N ation al P u b lic H ealth Training Centers Network

Training Centers Network

National Public Health

Public Health Training

Center Coordinating

Council









2004-2005 Annual Report

March 2005 - Final

1

Table of Contents



Executive Summary 3





PHTC Network Activities and Accomplishments 6





Uniform Progress Report Findings 11





Comprehensive Performance Management System Findings 13





Annual Narrative Reports 14





Conclusion 24





Appendix A: PHTC Network Logic Model 26





Appendix B: PHTC Partners List 28





Appendix C: Public Health Nursing Committee Survey Report 40





Appendix D: PHTC-ATSDR Environmental Health Nursing Project

Summary Report 44





Principal support for this program is provided by the Health Resources & Services

Administration (HRSA), DHHS





Prepared by: Angela Beck, MPH, CHES

ASPH/HRSA Public Health Fellow

Health Resources and Services Administration

Bureau of Health Professions

Division of State, Community and Public Health

Center for Public Health



Report developed in partial fulfillment of ASPH/HRSA fellowship obligations





2

EXECUTIVE SUMMARY

Established under Public Law 105-392, the Health Professions Education Partnerships Act of

1998, the Public Health Training Center (PHTC) Program improves the nation’s public health

system by strengthening the technical, scientific, managerial and leadership skills and

abilities of current and future public health professionals. It emphasizes development of the

existing workforce as a foundation for improving the nation’s public health infrastructure

and for achieving Healthy People 2010 objectives. PHTCs feature competency-based

training and education programs designed for delivery off-campus – at sites convenient to

public health workers. Fourteen PHTCs based at accredited schools of public health

currently exist, covering forty-two states and the District of Columbia.



PHTC Network Activities and Accomplishments

The PHTC National Network worked actively in 2004-2005. The PHTC Coordinating Council,

comprised of Principal Investigators and Coordinators, divided itself into three working

committees: Operations, Public Policy, and Partners and Clients. Each of these committees,

along with the full Council, held monthly meetings and addressed issues pertinent to the

mission of each committee. The Operations committee began discussions of developing a

national PHTC Core Curriculum. Work on this project will begin in Spring 2005. A

subcommittee of this group, composed of PHTC evaluators, developed a Logic Model for the

National Network. The Public Policy committee developed a multifaceted plan to assure

maximum support for the PHTC program. The Partners and Clients committee worked on

identifying the various partners of PHTCs and determining the value added by PHTC

collaboration and, where gaps existed, fostering involvement and support by national and

local public health organizations.



The Coordinating Council worked diligently on developing the PHTC “brand” and asserting

themselves as the national leaders in providing foundational public health continuing

education. Over the past year, two documents were drafted and distributed at national

conferences: the “external” document, Public Health Training Centers: Four Years of

Progress in Public Health Workforce Development, and a summarized “internal” document

or Operational Plan. The Coordinating Council also participated in a national preparedness

and education meeting, Preparedness Education & Training: Where We Are meeting in

Atlanta, sponsored by CDC, ASPH and HRSA. During the meeting, the PHTC program was

recognized by HRSA as providing the foundational public health skills competencies through

continuing education training from which more specialized skills, such as emergency

preparedness skills and leadership/management skills, are built.



The PHTC Coordinators Committee also met monthly via conference call. This active

committee discusses best practices and everyday operational issues of the PHTCs. The

Coordinators are also integrally involved in submitting the HRSA Annual Reports, and most

committee members served on a UPR-CPMS Workgroup aimed at preparing for report

submission and proposing recommendations for future reports. This year, the work of the

UPR-CPMS Workgroup assisted in the development of two new reporting tables that were

approved by HRSA and utilized in this year’s Uniform Progress Report.







3

Data Collection and Performance Measures

In an effort to evaluate the progress of the PHTCs, HRSA collects quantitative and

qualitative data annually from each grantee. This report reflects data captured through two

HRSA-mandated reporting systems, the Uniform Progress Report (UPR) and the

Comprehensive Performance Management System (CPMS) report, and from an annual

narrative report submitted voluntarily by each PHTC.



Findings

Uniform Progress Report Data The UPR captures program-specific data for each program

in the Bureau of Health Professions (BHPr). For PHTCs, this reporting period covers March

15, 2004 through March 15, 2005. The PHTCs fill out three tables that collect quantitative

data, including number of training courses offered, number of people trained, type of

training offered, and discipline and employment location of trainees.



In the past year, PHTCs offered over 1400 continuing education courses; 507 were distance

learning courses. The Training Centers trained 84,000 people; 49,000 were trained at a

distance. Sixty-five percent of people trained worked at a state or local health department.



Comprehensive Performance Management System Data The CPMS is designed to collect

data on BHPr program performance indicators. Though the CPMS collects some data similar

to those collected in the UPR, the reporting period covers July 1, 2003 through June 30,

2004, and grantees are asked to submit an unduplicated count of all trainees on CPMS

tables. PHTCs fill out up to eight CPMS tables that capture information on discipline and

employment location, minority status, age, and gender of all trainees.



The majority of people trained, 65 percent, identified themselves as public health workers.

Nurses, who are oftentimes the backbone of public health services in many communities,

comprised 18 percent of all trainees during this reporting period. Eighty-eight percent of

public health workers trained in the past year practice in an underserved area;

approximately 97 percent of those trainees worked in state or local health departments.

Approximately 19 percent of people trained last year are of minority or disadvantaged

status.



Annual Narrative Report Information Since the HRSA UPR system limits the space

available to report qualitative information, each PHTC submits a narrative report that

provides detailed descriptions of goals and accomplishments, center-building activities, field

placement activities, challenges, and lessons learned. Common themes were identified

among the Centers’ reports and highlighted:

• Cultural competency and diversity

• Field placements

• Partnerships with academic and practice organizations

• PHTC challenges

• PHTC lessons learned









4

PHTCs also report on their environmental health nurse training initiative, which received

supplemental funding through an Interagency Agreement with the Agency for Toxic

Substances and Disease Registry (ATSDR). A cumulative total of approximately 11,000 nurses

and other health professionals were trained through this initiative when the project ended in

September 2004.



Overall PHTC Impact Despite limitations to some of the data, detailed later in this

document the impact of PHTC in training the current public health workforce is

unmistakable. Now in its fifth full year of operation, the PHTC program is a solidly

established national effort that is reaching public health workers with high-quality training

products and services. The 2004-2005 reports document the progress and increasing success

of this program as the PHTC mature.



The PHTC program assures access to high-quality training experiences for 92 percent of the

estimated 450,000 public health workers nationally. In addition, the PHTC provide training

for many community based professionals and organizations that care for underserved

populations. Since training began, the PHTC have provided education and training resources

to over 190,000 people, representing the full range of health professions working in state

and local agencies, clinics, and community-based organizations. PHTC training efforts result

in better performance and increased competency of public health workers and agencies

nationwide.









5

TWORK

PHTC NETWORK ACTIVITIES AND ACCOMPLISHMENTS

PHTC National Network

As a result of meetings convened in FY 2004 by the ASPH and HRSA, the PHTC leadership has

agreed to support a National PHTC Network.



In forming a National Network, the Centers have now formalized the relationships and

sharing that has evolved over the years in order to further facilitate, coordinate and expand

the work of individual Centers. Furthermore, the leaderships of the PHTCs, ASPH, and HRSA

foresee the formalized National PHTC Network as becoming the leading resource for public

health workforce training across the nation, playing a key role in helping to achieve the

public health workforce training goals outlined in three Institute of Medicine reports.1



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

Network:



1. Improve quality and outcomes of public health training

2. Increase efficiency of PHTC operations and training delivery

3. Expand the coverage of the National PHTC Network

4. Evaluate the impact of training

5. Publicize work of PHTC Network

6. Advocate for broadened support for public health workforce training in

general and the PHTCs in particular





The development of this National PHTC Network is a high priority for all PHTCs, and signifies

a major accomplishment in coordination of training efforts.



In 2004-2005, the PHTC Network adopted a committee structure. The Coordinating Council,

chaired by Margaret Potter of the Pennsylvania and Ohio PHTC, is composed of the PIs

(directors) and Coordinators. The Council meets monthly via conference call and provides

leadership and guidance to the Network. Several committees operate under the auspices of

the Council, as depicted in the organizational chart that follows.









1

Relevant Institute of Medicine Reports: The Future of Public Health (1988), The Future of the Public’s Health in the

21st Century (2002), Who Will Keep the Public Healthy? Educating Public Health Professionals in the 21st Century

(2003)





6

Executive Committee:

Maggie Potter, Jack

Thompson, Toby Citrin, Dan

Merrigan, John Kress,

Coordinating Council Antigone Vickery

Maggie Potter, Chair



Operations Committee

Jack Thompson, Chair





UPR Workgroup Outcomes/Evaluation Workgroup

(Logic Model)





Partners & Clients Committee

Dan Merrigan, Chair





Public Policy Committee

Toby Citrin, Chair





Coordinators Committee







Public Health Nursing Committee

Ann Cary & Glenda Kelly, Co-Chairs





Rural Public Health Committee

Janet Place & Barbara Quiram, Co-Chairs









Public Health Training Center Network Organizational Chart, 2004



PHTC Committees

PHTC Network committees allow greater coordination between HRSA, PHTC staff, ASPH and

other academic and practice partners.



OPERATIONS/NETWORK BUILDING COMMITTEE

Chaired by Jack Thompson of the Northwest Center for Public Health Practice, the purpose

of this committee is to:



• Focus on how the Centers work together as a network

• Work towards core curriculum for the Network

• Work within the framework of the Operational Plan

• Share best practices and products



In 2004, the Coordinating Council developed and approved an Operational Plan; this

committee is charged with the implementation of the plan. The first objective will be to

establish a core curriculum for the PHTC Network. This committee has two subcommittee

workgroups composed of PHTC coordinators and project evaluators that focus on the

identification and development of better performance indicators for the PHTC program and

ensuring timely reporting to HRSA.









7

• UPR/CPMS Workgroup– Formed in FY 2003, this committee is composed of PHTC staff

responsible for preparing annual reports to HRSA. The goal is to assure timely and

consistent submission of required agency reports. This committee was actively

involved in the redesign of a HRSA UPR table that was approved for use in FY 2005.

The new UPR table allows HRSA to capture important information about the trainings

offered by the PHTC grantees, including topic, delivery mode, level of sophistication,

and competencies met. This table was adopted by several other HRSA Bureau of

Health Professions grant programs providing continuing education.



• Outcomes/Evaluation Workgroup– Formed in FY 2003, this committee is composed of

PHTC personnel concerned with broader issues of PHTC reporting and evaluation.

