health educ behav 2014 frank 19s 26sgfhgfh

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Health Education & Behavior

2014, Vol. 41(1S) 19S26S 2014 Society for Public

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DOI: 10.1177/1090198114543007heb.sagepub.com

Healthy Aging: Article

This article presents the evaluation of a model undergraduate

certificate program, the Skills for Healthy Aging Resources

and Programs (SHARP). SHARP is a competency-based

career technical education (CTE) program with tailored cur-

ricula designed to prepare personnel to work in community

aging service organizations. SHARP addresses an unmet

need for a well-prepared workforce to effectively plan, man-

age, and evaluate the proliferation of evidence-based health

promotion and disease management programs that are rap-

idly becoming the future of our community-based long-term

care support system.

SHARP is a 3-year project funded by the U.S. Department

of Educations prestigious Fund for the Improvement of

Postsecondary Education (FIPSE). SHARP was developed

collaboratively with the UCLA Multicampus Program in

Geriatric Medicine & Gerontology (UCLA) as the lead, part-

nering with College of the Canyons (COC), Santa Barbara

City College (SBCC), Partners in Care Foundation (PICF),

the California Council on Gerontology & Geriatrics (CCGG),

007HEBXXX10.1177/1090198114543007Health Education & Behavior 41(1S) Franketal.

1University of California, Los Angeles, CA, USA2University of North Carolina at Chapel Hill, Chapel Hill, NC, USA3Mt. San Antonio College, Fullerton, CA, USA4National Council on Aging, Washington, DC, USA5Goodman Research Group, Inc., Cambridge, MA, USA6College of the Canyons, Santa Clarita, CA, USA

Corresponding Author:

Janet C. Frank, Fielding School of Public Health, University of California,

Los Angeles, 10960 Wilshire Boulevard, Suite 1550, Los Angeles, CA

90095, USA.

Email:[email protected]

Preparing the Workforce for HealthyAging Programs: The Skills for HealthyAging Resources and Programs

(SHARP) Model

Janet C. Frank, DrPH1, Mary Altpeter, PhD, MSW, MPH2,

JoAnn Damron-Rodriguez, LCSW, PhD1, Joann Driggers, MA3,

Susan Lachenmayr, MPH4, Colleen Manning, MA5, Dana M. Martinez, MPH, PhD1,

Rachel M. Price, MSG1, and Patricia Robinson, PhD6

Abstract

Current public health and aging service agency personnel have little training in gerontology, and virtually no training in

evidence-based health promotion and disease management programs for older adults. These programs are rapidly becomingthe future of our community-based long-term care support system. The purpose of this project was to develop and test a

model community college career technical education program, Skills for Healthy Aging Resources and Programs (SHARP),for undergraduate college students, current personnel in aging service and community organizations, and others interested

in retraining. A multidisciplinary cross-sector team from disciplines of public health, sociology, gerontology and nursingdeveloped four competency-based courses that focus on healthy aging, behavior change strategies, program management, aninternship, and an option for leader training in the Chronic Disease Self-Management Program. To enhance implementation

and fidelity, intensive faculty development training was provided to all instructors and community agency partners. Baselineand postprogram evaluation of competencies for faculty and students was conducted. Process evaluation for both groups

focused on satisfaction with the curricula and suggestions for program improvement. SHARP has been piloted five timesat two community colleges. Trainees (n= 113) were primarily community college students (n= 108) and current aging

service personnel (n= 5). Statistically significant improvements in all competencies were found for both faculty and students.Process evaluation outcomes identified the needed logical and component adaptations to enhance the feasibility of programimplementation, dissemination, and student satisfaction. The SHARP program provides a well-tested, evidence-based effective

model for addressing workforce preparation in support of healthy aging service program expansion and delivery.

Keywords

competence, evidence-based programs, gerontology, healthy aging, workforce development

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20S Health Education & Behavior 41(1S)

and the National Council on Aging. FIPSE requires an exter-

nal evaluator, and UCLA contracted Goodman Research

Group, Inc. (GRG) from Cambridge, Massachusetts.

Representatives from each organization, and national advi-

sors, formed the projects Executive Committee. SHARP

was managed by the UCLA Administrative Core.

