Health Agency Staff Research Articles

VHA Support for Home Health Agency Staff and Patients During Natural Disasters

VHA Support for Home Health Agency Staff and Patients During Natural Disasters

Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline–spring 2018 and post-implementation – winter 2019). Data analysis guided by Leininger’s ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

Policy implementation strategies to address rural disparities in access to care for stroke patients.

Stroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC. This study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility. Researchers interviewed representatives engaged in implementing SSOC across six states. Informants (n = 34) included state public health agency staff and other public health and clinical practitioners. This study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability. Challenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches. This paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities.

Building capacity to implement sexual health risk and substance use disorder prevention services in adolescent behavioral health treatment: A case study

Adolescents with mental health and psychiatric disorders, as compared to their peers, are at increased risk for contracting sexually transmitted infections and developing substance use disorders (SUD). Practitioners need integrated programs addressing sexual health and substance misuse to promote healthy behaviors among vulnerable adolescent populations. Building agency capacity necessary to integrate sexual health education and SUD prevention can be challenging, but dissemination and implementation frameworks and models can provide a structured approach. This case study examines the application of the Interactive Systems Framework for Dissemination and Implementation and the Evidence-based System for Innovation Support to build the capacity of behavioral health agency staff to deliver an integrated sexual health risk and SUD prevention program with adolescents. Over a five-year period, researchers and behavioral health agency staff collaborated and increased agency capacity by using a training-of-trainers approach, comprehensive tools, proactive technical assistance, and quality assurance. While there were significant challenges, such as staff turnover and competing agency priorities, the team certified eight facilitators in the selected health promotion intervention and two agency trainers with the capacity for ongoing expansion and the expectation of sustainability of needed adolescent services.

Case Investigation and Contact Tracing in US State and Local Public Health Agencies: Sustaining Capacities and Applying Lessons Learned From the COVID-19 Pandemic and 2022 Mpox Outbreak.

The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies. For both routine outbreak response and epidemic preparedness, health agencies must have CI/CT program capacities in place prior to the detection of an outbreak to be ready to respond. Our research builds on previous work to identify the baseline CI/CT capacities needed in US state and local public health agencies to respond to any type of outbreak. Fifteen public health officials representing 10 public health agencies and 4 experts in CI/CT were interviewed about various aspects of their CI/CT program during the COVID-19 pandemic. The interviews coincided with the beginning of the 2022 mpox epidemic. Discussions on CI/CT during that response were collected to augment the interviews, where possible. Findings revealed that CI/CT capacities were underresourced prior to and during the pandemic, as well as during the mpox outbreak, even after substantial additional resourcing and efforts to scale up. Moreover, state and local health agencies encountered challenges in pivoting their COVID-19 CI/CT capacities for the mpox response, suggesting that CI/CT programs should either be designed with flexibility in mind, or should allow for specialization based on the pathogen's mode of transmission and the population at risk. Federal, state, and local health agency staff and officials should consider lessons learned from this research to plan for readily scalable and sustainable CI/CT programs to ensure readiness for future outbreaks.

Integrating human-centered design in public health data dashboards: lessons from the development of a data dashboard of sexually transmitted infections in New York State.

The increased availability of public data and accessible visualization technologies enhanced the popularity of public health data dashboards and broadened their audience from professionals to the general public. However, many dashboards have not achieved their full potential due to design complexities that are not optimized to users' needs. We used a 4-step human-centered design approach to develop a data dashboard of sexually transmitted infections for the New York State Department of Health: (1) stakeholder requirements gathering, (2) an expert review of existing data dashboards, (3) a user evaluation of existing data dashboards, and (4) an usability evaluation of the prototype dashboard with an embedded experiment about visualizing missing race and ethnicity data. Step 1 uncovered data limitations and software requirements that informed the platform choice and measures included. Step 2 yielded a checklist of general principles for dashboard design. Step 3 revealed user preferences that influenced the chart types and interactive features. Step 4 uncovered usability problems resulting in features such as prompts, data notes, and displaying imputed values for missing race and ethnicity data. Our final design was accepted by program stakeholders. Our modifications to traditional human-centered design methodologies to minimize stakeholders' time burden and collect data virtually enabled project success despite barriers to meeting participants in-person and limited public health agency staff capacity during the COVID-19 pandemic. Our human-centered design approach and the final data dashboard architecture could serve as a template for designing public health data dashboards elsewhere.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

The Exodus Of State And Local Public Health Employees: Separations Started Before And Continued Throughout COVID-19.