Committee activities include developing a logic model for the PHTC program

(provided in Appendix A), and determining outcomes and performance measures.



PUBLIC POLICY COMMITTEE

Chaired by Toby Citrin of the Michigan PHTC, the Public Policy Committee works on

strategies to ensure the long-term viability and support of the PHTC program. In 2004, the

Committee met monthly via conference call and outlined strategies to tell the PHTC story

most effectively to local and national partners, the larger public health community and

others with a concern and interest in supporting an improved public health infrastructure

through foundational training in the core competencies and essential public health services.

With the assistance of ASPH, activity focused on: 1) making the PHTC program better

recognized and supported by key stakeholders, 2) working closely with other public health

training programs, such as the CDC-funded Centers for Public Health Preparedness, to

develop a coordinated approach to advocating for increased support of all public health

workforce training programs, and 3) identifying local and national partners with an interest

in assuring the existence of high quality continuing education programs for the public health

workforce. The group continues to support ASPH’s efforts with the deans and works with

their own universities to support the PHTC program.



PARTNERS & CLIENTS COMMITTEE

Chaired by Dan Merrigan of the New England Public Health Workforce Development Alliance,

the purpose of this group is to:



• Establish the value-added for our partners

• Determine how we market ourselves to our partners and clients



This committee has identified several current and potential PHTC partners and clients (full

PHTC partner list provided in Appendix B). National partners include HRSA, ASPH, the

Association of State and Territorial Health Officials (ASTHO), the National Association of

County and City Health Officials (NACCHO), and the National Association of Local Boards of

Health (NALBOH), among others. Each PHTC also works closely with the state and local

health departments and community-based public health organizations in their service area.

Some of the key questions this committee is addressing are the following:



1. Who are our training partners (who else provides training)?





8

2. Who receives PHTC training?

3. How are we perceived by our partners? What is our leadership role?

4. Do we have a common PHTC brand and identity?

5. How do we fit in the context of broader state and/or regional workforce development

efforts?

6. How we market the PHTCs to potential partners and clients?

7. What additional partners do we wish to engage?

8. How are partners and clients engaged in the PHTC network support effort?

9. How can the PHTCs position themselves as the preeminent center for public health

workforce development across the country?



COORDINATORS COMMITTEE

This committee is composed of PHTC Administrators and Coordinators who meet monthly via

conference call to discuss issues of common concern and exchange best practices. In 2004,

this group discussed issues related to Learning Management Systems, HRSA reporting

requirements, course development, distance learning platforms, among others.



PUBLIC HEALTH NURSING COMMITTEE

Formed in FY 2004, this committee is composed of over 40 PHTC staff, academic and

practice partner representatives who have an interest in working on the special training

needs of public health nurses, who are one of the largest components of the public health

workforce. Ann Cary of the New England Public Health Workforce Development Alliance and

Glenda Kelly of the Heartland PHTC serve as the committee co-chairs. The mission of this

committee is “to advance public health nursing by addressing learning and training needs

through the partnership between academia and practice”.



This committee met several times in 2004 to discuss potential projects committee members

could engage in. Two surveys were sent to the group to narrow down the list of ideas

related to continuing education and training for public health nurses. In July, a final report

including priority rankings was returned to the committee. The top three priorities are

listed below; the full report is included as Appendix C.



1. Identify and prioritize training and education needs of practicing public health nurses

2. Address Public Health Nurses’ training needs in the following areas:

• Population Based Nursing Practice

• Evidence Based Practice

• Council on Linkages Core Public Health Competencies

• 8 Critical areas defined in IOM report

• Establishing Community Partnerships for Strategic Planning

• Community Mobilization to Reduce Health Disparities

• Knowledge of ANA Quad Council Standards of PHN Practice

• Identifying & articulating ph nursing sensitive outcomes

3. Develop and distribute a listing of existing PHN trainings and all other trainings that

could be used for public health nurses









9

Discussions of potential project support have been ongoing with HRSA’s Division of Nursing.

This committee hopes to implement some of these project ideas in 2005.



RURAL PUBLIC HEALTH COMMITTEE

Formed in FY 2002, this committee is composed of PHTC staff and academic and practice

partner representatives who have an interest in working on the special needs confronted by

rural communities and public health organizations and their workforce. The purpose of the

committee is to share best practices, concerns and programming, particularly as it relates to

the needs of the rural public health workforce with an emphasis on learning and training

needs. The committee is now considering new projects related to the development of the

rural public health workforce.



Other Network Accomplishments

Over the past year, the Coordinating Council made developing the PHTC “brand” a high

priority, and made efforts to attract recognition for Training Centers as national leaders in

providing foundational public health continuing education. Two documents were drafted

and distributed at national conferences: the “external” document, Public Health Training

Centers: Four Years of Progress in Public Health Workforce Development, which highlights

the accomplishments of the PHTC National Network, and a summarized “internal” document

or Operational Plan. Both of these documents were published by ASPH. The “external”

document can be accessed on the ASPH Public Health Training Centers web page at

http://www.asph.org/document.cfm?page=780.



On September 20 and 21, 2004, the ASPH convened the Preparedness Education & Training:

Where We Are meeting in Atlanta. Sponsored by CDC, ASPH and HRSA, this event brought

together over 250 professionals who work in preparedness education and training, including

PHTC Principal Investigators. The diverse group of attendees included state and local

governmental public health workers, clinicians and educators from schools of public health

and other academic institutions. Meeting goals included (1) discussions on terrorism

preparedness education strategies and expectations for funded recipients; (2) discussions by

regions/states to share available training resources and plans; and, (3) provide input to CDC

and HRSA regarding several unresolved preparedness education issues, including

preparedness competencies and the use of learning management systems for monitoring

preparedness training. The Coordinating Council used this opportunity to engage other public

health training and education programs and stimulate collaboration. The PHTC program was

recognized by HRSA as providing the foundational public health skills competencies through

continuing education training from which more specialized skills, such as emergency

preparedness and leadership/management, are built.









10

UNIFORM PROGRESS REPORT

The data collected in the UPR clearly show an increase in productivity and efficiency among

the PHTC. During the 2004-2005 reporting period both the number of trainings offered and

number of people trained increased considerably. In addition, PHTC made greater efforts to

reach busy public health workers in rural and urban areas through more effective utilization

of distance learning technology, resulting in more people trained through distance learning

formats.



Number Trained

In the past year 83,996 public health workers were trained by PHTCs. PHTCs have increased

the number of trainings provided each year, resulting in a yearly increase of workers

trained, as depicted in Figures 1 and 2. In the past year, the Centers offered 1,396 training

opportunities; this decrease in trainings from the previous year illustrates how the PHTCs are

becoming more effective with their training approach- more people are being reached with

fewer trainings. 190,361 public health workers have been trained through 5,518 training

offerings, consisting of over 450,000 contact hours, since the inception of the program.

Training participants continue to work primarily in governmental public health agencies. In

the past year, 65 percent of people trained worked in state and local health departments.



100000 3000

2705

Number Trained









Number of Trainings









80000 83996 2500



60000 2000

55428

1500

40000 37889 1396

1000 1012

20000

13048

500 405

0

2001 2002 2003 2004 0

2001 2002 2003 2004

Figure 1: Number of Public Health Workers

Trained by PHTC: 2001-2004 Figure 2: Number of PHTC Trainings

Offered: 2001-2004







Number and Diversity of Trainings Provided

In the past year, distance learning trainings comprised 48 percent of all trainings delivered,

though these trainings accounted for 59 percent of people trained. While the number of

distance learning trainings decreased this year, the trainings offered were successful in

reaching many more people. Figures 3 and 4 depict the delivery of distance learning

trainings. PHTCs utilize a broad range of distance learning mechanisms to bring trainings to

the public health workforce. The most popular distance learning delivery mode used in

2004-2005 was satellite broadcast (29% of all trainings). Other distance learning formats

included online courses, CD-ROM distribution, and telehealth conferences.









11

60000

100

50000 49432









Number Trained

80 66 71

63 40000

52

Percent of 60 48 30000

34 37

Trainings 40 29 20000 20278

13685

20 10000

6296

0

0

2001 2002 2003 2004 2001 2002 2003 2004

Figure 3: Percent of Face-to-Face and Distance Learning Figure 4: Number of PHTC Distance Learning

Training Provided by PHTC: 2001-2004 Participants: 2001-2004



Face-to-Face Trainings DL Trainings









Competency-Based Training

Of the 892 different trainings PHTC developed or offered, 86 percent have been

competency- based. Most trainings are developed based on the Council on Linkages Core

Competencies for Public Health Professionals, though other competency frameworks are also

utilized in course development. PHTC offer trainings at aware (22 percent), knowledgeable

(32 percent), and proficient levels (8 percent); the remaining 38 percent of trainings are

offered at a combination of levels or are appropriate for all levels (shown in Figure 5).





Council on Linkages Core Competency Domains

for Public Health Professionals

• Analytic/Assessment Skills Figure 5: Percentage of Levels

• Policy Development/Program Planning Skills of PHTC Trainings

• Communication Skills

• Cultural Competency Skills 9% 22%



• Community Dimensions of Practice Skills 29%



• Basic Public Health Sciences Skills 32%

8%

• Financial Planning and Management Skills A wa re Kno wle dge a ble P ro f ic ie nt A ll Le v e ls O t he r

• Leadership and Systems Thinking Skills

Source: Council on Linkages Between Academia and Public health

Practice. Core Competencies for Public Health Professionals, April 2001.









Partnership/Collaboration

Over 60 percent of all PHTC trainings were co-sponsored with other organizations, including

health departments, academic institutions, NACCHO, and local public health organizations,

and CDC Centers for Public Health Preparedness. This statistic highlights the importance

PHTC place on practice and academic collaboration for both programmatic development and

making best use of scarce resources.









12

COMPREHENSIVE PERFORMANCE MANAGEMENT SYSTEM

The information collected in the CPMS outlines the diverse workforce the PHTC train.

Diversity is captured not only in the race or ethnicity of the people trained, but also in the

disciplines and employment locations of the trainees. The following goals and outcomes

detail the characteristics of the public health workers trained during the July 1, 2003

through June 30, 2004 reporting period.



Diversity of Workforce Trained

In the past year, approximately 19 percent of all workers trained were of minority or

disadvantaged status; 76 percent of trained workers were female.



Over 20 different types of public health and health care workers are trained each year by

PHTC. Table 1 represents some of the workers trained by all PHTC in the past year.