Need for Workforce Preparedness to Promote

Healthy Aging

Labor force analyses of the readiness and educational back-

ground of current personnel working in health and social ser-

vices for older adults have documented content preparation

deficits, the need for increased training and education, and rec-

ommendations for improving competencies (Frank & Weiss,

2012; Institute of Medicine, 2008; U.S. Department of Health

and Human Services, 1995). A comprehensive labor force

study in California in 2005 (California Social Work Education

Center, 2009) documented that the states aging services work-

force is itself aging, with 52% of the workforce aged 50 yearsor older. Anticipated high rates of retirement will soon lead to

rapid turnover and the need for new personnel replacements at

all levels. In addition, 61% of agencies reported zero current

staff with formal gerontology education, defined as having had

a minimum of one academic course in aging content. A second

study of 363 Area Agencies on Aging (AAA) also documented

the aging of the aging services workforce, with 20% of cur-

rent staff projected to retire within the next 5 years. These data

also revealed that almost half (47%) of AAAs that responded

have at least one staff with either a certificate or degree in ger-

ontology and almost 27% have an evidence-based program

coordinator position. In addition, more than 60% of AAAs

have an established relationship with a college or university forthe purpose of securing well-trained personnel as positions

become available (Morgan, Markwood, Eltzeroth, & Reed,

2010; Straker, Lachmeyer, & Kunkel, 2010). No data in either

of these two studies addressed the workforce preparedness in

program planning, implementation and evaluation of evidence-

based health promotion programs (EBHPs), even for the evi-

dence-based program coordinator positions.

Competency-based education is increasingly the educa-

tional standard in addressing aging workforce development in

the health professions (American Association of Colleges of

Nursing & the John A. Hartford Foundation Institute for

Geriatric Nursing, 2000; American Geriatrics Society, 2000;

Council on Social Work Education, 2008). Over the past

decade, evidence regarding the effectiveness of this approach

has been collected through the national Hartford Partnership

Program in Aging Education. Social work students, partici-

pating in more than 76 different campus-based programs

throughout the country, improved significantly in their self-

reported gerontological competence and increased their com-

mitment to the field of aging (Damron-Rodriguez, Volland,

Wright, & Hooyman, 2009). The SHARP model applies this

competency-based approach to gerontology CTE.

Growth of EBHPs to Address Older Adult Chronic

Conditions

Chronic disease has reached epidemic proportions, with 91%

of older adults having at least one chronic condition and 73%

having at least two, many with functional limitations (U.S.

Department of Health and Human Services [U.S. DHHS],

2010). Chronic diseases currently account for 75% of the

more than $2.8 trillion spent for U.S. health care (Institute of

Medicine, 2012). As baby boomers reach age 65 at the rate of

10,000 a day through 2030, more than 6 of every 10 will be

managing more than one chronic condition (U.S. DHHS,

2011). EBHPs assist people of all ages who have chronic ill-

nesses to live as healthily and independently as possible. The

evidence-base for these programs has been established in

randomized-controlled trials resulting in positive, measur-

able results. These programs are standardized and imple-

mented with fidelity across sites and include tools that

measure satisfaction and outcomes (Altpeter, Schneider,

Bryant, Beattie, & Whitelaw, 2004).Although multiple studies have documented the effective-

ness of EBHPs, building capacity for program delivery has

been a slow but growing process (Center for the Advancement

of Health, 2006). Recognizing the critical need for expanding

access to these programs over the past 12 years, the

Administration for Community Living/Administration on

Aging has supported national initiatives to systematically

expand access to Stanford Universitys evidence-based

Chronic Disease Self-Management Program (CDSMP) and

strengthen the capacity of states and communities to deploy

CDSMP and other EBHPs that benefit older adults (Catalog of

Federal Domestic Assistance, 2012; U.S. Administration on

Aging, 2012). The National Council on Aging has served asthe National Resource Center for these programs, providing a

variety of technical assistance tools and trainings to assist state

and community networks in building workforce capacity and

developing a sustainable program delivery infrastructure.

In summary, published literature documents a continuing

need for well-trained gerontology personnel and EBHPs as a

growth area in community-based services. In addition, the

current workforce is itself aging, with an expected retirement

rate of 20% by 2015. To address all these needs, SHARP, as a

model program, offers the potential to improve the skill set of

the current aging services workforce, produce better qualified

future personnel for retiree replacements, and train new per-

sonnel required to support healthy aging program expansion.

