Table of Contents

Executive Summary 3

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National Public Health Training Centers Network

2004-2005 Annual ReportMarch 2005 - Final

Public Health Training Center Coordinating

Council

PHTC Network Activities and Accomplishments 6

Uniform Progress Report Findings 11

Comprehensive Performance Management System Findings 13

Annual Narrative Reports 14

Conclusion 24

Appendix A: PHTC Network Logic Model 26

Appendix B: PHTC Partners List 28

Appendix C: Public Health Nursing Committee Survey Report 40

Appendix D: PHTC-ATSDR Environmental Health Nursing Project Summary Report 44

EXECUTIVE SUMMARY

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Principal support for this program is provided by the Health Resources & Services Administration (HRSA), DHHS

Prepared by: Angela Beck, MPH, CHES ASPH/HRSA Public Health Fellow Health Resources and Services Administration Bureau of Health Professions Division of State, Community and Public Health Center for Public Health

Report developed in partial fulfillment of ASPH/HRSA fellowship obligations

Established under Public Law 105-392, the Health Professions Education Partnerships Act of 1998, the Public Health Training Center (PHTC) Program improves the nation’s public health system by strengthening the technical, scientific, managerial and leadership skills and abilities of current and future public health professionals. It emphasizes development of the existing workforce as a foundation for improving the nation’s public health infrastructure and for achieving Healthy People 2010 objectives. PHTCs feature competency-based training and education programs designed for delivery off-campus – at sites convenient to public health workers. Fourteen PHTCs based at accredited schools of public health currently exist, covering forty-two states and the District of Columbia.

PHTC Network Activities and AccomplishmentsThe PHTC National Network worked actively in 2004-2005. The PHTC Coordinating Council, comprised of Principal Investigators and Coordinators, divided itself into three working committees: Operations, Public Policy, and Partners and Clients. Each of these committees, along with the full Council, held monthly meetings and addressed issues pertinent to the mission of each committee. The Operations committee began discussions of developing a national PHTC Core Curriculum. Work on this project will begin in Spring 2005. A subcommittee of this group, composed of PHTC evaluators, developed a Logic Model for the National Network. The Public Policy committee developed a multifaceted plan to assure maximum support for the PHTC program. The Partners and Clients committee worked on identifying the various partners of PHTCs and determining the value added by PHTC collaboration and, where gaps existed, fostering involvement and support by national and local public health organizations.

The Coordinating Council worked diligently on developing the PHTC “brand” and asserting themselves as the national leaders in providing foundational public health continuing education. Over the past year, two documents were drafted and distributed at national conferences: the “external” document, Public Health Training Centers: Four Years of Progress in Public Health Workforce Development, and a summarized “internal” document or Operational Plan. The Coordinating Council also participated in a national preparedness and education meeting, Preparedness Education & Training: Where We Are meeting in Atlanta, sponsored by CDC, ASPH and HRSA. During the meeting, the PHTC program was recognized by HRSA as providing the foundational public health skills competencies through continuing education training from which more specialized skills, such as emergency preparedness skills and leadership/management skills, are built.

The PHTC Coordinators Committee also met monthly via conference call. This active committee discusses best practices and everyday operational issues of the PHTCs. The Coordinators are also integrally involved in submitting the HRSA Annual Reports, and most committee members served on a UPR-CPMS Workgroup aimed at preparing for report submission and proposing recommendations for future reports. This year, the work of the UPR-CPMS Workgroup assisted in the development of two new reporting tables that were approved by HRSA and utilized in this year’s Uniform Progress Report.Data Collection and Performance MeasuresIn an effort to evaluate the progress of the PHTCs, HRSA collects quantitative and qualitative data annually from each grantee. This report reflects data captured through two HRSA-

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mandated reporting systems, the Uniform Progress Report (UPR) and the Comprehensive Performance Management System (CPMS) report, and from an annual narrative report submitted voluntarily by each PHTC.

FindingsUniform Progress Report Data The UPR captures program-specific data for each program in the Bureau of Health Professions (BHPr). For PHTCs, this reporting period covers March 15, 2004 through March 15, 2005. The PHTCs fill out three tables that collect quantitative data, including number of training courses offered, number of people trained, type of training offered, and discipline and employment location of trainees.

In the past year, PHTCs offered over 1400 continuing education courses; 507 were distance learning courses. The Training Centers trained 84,000 people; 49,000 were trained at a distance. Sixty-five percent of people trained worked at a state or local health department.

Comprehensive Performance Management System Data The CPMS is designed to collect data on BHPr program performance indicators. Though the CPMS collects some data similar to those collected in the UPR, the reporting period covers July 1, 2003 through June 30, 2004, and grantees are asked to submit an unduplicated count of all trainees on CPMS tables. PHTCs fill out up to eight CPMS tables that capture information on discipline and employment location, minority status, age, and gender of all trainees.

The majority of people trained, 65 percent, identified themselves as public health workers. Nurses, who are oftentimes the backbone of public health services in many communities, comprised 18 percent of all trainees during this reporting period. Eighty-eight percent of public health workers trained in the past year practice in an underserved area; approximately 97 percent of those trainees worked in state or local health departments. Approximately 19 percent of people trained last year are of minority or disadvantaged status.

Annual Narrative Report Information Since the HRSA UPR system limits the space available to report qualitative information, each PHTC submits a narrative report that provides detailed descriptions of goals and accomplishments, center-building activities, field placement activities, challenges, and lessons learned. Common themes were identified among the Centers’ reports and highlighted:

• Cultural competency and diversity• Field placements• Partnerships with academic and practice organizations• PHTC challenges• PHTC lessons learned

PHTCs also report on their environmental health nurse training initiative, which received supplemental funding through an Interagency Agreement with the Agency for Toxic Substances and Disease Registry (ATSDR). A cumulative total of approximately 11,000 nurses and other health professionals were trained through this initiative when the project ended in September 2004.

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Overall PHTC Impact Despite limitations to some of the data, detailed later in this document the impact of PHTC in training the current public health workforce is unmistakable. Now in its fifth full year of operation, the PHTC program is a solidly established national effort that is reaching public health workers with high-quality training products and services. The 2004-2005 reports document the progress and increasing success of this program as the PHTC mature.

The PHTC program assures access to high-quality training experiences for 92 percent of the estimated 450,000 public health workers nationally. In addition, the PHTC provide training for many community based professionals and organizations that care for underserved populations. Since training began, the PHTC have provided education and training resources to over 190,000 people, representing the full range of health professions working in state and local agencies, clinics, and community-based organizations. PHTC training efforts result in better performance and increased competency of public health workers and agencies nationwide.

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PHTC NETWORK ACTIVITIES AND ACCOMPLISHMENTS

PHTC National NetworkAs a result of meetings convened in FY 2004 by the ASPH and HRSA, the PHTC leadership has agreed to support a National PHTC Network.

In forming a National Network, the Centers have now formalized the relationships and sharing that has evolved over the years in order to further facilitate, coordinate and expand the work of individual Centers. Furthermore, the leaderships of the PHTCs, ASPH, and HRSA foresee the formalized National PHTC Network as becoming the leading resource for public health workforce training across the nation, playing a key role in helping to achieve the public health workforce training goals outlined in three Institute of Medicine reports.1

The development of this National PHTC Network is a high priority for all PHTCs, and signifies a major accomplishment in coordination of training efforts.

In 2004-2005, the PHTC Network adopted a committee structure. The Coordinating Council, chaired by Margaret Potter of the Pennsylvania and Ohio PHTC, is composed of the PIs (directors) and Coordinators. The Council meets monthly via conference call and provides leadership and guidance to the Network. Several committees operate under the auspices of the Council, as depicted in the organizational chart that follows.

1 Relevant Institute of Medicine Reports: The Future of Public Health (1988), The Future of the Public’s Health in the 21st Century (2002), Who Will Keep the Public Healthy? Educating Public Health Professionals in the 21st Century (2003)

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As currently envisioned, there are five key objectives for the National PHTC Network:

1. Improve quality and outcomes of public health training2. Increase efficiency of PHTC operations and training delivery 3. Expand the coverage of the National PHTC Network 4. Evaluate the impact of training 5. Publicize work of PHTC Network6. Advocate for broadened support for public health workforce training in

general and the PHTCs in particular

Public Health Training Center Network Organizational Chart, 2004

PHTC Committees PHTC Network committees allow greater coordination between HRSA, PHTC staff, ASPH and other academic and practice partners.

OPERATIONS/NETWORK BUILDING COMMITTEEChaired by Jack Thompson of the Northwest Center for Public Health Practice, the purpose of this committee is to:

• Focus on how the Centers work together as a network • Work towards core curriculum for the Network • Work within the framework of the Operational Plan • Share best practices and products

In 2004, the Coordinating Council developed and approved an Operational Plan; this committee is charged with the implementation of the plan. The first objective will be to establish a core curriculum for the PHTC Network. This committee has two subcommittee workgroups composed of PHTC coordinators and project evaluators that focus on the identification and development of better performance indicators for the PHTC program and ensuring timely reporting to HRSA.

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Coordinating CouncilMaggie Potter, Chair

Operations CommitteeJack Thompson, Chair

Partners & Clients CommitteeDan Merrigan, Chair

Public Policy CommitteeToby Citrin, Chair

Coordinators Committee

UPR WorkgroupOutcomes/Evaluation Workgroup

(Logic Model)

Public Health Nursing CommitteeAnn Cary & Glenda Kelly, Co-Chairs

Rural Public Health CommitteeJanet Place & Barbara Quiram, Co-Chairs

Executive Committee: Maggie Potter, Jack Thompson, Toby Citrin, Dan Merrigan, John Kress, Antigone Vickery

• UPR/CPMS Workgroup– Formed in FY 2003, this committee is composed of PHTC staff responsible for preparing annual reports to HRSA. The goal is to assure timely and consistent submission of required agency reports. This committee was actively involved in the redesign of a HRSA UPR table that was approved for use in FY 2005. The new UPR table allows HRSA to capture important information about the trainings offered by the PHTC grantees, including topic, delivery mode, level of sophistication, and competencies met. This table was adopted by several other HRSA Bureau of Health Professions grant programs providing continuing education.

• Outcomes/Evaluation Workgroup– Formed in FY 2003, this committee is composed of PHTC personnel concerned with broader issues of PHTC reporting and evaluation. Committee activities include developing a logic model for the PHTC program (provided in Appendix A), and determining outcomes and performance measures.

PUBLIC POLICY COMMITTEEChaired by Toby Citrin of the Michigan PHTC, the Public Policy Committee works on strategies to ensure the long-term viability and support of the PHTC program. In 2004, the Committee met monthly via conference call and outlined strategies to tell the PHTC story most effectively to local and national partners, the larger public health community and others with a concern and interest in supporting an improved public health infrastructure through foundational training in the core competencies and essential public health services. With the assistance of ASPH, activity focused on: 1) making the PHTC program better recognized and supported by key stakeholders, 2) working closely with other public health training programs, such as the CDC-funded Centers for Public Health Preparedness, to develop a coordinated approach to advocating for increased support of all public health workforce training programs, and 3) identifying local and national partners with an interest in assuring the existence of high quality continuing education programs for the public health workforce. The group continues to support ASPH’s efforts with the deans and works with their own universities to support the PHTC program.

PARTNERS & CLIENTS COMMITTEEChaired by Dan Merrigan of the New England Public Health Workforce Development Alliance, the purpose of this group is to:

• Establish the value-added for our partners

• Determine how we market ourselves to our partners and clients

This committee has identified several current and potential PHTC partners and clients (full PHTC partner list provided in Appendix B). National partners include HRSA, ASPH, the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the National Association of Local Boards of Health (NALBOH), among others. Each PHTC also works closely with the state and local health departments and community-based public health organizations in their service area. Some of the key questions this committee is addressing are the following:

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1. Who are our training partners (who else provides training)?2. Who receives PHTC training?3. How are we perceived by our partners? What is our leadership role?4. Do we have a common PHTC brand and identity?5. How do we fit in the context of broader state and/or regional workforce development

efforts?6. How we market the PHTCs to potential partners and clients?7. What additional partners do we wish to engage?8. How are partners and clients engaged in the PHTC network support effort?9. How can the PHTCs position themselves as the preeminent center for public health

workforce development across the country?

COORDINATORS COMMITTEEThis committee is composed of PHTC Administrators and Coordinators who meet monthly via conference call to discuss issues of common concern and exchange best practices. In 2004, this group discussed issues related to Learning Management Systems, HRSA reporting requirements, course development, distance learning platforms, among others.

PUBLIC HEALTH NURSING COMMITTEEFormed in FY 2004, this committee is composed of over 40 PHTC staff, academic and practice partner representatives who have an interest in working on the special training needs of public health nurses, who are one of the largest components of the public health workforce. Ann Cary of the New England Public Health Workforce Development Alliance and Glenda Kelly of the Heartland PHTC serve as the committee co-chairs. The mission of this committee is “to advance public health nursing by addressing learning and training needs through the partnership between academia and practice”.

This committee met several times in 2004 to discuss potential projects committee members could engage in. Two surveys were sent to the group to narrow down the list of ideas related to continuing education and training for public health nurses. In July, a final report including priority rankings was returned to the committee. The top three priorities are listed below; the full report is included as Appendix C.

1. Identify and prioritize training and education needs of practicing public health nurses2. Address Public Health Nurses’ training needs in the following areas:

• Population Based Nursing Practice• Evidence Based Practice• Council on Linkages Core Public Health Competencies• 8 Critical areas defined in IOM report• Establishing Community Partnerships for Strategic Planning• Community Mobilization to Reduce Health Disparities• Knowledge of ANA Quad Council Standards of PHN Practice• Identifying & articulating ph nursing sensitive outcomes

3. Develop and distribute a listing of existing PHN trainings and all other trainings that could be used for public health nurses

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Discussions of potential project support have been ongoing with HRSA’s Division of Nursing. This committee hopes to implement some of these project ideas in 2005.

RURAL PUBLIC HEALTH COMMITTEE Formed in FY 2002, this committee is composed of PHTC staff and academic and practice partner representatives who have an interest in working on the special needs confronted by rural communities and public health organizations and their workforce. The purpose of the committee is to share best practices, concerns and programming, particularly as it relates to the needs of the rural public health workforce with an emphasis on learning and training needs. The committee is now considering new projects related to the development of the rural public health workforce.

Other Network Accomplishments Over the past year, the Coordinating Council made developing the PHTC “brand” a high priority, and made efforts to attract recognition for Training Centers as national leaders in providing foundational public health continuing education. Two documents were drafted and distributed at national conferences: the “external” document, Public Health Training Centers: Four Years of Progress in Public Health Workforce Development, which highlights the accomplishments of the PHTC National Network, and a summarized “internal” document or Operational Plan. Both of these documents were published by ASPH. The “external” document can be accessed on the ASPH Public Health Training Centers web page at http://www.asph.org/document.cfm?page=780.

