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PUBLIC HEALTH: IMPROVING HEALTH FOR ALL DISCUSSION SERIESAn overview of an innovative workforce development training

Aaron T. Gardner, MA

Wendy Hetherington, MPH

Directors of Public Health Nursing in California 2015 Fall ConferenceSan Diego, California

Learning ObjectivesParticipants will be able to:

Describe the key components of the Riverside County Department of Public Health’s health equity staff training program.

Design a health equity and social justice training series, adapted to meet the needs of your organization.

Identify important logistical items to address successful training implementation.

Identify two ways to evaluate a staff-driven training series

Riverside County: Who We Are

2.2 Million residents

Population expected to increase by 1 million over the next decade

55% of residents identify as non-white

Home to Palm Springs, California

Riverside County

San Francisco

San Diego

Los Angeles

County of Riverside Department of Public HealthHealth Equity Committee

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Improving Health for All Discussion Series

• Shift the Currents of Departmental Culture

• All staff on the same page

• Why reinvent the wheel?

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The Intervention:Improving Health for All (IHA)

• A six-module discussion series designed to build a public health workforce that is able to address health disparities and inequities

• Each module is 4-hours in length• Department requirement

Improving Health for All facilitators, Riverside County Department of Public Health, December 2012

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Public Health 101Riverside County, CA

Module I• An Overview of Public Health

Module II Cultural Competency &

AcceptanceModule III

• Deconstructing RacismModule IV

• Social Determinants of Health Module V

• Discrimination & StigmaModule VI

• Community Engagement & Capacity Building

Alameda County, CA

Module I An Overview of Public Health

Module II Cultural Competency &

Cultural HumilityModule III

Undoing RacismModule IV

Social and Health EquityModule V

Community Capacity Building

Alameda County Department of Public Health (2013). PH 101 Dialogue Series. Social and Health Equity. http://www.acphd.org/social-and-health-equity/organizational-transformation/trainings-and-dialogues/ph101.aspx

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Public Health: Improving Health for AllModule I

• Public Health History & System• Core Functions and Essential Services

of Public HealthModule II

• Cultural Competency & AcceptanceModule III

• Deconstructing RacismModule IV

• Social Determinants of Health Module V

• Discrimination & StigmaModule VI

• Community Engagement & Capacity Building

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Module 1: Overview of Public Health

Public health history and connections to social justice3 main organizational levels of the public health system3 core functions and 10 essential services of public

health and linked it to what we do each day

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Module 2: Cultural Competency & Acceptance

Difference between health inequities and health disparities

Importance of cultural competency and cultural acceptance

Application of lessons learned from this training to improve services provided to our community

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Module 3: Deconstructing Racism

Social, economic, and political conditions that disproportionately privilege some groups while disadvantaging others

How institutional racism impacts Riverside County residents

Ideas for addressing institutional racism and its impact  

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Module 4: Social Determinants of Health

• Describe and identify social determinants of health and how they lead to social and health inequities.

• Learn how DOPH is addressing social

determinants of health.

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Module 5: Discrimination & Stigma

The discussion focuses on three groups:oLGBToAgingoPeople with Disabilities

• To recognize and address the perceived discrimination and stigma among these three groups.

• Discuss ways we can avoid and undo discrimination among the groups discussed.

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Module 6: Community Engagement & Capacity Building

Discussion on:

The Department’s role in community engagement and capacity building

Discuss the benefits and challenges of community engagement and capacity building

Describe DOPH efforts to improve CE and CCB.

Articulate their role in CE and CCB

How to Begin

Getting department buy-in How did DOPH do this?

Educating and motivating Lots of meetings Use data to illustrate the

need

How to Begin

Getting department buy-in, continued Frequent communication Enlist support Get the information out…spread the word

How to Begin

Recommendations: Involve the chief

Chief administrators need an active role in goal setting, prioritizing, and launching of this effort

Additionally… Diverse development teams Constant communication with a feedback loop

Susan Harrington, MS, RDDirector, Public Health

Adapting the PH 101 Dialogue Series

Form a curriculum development team

A diverse group Need to spread the

work

Adapting the PH 101 Dialogue Series

Develop a visionConsult with the experts

Other jurisdictions, EAS, etc.Training coordinationKnow your staff

Awareness Survey Response ComparisonSelf-reported: “No knowledge of the topic”.

