Barriers to Meeting Community Needs in New York State during COVID-19: Results From a Pilot Survey of Nongovernmental Population and Community Health Professionals.

Capacity building and training help empower the community and population health organizations to partner with local health departments and collaboratively design multisectoral interventions that account for the complexity of public health and health promotion challenges in the era of COVID-19 and beyond. Ideally, training programs should be informed by an understanding of the needs and priorities of the professionals for whom they are intended. This brief report focuses on the results of a pilot online survey conducted as part of a larger pilot study by the New York State Association of County Health Officials and the Region 2 Public Health Training Center among population and community health professionals (n = 27) from four counties in New York State during the COVID-19 pandemic. Survey participants included a diverse group of staff members from various large and small nonprofit organizations, federally qualified health centers, academic institutions, hospitals, and insurers. Survey findings provide preliminary insights into the extent to which these organizations have been involved in the COVID-19 response in partnership with LHDs, barriers they faced in responding to the needs of the populations they serve and adjusting their work routines/operations to COVID-19 guidelines, and their top emerging organizational and training needs. Lessons learned from conducting an online survey during a public health emergency and implications for future training interventions for population and community health professionals are also discussed within the context of promoting multisectoral collaboration with local health departments, solving complex public health problems, and advancing health equity.

Developing Complex, Cross-Cutting Skills in the Public Health Workforce: Using a Crosswalk Analysis to Map Public Health Competencies to Strategic Skills for the Governmental Public Health Workforce.

In recent years, many public health organizations have used 2 frameworks for workforce development planning and action: the Core Competencies for Public Health Professionals (Core Competencies) and the Strategic Skills for the Governmental Public Health Workforce (Strategic Skills). A third framework is also available for organizations emphasizing population health: the Competencies for Population Health Professionals (Population Health Competencies). This crosswalk analysis-conducted by the Public Health Foundation with input from the Region 2 Public Health Training Center and the de Beaumont Foundation-harmonizes these 3 schemas by systematically mapping the 2014 version of the Core Competencies and the 2019 Population Health Competencies with the 2017 version of the Strategic Skills to produce a comprehensive matrix depicting their relationships. When developing training and curricula, health department personnel and academic faculty can use the results to identify competencies public health professionals may wish to master to build the Strategic Skills. Organizations can also replicate the analytic methodology to align the Core Competencies with other sets of strategic priorities.

Incorporating Systems Thinking Approaches Into Practice-Based Training to Strengthen Policy-Making Skills.

To be successful in advancing public health goals, public health practitioners need to develop competencies associated with policy engagement, a core function of public health work. Theoretical public health policy-making frameworks help practitioners understand steps in the policy process but often fail to reflect on-the-ground realities. Systems thinking approaches are relevant in addressing these complex realities, but training that breaks down seemingly complex concepts and that is useful for practical application is limited. This article discusses how the Region 2 Public Health Training Center developed online practice-based training modules that integrate systems thinking strategies into public health policy making.

Advancing Leadership Training to Address Health Equity and Respond to Public Health Emergencies.

CONTEXT: In 2015, Impactivo developed the Advancing Leadership in Times of Crisis (ALTC) program for the Region 2 Public Health Training Center under a subaward from the Health Resources and Services Administration. Puerto Rico's (PR) government had defaulted on its debt, and public health officials needed tools to face the fiscal crisis. The ALTC has since been adapted for PR's public health emergencies, including the Zika epidemic, category 5 hurricanes, earthquakes, and the Covid-19 pandemic. PROGRAM: The program incorporates Ron Heifetz's work on Adaptive Leadership and Marshall Ganz's work on community organizing to address the Centers for Disease Control and Prevention's Essential Public Health Services (EPHS) and health equity. The ALTC is a contextualized and modularized training program that has been provided in different modalities in person and online. IMPLEMENTATION: The Spanish language program has been carried out with 4 cohorts (totaling 82 graduates). Participants were 80% women and 100% Hispanic, empowering underrepresented groups to achieve change. EVALUATION: In the immediate postprogram survey, more than 90% strongly agree that their understanding of the subject matter improved, that they were able to identify actions that apply to their work, and that they were confident in their ability to apply it. Follow-up surveys after the COVID-19 pandemic found that 89% of respondents continue to work in public health, 25% were promoted, and 49% felt confident to train others. Participants also reported that ALTC helped them increase their public health tools (91%), expand their network (84%), and strengthen knowledge about the EPHS (90%). DISCUSSION: Evidence supports that ALTC is a promising training program to increase leadership skills and EPHS competencies that can be adapted to address contextual health equity and public health emergencies. Future research should explore the expansion of ALTC to other contexts and its impact on population health and health equity.