On September 20 and 21, 2004, the ASPH convened the Preparedness Education & Training: Where We Are meeting in Atlanta. Sponsored by CDC, ASPH and HRSA, this event brought together over 250 professionals who work in preparedness education and training, including PHTC Principal Investigators. The diverse group of attendees included state and local governmental public health workers, clinicians and educators from schools of public health and other academic institutions. Meeting goals included (1) discussions on terrorism preparedness education strategies and expectations for funded recipients; (2) discussions by regions/states to share available training resources and plans; and, (3) provide input to CDC and HRSA regarding several unresolved preparedness education issues, including preparedness competencies and the use of learning management systems for monitoring preparedness training. The Coordinating Council used this opportunity to engage other public health training and education programs and stimulate collaboration. The PHTC program was recognized by HRSA as providing the foundational public health skills competencies through continuing education training from which more specialized skills, such as emergency preparedness and leadership/management, are built.

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UNIFORM PROGRESS REPORT

The data collected in the UPR clearly show an increase in productivity and efficiency among the PHTC. During the 2004-2005 reporting period both the number of trainings offered and number of people trained increased considerably. In addition, PHTC made greater efforts to reach busy public health workers in rural and urban areas through more effective utilization of distance learning technology, resulting in more people trained through distance learning formats.

Number TrainedIn the past year 83,996 public health workers were trained by PHTCs. PHTCs have increased the number of trainings provided each year, resulting in a yearly increase of workers trained, as depicted in Figures 1 and 2. In the past year, the Centers offered 1,396 training opportunities; this decrease in trainings from the previous year illustrates how the PHTCs are becoming more effective with their training approach- more people are being reached with fewer trainings. 190,361 public health workers have been trained through 5,518 training offerings, consisting of over 450,000 contact hours, since the inception of the program. Training participants continue to work primarily in governmental public health agencies. In the past year, 65 percent of people trained worked in state and local health departments.

Number and Diversity of Trainings ProvidedIn the past year, distance learning trainings comprised 48 percent of all trainings delivered, though these trainings accounted for 59 percent of people trained. While the number of distance learning trainings decreased this year, the trainings offered were successful in reaching many more people. Figures 3 and 4 depict the delivery of distance learning trainings. PHTCs utilize a broad range of distance learning mechanisms to bring trainings to the public health workforce. The most popular distance learning delivery mode used in 2004-2005 was satellite broadcast (29% of all trainings). Other distance learning formats included online courses, CD-ROM distribution, and telehealth conferences.

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13048

3788955428

83996

0

20000

40000

60000

80000

100000

2001 2002 2003 2004Fig ure 1: Number of Public Health Workers

Trained by PHTC: 2001-2004

Num

ber

Tra

ined

405

1012

2705

1396

0

500

1000

1500

2000

2500

3000

2001 2002 2003 2004

2 : F ig ure N um be r o f P HTC Tra ining s: 20 0 1-2 00 4Offe re d

Nu

mbe

r of

Tra

inin

gs

Competency-Based TrainingOf the 892 different trainings PHTC developed or offered, 86 percent have been competency- based. Most trainings are developed based on the Council on Linkages Core Competencies for Public Health Professionals, though other competency frameworks are also utilized in course development. PHTC offer trainings at aware (22 percent), knowledgeable (32 percent), and proficient levels (8 percent); the remaining 38 percent of trainings are offered at a combination of levels or are appropriate for all levels (shown in Figure 5).

Partnership/CollaborationOver 60 percent of all PHTC trainings were co-sponsored with other organizations, including health departments, academic institutions, NACCHO, and local public health organizations, and CDC Centers for Public Health Preparedness. This statistic highlights the importance PHTC place on practice and academic collaboration for both programmatic development and making best use of scarce resources.

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Figure 5: Percentage of Levels

of PHTC Trainings

2 2%

32%8%

29%9%

A wa re Kno wle dg e a ble P ro f ic ie nt A ll Le v e ls Othe r

Council on Linkages Core Competency Domains for Public Health Professionals

• Analytic/Assessment Skills• Policy Development/Program Planning Skills• Communication Skills• Cultural Competency Skills• Community Dimensions of Practice Skills• Basic Public Health Sciences Skills• Financial Planning and Management Skills• Leadership and Systems Thinking Skills

Source: Council on Linkages Between Academia and Public health Practice. Core Competencies for Public Health Professionals, April 2001.

66

34

63

37 29

7152

48

0

20

40

60

80

100

Percent of

Trainings

2001 2002 2003 2004

Figure 3: Percent of Face-to-Face and

Distance Learning Training Provided by

- - F a c e to F a c e Tra ining s D L Tra ining s

629613685

20278

49432

0100002000030000

400005000060000

2001 2002 2003 2004

4 : F ig ure N um be r o f P HTC D is ta nc e Le a rning: 2 0 0 1-2 0 0 4P a rt ic ipa nts

Table 1: Public Health Workers Trained, by Discipline: July 1, 2003 - June 30, 2004

COMPREHENSIVE PERFORMANCE MANAGEMENT SYSTEM

The information collected in the CPMS outlines the diverse workforce the PHTC train. Diversity is captured not only in the race or ethnicity of the people trained, but also in the disciplines and employment locations of the trainees. The following goals and outcomes detail the characteristics of the public health workers trained during the July 1, 2003 through June 30, 2004 reporting period.

Diversity of Workforce TrainedIn the past year, approximately 19 percent of all workers trained were of minority or disadvantaged status; 76 percent of trained workers were female.

Over 20 different types of public health and health care workers are trained each year by PHTC. Table 1 represents some of the workers trained by all PHTC in the past year.

Eighty-eight percent of workers trained last year practice in an underserved area. The majority of the workers practice in health departments; however, some trainees work in Rural Health Clinics, Community Health Centers, and other underserved areas.

* Note, the total figure above and that on page 4 differ in that they represent two overlapping time periods.

Type of Worker Number Trained

Percent of Total

Public Health 36922 65.2%Nursing 10207 18.0%Medicine 1316 2.3%Health Administration 1553 2.7%Health Information 254 0.4%Dentistry/Dental Public Health

132 0.2%

Social Work 513 0.9%Laboratory Science 183 0.3%Physician Assistant 52 0.1%Food/Nutrition Science 256 0.5%Other 5187 9.4%

56645* 100.00%

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PHTCs provide foundational, competency-

based training for a diverse public health

workforce

ANNUAL NARRATIVE REPORTS

The narrative reports submitted by the PHTC contain valuable qualitative information about how the Centers operate on a day-to-day basis, what types of center-building activities they are engaged in, and the outcomes of needs assessments and training evaluations. The Centers follow a standard format when drafting their narrative reports, allowing for common themes to be extracted and analyzed. Important themes identified include work on the environmental health nurse training initiative, cultural competency and diversity, field placements, needs assessment, evaluation, partnerships with academic and practice organizations, PHTC challenges, and PHTC lessons learned. The following sections outline highlights of the summary reports of a few of these topical areas.

Environmental Health Nurse Training Initiative In 1995 an Institute of Medicine report concluded that nurses could play a vital role in addressing key environmental health concerns, but lacked the formal education and preparation to do so. The Environmental Health Nurse Training Initiative provides competency-based continuing education training that teaches nurses how to incorporate environmental health concepts into everyday practice. PHTC, currently receiving supplemental funding of $10,000 per Center through an Interagency Agreement with the Agency for Toxic Substance and Disease Registry (ATSDR), adapt and present curricula developed by ATSDR, along with developing their own related course material based on needs assessment results. The PHTC use a broad range of mechanisms to deliver environmental health training, utilizing creative approaches in reaching the nursing workforce such as telehealth conferences, online courses, and train-the-trainer courses.

In its final year of funding, this project continued to be a tremendous success. PHTCs trained over 11,000 nurses and other public health professionals nationwide over three years. The PHTCs have proven to be an ideal vehicle for disseminating information to public health nurses. The Centers have learned how to successfully implement the programs, and have become self-sufficient in terms of organizing trainings and reporting outcomes. HRSA and ATSDR project officers monitored the progress of the Training Centers, but did not provide extensive technical or logistical support. A full report of this three-year training initiative has been provided as Appendix D.

Field Placements and InternshipsMany PHTC are involved in field placement and/or internship programs. Most involve public health graduate student placement into community based organizations or state and local health departments. The following are examples of field placement and internship programs reported by PHTC:

• Pennsylvania and Ohio PHTC developed the procedures for students to intern for academic credit in lieu of payment

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• MidAtlantic PHTC continued its PHASE (Public Health Application for Student Experience) Graduate Student Internship Project

o During its second year, PHASE has expanded its internship offerings beyond the department of epidemiology, which was the pilot department for this project, to Environmental Health Sciences and Population and Family Health Sciences departments

o To date, the PHASE Internship program has made available 28 internship opportunities at both the local state health department and at the Maryland Department of the Environment

o The benefit of such a project has been seen by the school’s administration and there has been discussion of making the PHASE internship program more integrated with the school

o In addition to the internship offerings, the MAPHTC works with a group of PHASE students to offer monthly PHASE Seminars that provide students with information about career opportunities in public health beyond academia

• New York and New Jersey PHTC efforts focused on both enhancing student practicum opportunities in general, and placing individual students in experiential learning situations

o A day-long conference entitled “Increasing the Number and Quality of MPH Student Practica in Health Departments in New York and New Jersey” took place in July of 2004 that brought together key faculty members from schools and programs of public health and health department colleagues directly involved in designing, implementing, and evaluating student practica in New York and New Jersey

The goal of the meeting was to identify the barriers and facilitators to instituting quality practicum opportunities for MPH students at health departments, and to present successful models for both placing students in health department practica and effectively mentoring them once they have begun their internship

o The University of Medicine and Dentistry of New Jersey School of Public Health (UMDNJ-SPH) recruited approximately twenty current MPH students or recent MPH graduates as consultants to assist with the completion of an organizational assessment by local health departments in New Jersey

The project, funded by the New Jersey Department of Health and Senior Services, is based on NACCHO’s “Assessment Protocol for Excellence in Public Health” (APEX-PH), Part 1

For seven months consultants, recruited from the UMDNJ-SPH and the Columbia University Mailman SPH, assisted all 114 local health departments in New Jersey to complete this assessment, providing them with a unique opportunity to work intimately with local health departments and to gain a more sophisticated understanding of local public health in New Jersey

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• Michigan PHTC continued the MPHTC-Graduate Student Training Program (GSTP) o GSTP has given masters students in public health in-depth experience in

community-based public health practice while addressing priority health issues in underserved communities

o At the beginning of the program, students and their field supervisor (or designated staff) elect at least one MPHTC short course; the course helps build the skills of the student and the preceptor to carry out their project together

o Student projects have addressed such varied topics as youth violence, homeless health care, tobacco policy and smoking cessation for youth, HIV and STD health education, obesity, lead abatement, and air quality

o Placements are located throughout Michigan serving African American, Arab American, Native American, and urban and migrant Latino populations

o Students from all departments have participated in GSTP; the program is designed to meet the internship requirements of each department

o In the summer of 2004, a total of eleven public health graduate students were placed with community-based organizations in Detroit, Flint, Ann Arbor, and Dearborn, Michigan; in the fall of 2004, all eleven students elected an Independent Study for course credit to complete their projects, further integrating community-based public health into their public health practice

o These students received a certificate in Community-Based Public Health in December 2004 after fulfilling all requirements of the GSTP

• Pacific PHTC-enabled collaborative relationships among partner universities and health departments have resulted in a significant increase in both graduate and undergraduate student internships

o Internship opportunities for graduate students in the local health departments for whom the PPHTC had provided training have doubled over the past two years

o University of California Berkeley’s priority training and collaborative project focused on health disparities and cultural competency has resulted in over 25 internships specifically targeted on these areas being made available to PPHTC graduate students

o A large percentage of the internships offered by each partner school are now made available to graduate students from other PPHTC schools; PPHTC faculty members also collaborate closely to assist students in finding placements in another partner school’s region

o The planned PPHTC job and internship board will further expand the number of and access to opportunities

• Mid-America PHTC’s executive committee is working with state partners to increase the availability of field placement opportunities for students in each state within local and public health agencies

o Over the past year, 32 students were placed within the Community Health Sciences Department at the UIC School of Public Health

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• Southeast PHTC continued to recruit students to participate in internships and fellowships

oIn the past year, SPHTC began collaborating with the North Carolina Center for

Public Health Preparedness (NCCPHP) to recruit students for NCCPHP’s Team Epi-Aid project

Formed in January 2003, Team Epi-Aid is a response team organized to

assist the North Carolina Division of Public Health with outbreak investigations and other short-term projects

Student volunteers from UNC’s Schools of Public Health, Medicine,

Pharmacy and Nursing participate in Team Epi-Aid, providing workforce surge capacity to investigate outbreaks and respond to disasters, such as floods and hurricanes

Team Epi-Aid provides students opportunities to gain practical public

health experience by working with the state health department

Over 110 students are on the Team Epi-Aid listserv. They contributed

nearly 1,600 volunteer hours during 2003o SPHTC also partners with the Kellogg Fellowships for Emerging Leaders in Public

Health, based within the North Carolina Institute for Public Health This nine-month intensive fellowship targets minority individuals

committed to public health careers Fellows learn skills essential to lead and manage in a turbulent public

health environment through a combination of on-site intensive workshops, personalized coaching, action learning teams, and individualized leadership coaching

SPHTC has assisted with developing web-based public health crisis simulations and with recruiting fellows from partner states

• Each of Texas PHTC’s academic partners assigned one intern to a local health department; the focus of the internships was to assist the local health departments determine how well they met the National Public Health Performance Standards

Partnerships/CollaborationPartnerships and collaborations are essential to PHTCs. Partnering occurs between the PHTCs themselves, and with outside organizations. The fourteen Centers combined have 109 academic partners and over 340 practice partners. The PHTCs reported examples of collaborations in their 2004 Narrative Reports a selection of which follow:

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• In August of 2004, the New York and New Jersey PHTC co-sponsored the Columbia

Center for Public Health Preparedness’ (CPHP) 2-day “Competencies to Curriculum in the Context of Preparedness” conference in New York City o The goal of the meeting was to share the Columbia CPHP’s experience developing

competency-based training for local health departments in the areas of bioterrorism and emergency preparedness

o The “Competencies to Curriculum Toolkit,” a publication of the Center for Health Policy, Columbia University School of Nursing, and the Association of Teachers of Preventive Medicine, provided the framework for the event

• Pennsylvania and Ohio PHTC collaborates with other federally-funded projects and programs to design and deliver workforce development including: the Maternal Child Health Leadership Training Center at the University of Pittsburgh, the Area Health Education Centers, the ATSDR Environmental Health Nursing Initiative, and the Bioterrorism Training and Curriculum Development Program at Thomas Jefferson University. The synergies of these programs will yield better products and progress toward objectives than either could accomplish alone

• At the Texas PHTC:

ocollaboration has been extended to include other organizations for specific

projects such as the Texas Association of Local Health Officials (TALHO) and the Texas Society of Public Health Educators (TSOPHE), both of which include rural agencies and individuals in their membership

o The HRSA funded Health Professions Education grant and the CDC funded Centers for Public Health Preparedness grants to the University of Texas School of Public Health Center on Biosecurity and Public Health Preparedness have utilized the TPHTC infrastructure as part of the resources of those initiatives

o TPHTC’s contributions have provided organization and presentation of topics to public health department and first responder audiences as well as additional use of TPHTC’s training needs assessment reports and its development of strategic partnerships with public health organizations at state and local levels

o Through these cooperative inter-agency relationships the TPHTC has gained statewide visibility and recognition. Training offerings to the public health workforce by other organizations (Statewide Health Coordinating Council, Texas Department of Health, Texas Society of Public Health Educators, Texas Association of Local Health Officials) have been augmented and facilitated by co-sponsorship of training with the TPHTC