Type of Worker Number Percent

Trained of Total

Public Health 36922 65.2%

Nursing 10207 18.0%

Medicine 1316 2.3% PHTCs provide

Health Administration 1553 2.7% foundational,

Health Information 254 0.4% competency-

Dentistry/Dental Public 132 0.2% based training

Health for a diverse

public health

Social Work 513 0.9%

workforce

Laboratory Science 183 0.3%

Physician Assistant 52 0.1%

Food/Nutrition Science 256 0.5%

Other 5187 9.4%

56645* 100.00%

Table 1: Public Health Workers Trained, by Discipline:

July 1, 2003 - June 30, 2004



Eighty-eight percent of workers trained last year practice in an underserved area. The

majority of the workers practice in health departments; however, some trainees work in

Rural Health Clinics, Community Health Centers, and other underserved areas.

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









13

ANNUAL NARRATIVE REPORTS

The narrative reports submitted by the PHTC contain valuable qualitative information about

how the Centers operate on a day-to-day basis, what types of center-building activities they

are engaged in, and the outcomes of needs assessments and training evaluations. The

Centers follow a standard format when drafting their narrative reports, allowing for common

themes to be extracted and analyzed. Important themes identified include work on the

environmental health nurse training initiative, cultural competency and diversity, field

placements, needs assessment, evaluation, partnerships with academic and practice

organizations, PHTC challenges, and PHTC lessons learned. The following sections outline

highlights of the summary reports of a few of these topical areas.



Environmental Health Nurse Training Initiative

In 1995 an Institute of Medicine report concluded that nurses could play a vital role in

addressing key environmental health concerns, but lacked the formal education and

preparation to do so. The Environmental Health Nurse Training Initiative provides

competency-based continuing education training that teaches nurses how to incorporate

environmental health concepts into everyday practice. PHTC, currently receiving

supplemental funding of $10,000 per Center through an Interagency Agreement with the

Agency for Toxic Substance and Disease Registry (ATSDR), adapt and present curricula

developed by ATSDR, along with developing their own related course material based on

needs assessment results. The PHTC use a broad range of mechanisms to deliver

environmental health training, utilizing creative approaches in reaching the nursing

workforce such as telehealth conferences, online courses, and train-the-trainer courses.



In its final year of funding, this project continued to be a tremendous success. PHTCs

trained over 11,000 nurses and other public health professionals nationwide over three

years. The PHTCs have proven to be an ideal vehicle for disseminating information to public

health nurses. The Centers have learned how to successfully implement the programs, and

have become self-sufficient in terms of organizing trainings and reporting outcomes. HRSA

and ATSDR project officers monitored the progress of the Training Centers, but did not

provide extensive technical or logistical support. A full report of this three-year training

initiative has been provided as Appendix D.



Field Placements and Internships

Many PHTC are involved in field placement and/or internship programs. Most involve public

health graduate student placement into community based organizations or state and local

health departments. The following are examples of field placement and internship programs

reported by PHTC:



• Pennsylvania and Ohio PHTC developed the procedures for students to intern for

academic credit in lieu of payment









14

• MidAtlantic PHTC continued its PHASE (Public Health Application for Student

Experience) Graduate Student Internship Project

o During its second year, PHASE has expanded its internship offerings beyond the

department of epidemiology, which was the pilot department for this project,

to Environmental Health Sciences and Population and Family Health Sciences

departments

o To date, the PHASE Internship program has made available 28 internship

opportunities at both the local state health department and at the Maryland

Department of the Environment

o The benefit of such a project has been seen by the school’s administration and

there has been discussion of making the PHASE internship program more

integrated with the school

o In addition to the internship offerings, the MAPHTC works with a group of

PHASE students to offer monthly PHASE Seminars that provide students with

information about career opportunities in public health beyond academia



• New York and New Jersey PHTC efforts focused on both enhancing student practicum

opportunities in general, and placing individual students in experiential learning

situations

o A day-long conference entitled “Increasing the Number and Quality of MPH

Student Practica in Health Departments in New York and New Jersey” took

place in July of 2004 that brought together key faculty members from schools

and programs of public health and health department colleagues directly

involved in designing, implementing, and evaluating student practica in New

York and New Jersey

The goal of the meeting was to identify the barriers and facilitators to

instituting quality practicum opportunities for MPH students at health

departments, and to present successful models for both placing students

in health department practica and effectively mentoring them once they

have begun their internship

o The University of Medicine and Dentistry of New Jersey School of Public Health

(UMDNJ-SPH) recruited approximately twenty current MPH students or recent

MPH graduates as consultants to assist with the completion of an organizational

assessment by local health departments in New Jersey

The project, funded by the New Jersey Department of Health and Senior

Services, is based on NACCHO’s “Assessment Protocol for Excellence in

Public Health” (APEX-PH), Part 1

For seven months consultants, recruited from the UMDNJ-SPH and the

Columbia University Mailman SPH, assisted all 114 local health

departments in New Jersey to complete this assessment, providing them

with a unique opportunity to work intimately with local health

departments and to gain a more sophisticated understanding of local

public health in New Jersey









15

• Michigan PHTC continued the MPHTC-Graduate Student Training Program (GSTP)

o GSTP has given masters students in public health in-depth experience in

community-based public health practice while addressing priority health issues

in underserved communities

o At the beginning of the program, students and their field supervisor (or

designated staff) elect at least one MPHTC short course; the course helps build

the skills of the student and the preceptor to carry out their project together

o Student projects have addressed such varied topics as youth violence, homeless

health care, tobacco policy and smoking cessation for youth, HIV and STD

health education, obesity, lead abatement, and air quality

o Placements are located throughout Michigan serving African American, Arab

American, Native American, and urban and migrant Latino populations

o Students from all departments have participated in GSTP; the program is

designed to meet the internship requirements of each department

o In the summer of 2004, a total of eleven public health graduate students were

placed with community-based organizations in Detroit, Flint, Ann Arbor, and

Dearborn, Michigan; in the fall of 2004, all eleven students elected an

Independent Study for course credit to complete their projects, further

integrating community-based public health into their public health practice

o These students received a certificate in Community-Based Public Health in

December 2004 after fulfilling all requirements of the GSTP



• Pacific PHTC-enabled collaborative relationships among partner universities and

health departments have resulted in a significant increase in both graduate and

undergraduate student internships

o Internship opportunities for graduate students in the local health departments

for whom the PPHTC had provided training have doubled over the past two

years

o University of California Berkeley’s priority training and collaborative project

focused on health disparities and cultural competency has resulted in over 25

internships specifically targeted on these areas being made available to PPHTC

graduate students

o A large percentage of the internships offered by each partner school are now

made available to graduate students from other PPHTC schools; PPHTC faculty

members also collaborate closely to assist students in finding placements in

another partner school’s region

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

and access to opportunities



• Mid-America PHTC’s executive committee is working with state partners to increase

the availability of field placement opportunities for students in each state within local

and public health agencies

o Over the past year, 32 students were placed within the Community Health

Sciences Department at the UIC School of Public Health









16

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

fellowships

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

Public Health Preparedness (NCCPHP) to recruit students for NCCPHP’s Team

Epi-Aid project

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

assist the North Carolina Division of Public Health with outbreak

investigations and other short-term projects

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

Pharmacy and Nursing participate in Team Epi-Aid, providing workforce

surge capacity to investigate outbreaks and respond to disasters, such as

floods and hurricanes

Team Epi-Aid provides students opportunities to gain practical public

health experience by working with the state health department

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

nearly 1,600 volunteer hours during 2003

o SPHTC also partners with the Kellogg Fellowships for Emerging Leaders in

Public Health, based within the North Carolina Institute for Public Health

This nine-month intensive fellowship targets minority individuals

committed to public health careers

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

health environment through a combination of on-site intensive

workshops, personalized coaching, action learning teams, and

individualized leadership coaching

SPHTC has assisted with developing web-based public health crisis

simulations and with recruiting fellows from partner states



• Each of Texas PHTC’s academic partners assigned one intern to a local health

department; the focus of the internships was to assist the local health departments

determine how well they met the National Public Health Performance Standards



Partnerships/Collaboration

Partnerships and collaborations are essential to PHTCs. Partnering occurs between the

PHTCs themselves, and with outside organizations. The fourteen Centers combined have 109

academic partners and over 340 practice partners. The PHTCs reported examples of

collaborations in their 2004 Narrative Reports a selection of which follow:



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

Center for Public Health Preparedness’ (CPHP) 2-day “Competencies to Curriculum in

the Context of Preparedness” conference in New York City

o The goal of the meeting was to share the Columbia CPHP’s experience developing

competency-based training for local health departments in the areas of

bioterrorism and emergency preparedness

o The “Competencies to Curriculum Toolkit,” a publication of the Center for Health

Policy, Columbia University School of Nursing, and the Association of Teachers of

Preventive Medicine, provided the framework for the event





17

• Pennsylvania and Ohio PHTC collaborates with other federally-funded projects and

programs to design and deliver workforce development including: the Maternal Child

Health Leadership Training Center at the University of Pittsburgh, the Area Health

Education Centers, the ATSDR Environmental Health Nursing Initiative, and the

Bioterrorism Training and Curriculum Development Program at Thomas Jefferson

University. The synergies of these programs will yield better products and progress

toward objectives than either could accomplish alone



• At the Texas PHTC:

o collaboration has been extended to include other organizations for specific

projects such as the Texas Association of Local Health Officials (TALHO) and the

Texas Society of Public Health Educators (TSOPHE), both of which include rural

agencies and individuals in their membership

o The HRSA funded Health Professions Education grant and the CDC funded Centers

for Public Health Preparedness grants to the University of Texas School of Public

Health Center on Biosecurity and Public Health Preparedness have utilized the

TPHTC infrastructure as part of the resources of those initiatives

o TPHTC’s contributions have provided organization and presentation of topics to

public health department and first responder audiences as well as additional use

of TPHTC’s training needs assessment reports and its development of strategic

partnerships with public health organizations at state and local levels

o Through these cooperative inter-agency relationships the TPHTC has gained

statewide visibility and recognition. Training offerings to the public health

workforce by other organizations (Statewide Health Coordinating Council, Texas

Department of Health, Texas Society of Public Health Educators, Texas Association

of Local Health Officials) have been augmented and facilitated by co-sponsorship

of training with the TPHTC



Cultural Competency/Diversity

Based on needs assessment results, several PHTC have incorporated cultural competency and

diversity training into their curricula. According to Table 6 of the Uniform Progress Report,

over 25 different courses directly focused on cultural competency, diversity, or health

disparities. The PHTCs reported that approximately 143 of the 892 unique trainings offered

in the past year incorporated some aspects of the Council on Linkages cultural competency

skills domain. Others have participated in committees designed increase the number of

minority students in schools of public health, and supported the Kids Into Health Careers

program, designed to interest K-12 students in health careers. The following are examples

of PHTC activities related to cultural competency and diversity reported in 2004:



