public health workforce training needs in livingston county, ny

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This brief report summarizes an assessment of professional development and training needs of the public health workforce in Livingston County, NY. A capable and qualified workforce is an essential component of the public health infrastructure and fundamental to the provision of essential public health services. The report outlines training needs identified by the leadership and management level staff of the Livingston County Department of Health. Detailed tables of results are in the appendices.

A few socio-demographic and health statistics are provided as background to help place public health workforce training needs within current health challenges facing Livingston County. The population of Livingston County has a median age of 40.1 years and 88.6% of adult residents have at least a high school degree while 23.6% have a bachelor's degree or higher. During 2010, the median household income in the county was $51,734 and the overall poverty level 14.8%.¹ Though Hispanics make up less than 3% of the total population in Livingston County, 54% of this ethnic group are living in poverty compared to 13.8% of Whites who make up 93% of the county's population.^1,2 According to County Health Rankings, Livingston County ranks 12 out of 62 New York counties in overall health ranking.³ Thirty percent of adults are obese, compared to 24% statewide.² Since 2010, emergency department visits related to drug overdoses increased sharply.⁴ The three leading causes of death in Livingston County are cancer, heart disease, and chronic lower respiratory diseases.⁵

Health Priorities Identified by Leadership and Management Level Staff

Leadership and management level staff were asked to identify the top health priorities of the Livingston County Department of Health. A list of health topics was provided based on the goals and objectives set out by the New York State Prevention Agenda.⁶

The Health Commissioner in Livingston County rated preventing substance abuse and other mental, emotional and behavioral disorders, as well as promoting mental, emotional, and behavioral well-being in communities, as the top priority topic areas for the Health Department for the next 12 months. Manage- ment level staff rated reducing obesity in children and adults, as well as preventing substance abuse and other mental, emotional,

and behavioral disorders, as the priorities, with at least 45% of respondents selecting these topics as priority areas of responsibility for them. Other health areas that were selected as priorities by at least

1 United States Census Bureau. (n.d.) American Fact Finder: Livingston County, New York. Retrieved from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml?src=bkmk.

2 New York State Community Action Association. (2015). New York State Poverty Report. Retrieved from http://nyscommunityaction.org/wp- content/uploads/2014/03/2015-Poverty-Report-w-50th-logos-for-online.pdf

3 University of Wisconsin Population Health Institute. (2016). County Health Rankings: New York - Livingston. Retrieved from http://www.countyhealthrankings.org/app/new-york/2016/rankings/livingston/county/outcomes/overall/snapshot.

4 New York State Department of Health. (2017). Livingston County All Drug Overdose Outpatient Emergency Deparment Visit Rate per 100,000.

Retrieved from https://www.health.ny.gov/statistics/opioid/data/e1_24.htm

5 New York State Department of Health. (2016). Leading Causes of Death by County, New York State 2014. Retrieved from https://www.health.ny.gov/statistics/leadingcauses_death/deaths_by_county.htm.

6 For full listing of New York State Prevention Agenda goals see: https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/

NY State Prevention Agenda Goals and Objectives Livingston County Department of Health Priorities

 Prevent substance abuse and other mental, emotional, and behavioral disorders

 Promote mental, emotional, and behavioral well- being in communities

 Reduce obesity in children and adults

*Example report - do not quote or cite without permission

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35% of management level respondents included promoting mental, emotional, and behavioral well- being in communities in addition to maternal and infant health. Standardized surveys were used to collect information about workforce training needs with reference to these health department priorities.

Management Training Needs Identified by Leadership The Council on Linkages, a collaboration between health, public health, and academic institutions, has developed the Core Competencies for Public Health Professionals⁷ as a set of skills important to achieve the 10 Essential Public Health Services, activities that health departments should undertake to protect public health through the prevention and control of disease, injury, and disability.⁸ The Core Competencies are a starting point for public health practice organizations to assess, understand, and meet their work-force training needs to address the health issues of the communities they serve.

The Livingston County Health Commissioner was asked to rate the priority for training (high priority, moderate priority, low priority) for their management level staff on

Core Competencies which are organized into eight skill areas or domains. Each of the domains is comprised of a range of different skills and knowledge areas associated with the abilities required for effective public health practice. The Health Commissioner rated to the domains Communication Skills, Financial Planning and Management Skills, and Leadership and Systems Thinking Skills as areas of high priority training needs for the Livingston County Department of Health (See Appendix A, Table 1).