Cultural Competency/DiversityBased on needs assessment results, several PHTC have incorporated cultural competency and diversity training into their curricula. According to Table 6 of the Uniform Progress Report, over 25 different courses directly focused on cultural competency, diversity, or health

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disparities. The PHTCs reported that approximately 143 of the 892 unique trainings offered in the past year incorporated some aspects of the Council on Linkages cultural competency skills domain. Others have participated in committees designed increase the number of minority students in schools of public health, and supported the Kids Into Health Careers program, designed to interest K-12 students in health careers. The following are examples of PHTC activities related to cultural competency and diversity reported in 2004:

• The MidAtlantic PHTC continued its efforts with the Minority Summer Internship

Program (MSIP); the goal of this program is to create a pipeline for the public health professiono In its third year, the MSIP has now placed a total of 35 high school students in

public health based positions throughout the School and several health department partner organizations; this year MAPHTC assisted in placing 8 students in public health sites

• Pennsylvania and Ohio PHTC offered at least two trainings dedicated explicitly to

cultural competency and communication; several offerings addressed the Council on Linkages cultural competency domain while focusing on other competencies o Ohio’s cultural diversity awareness curriculum is currently being used as a basis for

the development of a curriculum on culturally relevant risk communication message development for the Ohio Center for Public Health Preparedness and the Ohio Department of Health

• In addition to offering courses focusing on cultural competency, such as Communicate

to Make a Difference: Exploring Cross-Cultural Communication (accessible at www.nynj-phtc.org/cc/default.cfm ), the New York and New Jersey PHTC has made great efforts to increase student diversity at the Columbia University Mailman School of Public Health (MSPH)o The PI and Program Coordinator have been active members of a School-wide

Diversity Committee working to develop three sections of a Strategic Plan to increase the racial and ethnic diversity (black and Hispanic) of students, faculty and staff at the MSPH, and have contributed significantly to the analysis of baseline student data and the development of the Sub-committee’s final report

o This report: 1) documents the MSPH’s performance over the last ten years with regard to diversity, 2) identifies facilitators that have helped the MSPH thus far do as well as it has, 3) identifies barriers that inhibit an even better performance, 4) provides recommendations to address barriers, and 5) provides a template with recommendations and baseline data included for a 5-year Strategic Plan to increase the racial/ethnic diversity of graduates of the MSPH

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o The work done on student diversity at the MSPH to date has potentially far-reaching effects: first, the work has enabled us to do a thorough analysis of the actual numbers of people applying to, being accepted at, and matriculating at the MSPH; second, a detailed analysis conducted over the summer of 2004 of matriculating students’ GRE scores indicates these scores have little, if any, relationship to subsequent grades obtained by black and Hispanic students in the core biostatistics and epidemiology courses at the MSPH Because of this finding, there are current discussions regarding suspending

the use of GRE scores from admissions considerations for a trial period at the MSPH, which could result in more minority applicants being accepted to the school

o A third important effect of the work done to date is a current discussion regarding how best to promote an initiative with the Association of Schools of Public Health (ASPH) Deans for a new National Public Health Service Corps, which would provide student loan forgiveness for public health graduates taking jobs in federally defined underserved areas Since high tuition costs have historically been identified as a key barrier to

minorities applying to graduate programs at private institutions like the MSPH, this type of a program could potentially result in increasing the number of minority applicants to public health programs while at the same time increasingly the number of culturally competent public health workers taking jobs in underserved areas

• Upper Midwest PHTC is conducting three initiatives to increase diversity in Iowa’s health workforce:o The Center is funding the development of a strategic plan by 8/31/05 to assist

racial and ethnic minorities, immigrants, and refugees to enter and succeed in Iowa’s health workforce, in partnership with the University of Northern Iowa, Center for Health Disparities

o The Center is funding an intern in the Iowa Department of Public Health, Office of Multicultural Health, to prepare a compendium of resources in Iowa’s postsecondary academic institutions that improve retention of minority students in health occupations programs This project is being accomplished through a review of existing support

programs, personal interviews, and a focus group The product will be a working document designed for use by academic

institutions, students, and the public to learn more about programs that support minority students enrolled in Iowa’s health programs

o The center is working in partnership with the Iowa Department of Public Health, State Office of Rural Health, to identify opportunities to partner with the Iowa Department of Education and other entities to prepare middle and high school students for entry into health careers This project is being accomplished through a review of existing academic and

recruitment programs, personal interviews, and presentations to student and other groups

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• Michigan PHTC continues its efforts to emphasize cultural competency and diversity in its course topics and in recruitment of training participants o Thirty four percent of participants are from racial or ethnic minorities; the face-

to-face courses of the MPHTC have purposefully been held in underserved urban areas in Michigan to provide access to this training to a diverse workforce

oDetroit’s Racial and Ethnic Approaches to Community Health project manager

notes “MPHTC has provided excellent course offerings for defining health disparities and improving cultural competence in communication with clients and co-workers. It is key that the Training Center has been able to offer courses in Detroit, providing access to community-based organization (CBO) staff who would have difficulty traveling outside of the city. They have provided scholarships to the courses for CBO participants which has been essential to the attendance of many CBO participants”

oThe Art and Technique of Effective Communication course focused the third day of

training on integrating the role of culture into individual and group communication processes The New York/ New Jersey Public Health Training Center online course

“Communicate to Make a Difference” will be incorporated as a resource to course participants; other resources that may be employed are cultural sensitivity training tapes developed by the Chicago Police Department

This course continues to pair an academic and CBO practitioner as instructors, furthering the linkages between academe, practice and community

• The Midwest Center for Life-Long-Learning in Public Health successfully launched its series of courses focusing on culturally responsive health care in the 2004 Public Health Institute, offering four (4) courses:

oCulturally Based Community Health Immersion was developed and presented as a

one credit module The course is structured around a field trip to sites serving the Somali

population in the Twin Cities; students were provided with an opportunity to explore in depth the challenges facing this community and to consider how the knowledge gained in the course might impact their own practice.

oCommunity Based Program Evaluation explored issues that emerge when cultural

communities are evaluated, and the impact of cultural assumptions, values, and expectations. Models for conducting evaluation in diverse communities were explored

oCommunity Health Data addressed fundamentals of using and working with public

health data and using it on a community level. Strategies for data collection in diverse communities was an integral element of the module

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oCulturally Responsive Leadership and Management was designed to integrate

application of leadership/management principles in diverse communities o Across these four modules, eighty-seven (87) students attended eleven hundred

seventy-seven and one half (1,177.5) hours of education focusing on provision of culturally responsive health care. A key element in the training was the selection of persons from underserved/underrepresented communities as faculty; this element was critical in creating a credible learning experience for the students

PHTC Challenges and Lessons LearnedCHALLENGESThis year PHTC reported the challenges they face in developing and delivering trainings. The most common challenges reported were:

• Lack of fiscal resources

• Developing incentives for members of the public health workforce for participation in training programs, in absence of a recognized public health credential or accreditation system

• Developing Learning Management Systems, which allow for the assessment, delivery, tracking, and evaluation of learner needs and training and education

• Technology compatibility between states (for multi-state PHTC)

• The need to stress the importance of training in the core competencies as the foundation for specialized leadership and preparedness skills. These are complimentary needs; however, PHTC are often put in the position of competing for training participants due to a lack of training time and resources

• Translating the public health and public health preparedness competencies to course objectives and course content. At this point very few educational specialists are expert at doing this and few faculty have attempted it

• State budget crises and related changes in health department policies during the past year created new, or increased, barriers to staff travel to meetings and trainings within or outside of their states

• Designing a true systems evaluation. Learning management systems often have significant flaws as an evaluative tool

• Attempts to conduct six-month post-training follow up evaluations have been challenged by lack of agency response and competing priorities

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• Reluctance of faculty at Schools of Public Health and other academic Health Programs to engage in public health practice activities and to adopt distance learning techniques in their education and training activities

• Balancing the perceived value and need for distance learning courses with the high costs associated with the development of such courses and lower enrollment to date as compared with face-to-face courses

• Develop an effective statewide strategy for training

• A statewide and regional learning management system is critical to building the database necessary for system-wide evaluation

LESSONS LEARNEDThe following lessons learned were noted by the PHTCs:• A diverse representation of public health professionals plays instrumental roles on

planning committees and the steering committees of PHTCs

• Important to build on the national network for public health training centers to obtain shared resources on curriculum, technology, and evaluation

• The preferred mode of training continues to be face-to-face

• Important to increase and maintain a variety of face-to-face and distance learning modalities for course offerings, recognizing that there is no ‘one size fits all’ method of training

• One approach to providing training to rural communities that has been successful is the “roadshow” approach. This method saves tremendously on travel costs and travel time for the trainers and enables us to cover a large geographic area in a relatively small amount of time

• Practitioners desire training less focused on academic theory than public health practice and with emphasis on field applications

• Public health disciplines have different preferences for training delivery, i.e., nurses were open to online learning but preferred academics to facilitate; sanitarians wanted traditional classroom/workshops but were open to colleagues as instructors (“train the trainer”)

• Important to tailor courses by professional discipline and involve professional associations in the planning, development and delivery of the courses

• Instructional design considerations must embrace the principles of adult learning

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• Need to develop and/or refine portable courses or products that can be offered by the PHTC on a regional basis

• Implementation protocol, staff and consultant support to training courses are essential

• It is difficult to obtain and report personal information, e.g. race/ethnicity, from those trained

• Difficult to capture trainee information from those who use training products passed on by others, e.g. CD-ROM, cassettes, videotapes

• The training centers have a special niche. We have embraced broader workforce issues that are not being addressed by the preparedness centers, such as rural public health, environmental health and nursing and public health nursing. All of these have important implications for “preparedness skills”

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CONCLUSION

The quantitative and qualitative data captured through the reporting systems outlined in this document clearly show that PHTC have become more productive and efficient in training public health workers in foundational public health skills and competencies each year since the Centers’ inception in September 2000.

Data Limitations While these data show accurate trends in number of training courses developed and number of people trained, they do have some limitations. The complexity of the UPR and CPMS reports, which are submitted at the same time, often cause mistakes in reporting. For example, the reports ask the Centers to capture and report training information for two different, but overlapping, time periods. Additionally, the CPMS asks for an unduplicated count of trainees. Because of the high volume of training participants several PHTC have, most do not yet have data collection systems sophisticated enough to sort duplicate participants and easily distinguish data between the two reporting periods. This is an especially difficult task for multi-state PHTC, who serve up to six states and rely on information collected by academic and practice partners. Therefore, some of the data collected by the CPMS include trainees who have taken two or more PHTC trainings. The time period covered by each report may not match the reporting period requested by HRSA, but it does reflect a full year of training activity. Minority status, age, and gender data reported in the CPMS are all estimates, as some trainees prefer not to disclose that information to the Training Centers. Estimates were made by calculating percentages from the data collected, and applying them to the total number trained.

Two new tables were introduced into the Uniform Progress Report this year. While the PHTC Coordinators had input during the development of the new tables, they did not find out until a few months before the reports were due that these tables had been approved and would be required in this year’s reports. As a result, most Centers had not captured data in the level of detail required by the new tables. The PHTCs will be better equipped to report such data in future years.

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PHTC WEB PAGES

Heartland Public Health Education and Training Centerhttp://www.slu.edu/centers/heartland

Michigan Public Health Training Centerhttp://www.mitrainingcenter.org

Mid-America Public Health Training Centerhttp://www.uic.edu/sph/maphtc

Mid-Atlantic Public Health Training Center http://maphtc.jhsph.edu

Midwest Center for Life-Long-Learning in Public Healthhttp://www.publichealthplanet.org

New England Public Health Workforce Development Alliancehttp://www.bu.edu/publichealthworkforce/index.html

New York and New Jersey Public Health Training Centerhttp://www.nynj-phtc.org

Northwest Center for Public Health Practicehttp://healthlinks.washington.edu/nwcphp/hrsa/

Pacific Public Health Training Centerhttp://www.pphtc.org

Pennsylvania and Ohio Public Health Training Centerhttp://www.pophtc.pitt.edu/

South Central Public Health Training Centerhttp://scphp.sph.tulane.edu/scphtc/

Southeast Public Health Training Centerhttp://www.sphtc.org

Texas Public Health Training Centerhttp://www.txphtrainingcenter.org/

Upper Midwest Public Health Training Centerhttp://www.public-health.uiowa.edu/UMPHTC/

Health Resources and Services Administration Bureau of Health Professionshttp://bhpr.hrsa.gov/publichealth/phtc.htm

Association of Schools of Public Healthhttp://www.asph.org/

Appendix A: Draft PHTC Network Logic Model r.10/20/04Goal: Improve the quality, utilization, efficiency and competence of the current and future public health workforce by creating and diffusing state of the art CE and related learning programs.

Resources/Inputs Activities Outputs Short & Long Term Outcomes, Impacts.

TIER I

TIER 2HRSA funding

PHTC • Staff• Technical

Assistance

University Faculty

Partners• Health

Departments• Practice

partners• Academic

partners

States• Centers/

Contracted Agencies

• Staff• Advisory

committees

Infrastructure Building• Designate geographic service area

for each PHTC• Establish and operate PHTCs• Establish meaningful partnerships

with academic and practice organizations

• Develop and implement a system for program evaluation and reporting

• Develop a system of recognition for educational/professional development

• Develop a strategy for sustainability (i.e. leveraging resources)

• Develop National Network • Establish mechanisms for

coordination and communication among Centers

Workforce Analysis • Assess the phwf learning needs of

each service area• Collaborate with state HD to identify

gaps in capacity and to identify local learning/training resources

Training • Develop/deliver competency-based

learning programs to address needs• Provide trainings that range in

length, topics, and level of competency using distance learning where appropriate

• Develop/implement systems/plans to evaluate PHTC trainings

• Assess individual learning needs• Identify faculty and support

development of distance-based teaching skills

Field Placements and Collaborative Projects• Develop collaborative projects

linking academic programs, practice partners and graduate ph students with underserved communities and/or pops.