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

Program (MSIP); the goal of this program is to create a pipeline for the public health

profession

o In its third year, the MSIP has now placed a total of 35 high school students in

public health based positions throughout the School and several health department





18

partner organizations; this year MAPHTC assisted in placing 8 students in public

health sites



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

cultural competency and communication; several offerings addressed the Council on

Linkages cultural competency domain while focusing on other competencies

o Ohio’s cultural diversity awareness curriculum is currently being used as a basis for

the development of a curriculum on culturally relevant risk communication

message development for the Ohio Center for Public Health Preparedness and the

Ohio Department of Health



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

to Make a Difference: Exploring Cross-Cultural Communication (accessible at

www.nynj-phtc.org/cc/default.cfm),the New York and New Jersey PHTC has made

great efforts to increase student diversity at the Columbia University Mailman School

of Public Health (MSPH)

o The PI and Program Coordinator have been active members of a School-wide

Diversity Committee working to develop three sections of a Strategic Plan to

increase the racial and ethnic diversity (black and Hispanic) of students,

faculty and staff at the MSPH, and have contributed significantly to the analysis

of baseline student data and the development of the Sub-committee’s final

report

o This report: 1) documents the MSPH’s performance over the last ten years with

regard to diversity, 2) identifies facilitators that have helped the MSPH thus far

do as well as it has, 3) identifies barriers that inhibit an even better

performance, 4) provides recommendations to address barriers, and 5) provides

a template with recommendations and baseline data included for a 5-year

Strategic Plan to increase the racial/ethnic diversity of graduates of the MSPH

o The work done on student diversity at the MSPH to date has potentially far-

reaching effects: first, the work has enabled us to do a thorough analysis of

the actual numbers of people applying to, being accepted at, and matriculating

at the MSPH; second, a detailed analysis conducted over the summer of 2004 of

matriculating students’ GRE scores indicates these scores have little, if any,

relationship to subsequent grades obtained by black and Hispanic students in

the core biostatistics and epidemiology courses at the MSPH

Because of this finding, there are current discussions regarding suspending

the use of GRE scores from admissions considerations for a trial period at

the MSPH, which could result in more minority applicants being accepted to

the school

o A third important effect of the work done to date is a current discussion

regarding how best to promote an initiative with the Association of Schools of

Public Health (ASPH) Deans for a new National Public Health Service Corps,

which would provide student loan forgiveness for public health graduates

taking jobs in federally defined underserved areas

Since high tuition costs have historically been identified as a key barrier to

minorities applying to graduate programs at private institutions like the





19

MSPH, this type of a program could potentially result in increasing the

number of minority applicants to public health programs while at the same

time increasingly the number of culturally competent public health workers

taking jobs in underserved areas



• Upper Midwest PHTC is conducting three initiatives to increase diversity in Iowa’s

health workforce:

o The Center is funding the development of a strategic plan by 8/31/05 to assist

racial and ethnic minorities, immigrants, and refugees to enter and succeed in

Iowa’s health workforce, in partnership with the University of Northern Iowa,

Center for Health Disparities

o The Center is funding an intern in the Iowa Department of Public Health, Office of

Multicultural Health, to prepare a compendium of resources in Iowa’s

postsecondary academic institutions that improve retention of minority students in

health occupations programs

This project is being accomplished through a review of existing support

programs, personal interviews, and a focus group

The product will be a working document designed for use by academic

institutions, students, and the public to learn more about programs that

support minority students enrolled in Iowa’s health programs

o The center is working in partnership with the Iowa Department of Public Health,

State Office of Rural Health, to identify opportunities to partner with the Iowa

Department of Education and other entities to prepare middle and high school

students for entry into health careers

This project is being accomplished through a review of existing academic and

recruitment programs, personal interviews, and presentations to student and

other groups



• Michigan PHTC continues its efforts to emphasize cultural competency and diversity in

its course topics and in recruitment of training participants

o Thirty four percent of participants are from racial or ethnic minorities; the face-

to-face courses of the MPHTC have purposefully been held in underserved urban

areas in Michigan to provide access to this training to a diverse workforce

o Detroit’s Racial and Ethnic Approaches to Community Health project manager

notes “MPHTC has provided excellent course offerings for defining health

disparities and improving cultural competence in communication with clients and

co-workers. It is key that the Training Center has been able to offer courses in

Detroit, providing access to community-based organization (CBO) staff who would

have difficulty traveling outside of the city. They have provided scholarships to

the courses for CBO participants which has been essential to the attendance of

many CBO participants”

o The Art and Technique of Effective Communication course focused the third day

of training on integrating the role of culture into individual and group

communication processes

The New York/ New Jersey Public Health Training Center online course

“Communicate to Make a Difference” will be incorporated as a resource to





20

course participants; other resources that may be employed are cultural

sensitivity training tapes developed by the Chicago Police Department

This course continues to pair an academic and CBO practitioner as instructors,

furthering the linkages between academe, practice and community



• The Midwest Center for Life-Long-Learning in Public Health successfully launched its

series of courses focusing on culturally responsive health care in the 2004 Public

Health Institute, offering four (4) courses:

o Culturally Based Community Health Immersion was developed and presented as a

one credit module

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

population in the Twin Cities; students were provided with an opportunity to

explore in depth the challenges facing this community and to consider how the

knowledge gained in the course might impact their own practice.

o Community Based Program Evaluation explored issues that emerge when cultural

communities are evaluated, and the impact of cultural assumptions, values, and

expectations. Models for conducting evaluation in diverse communities were

explored

o Community Health Data addressed fundamentals of using and working with public

health data and using it on a community level. Strategies for data collection in

diverse communities was an integral element of the module

o Culturally Responsive Leadership and Management was designed to integrate

application of leadership/management principles in diverse communities

o Across these four modules, eighty-seven (87) students attended eleven hundred

seventy-seven and one half (1,177.5) hours of education focusing on provision of

culturally responsive health care. A key element in the training was the selection

of persons from underserved/underrepresented communities as faculty; this

element was critical in creating a credible learning experience for the students



PHTC Challenges and Lessons Learned

CHALLENGES

This year PHTC reported the challenges they face in developing and delivering trainings.

The most common challenges reported were:



• Lack of fiscal resources



• Developing incentives for members of the public health workforce for participation in

training programs, in absence of a recognized public health credential or accreditation

system



• Developing Learning Management Systems, which allow for the assessment, delivery,

tracking, and evaluation of learner needs and training and education



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









21

• The need to stress the importance of training in the core competencies as the foundation

for specialized leadership and preparedness skills. These are complimentary needs;

however, PHTC are often put in the position of competing for training participants due to

a lack of training time and resources



• Translating the public health and public health preparedness competencies to course

objectives and course content. At this point very few educational specialists are expert

at doing this and few faculty have attempted it



• State budget crises and related changes in health department policies during the past

year created new, or increased, barriers to staff travel to meetings and trainings within

or outside of their states



• Designing a true systems evaluation. Learning management systems often have significant

flaws as an evaluative tool



• Attempts to conduct six-month post-training follow up evaluations have been challenged

by lack of agency response and competing priorities



• Reluctance of faculty at Schools of Public Health and other academic Health Programs to

engage in public health practice activities and to adopt distance learning techniques in

their education and training activities



• Balancing the perceived value and need for distance learning courses with the high costs

associated with the development of such courses and lower enrollment to date as

compared with face-to-face courses



• Develop an effective statewide strategy for training



• A statewide and regional learning management system is critical to building the database

necessary for system-wide evaluation



LESSONS LEARNED

The following lessons learned were noted by the PHTCs:

• A diverse representation of public health professionals plays instrumental roles on

planning committees and the steering committees of PHTCs



• Important to build on the national network for public health training centers to obtain

shared resources on curriculum, technology, and evaluation



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



• Important to increase and maintain a variety of face-to-face and distance learning

modalities for course offerings, recognizing that there is no ‘one size fits all’ method of

training





22

• One approach to providing training to rural communities that has been successful is the

“roadshow” approach. This method saves tremendously on travel costs and travel time

for the trainers and enables us to cover a large geographic area in a relatively small

amount of time



• Practitioners desire training less focused on academic theory than public health practice

and with emphasis on field applications



• Public health disciplines have different preferences for training delivery, i.e., nurses

were open to online learning but preferred academics to facilitate; sanitarians wanted

traditional classroom/workshops but were open to colleagues as instructors (“train the

trainer”)



• Important to tailor courses by professional discipline and involve professional associations

in the planning, development and delivery of the courses



• Instructional design considerations must embrace the principles of adult learning



• Need to develop and/or refine portable courses or products that can be offered by the

PHTC on a regional basis



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



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

trained



• Difficult to capture trainee information from those who use training products passed on

by others, e.g. CD-ROM, cassettes, videotapes



• The training centers have a special niche. We have embraced broader workforce issues

that are not being addressed by the preparedness centers, such as rural public health,

environmental health and nursing and public health nursing. All of these have important

implications for “preparedness skills”









23

CONCLUSION

The quantitative and qualitative data captured through the reporting systems outlined in

this document clearly show that PHTC have become more productive and efficient in

training public health workers in foundational public health skills and competencies each

year since the Centers’ inception in September 2000.



Data Limitations While these data show accurate trends in number of training courses

developed and number of people trained, they do have some limitations. The complexity of

the UPR and CPMS reports, which are submitted at the same time, often cause mistakes in

reporting. For example, the reports ask the Centers to capture and report training

information for two different, but overlapping, time periods. Additionally, the CPMS asks for

an unduplicated count of trainees. Because of the high volume of training participants

several PHTC have, most do not yet have data collection systems sophisticated enough to

sort duplicate participants and easily distinguish data between the two reporting periods.

This is an especially difficult task for multi-state PHTC, who serve up to six states and rely

on information collected by academic and practice partners. Therefore, some of the data

collected by the CPMS include trainees who have taken two or more PHTC trainings. The

time period covered by each report may not match the reporting period requested by HRSA,

but it does reflect a full year of training activity. Minority status, age, and gender data

reported in the CPMS are all estimates, as some trainees prefer not to disclose that

information to the Training Centers. Estimates were made by calculating percentages from

the data collected, and applying them to the total number trained.



Two new tables were introduced into the Uniform Progress Report this year. While the PHTC

Coordinators had input during the development of the new tables, they did not find out until

a few months before the reports were due that these tables had been approved and would

be required in this year’s reports. As a result, most Centers had not captured data in the

level of detail required by the new tables. The PHTCs will be better equipped to report such

data in future years.









