WORKFORCE DEVELOPMENT AT THE ALLEGHENY COUNTY HEALTH
DEPARTMENT:
IDENTIFYING TRAINING PRIORITIES THROUGH SELF-ASSESSMENT
by
Alyssa K. Landen
BA, Franklin & Marshall College, 2012
Submitted to the Graduate Faculty of
the Department of Health Policy & Management
Graduate School of Public Health in partial fulfillment
of the requirements for the degree of
Master of Public Health
University of Pittsburgh
2014
i
UNIVERSITY OF PITTSBURGH
GRADUATE SCHOOL OF PUBLIC HEALTH
This essay is submitted
by
Alyssa K. Landen
on
December 4, 2014
and approved by
Essay Advisor:
Gerald M. Barron, MPH
Associate Professor
Department of Health Policy & Management
Graduate School of Public Health
University of Pittsburgh
__________________________________
Essay Reader:
Ronald Voorhees, MD MPH
Professor of Public Health Practice
Department of Epidemiology
Associate Dean for Public Health Practice
Director, Center of Public Health Practice
Graduate School of Public Health
University of Pittsburgh
__________________________________
Essay Reader:
Jamie Sokol, MPH
__________________________________
Workforce Development and Training Administrator
Allegheny County Health Department
Allegheny County, Pennsylvania
ii
Copyright © by Alyssa K. Landen
2014
iii
Gerald M. Barron, MPH
WORKFORCE DEVELOPMENT AT THE ALLEGHENY COUNTY HEALTH
DEPARTMENT:
IDENTIFYING TRAINING PRIORITIES THROUGH SELF-ASSESSMENT
Alyssa K. Landen, MPH
University of Pittsburgh, 2014
ABSTRACT
A competent and skilled public health workforce is crucial in delivering the ten essential services
of public health. Recognizing this, the Public Health Accreditation Board has incorporated
workforce development and training into its national accreditation standards for State, Local, and
Tribal Health Departments. Currently, the Allegheny County Health Department is in the preapplication phase of accreditation. Achieving accreditation status will ensure that the health
department maintains standards related to population health. In June 2014, the Allegheny County
Health Department administered a self-assessment of the Core Competencies for Public Health
Professionals to its entire workforce to identify the training needs of the staff. The results of the
survey will provide important, baseline data upon which a workforce development and training
plan can be developed in accordance with accreditation standards. Through initial analysis of the
assessment, it is recommended that the Allegheny County Health Department focus its efforts on
public health policy, cultural competency, and the identification of community stakeholders. In
addition, deputy directors and department managers will review assessment data relevant to their
staff and identify trainings that can support the achievement of program-specific goals.
Developing a training plan that supports the diversity of programs at Allegheny County Health
Department will be a challenge; however, utilizing this type of evidence-based approach will
best prepare its workforce to address current and future public health issues.
iv
TABLE OF CONTENTS
PREFACE ..................................................................................................................................... X
1.0
CASE SITE ................................................................................................................... 1
1.1
THE STRUCTURE OF PUBLIC HEALTH IN PENNSYLVANIA .............. 1
1.1.1
Act 315: Pennsylvania’s Local Health Administration Law ....................... 2
1.2
THE ALLEGHENY COUNTY HEALTH DEPARTMENT .......................... 3
1.3
POPULATION THE ALLEGHENY COUNTY HEALTH DEPARTMENT
SERVES ............................................................................................................................... 7
2.0
ISSUE AT HAND ....................................................................................................... 10
2.1
DOMAIN 8 OF ACCREDITATION: MAINTAIN A COMPETENT
PUBLIC HEALTH WORKFORCE ................................................................................. 11
2.2
ACCREDITATION AT THE ALLEGHENEY COUNTY HEALTH
DEPARTMENT .................................................................................................................. 12
3.0
LITERATURE REVIEW.......................................................................................... 13
3.1
WORKFORCE DEVELOPMENT DEFINED ............................................... 13
3.2
WORKFORCE DEVELOPMENT IN THE UNITED STATES .................. 14
3.2.1
History of Workforce Development ............................................................. 15
3.2.2
Workforce Development and Accreditation ............................................... 16
3.2.3
Methods for Workforce Development ......................................................... 16
v
3.3
THE IMPORTANCE OF INVESTING IN THE PUBLIC HEALTH
WORKFORCE ................................................................................................................... 17
4.0
METHODS ................................................................................................................. 19
4.1
DEVELOPMENT OF SURVEY ...................................................................... 19
4.2
DETERMINATION OF METHODS OF ANALYSIS .................................. 22
4.3
ADMINISTRATION OF SURVEY ................................................................. 22
4.4
ANALYSIS OF SURVEY RESPONSES ......................................................... 23
4.5
DETERMINATION OF TRAINING PRIORITIES...................................... 25
4.6
NEXT STEPS ..................................................................................................... 28
5.0
RECOMMENDATIONS ........................................................................................... 30
5.1
PUBLIC HEALTH POLICY............................................................................ 31
5.1.1
Reason to Address ......................................................................................... 31
5.1.2
Recommended Trainings .............................................................................. 32
5.2
CULTURAL COMPETENCY ......................................................................... 33
5.2.1
Reason to Address ......................................................................................... 33
5.2.2
Recommended Trainings .............................................................................. 34
5.3
6.0
IDENTIFICATION OF STAKEHOLDERS .................................................. 35
5.3.1
Reason to Address ......................................................................................... 35
5.3.2
Recommended Trainings .............................................................................. 36
CONCLUSION........................................................................................................... 38
APPENDIX A: ORGANIZATIONAL STRUCTURE OF ALLEGHENY COUNTY
HEALTH DEPARTMENT ........................................................................................................ 39
vi
APPENDIX B: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY QUESTIONS .................................................................................. 41
APPENDIX C: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY SUMMARY OF DATA ANALYSIS ............................................ 54
APPENDIX D: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY AND THE TEN ESSENTIAL SERVICES OF PUBLIC
HEALTH ..................................................................................................................................... 56
APPENDIX E: SCREENSHOT OF TRAIN TOOL................................................................ 60
BIBLIOGRAPHY ....................................................................................................................... 61
vii
LIST OF TABLES
Table 1: Allegheny County Health Department number of employees by years in current position
......................................................................................................................................................... 5
Table 2: Allegheny County Health Department number of employees by program ...................... 6
Table 3: Training needs assessment survey average domain response......................................... 24
Table 4: Training needs assessment survey question findings ..................................................... 25
viii
LIST OF FIGURES
Figure 1: State public health structure within the United States agency ........................................ 1
Figure 2: Allegheny County Health Department percent of employees by years in current
position............................................................................................................................................ 4
Figure 3: Allegheny County Health Department percent of employees by program ..................... 5
Figure 4: Location of Allegheny County Pennsylvania .................................................................. 8
Figure 5: Analysis of training needs assessment survey data breakdown .................................... 23
Figure 6: Training needs assessment survey average domain response ....................................... 26
Figure 7: Training needs assessment survey average domain response ....................................... 26
Figure 8: Ten Essential Services of Public Health........................................................................ 28
Figure 9. Allegheny County Health Department Organizational Structure .................................. 40
ix
PREFACE
I would like to take this opportunity to thank my advisor Gerald M. Barron, MPH for all of his
support in identifying a case site for my essay and for his encouragement. I would like to thank
Ronald Voorhees, MD MPH for his support through my practicum experience at the Allegheny
County Health Department and for agreeing to be a reader of my essay.
I would also like to thank the Allegheny County Health Department for providing me with the
opportunity to participate in their accreditation and workforce development and training efforts. I
would especially like to thank Jamie Sokol, MPH my mentor at the health department and to
whom I owe much of my success in identification of an essay topic and writing this essay.
x
1.0
1.1
CASE SITE
THE STRUCTURE OF PUBLIC HEALTH IN PENNSYLVANIA
Public health infrastructure varies from state to state. Local agency responsibility can be
independent or shared with the state health agency (National Association of County and City
Health Officials, 2014). Health departments within a state can be centralized (state governed),
decentralized (locally governed), or a mix of the two agency (National Association of County
and City Health Officials, 2014). As shown in Figure 1, Pennsylvania’s structure is mixed.
(Source: National Association of County and City Health Officials, 2014)
Figure 1: State public health structure within the United States agency
1
The financing of public health and public health staff within a state also vary among states. It is
estimated that from 2008-2013, local health departments in the United States lost approximately
28,000 total employees, approximately a 12% decrease in FTEs (National Association of County
and City Health Officials, 2014). Although the amount of funding a state receives depends on the
economic status of the state, about 50% of the funding for states come from the federal
government, through grants, cooperative agreements, and contracts (Salinsky, 2010). In 2009,
76% of state health departments and 55% of local health departments reported cuts within the
past 12 months (Meyer and Weiselberg, 2009). In Pennsylvania, the median annual per capita
local health expenditure is less than $20 (National Association of County and City Health
Officials, 2014). Such losses in funding and staff have significantly reduced the number of
initiatives and programs that a community can implement, and they must find ways to insure that
the programs and interventions within the state are improving the health status of the community
in which they serve.
1.1.1 Act 315: Pennsylvania’s Local Health Administration Law
Act 315 and its amendments guide health departments within Pennsylvania. Since its
establishment in 1951, provisions and amendments have been made to strengthen the act. These
include (Pennsylvania Department of Health, 2013):