• Expand the number and quality of field placements of graduate ph students in underserved areas or with orgs serving underserved pops

• Contribute to the production of the next ph generation through programs targeting HS and undergrad students

• # states & HDs covered by PHTC• # of PHTC funded• # academic and PH WF partners• # trainings co-sponsored by partners• # partners on Advisory Boards/comm.• # reports submitted to HRSA• # of useable data reported to HRSA• # of other orgs providing resources to

sustain PHTCs• # of SPH that include PHTC within org

structure of other phwf training programs

• # Coord Council meetings/participants• # PHTC committee meetings• # of shared curricula• # collab activities between PHTC• # curricula developed

• % PHTC contributing/utilizing national • % of PHTC completing assessmts• # PHWF learning needs assessmts

performed• # of resource and capacity assessmts

completed• Type/# of available learning resources

and trainings• #/nature of capacity gaps identified• # individuals assessed• # counties/states/regions assessed• #/range of comps incorp into assessmt

•

• # persons trained• # competency-based trainings• # persons trained in 10 EPHS & CCs• #, scope, and focus of trainings • # distance based trainings• # of eval systems/plans implemented• # evaluations/reports developed• # faculty experts providing distance

based training

• % of PHTC with collaborative projects• # of students, faculty, and practice

participants involved in collaborative projects

• # and focus of projects• # underserved community members

participating in collaborative projects• # and location of field placements

Improvements/Opportunities• Increase in training opportunities• Improved regional training approaches• Increased capacity of states/agencies to

provide training opportunities• Greater involvemt and support of partners

in PHTC activities• Improved delivery of trainings• Improved outreach to underserved areas*• Increased number of workers trained• Agency improvemt in 10 EPHS and CCs• Increased collaboration between partners• Improved integration of research to

practice• Improved tech to support PHTC trainings

Impact of Network• Improved communication between PHTC • Increased level of part. in Network

activities• Improved dissemination of best practices• Improved efficiency and performance of

PHTC• Improved cost efficiency of PHTC

trainings• Increased partnership/resource sharing

with other phwf training initiatives

• Increased ability to assess wf training needs

• Learning needs are correlated to core PH outcomes

• Increased matching of learning needs with courses being offered*

• Increase in number of trainings that utilize the training resources of PH orgs

• Increased training provided to PHWF• Improved ability of PHTC to respond to

an individual’s training needs• Improved access and delivery of trainings• Improved curricula to suit needs of wf

• Increased partnership between students, faculty, and practice organizations

• Increase in projects addressing needs of underserved communities and/or populations

• Increase in # of underserved communities being served

• Increase in # and quality of field placements offered to graduate ph students

Increase in knowledge & skills of PH WF

Improvements in agency’s response to PH issues and emergencies

Tier 3- IMPACTStronger, more capable, and prepared PH workforce resulting in the improved health of populations in areas served by the PHTCs

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Glossary:

CC: Core CompetenciesESPH: Essential Public Health ServicesHD: Health DepartmentPHTC: Public Health Training CenterPH: Public HealthPHWF: Public Health WorkforceSPH: School of Public HealthUnderserved area: State, local, or federal health agencies

Outputs left out:• # of contacts made to facilitate increasing the quality and quantity of MPH student practica in underserved areas

including HDs• % of PHTC with PH workforce pipeline programs• # of participating schools and teachers• # of congressional districts covered

Outcomes left out:

• Increased # of students who choose to do a field placement in an underserved area • Improved collaboration between students, faculty, and practice organizations• Improved knowledge of public health careers among high school and undergraduate students• Increase in % of students who are considering a public health career• Expand reach of placements in underserved communities• Increased used of shared database of evaluation reports and results• Improved use of evaluation data for program renewal• Decreased dependency on federal funds• Improved use of state and federal fiscal resources in addressing population-based health needs due to improved

competency and capacity of the public health workforce• Expansion of PHTC National Network to include all US states and territories• More participants have engaged in needs assessment process over time• Increase in number of trainings that utilize the training resources and capacities of PH organizations in service area• Improved training resources and capacities in service area• Implementation and assessment of collaborative plan for addressing capacity gaps• Gain understanding of successful training methods• Pinpoint areas for improvement• Increased availability of qualified public health experts with distance-based teaching skills• Increased distance-based learning skills• Ongoing availability of public health training through HRSA-funded PHTC• Establishment of a system-wide commitment to lifelong learning for the public health workforce• Increase in proportion of students reached who pursue a public health career

Impacts left out:• Increase in public health students practicing in underserved areas or organizations upon graduation• Increase in number of students choosing to study and practice public health

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Appendix B: Practice and Academic Partners List

Public Health Training CentersPractice and Academic Partners

HEARTLAND (Missouri and Kansas)Practice PartnersMissouri Department of Health and Senior ServicesMissouri Public Health AssociationMissouri Center for Safe SchoolsMissouri Association for School NursesMissouri Council for Public Health NursingMissouri Association of Local Public Health AgenciesKansas Division of Emergency ManagementKansas Department of Health and EnvironmentKansas Public Health AssociationKansas Association for School NursesGasconade/Osage (MO) County Health DepartmentKingman County (KS) Health DepartmentWyandotte County (KS) Health DepartmentJefferson County (MO) Health DepartmentJefferson City (MO) Department of Health and Senior ServicesPlatte County (MO) Health DepartmentBollinger County (MO) Health DepartmentKansas Association of Local Health DepartmentsVernon County (MO) Health DepartmentMissouri Institute for Community HealthSt. Louis County (MO) Department of HealthSt. Louis City (MO) Department of HealthKansas City (MO) Department of HealthKansas Health Foundation

Academic PartnersSaint Louis University SPH, St. Louis, MOSLU School of NursingSLUSPH Prevention Research CenterSLUSPH Center for Environmental Education and TrainingUniversity of Missouri-Sinclair School of NursingUniversity of Kansas School of Medicine, Department of Preventive MedicineKansas WALD CenterMissouri AHECKansas AHEC

MICHIGANPractice PartnersMichigan Department of Community Health

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Michigan Association for Local Public HealthMichigan Public Health InstituteAgency-Faculty Forum, Southeastern MichiganAllegan County Health DepartmentDetroit Community-Academic Urban Research CenterDetroit Department of Health and Wellness PromotionFaith Access to Community and Economic Development, FlintFlint Odyssey House Health Awareness CenterFriends of Parkside, DetroitGenesee County Health DepartmentGreater Detroit Health CouncilGreat Lakes Chapter, Society of Public Health EducatorsHenry Ford Health SystemInter-Tribal Council of MichiganKent County Health DepartmentMichigan Health and Hospital AssociationMichigan League for Human ServicesMichigan Osteopathic AssociationMichigan Council for Maternal and Child HealthMichigan Primary Care AssociationMichigan Public Health AssociationNational Association of County and City Health OfficialsNurse Administrator’s Forum, Michigan Association for Local Public HealthOakland County Health DivisionPrevention Research Center of MichiganREACH DetroitUniversity of Michigan Health System

Academic PartnersMichigan State University

Area Health Education Center (AHEC)Michigan Center for Rural HealthSchool of Social Work

University of Michigan Ann Arbor, MINIOSH Education and Resource Center, School of EngineeringSchool of NursingSchool of Public Health

Michigan Center for Genomics and Public HealthMichigan Center for Public Health PreparednessMI-INFO (with funding from the National Library of Medicine)Public Health Library and Informatics

School of Social WorkWayne State University, Institute for Learning and Performance Improvement

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MIDAMERICA (Illinois and Indiana)Practice PartnersLake County (IL) Health DepartmentOak Park (IL) Health DepartmentIndiana State Department of HealthHRSA Region V Field OfficeChicago Department of Public HealthIllinois Department of Public HealthIllinois Department of Human Services, Family Health DivisionIllinois Public Health AssociationIllinois Association of Boards of HealthIllinois Association of Public Health AdministratorsIllinois Rural Health AssociationIllinois Primary Care AssociationKane County (IL) Health DepartmentIndiana Primary Health Care AssociationIndiana Public Health AssociationIndiana Rural Health Association Indiana Counter-Terrorism Agency/Security Council Indiana State Medical Association Indiana State Emergency Management Agency Indiana Hospital & Health Association Indiana Tobacco Prevention & Cessation Agency Center for Public Health Law--Partnerships & Professional Education Indiana Local Health Departments Represented: Tippecanoe County, Howard County, Wayne County, Clinton County, Marion County

Academic PartnersUniversity of Illinois at Chicago School of Public Health, Chicago, ILIndiana University School of Medicine, Department of Public Health, Indianapolis, INIndiana University Ruth Lilly Medical Library Indiana University School of Nursing Purdue University School of Nursing Illinois AHECIndiana AHEC

MIDATLANTIC (Maryland, Delaware, and District of Columbia)Practice PartnersDelaware Department of Health and Social ServicesMaryland Department of Health and Mental Hygiene (24 county health departments)Maryland Association of County and City Health OfficialsMidAtlantic Health Leadership InstituteDunbar School (Baltimore)DC Department of HealthPublic Health FoundationAnnie Casey Foundation

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Maryland General AssemblyHoward University Cancer CenterMorgan State Public Health ProgramRegion III STD/HIV Prevention and TrainingMaryland Public Health AssociationMetropolitan Washington Public Health AssociationJohns Hopkins Preventive Medicine ProgramMaryland Hearing and Speech AgencyEducation and Research Center for Occupational Safety and HealthUrban Health InstituteMedChi – The Maryland State Medical SocietyDC AHECEastern Shore AHECWestern Maryland AHECMetropolitan Washington Council of Governments

Academic PartnersJohns Hopkins University SPH, Baltimore, MDGeorge Washington University School of Public Health and Health ScienceJohns Hopkins School of Nursing

MIDWEST CENTER for LIFE-LONG-LEARNING IN PUBLIC HEALTH (Minnesota, North Dakota and Wisconsin)Practice PartnersAmerican Indian Family Network, Children’s InitiativeCenter for Cross-Cultural HealthDakota County Public Health Health AdvocatesHealthPartners/Regions HospitalLittle Earth Community PartnershipMinnesota Department of AgricultureMinnesota Department of HealthMinnesota International Health Volunteers ProgramMinnesota Local Public Health AssociationMinnesota Partnership for Action Against TobaccoMinnesota Public Health AssociationNorth Dakota Department of HealthPowderhorn/Phillips Cultural Wellness CenterSomali Health OrganizationVeterans AdministrationWisconsin Department of Health and Family ServicesWoodlands Wisdom

Academic PartnersMetropolitan State University, St. Paul, MinnesotaUniversity of Minnesota Academic Health Center Career Center

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University of Minnesota Academic Health Education CenterUniversity of Minnesota College of Agriculture, Food, and Environmental SciencesUniversity of Minnesota College of Veterinary MedicineUniversity of Minnesota Humphrey Inst of Public Affairs University of Minnesota Office of Multicultural AffairsUniversity of Minnesota SPH, Minneapolis, MNUniversity of North Dakota College of Nursing – Grand ForksUniversity of North Dakota School of Medicine & Health Sciences – Grand ForksUniversity of Wisconsin – Green BayUniversity of Wisconsin – Milwaukee

NEW ENGLAND (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island)Practice PartnersNEHA, Region 9CT Association of Public Health NursesCT Department of Health CT Environmental Health AssociationCT League for NursingCt Nurses AssociationMaine Center for Public HealthMaine Bureau of Health University of New England Boston Public Health CommissionCoalition for Local Public Health (MA)Harvard School of Public Health Public Health Preparedness CenterMassachusetts Association of Health BoardsMassachusetts Association of Public Health NursesMassachusetts Department of Public HealthMassachusetts Environmental Health AssociationMassachusetts Health Officer’s AssociationMassachusetts Public Health Association, Community Health Institute (NH)Manchester, NH Department of HealthNew Hampshire Department of Health and Human ServicesRhode Island Department of HealthVermont Department of Public Health

Academic PartnersBoston University School of Public Health, Boston, MAUniversity of Massachusetts School of Public Health and Health Sciences, Amherst, MAHarvard School of Public Health, Boston, MAYale University Department of Epidemiology and Public Health, New Haven, CTTufts University School of Medicine Public Health Programs, Boston, MAConnecticut AHEC Program

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NEW YORK and NEW JERSEYPractice PartnersCommunity Healthcare NetworkNYS Association of County Health OfficialsNew York State Department of Public HealthNortheast Public Health Leadership InstituteNew Jersey Public Health AssociationPublic Health Association of New York CityNYS Public Health AssociationNYC Department of Health and Mental HygieneNew Jersey Department of Health and Senior ServicesNew Jersey Health Officers Association

Academic PartnersMailman School of Public Health, Columbia University, New York, NYUniversity at Albany School of Public Health, SUNY, Rensselaer, NYUniversity of Medicine and Dentistry of New Jersey School of Public Health, New Brunswick, NJ

NORTHWEST CENTER FOR PUBLIC HEALTH PRACTICE (Washington, Oregon, Idaho, Wyoming, Alaska, Montana)Practice PartnersAlaska Division of Public HealthIdaho Department of Health and WelfareIdaho Health District Region 1 Coeur d’AleneIdaho Health District Region 2 LewistonIdaho Health District Region 3 CaldwellIdaho Health District Region 4 BoiseIdaho Health District Region 5 Twin FallsIdaho Health District Region 6 PocatelloIdaho Health District Region 7 Idaho FallsMountain States Group, Inc. (Idaho)Montana Department of Public Health and Human ServicesGallatin County Health Department (Montana)Richland County Health Department (Montana)Oregon Department of Health Services DivisionPublic Health Seattle-King CountyWashington State Department of HealthUniversity of WyomingWyoming Department of Health

Northwest Portland Area Indian Health Board

Northwest Indian CollegeDepartment of Health and Human Services Region 10

Academic PartnersArea Health Education Center, Alaska

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Area Health Education Center, Eastern and Western WashingtonArea Health Education Center, MontanaBoise State University, Boise, IDOregon Health Sciences University, Portland, ORPortland State University, Portland, ORMontana State University, Bozeman, MTUniversity of Alaska AnchorageUniversity of Montana, Missoula, MTUniversity of Washington SPH, Seattle, WAUniversity of Wyoming, Laramie, WY

PACIFIC (California, Hawaii and the American Pacific Islands)Practice PartnersAlameda County Public Health DepartmentAmerican Lung AssociationCalifornia Conference of Local Health OfficersCalifornia Department of Health ServicesCalifornia Distance Learning Health NetworkCalifornia Pan Ethnic Health NetworkCalifornia Public Health Workforce Training and Technology CoalitionCDC National Center for Environmental HealthCenter for Health LeadershipCenter for Public Health LeadershipCentral California Public Health Training AcademyCommunity-Campus Partnerships for HealthCounty Health Executives Association of CaliforniaFilipino Nurses AssociationHawaii Primary Care AssociationHawaii Public Health AssociationHawaii State Department of HealthHealth NetHRSA Field Director, Pacific ClusterHumboldt County Department of Public HealthImperial County Department of HealthKaiser PermanenteLA-Care Health PlanLake County Department of Public HealthLatino Coalition for a Healthy CaliforniaLos Angeles County Health DepartmentMadera County Public Health DepartmentNCMHD Center for Excellence for Nutritional GenomicsNorthern California Public Health AssociationPalau Ministry of HealthPublic Health Alumni AssociationPublic Health Foundation EnterprisesPublic Health Institute

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Riverside County Department of HealthSan Bernardino County Department of HealthSouthern California Public Health AssociationSutter HealthUCLA Center for Public Health and Disasters

Academic PartnersUniversity of California Los Angeles School of Public Health, Los Angeles, CACalifornia State University Graduate School of Public Health, San Diego, CAUniversity of California Berkeley School of Public Health, Berkeley, CALoma Linda University School of Public Health, Loma Linda, CAUniversity of Hawaii School of Nursing & Dental Hygiene, Honolulu, HICalifornia State University at Fresno