Management Training Needs Identified by Management Self-Report

Management level staff were asked to rate themselves on the same eight Core Competency domains included in the leadership survey. Respondents rated themselves on a number of specific skills within each Core Competency domain with regard to the importance of the skill for their current position within the Livingston County Department of Health (very important, somewhat important, not important) and their confidence in their ability to perform the skill (very confident, somewhat confident, not confident). The proportion of management level staff who rated a competency as very important but their confidence in performing it as less than very confident was taken as an indicator of priority for training to develop or improve skills in the particular competency area.

To identify the highest priority needs for training or professional development across the Livingston County Department of Health, based on the management level self-assessment survey results, we examined each domain and

7PHF (n.d.) Core Competencies for Public Health Professionals. http://www.phf.org/resourcestools/pages/core_public_health_competencies.aspx

8 CDC (2014). The Public Health System and the 10 Essential Public Health Services. https://www.cdc.gov/nphpsp/essentialservices.html Figure 1: Priority Training Needs for Management Level Staff

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calculated the percentage of all skill questions in the domain for which 50% or more of respondents rated a skill very important to their current position but they indicated that they were less than very confident in their ability to perform it. Using these criteria, the competency domains with the highest priority ratings include: Cultural Competency Skills, Financial Planning and Management Skills, and Policy Development/ Program Planning Skills.

Figure 1 shows priority training needs by competency domain for management and supervisory level staff, based on reports of the Livingston County Health Commissioner as well as self-reports by management staff themselves. The competency domain rated as the top priority for training needs is Financial Planning and Management Skills. Both the Health Commissioner and at least 50% of management staff rated four skills in this domain as high priority. Cultural Competency Skills and Communication Skills are the next priority domains for training needs followed by Policy Development/ Program Planning Skills. Training in other core competency areas, specifically Community Dimensions of Practice Skills, were not seen as a priority for training at this time.

Within the broad competency areas, there were several specific skill areas identified by both leadership and management level staff as priority for management level training. With regard to Analytical and Assessment Skills, management level training on “how to turn data into information for action” was identified as a priority by leadership as well as managers themselves. In the domain of Policy Development and Program Planning Skills, training to “plan, implement, evaluate, and improve policies or programs” was rated as high priority for management level training. In Public Health Science Skills, both leadership and management level staff rated "using evidence in developing, implementing, evaluating, and improving programs and services" as a high priority for further training. Lastly three skills in the domain of financial planning and management skills were identified by both leadership and management level staff as priority for management level training. These include: "Explain public health and health care funding mechanisms and procedures;" "Develop and use performance management systems;" and "Use financial analysis methods for policies, programs, and services." (See Appendix C, Table 7).

Training Needs of Front Line Staff

Management level staff were asked to about need for training of their front line staff whom they supervise in a series of yes/no

questions about each of the 10 Essential Public Health Services.

Figure 2 shows the percentage answering ‘yes,’ their front line staff has a need for training or further training for each of the service areas listed.

The top three Essential Public Health service areas in need of training for front line staff are the following:

“Diagnose and investigate health problems and health hazards in the community” and "Monitor health status to identify and solve community health problems.” (Appendix C,

Table 7). Figure 2: Front Line Staff Training Needs: Essential Public Health Services

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Management level staff were also asked to rate the priority for training (high priority, moderate priority, low priority) for their front line staff on the Council of Linkages Core Competencies for Public Health Professionals. Supervisors rated Community Dimensions of Practice Skills, Leadership and Systems Thinking Skills, and Analytic/ Assessment Skills as domains of high priority training need for front line staff. (See Appendix C, Table 8).

Recommendations and Next Steps

Based on this training needs assessment, the overarching training need for management level staff is Financial Planning and Management. There are a number of high-quality distance-based trainings that exist within this domain, including the following: Mastering the Roles of Supervision and National Accreditation and New York State Departments of Health. The overarching training need for front line staff within the essential public health services is “Diagnose and investigate health problems and health hazards in the community” and "Monitor health status to identify and solve community health problems.” One essential tool for approaching community health needs assessments is creating a logic model. The training, Building Logic Models is an excellent introduction to this tool, and might be of use to the front line staff at the Livingston Health Department.