New York State Local Health Department Preparedness for and Response to the COVID-19 Pandemic: An In-Progress Review.

A mixed-methods approach was taken to describe lessons learned by local health department leaders during the early stages of the COVID-19 pandemic in New York State and to document leaders' assessments of their departments' emergency preparedness capabilities and capacities. Leaders participating in a survey rated the effectiveness of their department's capabilities and capacities in administrative and public health preparedness, epidemiology, and communications on a scale from 1 to 5; those partaking in focus groups answered open-ended questions about the same 4 topics. Subjects rated intragovernmental activities most effective ( = 4.41, SD = 0.83) and reported receiving assistance from other county agencies. They rated level of supplies least effective ( = 3.03, SD = 1.01), describing low supply levels and inequitable distribution of testing materials and personal protective equipment among regions. Local health departments in New York require more state and federal aid to maintain the public health workforce in preparation for future emergencies.

Rationale and Design of Distance-Based Training to Persuade Local Health Department Employees that Addressing Social Determinants of Health Is Their Job, Too.

Public health workers in local health departments frequently rate skills needed to address social determinants of health among their top training needs. These workers have the ability to impact social determinants of health, but many may believe this responsibility is not part of their job description or that they do not have the necessary skills or resources. Guided by the Elaboration Likelihood Model of Persuasion and employing the case study method of instruction, the Region 2 Public Health Training Center designed a 45-minute, self-paced, online training module, titled Strategies to Advance Health Equity: How Health Departments Can Promote Living Wages, to persuade public health workers that addressing social determinants of health, especially those related to income disparities, is part of their day-to-day responsibilities. This article describes the module design, promising preliminary assessment data, and the formal evaluation plan.

Individualised motivational counselling to enhance adherence to antiretroviral therapy is not superior to didactic counselling in South African patients: findings of the CAPRISA 058 randomised controlled trial.

Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n = 150), or an intensive motivational adherence intervention after initiating ART (n = 147). Study arms were similar for age (mean 35.8 years), sex (43.1 % male), CD4+ cell count (median 121.5 cells/µl) and viral load (median 119,000 copies/ml). Virologic suppression at 9 months was achieved in 89.8 % of didactic and 87.9 % of motivational counselling participants (risk ratio [RR] 0.98, 95 % confidence interval [CI] 0.90-1.07, p = 0.62). 82.9 % of didactic and 79.5 % of motivational counselling participants achieved >95 % adherence by pill count at 6 months (RR 0.96, 95 % CI 0.85-1.09, p = 0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting.

Using innovative instructional technology to meet training needs in public health: a design process.

Technology and distance learning can potentially enhance the efficient and effective delivery of continuing education to the public health workforce. Public Health Training Centers collaborate with instructional technology designers to develop innovative, competency-based online learning experiences that meet pressing training needs and promote best practices. We describe one Public Health Training Center's online learning module design process, which consists of five steps: (1) identify training needs and priority competencies; (2) define learning objectives and identify educational challenges; (3) pose hypotheses and explore innovative, technology-based solutions; (4) develop and deploy the educational experience; and (5) evaluate feedback and outcomes to inform continued cycles of revision and improvement. Examples illustrate the model's application. These steps are discussed within the context of design practices in the fields of education, engineering, and public health. They incorporate key strategies from across these fields, including principles of programmatic design familiar to public health professionals, such as backward design. The instructional technology design process we describe provides a structure for the creativity, collaboration, and systematic strategies needed to develop online learning products that address critical training needs for the public health workforce.