PENNSYLVANIA and OHIOPractice PartnersAllegheny County Health DepartmentAllentown Bureau of HealthAssociation of Ohio Health CommissionersCenter for Terrorism Preparedness, University of FindlayColumbus (OH) Health DepartmentCuyahoga County (OH) Board of HealthDelaware General Health District (OH)Drexel UniversityErie County Department of HealthFamily Health Council, Inc.Greene County (OH) Combined Health DistrictJackson County (OH) Health DepartmentLocal health officersOhio Department of HealthOhio Public Health Leadership InstituteOhio Society for Public Health EducationOhio Statewide AHEC ProgramPenn State UniversityPennsylvania Department of HealthPennsylvania Forum for Primary Health CarePennsylvania Public Health AssociationPhiladelphia Department of HealthSociety for Public Health Education (PA)Southwest Pennsylvania AHECSUNY AlbanyThe Ohio State University ExtensionUniversity of Pittsburgh Center for Public Health Preparedness

Academic PartnersUniversity of Pittsburgh GSPH, Pittsburgh, PA

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University of Pittsburgh Health Sciences Library SystemUniversity of Pittsburgh School of EducationUniversity of Pittsburgh School of NursingThe Ohio State University School of Public Health, Columbus, OH

SOUTH CENTRAL (Louisiana, Alabama, Arkansas, Mississippi)Practice PartnersAlabama Public Health AssociationAlabama Environmental Health Association, Inc.Mobile (AL) County Health DepartmentAlabama Southern Rural Access ProgramAlabama Department of Public HealthArkansas Public Health AssociationArkansas Center for Health InvolvementCommunity Health Centers of ArkansasArkansas Department of HealthLouisiana Public Health AssociationLouisiana Department of Health and HospitalsCooperative Extension Service, Southern University and A&M CollegeMississippi Public Health AssociationMississippi Nurses AssociationMississippi Association of Public Health PhysiciansMississippi State Department of HealthMississippi Primary Health Care Association

Academic PartnersTulane School of Public Health and Tropical Medicine, New Orleans, LAUniversity of Alabama at Birmingham School of Public HealthUniversity of Arkansas Medical Sciences College of Public Health, Little Rock, AR Louisiana State University Health Sciences Center, New Orleans, LACentral Louisiana AHECUniversity of Alabama College of Communication and Information Sciences

SOUTHEAST (North Carolina, South Carolina, Kentucky, Tennessee, Virginia, West Virginia)Practice PartnersKentucky Public Health Leadership InstituteKentucky Department of Public HealthNorth Carolina Department of Health and Human ServicesNorth Carolina Department of Environment and Natural ResourcesSouth Carolina Department of Health and Environmental ControlTennessee Department of HealthVirginia Department of HealthWest Virginia Bureau for Public Health

Academic Partners University of North Carolina SPH, Chapel Hill, NC

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University of South Carolina School of Public Health, Columbia, SCUniversity of Kentucky College of Public Health, Lexington, KYEastern Virginia Medical School/Old Dominion University Graduate Program in Public Health, Norfolk, VAWest Virginia University Department of Community Medicine, Morgantown, WVNorth Carolina AHECEast Tennessee State University, Johnson City, TNOther PartnersKY Public Health AssociationKY AHECNC Public Health AssociationNC Association of Local Boards of HealthNC AHECUNC School of NursingUNC-Greensboro School of NursingUNC-Charlotte School of NursingEastern Carolina Univ. School of NursingBarton College School of NursingGardner-Webb College of NursingWinston Salem State School of NursingNC A & T University School of NursingNC Central University School of NursingWestern Carolina School of NursingSC Center for Public Health PreparednessSC Public Health AssociationSC AHECSC Turning PointTN Primary Health Care AssociationTN Public Health AssociationOld Dominion UniversityJames Madison UniversityVirginia Commonwealth UniversityVA Public Health AssociationVA Turning PointWest Virginia Turning PointWest Virginia Council on Higher EducationWV Public Health AssociationBethany College, WV

TEXASPractice PartnersTexas Department of State Health ServicesTexas Department of Health UnitsInfectious Disease DivisionZoonosis Control DivisionOffice of Public Health Practice

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Health Matters, Inc.Texas Institute for Health Policy Research, Inc.City of Garland Health DepartmentMilam County Health DepartmentGrayson County Health DepartmentLubbock City Health DepartmentGalveston County Health DistrictTarrant County Health DepartmentTexas Public Health AssociationTexas Society of Public Health EducatorsTexas State Board of HealthCity of Amarillo, Department of Public HealthCity of Houston, Department of Health and Human ServicesTexas Statewide Health Coordinating CouncilTexas Association of Local Health OfficialsTexas Association of Municipal Health OfficialsHarris County Mosquito Control DistrictMental Health Association of Texas

Academic PartnersUniversity of Texas School of Public Health, Houston, TXUniversity of North Texas School of Public Health, Fort Worth, TXTexas A& M University School of Rural Public Health, College Station, TXUniversity of Texas SPH Centers and Programs

a. Center for Health Policy Studiesb. Center for Bio-security and Public Health Preparednessc. Southwest Center for Occupational and Environmental Health

University of Texas School of Medicine, Houston – Department of PsychiatryUniversity of Texas HSC, San Antonio, Teleconference Network of TexasEast Texas AHECSouth Texas AHECTexas Alliance for Healthy Communities

UPPER MIDWEST (Iowa, Nebraska and North Dakota)Practice PartnersIowa PartnersIowa/Nebraska Primary Care AssociationBureau of Health Care Access, Iowa Department of Public HealthBroadlawns Medical CenterIowa Public Health AssociationPeoples Community Health ClinicIowa Department of Public HealthCenter for Healthy CommunitiesIowa Association of Local Public Health AgenciesIowa Environmental Health AssociationIowa Department of Education

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Nebraska PartnersAlegent HealthBoys Town National Hospital & Nebraska Association of Behavioral Health OrganizationsLincoln Lancaster County Health DepartmentNebraska Health & Human Services SystemNebraska Minority Public Health AssociationNebraska Association of Boards of HealthNebraska State College SystemNebraska Hospital AssociationNebraska Nurses AssociationNebraska Medical AssociationNebraska Association of Community Action AgenciesNebraska Partnership of Local Health DepartmentsNebraska Rural Health AssociationRUPRI Center for Rural Health Policy AnalysisPublic Health Association of NebraskaSouth Dakota PartnersSouth Dakota State Health DepartmentCommunity Health Care AssociationSouth Dakota State Medical AssociationSouth Dakota Department of Education

Academic PartnersUniversity of Iowa College of Public HealthUniversity of Iowa College of NursingUniversity of Northern Iowa, Global Health Corp.Des Moines UniversityUNMC/UN Omaha Master of Public Health ProgramUniversity of Nebraska Medical CenterUniversity of Nebraska at OmahaUniversity of Nebraska Public Policy CenterCreighton University Health ServicesOffice of Research and Graduate Education, University of South DakotaSouth Dakota University Affiliated Program (SDUAP), University of South Dakota

r.2/05

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Appendix C: Public Health Nursing Committee Survey

Public Health Training CenterPublic Health Nursing Committee

Results of Committee Project Survey 2

July 12, 2004

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INTRODUCTIONThe Public Health Training Center (PHTC) Public Health Nursing Committee was established in December 2003. Committee representatives include practice and academic partners of all fourteen PHTCs. The group developed the following mission to coincide with the stated mission of the PHTC program:

Public Health Nursing Committee Mission Statement: To advance public health nursing by addressing learning and training needs through the partnership between public health academia and practice.*

*Public health nursing is an umbrella term used for public health and community health nursing.

PHTC Mission: Improve the Nation’s public health system by strengthening the technical, scientific, managerial and leadership competence of the current and future public health workforce

Meetings of the Committee focused on brainstorming project ideas for the group to undertake. An initial survey was conducted in April 2004, which resulted in a narrowing down of the list of ideas. In June 2004, a second survey was conducted to prioritize the most relevant and feasible projects identified in the first survey. This document details the results of the second survey.

Members of the Public Health Nursing Committee were requested to rank order fifteen projects based on priority. Committee members were asked to review the stated mission of the Public Health Training Centers and the Public Health Nursing Committee and prioritize suggestions based on the following criteria:

Adherence to PHTC Program Mission Adherence to Committee Mission Feasibility Duplication of other efforts Potential for financial support Potential for PHTC involvement in the effort

METHODSSurveys were emailed to all 44 members of the PHTC Public Health Nursing Committee. Survey responses were emailed back to HRSA and analyzed. Survey rankings were averaged and the results were ordered from lowest number to highest number, with the lowest number being the top priority. Some projects were deemed “not applicable” (n/a) or “outside the scope of the mission” by members of the committee. In these cases, rankings were averaged by excluding the number of people who indicated that the project was n/a from the denominator. Average rankings were calculated for the combined group of respondents, and also for the individual groups of practice partners (12 responses), academic partners (11 responses), and PHTC staff (7 responses). One respondent was included in both the academic partner group and in the PHTC staff group.

RESULTS Twenty-nine survey responses were received from Committee members (67% response rate). The following table lists the project rankings:

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PHTC Public Health Nursing Committee Project RankingsProject Suggestion Combined

RankingPractice Partner Ranking

Academic Partner Ranking

PHTC Staff

Ranking

# of n/aResponses

Identify and prioritize training and education needs of practicing public health nurses 1 2 1 1 0Address Public Health Nurses’ training needs in the following areas:

Population Based Nursing Practice Evidence Based Practice Council on Linkages Core Public Health Competencies 8 Critical areas defined in IOM report Establishing Community Partnerships for Strategic Planning Community Mobilization to Reduce Health Disparities Knowledge of ANA Quad Council Standards of PHN Practice Identifying & articulating ph nursing sensitive outcomes

2 1 2 2 0

Develop and distribute a listing of existing PHN trainings and all other trainings that could be used for public health nurses

3 4 3 3 0

Describe and distribute a model for field experiences and orientation for new nursing graduates going into local public health departments

4 3 5 (tie) 6 0

Create joint training with other members of the public health workforce with a focus on multiple discipline teams

5 5 4 4 0

Research and address barriers that keep the current workforce from getting continuing education

6 6 8 5 2

Identify and prioritize training and education needs for future PH nurses 7 11 5 (tie) 8 2Identify and propose needed changes to Nursing School courses and curriculum that could include:

Encourage schools of nursing to value public health and community health nursing in their curriculums

Integrating more public health curriculum into nursing curriculum Incorporating PHTC Environmental Health Nursing material into curriculum Courses that result in competency development, and provide credit toward BSN and

MSN or MPH degrees

8 7 10 9 0

Address concern that faculty teaching public health nursing are not always public health-prepared

9 8 7 12 2

Identify funding sources for PHN Field Experiences 10 14 12 (tie) 7 0Support collaborative projects or improved field placement opportunities for students at all levels 11 9 11 10 0Locate funding for externships for BSN juniors to do their summer experience in local or state health departments

12 10 9 11 0

Develop an internship manual that addresses issues at the student level and the organizational level for placement of students at health departments

13 12 15 14 2

Research and address barriers keeping students from pursuing a career in public health nursing 14 13 14 15 0Provide guidance to health departments regarding the importance of public health nurses actively participating in education of students

15 15 12 (tie) 13 0

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

Appendix D: PHTC-ATSDR Environmental Health Nursing Project Summary

Public Health Training CentersEnvironmental Health Nurse Training Initiative

Summary Report

March 1, 2005

The Public Health Training Centers program was established under Section 766 of the Public Health Service Act, as amended by Public Law 105-392. Principal support for the program is provided by the Health Resources and Services Administration, DHHS.

The Environmental Health Nurse Training Initiative was funded through an Interagency Agreement with the Agency for Toxic Substances and Disease Registry, Fiscal Years 2001-2004.

Prepared by: Angela Beck, MPH, CHES ASPH/HRSA Public Health Fellow Health Resources and Services Administration Bureau of Health Professions Division of State, Community and Public Health Center for Public Health

Report developed in partial fulfillment of ASPH/HRSA fellowship obligations

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PROJECT OVERVIEWIn 1995, the Agency for Toxic Substances and Disease Registry (ATSDR) along with the Health Resources and Services Administration (HRSA) and other federal agencies, commissioned the Institute of Medicine (IOM) to determine the status of education and preparation for nurses on environmental health. The result was a landmark report entitled, Nursing, Health and the Environment: Strengthening the Relationship to Improve the Public’s Health. The report determined:

1. few schools included environmental health principles in existing programs of nursing education;

2. a demand existed for nurses to be knowledgeable regarding the health impacts from environmental exposures;

3. nurses are well suited for addressing environmental health due to their comprehensive approach to health;

4. the nursing workforce numbers (now 2.7 million); and5. the strategic position of nurses in a variety of occupational settings in schools,

workplaces, homes, and places of recreation.

To provide guidance in incorporating environmental health concepts into nursing practice and education, four basic competencies were recommended for all nurses:

1. develop a basic knowledge and awareness of scientific principles of environmental health;

2. complete an exposure history and subsequently make appropriate referrals;3. understand the role of advocacy, ethics, and risk communication with respect to actual

or potential adverse health effects from the environment; and4. understand policy and legislation related to the environment.

As a result of the IOM reports, ATSDR and HRSA implemented a new strategy for training public health nurses in environmental health competencies. ATSDR’s national Environmental Health Nursing Initiative is a program dedicated to promoting capacity to address environmental health issues in all areas of professional nursing, including practice, education, and research. The strategy of the initiative was to provide a coordinated structure for capacity building in environmental health nursing. The purpose of the HRSA Public Health Training Centers (PHTCs) is to address the learning needs of the current and future public health workforce by providing foundational, competency-based public health training. HRSA has fourteen PHTCs that cover 42 states and the District of Columbia.

This three-year project provided competency-based continuing education training that taught nurses how to incorporate environmental health concepts into everyday practice. HRSA PHTCs, through an Interagency Agreement (IAA) with ATSDR, received annual supplemental funding of approximately $10,000 per Center to adapt and present curricula developed by ATSDR, including utilization of I PREPARE cards and Taking an Exposure History booklets, and develop their own related course material based on needs assessment results.

In three years of funding, this project had tremendous success, training over 11,000 nurses and other public health professionals nationwide. The IAA supported an organized, successful effort to continually train the nation’s public health nurses in strategies to address

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

environmental health concerns. The PHTCs have proven to be an ideal vehicle for disseminating information to public health nurses; they are aware of how to implement the programs, and are self-sufficient in terms of organizing trainings and reporting outcomes.

OUTCOMES AND LESSONS LEARNEDDuring the three years of the project, the Public Health Training Centers clearly demonstrated increased performance and effectiveness with regard to training nurses and other public health professionals in environmental health concepts. Foundational environmental health training was provided to over eleven thousand public health workers, improving their environmental health skills and competencies. PHTCs developed innovative approaches to delivering environmental health training to meet the needs of workers in their service areas, such as traveling face to face training "road shows", on-line computer based modules, train-the-trainer courses, and telehealth conferences. Many PHTCs broadened their trainings to provide more advanced material and topics in environmental health and several PHTCs offered nursing continuing education credits for their environmental health trainings. The following chart illustrates the number of people trained in the three years of this project.

2001-2002 2002-2003 2003-2004 Total2603 3561 5398 11562

As the reach of this project continued to expand, the cost-effectiveness of the trainings improved. The three-year cost of this project was $420,000; the average cost per trainee equaled $36.33 for 2-8 hours of training. Many PHTCs were able to offer these trainings for little or no cost to the trainee.