Among the New York State Prevention Agenda goals, the highest priority topic areas identified by management were “Prevent substance abuse and other mental, emotional, and behavioral disorders,”

and “Promote mental, emotional, and behavioral well-being in communities.” Management and leadership might consider reviewing the New York-specific Public Health and Mental, Emotional and Behavioral Health Webinar series for information on approaching mental health literacy from a public health perspective, tools to engage families in supporting individuals with behavioral health needs, research on Adverse Childhood Experiences (ACEs) and the transformation of the New York Mental Health System to a Medicaid Managed Care Model. “Reduce obesity in children and adults” was another high-priority New York State Prevention Agenda priority. Staff could review a recent webinar, Sex Differences in the Relation Between Social Stressors and Obesity for insight into this complex public health problem.

Representatives from the Region 2 PHTC are available to schedule a conference call to discuss the findings of the needs assessment or to help identify training resources that may be available to you.

Please contact Peggy DiManno, MS, New York State Association of County Health Officials (NYSACHO) Projects Executive at (518) 456-7905 ext. 106 or [email protected], or Region 2 PHTC Center Coordinator at (212)305-6984 and/or phtc@ columbia.edu.

Report prepared by:

Angela Aidala, PhD

Brittney Cavaliere, MPH Candidate Sarah Paliani, MPH Candidate

Region 2 Public Health Training Center

Columbia University Mailman School of Public Health.

2/28/2017

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Appendix A:

Training Needs of Staff Reported by Livingston County’s Health Commissioner

Table 1: Livingston County Health Commissioner Ratings of Priority Training Needs for Management Level Staff Based on Core Competencies for Public Health Professionals

Analytic / Assessment Skills

Turn data into information for action.

Policy Development / Program Planning Skills

Plan, implement, evaluate, and improve policies or programs Communication Skills

Information dissemination to diverse audiences.

Solicitation of community input, active listening with individuals and groups.

Communicate in writing, orally, and online with linguistic and cultural proficiency Public Health Sciences Skills

Use evidence in developing, implementing, evaluating, and improving programs and services.

Apply public health sciences in administration and management Financial Planning and Management Skills

Explain public health and health care funding mechanisms and procedures Use financial analysis methods for policies, programs, and services

Establish teams and motivate personnel for achieving program and organizational goals Develop and use performance management systems

Leadership and Systems Thinking Skills

Explain ways public health, health care, and other organizations can work together as part of an inter-related system to impact community health

Collaborate with individuals and organizations in developing a vision for a healthy community Provide and ensure use of training and professional development opportunities

Table 2: Training needs for top three priority NY Prevention Agenda topic areas:

Topic Area

1. Prevent Substance Abuse and other Mental Emotional Behavioral Disorders

2. Promote Mental, Emotional and Behavioral Well-Being in Communities

Specific Training Needs

I believe that staff would benefit from a training showing how all of this fits into the Public Health system today Staff needs an awareness from outside the agency on how this relates to population health and the public health system today

Table 3: Training needs related to Public Health Training National Network Content Areas:

Topic Area Specific Training Needs

1. Health Disparities, Health Equity,

Social Determinants of Health No additional comments 2. Behavioral Health - Mental Health

and Substance Abuse No additional comments 3. Nutrition, Physical Activity, and

Obesity No additional comments

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Appendix B:

Health Priorities and Training Needs Identified by Management Level Staff

Table 4: NY Prevention Agenda Topics Identified as Priorities by Management Level Staff

New York Prevention Agenda Priorities

Rated Priority or Area of Responsibility

% (n)

Reduce obesity in children and adults 54.5 (6)

Prevent substance abuse and other mental, emotional, and behavioral disorders 45.5 (5) Promote mental, emotional and behavioral well-being in communities 36.4 (4)

Maternal and infant health 36.4 (4)

Reproductive, preconception, and inter-conception health 27.3 (3)

Prevent HIV and STDs 27.3 (3)

Prevent Vaccine-Preventable diseases 27.3 (3)

Reduce illness, disability, and death related to tobacco use and secondhand smoke

exposure ^{18.2 (2)}

Water quality 18.2 (2)

Child health 18.2 (2)

Outdoor air quality 9.1 (1)

Built environment 9.1 (1)

Injuries, violence, and occupational health 9.1 (1)

Increase access to high-quality chronic disease preventive and management in

clinical and community settings ^{9.1 (1)}

Strengthen infrastructure across systems 9.1 (1)

Prevent health care-associated infections 9.1 (1)

Other:

 Food safety

 Breast feeding promotion and support Total number answering question = 11

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Table 5: Livingston County Management Self-Assessment Rating of Importance of Skills and Confidence in Performing Skills