Steps to establish a health department in Pennsylvania
Act 12, which adds environmental health support
Provisions to chapters 13, 15, 17, and 27
2
Additionally, Act 315 provides communities with (Pennsylvania Department of Health, 2013;
Local Health Administration Law):






The authority to establish local health departments to serve their residents
The process of how to establish a local health department
Financial administration guidance
Documentation of powers and duties of local health departments, the director, and board
of health
Local health department jurisdiction
State funding to recognized health departments to deliver public health services
Health departments within Pennsylvania, under Act 315, are required to address administrative
and supportive services, personal health services, and environmental health services
(Pennsylvania Department of Health, 2013).
1.2
THE ALLEGHENY COUNTY HEALTH DEPARTMENT
The Allegheny County Health Department was founded in 1957 (Allegheny County Health
Department, 2014) and today serves the over 1.2 million residents of Allegheny County
Pennsylvania. A Board of Health governs the Allegheny County Health Department, its nine
members receiving their appointments from the County Chief Executive and approved by the
County Council (Allegheny County Health Department, 2013). During their four-year
appointment, these members advise the County Health Director (and appoint one if needed) and
perform the following duties (Allegheny County Health Department, 2013):



Formulate rules and regulations for the prevention of disease
Formulate rules and regulations for the prevention and removal of conditions which
constitute a menace to health
Formulate rules and regulations for the promotion and preservation of the public health
3
The Allegheny County Health Department is one of only 6 county and 4 municipal health
departments in Pennsylvania (Pennsylvania Department of Health, 2013). The mission of the
Allegheny County Health Department is “to protect, promote, and preserve the health and wellbeing of all Allegheny County residents, particularly the most vulnerable” (Allegheny County
Health Department, 2014). The workforce of the health department strives to fulfill the mission
of the health department through programs and interventions aimed at improving health and
well-being.
The health department employs 349 individuals, not including contractors (as of September 30,
2014). Demographics of health department employees are not available because the health
department is an equal opportunity employer. Based on a self-assessment, it is possible to
determine the number of years individuals working at the health department have been in their
current role (Figure 2 and Table 1) and distinguish which programs individuals work in (Figure 3
and Table 2). Appendix A provides a current organizational structure of the Allegheny County
Health Department.
Allegheny County Health Department
Percent of Employees By Years In Current Position
14.8%
23.8%
Less than 1 year
1-5 years
5-10 years
22.9%
7.2%
10-15 years
15-20 years
Over 20 years
10.2%
21.1%
Figure 2: Allegheny County Health Department percent of employees by years in current position
4
Table 1: Allegheny County Health Department number of employees by years in current position
Allegheny County Health Department
Number of Employees By Years
In Current Position
Less than 1 year
1-5 years
5-10 years
10-15 years
15-20 years
Over 20 years
Response Count
Percent (%)
49
76
70
34
24
79
14.8
22.9
21.1
10.2
7.2
23.8
Administration
Allegheny County Health Department
Percent of Employees By Program
Air Quality
Chronic Disease and Injury
Prevention
Dental
14.2%
1.2%
Directors Office/Leadership
Team
Epidemiology and Biostatistics
9.0%
4.2%
13.9%
0.6%
1.5%
9.9%
0.9%
3.0%
0.9%
2.4%
7.2%
9.3%
7.8%
Food Safety
Housing and Community
Environment
Infectious Diseases/STD
Legal
MIS
Maternal Child Health
Other
12.3%
Preparedness
0.6%
Public Drinking Water/Waste
Management
0.9%
Figure 3: Allegheny County Health Department percent of employees by program
5
Table 2: Allegheny County Health Department number of employees by program
Allegheny County Health Department
Number of Employees By Program
Administration
Air Quality
Chronic Disease and Injury Prevention
Dental
Directors Office/Leadership Team
Epidemiology and Biostatistics
Food Safety
Housing and Community Environment
Infectious Diseases/STD
Legal
MIS
Maternal Child Health
Other
Preparedness
Public Drinking Water/Waste Management
Public Health Laboratory
Public Information, Health Information
Publications
WIC
Response Count
Percent (%)
30
46
2
5
3
8
24
26
41
3
2
31
10
3
33
14
9.0
13.9
0.6
1.5
0.90
2.4
7.2
7.8
12.3
0.9
0.6
9.3
3.0
0.9
9.9
4.2
1.2
and
4
47
14.2
It is important to note that most of the individuals working in the health department work in
regulatory roles and very few provide administrative support.
To better prepare employees to achieve the ten essential services of public health, the health
department currently offers a limited set of trainings to employees. These trainings include:


Required Preparedness Trainings
o Incident Command System 100 and 700
o Points-of-Dispensing
o American Heart Association CPR
o American Heart Association First Aid
o Hazmat Awareness (environmental health staff only)
Non-Required Preparedness Trainings
o Personal Preparedness
o Swift Water Awareness
o Incident Command System 300/400 (for certain staff only)
6