As indicated in the synopses of individual PHTC projects, all fourteen PHTCs developed trainings with an interdisciplinary approach. Training Centers attracted audiences comprised of several different nursing disciplines, including public health nurses, school nurses, occupational nurses, pediatric nurses, nurse educators, emergency room nurses, and others. Professionals in other public health fields, such as sanitarians, physicians, health educators, epidemiologists/toxicologists, and social workers also attended PHTC environmental health trainings, noting the need for this type of training among a diverse group of health professionals. This approach resulted in an untended important outcome of this project: collaboration. Several PHTCs noted that training participants found the opportunity to work and learn together with other types of health professionals to be an important aspect of the trainings.

Overall, this project has clearly been successful in meeting the goal of the ATSDR Environmental Health Nursing Initiative: promoting capacity to address environmental health issues in all areas of professional nursing, including practice, education, and research. The training opportunities that the Public Health Training Centers offered were consistent with the environmental health concepts outlined by the IOM report, Nursing Health and the Environment. This project is a prime example of successful collaboration between two Federal agencies, ATSDR and HRSA, and the Public Health Training Centers, a HRSA program grantee. ATSDR provided curriculum materials for environmental health trainings, along with project assistance; HRSA provided project management through the coordination of the Public Health Training Centers. The project ended in FY 2004, when ATSDR could no longer

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

financially support the project. However, several PHTC program staff have indicated that they intend to continue developing and offering environmental health trainings due to the demand for such courses among public health professionals. PHTC PROJECT SUMMARIESEach of the fourteen PHTCs provided a synopsis of the approach they used and the trainings they developed to implement the ATSDR Environmental Health Nursing Initiative:

Heartland Public Health Education and Training Center (HETC)Serves Missouri and Kansas

HETC used the approach of collaborating with state health departments to reach nurses at the local level. The state health departments in the HETC service area, Missouri Department of Health and Senior Services and the Kansas Department of Health and Environment, contract with the local health departments and are familiar with the needs of the nurses in the local public health agencies in regards to environmental issues. In addition, marketing or advertising through the state health departments proved to be very successful for reaching nurses throughout the states.

In Spring 2004, HETC delivered a web-broadcast as a new means of reaching the target audience. Many health professionals are unable to leave the worksite for an entire day of training; however, they may be able to view a one to two-hour broadcast as an alternative learning method. This learning modality was successful in reaching new audiences.

Interdisciplinary participation is fostered through the use of marketing techniques. Multiple e-mail list-servs have been utilized for marketing trainings including a listserv for occupational nurses and environmental specialists. A key partner in Missouri, the Center for Environmental Education and Training located in Saint Louis University School of Public Health, facilitates multiple trainings on a weekly basis and has proven to be a critical partner for fostering interdisciplinary participation. This center provides training and education services to professionals in environmental health and safety, as well as to general workers and the community at large. In addition to regularly scheduled courses, the Center for Environmental Education and Training provides customized training to business, industry and public agencies either at the University or on site. The center also offers consulting services in a number of areas, including environmental training/education, industrial hygiene, occupational health, safety and risk assessment and compliance management.

The partnership with the Center for Environmental Education and Training was new with the inception of this project. As stated above, this partnership has been critical in fostering interdisciplinary participation. In addition, the partnership has been critical for gaining expertise in the field of environmental health for trainings. Another new partnership has been formed with the Environmental sections at each of the state health departments. Before this project HETC had not worked individually with the environmental sectors. This project has fostered strengthened collaborations with the overall state health departments due to the diversity of projects and programs.

Examples of trainings offered:

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

• Missouri School Nurse Annual Conference –HETC co-sponsored this 52nd annual school

nurse conference with the Missouri Association of School Nurses. Plenary sessions and breakout sessions encompassed a wide range of workforce training for the school nurses including Health care needs of Refugee and Immigrant Children, the DFS system, Diabetes Management, Eating Disorders, and emergency planning in the school setting. A keynote speaker was provided to educate on “The School Nurse’s Role in Bioterrorism”.

• Missouri PH Nursing Practice Workshop –HETC co-sponsored this annual workshop with

the Missouri Public Health Association, MDHSS, and the Council of Public Health Nursing. The conference was titled, “Keeping the Wheel Turning: Enhancing Your Skills” and focused on building skills in the public health interventions of coalition building, case management, and health promotion teaching. The keynote speaker addressed the Evolution and History of Public Health Nursing.

• Environmental Health for Nurses Workshops in MO – HETC co-sponsored a series of

trainings with MDHSS and the Center for Environmental Education and Training at St. Louis University School of Public Health. The training was offered in three locations in Missouri. The program provided an overview of environmental health hazards in the home, workplace, and community. The nurse’s responsibilities in promoting environmental health were defined. The program integrated the four general environmental health competencies for nurses: 1) basic knowledge and concepts; 2) assessment and referral; 3) advocacy, ethics, and risk communication; and 4) legislation and regulation.

• Kansas School Nurse Annual Conference –HETC co-sponsored this 14th annual school

nurse conference with the Kansas Association of School Nurses, American Lung Association, KDHE, Merck Vaccine Division, School Health Corporation, Wichita State University, and Books are Fun. Plenary and breakout sessions encompassed a wide range of workforce training for school nurses including an orientation to school nursing for new nurses in the state, Guidelines for children with Special Health Care Needs, Masters of Disaster Training, Tobacco Free Teens Training, Understanding School Indoor Air Quality, bioterrorism/emergency preparedness sessions and many others. A keynote speaker was provided to educate on “The School Nurse’s Role in Bioterrorism”.

• MO School Nurse Annual Workforce Development training –HETC co-sponsored this

training with MDHSS Missouri School-Age Children’s Health Services Program. The training focused on education for school nurses on Evidence-Based Guidelines Related to the Care of School-Aged Children with Asthma, and the School Health Index for Physical Activity, Healthy Eating, and a Tobacco-Free Lifestyle.

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

• MO School Nurse Logic Model Training- HETC co-sponsored these trainings with MDHSS.

The trainings were offered in three locations in Missouri. The program focused on education for school nurses in developing a logic model and writing measurable outcomes.

• Material Distribution- Environmental Health for Nurses- HETC distributed educational

materials to approximately 400 nurses in Missouri including public health nurses, nurse educators, nursing students, and environmental specialists. The materials included “I PREPARE” cards on how to do an environmental exposure risk assessment, an overview of environmental health hazards in the home, workplace, and community, and the four general environmental health competencies for nurses: 1) basic knowledge and concepts; 2) assessment and referral; 3) advocacy, ethics, and risk communication; and 4) legislation and regulation.

• MO Council for Public Health Nursing meeting- HETC co-sponsored this meeting with MDHSS. Training was provided on strategic planning and board training. Emphasis was placed on team building, including skill and contact sharing.

• School Nurse FERPA & HIPAA Training –HETC co-sponsored these trainings with MDHSS Section of Healthy Community and Schools. The training was offered in three locations throughout Missouri. Education was provided for school nurses on the legal accountability for student health records, comparison of HIPAA and FERPA regulations, and identifying strategies for the new era of personal privacy rights.

• Indoor Air Quality & Effects of Mold- sponsored by HETC, this webcast was developed for public health nurses and other public health professionals. It addressed common indoor contaminants, demonstrated investigative techniques and provided basic solutions. Additional focus was given to mold as one of the greatest risks to indoor air quality and respiratory health.

Michigan Public Health Training Center (MPHTC)Serves Michigan

MPHTC educates an interdisciplinary team of environmental health professionals in areas intersecting nursing and environmental health. The target audience for face-to-face workshops includes public health nurses, nurse practitioners, other health professionals, environmental health specialists and health educators. MPHTC is a provider of continuing education in nursing and health education (CHES) and has routinely received continuing medical education credit designation for course offerings. These designations improve MPHTC’s ability to attract a diverse group of professionals. MPHTC has used face to face courses, a self-paced online mentored course, and key informant interviews with individuals in nursing and environmental health at the state and local level to foster the goals of the Agency for Toxic Substances and Disease Registry with respect to Environmental Health and Nursing.

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

The initial face to face offering, Public Health Nursing Basics: Health and the Environment, focused on the following learning objectives:

• Develop a basic knowledge and awareness of scientific principles of environmental health

• Complete an exposure history as part of the nursing assessment• Make appropriate referrals to environmental health resources• Understand the role of nurse advocates with respect to actual or potential adverse

effects from the environment• Increase familiarity and expertise with Internet technology and resources, particularly

those relating to environmental health in support of professional development.

The course was attended exclusively by nurses, perhaps due to the title and that the only continuing education credits offered were for nurses. However, faculty was asked to present a synopsis of the training to the Michigan’s Environmental Health Directors Conference in September 2002. This expanded the circle of influence of the workshop and promoted collegiality between nursing and environmental health professionals in local public health departments.

Given the interest generated by the nurse advocate panel presentation which was part of this workshop, MPHTC focused development of its online course offering on advocacy. Advocating for Healthy Environments and Healthy People builds on the work of the Midwest Center for Life-Long-Learning in Public Health basic online course, Introduction to Environmental Health Nursing. The primary audience for both these courses is nurses, although others interested in advocacy would benefit from the course.

To address the issue of fostering interdisciplinary participation, the planning team and presenters for the year 3 face to face training was expanded to include experts in environmental health and occupational medicine. In addition to nurses, a physician and toxicologists were recruited to be part of the planning team. The face to face offering was titled more generally as follows: Addressing Environmental Contaminants and their Effect on Human Health. The course is co-sponsored by the Center for Occupational Safety and Health Education, the University of Michigan NIOSH Education and Resource Center. In addition, CME and CHES credits were offered, along with contact hours in nursing. Continuing Education Units are also offered to make the course more attractive to a broader range of professionals. The focus of this course is on specific environmental contaminants of concern in Michigan: lead, mold, mercury and pesticides. Presenters focus on separating myth vs. fact of the health effects of these contaminants and address the role of the health and environmental professional in environmental illness. Further, information about the CDC Environmental Public Health Tracking System is also covered.

To date, all courses have included a post-course evaluation component, assessing the effectiveness of teaching methods and material presented. Evaluation results for year 1 assessed success in meeting the course learning objectives. Face to face trainings held to develop the online course in year 2 assessed changes in knowledge and applicability of the training to practice. Results indicate 100% in applicability to practice and pre-post results in five areas tested indicating between and 18% to 67% increase in knowledge. The online course

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

and year 3 workshop will include pre and post knowledge based tests. In addition, there are plans to survey participants three to six months post course to help understand the impact of the training on practice.

In year 3 MPHTC worked with state and local health nursing and environmental health leadership to understand communication networks and to encourage nursing leadership in Michigan to include environmental health education in key principles for training and education. Since 1996, responsibilities for some environmental health programs were split between the Michigan Department of Community Health (the state health department) and the Michigan Department of Environmental Quality. Split responsibilities exist at the local level and at the federal level, as well. This presents an opportunity to foster greater communication and collaboration in the state between nursing and environmental health professionals.

Examples of trainings offered:• The Nurse and the Environment: Tools for Action -one day workshop held in several sites

throughout Michigan. Materials used to develop course content included Volume 1 Case Studies in Environmental Medicine (CSEM) as CD-ROM including 15 CSEM, including Taking an Exposure History, Disease Clusters, Asthma, and Pediatric Environmental Health, supplied by ATSDR.

• Addressing Environmental Contaminants and their Effect on Human Health- This course

on CD-ROM covers concerns on common environmental contaminants and their potential effects on human health. Presentations include mold, lead, mercury, and pesticides, all of which are found in the home, the community, and the workplace.

• Advocating for Healthy Environments and Healthy People- online course: There is cause for

concern based on existing, though limited, information about contaminants in our daily environments. Of the 20 environmental pollutants reported to the EPA in 1997, nearly 75% were known or suspected neurotoxins; more than a billion pounds of neurotoxins being released into the air, water and land. The key components of protecting the environment, protecting human health and the role nurses can play as advocates are the focus on this course. Course Objectives are as follows:

o List two environmental health competencies for nurses o Describe ways nurses can advocate for environmental health and justice o Describe a Michigan environmental health initiative o Name two environmental health resources o Utilize environmental health resources

Mid-America Public Health Training Center (MAPHTC)Serves Illinois and Indiana MAPHTC’s main approach to training public health nurses has been face to face trainings. More on-line training will be incorporated into the learning management system and website is

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improved and upgraded. Training sessions are now being video-recorded. The recordings will be encoded for internet delivery and then provided through the MAPHTC web site as competency based training courses. When participants register for training, they will be able to take an on-line needs assessment before viewing the session, similar to what is done through the Illinois Public Health Preparedness Center (http://www.uic.edu/sph/prepare/). The same competency framework will be used and new competencies will be added as new courses are added (for public health nursing and environmental health training).

The Mid-America Public Health Training Center has increased its involvement with a number of groups in Illinois and Indiana, including the state-wide training committees, state public health nursing associations, local health departments, Great Lakes Center for Environmental and Occupational Health and Safety, and the Center for Advancement of Distance Education for the training of public health nurses in environmental health. MAPHTC has partnered with the Great Lakes Center for Environmental and Occupational Health and Safety program here at the University of Illinois-Chicago to host several trainings.

A public health nurse who serves on Training Center advisory committees and participates in the environmental health training program, shared that the training successfully expands the participants’ knowledge of environmental resources on environment. She noted that local communities look to local health departments, and frequently to public health nurses, for information on how the environment affects individual health, as well as the health of the community. Communities are looking to local health departments for credible information on environmental changes, as a result of development, industrial pollution or even recreational development, might affect their health for years to come. The training made participants more sensitive to these issues and illustrated how they could assist individuals through careful and purposeful assessments and interventions.

Examples of trainings offered:• Core Curriculum in Environmental Health• Illinois Leadership Society Annual Nurses Update• Illinois Rural Health Association (exhibit)• Resources for Incorporation of Environmental Health into Undergraduate Curriculum• Healthy Mothers, Healthy Babies, Healthy Environments: A Nurse's Role in Assessing

and Addressing the Health Risks to Mothers and Babies from Environmental Exposures – This conference will target professional nurses employed in clinical practice settings, particularly, but not limited to those who practice in Labor, Delivery, Postpartum and Newborn Nursery, student nurses and visiting public health nurses. Occupational health nurses, midwives and health educators will likewise benefit from the program content. The goal of this project is to develop the four basic competencies in environmental health for the nursing workforce. Regional nursing leaders in environmental health will act as planning committee members and presenters during the day long conference. After attending the conference, nurse attendees will be better risk communicators to their patients and will be better able to advocate for change necessary for safer, healthier environments.

• Environmental Health for Children in Illinois

Mid-Atlantic Public Health Training Center

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

Serves Maryland, Delaware, and the District of Columbia

Mid-Atlantic PHTC’s Environmental Health Nursing Project is comprised of an Environmental Health Nursing Educational Team (EHNT). The group includes public health nurses, nurse practitioners, and others with an interest in participating in projects aimed at training other nurses. All have formal training and/or research and educational experience in occupational/ environmental health.