The SHARP Program

SHARP project goals were to develop and evaluate a compe-

tency-based certificate program focused on EBHPs and

healthy aging at two community colleges, to train 20 faculty,

and provide the program to 55 students. SHARP incorpo-

rated 13 of the Association of Gerontology in Higher

Educations Gerontology Competencies (Wendt, Peterson, &

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Frank et al. 21S

Douglass, 1993), which are listed in Supplemental Table 1

(available online at heb.sagepub.com/supplemental).

After reviewing the literature to identify needed content

(Schneider, Altpeter, & Whitelaw, 2007), and interviewing

key thought leaders in health promotion program delivery, the

SHARP Certificate of Specialization was organized as four

undergraduate college courses. Supplemental Appendix 1(available online at heb.sagepub.com/supplemental) provides

an overview of course content and the sequencing of SHARPs

four courses and optional program components. The four

courses were purposely designed for community college stu-

dents for two primary reasons. First, the funding opportunity

that supported SHARP was solely for education in community

colleges. Second, we wanted to take advantage of the CTE

platform offered at community colleges that includes a variety

of certificates and degrees related to career-focused areas.

Students completed the courses over one semester. SHARP

students were (a) completing undergraduate units who plan to

transfer to a 4-year college or university or (b) returning to col-

lege with or without a previous academic degree to seek newjob skills, and (c) current aging services personnel seeking

SHARP-specific skills to address new work requirements or

opportunities. Furthermore, SHARP courses were designed

and approved as first-year college courses, so they may also be

appropriately offered in the freshman year of 4-year college

curricula (see Supplemental Appendix 1 online).

SHARP Program Delivery. In addition to linking content to

national consensus-based competencies, each course had

learning objectives, detailed course outlines, student evalua-

tion mechanisms, and supplemental program materials. These

course packages were approved at the two community col-

leges where SHARP was offered, COC and SBCC. COC is

located in Valencia, California, at the north end of the San Fer-

nando Valley region of Los Angeles, and has 40,000 students.

SBCC has 22,000 students, serves the Central Coast commu-

nities in California, and has one of the largest nursing pro-

grams in the nation. SHARP was offered first at COC in Fall,

2010, and began at SBCC in Fall, 2012. This roll-out plan

allowed process evaluation data for quality improvements,

and the testing of a practice replication at SBCC. SHARP

has now been offered five times at COC and once at SBCC.

Faculty Development. SHARP was designed to live and

continue at the host community college, so community col-lege faculty were recruited to teach the courses. Potential

faculty participated in extensive SHARP Faculty Develop-

ment Programs that addressed important course content top-

ics such as evidence-based health promotion for older adults,

SHARP goals, objectives and curriculum, the Stanford

Chronic Disease Self-Management Program (called Health-

ier Living in California), and competency-based evaluation

approaches.

Each faculty development program was developed spe-

cifically for each campus with lessons learned at COC

integrated into the SBCC faculty training program. We

trained more faculty than was necessary to teach a four-

course certificate program to maximize depth of capacity and

to increase options for college administrators. Program mate-

rials included a SHARP Faculty Guide and supplemental

teaching materials, including readings, assignments, in-class

exercises, and website resources.

Method

The multiyear SHARP evaluation produced formative, pro-

cess, and outcome data that were collected at baseline, mid-

point, postprogram, and follow-up between 9 and 12

months. The comprehensive evaluation addressed out-

comes at four levels: program, college, faculty, and student.

This article only reports faculty and student process and

outcome data.

Data were collected using multiple methods including

focus groups and surveys. The formative and process evalu-

ation was designed as a feedback loop to allow for midcoursecorrections allowing real-time modifications from one

semester to the next and prior to starting SHARP at SBCC.

Process Evaluation Methods

To address the student-level process outcomes, enrollment and

retention rates were monitored for each semester and students

were asked to participate in voluntary debriefing sessions to

gather feedback for improvement. Debriefing sessions

occurred at midpoint and at the end of each semester.

Outcome Evaluation MethodsGoodman Research Groups external evaluation included

student baseline and postprogram surveys. Students com-

pleted a survey (either online or on paper) at the beginning

and end of their courses. The surveys centered on students

self-assessments of their gerontology competencies using a

5-point scale from 0 (not skilled at all) to 4 (expert skill). A

baseline survey captured demographic information and the

postprogram survey gathered feedback about the program.