Health Department Wide Trainings
o HIPAA
o New Staff Orientation
o Public Health 101
Additional trainings are needed to improve the competencies and capabilities of the workforce at
the Allegheny County Health Department.
1.3
POPULATION THE ALLEGHENY COUNTY HEALTH DEPARTMENT
SERVES
Allegheny County is located in Southwestern Pennsylvania (Figure 4). Historically, Allegheny
County and the City of Pittsburgh were major players in manufacturing and soon became a major
port city due to the strategic location of rivers and location of the early towns on the riverbanks
(Allegheny County Pennsylvania, n.d). In 1852, the Pennsylvania Railroad opened up Allegheny
County and Pittsburgh to continued trade and Allegheny County soon became known for its steel
and iron industries (Allegheny County Pennsylvania, n.d).
7
(Source: Pennsylvania Department of Transportation , 2014)
Figure 4: Location of Allegheny County Pennsylvania
As of 2013, the estimated population of Allegheny County Pennsylvania is 1,231,527 (United
States Census Bureau, 2014). Of these individuals, 81.3% identify as white (79.9% identify as
white not Hispanic or Latino), 13.3% identify as black, 0.2% identity as American Indian and
Alaska Native, 3.2% identify as Asian, 1.9% identify as two or more races, and 1.8% identity as
Hispanic or Latino (United States Census Bureau, 2014). In Allegheny County, the median
household income from 2008-2012 was $50,644, with 12.7% of the population living below
poverty level (United States Census Bureau, 2014). In Allegheny County, 5.2% of the
individuals are under the age of 5, 19.2% are under the age of 18, 17.1% are 65 years of age or
older, 51.9% of individuals are female, and 48.1% individuals are male (United States Census
Bureau, 2014). Educational attainment estimates from 2008-2012 are listed below (United States
Census Bureau: American FactFinder, 2014):
8







Less than 9th grade: 2.1%
9-12 grade, no diploma: 5.3%
High school graduate: 31.5%
Some college, no diploma: 17.2%
Associate’s degree: 8.8%
Bachelor’s degree: 20.8%
Graduate or professional degree: 14.3%
9
2.0
ISSUE AT HAND
The Public Health Accreditation Board (PHAB) notes “accreditation using the PHAB standards
and measures can help a health department achieve performance excellence” (Public Health
Accreditation Board, 2013b). The PHAB began working with health departments towards
accreditation in September of 2011, with accreditation beginning in 2013 (Centers for Disease
Control and Prevention, 2013). Accreditation of health departments is a voluntary program and
signifies a health department is meeting national standards (Centers for Disease Control and
Prevention , 2013). According to the PHAB, as of September 16, 2014, 54 health departments in
the United States have received national accreditation (Public Health Accreditation Board,
2013a). National accreditation of health departments, although spearheaded by the PHAB, is
supported by the Centers for Disease Control and Prevention and the Robert Wood Johnson
Foundation (Centers for Disease Control and Prevention, 2014a). Benefits and impacts of
accreditation include (Centers for Disease Control and Prevention , 2010):





Improvement of health departments and infrastructure
Valuable and measurable feedback on strengths and areas for improvement
Improvements to delivery of public health services and programs
Quality and performance improvement within all public health programs to better
respond to health challenges
Increasing accountability and credibility
There are seven steps of accreditation (Public Health Accreditation Board, 2014):
1. Pre-application
2. Application
3. Documentation Selection and Submission
10
4.
5.
6.
7.
Site Visit
Accreditation Decision
Reports
Reaccreditation
There are 12 domains of accreditation (Public Health Accreditation Board, 2013c):












2.1
Domain 1: Conduct and Disseminate Assessments Focused on Population Health Status
And Public Health Issues Facing the Community
Domain 2: Investigate Health Problems and Environmental Public Health Hazards to
Protect the Community
Domain 3: Inform and Educate about Public Health Issues and Functions
Domain 4: Engage with the Community to Identify and Address Health Problems
Domain 5: Develop Public Health Policies and Plans
Domain 6: Enforce Public Health Laws
Domain 7: Promote Strategies to Improve Access to Health Care
Domain 8: Maintain a Competent Public Health Workforce
Domain 9: Evaluate and Continuously Improve Processes, Programs, and Interventions
Domain 10: Contribute to and Apply the Evidence Base of Public Health
Domain 11: Maintain Administrative and Management Capacity
Domain 12: Maintain Capacity to Engage the Public Health Governing Entity
DOMAIN 8 OF ACCREDITATION: MAINTAIN A COMPETENT PUBLIC
HEALTH WORKFORCE
Domain 8 of the accreditation process focuses on building a competent workforce that is better
prepared to deliver the ten essential services of public health. Domain 8 has two standards that
are required of health departments (Public Health Accreditation Board, 2013c):


Encourage the Development of a Sufficient Number of Qualified Public Health Workers
Assess Staff Competencies and Address Gaps by Enabling Organizational and Individual
Training and Development
Under these standards, the health department must provide documentation of the following to
measure each standard (Public Health Accreditation Board, 2013c):
11





Relationships and/or collaborations that promote the development of future public health
workers
Workforce development strategies
A competent health department workforce
Professional and career development for all staff
Work environment that is supportive to the workforce
2.2
ACCREDITATION AT THE ALLEGHENEY COUNTY HEALTH
DEPARTMENT
Currently, the Allegheny County Health Department is in the pre-application phase of the
accreditation process. This requires collaboration among staff members within different bureaus
of the health department. Although there are many domains that must be addressed to become
accredited, this essay looks at the second bullet above and addresses the process of determining
the training needs of staff based on a self-assessment of core competencies. The documentation
required for the measure “workforce development strategies” must include a workforce
development plan and demonstrate that the health department implemented workforce
development strategies (Public Health Accreditation Board, 2013c). An interdisciplinary
working group, comprised of roughly twenty staff across all bureaus, has been developed to
identify appropriate documentation for accreditation measures. The Allegheny County Health
Department aims to submit an application for accreditation prior to December of 2015 and
submit necessary documentation prior to December of 2016.
12
3.0
3.1
LITERATURE REVIEW
WORKFORCE DEVELOPMENT DEFINED
It is challenging to define workforce development within the context of public health due to the
difficulties in even determining who is considered a public health professional. A public health
worker can be interpreted to include those who are drivers within a health agency, transporting
lab samples, or to include doctors who provide guidance to individuals on their health and
behaviors that impact their health. A public health worker can be defined as an individual who
“provide[s] essential public health services, regardless of the nature of the employing agency”
(Beck et al, 2012), including those at public, private, and voluntary organizations (Turnock,
2003). This includes “all those engaged during a significant part of time in work that creates the
conditions within which people can be healthy” (Tilson and Gebbie, 2004).
Interviews with leaders in public health indicated that (Miner and Allan, 2014):