The goal of the project is to develop trainings based on environmental health competencies for the nursing workforce, specifically in the areas of:

1. knowledge and awareness of scientific principles of environmental health;2. taking exposure histories and making referrals; 3. understanding the roles of advocacy, ethics, and risk communication; and 4. understanding policy and legislation related to environmental health.

In addition to reaching the current public health nurse workforce, the project also reaches the future public health nurse workforce through course lectures and other trainings conducted by the EHNT members for students at the Hopkins School of Nursing.

The EHNT has developed a series of six seminars with the Maryland Center for Environmental Training (MCET) at the College of Southern Maryland. This seminar series was held in FY 2004. Topics included indoor air quality, fire protection, drinking water treatment methods and ergonomics for nursing home workers. A member of the project actively worked with The Safety Council of Maryland, Inc. to develop two presentations for the Delaware affiliate, served on the planning committee for the Maryland Conference on Safety, Health and Environment that took place April 28, 2004, and has attended meetings of the Maryland Conference of Local Environmental Health Directors to determine objectives of this organization and identify potential educational topics for nurses in the region. Faculty of the EHNT presented at the Maryland Association of School Health Nurses conference on the topic of “Take Home Toxins.” Meetings have been held with members of the Calvert County Health Department to assess their training needs related to environmental health topics. As a result, resource packets will be developed for County Public Health Departments.

Examples of trainings offered:

• Principles of Environmental Health: A Sanitarian Review Course-Developed in

partnership with the Maryland Department of Local Environmental Health Directors, the Maryland Department of Health and Mental Hygiene, the Maryland Department of the Environment, the Johns Hopkins Environmental Health Resource Center and the Center for Excellence in Environmental Health Practice, the Principles of Environmental Health provided an introduction the concepts and principles of environmental health for public health practitioners. This training was designed primarily for sanitarians in training who are preparing the State of Maryland Registered Sanitarians exam. This was a two week course covered the following topics:

o Perspective of Environmental Health for Marylando Board of Environmental Sanitarianso General Health & Scientific Concepts

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HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005

o Occupational Health & Safetyo Program Planning and Legal Aspectso Water & Waste Watero Waste Managemento Watero Recreationo Vector and Pest Controlo Radiationo Hazardous Materials Managemento Air Quality and Noiseo Housing and Institutionso Foodo Emergency Preparedness

The Mid-Atlantic PHTC plans to continue offering this course and expand its scope to beyond the focus of Maryland-based sanitarians. Mid-Atlantic PHTC understands that trainings of this kind are in demand by those who plan to take the registered sanitarian exam. We hope to be able to translate much of this information to distance learning format so that a broader audience can be reached.

• Pesticides and Public Health: Identifying the Threat, Treating the Problem• The Air in Schools: State of the Science Indoor Air Quality Management• Terrorism Response and Preparedness Within and Around Buildings• Uniting the Healthcare Community in Times of Need• Introduction to Weapons of Mass Destruction and Preparedness• Terrorism Response and Preparedness: What You Need to Know• Biological, Chemical, and Radiological Weapons of Mass Destruction

• Essentials of Health Homes: A Health Homes Practitioner Course- The Johns Hopkins

Bloomberg School of Public Health serves as the virtual center for the new National Health Homes Training Center and Network (HHTC). The HHTC was established to “develop and disseminate training that integrates knowledge from the disciplines of health, housing, and the environment and is focused on improving the health and safety of housing.” The target audience for such trainings is environmental health specialists, community-based nurses, code inspectors, asset managers, architects/engineers, and community organizers.

Midwest Center for Life-Long Learning in Public Health (MCLPH)Serves Minnesota, Wisconsin, and North Dakota MCLPH has used several approaches to help educate and inform nurses about Environmental Health Nursing issues. During the past two years, information was distributed about training opportunities at exhibits throughout the region; collaborative partnerships were developed with nurse leaders in faculty positions in Schools or Departments of Nursing at Universities; and an online module was created to introduce nurses to Environmental Health Nursing concepts and principles; and provided guest lectures for undergraduate nursing students and

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degree completion RNs to discuss the opportunities for integration of key environmental health concepts in the practice of nursing.

Exhibits

Promotion of the online module and information about environmental health nursing has reached over 3,000 nurses and/or health and safety professionals. Exhibits were conducted at the Minnesota Environmental Health Association Conference, Minnesota Public Health Association Annual Meeting/Conference, Minnesota Pollution Control Agency Conference, and Minnesota Safety Council, Wisconsin Association of Local Health Departments and Boards and Dakota Conference on Rural and Public Health in Bismarck, North Dakota.

Collaboration

Nurse leaders from the University of Minnesota; University of North Carolina; and The Johns Hopkins University provided a review of the Introduction to Environmental Health Nursing module. To assist with piloting and dissemination of information about the module, three nursing faculty (Metropolitan State University, St. Paul, MN; University of North Dakota- Grand Forks; University of Wisconsin – Green Bay) were appointed to the interdisciplinary Advisory Cooperative of the Midwest Center for Life-Long-Learning in Public Health with the designated role of Environmental Health Nursing Liaison.

Online Module

“Introduction to Environmental Health and Nursing”, an online module, is accessible at no charge for those who are taking the course without continuing education credit. Those taking it at no cost were asked to complete a series of pre-test/post-test questions so that evaluation in knowledge acquisition could be measured. This study, conducted by a candidate in the dual degree program of the UMN School of Public Health, Environmental Health Major and the School of Nursing, Public Health Nursing (MPH/MSN) was recently completed, and publication of a manuscript outlining the findings is being developed.

From the range, mean and median scores indicate that nurses completing the module increased their knowledge base about environmental health to some degree. While some completed the online module as part of their course requirements, others responded that they accessed the module due to “curiosity, general interest, an interest in improving their professional practice, and/or to improve a course they offered. Comments from these nurses identified an unintended outcome: greater familiarity and comfort in accessing timely information on the Internet. This may have implications for those evaluating the appropriateness of the Internet as a means to quickly communicate with specific groups of professionals. To date, over 700 nurses and other professionals have accessed the module. Seven additional modules were developed in 2004. Each module provides three hours of continuing education and has been approved by the American Association of Occupational Health Nurses, Inc. (AAOHN), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. These modules can be accessed on the Midwest Center for Life-Long-Learning in Public Health website at www.publichealthplanet.org.

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Presentations

Environmental Health Nursing is not a traditional aspect of undergraduate nursing curricula, but informing nurses of this specialty is key to attracting new professionals to the field. For this reason, guest lectures to undergraduate nursing students represent a values mechanism for informing and influencing this next generation of practitioners. Three hundred eighty-five student nurses have been reached through this mechanism. Presentations were well received. Course offerings now use the online module and taped resources rather than guest lectures to advance this activity within undergraduate programs. Materials produced by ATSDR have been furnished to complement electronic media.

Examples of trainings offered:• Introduction to Environmental Health Nursing • Introduction to Environmental Health Nursing- online module• Minnesota Environmental Health Association (exhibit)• Minnesota Pollution Control Conference (exhibit)• Minnesota Public Health Association (exhibit)• Minnesota Safety Council (exhibit)• MN DOH, Division of Community Health Services Annual Conference (exhibit)• University of Minnesota School of Nursing presentation

New England Public Health Workforce Development AllianceServes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont The New England Alliance for Public Health Workforce Development employs a broad range of training and education strategies that improve the capacity of the public health workforce in each New England State: Massachusetts, Vermont, New Hampshire, Maine, Rhode Island and Connecticut. Though the public health delivery systems are organized very differently in each state (ranging from a dozen state district offices in one state to over 300 local health offices in another), public health nurses are at the forefront of local public health practice. The specific types of essential services provided by nurses vary from state to state, but in most jurisdictions nurses have responsibility for environmental health assessment and associated activities. Funding resources provided by the interagency agreement between the HRSA and ATSDR have helped the New England Alliance for Workforce Development respond to the need to train nurses to become more equipped to address current and growing environmental health issues.

The state public health nurses associations provide direct access to the majority of practicing nurses in the public systems throughout the New England region. For example, in 2004 the New England Alliance supported and contributed to the 1st New England Public Health Nursing Conference – Health, Nursing and the Environment: Strengthening the Relationship to Protect & Improve the Public’s Health. The planning committee was made up of representatives from local and state level public health professionals to leaders from schools of nursing in New England. This venue is bringing nationally and regionally recognized speakers, e.g. Kristine Gebbie and Stephanie Chalupka, to provide state of the art information and

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training to nurses and other environmental health workforce members from New England. The Alliance helped to design the training, cover expenses and in some cases provide “mini scholarships” that provided access to nurses and practitioners from the farthest locations. All participants received practice resources including a current edition of the handbook, Pediatric Environmental Health, to take back to their practice sites.

The New England Alliance, with partial support of interagency agreement between HRSA and ATSDR, also developed Foundations for Local Public Health Practice: Tools Needed to Get the Job Done, in direct response to many requests from local public health workers, representatives of professional public health associations, local public health coalitions and health department leadership from several states. This course offers a cross-disciplinary perspective that focuses on both nursing and local environmental issues and serves as a solid foundation for other more advanced trainings in several related public health areas.

The primary impact of the environmental health nursing initiative has been the provision of more training to more nurses through increased collaboration among state nursing associations, state health departments and schools of nursing on environmental health matters. As a result, local health public health nurses have enhanced knowledge, skills, competencies that should improve job performance that leads to better protection of the public’s health.

Examples of trainings offered:• Orientation to Leadership Guide and Resource Manual and BT Preparedness• Strengthening Ourselves: Building Competency for Preparedness and Prevention• Foundations for Local Public Health Practice: Tools Needed to Get the Job Done-

developed in direct response to many requests from local public health workers, representatives of professional public health associations, local public health coalitions and health department leadership from several states. This course offers a cross disciplinary perspective that focuses on both nursing and local environmental issues and serves as a solid foundation for other more advanced trainings in several related public health areas.

• Health, Nursing, and the Environment

New York and New Jersey Public Health Training Center (NYNJ PHTC)Serves New York and New Jersey

The NYNJ-PHTC has offered in-person Environmental Health Nurse (EHN) training opportunities through a course entitled Environmental Health Training for Nurses and Other Members of the Public Health Workforce. Trainings have evolved from an exclusively didactic lecture approach to one integrating hands-on learning activities and a train-the-trainer component. In 2002, four lectures were offered that were facilitated by a nurse and member of the University of Medicine and Dentistry of New Jersey School of Public Health faculty. During year two, the trainings were offered at 7 locations throughout New York State, New York City, and New Jersey, and included application of case studies as a training activity. In year three, nurses who were trained as trainers during previous year's program served as facilitators for the training sessions.

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Data has been collected on training impact. Preliminary review of the impact surveys indicates that attending the Environmental Health Nurse training has resulted in increased knowledge of the overall discipline of environmental health. More specifically, there is an increased knowledge of environmental health concepts and available resources, and participants' levels of interest in the subject matter has increased. Among the gains, the course has been credited with reinforcing both the need to conduct environmental health exposure assessments as part of an overall patient history and assessment, and the necessity of identifying populations susceptible to environmental exposures.

Several new leaders and partnerships have emerged each year. Approximately ten nurses were hired as nurse training consultants who disseminated information on behalf of the NYNJ-PHTC for year three programming. Additionally, since bringing this program to the states of New York and New Jersey, a variety of partnerships and/or networks have been strengthened or developed:

• The New York City Department of Health and Mental Hygiene (NYCDHMH) solicited the NYNJ PHTC to offer the EHN training as one training option at their annual back to school workshops for their public health school nurses. As a result of this service and partnership, the NYCDHMH endorsed the center's needs assessment survey and arranged for dissemination among their public health school nurses.

• The Director of Nursing at Felician College of Nursing attended the EHN training where she was informed about the UMNDJ-SPH monthly Public Health Seminar Series (PHSS). In an effort to offer her nursing students exposure to "real world public health," one of her classes attended several PHSS as a group; she also instituted completion of the center's on-line PH 101 module as part of her class requirement.

• Nurses who attended EHN trainings are part of a "network" of nurses who are kept informed about NYNJ PHTC developments and other public health nursing news via email communication.

Again, preliminary qualitative results from the impact survey reveal changes in nursing at three levels: practice, training, and policy. At the practice level, there has been an overall increased insight into the impact of environmental factors on health, which subsequently has led to increased assessment of patient populations, especially pediatric and susceptible populations such as farmers and those living in close proximity to farms. Participants report that they apply the concepts learned in the EHN training more regularly in their daily practice. Nurses also reported an increase in their abilities to identify environmental health issues among their patients.

From a training perspective, students of the EHN trainings have opted to disseminate this material in a variety of ways. For example, some report preparing synopses of the training and sharing the material with their colleagues in written form and at in-service trainings and staff meetings. One nurse presented highlights of this training to high school teachers at an in-service training prior to the start of school last fall. Others reported integrating various aspects of this course into nursing school curricula. Integration of an environmental health exposure assessment was the most frequently cited addition to nursing school curricula. One nurse

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respondent even cited using her EHN take home materials to help review for the Certified Occupational Health Nurse exam.

The EHN curriculum has successfully been integrated into new nurse-hire training/orientation, and has influenced the updating of one respondent’s organization's initial assessment practice. The resulting policy requires nurses to assess environmental factors at each new home visit and/or as part of all patient assessments. Other training attendees have been successful at updating their organization's initial assessments and integrating the concepts learned into their organization's practice.

As previously stated, a variety of policy changes have resulted or are being considered. These include augmenting nursing school curricula with NYNJ PHTC training material, adding components of the curriculum to new hire orientation, and modifying patient initial assessment procedures.

Pre and post tests were administered at all of last year's trainings. However, they were utilized for the edification of students and no quantitative analysis was conducted. The impact survey respondents reported increases in their knowledge and awareness. Specific areas of knowledge gain were reported in the following topic areas: communicable diseases, cultural competency, indoor air quality, lead, MSDS, PCBs, principles of adult learning, process of cross contamination and routes of transmission, sanitation, and an overall increase in knowledge in environmental health.

The availability of this training has served several purposes for the New York-New Jersey region's nursing workforce. For some, new material has been introduced; for others a refresher was provided, and for others the materials reinforced or validated their current practice. Numerous respondents reported that attending this training resulted in increased confidence in their knowledge base and that they feel this training is important to nurses without a formal public health background. If the training had never existed, there would not be a cohort of nurses who have received specialized training in critical environmental health issues. In addition, certain networks and collaborations would not have been established. Finally, a segment of the patient population, the recipients of these nurses’ services, would not be privy to the benefits of their continuing education activities in nursing practice.

Pacific Public Health Training Center (PPHTC)Serves California and Hawaii An extensive survey conducted for the PPHTC by Loma Linda University among approximately 7,000 nurses in California and Hawaii demonstrated that the #1 environmental interest or concern among nurses in California and Hawaii was dealing with food borne illnesses. Follow up work with small groups of nurses in Hawaii confirmed the survey’s results. In response, PPHTC has developed and presented food borne illnesses trainings in California.

In addition, the PPHTC has developed a “roadshow” training approach by traveling to several counties in California to deliver trainings in order to reach more practicing nurses.