Follow-up surveys were conducted with the first and second

cohorts of SHARP completers between 9 and 12 months

after the program to assess academic and employment status

postprogram.In addition, pretraining surveys were administered to all fac-

ulty trained, with postsurveys administered to only faculty who

taught SHARP courses. Faculty evaluation focused on new

EBHP content learned and teaching skills acquired both during

the training and as a process of teaching. Faculty self-assessed

their content mastery on a 7-point scale from 1 (no content mas-

tery) to 7 (expert content mastery). A series of paired-samples

t-tests were conducted to compare students gerontology com-

petencies before and after the SHARP program and faculty con-

tent mastery before and after the SHARP program.

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Results

Demographics of Students

As shown in Table 1, across all five cohorts of SHARP stu-

dents at the two colleges, the vast majority (82%) of students

were female. One third of the respondents were younger than

30 years, 26% were in their 30s or 40s, and 41% were 50

years or older. More than one third (35%) of students repre-

sented racial or ethnic minority groups.

Process Outcome Data

Process evaluation ensured that the SHARP program ful-

filled its intended implementation goals and created the

strongest delivery model possible. As shown in Figure 1,

across all cohorts, a total of 113 students enrolled in

SHARP courses and 85 of them (75%) completed the

SHARP program. Twenty-three students (20%) dropped

out of the program because of financial problems, job con-

straints, or the program not meeting expectations. More

than 90% of the original 113 students completed a baseline

survey (n= 106), and 62 students who completed the pro-

gram completed a postsurvey (73%).

In addition, students were invited to attend voluntary

debriefing sessions during each semester of SHARP. Across

five cohorts of students, 92 students participated in mid- and/

or end-of-semester sessions (some students attended both).

The COC Faculty Development Program was offered in

March 2011 for 14 faculty. The courses were then team

taught allowing COC to use its experienced full-time fac-

ulty to coteach SHARP who could not have done so if they

had taught it alone. Faculty came from different disciplines,

such as nursing, recreation, sociology, psychology, commu-

nications, and social work. In SHARP, the team teaching was

accomplished by the faculty sharing the teaching responsi-bilities and dividing up the weekly lectures, rather than being

in the classroom together.

The importance of involving community agency leadership

early on was noted through the experience with COC. Thus, key

leaders were invited to join the SBCC Faculty Training Program

offered in February 2012. Of the 38 individuals who partici-

pated, 12 were SBCC faculty; the remaining 26 attendees were

college administrators and community agency personnel.

Of the faculty who were trained at COC and SBCC, nine

ultimately taught in the program. Four taught for one semester

Table 1. Baseline Demographics of SHARP Students.

Variable Number Percentage

Gender

Female 87 82.1

Male 16 15.1

Did not respond 3 2.8

Age (years)

18-29 35 33

30-49 28 26.4

50-78 43 40.6

Race/ethnicitya

American Indian or Alaskan Native 3 2.8

Asian 7 6.6

Black or African American 5 4.7

Hispanic or Latino 26 24.5

Native Hawaiian or Other PacificIslander

2 1.9

White 74 69.8

Other 1 0.9

Two or more 37 35Native language

English 86 81.1

Other 18 17.0

Did not respond 2 1.9

Financially independent from parents

Yes 82 77.4

No 24 22.6

Contributing financially to others

Yes 52 49.1

No 54 50.9

Note. N= 106. SHARP = Skills for Healthy Aging Resources and Programs.aRespondents could check all that applied, thus percentages total more

than 100%.

113 Enrolled inSHARP courses

106 CompletedBaseline Survey

92 Participated in

Mid or End of

Session Debriefs

85 CompletedCertiicate

62 CompletedPost Survey

56 Completed

Baseline and Post

Survey

6 Completed Post

Survey Only

28 Did Not

Complete

Certiicate

23 Dropped Out

2 Failed a Course

2 Did Not Finish

for UnknownReasons

1 Intends toComplete

Figure 1. SHARP (Skills for Healthy Aging Resources andPrograms) student enrollment, completion, and participation inevaluation. This figure illustrates the total SHARP enrollmentacross five cohorts of students and their participation inevaluation activities.



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Frank et al. 23S

only and five taught for more than one semester (with four of

these having taught four-five semesters consecutively). An

additional 10th faculty participated in part, but not all, of the

formal training program and taught one semester.