Confidence to Perform Skill Among those who

consider VERY IMPORTANT Rate skill VERY

IMPORTANT

NOT VERY confident

VERY confident

% (n) % (n) % (n)

ANALYTICAL/ ASSESSMENT SKILLS

1. Assess needs and assets to address community health needs 63.6 (7) 71.4 (5) 28.6 (2)

2. Turn data into information for action 90.9 (10) 70.0 (7) 30.0 (3)

3. Identify and understand data 81.8 (9) 55.6 (5) 44.4 (4)

4. Describe the broad array of factors affecting the health of a

community 63.6 (7) 42.9 (3) 57.1 (4)

5. Other analytic/assessment skills important for your current

position (n=4) 100 (4) 100 (4) 0.0 (0)

POLICY DEVELOPMENT/ PROGRAM PLANNING SKILLS

1. Plan, implement, evaluate, and improve policies or programs 90.9 (10) 60.6 (6) 40.0 (4)

2. Effectively advocate for policies 81.8 (9) 55.6 (5) 44.4 (4)

3. Strategic planning, determine needed policies (n=10) 60.0 (6) 50.0 (3) 50.0 (3) 4. Other policy development/program planning skills important

for your current position (n=4) 75.0 (3) 33.3 (1) 66.7 (2)

COMMUNICATION SKILLS

1. Information dissemination to diverse audiences 63.6 (7) 71.4 (5) 28.6 (2) 2. Communication to influence behavior and improve health 81.8 (9) 55.6 (5) 44.4 (4) 3. Solicitation of community input, active listening with

individuals and groups 36.4 (4) 44.4 (4) 0.0 (0)

4. Communicate in writing, orally, and online with linguistic and

cultural proficiency (n=10) 80.0 (8) 37.5 (3) 62.5 (5)

5. Other communication skills important for your current position

(n=2) 100 (2) 0.0 (0) 100 (2)

Total number answering question = 11 unless otherwise noted

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Table 5: Livingston County Management Self-Assessment Rating of Importance of Skills and Confidence in Performing Skills (cont.)

IMPORTANT

% (n) % (n) % (n)

CULTURAL COMPETENCY SKILLS

1. Describe and advocate for workforce diversity 27.3 (3) 100 (3) 0.0 (0) 2. Recognize cultural influences on policies, programs, and

services 63.6 (7) 100 (7) 0.0 (0)

3. Assess policy, program, and service impacts on different

populations 72.7 (8) 100 (8) 0.0 (0)

4. Understand and effectively respond to the diversity of

individuals and populations in a community 72.7 (8) 75.0 (6) 25.0 (2) 5. Other cultural competency skills important for your current

position (n=2) 100 (2) 0.0 (0) 100 (2)

COMMUNITY DIMENSIONS OF PRACTICE SKILLS

1. Advocate for policies, programs, and resources 63.6 (7) 42.9 (3) 57.1 (4) 2. Distinguish roles of governmental and non-governmental

organizations for community programs and services 45.5 (5) 40.0 (2) 60.0 (3) 3. Develop and maintain relationships and linkages within the

community that affect health 72.7 (8) 37.5 (3) 62.5 (5)

4. Facilitate collaboration among partners and community

engagement 54.5 (6) 33.3 (2) 66.7 (4)

5. Other community dimensions of practice skills important for

your current position (n=1) 100 (1) 0.0 (0) 100 (1)

PUBLIC HEALTH SCIENCE SKILLS

1. Apply public health sciences for policies, programs, services,

and research 45.5 (5) 100 (5) 0.0 (0)

2. Use evidence in developing, implementing, evaluating, and

improving programs and services 63.6 (7) 85.7 (6) 14.3 (1)

3. Apply public health sciences in administration and

management 45.5 (5) 80.0 (4) 20.0 (1)

4. Describe the laws, regulations, policies, and procedures for the

ethical conduct of research 45.5 (5) 60.0 (3) 40.0 (2)

5. Other public health science skills important for your current

position (n=1) 100 (1) 100 (1) 0.0 (0)

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Table 5: Livingston County Management Self-Assessment Rating of Importance of Skills and Confidence in Performing Skills (cont.)