County of RiversideDOPH

Alameda CountyPHD

Relationship between Institutional Racism and Health Inequities

19.1% 11.8%

Definition and Measurement of Health 18.4% 11.8%

Social Determinants of Health 17.0% 9.9%

Community Capacity Building 36.8% 17.5%

How Community Capacity Building Supplements Traditional Program & Service Delivery

39.3% 20.3%

Adapting a PH 101 Dialogue Series

Recommendations: Have a development team Assess and alert your staff Create deadlines Allow evolution

Training and Recruitment of Facilitators Who are the

facilitators?Optimal pairing Support from Public

Health Director Have staff

development team

Training and Recruitment of Facilitators

Employee Assistance Services

RehearseFacilitators’ Meetings Alameda County (ACDPH)

Site Visit

Dr. Jamie Rotnofsky, PhDDirector, Employee Assistance Services

Training and Recruitment

Recommendations: Administrator Recognition Have a Staff Development

Team Mandatory Rehearsals

Implementation and Logistics

Training is mandatory

Diverse facilitation Use Dry-runs and

pilots

Implementation and Logistics

Plan for challengesConstant feedbackUse the skills of a PIODeveloping a toolkit Jose Arballo

Public Information Specialist

Implementation and Logistics

Recommendations: Mandate training participation Have diverse facilitation teams Use rehearsals Have a staff development team…

ring a bell?

Sakeena Al-AminStaff Development Team Member

How Ready Are You?What’s your organization’s need? Is your organization ready for a change in

culture? Time, resources, and personnel…do you have

enough? Can your organization sustain the effort?

Let’s take a minute to assess your organization’s readiness!

EvaluationBe sure to develop an evaluation plan

Don’t back into evaluation A must have in order to determine your program’s

effectiveness Can help you figure out what is or is not working Can be an integral part of your planning

Designating Evaluation

Plans

Designing Data

Collection Tools

Collecting Data

Analyzing Results

Reporting Findings

Planning Program Changes

EvaluationProcess evaluation

“Hot Wash” Feedback Participant census

Outcome evaluation Knowledge, self-efficacy, attitudinal, and behavioral

intentions scale

Impact evaluation Long-term and may be hard to measure Organizational assessment

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Evaluation

• Two levels of evaluation• Class level• Outcome Evaluation – Improving Health for All Research Study

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The Improving Health for All Research Study

• To examine the effects of the Improving Health for All program on staff of County of Riverside’s Department of Public Health

• Received IRB Approval on March 27, 2013• Study period: April 22, 2013 - Sept. 26, 2013

Penny, M., Modeste, N., Herring, P., Marshak, H., & Gardner, A. (2014). Examining the role of knowledge and perceptions in predicting the intention to address health disparities among public health staff. Manuscript submitted for publication.

Penny, M., Modeste, N., Herring, P., Marshak, H., & Gardner, A. (2014). Effects of Public Health Workforce Development on Knowledge, Perceptions and Intention to Develop Strategies to Reduce Health Disparities. Manuscript submitted for publication.

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Theoretical Framework

The hypothesized relationships using the theory of planned behavior (TPB) to illustrate the influence of knowledge, attitude, subjective norm, and perceived behavioral control on behavioral intention.

Subjective Norm to perform behavior

Behavioral Intention

Improving Health for all Intervention

Attitude towards behavior

Perceived Behavioral Control to engage in behavior

Knowledge

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Study Research Questions1. Are there differences in knowledge, attitudes, subjective norm,

perceived behavioral control, and behavioral intention to address health disparities and inequities after participating in the intervention, compared to perceptions of those variables prior to the intervention?

2. After controlling for pretest values, are there differences in posttest knowledge and TPB variables among those who have formal public health training (FPHT) compared to those who do not have formal public health training (FPHT)?

3. After controlling for pretest values, do staff posttest reports of knowledge, and TPB variables predict their posttest reports of behavioral intention?

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Results - Effect of IHA Intervention• Results indicate a positive effect of IHA on knowledge and

perceptions as they relate to issues of health disparities

• Knowledge and all TPB variable scores were statistically significantly higher at posttest compared to retrospective pretest.

• Posttest knowledge and PBC scores were statistically significantly higher among those with FPHT compared to those without.

• Pretest scores of attitude and Posttest scores of attitude, PBC, and SN were significant predictors of behavioral intention [R2=.66, F(17, 138) = 16.018, p<.001].

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Why has this been so successful?

• Time!• Priority• Listening to all members and facilitators• Must have successes: How are these defined?

Evaluation Recommendation Do one! Start it early Be sure to have a clear program goal and

objectives Keep records

Meeting agendas and minutes Old versions of material Focus group notes

Biggest Challenges and Successes

Challenges Administrative

changes Fear of the unknown Logistics Maintaining a

facilitator pool Communication

Successes Supportive

administrators High level of interest Staff Development Strong facilitator

support and dedication

Work in progress

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Summary/Q&A

• What are your thoughts?

• What are your suggestions?

• Any questions?

Improving Health for All facilitators, Riverside County Department of Public Health, June 2013