24

PHTC WEB PAGES



Heartland Public Health Education and Training Center

http://www.slu.edu/centers/heartland



Michigan Public Health Training Center

http://www.mitrainingcenter.org



Mid-America Public Health Training Center

http://www.uic.edu/sph/maphtc



Mid-Atlantic Public Health Training Center

http://maphtc.jhsph.edu



Midwest Center for Life-Long-Learning in Public Health

http://www.publichealthplanet.org



New England Public Health Workforce Development Alliance

http://www.bu.edu/publichealthworkforce/index.html



New York and New Jersey Public Health Training Center

http://www.nynj-phtc.org



Northwest Center for Public Health Practice

http://healthlinks.washington.edu/nwcphp/hrsa/



Pacific Public Health Training Center

http://www.pphtc.org



Pennsylvania and Ohio Public Health Training Center

http://www.pophtc.pitt.edu/



South Central Public Health Training Center

http://scphp.sph.tulane.edu/scphtc/



Southeast Public Health Training Center

http://www.sphtc.org



Texas Public Health Training Center

http://www.txphtrainingcenter.org/



Upper Midwest Public Health Training Center

http://www.public-health.uiowa.edu/UMPHTC/



Health Resources and Services Administration

Bureau of Health Professions

http://bhpr.hrsa.gov/publichealth/phtc.htm



Association of Schools of Public Health

http://www.asph.org/









25

Appendix A: Draft PHTC Network Logic Model r.10/20/04

Goal: Improve the quality, utilization, efficiency and competence of the current and future public health workforce by creating and diffusing state of the art CE and related learning programs.



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

TIER I Improvements/Opportunities

Infrastructure Building • Increase in training opportunities

• Designate geographic service area for • # states & HDs covered by PHTC • Improved regional training approaches

each PHTC • # of PHTC funded • Increased capacity of states/agencies to

HRSA funding • Establish and operate PHTCs • # academic and PH WF partners TIER 2

provide training opportunities

• Establish meaningful partnerships with • # trainings co-sponsored by partners • Greater involvemt and support of partners in

academic and practice organizations • # partners on Advisory Boards/comm. PHTC activities

• Develop and implement a system for • # reports submitted to HRSA • Improved delivery of trainings

program evaluation and reporting • # of useable data reported to HRSA • Improved outreach to underserved areas*

• Develop a system of recognition for • # of other orgs providing resources to • Increased number of workers trained

educational/professional development sustain PHTCs • Agency improvemt in 10 EPHS and CCs

• Develop a strategy for sustainability • # of SPH that include PHTC within org

Increase in

PHTC • Increased collaboration between partners

(i.e. leveraging resources) structure of other phwf training programs • Improved integration of research to practice

knowledge &

• Staff • Develop National Network skills of PH WF

• # Coord Council meetings/participants • Improved tech to support PHTC trainings

• Technical • Establish mechanisms for coordination • # PHTC committee meetings • Increased support of PH accreditation

Assistance and communication among Centers • # of shared curricula

• Develop competency- based national • # collab activities between PHTC

curriculum • # curricula developed Impact of Network

• % PHTC contributing/utilizing national • Improved communication between PHTC

curricula • Increased level of part. in Network activities

Workforce Analysis • Improved dissemination of best practices

University Faculty • Assess the phwf learning needs of each • Improved efficiency and performance of

service area • % of PHTC completing assessmts PHTC Improvements in

• Collaborate with state HD to identify • # PHWF learning needs assessmts • Improved cost efficiency of PHTC trainings agency’s response

gaps in capacity and to identify local performed

• Increased partnership/resource sharing with to PH issues and

learning/training resources • # of resource and capacity assessmts other phwf training initiatives

completed emergencies

• Greater dev of national comp-based curricula

• Type/# of available learning resources and

Training trainings

States • Develop/deliver competency-based • #/nature of capacity gaps identified

• Centers/ learning programs to address needs • Increased ability to assess wf training needs

• # individuals assessed

Contracted • Provide trainings that range in length, • Learning needs are correlated to core PH

• # counties/states/regions assessed

Agencies topics, and level of competency using outcomes

• #/range of comps incorp into assessmt

distance learning where appropriate • Increased matching of learning needs with

• Staff • Develop/implement systems/plans to courses being offered*

• Advisory evaluate PHTC trainings • Increase in number of trainings that utilize

committees • Assess individual learning needs • # persons trained the training resources of PH orgs Tier 3- IMPACT

• Identify faculty and support • # competency-based trainings Stronger, more

development of distance-based teaching • # persons trained in 10 EPHS & CCs

• #, scope, and focus of trainings

capable, and

skills

• # distance based trainings • Increased training provided to PHWF prepared PH

• # of eval systems/plans implemented • Improved ability of PHTC to respond to an workforce

• # evaluations/reports developed individual’s training needs resulting in the

Field Placements and Collaborative • Improved access and delivery of trainings

Partners Projects • # faculty experts providing distance based improved health

training • Improved curricula to suit needs of wf

• Health • Develop collaborative projects linking of populations in

Departments academic programs, practice partners areas served by the

and graduate ph students with • Increased partnership between students,

• Practice partners • % of PHTC with collaborative projects faculty, and practice organizations PHTCs

underserved communities and/or pops.

• Academic • Expand the number and quality of field • # of students, faculty, and practice • Increase in projects addressing needs of

partners placements of graduate ph students in participants involved in collaborative underserved communities and/or populations

underserved areas or with orgs serving projects • Increase in # of underserved communities

underserved pops • # and focus of projects being served

• Contribute to the production of the next • # underserved community members • Increase in # and quality of field placements

ph generation through programs participating in collaborative projects offered to graduate ph students 26

targeting HS and undergrad students • # and location of field placements

Glossary:

CC: Core Competencies

ESPH: Essential Public Health Services

HD: Health Department

PHTC: Public Health Training Center

PH: Public Health

PHWF: Public Health Workforce

SPH: School of Public Health

Underserved area: State, local, or federal health agencies



Outputs left out:

• # of contacts made to facilitate increasing the quality and quantity of MPH student practica in underserved areas including

HDs

• % of PHTC with PH workforce pipeline programs

• # of participating schools and teachers

• # of congressional districts covered



Outcomes left out:

• Increased # of students who choose to do a field placement in an underserved area

• Improved collaboration between students, faculty, and practice organizations

• Improved knowledge of public health careers among high school and undergraduate students

• Increase in % of students who are considering a public health career

• Expand reach of placements in underserved communities

• Increased used of shared database of evaluation reports and results

• Improved use of evaluation data for program renewal

• Decreased dependency on federal funds

• Improved use of state and federal fiscal resources in addressing population-based health needs due to improved

competency and capacity of the public health workforce

• Expansion of PHTC National Network to include all US states and territories

• More participants have engaged in needs assessment process over time

• Increase in number of trainings that utilize the training resources and capacities of PH organizations in service area

• Improved training resources and capacities in service area

• Implementation and assessment of collaborative plan for addressing capacity gaps

• Gain understanding of successful training methods

• Pinpoint areas for improvement

• Increased availability of qualified public health experts with distance-based teaching skills

• Increased distance-based learning skills

• Ongoing availability of public health training through HRSA-funded PHTC

• Establishment of a system-wide commitment to lifelong learning for the public health workforce

• Increase in proportion of students reached who pursue a public health career



Impacts left out:

• Increase in public health students practicing in underserved areas or organizations upon graduation

• Increase in number of students choosing to study and practice public health









27

Appendix B: Practice and Academic Partners List



Public Health Training Centers

Practice and Academic Partners

HEARTLAND (Missouri and Kansas)

Practice Partners

Missouri Department of Health and Senior Services

Missouri Public Health Association

Missouri Center for Safe Schools

Missouri Association for School Nurses

Missouri Council for Public Health Nursing

Missouri Association of Local Public Health Agencies

Kansas Division of Emergency Management

Kansas Department of Health and Environment

Kansas Public Health Association

Kansas Association for School Nurses

Gasconade/Osage (MO) County Health Department

Kingman County (KS) Health Department

Wyandotte County (KS) Health Department

Jefferson County (MO) Health Department

Jefferson City (MO) Department of Health and Senior Services

Platte County (MO) Health Department

Bollinger County (MO) Health Department

Kansas Association of Local Health Departments

Vernon County (MO) Health Department

Missouri Institute for Community Health

St. Louis County (MO) Department of Health

St. Louis City (MO) Department of Health

Kansas City (MO) Department of Health

Kansas Health Foundation



Academic Partners

Saint Louis University SPH, St. Louis, MO

SLU School of Nursing

SLUSPH Prevention Research Center

SLUSPH Center for Environmental Education and Training

University of Missouri-Sinclair School of Nursing

University of Kansas School of Medicine, Department of Preventive Medicine

Kansas WALD Center

Missouri AHEC

Kansas AHEC



MICHIGAN

Practice Partners

Michigan Department of Community Health





28

Michigan Association for Local Public Health

Michigan Public Health Institute

Agency-Faculty Forum, Southeastern Michigan

Allegan County Health Department

Detroit Community-Academic Urban Research Center

Detroit Department of Health and Wellness Promotion

Faith Access to Community and Economic Development, Flint

Flint Odyssey House Health Awareness Center

Friends of Parkside, Detroit

Genesee County Health Department

Greater Detroit Health Council

Great Lakes Chapter, Society of Public Health Educators

Henry Ford Health System

Inter-Tribal Council of Michigan

Kent County Health Department

Michigan Health and Hospital Association

Michigan League for Human Services

Michigan Osteopathic Association

Michigan Council for Maternal and Child Health

Michigan Primary Care Association

Michigan Public Health Association

National Association of County and City Health Officials

Nurse Administrator’s Forum, Michigan Association for Local Public Health

Oakland County Health Division

Prevention Research Center of Michigan

REACH Detroit

University of Michigan Health System



Academic Partners

Michigan State University

Area Health Education Center (AHEC)

Michigan Center for Rural Health

School of Social Work

University of Michigan Ann Arbor, MI

NIOSH Education and Resource Center, School of Engineering

School of Nursing

School of Public Health

Michigan Center for Genomics and Public Health

Michigan Center for Public Health Preparedness

MI-INFO (with funding from the National Library of Medicine)

Public Health Library and Informatics

School of Social Work

Wayne State University, Institute for Learning and Performance Improvement









29

MIDAMERICA (Illinois and Indiana)