IMPORTANT

% (n) % (n) % (n)

FINANCIAL PLANNING AND MANAGEMENT SKILLS

1. Explain public health and health care funding mechanisms and

procedures 63.6 (7) 85.7 (6) 14.3 (1)

2. Develop and use performance management systems 63.6 (7) 85.7 (6) 14.3 (1) 3. Use financial analysis methods for policies, programs, and

services 81.8 (9) 77.8 (7) 22.2 (2)

4. Prepare proposals for funding 72.7 (8) 62.5 (5) 37.5 (3)

5. Establish teams and motivate personnel for achieving program

and organizational goals 72.7 (8) 62.5 (5) 37.5 (3)

6. Develop, justify, and defend program budgets 90.9 (10) 60.0 (6) 40.0 (4) 7. Other financial planning and management skills important for

your current position (n=1) 100 (1) 100 (1) 0.0 (0)

LEADERSHIP AND SYSTEMS THINKING SKILLS

1. Analyze internal and external facilitators and barriers affecting

delivery of public health services and programs 72.7 (8) 75.0 (6) 25.0 (2) 2. Explain ways public health, health care, and other

organizations can work together as part of an inter-related system to impact community health

63.6 (7) 71.4 (5) 28.6 (2) 3. Modify organizational practices in consideration of social,

political, economic, or scientific change 63.6 (7) 71.4 (5) 28.6 (2) 4. Contribute to continuous improvement of individual, program,

and organizational performance 63.6 (7) 71.4 (5) 28.6 (2)

5. Provide and ensure use of training and professional

development opportunities 72.7 (8) 50.0 (4) 50.0 (4)

6. Collaborate with individuals and organizations in developing a

vision for a healthy community 72.7 (8) 37.5 (3) 62.5 (5)

7. Other leadership and systems thinking skills important for your

current position (n=1) 100 (1) 100 (1) 0.0 (0)

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Table 6: Open-Ended Responses of Management Level Staff Describing Additional Training Needs by Competency Domain

 Computer data training

POLICY DEVELOPMENT/ PROGRAM PLANNING SKILLS

 Knowledge of water system infrastructure and review of existing regulation; training on new regulations related to water systems

 Working with rural communities COMMUNICATION SKILLS

 Health literacy

 Training from stakeholder groups that are connected to the community – what they do and how they can benefit our program

 Training on motivational interviewing and stages of behavior change are needed on an ongoing basis for staff to develop skills

 Any type of training on communicating with different cultural populations within Livingston County.

We had a training on the Amish community that was extremely helpful to understanding their lifestyles.

PUBLIC HEALTH SCIENCES SKILLS

 Continued training on updates, review of existing regulations, and other technical related trainings FINANCIAL PLANNING AND MANAGEMENT SKILLS

 As this is an area where the financial department would take the lead and supervisors would take more of a supporting role, any training in this area would be beneficial. Perhaps an occasional training on what financial planning in our department entails.

LEADERSHIP AND SYSTEMS THINKING SKILLS

 One of the best ways to grow in this area is to take part in collaborative groups that are working toward a common cause and involve/encourage staff in the same.

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Appendix C:

Management Level Training Needs Identified by Health Commissioner and Managers Table 7: Livingston County Health Commissioner Ratings of Priority Training Needs for

Management Level Staff Based on Core Competencies for Public Health Professionals Analytic/Assessment Skills

Turn data into information for action.

Policy Development / Program Planning Skills

Plan, implement, evaluate, and improve policies or programs.

Public Health Science Skills

Use evidence in developing, implementing, evaluating, and improving programs and services.

Financial Planning and Management Skills

Explain public health and health care funding mechanisms and procedures.

Develop and use performance management systems.

Use financial analysis methods for policies, programs, and services.

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Appendix D:

Training Needs of Front Line Staff as Identified by Management Level Staff

Table 8: Livingston County Management Assessment of Front Line or Entry Level Staff Training Needs in the 10 Essential Public Health Services

Rated Training Need

% (n) 1. Monitor health status to identify and solve community health problems 80.0 (4) 2. Diagnose and investigate health problems and health hazards in the community 80.0 (4)

3. Inform, educate, and empower people about health issues 60.0 (3)

4. Mobilize community partnerships and action to identify and solve health problems 60.0 (3) 5. Develop policies and plans that support individual and community health efforts 60.0 (3) 6. Link people to needed personal health services and assure the provision of quality health

care 60.0 (3)

7. Assure competent public and personal health care workforce 60.0 (3)

8. Evaluate effectiveness, accessibility, and quality of personal and population-based health

services 60.0 (3)

9. Research for new insights and innovative solutions to health problems 60.0 (3) 10. Enforce laws and regulation that protect health and ensure safety 40.0 (2)

N = 5 managers reporting

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Table 9: Livingston County Management Assessment of Front Line or Entry Level Staff Training Needs in the Core Competencies for Public Health Professionals