Understanding the size and composition of the state and local governmental public health workforce in the United States is critical for promoting and protecting the health of the public. Using pandemic-era data from the Public Health Workforce Interests and Needs Survey fielded in 2017 and 2021, this study compared intent to leave or retire in 2017 with actual separations through 2021 among state and local public health agency staff. We also examined how employee age, region, and intent to leave correlated with separations and considered the effect on the workforce if trends were to continue. In our analytic sample, nearly half of all employees in state and local public health agencies left between 2017 and 2021, a proportion that rose to three-quarters for those ages thirty-five and younger or with shorter tenures. If separation trends continue, by 2025 this would represent more than 100,000 staff leaving their organizations, or as much as half of the governmental public health workforce in total. Given the likelihood of increasing outbreaks and future global pandemics, strategies to improve recruitment and retention must be prioritized.

Maternal and neonatal risk-appropriate care: gaps, strategies, and areas for further research.

Risk-appropriate care is a strategy to improve perinatal health outcomes by providing care to pregnant persons and infants in facilities with the personnel and services capable of meeting their health needs. The Association of State and Territorial Health Officials hosted discussions among state health officials, health agency staff, and clinicians to advance risk-appropriate care. The discussions focused on neonatal levels of care, levels of maternal care, ancillary services utilized for care of both populations including transport and telemedicine, and issues affecting provision of care such as standardization of state policies or approaches, reimbursement for services, gaps in risk-appropriate care, and equity. State-identified implementation strategies for improvement were presented. In this Perspective, we summarize current studies describing provision of risk-appropriate care in the United States, identify gaps in research, and highlight ongoing and proposed activities to address research gaps and support state health officials and clinicians.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 2014-2021.

The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce. To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey. State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey. State health agency staff. PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts. The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair. The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.

Implementation of a Nationwide Knowledge-Based COVID-19 Contact Tracing Training Program, 2020.

In the United States, the public health response to control COVID-19 required rapid expansion of the contact tracing workforce from approximately 2200 personnel prepandemic to more than 100 000 during the pandemic. We describe the development and implementation of a free nationwide training course for COVID-19 contact tracers that launched April 28, 2020, and summarize participant characteristics and evaluation findings through December 31, 2020. Uptake of the online asynchronous training was substantial: 90 643 registrants completed the course during the first 8 months. In an analysis of a subset of course participants (n = 13 697), 7724 (56.4%) reported having no prepandemic public health experience and 7178 (52.4%) reported currently serving as case investigators, contact tracers, or both. Most participants who completed a course evaluation reported satisfaction with course utility (94.8%; 59 497 of 62 753) and improved understanding of contact tracing practice (93.0%; 66 107 of 71 048). These findings suggest that the course successfully reached the intended audience of new public health practitioners. Lessons learned from this implementation indicate that an introductory course level is appropriate for a national knowledge-based training that aims to complement jurisdiction-specific training. In addition, offering a range of implementation options can promote course uptake among public health agency staff. This course supported the emerging needs of the public health practice community by training a workforce to fill an important gap during the COVID-19 pandemic and could serve as a feasible model for enhancing workforce knowledge for future and ongoing public health threats.

Abstract P852: “They Were Wonderful...They Helped a Great Deal”: Patient and Caregiver Reports of Home Health Care as a Transition of Care Practice After Ischemic Stroke