Practice Partners

Lake County (IL) Health Department

Oak Park (IL) Health Department

Indiana State Department of Health

HRSA Region V Field Office

Chicago Department of Public Health

Illinois Department of Public Health

Illinois Department of Human Services, Family Health Division

Illinois Public Health Association

Illinois Association of Boards of Health

Illinois Association of Public Health Administrators

Illinois Rural Health Association

Illinois Primary Care Association

Kane County (IL) Health Department

Indiana Primary Health Care Association

Indiana Public Health Association

Indiana Rural Health Association

Indiana Counter-Terrorism Agency/Security Council

Indiana State Medical Association

Indiana State Emergency Management Agency

Indiana Hospital & Health Association

Indiana Tobacco Prevention & Cessation Agency

Center for Public Health Law--Partnerships & Professional Education

Indiana Local Health Departments Represented: Tippecanoe County, Howard County, Wayne County,

Clinton County, Marion County



Academic Partners

University of Illinois at Chicago School of Public Health, Chicago, IL

Indiana University School of Medicine, Department of Public Health, Indianapolis, IN

Indiana University Ruth Lilly Medical Library

Indiana University School of Nursing

Purdue University School of Nursing

Illinois AHEC

Indiana AHEC



MIDATLANTIC (Maryland, Delaware, and District of Columbia)

Practice Partners

Delaware Department of Health and Social Services

Maryland Department of Health and Mental Hygiene (24 county health departments)

Maryland Association of County and City Health Officials

MidAtlantic Health Leadership Institute

Dunbar School (Baltimore)

DC Department of Health

Public Health Foundation

Annie Casey Foundation







30

Maryland General Assembly

Howard University Cancer Center

Morgan State Public Health Program

Region III STD/HIV Prevention and Training

Maryland Public Health Association

Metropolitan Washington Public Health Association

Johns Hopkins Preventive Medicine Program

Maryland Hearing and Speech Agency

Education and Research Center for Occupational Safety and Health

Urban Health Institute

MedChi – The Maryland State Medical Society

DC AHEC

Eastern Shore AHEC

Western Maryland AHEC

Metropolitan Washington Council of Governments



Academic Partners

Johns Hopkins University SPH, Baltimore, MD

George Washington University School of Public Health and Health Science

Johns Hopkins School of Nursing



MIDWEST CENTER for LIFE-LONG-LEARNING IN PUBLIC HEALTH (Minnesota, North

Dakota and Wisconsin)

Practice Partners

American Indian Family Network, Children’s Initiative

Center for Cross-Cultural Health

Dakota County Public Health

Health Advocates

HealthPartners/Regions Hospital

Little Earth Community Partnership

Minnesota Department of Agriculture

Minnesota Department of Health

Minnesota International Health Volunteers Program

Minnesota Local Public Health Association

Minnesota Partnership for Action Against Tobacco

Minnesota Public Health Association

North Dakota Department of Health

Powderhorn/Phillips Cultural Wellness Center

Somali Health Organization

Veterans Administration

Wisconsin Department of Health and Family Services

Woodlands Wisdom



Academic Partners

Metropolitan State University, St. Paul, Minnesota

University of Minnesota Academic Health Center Career Center







31

University of Minnesota Academic Health Education Center

University of Minnesota College of Agriculture, Food, and Environmental Sciences

University of Minnesota College of Veterinary Medicine

University of Minnesota Humphrey Inst of Public Affairs

University of Minnesota Office of Multicultural Affairs

University of Minnesota SPH, Minneapolis, MN

University of North Dakota College of Nursing – Grand Forks

University of North Dakota School of Medicine & Health Sciences – Grand Forks

University of Wisconsin – Green Bay

University of Wisconsin – Milwaukee



NEW ENGLAND (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island)

Practice Partners

NEHA, Region 9

CT Association of Public Health Nurses

CT Department of Health

CT Environmental Health Association

CT League for Nursing

Ct Nurses Association

Maine Center for Public Health

Maine Bureau of Health

University of New England

Boston Public Health Commission

Coalition for Local Public Health (MA)

Harvard School of Public Health Public Health Preparedness Center

Massachusetts Association of Health Boards

Massachusetts Association of Public Health Nurses

Massachusetts Department of Public Health

Massachusetts Environmental Health Association

Massachusetts Health Officer’s Association

Massachusetts Public Health Association,

Community Health Institute (NH)

Manchester, NH Department of Health

New Hampshire Department of Health and Human Services

Rhode Island Department of Health

Vermont Department of Public Health



Academic Partners

Boston University School of Public Health, Boston, MA

University of Massachusetts School of Public Health and Health Sciences, Amherst, MA

Harvard School of Public Health, Boston, MA

Yale University Department of Epidemiology and Public Health, New Haven, CT

Tufts University School of Medicine Public Health Programs, Boston, MA

Connecticut AHEC Program









32

NEW YORK and NEW JERSEY

Practice Partners

Community Healthcare Network

NYS Association of County Health Officials

New York State Department of Public Health

Northeast Public Health Leadership Institute

New Jersey Public Health Association

Public Health Association of New York City

NYS Public Health Association

NYC Department of Health and Mental Hygiene

New Jersey Department of Health and Senior Services

New Jersey Health Officers Association



Academic Partners

Mailman School of Public Health, Columbia University, New York, NY

University at Albany School of Public Health, SUNY, Rensselaer, NY

University of Medicine and Dentistry of New Jersey School of Public Health, New Brunswick, NJ



NORTHWEST CENTER FOR PUBLIC HEALTH PRACTICE (Washington, Oregon, Idaho,

Wyoming, Alaska, Montana)

Practice Partners

Alaska Division of Public Health

Idaho Department of Health and Welfare

Idaho Health District Region 1 Coeur d’Alene

Idaho Health District Region 2 Lewiston

Idaho Health District Region 3 Caldwell

Idaho Health District Region 4 Boise

Idaho Health District Region 5 Twin Falls

Idaho Health District Region 6 Pocatello

Idaho Health District Region 7 Idaho Falls

Mountain States Group, Inc. (Idaho)

Montana Department of Public Health and Human Services

Gallatin County Health Department (Montana)

Richland County Health Department (Montana)

Oregon Department of Health Services Division

Public Health Seattle-King County

Washington State Department of Health

University of Wyoming

Wyoming Department of Health



Northwest Portland Area Indian Health Board

Northwest Indian College

Department of Health and Human Services Region 10



Academic Partners

Area Health Education Center, Alaska







33

Area Health Education Center, Eastern and Western Washington

Area Health Education Center, Montana

Boise State University, Boise, ID

Oregon Health Sciences University, Portland, OR

Portland State University, Portland, OR

Montana State University, Bozeman, MT

University of Alaska Anchorage

University of Montana, Missoula, MT

University of Washington SPH, Seattle, WA

University of Wyoming, Laramie, WY



PACIFIC (California, Hawaii and the American Pacific Islands)

Practice Partners

Alameda County Public Health Department

American Lung Association

California Conference of Local Health Officers

California Department of Health Services

California Distance Learning Health Network

California Pan Ethnic Health Network

California Public Health Workforce Training and Technology Coalition

CDC National Center for Environmental Health

Center for Health Leadership

Center for Public Health Leadership

Central California Public Health Training Academy

Community-Campus Partnerships for Health

County Health Executives Association of California

Filipino Nurses Association

Hawaii Primary Care Association

Hawaii Public Health Association

Hawaii State Department of Health

Health Net

HRSA Field Director, Pacific Cluster

Humboldt County Department of Public Health

Imperial County Department of Health

Kaiser Permanente

LA-Care Health Plan

Lake County Department of Public Health

Latino Coalition for a Healthy California

Los Angeles County Health Department

Madera County Public Health Department

NCMHD Center for Excellence for Nutritional Genomics

Northern California Public Health Association

Palau Ministry of Health

Public Health Alumni Association

Public Health Foundation Enterprises

Public Health Institute







34

Riverside County Department of Health

San Bernardino County Department of Health

Southern California Public Health Association

Sutter Health

UCLA Center for Public Health and Disasters



Academic Partners

University of California Los Angeles School of Public Health, Los Angeles, CA

California State University Graduate School of Public Health, San Diego, CA

University of California Berkeley School of Public Health, Berkeley, CA

Loma Linda University School of Public Health, Loma Linda, CA

University of Hawaii School of Nursing & Dental Hygiene, Honolulu, HI

California State University at Fresno



PENNSYLVANIA and OHIO

Practice Partners

Allegheny County Health Department

Allentown Bureau of Health

Association of Ohio Health Commissioners

Center for Terrorism Preparedness, University of Findlay

Columbus (OH) Health Department

Cuyahoga County (OH) Board of Health

Delaware General Health District (OH)

Drexel University

Erie County Department of Health

Family Health Council, Inc.

Greene County (OH) Combined Health District

Jackson County (OH) Health Department

Local health officers

Ohio Department of Health

Ohio Public Health Leadership Institute

Ohio Society for Public Health Education

Ohio Statewide AHEC Program

Penn State University

Pennsylvania Department of Health

Pennsylvania Forum for Primary Health Care

Pennsylvania Public Health Association

Philadelphia Department of Health

Society for Public Health Education (PA)

Southwest Pennsylvania AHEC

SUNY Albany

The Ohio State University Extension

University of Pittsburgh Center for Public Health Preparedness



Academic Partners

University of Pittsburgh GSPH, Pittsburgh, PA







35

University of Pittsburgh Health Sciences Library System

University of Pittsburgh School of Education

University of Pittsburgh School of Nursing

The Ohio State University School of Public Health, Columbus, OH



SOUTH CENTRAL (Louisiana, Alabama, Arkansas, Mississippi)

Practice Partners

Alabama Public Health Association

Alabama Environmental Health Association, Inc.

