evaluation of public health preparedness and response trainings.

INTRODUCTION: The Centers for Disease Control and Prevention funded Preparedness and Emergency Response Learning Centers (PERLCs) across the United States. The PERLCs provide training to state, local, and tribal public health organizations to meet workforce development needs in the areas of public health preparedness and response, specialized training, education, and consultation. METHODS/ACTIVITY: Using Donald Kirkpatrick's training evaluation model, the PERLC network established 4 evaluation working groups that developed evaluation criteria to address each level of the model. The purpose of the working groups was to inform and promote center-level and program-level evaluation across the PERLC network; identify common training evaluation methods and measures; and share materials, resources, and lessons learned with state, local, and tribal public health organizations for potential replication. RESULTS/OUTCOMES: The evaluation of education and training, irrespective of its modality (eg, in-person, online, webinars, seminars, symposia) can be accomplished using Kirkpatrick's 4-level taxonomy. DISCUSSION: The 4 levels aim to measure the following aspects of training programs: (1) trainees' reaction; (2) knowledge acquired, skills improved, or attitudes changed; (3) behavior changed; and (4) results or impact. To successfully evaluate emergency preparedness training, drills and exercises, it is necessary to understand the fundamental tenets of each level and how to apply each to measure training outcomes. LESSONS LEARNED/NEXT STEPS: The PERLC evaluators have adopted the basic schema of Kirkpatrick's 4-level model and applied its structure to a wide variety of preparedness and emergency response training and related activities. The PERLC evaluation working groups successfully developed and tested survey methods and instruments for each of the 4 levels of Kirkpatrick's training evaluation model. Each can be used for replication by state, local, and tribal public health professionals.

Ensuring a competent public health responder workforce: The CDC experience.

INTRODUCTION: From 2009 to 2016, the Centers for Disease Control and Prevention (CDC) activated its Incident Management System for a public health emergency 91 percent of the time. The CDC must ensure its workforce is prepared for the evolving nature of emergencies. OBJECTIVES: The purpose of this assessment was to identify perceived preparedness and response training needs for the CDC responder workforce. METHODS: Between November 2012 and January 2013, focus groups and in-depth interviews were conducted with CDC responders, including senior leaders. The evaluation questions were: (1) How well does the current training system prepare CDC staff to respond to emergency events? (2) What gaps exist in the current training system? and (3) What trainings are essential and should be included in the training system? RESULTS: Eight focus groups were conducted with 51 responders and 18 interviews with response leaders. Themes were identified for each main outcome measure and translated to training improvements. CONCLUSIONS: The CDC workforce received foundational training. Recommendations are provided to better prepare responders during an emergency. Periodic assessments are necessary to expand training and remain responsive to the complexities of emerging threats.

Assessing Participants' Experiences in a Service-Learning Program: A Psychometric Evaluation.

There is currently a gap in the literature regarding the creation of psychometrically sound measurement tools assessing service-learning programs in health-related fields. Without comprehension of a survey's psychometric properties, evaluators cannot ensure that survey instruments are reliable or valid. This study describes the psychometric evaluation of the Public Health Associate Program (PHAP) Service-Learning Scale (PSLS). PSLS assesses participant experience in PHAP, a Centers for Disease Control and Prevention program. This paper explains survey development, scale validity and reliability, and the internal factor structure of the PSLS. The final scale consisted of 22 items with a high internal consistency (Cronbach's α=.90). Exploratory Factor Analysis (EFA) was used to determine the scale's factor structure; five factors comprising of all 22 items were retained. The factors, or subscales, were Learning Outcomes, Mentoring, Experiential Assignment, Self-Efficacy in Program Competency Domains, and Program Satisfaction. All were also found to have adequate internal consistency (Cronbach's α >.70). Service-learning is vital in developing the next generation of the workforce. These study findings suggest the PSLS fills a critical gap in the literature by providing a valid and reliable instrument to evaluate experiences and satisfaction in service-learning programs and other fellowships.

A whole community approach to emergency management: Strategies and best practices of seven community programs.

OBJECTIVE: In 2011, the Federal Emergency Management Agency (FEMA) published the Whole Community Approach to Emergency Management: Principles, Themes, and Pathways for Action, outlining the need for increased individual preparedness and more widespread community engagement to enhance the overall resiliency and security of communities. However, there is limited evidence of how to build a whole community approach to emergency management that provides real-world, practical examples and applications. This article reports on the strategies and best practices gleaned from seven community programs fostering a whole community approach to emergency management. DESIGN: The project team engaged in informal conversations with community stakeholders to learn about their programs during routine monitoring activities, site visits, and during an in-person, facilitated workshop. A total of 88 community members associated with the programs examples contributed. Qualitative analysis was conducted. RESULTS: The findings highlighted best practices gleaned from the seven programs that other communities can leverage to build and maintain their own whole community programs. The findings from the programs also support and validate the three principles and six strategic themes outlined by FEMA. CONCLUSIONS: The findings, like the whole community document, highlight the importance of understanding the community, building relationships, empowering action, and fostering social capital to build a whole community approach.

Evaluation of a federally funded workforce development program: the Centers for Public Health Preparedness.

The Centers for Public Health Preparedness (CPHP) program was a five-year cooperative agreement funded by the Centers for Disease Control and Prevention (CDC). The program was initiated in 2004 to strengthen terrorism and emergency preparedness by linking academic expertise to state and local health agency needs. The purposes of the evaluation study were to identify the results achieved by the Centers and inform program planning for future programs. The evaluation was summative and retrospective in its design and focused on the aggregate outcomes of the CPHP program. The evaluation results indicated progress was achieved on program goals related to development of new training products, training members of the public health workforce, and expansion of partnerships between accredited schools of public health and state and local public health departments. Evaluation results, as well as methodological insights gleaned during the planning and conduct of the CPHP evaluation, were used to inform the design of the next iteration of the CPHP Program, the Preparedness and Emergency Response Learning Centers (PERLC).

The meta-leadership summit for preparedness initiative: an innovative model to advance public health preparedness and response.

This article reports on the design, evaluation framework, and results from the Meta-Leadership Summit for Preparedness Initiative. The Meta-Leadership Summit for Preparedness was a 5-year initiative based on the premise that national preparedness and emergency response is not solely the responsibility of government. From 2006 to 2011, 36 Meta-Leadership Summits were delivered in communities across the country. Summits were customized, 10-hour leadership development, networking, and community action planning events. They included participation from targeted federal, state, local, nonprofit/philanthropic, and private sector leaders who are directly involved in decision making during a major community or state-wide emergency. A total of 4,971 government, nonprofit, and business leaders attended Meta-Leadership Summits; distribution of attendees by sector was balanced. Ninety-three percent of respondents reported the summit was a valuable use of time, 91% reported the overall quality as "good" or "outstanding," and 91% would recommend the summit to their colleagues. In addition, approximately 6 months after attending a summit, 80% of respondents reported that they had used meta-leadership concepts or principles. Of these, 93% reported that using meta-leadership concepts or principles had made a positive difference for them and their organizations. The Meta-Leadership Summit for Preparedness Initiative was a value-added opportunity for communities, providing the venue for learning the concepts and practice of meta-leadership, multisector collaboration, and resource sharing with the intent of substantively improving preparedness, response, and recovery efforts.