“The public health workforce needs to be up-to-date in the practice of public health at the
federal, state, and local levels
There are organizations, personnel, and strategies in place to make this happen
Public health academia should be more engaged in educating and training for public
health practice with this increase practice engagement also benefitting academia
There is a sense of ‘now is the time’ for public health to be as an essential player in the
health care system”
13
Workforce development in public health “reflects the multiple disciplines constituting the field
of public health” (Kaufman et al, 2014). Workforce development is thought to be a solution to
gaps in competencies for public health workers who do not have a public health degree, a group
that makes up a large portion of public health workers in the United States (Miner and Allan,
2014). However, not having a degree in public health or a lack of formal public health training
does not mean that the current public health workforce is unprepared (Turnock, 2003).
A systematic review of public health workforce literature, published in 2012, noted four themes
and also indicated few articles were empirically based, peer reviewed, or provided evidencebased findings (Beck et al., 2012):
1.
2.
3.
4.
Size and composition
Effectiveness and health impact
Demand
Policy
3.2
WORKFORCE DEVELOPMENT IN THE UNITED STATES
In 2000, the Public Health Functions Steering Committee published a report estimating there
were approximately 500,000 public health professionals within government organizations and
noted that there was a decrease in the public health workforce in comparison to a report they
published in 1980 (Gebbie and Turnock, 2006).
In acknowledgement of a decline in the public health workforce and gaps in competencies in the
workforce, the federal government developed grant funded programs addressing training and
preparedness (Gebbie and Turnock, 2006). Public health training centers were established to
14
“provide competency-based trainings and practice-based opportunities to advance the current and
future public heath workforces” (Freedman et al., 2014). There are five steps in training module
development in the public health training centers model (Millery et al., 2014):
1.
2.
3.
4.
5.
Assess needs and identify priority competencies
Define learning objectives and identify educational challenges
Pose hypotheses and explore innovative technology based solutions
Develop and deploy the educational experience
Collect feedback and evaluate to inform continued cycles of revision and improvement
For a short period of time, it appeared that the number of public health workers was increasing,
peaking in 2003; however, a reverse in this trend appeared in 2004 (Gebbie and Turnock, 2006).
The decline in the workforce of public health professionals can potentially be attributed to
improvements in technology and changes in political and bureaucratics within government
organizations (Gebbie and Turnock, 2006).
3.2.1 History of Workforce Development
In 1988, the Institutes of Medicine noted the public health system as being in disarray (Beck et
al., 2012) and “called for broad, crosscutting skills and competencies for public health
practitioners” (Kaufman et al, 2014). In 2003, the Institutes of Medicine called for “continuous,
lifelong training for the public health workforce” (Kenefick et al, 2014). In 2000,
HealthyPeople2010 noted that improving the infrastructure of public health through investing in
the workforce was a priority (Gebbie and Turnock, 2006), as concerns existed regarding the
“composition, distribution, skills, and performance of the public health workforce” (Gebbie and
Turnock, 2006). Today, HealthyPeople2020 still considers workforce development a priority for
the nations public health officials.
15
3.2.2 Workforce Development and Accreditation
In theory, addressing the competencies of a workforce through workforce development and
training appears to be a simple and reasonable solution. Although it is acknowledged that
additional training is needed, it was unclear for some time on how to determine baseline
competencies of public health workers and what suggested workforce competencies should be.
This lead to a project, that took a decade, by the Council on Linkages to develop a list of such
competencies and how to assess for them in the workplace (Gebbie and Turnock, 2006). These
established competencies “are critical for defining the desired outcomes of an educational
activity, thus [provide] metrics useful for evaluating the effectiveness of skills acquisition” (Koo
and Miner, 2010) and are “critical for public transparency and accountability” (Koo and Miner,
2010).
Workforce development plays an important role in accreditation of health departments.
Accreditation of health departments can serve as a method for monitoring the public health
workforce.
3.2.3
Methods for Workforce Development
A struggle exists between investing in training for the public health workforce and budget
constraints. Recent studies have suggested using methods such as distance and online trainings.
This method is possible due to advances in technology. These trainings are relatively inexpensive
and this method removes the need for traveling to training centers, remove limits on the number
16
of individuals trained, and remove constraints due to time of training (Millery et al., 2014). It is
recommended that training is active and that trainings include activities incorporating casestudies, problem solving, and bring learning into the workplace (Millery et al., 2014; Koo and
Miner, 2010). When training adults, it is necessary to keep in mind adults (Koo and Miner, 2010;
Kenefick et al., 2014):