Mobile (AL) County Health Department

Alabama Southern Rural Access Program

Alabama Department of Public Health

Arkansas Public Health Association

Arkansas Center for Health Involvement

Community Health Centers of Arkansas

Arkansas Department of Health

Louisiana Public Health Association

Louisiana Department of Health and Hospitals

Cooperative Extension Service, Southern University and A&M College

Mississippi Public Health Association

Mississippi Nurses Association

Mississippi Association of Public Health Physicians

Mississippi State Department of Health

Mississippi Primary Health Care Association



Academic Partners

Tulane School of Public Health and Tropical Medicine, New Orleans, LA

University of Alabama at Birmingham School of Public Health

University of Arkansas Medical Sciences College of Public Health, Little Rock, AR Louisiana State

University Health Sciences Center, New Orleans, LA

Central Louisiana AHEC

University of Alabama College of Communication and Information Sciences



SOUTHEAST (North Carolina, South Carolina, Kentucky, Tennessee, Virginia, West Virginia)

Practice Partners

Kentucky Public Health Leadership Institute

Kentucky Department of Public Health

North Carolina Department of Health and Human Services

North Carolina Department of Environment and Natural Resources

South Carolina Department of Health and Environmental Control

Tennessee Department of Health

Virginia Department of Health

West Virginia Bureau for Public Health



Academic Partners

University of North Carolina SPH, Chapel Hill, NC







36

University of South Carolina School of Public Health, Columbia, SC

University of Kentucky College of Public Health, Lexington, KY

Eastern Virginia Medical School/Old Dominion University Graduate Program

in Public Health, Norfolk, VA

West Virginia University Department of Community Medicine, Morgantown, WV

North Carolina AHEC

East Tennessee State University, Johnson City, TN

Other Partners

KY Public Health Association

KY AHEC

NC Public Health Association

NC Association of Local Boards of Health

NC AHEC

UNC School of Nursing

UNC-Greensboro School of Nursing

UNC-Charlotte School of Nursing

Eastern Carolina Univ. School of Nursing

Barton College School of Nursing

Gardner-Webb College of Nursing

Winston Salem State School of Nursing

NC A & T University School of Nursing

NC Central University School of Nursing

Western Carolina School of Nursing

SC Center for Public Health Preparedness

SC Public Health Association

SC AHEC

SC Turning Point

TN Primary Health Care Association

TN Public Health Association

Old Dominion University

James Madison University

Virginia Commonwealth University

VA Public Health Association

VA Turning Point

West Virginia Turning Point

West Virginia Council on Higher Education

WV Public Health Association

Bethany College, WV



TEXAS

Practice Partners

Texas Department of State Health Services

Texas Department of Health Units

Infectious Disease Division

Zoonosis Control Division

Office of Public Health Practice







37

Health Matters, Inc.

Texas Institute for Health Policy Research, Inc.

City of Garland Health Department

Milam County Health Department

Grayson County Health Department

Lubbock City Health Department

Galveston County Health District

Tarrant County Health Department

Texas Public Health Association

Texas Society of Public Health Educators

Texas State Board of Health

City of Amarillo, Department of Public Health

City of Houston, Department of Health and Human Services

Texas Statewide Health Coordinating Council

Texas Association of Local Health Officials

Texas Association of Municipal Health Officials

Harris County Mosquito Control District

Mental Health Association of Texas



Academic Partners

University of Texas School of Public Health, Houston, TX

University of North Texas School of Public Health, Fort Worth, TX

Texas A& M University School of Rural Public Health, College Station, TX

University of Texas SPH Centers and Programs

a. Center for Health Policy Studies

b. Center for Bio-security and Public Health Preparedness

c. Southwest Center for Occupational and Environmental Health

University of Texas School of Medicine, Houston – Department of Psychiatry

University of Texas HSC, San Antonio, Teleconference Network of Texas

East Texas AHEC

South Texas AHEC

Texas Alliance for Healthy Communities



UPPER MIDWEST (Iowa, Nebraska and North Dakota)

Practice Partners

Iowa Partners

Iowa/Nebraska Primary Care Association

Bureau of Health Care Access, Iowa Department of Public Health

Broadlawns Medical Center

Iowa Public Health Association

Peoples Community Health Clinic

Iowa Department of Public Health

Center for Healthy Communities

Iowa Association of Local Public Health Agencies

Iowa Environmental Health Association

Iowa Department of Education







38

Nebraska Partners

Alegent Health

Boys Town National Hospital & Nebraska Association of Behavioral Health Organizations

Lincoln Lancaster County Health Department

Nebraska Health & Human Services System

Nebraska Minority Public Health Association

Nebraska Association of Boards of Health

Nebraska State College System

Nebraska Hospital Association

Nebraska Nurses Association

Nebraska Medical Association

Nebraska Association of Community Action Agencies

Nebraska Partnership of Local Health Departments

Nebraska Rural Health Association

RUPRI Center for Rural Health Policy Analysis

Public Health Association of Nebraska

South Dakota Partners

South Dakota State Health Department

Community Health Care Association

South Dakota State Medical Association

South Dakota Department of Education



Academic Partners

University of Iowa College of Public Health

University of Iowa College of Nursing

University of Northern Iowa, Global Health Corp.

Des Moines University

UNMC/UN Omaha Master of Public Health Program

University of Nebraska Medical Center

University of Nebraska at Omaha

University of Nebraska Public Policy Center

Creighton University Health Services

Office of Research and Graduate Education, University of South Dakota

South Dakota University Affiliated Program (SDUAP), University of South Dakota



r.2/05









39

Appendix C: Public Health Nursing Committee Survey









Public Health Training Center

Public Health Nursing Committee









Results of Committee Project Survey 2

July 12, 2004









40

INTRODUCTION

The Public Health Training Center (PHTC) Public Health Nursing Committee was established in

December 2003. Committee representatives include practice and academic partners of all fourteen

PHTCs. The group developed the following mission to coincide with the stated mission of the PHTC

program:



Public Health Nursing Committee Mission Statement: To advance public health nursing by addressing

learning and training needs through the partnership between public health academia and practice.*



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



PHTC Mission: Improve the Nation’s public health system by strengthening the technical, scientific,

managerial and leadership competence of the current and future public health workforce



Meetings of the Committee focused on brainstorming project ideas for the group to undertake. An initial

survey was conducted in April 2004, which resulted in a narrowing down of the list of ideas. In June

2004, a second survey was conducted to prioritize the most relevant and feasible projects identified in

the first survey. This document details the results of the second survey.



Members of the Public Health Nursing Committee were requested to rank order fifteen projects based

on priority. Committee members were asked to review the stated mission of the Public Health Training

Centers and the Public Health Nursing Committee and prioritize suggestions based on the following

criteria:

Adherence to PHTC Program Mission

Adherence to Committee Mission

Feasibility

Duplication of other efforts

Potential for financial support

Potential for PHTC involvement in the effort



METHODS

Surveys were emailed to all 44 members of the PHTC Public Health Nursing Committee. Survey

responses were emailed back to HRSA and analyzed. Survey rankings were averaged and the results

were ordered from lowest number to highest number, with the lowest number being the top priority.

Some projects were deemed “not applicable” (n/a) or “outside the scope of the mission” by members of

the committee. In these cases, rankings were averaged by excluding the number of people who

indicated that the project was n/a from the denominator. Average rankings were calculated for the

combined group of respondents, and also for the individual groups of practice partners (12 responses),

academic partners (11 responses), and PHTC staff (7 responses). One respondent was included in

both the academic partner group and in the PHTC staff group.



RESULTS

Twenty-nine survey responses were received from Committee members (67% response rate). The

following table lists the project rankings:









41

PHTC Public Health Nursing Committee Project Rankings

Project Suggestion Combined Practice Academic PHTC # of n/a

Ranking Partner Partner Staff Responses

Ranking Ranking Ranking

Identify and prioritize training and education needs of practicing public health nurses 1 2 1 1 0

Address Public Health Nurses’ training needs in the following areas: 2 1 2 2 0

Population Based Nursing Practice

Evidence Based Practice

Council on Linkages Core Public Health Competencies

8 Critical areas defined in IOM report

Establishing Community Partnerships for Strategic Planning

Community Mobilization to Reduce Health Disparities

Knowledge of ANA Quad Council Standards of PHN Practice

Identifying & articulating ph nursing sensitive outcomes

Develop and distribute a listing of existing PHN trainings and all other trainings that could be 3 4 3 3 0

used for public health nurses

Describe and distribute a model for field experiences and orientation for new nursing graduates 4 3 5 (tie) 6 0

going into local public health departments

Create joint training with other members of the public health workforce with a focus on multiple 5 5 4 4 0

discipline teams

Research and address barriers that keep the current workforce from getting continuing 6 6 8 5 2

education

Identify and prioritize training and education needs for future PH nurses 7 11 5 (tie) 8 2

Identify and propose needed changes to Nursing School courses and curriculum that could 8 7 10 9 0

include:

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

their curriculums

Integrating more public health curriculum into nursing curriculum

Incorporating PHTC Environmental Health Nursing material into curriculum

Courses that result in competency development, and provide credit toward BSN and

MSN or MPH degrees

Address concern that faculty teaching public health nursing are not always public health- 9 8 7 12 2

prepared

Identify funding sources for PHN Field Experiences 10 14 12 (tie) 7 0

Support collaborative projects or improved field placement opportunities for students at all levels 11 9 11 10 0

Locate funding for externships for BSN juniors to do their summer experience in local or state 12 10 9 11 0

health departments

Develop an internship manual that addresses issues at the student level and the organizational 13 12 15 14 2

level for placement of students at health departments

Research and address barriers keeping students from pursuing a career in public health nursing 14 13 14 15 0

Provide guidance to health departments regarding the importance of public health nurses 15 15 12 (tie) 13 0

actively participating in education of students

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





Appendix D: PHTC-ATSDR Environmental Health Nursing Project Summary









Public Health Training Centers

Environmental Health Nurse Training Initiative

Summary Report



March 1, 2005









Prepared by: Angela Beck, MPH, CHES

ASPH/HRSA Public Health Fellow

Health Resources and Services Administration

Bureau of Health Professions

Division of State, Community and Public Health

Center for Public Health



Report developed in partial fulfillment of ASPH/HRSA fellowship obligations









The Public Health Training Centers program was established under Section 766 of the Public Health Service Act,

as amended by Public Law 105-392. Principal support for the program is provided by the Health Resources and

Services Administration, DHHS.





The Environmental Health Nurse Training Initiative was funded through an Interagency Agreement with the Agency for Toxic

Substances and Disease Registry, Fiscal Years 2001-2004.









43

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





PROJECT OVERVIEW

In 1995, the Agency for Toxic Substances and Disease Registry (ATSDR) along with the Health

Resources and Services Administration (HRSA) and other federal agencies, commissioned the

Institute of Medicine (IOM) to determine the status of education and preparation for nurses on

environmental health. The result was a landmark report entitled, Nursing, Health and the

Environment: Strengthening the Relationship to Improve the Public’s Health. The report

determined:

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

education;

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

environmental exposures;

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

approach to health;

4. the nursing workforce numbers (now 2.7 million); and

5. the strategic position of nurses in a variety of occupational settings in schools,

workplaces, homes, and places of recreation.



To provide guidance in incorporating environmental health concepts into nursing practice and

education, four basic competencies were recommended for all nurses:



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

health;

2. complete an exposure history and subsequently make appropriate referrals;

3. understand the role of advocacy, ethics, and risk communication with respect to actual

or potential adverse health effects from the environment; and

4. understand policy and legislation related to the environment.



As a result of the IOM reports, ATSDR and HRSA implemented a new strategy for training

public health nurses in environmental health competencies. ATSDR’s national Environmental

Health Nursing Initiative is a program dedicated to promoting capacity to address

environmental health issues in all areas of professional nursing, including practice, education,

and research. The strategy of the initiative was to provide a coordinated structure for capacity

building in environmental health nursing. The purpose of the HRSA Public Health Training

Centers (PHTCs) is to address the learning needs of the current and future public health

workforce by providing foundational, competency-based public health training. HRSA has

fourteen PHTCs that cover 42 states and the District of Columbia.