Program Outcomes Data

Faculty Development Program Outcomes. Across the two pro-

grams, 6 of the 10 faculty members completed both baseline

and postprogram surveys and a seventh faculty member

completed a postprogram survey only. The paired-sample

t-tests on prepost content mastery revealed significant

improvement on 10 of the 18 content areas (Table 2). Table 2

also shows the mean pre- and postratings and the level of

statistical significance for each content area. Of note, there

was a significant increase in all four of the items related to

EBHP and disease management.

Students Baseline and Competency Self-Assessments. Table 3

shows the mean pre- and postratings and the level of statisti-

cal significance for each competency. For each of the 13

competencies there was a significant prepost difference in

students self-assessment of their skills. For the most part, all

differences represent students moving from a beginning skill

level, at which they had to consciously work at the skill, to a

moderate to advanced skill level, at which the skill had

become more integrated into their repertoire and they felt

confident practicing the skill. The greatest increases were

students perceived competency to maintain currency in

EBHP research ( = 2.01).

Student 1-Year Follow-up Results. The 1-year follow-up surveywas administered to the 45 SHARP completers of the first

two semesters of SHARP and 32 responded, yielding a 71%

response rate. One year after they had completed the SHARP

program, 14 of the 32 respondents remained degree-seeking

students at COC. Two of the 32 were enrolled in degree pro-

grams at a 4-year college or university, and 5 respondents

were enrolled in college courses, but not seeking a degree.

Eleven were not enrolled in any type of course or school at

the time of follow-up.

In retrospect, respondents found SHARP particularly

important to their professional activities. A majority of the

respondents rated the program as very or extremely impor-

tant in strengthening their resume, in improving their train-

ing for their existing profession, in helping them prepare for

a new profession, in their decision to seek a new profession,

and in strengthening their application for another academic

program (data table not provided).

Discussion

SHARP is an innovative career and professional develop-

ment model training program that uses principles of

Table 2. Faculty Self-Reported Content Mastery Before and After the SHARP Certificate Program.

Content Variables Pre-SHARP,M(SD) Post-SHARP,M(SD) Difference

Biopsychosocial aspects of health and aging

Biological theories of aging 4.33 (1.03) 5.17 (1.84) 0.84

Organ systems 3.50 (1.38) 5.00 (1.67) 1.50

Sensory changes 4.17 (0.75) 5.50 (1.05) 1.33*

Body composition 4.50 (1.38) 5.33 (0.82) 0.83*

Sex and race differences 3.83 (1.72) 5.17 (1.72) 1.34*

Functioning: Activities of daily living 3.83 (1.60) 5.17 (1.03) 1.34

Physical health and sexuality 5.00 (1.27) 5.67 (1.03) 0.67

Chronic illness 4.33 (1.63) 5.83 (1.17) 1.50

Disability 3.50 (1.87) 5.50 (0.84) 2.00*

Polypharmacy 2.83 (2.48) 5.33 (1.37) 2.50*

Behavior change theories and practices

Behavioral change theories 4.17 (1.72) 5.83 (1.33) 1.66*

Motivational theories 5.17 (1.72) 6.00 (1.10) 0.83

Communication skills 5.33 (1.51) 5.83 (1.33) 0.50

Group dynamics 4.67 (1.51) 5.67 (1.21) 1.00

Evidenced-based health promotion and disease management

History of EBHP 2.17 (0.98) 5.00 (1.27) 2.83** Documented positive outcomes of EBHP programs 2.17 (1.60) 4.83 (1.94) 2.66*

Delivery systems 2.33 (1.21) 4.67 (1.75) 2.34*

Specific EBHP model programs 2.83 (1.94) 4.67 (1.75) 1.84*

Note. N= 6. Significant at the p< .01 level. Scale range: 0 = no content masteryto 7 = expert content mastery. SHARP = Skills for Healthy Aging Resourcesand Programs; EBHP = evidence-based health promotion programs.*p< .05. **p< .01.



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competency-based CTE. It addresses aging service educa-

tional deficits and supports the growth of EBHPs through

workforce preparation. From our review of the literature,

these data represent the first-ever reported evaluation of a

college-level training program in evidence-based health pro-

motion community-based program delivery for older adults.