Are active learners
Are reflective learners
Need to know why they are learning
Need to know what the goal is
Need to know whether they can achieve the goal or not
Generally favor short, self-paced, asynchronous, non-degree continuing education
programs
Are less confident using online chat rooms, discussion boards, or video technology
These learning modules can be program specific or offered to an entire agency. Improvements in
performance based on trainings can be monitored through employee performance reviews and
achievement of yearly goals and objectives (Turnock, 2003). However, it is important to note
that a gap in competencies may be concerning technology and individuals my need to be trained
in using technology to advance knowledge and skills before computers and web-based courses
can serve as training methods for public health workers.
3.3
THE IMPORTANCE OF INVESTING IN THE PUBLIC HEALTH
WORKFORCE
Workforce development mostly focuses on investing in the current public health workforce, but
it is also important to discuss how future public health professionals are trained and prepared for
their future careers. Today schools of public health have the ability to become accredited, by the
17
Council on Education for Public Health. Students at accredited schools of public health receive
an education that meets a certain number of established standards. Students who have attended
an accredited school have the opportunity to become certified in public health. Since the first
exam in 2008, students can become certified to demonstrate they are competent and have
mastered the public health skills necessary to improve the health and well-being of the
community in which they serve (National Board of Public Health Examiners , 2014). However,
until the establishment of the certification, standards were not available to assess the
competencies of the public health workforce, including those who have masters in public health.
Investing in the workforce, through training and professional development, must become
accepted by all public health professionals, and must be incorporated into budgets and strategic
directions of not only health departments, but all public health agencies. The public health
workforce “is the backbone of the public health infrastructure, critical to the success of public
health programs, and requires immediate intervention to improve capacity to deliver essential
public health services” (Beck et al, 2012). It is essential that trainings are evaluated to determine
if the trainings provided are sufficiently improving the knowledge and skills of the public health
workforce (Freedman et al., 2014).
18
4.0
METHODS
The Allegheny County Health Department set out to develop a self-assessment for employees of
the health department. This process consisted of 5 steps: (1) development of survey, (2)
determination of methods of analysis, (3) administration of survey, (4) analysis of survey
responses, and (5) determination of health department priorities.
4.1
DEVELOPMENT OF SURVEY
The Allegheny County Health Department sought guidance from the Public Health Foundation
(PHF) in the determination of survey questions. The PHF is “a private, non-profit, 501(c)3
organization based in Washington, DC, improves the public’s health by strengthening the quality
and performance of public health practice” (Public Health Foundation, 2014a). The PHF has
worked with community partners to develop tools for workforce development and training needs
of local and state health departments. The PHF has recommended assessing the workforce at
three tier levels (Public Health Foundation, 2014d):
“Tier 1 – Front Line Staff/Entry Level. Tier 1 competencies apply to
public health professionals who carry out the day-to-day tasks of public
health organizations and are not in management positions. Responsibilities of
19
these professionals may include data collection and analysis, fieldwork,
program planning, outreach, communications, customer service, and program
support.
Tier 2 – Program Management/Supervisory Level. Tier 2 competencies
apply to public health professionals in program management or supervisory
roles. Responsibilities of these professionals may include developing,
implementing, and evaluating programs; supervising staff; establishing and
maintaining community partnerships; managing timelines and work plans;
making policy recommendations; and providing technical expertise.
Tier 3 – Senior Management/Executive Level. Tier 3 competencies apply
to public health professionals at a senior management level and to leaders of
public health organizations. These professionals typically have staff who
report to them and may be responsible for overseeing major programs or
operations of the organization, setting a strategy and vision for the
organization, creating a culture of quality within the organization, and
working with the community to improve health.”
In collaboration with University of North Carolina and their already existing set of competencies,
the PHF developed a 74-question survey that assesses competencies of health department staff
(Public Health Foundation, 2012). The survey assesses eight domains and approximately 68
competencies. According to the PHF, the core competencies “represent a set of skills desirable
20
for the broad practice of public health that professionals may want to possess as they work to
protect and improve the nation's health” (Public Health Foundation, 2014b). The eight domains
addressed in the survey are (Public Health Foundation, 2014c):
1.
2.
3.
4.
5.
6.
7.
8.
Analytical/Assessment Skills
Policy Development/Program Planning Skills
Communication Skills
Cultural Competency Skills
Community Dimensions of Practice Skills
Public Health Sciences Skills
Financial Planning and Management Skills
Leadership and Systems Thinking Skills
Questions from the PHF were adapted to better meet the needs of the health department, a
practice that is encouraged by the PHF. Questions were simplified and combined to shorten the
survey and to make the survey more relevant to the job duties of health department employees.
The final survey addressed all eight competencies and consisted of 36 questions (32 of which
addressed the sub-competencies). The questions can be reviewed in Appendix B.
This essay addresses the Tier 1 assessment only. Tier 1 assessment is inclusive of all employees
in the health department. After completion of training determination for Tier 1, Tier 2, and Tier 3
questions will be developed.
The Allegheny County Health Department used the 2012 version of the core competencies
questions. An updated version was published in 2014 after the start of the project.
21
4.2
DETERMINATION OF METHODS OF ANALYSIS
The Allegheny County Health Department contacted the PHF to determine the best methods of
analysis for the survey. It was determined that the health department would base the analysis on
the 3-Step Competency Prioritization Sequence (Public Health Foundation, n.d.). Excel was
determined to be the best method for sorting data and determining averages of competencies.
4.3
ADMINISTRATION OF SURVEY
Survey Monkey was determined to be the platform to administer the survey. The survey was sent
via email to the 348 employees of the health department on June 30, 2014. Follow up emails
were sent as reminders to complete the survey. 39 individuals at the health department do not
have email addresses or access to the internet during their workday and were provided with a
paper copy of the survey. The initial deadline for completion was July 18, 2014. The survey was
kept open until August 1, 2014, at which time data were exported for analysis.
Employees completed 32 questions of the self-assessment using the following sale.
1= None (I am unaware, or have very little knowledge of the item)
2= Aware (I have heard of it; limited knowledge and/or ability to apply the skill)
3= Knowledgeable (I am comfortable with knowledge or ability to apply the skill)
4= Proficient (I am very comfortable, an expert; could teach this to others)
22
4.4
ANALYSIS OF SURVEY RESPONSES
332 (95.4%) employees responded (5 incomplete responses, 39 manual entries, 293 online
responses). 16 employees did not respond to the survey at the time of analysis. Data were
exported into excel using the Survey Monkey analysis tool. The data exported included overall
question responses and unidentifiable individual responses. Survey Monkey provided averages
for each question and for the data broken out by program and duty. Data were manually analyzed
to determine bureau averages. This process included sorting data by program and then each
program to its respective bureau. Overall domain averages were also completed by hand through
a process recommended by the PHF. The following figure outlines how the data were analyzed.
Figure 5: Analysis of training needs assessment survey data breakdown
23
Table 3 indicates the average responses for each of the 8 domains. These data were then used to
help determine priorities, discussed later in this section.
Table 3: Training needs assessment survey average domain response
Data were analyzed overall (Appendix C), as well as by program, by bureau, and by job duty for
a comprehensive understanding of the competencies of the health department.
Individual
question averages were analyzed for contradicting answers and notable responses. Table 4 below
describes these findings.
24
Table 4: Training needs assessment survey question findings
4.5
DETERMINATION OF TRAINING PRIORITIES
Data were presented to the Director of the health department (Dr. Karen Hacker, MD MPH) and
the four Deputy Directors: LuAnn Brink, PhD Roderick Harris DrPH., James Thompson, and
Ronald Sugar Esq. Data provided a snapshot of the competencies of each bureau and program
within the bureau. Deputy Directors were asked to determine their top three priorities for the
health department based on the self-assessment data and the health department’s strategic
direction. The Allegheny County Health Department used the general guidelines from the 3-Step
25
Competency Prioritization Sequence from the PHF (Public Health Foundation, n.d.) but adapted
it to fit the needs of the health department. Figures 6 and 7 show the current gaps.
Domain Averages:
Analytical/Assessment Skills: 2.54
Policy Development/Program Planning Skills: 2.73
Communication Skills: 2.72
Cultural Competency Skills: 2.77
Community Dimensions of Practice Skills: 2.48
Public Health Science Skills: 2.41
Financial Planning and Management Skills: 2.50
Leadership and Systems Thinking Skills: 2.62
Figure 6: Training needs assessment survey average domain response
Figure 7: Training needs assessment survey average domain response
26
The deputy directors are working to determine priorities for the upcoming year. These priorities
will be based on the results of the self-assessment, the health department’s strategic plan, and
gaps the deputy’s identified within their department. Some trainings will be offered department
wide, while others may only be offered to those programs that have a particular training need.
Addressing the gaps and priorities, the Allegheny County Health Department will be able to
better achieve the Ten Essential Public Health Services. The Ten Essential Services of Public
Health, listed below, aim to achieve the core functions of public health: assessment, assurance,
and policy development (Centers for Disease Control and Prevention, 2014b).
1.
2.
3.
4.
5.
6.
7.
Monitor health status to identify and solve community health problems.
Diagnose and investigate health problems and health hazards in the community.
Inform, educate, and empower people about health issues.
Mobilize community partnerships and action to identify and solve health problems.
Develop policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Link people to needed personal health services and assure the provision of health care
when otherwise unavailable.
8. Assure competent public and personal health care workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health
services.
10. Research for new insights and innovative solutions to health problems.
The Centers for Disease Control and Prevention, to better illustrate these functions, has created a
wheel depicting the ten essential services, see Figure 8.
27
(Source: The Centers for Disease Control and Prevention, 2014b)
Figure 8: Ten Essential Services of Public Health
The idea is that through addressing the gaps in competencies of the public health workforce at
Allegheny County Health Department, the health department is better prepared to deliver these
essential services to the community in which it serves. See Appendix D for an overview of how
the core competency self-assessment addresses all Ten of the Essential Services of Public Health.
4.6
NEXT STEPS
Based on the priorities determined by the deputy directors, the health department will use the
PHF TRAIN tool to provide online trainings to health department employees. The Allegheny
County Health Department has become a Course Provider, and will upload trainings and use
existing training to improve workforce competencies. See Appendix E for a screen shot of the
TRAIN tool. Upon determination of the training recommendations for the workforce, Tiers 2 and
28
3 will be surveyed to determine additional training needs for higher-level staff. A workforce
development plan will then be completed for the accreditation process.
29
5.0
RECOMMENDATIONS
The self-assessment helped to determine the staff’s competencies and training needs. This
section provides guidance on potential trainings for Allegheny County Health Department
employees. However, training recommendations are not solely based on the wants and needs of
the staff, but also dependent on the strategic direction of the health department. The deputy
directors have their own opinions and recommendations for trainings. In this section,
recommendations will be provided solely based on the self-assessment.
The eight domains were ranked from one to eight based on the average self-assessment score.
1. Public Health Science Skills: 2.41
2. Community Dimensions of Practice Skills: 2.48
3. Financial Planning and Management Skills: 2.50
4. Analytical/Assessment Skills: 2.54
5. Leadership and Systems Thinking Skills: 2.62
6. Communication Skills: 2.72
7. Policy Development/Program Planning Skills: 2.73
8. Cultural Competency Skills: 2.77
The narrow range of average scores indicates that individual questions should be analyzed to
determine priorities. Determination of priorities were based on the following findings when data
were analyzed (Table 4):
1. While staff have an awareness of how policy can influence public health, their ability to
apply it to their work is limited.
2. Overall the department has a limited ability to describe the role of governmental and nongovernmental organizations in the delivery of public health services.
3. As a department we are aware of the importance of communicating clearly and with
cultural understanding, but we report limited ability to apply this skill.
30
4. There is awareness of the importance of identifying stakeholders and assets; the ability to
incorporate them into their work is limited.
Although there are eight domains that the training needs assessment addressed, the three
priorities recommended for training are:
1. Public Health Policy (both within government organizations and non-government
organizations)
2. Cultural Competency (both within the organization and when working with the
community)
3. Identification of Stakeholders
These three priorities can be addressed and offered department wide and are not trainings
specific to a bureau or program, although examples may vary depending on audience of training.
5.1
PUBLIC HEALTH POLICY
5.1.1 Reason to Address
The Centers for Disease Control and Prevention define a policy “as a law, regulation, procedure,
administrative action, incentive, or voluntary practice of governments and other institutions”
(The Centers for Disease Control and Prevention , 2013). According to the World Health
Organization, health policy “refers to decisions, plans, and actions that are undertaken to achieve
specific health care goals within a society (World Health Organization, 2014).” Policies within
the context of public health aim to:



“define a vision for the future which in turn helps to establish targets and points of
reference for the short and medium term” (World Health Organization , 2014)
improve health, through limiting unhealthy behaviors and promoting healthy
behaviors
create sustainable change
31
It is important that individuals within a health department not only understand organization
policy, but also public health policy within the county, state, and at the federal level. This
includes an understanding of public health law and the precedents that allow the staff to perform
their everyday duties. In addition to understanding how policy impacts their jobs, it is necessary
that employees understand how implementing policy within the county can improve the health of
its residents. With budget constraints and limits to program resources available to health
department employees, policy change (if feasible) to promote health and behavior change is
viewed as an intervention that will not only be sustainable, but impact a large number of
individuals.
5.1.2 Recommended Trainings
The following trainings are currently available on the TRAIN website as options for staff of the
health department to participate in (under the search term “policy”) (Public Health Foundation,
n.d.b):







Public Health Policy and Advocacy
Applying Performance Measurement to Policy Activities
Engaging Communities in Public Health Research, Practice and Policy
The Intersections of Cultural Diversity, Health Policy Development and Policy
Analysis
Making Data, Policy and Politics Work for Public Health
The Role and Use of Evidence in Policy
Using Evidence-Based Health Framework to Move Policy Forward
32
5.2
CULTURAL COMPETENCY
5.2.1 Reason to Address
The goal of cultural competence is “to create a health care system and workforce that are capable
of delivering the highest-quality care to every patient regardless of race, ethnicity, culture, or
language proficiency” (Betancourt et al., 2005). According to the National Institutes of Health,
“cultural competency is critical to reducing health disparities and improving access to highquality health care, health care that is respectful of and responsive to the needs of diverse
patients” (National Institutes of Health, 2014). Understanding cultural competency is important
because individuals have a broad range of knowledge and opinions regarding health, which is
influenced “by their social or cultural backgrounds (Betancourt et al., 2005).
Through trainings in cultural competency, staff are able to better understand their co-workers as
well as the needs of the population they serve. Understanding differences among a diverse set of
community members, the health department will better serve the community and more
effectively implement programs. The Commonwealth Fund identify the following as barriers to
culturally competent care (Betancourt, 2002):



“Lack of diversity in health care’s leadership and workforce.
Systems of care poorly designed to meet the needs of diverse patient populations.
Poor communication between providers and patients of different racial, ethnic, or cultural
backgrounds.”
Current programs that address diverse populations include:
 Women, Infants, and Children
 Maternal Child Health
 Dental
 TB
33





Infectious Disease
STD
Housing
Preparedness
AmeriCorps
5.2.2 Recommended Trainings
The following trainings are currently available on the TRAIN website as options for staff of the
health department to participate in (under the search term “cultural competency”) (Public Health
Foundation, n.d.a):








Cultural Competency and Disaster Mental Health
Introduction to Cultural Competency and Title VI
Cultural Competency for Community Management of Special Needs Patients in
Disaster
Diversity and Cultural Competency in Public Health Settings- Basic Level
Cultural Diversity, Health Disparities and Public Health
Exploring Cross Cultural Communication
Practicing Cross Cultural Communication- Community Health Worker Program
Public Health Accreditation & Competency Based Learning: A Model Based on
the TRAIN Learning Management System
Alternatives to a required online module for health department staff is an in person cultural
competency training during a staff meeting. An expert within the field of cultural competency
from the county, The University of Pittsburgh, or another organization within Allegheny County,
can be contracted to provide cultural competency training and workshops to help staff better
understand and work with diverse populations within Allegheny County. Supplemental cultural
competency trainings can be offered to staff in individual programs that work with specific
populations on a regular basis, such as WIC or maternal child health program staff.
34
5.3
IDENTIFICATION OF STAKEHOLDERS
5.3.1 Reason to Address
Public health agencies do not have the resources or the expertise to provide public health
services to the community on their own. For this reason it is necessary to engage with
stakeholders. A stakeholder is a group or individuals who have an interest in a public health
decision or program, and has a unique perspective or opinion regarding this decision or program.
According to Longest and Rohrer, communication with stakeholders assists in carrying out the
health department’s mission and provides resources that allow for programs and efforts to be
sustainable within the county (Longest and Rohrer, 2005).
Stakeholders will vary based on intervention or program the health department is focusing on. It
is essential that individuals at the Allegheny County Health Department be able to identify
organizations within Allegheny County and the region to assist in their public health efforts.
Program heads may have an idea or concept for an intervention that will improve the
population’s health but it may not be successfully implemented without the assistance of others
within the community.
The Centers for Disease Control and Prevention indicate that stakeholders fall into three
categories: those affected by the intervention, those involved in the operation of the intervention,
and those involved in the evaluation of the intervention (Centers for Disease Control and
Prevention, n.d.).
They list the following as potential stakeholders in public health
efforts(Centers for Disease Control and Prevention, n.d.):
35

















Program managers and staff
Local, state, and regional coalitions interested in the public health issue
Local grantees of your funds
Local and national advocacy partners
Other funding agencies, such as national and state governments
State or local health departments and health commissioners
State education agencies, schools, and other educational groups
Universities and educational institutions
Local government, state legislators, and state governors
Privately owned businesses and business associations
Health care systems and the medical community
Religious organizations
Community organizations
Private citizens
Program critics
Representatives of populations disproportionately affected by the problem
Law enforcement representatives
5.3.2 Recommended Trainings
The following trainings are currently available on the TRAIN website as options for staff of the
health department to participate in (under the search term “stakeholders”) (Public Health
Foundation, n.d.c):