COVID-19 Vaccine Administration: Phase 2 of an in Progress Review in New York State Local Health Departments.

Since the onset of the COVID-19 pandemic in New York State (NYS), local health departments (LHDs) have worked to mitigate the highly infectious disease. As lead public health experts in their communities, LHDs are responsible for providing communicable disease control, emergency response, and establishing immunization programs, including leading large-scale vaccine distribution efforts. The aim of this qualitative study was to understand the processes used by LHDs in NYS to administer COVID-19 vaccines, as well as identify successes and challenges, and highlight lessons learned to improve future mass vaccination campaigns. Data were collected in two phases: (1) extant data collection of public communications; and (2) discussion groups with public health leaders across the state. Notable themes from both phases include: partnerships, programmatic elements, communication, role of LHD, State-LHD coordination, and human and physical resources. Analysis of both public and internal communications from LHDs across NYS revealed several core challenges LHDs faced during COVID-19 vaccine rollout and identified innovative solutions that LHDs used to facilitate vaccine access, administration, and uptake in their communities. Findings from this multi-phase qualitative analysis support the need to bolster the capacity and training of the local public health workforce to ensure preparedness for future public health emergencies.

Considering theory-based reflection in the service-learning training of Advanced Education in General Dentistry (AEGD) residents.

Columbia University College of Dental Medicine, in partnership with the Harlem United Community AIDS Center, has developed a service-learning (SL) program for use in the training of Advanced Education in General Dentistry (AEGD) residents. This article presents basic tenets of SL, their applicability for dentistry, and our experience implementing SL in care of people living with HIV/AIDS. It proposes that social-behavioral theory, when incorporated into the basic components of SL, can play a useful role in resolving a number of challenges inherent in competency-based training programs. Although the article provides examples of how a particular theory, the Theory of Planned Behavior, might be applied in the SL context, opportunities for the application of other social-behavioral theories potentially exist.

A competency-based framework for training in advanced dental education: experience in a community-based dental partnership program.

While goals and objectives are useful to assess programmatic outcomes, they are not able to evaluate individual trainees' performance and/or corrective actions needed to improve performance. As a result, competency-based evaluation is increasingly being used to assess trainee performance at both the doctoral and postdoctoral levels. However, the translation of broadly stated competency statements into evaluable action statements continues to pose a challenge, especially in nontechnical domains such as the assessment and integration of cultural and sociodemographic variables in the development and execution of treatment plans. This article describes a process used to develop a competency-based framework that includes specific evaluable action statements to assess the performance of Advanced Education in General Dentistry (AEGD) residents providing dental care services to medically compromised patients in a community-based partnership program. Although the resultant framework may not itself be generalizable across training programs, the process described to develop the framework can be used by those individuals involved in evaluating students and/or residents in training programs.

The impact of HIV scale-up on the role of nurses in South Africa: Time for a new approach.

South Africa's health care system is struggling to respond to the devastating impact of HIV/AIDS while at the same time respecting its postapartheid mandate to provide equitable health services to all. These unprecedented challenges are forcing a rethinking and reorganization of health resources and systems and a reappraisal of the role of nurses in the care of complex and chronic illness. Increasingly, the scale-up of HIV services is being reconceptualized to match both the urgent need for prevention, care, and treatment and the national vision of decentralized primary health care. HIV scale-up has triggered innovations in nurse training, task shifting, retention, and scope of practice that need not remain HIV specific. Lessons learned in the context of HIV have the potential to enhance nursing practice and human resources for health more generally, strengthening South Africa's health systems and improving access to effective health services.

Effectiveness of an emergency preparedness training program for public health nurses in New York City.

A public health workforce that is competent to respond to emergencies is extremely important. We report on the impact of a training program designed to prepare public health nurses to respond appropriately to emergencies. The program focused on the basic public health emergency preparedness competencies and the emergency response role of public health workers employed by the New York City School Department of Health and Mental Hygiene School Health Program. The evaluation methods included pre/post-testing followed by a repeat post-test one month after the program. The program resulted in positive shifts in both knowledge and emergency response attitudes.