Rated High Priority

% (n) ANALYTICAL/ ASSESSMENT SKILLS

1. Assess needs and assets to address community health needs 40.0 (2)

2. Turn data into information for action 40.0 (2)

3. Describe the broad array of factors affecting the health of a community 20.0 (1)

4. Identify and understand data 20.0 (1)

5. Other analytic/assessment skills important for your current position (n=3) 33.3 (1) POLICY DEVELOPMENT/ PROGRAM PLANNING SKILLS

1. Strategic planning, determine needed policies 0.0 (0)

2. Effectively advocate for policies 0.0 (0)

3. Plan, implement, evaluate, and improve policies or programs 0.0 (0) 4. Other policy development/program planning skills important for your current position (n=3) 0.0 (0) COMMUNICATION SKILLS

1. Communication to influence behavior and improve health 40.0 (2)

2. Communicate in writing, orally, and online with linguistic and cultural proficiency 20.0 (1) 3. Solicitation of community input, active listening with individuals and groups 20.0 (1)

4. Information dissemination to diverse audiences 20.0 (1)

5. Other communication skills important for your current position (n=3) 33.3 (1) CULTURAL COMPETENCY SKILLS

1. Understand and effectively respond to the diversity of individuals and populations in a

community 20.0 (1)

2. Describe and advocate for workforce diversity 0.0 (0)

3. Recognize cultural influences on policies, programs, and services 0.0 (0) 4. Assess policy, program, and service impacts on different populations 0.0 (0) 5. Other cultural competency skills important for your current position (n=2) 50.0 (1) COMMUNITY DIMENSIONS OF PRACTICE SKILLS

1. Develop and maintain relationships and linkages within the community that affect health 40.0 (2) 2. Facilitate collaboration among partners and community engagement 40.0 (2)

3. Advocate for policies, programs, and resources 40.0 (2)

4. Distinguish roles of governmental and non-governmental organizations for community

programs and services 20.0 (1)

5. Other community dimensions of practice skills important for your current position (n=3) 66.7 (2) N= 5 managers reporting unless otherwise noted

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Table 9: Livingston County Management Assessment of Front Line or Entry Level Staff Training Needs in the Core Competencies for Public Health Professionals (cont.)

Rated High Priority

% (n) PUBLIC HEALTH SCIENCE SKILLS

1. Describe the laws, regulations, policies, and procedures for the ethical conduct of research

(n=4) 25.0 (1)

2. Apply public health sciences for policies, programs, services, and research 20.0 (1) 3. Apply public health sciences in administration and management 20.0 (1) 4. Use evidence in developing, implementing, evaluating, and improving programs and services 20.0 (1) 5. Other public health science skills important for your current position (n=2) 0.0 (0) FINANCIAL PLANNING AND MANAGEMENT SKILLS

1. Explain public health and health care funding mechanisms and procedures 40.0 (2)

2. Develop, justify, and defend program budgets 20.0 (1)

3. Prepare proposals for funding 20.0 (1)

4. Use financial analysis methods for policies, programs, and services 20.0 (1) 5. Establish teams and motivate personnel for achieving program and organizational goals 20.0 (1)

6. Develop and use performance management systems 20.0 (1)

7. Other financial planning and management skills important for your current position (n=2) 0.0 (0) LEADERSHIP AND SYSTEMS THINKING SKILLS

1. Explain ways public health, health care, and other organizations can work together as part of

an inter-related system to impact community health (n=4) 50.0 (2)

2. Collaborate with individuals and organizations in developing a vision for a healthy community

(n=4) 50.0 (2)

3. Analyze internal and external facilitators and barriers affecting delivery of public health

services and programs (n=4) 50.0 (2)

4. Contribute to continuous improvement of individual, program, and organizational

performance (n=4) 50.0 (2)

5. Provide and ensure use of training and professional development opportunities (n=4) 25.0 (1) 6. Modify organizational practices in consideration of social, political, economic, or scientific

change (n=4) 25.0 (1)

7. Other leadership and systems thinking skills important for your current position (n=2) 50.0 (1) Total number answering question = 5 unless otherwise noted

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Table 10: Open-Ended Responses of Management Level Staff Describing Additional Training Needs for Front Line Staff

 Identifying high-risk populations, factors affecting those populations and support services to help those populations (MCH, Lead, TB)

 Cultural differences of Asian, Afghani, Pakistani, Mexican, Filipino cultures