Introduction to Program Monitoring and Evaluation in Maternal and Child Health:
Session One- Monitoring & Evaluation: What? When? Who?
Community Toolbox Module 1: Assuring Engagement in Community Health
Improvement Efforts
Effective Leadership for Healthy Communities: Concepts, Collaborations and Case
Studies
Beyond the Affordable Care Act: The Next Frontiers for US Health Reform
Some of these trainings are general, while others are specific to a program or intervention. These
trainings can be used as is or adapted by health department staff to better meet the training needs
of employees. It is recommended that trainings also provide examples of stakeholders within the
county and current organizations with in which the health department already collaborates. It is
36
recommended that all staff within the health department receive a general training on engaging
stakeholders and receive additional program specific training, if necessary.
The goal of training the health department staff on the importance of community stakeholders
and potential stakeholders within the county is to better achieve the ten essential services of
public health. If a workforce at the health department understands the importance of stakeholder
involvement and understands how successes of programs depend on involvement of
stakeholders, they may be more willing to engage them. With cuts in funding to public health, it
is important now more than ever to involve stakeholders that can provide resources to the health
department for successful implementation of programs and provide guidance on the most
effective allocation of limited resources. The health department alone cannot achieve
improvements in the public’s health.
37
6.0
CONCLUSION
Local health departments within the United States function to achieve the ten essential services
of public health. With cuts in funding and a reduction in health department staff, a competent and
efficient workforce is needed to provide the services necessary for population health.
Accreditation attempts to hold health departments to standards necessary for optimal
performance. Through addressing domain 8 of accreditation, maintain a competent public health
workforce, Allegheny County Health Department is working to better prepare its workforce for
current and future public health issues. Few current employees have formal public health training
and through self-assessment have determined that there is room for improvement in their public
health competencies. It is necessary that the Allegheny County Health Department better prepare
its workforce to address public health issues and should focus on training staff in public health
policy, cultural competency, and identification of stakeholders. These trainings will align with
the health department’s strategic direction and will ensure that the health of the 1.2 million
individuals the Allegheny County Health Department serves improves not only now but for
future years to come.
38
APPENDIX A: ORGANIZATIONAL STRUCTURE OF ALLEGHENY COUNTY
HEALTH DEPARTMENT
39
Figure 9. Allegheny County Health Department Organizational Structure
40
APPENDIX B: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY QUESTIONS
41
42
43
44
45
46
47
48
49
50
51
52
53
APPENDIX C: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY SUMMARY OF DATA ANALYSIS
Domain 1: Analytical/Assessment Skills
Question
Describe a community's overall level of health and the factors that affect community health
(e.g. quality, availability of health services, economic circumstances, environment)
Identify sources of reliable public health data and information
Use information technology (e.g. computers, data bases) and other appropriate tools to
collect, store, and use data and information
Describe the use of data that measure public health conditions
Collect, use, and share data and information in an ethical manner
Overall
2.40
2.43
2.84
2.28
2.74
Domain 2: Policy Development/Program Planning Skills
Question
Gather information that can be used for policy decisions in your program (e.g. health
information, fiscal information)
Understand laws, regulations, and policies relevant to your work at the health department
(e.g. HIPAA)
Describe how policy can influence public health programs (e.g. funding, legal regulations)
Identify ways to improve the quality and effectiveness of your work
Overall
2.57
3.01
2.42
2.92
Domain 3: Communication Skills
Question
Identify the health literacy (understanding of health-related terms) of the populations your
program serves
Communicate clearly and with cultural understanding in writing, speaking, and through
other formats (e.g. community presentations, webinars)
Use good communication skills with individuals and within groups (e.g conflict resolution,
active listening, risk communication)
54
Overall
2.55
2.64
2.96
Domain 4: Cultural Competency Skills
Question
Recognize that cultural, social, and behavioral factors impact how people access and use
public health services
Describe the need for a diverse public health workforce
Work to interact effectively with persons from diverse backgrounds (e.g. cultural,
socioeconomic, educational, racial, gender, age, ethnic, sexual orientation, professional,
religious affiliation, mental and physical capabilities)
Respond to the diverse needs that might result from cultural differences
Overall
2.76
2.67
2.94
2.70
Domain 5: Community Dimensions of Practice Skills
Question
Identify stakeholders (people or organizations) and community assets that can help your
program
Collaborate with the community and encourage community involvement within your
program
Describe the role of governmental and non-governmental organizations in the delivery of
public health services
Inform the population your program serves about policies, programs, and resources
Overall
2.36
2.46
2.34
2.76
Domain 6: Public Health Science Skills
Question
Explain the role each of the following play in the field of public:
Biostatistics
Epidemiology
Environmental health
Health services administration
Social and behavioral health sciences
Recognize the Core Public Health Functions and the Ten Essential Services of Public Health
Follow laws and procedures for the ethical conduct of research (e.g. HIPAA)
Overall
2.15
2.29
2.63
2.37
2.31
2.29
2.83
Domain 7: Financial Planning and Management Skills
Question
Describe the roles of local, state, and federal public health agencies
Follow all Allegheny County Health Department policies
Identify potential funding sources (e.g. grants) that can help your program deliver services
Prioritize tasks in order to operate within your program's budget
Use feedback (individual and program) to improve performance
Report program performance
Overall
2.42
2.95
2.02
2.45
2.71
2.43
Domain 8: Leadership and Systems Thinking Skills
Question
Recognize factors (both within and outside the health department) that affect the delivery of
the Ten Essential Services of Public Health
Interact in a professional manner with organizations, communities, and individuals
Describe how public health operates within a larger social, political, and economic
environment
Participate in trainings and educational opportunities for personal and professional
development
55
Overall
2.15
3.09
2.38
2.88
APPENDIX D: ALLEGHENY COUNTY HEALTH DEPARTMENT TRAINING NEEDS
ASSESSMENT SURVEY AND THE TEN ESSENTIAL SERVICES OF PUBLIC
HEALTH
Adapted from the Indiana Public Health Workforce Development Education & Training Toolkit
(Indiana Public Health , n.d.).
56
57
58
59
APPENDIX E: SCREENSHOT OF TRAIN TOOL
60
BIBLIOGRAPHY
Allegheny County Health Department. (2013). Board of Health. Retrieved from
http://www.achd.net/board/index.html
Allegheny County Health Department. (2014). Welcome to the Allegheny County Health