It used a multiyear, multilevel, multimethod comprehensive

evaluation that demonstrated positive results. Process evalu-

ation ensured that SHARP fulfilled, and actually exceeded,

its intended goals. Feedback data allowed SHARP to con-

tinuously make program quality improvements to refine the

model program.SHARP did attract and retain its target audiences of both cur-

rent personnel working in the aging services field and students

wanting to work in the field. As noted, studies of the current

aging services personnel demonstrate the need for further train-

ing, especially as related to the new national program emphasis

in evidence-based health promotion and disease management

programs. It seems that SHARPs two-prong approach to

marketing to those currently in the field, and those wishing to

enter the field, can address both current and future workforce

preparedness needs. The average age of community college

students is 29 years (American Association of Community

Colleges, 2014), yet SHARP attracted a slightly older age group

of students than is typical for community colleges or in a

Freshman class at a 4-year institution. If future college programs

were considering implementing SHARP for the sole purpose of

preparing students to enter a new career in aging services, their

marketing might be focused on high school students who are

still deciding on career and college options. Likewise, if com-

munity colleges wished to focus more on career professional

development, they might identify priority audiences of current

aging services personnel. In fact, the developers of SHARPhave also developed and are seeking funding to test SHARP-

Pro, a scaled down training program for current aging services

personnel that can be offered within agencies to promote skills

acquisition around implementation of EBHPs.

Outcome data demonstrate that faculty reported acquiring

new skills and knowledge through the SHARP faculty train-

ing to teach SHARP classes effectively. Of note, there was a

significant increase in all four of the items related to EBHP

and disease management, essential for the SHARP curricula.

Table 3. Students Self-Reported Competencies Before and After the SHARP Certificate Program.

Competency Pre-SHARP,M(SD) Post-SHARP,M(SD) Difference n

1. Understand the trajectories of improvement and/or decrementin individual functioning

1.21 (1.11) 2.75 (0.86) 1.54*** 55

2. Understand state and national aging policy and programs 0.91 (1.04) 2.35 (1.02) 1.44*** 56

3. Establish rapport and sustain effective working relationships

with a wide range of older adults, their families, and caregivers

1.68 (1.25) 3.11 (0.93) 1.43*** 55

4. Define/describe the bio/psycho/social concepts and theoriesused to study aging

0.76 (1.02) 2.55 (0.94) 1.79*** 56

5. Identify how an older person is affected by the personenvironment interactions

1.64 (1.23) 3.05 (0.90) 1.41*** 55

6. Knowledge of general ethical principles and how they relate toprofessional practice in gerontology

1.16 (1.20) 2.89 (0.98) 1.73*** 56

7. Understand common threats to loss of independence: falls,medication management, and lifestyle

1.77 (1.19) 3.18 (0.92) 1.41*** 56

8. Understand the role of social service, community recreation,and health service providers in their involvement with olderpersons

1.51 (1.27) 3.00 (1.02) 1.49*** 55

9. Maintain currency in research findings of evidence-based diseasemanagement programs, including frameworks, theories, and

models

0.63 (0.95) 2.64 (1.09) 2.01*** 56

10. Facilitate elders and families adaptive capacity related todisease and geriatric syndrome management

0.82 (1.04) 2.51 (1.22) 1.69*** 55

11. Understand the requisite practice skills appropriate to areas ofgerontological practice

0.78 (0.94) 2.49 (1.12) 1.71*** 56

12. Understand the importance of program review and evaluationfor program effectiveness

1.45 (1.20) 2.98 (0.99) 1.53*** 56

13. Understand issues of diversity among older adults and theirfamiliesa

1.30 (1.14) 2.93 (0.89) 1.63*** 40

Note. SHARP = Skills for Healthy Aging Resources and Programs. Significant at the p< .001 level. Scale range: 0 = no content masteryto 7 = expert contentmastery. See Wendt, Peterson, and Douglass (1993) for source of competencies.aThis item was not included on the Cohort 1 measures.*p< .05. **p< .01. ***p< .001.



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Frank et al. 25S

Importantly, SHARP students self-assessments reflected

across the board increases in competence areas of EBHP and

healthy aging. These data support SHARPs effectiveness in

student self-reported acquisition of needed content and skills

to support EBHP program expansion.

LimitationsThere are a number of limitations related to developing and

testing the SHARP model program. First, the program was

only tested at two community colleges, and the experiences

there do not represent how the program may work at other

community colleges or undergraduate college programs.