Background: Transitions of care (TOC) following ischemic stroke (IS) are complex for patients and caregivers; the post-hospital discharge period is stressful, fragmented, and often carries with it a fear of new stroke. Improvements in education, medication management, and support for community integration following discharge to home could ease TOC challenges and assist in reducing hospital readmissions. Methods: Diagnosis-driven certified home health agency (CHHA) referrals for IS patients were initiated at a Comprehensive Stroke Center as a TOC improvement with a goal of decreasing “missed” referrals for patients not previously considered but eligible for CHHA services. Patients discharged to home (50 patient/caregiver dyads) were interviewed 30 days following hospital discharge to solicit feedback regarding CHAA services. Results: Of those contacted, 27 (54%) received CHAA services. Three patients/caregivers (11.1%) responded with neutral feelings regarding the visit, 24 (88.9%) responded that the visit was helpful. Eleven respondents had no comment/opinion when asked how the visit was/was not helpful. The remainder of patients had responses that could be grouped into domains including encouragement/concern for me ( n = 4), teaching/guidance ( n = 4), therapy/exercise ( n = 6), functional improvement/independence ( n = 2), medications ( n = 3), blood pressure management ( n = 3), and home health agency staff ( n = 2). There were multiple positive comments such as one patient who reported that the home care nurse was “very good... called right away and got the outpatient therapy transition arranged.” A patient with a new diagnosis of diabetes felt that education and concern for how things were going was very important to understanding and managing this new diagnosis. Multiple patients reported the importance of medication reconciliation after discharge and specific comments regarding the CHHA staff included, “Really helpful. They were wonderful... they helped a great deal.” Conclusions: Positive experiences regarding TOC practices strongly supported referral for CHHA services. Comments regarding the services suggest that increasing CHHA referrals could meet perceived needs of IS patients and caregivers in the transition from hospital to home.

Bridging Systems to Implement HIV/STI Programming Within the Juvenile Justice System: Strengths and Challenges of a Local Change Team Approach.

Justice-involved youth are at risk for HIV/STIs but do not access services. The complex challenges of improving the delivery of health-related services within juvenile justice (JJ) settings warrant exploration of strategies to close this service gap. This study describes the successes and challenges of utilizing a local change team (LCT) strategy comprising JJ and health agency staff to implement HIV/STI programming in JJ settings, across six counties in six states in the U.S. Five focus groups comprising n = 28 JJ and health agency staff who served as LCT members were conducted. Results demonstrated the structured nature of the collaborative process and strength of commitment among LCT members were necessary for successful implementation of HIV/STI programming. The use of LCTs comprising membership of JJ and (behavioral) health systems has broader applicability to other health and behavioral health issues faced by youth on probation that JJ staff may feel ill equipped to address.

Building Informatics-Savvy Health Departments: The Systems Development Life Cycle.

Building Informatics-Savvy Health Departments: The Systems Development Life Cycle.

Community mental health center staff attitudes about employment for persons with serious mental illness.

To measure community mental health agency staff attitudes about employment for persons with serious mental illness. An online survey was developed and sent to 2,218 staff at 4 community mental health centers (CMHC) in 1 New England state. The survey collected quantitative and qualitative data about staff attitudes about employment for persons with serious mental illness. Descriptive statistics and qualitative results are provided. Results from analysis of variance are provided as well, assessing differences in staff views by staff characteristics. A mix of clinical and administrative staff participated in the survey (N = 221). Staff views on the benefits of work, the ability of clients to handle the demands of the worker role, and client motivation to work were mixed. Staff with higher levels of education held significantly more supportive views than those with less education. CMHC staff need to consistently convey supportive attitudes about employment to their clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Financial and Business Analysis Capacities of the State and Local Public Health Workforce.

To assess the financial competencies and skills of the state and local public health workforce. Analysis of the 2017 wave of the Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate statistics and logistic regression models identified correlates and predictors of financial skills and skills gaps in the workforce. PH WINS was fielded to a nationally representative sample of all staff at all local health departments serving 25 000 or more persons and all state health agency staff. A total of 47 604 people responded to PH WINS in 2017 (overall response rate 48%). Financial competencies were measured in 3 areas: public health program and service delivery, public health agency funding, and public health agency business planning. A moderate percentage of the state and local public health workforce (36.7%-40.6%) reported that financial skills were not applicable to their job. Skill levels tended to be modestly but significantly higher for the state health workforce than for the local health workforce. Correlates of financial proficiency and skills gaps varied for the 3 areas assessed and by state versus local setting. In general, administrators, managers and executives, older individuals, and persons working in decentralized or shared departments tended to have higher levels of financial skills proficiency. Persons working in clinical roles, supervisors, newer managers, and persons reporting higher levels of burnout were more likely to report a skills gap. There are areas of notable strengths in state and local public health workforce financial skills. Yet portions of the workforce that may have been subjected to newer financial training approaches did not consistently report higher financial skills. Findings suggest areas for further improvement in the financial competency of the state and local public health workforce.

Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers.

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health and domestic violence service agencies. Results from this exploratory study suggest that women with severe mental illnesses who experience intimate partner violence face additional challenges that exacerbate behavioral health and domestic violence issues and put these women at greater risk for continued victimization. DV and behavioral health agency staff experience individual-, provider-, and system-level barriers to serving this high-risk, high-need population. Recommendations and implications for domestic violence and behavioral health providers are discussed.

Strategic framework for education and training in Quality by Design (QbD) and process analytical technology (PAT)

The regulatory and technical landscape of the pharmaceutical field is rapidly evolving from one focused predominantly on development of small molecules, using well established manufacturing technologies towards an environment in which biologicals and complex modalities are being developed using advanced science and technology coupled with the application of modern Quality by Design (QbD) principles. In order that Europe keeps pace with these changes and sustains its position as major player in the development and commercialization of medicines, it is essential that measures are put in place to maintain a highly skilled workforce. A number of challenges however exist to equipping academic, industrial and health agency staff with the requisite knowledge, skills and experience to develop the next generation of medicines. In this regard, the EUFEPS QbD and PAT Sciences Network has proposed a structured framework for education, training and continued professional development, which comprises a number of pillars covering the fundamental principles of modern pharmaceutical development including the underpinning aspects of science, engineering and technology innovation. The framework is not prescriptive and is not aimed at describing specific course content in detail. It should however be used as a point of reference for those institutions delivering pharmaceutical based educational courses, to ensure that the necessary skills, knowledge and experience for successful pharmaceutical development are maintained. A positive start has been made and a number of examples of formal higher education courses and short training programs containing elements of this framework have been described. The ultimate vision for this framework however, is to see widespread adoption and proliferation of this curriculum with it forming the backbone of QbD and PAT science based skills development.

Characterizing the Business Skills of the Public Health Workforce: Practical Implications From the Public Health Workforce Interests and Needs Survey (PH WINS).

Public health financial competencies are often overlooked or underrepresented in public health training programs. These skills are important for public health workforce members who are involved in managing resources and strategic planning and have been defined as key competencies by several national entities. To characterize business skills among state health agency employees and examine self-reported skill levels and their association with job satisfaction, worksite training and development opportunities, and annual salary. A cross-sectional survey, the Public Health Workforce Interests and Needs Survey (PH WINS), of state health agency central office employees was conducted in 2014. Multivariable logistic regression analyses, controlling for job classification, supervisory status, years of public health practice, annual compensation, educational attainment, geographic region, and sociodemographic status, were used to assess the relationship between business skills and training environment and job satisfaction. Linear regression was used to correlate business skills and annual compensation. A total of 10,246 state health agency staff completed a Web-based survey. Self-reported proficiency in business skills, job satisfaction, opportunities for training, and annual salary. The workforce reported high levels of proficiency in applying quality improvement concepts and managing change (67.5% and 69.2%, respectively). Half of the respondents reported proficiency in budget skills (49.3%). Participants who were proficient in applying quality improvement concepts were significantly more likely to report job satisfaction (OR = 1.27). A supportive training environment was significantly associated with business competencies (range of OR = 1.08-1.11). Managing change (β = .15) and budget skill proficiency (β = .37) were significantly associated with increased yearly compensation. Public health workers who self-report proficiency with business skills report increased job satisfaction, higher annual salary, and a supportive training environment. These findings support the need for the development of appropriately designed business skill training opportunities to increase competencies in this critical domain.

Collaboration Between Managed Care and Mental Health Agency Staff: Consumer Satisfaction, Medication Compliance, Psychosocial Improvement, and Cost Outcomes

Collaboration Between Managed Care and Mental Health Agency Staff: Consumer Satisfaction, Medication Compliance, Psychosocial Improvement, and Cost Outcomes