Department Website! Retrieved from http://www.achd.net/admin/dir-office.html
Allegheny County Pennsylvania. (n.d.). Inception of Allegheny County. Retrieved from
http://www.alleghenycounty.us/about/inception.aspx
Beck, A.J., et al. (2012). Building an Effective Workforce: A Systematic Review of Public
Health Workforce Literature. American Journal of Preventive Medicine, 42(5s1): s6-s16.
Betancourt, J.R. (2002). Cultural Competence In Health Care: Emerging Frameworks And
Practical Approaches. Retrieved from
http://www.commonwealthfund.org/usr_doc/betancourt_culturalcompetence_576.pdf
Betancourt, J.R. et al. (2005). Cultural Competence and Health Care Disparities: Key
Perspectives and Trends. Health Affairs, 24(2): 499-505.
Centers for Disease Control and Prevention. (2010). National Voluntary Accreditation for Public
Health Departments: Benefits & Impacts of Accreditation. Retrieved from
http://www.cdc.gov/stltpublichealth/accreditation/benefits.html
Centers for Disease Control and Prevention. (2013). National Voluntary Accreditation for Public
Health Departments. Retrieved from
http://www.cdc.gov/stltpublichealth/hop/pdfs/NVAPH_Factsheet.pdf
Centers for Disease Control and Prevention. (2013). Public Health Policy. Retrieved from
http://www.cdc.gov/stltpublichealth/policy/
Centers for Disease Control and Prevention. (2014a). National Voluntary Accreditation for
Public Health Departments. Retrieved from
http://www.cdc.gov/stltpublichealth/accreditation/
61
Centers for Disease Control and Prevention. (2014b). The Public Health System and the Ten
Essential Public Health Services. Retrieved from
http://www.cdc.gov/nphpsp/essentialservices.html
Centers for Disease Control and Prevention. (n.d.). Introduction to Evaluation for Public Health
Programs. Retrieved from http://www.cdc.gov/getsmart/program-planner/step1.pdf
Freedman, A.M. et al. (2014). Public Health Training Center Evaluation: A Framework for
Using Logic Models to Improve Practice and Educate the Public Health Workforce.
Health Promotion Practice, 15: 80s-88s.
Gebbie, K.M., Turnock, B.J. (2006). The Public Health Workforce, 2006: New Challenges.
Health Affairs, 25 (4): 923-933.
Indiana Public Health. (n.d.). Indiana Public Health Workforce Development Education &
Training Toolkit. Retrieved from http://www.in.gov/isdh/files/24_Appendix1.pdf
Kaufman, N.J., et al. (2014). Thinking Beyond Silos: Emerging Priorities in Workforce
Development for State and Local Government Public Health Agencies. Journal of Public
Health Management Practice, 00:1-9.
Kenefick, H.W., et al. (2014). On Your Time: Online Training for the Public Health Workforce.
Health Promotion Practice, 15: 48s-55s.
Koo, D., Miner, K. (2010). Outcome-Based Workforce Development and Education in Public
Health. Annual Review of Public Health, 31: 253-269.
Local Health Administration Law, Act 315. 16 P.S. § 12001 et seq (1995)
Longest, B.B. & Rohrer, W.M. (2005). Communication Between Public Health Agencies and
Their External Stakeholders. Journal of Health and Human Services Administration,
28(2): 189-217.
Meyer, J., & Weiselberg, L. (prepared by). (2009). County and City Health Departments: The
Need for Sustainable Funding and the Potential Effect of Health Care Reform on their
Operations. Health Management Associates, 1-29.
Miner, K., Allan, S. (2014). Future of Public Workforce Training: Thought Leaders’
Perspectives. Health Promotion Practice, 15: 10s-13s.
Millery, M., et al. (2014). Using Innovative Instructional Technology to Meet Training Needs in
Public Health: A Design Process. Health Promotion Practice, 15: 39s-47s.
National Association of County and City Health Officials. (2014). 2013 National Profile of Local
Health Departments. Retrieved from
http://www.naccho.org/topics/infrastructure/profile/upload/2013-National-Profile-ofLocal-Health-Departments-report.pdf
62
National Board of Public Health Examiners. (2014). About the CPH. Retrieved from
https://www.nbphe.org/aboutthecph.cfm
National Institutes of Health. (2014). Cultural Competency. Retrieved from
http://www.nih.gov/clearcommunication/culturalcompetency.html
Pennsylvania Department of Health. (2013). County Municipal Health Departments & Act
315/Act 12. Retrieved from
http://www.portal.state.pa.us/portal/server.pt/community/communities/14133/cmhd___act
_315_page/556748
Pennsylvania Department of Transportation. (2014). Pennsylvania County Type 10 Maps in PDF
Format. Retrieved from
http://www.dot.state.pa.us/Internet/Bureaus/pdPlanRes.nsf/infoBPRCartoCountyType10
Public Health Accreditation Board. (2013a). Accredited Health Departments. Retrieved from
http://www.phaboard.org/news-room/accredited-health-departments/
Public Health Accreditation Board. (2013b). Accreditation Overview.
http://www.phaboard.org/accreditation-overview/
Public Health Accreditation Board. (2013c). Public Health Accreditation Board Standards &
Measures. Retrieved from http://www.phaboard.org/wp-content/uploads/SM-Version-1.5Board-adopted-FINAL-01-24-2014.docx.pdf
Public Health Accreditation Board. (2014). The Seven Steps of Public Health Department
Accreditation. Retrieved from http://www.phaboard.org/accreditation-process/sevensteps-of-public-healthaccreditation/
Public Health Foundation. (2012). Competency Assessment: Tier 3 Public Health Professionals.
Retrieved from
http://www.phf.org/resourcestools/Documents/Competency_Assessment_Tier3_2012Jan.p
df
Public Health Foundation. (2014a) About PHF. Retrieved from
http://www.phf.org/AboutUs/Pages/default.aspx
Public Health Foundation. (2014b). Competency Assessments for Public Health Professionals.
Retrieved from
http://www.phf.org/resourcestools/Pages/Competency_Assessments_For_Public_Health_
Professionals.aspx
63
Public Health Foundation. (2014c). Core Competencies for Public Health Professionals:
Domains. Retrieved from
http://www.phf.org/programs/corecompetencies/Pages/Core_Competencies_Domains.asp
x
Public Health Foundation. (2014d) Core Competencies for Public Health Professionals: Tiers.
Retrieved from
http://www.phf.org/programs/corecompetencies/Pages/COL_CorePublicHealthCompetenc
ies_Guidance_Definitions.aspx
Public Health Foundation. (n.d.). 3-Step Competency Prioritization Sequence. Retrieved from
http://www.phf.org/resourcestools/Documents/3Step_Competency_Prioritization_Sequence.pdf
Public Health Foundation. (n.d.a). TRAIN National. Retrieved from
https://www.train.org/DesktopShell.aspx?tabId=62&goto=browse&browse=keyword&ke
yword=cultural+competency&keyoption=Both&clinical=Both&local=All&ByCost=0
Public Health Foundation. (n.d.b). TRAIN National. Retrieved from
https://www.train.org/DesktopShell.aspx?tabId=62&goto=browse&browse=keyword&ke
yword=policy&keyoption=Both&clinical=Both&local=All&ByCost=0
Public Health Foundation. (n.d.c). TRAIN National. Retrieved from
https://www.train.org/DesktopShell.aspx?tabId=62&goto=browse&browse=keyword&ke
yword=stakeholders&keyoption=Both&clinical=Both&local=All&ByCost=0
Salinsky, E. (consultant). (2010). Governmental Public Health: An Overview of State and Local
Public Health Agencies. Retrieved from http://www.nhpf.org/library/backgroundpapers/BP77_GovPublicHealth_08-18-2010.pdf
Turnock, B.J. (2003). Roadmap for Public Health Workforce Preparedness. Journal of Public
Health Management and Practice, 9(6): 471-480.
Tilson, H., Gebbie, K.M. (2004). The Public Health Workforce. Annual Review of Public Health,
25: 341-356.
United States Census Bureau. (2014). State & County Quick Facts: Allegheny County,
Pennsylvania. Retrieved from http://quickfacts.census.gov/qfd/states/42/42003.html
United States Census Bureau: American FactFinder. (2014). Community Facts. Retrieved from
http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml
World Health Organization. (2014). Health Policy. Retrieved from
http://www.who.int/topics/health_policy/en/
64