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An overview of an innovative workforce development training
Aaron T. Gardner, MA
Wendy Hetherington, MPH
Directors of Public Health Nursing in California
2015 Fall Conference
San Diego, California

 Participants 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

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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
San Francisco
Riverside County
Los
Angeles
San Diego

County of Riverside Department of Public Health
Health 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?

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

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Alameda County, CA
Module I
 An Overview of Public Health
Module II
 Cultural Competency &
Cultural Humility
Module III
 Undoing Racism
Module IV
 Social and Health Equity
Module V
 Community Capacity Building
Riverside County, CA
Module I
• An Overview of Public Health
Module II
 Cultural Competency &
Acceptance
Module III
• Deconstructing Racism
Module IV
• Social Determinants of Health
Module V
• Discrimination & Stigma
Module VI
• Community Engagement &
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

Module I
•
• Public Health History & System
Core Functions and of Public Health
Essential Services
Module II
• Cultural Competency & Acceptance
Module III
• Deconstructing Racism
Module IV
• Social Determinants of Health
Module V
• Discrimination & Stigma
Module VI
• Community Engagement &
Building
Capacity
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 Public health history and connections to social justice
 3 main organizational levels of the public health system
 3 core functions and 10 essential services of public health and linked it to what we do each day

 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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 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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• 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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The discussion focuses on three groups : o LGBT o Aging o People 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.

Discussion on:
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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
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Getting department buy-in
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How did DOPH do this?
Educating and motivating
Lots of meetings
Use data to illustrate the need

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

How to Begin
Recommendations:
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Involve the chief
Susan Harrington, MS, RD
Director, Public Health
Chief administrators need an active role in goal setting, prioritizing, and launching of this effort
 Additionally…
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Diverse development teams
Constant communication with a feedback loop

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Form a curriculum development team
A diverse group
Need to spread the work

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Develop a vision
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Consult with the experts
Other jurisdictions, EAS, etc.
Training coordination
 Know your staff

Self-reported: “No knowledge of the topic”.
Relationship between
Institutional Racism and Health
Inequities
Definition and Measurement of
Health
Social Determinants of Health
Community Capacity Building
How Community Capacity
Building Supplements
Traditional Program & Service
Delivery
County of Riverside
DOPH
19.1%
18.4%
17.0%
36.8%
39.3%
Alameda County
PHD
11.8%
11.8%
9.9%
17.5%
20.3%

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

Training and Recruitment of Facilitators
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Who are the facilitators?
Optimal pairing
Support from Public
Health Director
Have staff development team

Training and Recruitment of Facilitators
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Employee Assistance
Services
Rehearse
Facilitators’ Meetings
Alameda County (ACDPH)
Site Visit
Dr. Jamie Rotnofsky, PhD
Director, Employee Assistance Services

Recommendations:
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Administrator Recognition
Have a Staff Development
Team
 Mandatory Rehearsals

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Training is mandatory
Diverse facilitation
Use Dry-runs and pilots

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Plan for challenges
Constant feedback
Use the skills of a PIO
Developing a toolkit
Jose Arballo
Public Information Specialist

Recommendations:
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Mandate training participation
Have diverse facilitation teams
Use rehearsals
Have a staff development team…ring a bell?
Sakeena Al-Amin
Staff Development Team Member

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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!

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Be sure to develop an evaluation plan
Don’t back into evaluation
A must have in order to determine your program’s effectiveness
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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

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Process evaluation
“Hot Wash”
Feedback
Participant census
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Outcome evaluation
Knowledge, self-efficacy, attitudinal, and behavioral intentions scale
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Impact evaluation
Long-term and may be hard to measure
Organizational assessment

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

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• 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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Attitude towards behavior
Improving
Health for all
Intervention
Knowledge
Subjective Norm to perform behavior
Behavioral
Intention
Perceived
Behavioral
Control to engage in behavior
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.

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1.
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 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.
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Pretest scores of attitude and Posttest scores of attitude , PBC , and SN were significant predictors of behavioral intention
[R 2 =.66, F(17, 138) = 16.018, p<.001].

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

 Do one!
 Start it early
 Be sure to have a clear program goal and objectives
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Keep records
Meeting agendas and minutes
Old versions of material
Focus group notes

 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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• What are your thoughts?
• What are your suggestions?
• Any questions?
Improving Health for All facilitators, Riverside County Department of Public Health,
June 2013