Examples of trainings offered:

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• Environmental Health Nursing “Roadshow”- ½ day training delivered to public health nurses and environmental health specialists; travels to various counties in California

• Environmental Health Nursing for Public Health Nurses• Mold, Management and the Media

• 16th Annual Pacific Nursing Research Conference

• Food-borne Illnesses Conference• Introduction to Core Functions• Core Functions and Cultural Competency• Core Functions and Public Health• Public Health and Disaster Preparedness

Pennsylvania & Ohio Public Health Training Center (POPHTC)Serves Pennsylvania and Ohio

POPHTC Environmental Education of the Nursing Workforce project targets nurses and other professionals such as health educators, environmental health specialists, and teachers employed in schools, public health departments, and other agencies that protect and promote the public’s health. Both Registered Nurses and Registered Sanitarians/Environmental Health Specialists are targeted with promotional materials for the resources and face-to-face training programs. Continuing education credit is offered for professional groups in Ohio. Examples and Web resource demonstrations from both nursing and sanitarian perspectives are used in the training programs. Case studies used are relevant to both professional groups and dialog is encouraged between groups during training activities. This collaborative participation in environmental health education sessions helps to foster the interdisciplinary approach necessary in public health practice.

The goal of the POPHTC project was to develop competencies for the nurses and other cooperative professional workforces in the area of environmental health. The professional networks of POPHTC's staff, advisory group, and partnering local agencies in both states will be vehicles for disseminating information and marketing materials and for providing training. Positive professional working relationships with public health associations, state health departments and the academic institutions in Pennsylvania and Ohio provided linkages to both subject matter experts and to the intended audiences.

POPHTC has relied on two main approaches to reach the target populations:

• On-line listing and links to ATSDR and other environmental resources• Face-to-face training delivery with a Train-the-Trainer approach

Resources and events are promoted through professional association listservs and exhibits, Training Center distribution lists and advisors, and electronic messages to local health agencies.

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Course evaluations have been collected for each training session to determine the participants’ perceived ability to perform the stated objectives pre-and post training, including after six-months (this evaluation follows an established POPHTC evaluative procedure).

Examples of trainings offered:• Environmental Assessment for Public Health Nurses and Environmental Specialists-

face-to-face training provided by the Pennsylvania & Ohio PHTC using an interdisciplinary approach to train nurses and environmental specialists

• Environmental Education for the Nursing Workforce: Bringing Education and Practice• Fundamentals of Environmental Health for Public Health Nurses and Sanitarians

South Central Public Health Training Center (SCPHTC)Serves Alabama, Arkansas, Louisiana, and Mississippi

SCPHTC activities associated with the environmental health nursing project include:• Conducting a one year follow-up evaluation study to assess the extent to which the

knowledge, skills, and abilities associated with the Health Risk Assessment and Taking an Exposure History course transfer to improved job performance.

o A competency-based survey was developed to gather both quantitative (e.g., performance ratings) and qualitative (e.g., explanations of changes in on-the-job behavior) data regarding workplace behaviors

o One hundred forty-six public health practitioners who completed the training were surveyed; twenty-six public health practitioners completed the survey.

o The findings of the evaluation suggest that successful completion of the Health Risk Assessment and Taking an Exposure History course results in enhanced job performance with respect to environmental health issues confronted by many public health professionals.

• Receiving supplemental funding to conduct a Delphi study among primary health care professionals. The health care professionals evaluated an environmental health web-based toolkit of training materials. This project was conducted in collaboration with the Texas Public Health Training Center and ended fall 2003.

Examples of trainings offered:• Risk Assessment and Taking Exposure History• Introduction to Health Assessment and Taking an Exposure History

• Association of State and Territorial Directors of Health Promotion and Public Health

Education (ASTDHPPHE 20th National Conference on Health Promotion and Health Education) in New Orleans.

Southeast Public Health Training Center (SPHTC)Serves Kentucky, North Carolina, South Carolina, Tennessee, Virginia, West Virginia

SPHTC focuses on life long learning for public health nurses. The center developed and facilitates a network of public health nursing faculty from all BSN programs in the state. This committee works with local nursing directors to develop public health field placements for

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nursing students to recruit and prepare them for careers in public health nursing. Particular emphasis is placed on recruiting nursing students from Historically Black Colleges.

SPHTC began a network of public health nursing faculty that is linked to local nursing directors. They are all, in turn, linked to the resources of the SPHTC, specifically, and the North Carolina Institute for Public Health in general. This has already had the impact of providing nursing faculty with resources that improve teaching, but also has become an avenue for sharing “best practices’ on how to create meaningful public health clinical experiences for nursing students. Exemplar clinical placement programs are currently underway in several counties with local nursing schools. This network is critical for building a culture of collaboration rather than competition.

This network is an important avenue for institutionalizing environmental health in nurse training and education as part of the HRSA/ATSDR initiative. The network has an active listserv and held a state-wide educational conference on the future of public health nursing in the state, which focused on environmental health.

The Southeast Public Health Training Center has benefited from the association with ATSDR is many ways. Through partnership with ATSDR SPHTC has been able to institutionalize environmental health content into established required public health nursing courses aimed at history-taking and assessment skills such as Adult Physical Assessment and Child Health Screening and school nurse training. The nurses completing Adult Physical Assessment and Child Health courses provide the majority of history-taking and physical assessments of health department clients, especially in underserved areas. They are a natural target audience for this type of training. The goal is to teach public health nurses the importance of identifying and reporting environmental health risks among their patient populations and in their communities. Environmental health materials have also been incorporated into Introduction to the Principles and Practice of Public Health Nurses, which is required of all new public health nurses with two or three year degrees.

A second target is school nurses. The North Carolina Annual School Nurse Conference attracts upwards of 400 nurses each year. SPHTC presented to this audience in 2003 and 2004. The focus has been on providing nurses with tools, such as the “I Prepare” cards, ATSDR newsletters, and/or case studies appropriate for the specific audience from the ATSDR “Case Studies in Environmental Medicine.”

The public health nurses in NC reflect the vast spectrum of practicing public health nurses and future public health nurses as well as nursing faculty. While ATSDR’s priority is working public health nurses, SPHTC feels strongly that the entire continuum of nurses must be addressed to assure that new public health nurses are prepared for the role. For this reason, some of the focus is on nursing students and nursing faculty.

SPHTC has introduced ATSDR material into classrooms in nursing schools across North Carolina through the newly created network of community health nursing faculty teaching. This local group, as well as the nationally recognized body the Association of Community Health Educators, (ACHNE), as well as the American Public Health Association Public Health Nursing Section, are all struggling to translate the “core competencies of public health nursing”

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into vital curriculum for both undergraduate and graduate nurses. The newly formed community health faculty network has been formed to share resources such as the Basic Environmental Health Module and Risk Communication and the activities of the Environmental Health Nursing Initiative. There is strong interest in partnering with public health nursing directors around collaborative research, and environmental health issues, particularly lead poisoning in children, is a North Carolina legislative priority.

Over the course of these initiatives, SPHTC learned a great deal about nursing and environmental health and continued to modify trainings accordingly. The first lesson is that it is not enough to teach about environmental health assessments. Public health nurses have a fairly good understanding of this process; however, several participants noted concern about efforts to follow-up on environmental risks and getting no help. Consequentially, SPHTC now collaborates with local environmental health officers in order to provide better information on dealing with environmental exposure concerns and communicating risk appropriately.

In dealing with school nurses SPHTC found that it is difficult for many nurses to get past the environmental risks within the walls of their own schools. Rather than teaching about environmental risks in the community, the trainings provide tools relating to such issues as dealing with molds and toxins found within school buildings.

The biggest impact of SPHTC efforts has been a greater understanding of environmental risks. The Training Center now gets more requests for specific training. The North Carolina Public Health Association has requested regional trainings on the environmental impact of methamphetamine labs. In addition, the annual North Carolina Public Health Nursing Academic and Practice Summit focused on environmental health.

The collaboration between the SPHTC and ATSDR has created an important momentum in North Carolina and has resulted in increased demand for training. In addition, SPHTC staff has become very knowledgeable about environmental health issues and more practitioners are contacting SPHTC as a resource. SPHTC also saw an increased interest in environmental health nursing training from the other states in the SPHTC region. In June 2004 SPHTC sponsored an all-day Environmental Health Law training for local health departments in Virginia that focused on local health directors and nursing directors. This interdisciplinary training is designed to help more public health leaders to be able to deal with environmental risks identified in their health departments.

Examples of trainings offered:

• Incorporation of environmental health information into assessment courses for public

health nurse screeners, such as adult and child health assessment: These are 4-8 week courses taught through videoconferencing and hands on practice and followed by a six-month clinical practicum. Completion of these courses allows public health nurses to perform clinical functions that they could not do with a nursing degree alone.

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• Statewide videoconference in North Carolina on Community Environmental

Assessment/Risk Communications: This will be an interactive videoconference at 15 sites located in health departments in North Carolina. A form of this conference was proposed last year, but focused more on patient assessment, and there seemed to be little interest. This year we plan to partner with the NC Center for Public Health Preparedness. The first half will focus on basic data collection and the second will focus on risk communication using CDCynergy materials. I PREPARE cards will be disseminated.

• Online Basic Environmental Health Module- in development: This module is part of an overall training center initiative to develop basic core concepts modules. The need for basic training in environmental health has been identified as a need throughout the training center region.

• Making Public Health Nursing Competencies Work for Practice and Education- Especially Environmental Health

• Include an environmental health speaker or disseminate resources through exhibit booths at:o NC Nurse Administrator Meetingo NC Public Health Association Meeting

oNC School Nurse Conference 26th Annual Minority Health Conference,

o “Health and the Environment”

Texas Public Health Training Center (TPHTC)Serves Texas

TPHTC uses multiple approaches to connecting with the target audience. In order to effectively reach participants across the State, environmental health training has been presented using live, interactive telehealth conferencing technology to broadcast to multiple, geographically-diverse sites. With the goal that participants be able to attend a site within a 100 mile radius, this type of broadcast has provided training opportunities to groups that might otherwise be isolated due to distance.

In addition, TPHTC has responded to that segment of the target audience that resists web-based training due to comfort level or lack of easy computer access. By offering self-instructional materials in a hard-copy format, participants have a choice of training modalities that meet individual needs.

In order to foster interdisciplinary training, all training opportunities focusing on environmental health issues were marketed to a broad audience of health professionals

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including practicing nurses in a wide range of job categories, nurse practitioners, physicians, and public health professionals.

TPHTC notes the following as evidence of the impact of this project:

• Calls and emails from across the state indicate that participants want additional training sites and/or downloadable capability at the work site. TPHTC partnered with the Texas Association of Local Health Officials to pilot a conference that could be broadcast to all participating health departments in the State, making the conference available to many public health practitioners at the work site.

• The response rate from the TPHTC marketing strategy indicated a significant need in the predominantly rural areas of the state for non-computer-based training materials and marketing strategies. TPHTC continued to offer this training modality as an option.

• Feedback from the conference evaluation forms indicated a strong interest in the topic of risk communication. Several participants suggested that this information would be beneficial to all health professionals and would warrant a telehealth conference focusing on this topic. The Texas Public Health Training Center initiated such a conference and offered it three times to a total of 10 sites across Texas, targeting a broad audience of health professionals.

• The concept of the “circles of influence” is illustrated in the following: the announcement for the Environmental Health Update for Practicing Nurses telehealth conference was sent to a potential participant targeted within the State of Texas; she forwarded the email to the GIS coordinator for US EPA Region 6, who in turn posted it to an environmental health work group list-serv; from there, it was distributed to the Director of Border Health at the Texas Department of Health, the Assistant Administrator at ATSDR, and a division director at the Agency.

• Registration packets were mailed to a finite number of nurses practicing in one of the 65 targeted counties. It readily became evident that registration forms were being duplicated by the recipients and shared among their peers; registration forms from nurses and other professionals outside the targeted geographic areas were received by TPHTC, requesting the training educational materials.

Examples of trainings offered:• Environmental Health for the Public Health Professional- telehealth conference

broadcast simultaneously by the Texas PHTC to participants in several cities• Maintaining Quality of Life Conference (exhibit)• Environmental Health Case Studies: Taking an Exposure History• Environmental Health Case Studies: Pediatric Environmental Health• Environmental Health Update for Practicing Health Professionals• Environmental Health and Children

Upper Midwest Public Health Training Center (UMPHTC)

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Serves Iowa, Nebraska, and South Dakota

At UMPHTC, interdisciplinary participation in trainings is fostered through promotion of the training sessions through the professional organizations of the health professionals involved in environmental health. The interdisciplinary approach helps bridge the gaps so often seen between prevention and care.

This training project provided a venue for offering an integrated perspective on environmental health to all health professionals. It provides an opportunity to cover the impact of all aspects of the environment on the lives of citizens across the country, while bringing together the components of prevention and acute and chronic care related to environmental health. This is an opportunity that does not routinely exist in the health care community but is essential to positive health outcomes.

However, to fully bridge the gaps in environmental health, consideration might be given to including non-health related professionals who are directly impacted by environmental health issues in fulfilling their daily responsibilities and whose professions deal directly with the impact of the environment on those they provide services to. Examples of such professions who might benefit from specifically developed integrated environmental health training are EMS, Public Safety, Boards of Health and other local governmental decision makers.

UMPHTC administered a Public Health Training and Education Needs Assessment upon completion of their first environmental health training offerings. Results from this assessment, as well as the results from training evaluations and post-training surveys, were utilized in determining the changes in curriculum content and what types of trainings to offer in subsequent years.

Results from a three month post-training questionnaire sent to training attendees indicated the following:

• 60% agreed or strongly agreed that they had a better awareness of environmental hazards and their potential health effects.

• 30% agreed that they had engaged in activities related to policy development since they attended the training.

• 60% have shared the information from the trainings with others, including supervisors, students, staff in health department, etc.

• 60% said they would be interested in attending another environmental health training session in the future.

In Iowa, 7 of 19 who attended the training practice in medically underserved areas. Fourteen (14) of the 19 attendees were from rural communities. Subsequent training sessions were linked to rural and underserved areas in Iowa via the Iowa Communication Network.

One attendee commented following the training, that she now knew what she needed to do back in her community to begin the process to change policies within the local school system regarding asthma, medication and activity requirements. Her child had nearly died when he wasn’t allowed to use his inhaler during a gym class because of the “medication policy” of the school but prior to the training, she did not know how to start the process of change.

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Examples of trainings offered:• Environmental Health Update for Practicing Nurses-distance learning • Environmental Health Update for Practicing Nurses presentation• A Practice Approach to Environmental Health Issues and Toxic Exposures

Northwest Center for Public Health Practice (NWC)Serves Alaska, Idaho, Montana, Oregon, Washington, Wyoming

The Northwest Center for Public Health Practice continues to provide foundational environmental health continuing education training for nurses and other health professionals. The NWC uses several modes of delivery to ensure broad audience participation in trainings. In 2004, several trainings were offered via distance learning, particularly by satellite broadcast, allowing a large group of health professionals from health departments and other health organizations to participate in the trainings.

Examples of trainings offered: • Integrating Environmental Health into Nursing Practice- This 1-day in-person

workshop was offered in Seattle in conjunction with a June 20, 2003 American Association of Occupational Health Nurses conference.

• Assessing Chemical Exposure• Potable Water: A Public Health Issue• Bridging Environmental Health and Health Promotion• Bridging Traditional Environmental Health

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