Indeed, important differences were found at the two test col-

leges, such as in administrative support and processes, leader-

ship, and community and student resources. Second, the

sample size of participating students was small, limiting the

external validity of our outcome results and preventing sub-

group analyses of outcomes. The number of faculty who

taught SHARP courses was also very small (n= 10), there-fore, the significance of the outcome data should be inter-

preted cautiously. In addition, longer term outcomes were

available for only two cohorts of COC students and only one

semester of data from SBCC. The self-reporting of outcomes,

the dropout rate, and response rates for data collection, may

have introduced a systematic positive bias to the results. The

20% student drop rate from SHARP was greatly influenced

by a high first semester dropout rate, which improved over

time with program adaptations. However, benchmarking this

percentage to national data, SHARP did exceedingly well.

The National Center for Education Statistics reports that 65%

of all CTE certificate students, and only 43% in health sci-

ences, persisted or attained their certificates (U.S. Departmentof Education, National Center for Education Statistics, 2009),

whereas SHARP showed a 75% certificate completion rate.

The 1-year follow-up for the first two SHARP program

offerings may have limited the ability to assess the longer

term program benefits, such as entry into aging services

employment by SHARP graduates. The general malaise of

the economy during the SHARP roll-out, reflected in state

budget cuts and reductions in community-based aging ser-

vice programs (National Association of AAA, 2014), may

have influenced the general hiring practices of organizations

that could benefit from hiring SHARP graduates. In addition,

the general state of the economy (high unemployment,

increase in adults seeking retraining or developing new skills

by going back to school) may have also affected participants

decision to enroll in SHARP classes, creating the older-than-

average age of participants.

Conclusion

The SHARP program provides a well-tested effective model

for addressing workforce preparation in support of healthy

aging service program expansion and delivery. In addition to

its demonstrated effectiveness, SHARP is innovative in that

it is, to our knowledge, the only competency-based CTE pro-

gram on aging and health promotion. The formative evalua-

tion from this study established the effectiveness of SHARP

in raising faculty knowledge for teaching gerontology skills

and students self- assessed competency levels. This findingfor a CTE program is in line with the findings of professional

education programs in aging using a competency-based

model (Damron-Rodriguez et al., 2009). The evaluation pro-

vides a foundation of evidence on how to deliver the model

most effectively. The SHARP team documented many les-

sons learned and has developed an online manual of proce-

dures to support future replication. The two colleges where

SHARP was tested are continuing the program without grant

support, an amazing feat in this era of reduced support for

higher education.

Much work remains to brand and market SHARP to

attract existing aging services personnel into it for needed

professional development, in addition to attracting youngpeople into the field. The timing of SHARP coming into the

market may not be ideal. Federal and state support for

aging service programs has not kept pace with the increas-

ing aging population and service programs have been

reduced or eliminated because of the economic and budget

crisis (National Association of AAA, 2014). Students are

attracted into CTE and other college applied programs

because they can see the potential for future jobs. The chal-

lenge for SHARP, and programs like it, is to attract people

into the program to prepare them for the work, with the

promise of future jobs. The timing is critical. Will we be

ready?

Acknowledgments

Acknowledgment to SHARP Committee Members: Jolene

Fassbinder, formerly California Council on Gerontology &

Geriatrics, currently Archstone Foundation; Sheri Shields, Santa

Barbara City College; Natalie Zappella, Partners in Care Foundation.

Authors Note

The contents of this article do not necessarily represent the policy of

the U.S. Department of Education, and one should not assume

endorsement by the Federal Government.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to

the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for

the research, authorship, and/or publication of this article: The con-

tents of this article were developed under Grant No. P116W090120

from the U.S. Department of Education, Fund for the Improvement

of Postsecondary Education.

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Supplemental Material

Additional supporting information is available at heb.sagepub.com/

supplemental.

Supplement Issue Note

This article is part of an open access supplement Fostering

Engagement and Independence: Opportunities and Challenges for anAging Society, published in SOPHEs Health Education &

Behavior. This supplement was supported by funding provided by

the Centers for Disease Control and Preventions (CDC) National

Center for Chronic Disease Prevention and Health Promotion,

Healthy Aging Program (Cooperative Agreement #U38HM000454)

via the Association of State and Territorial Health Officials, and from

a grant provided by the Retirement Research Foundation. Views

presented herein do not represent the official views of the CDC.

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