This three-year project provided competency-based continuing education training that taught

nurses how to incorporate environmental health concepts into everyday practice. HRSA

PHTCs, through an Interagency Agreement (IAA) with ATSDR, received annual supplemental

funding of approximately $10,000 per Center to adapt and present curricula developed by

ATSDR, including utilization of I PREPARE cards and Taking an Exposure History booklets,

and develop their own related course material based on needs assessment results.



In three years of funding, this project had tremendous success, training over 11,000 nurses and

other public health professionals nationwide. The IAA supported an organized, successful

effort to continually train the nation’s public health nurses in strategies to address





44

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





environmental health concerns. The PHTCs have proven to be an ideal vehicle for

disseminating information to public health nurses; they are aware of how to implement the

programs, and are self-sufficient in terms of organizing trainings and reporting outcomes.



OUTCOMES AND LESSONS LEARNED

During the three years of the project, the Public Health Training Centers clearly demonstrated

increased performance and effectiveness with regard to training nurses and other public health

professionals in environmental health concepts. Foundational environmental health training

was provided to over eleven thousand public health workers, improving their environmental

health skills and competencies. PHTCs developed innovative approaches to delivering

environmental health training to meet the needs of workers in their service areas, such as

traveling face to face training "road shows", on-line computer based modules, train-the-trainer

courses, and telehealth conferences. Many PHTCs broadened their trainings to provide more

advanced material and topics in environmental health and several PHTCs offered nursing

continuing education credits for their environmental health trainings. The following chart

illustrates the number of people trained in the three years of this project.



2001-2002 2002-2003 2003-2004 Total

2603 3561 5398 11562



As the reach of this project continued to expand, the cost-effectiveness of the trainings

improved. The three-year cost of this project was $420,000; the average cost per trainee

equaled $36.33 for 2-8 hours of training. Many PHTCs were able to offer these trainings for

little or no cost to the trainee.



As indicated in the synopses of individual PHTC projects, all fourteen PHTCs developed

trainings with an interdisciplinary approach. Training Centers attracted audiences comprised

of several different nursing disciplines, including public health nurses, school nurses,

occupational nurses, pediatric nurses, nurse educators, emergency room nurses, and others.

Professionals in other public health fields, such as sanitarians, physicians, health educators,

epidemiologists/toxicologists, and social workers also attended PHTC environmental health

trainings, noting the need for this type of training among a diverse group of health

professionals. This approach resulted in an untended important outcome of this project:

collaboration. Several PHTCs noted that training participants found the opportunity to work

and learn together with other types of health professionals to be an important aspect of the

trainings.



Overall, this project has clearly been successful in meeting the goal of the ATSDR

Environmental Health Nursing Initiative: promoting capacity to address environmental health

issues in all areas of professional nursing, including practice, education, and research. The

training opportunities that the Public Health Training Centers offered were consistent with the

environmental health concepts outlined by the IOM report, Nursing Health and the

Environment. This project is a prime example of successful collaboration between two

Federal agencies, ATSDR and HRSA, and the Public Health Training Centers, a HRSA program

grantee. ATSDR provided curriculum materials for environmental health trainings, along with

project assistance; HRSA provided project management through the coordination of the Public

Health Training Centers. The project ended in FY 2004, when ATSDR could no longer





45

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





financially support the project. However, several PHTC program staff have indicated that they

intend to continue developing and offering environmental health trainings due to the demand

for such courses among public health professionals.



PHTC PROJECT SUMMARIES

Each of the fourteen PHTCs provided a synopsis of the approach they used and the trainings

they developed to implement the ATSDR Environmental Health Nursing Initiative:



Heartland Public Health Education and Training Center (HETC)

Serves Missouri and Kansas



HETC used the approach of collaborating with state health departments to reach nurses at the

local level. The state health departments in the HETC service area, Missouri Department of

Health and Senior Services and the Kansas Department of Health and Environment, contract

with the local health departments and are familiar with the needs of the nurses in the local

public health agencies in regards to environmental issues. In addition, marketing or

advertising through the state health departments proved to be very successful for reaching

nurses throughout the states.



In Spring 2004, HETC delivered a web-broadcast as a new means of reaching the target

audience. Many health professionals are unable to leave the worksite for an entire day of

training; however, they may be able to view a one to two-hour broadcast as an alternative

learning method. This learning modality was successful in reaching new audiences.



Interdisciplinary participation is fostered through the use of marketing techniques. Multiple e-

mail list-servs have been utilized for marketing trainings including a listserv for occupational

nurses and environmental specialists. A key partner in Missouri, the Center for Environmental

Education and Training located in Saint Louis University School of Public Health, facilitates

multiple trainings on a weekly basis and has proven to be a critical partner for fostering

interdisciplinary participation. This center provides training and education services to

professionals in environmental health and safety, as well as to general workers and the

community at large. In addition to regularly scheduled courses, the Center for Environmental

Education and Training provides customized training to business, industry and public agencies

either at the University or on site. The center also offers consulting services in a number of

areas, including environmental training/education, industrial hygiene, occupational health,

safety and risk assessment and compliance management.



The partnership with the Center for Environmental Education and Training was new with the

inception of this project. As stated above, this partnership has been critical in fostering

interdisciplinary participation. In addition, the partnership has been critical for gaining

expertise in the field of environmental health for trainings. Another new partnership has been

formed with the Environmental sections at each of the state health departments. Before this

project HETC had not worked individually with the environmental sectors. This project has

fostered strengthened collaborations with the overall state health departments due to the

diversity of projects and programs.



Examples of trainings offered:





46

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





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

nurse conference with the Missouri Association of School Nurses. Plenary sessions and

breakout sessions encompassed a wide range of workforce training for the school nurses

including Health care needs of Refugee and Immigrant Children, the DFS system, Diabetes

Management, Eating Disorders, and emergency planning in the school setting. A keynote

speaker was provided to educate on “The School Nurse’s Role in Bioterrorism”.



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

the Missouri Public Health Association, MDHSS, and the Council of Public Health Nursing.

The conference was titled, “Keeping the Wheel Turning: Enhancing Your Skills” and

focused on building skills in the public health interventions of coalition building, case

management, and health promotion teaching. The keynote speaker addressed the Evolution

and History of Public Health Nursing.



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

trainings with MDHSS and the Center for Environmental Education and Training at St.

Louis University School of Public Health. The training was offered in three locations in

Missouri. The program provided an overview of environmental health hazards in the home,

workplace, and community. The nurse’s responsibilities in promoting environmental health

were defined. The program integrated the four general environmental health competencies

for nurses: 1) basic knowledge and concepts; 2) assessment and referral; 3) advocacy,

ethics, and risk communication; and 4) legislation and regulation.



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

nurse conference with the Kansas Association of School Nurses, American Lung

Association, KDHE, Merck Vaccine Division, School Health Corporation, Wichita State

University, and Books are Fun. Plenary and breakout sessions encompassed a wide range of

workforce training for school nurses including an orientation to school nursing for new

nurses in the state, Guidelines for children with Special Health Care Needs, Masters of

Disaster Training, Tobacco Free Teens Training, Understanding School Indoor Air Quality,

bioterrorism/emergency preparedness sessions and many others. A keynote speaker was

provided to educate on “The School Nurse’s Role in Bioterrorism”.



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

training with MDHSS Missouri School-Age Children’s Health Services Program. The

training focused on education for school nurses on Evidence-Based Guidelines Related to

the Care of School-Aged Children with Asthma, and the School Health Index for Physical

Activity, Healthy Eating, and a Tobacco-Free Lifestyle.



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

The trainings were offered in three locations in Missouri. The program focused on

education for school nurses in developing a logic model and writing measurable outcomes.



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

materials to approximately 400 nurses in Missouri including public health nurses, nurse

educators, nursing students, and environmental specialists. The materials included “I







47

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





PREPARE” cards on how to do an environmental exposure risk assessment, an overview of

environmental health hazards in the home, workplace, and community, and the four

general environmental health competencies for nurses: 1) basic knowledge and concepts; 2)

assessment and referral; 3) advocacy, ethics, and risk communication; and 4) legislation

and regulation.



• MO Council for Public Health Nursing meeting- HETC co-sponsored this meeting with

MDHSS. Training was provided on strategic planning and board training. Emphasis was

placed on team building, including skill and contact sharing.



• School Nurse FERPA & HIPAA Training –HETC co-sponsored these trainings with MDHSS

Section of Healthy Community and Schools. The training was offered in three locations

throughout Missouri. Education was provided for school nurses on the legal accountability

for student health records, comparison of HIPAA and FERPA regulations, and identifying

strategies for the new era of personal privacy rights.



• Indoor Air Quality & Effects of Mold- sponsored by HETC, this webcast was developed for

public health nurses and other public health professionals. It addressed common indoor

contaminants, demonstrated investigative techniques and provided basic solutions.

Additional focus was given to mold as one of the greatest risks to indoor air quality and

respiratory health.



Michigan Public Health Training Center (MPHTC)

Serves Michigan



MPHTC educates an interdisciplinary team of environmental health professionals in areas

intersecting nursing and environmental health. The target audience for face-to-face workshops

includes public health nurses, nurse practitioners, other health professionals, environmental

health specialists and health educators. MPHTC is a provider of continuing education in

nursing and health education (CHES) and has routinely received continuing medical education

credit designation for course offerings. These designations improve MPHTC’s ability to attract

a diverse group of professionals. MPHTC has used face to face courses, a self-paced online

mentored course, and key informant interviews with individuals in nursing and environmental

health at the state and local level to foster the goals of the Agency for Toxic Substances and

Disease Registry with respect to Environmental Health and Nursing.



The initial face to face offering, Public Health Nursing Basics: Health and the Environment,

focused on the following learning objectives:



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

health

• Complete an exposure history as part of the nursing assessment

• Make appropriate referrals to environmental health resources

• Understand the role of nurse advocates with respect to actual or potential adverse

effects from the environment









48

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





• Increase familiarity and expertise with Internet technology and resources, particularly

those relating to environmental health in support of professional development.



The course was attended exclusively by nurses, perhaps due to the title and that the only

continuing education credits offered were for nurses. However, faculty was asked to present a

synopsis of the training to the Michigan’s Environmental Health Directors Conference in

September 2002. This expanded the circle of influence of the workshop and promoted

collegiality between nursing and environmental health professionals in local public health

departments.



Given the interest generated by the nurse advocate panel presentation which was part of this

workshop, MPHTC focused development of its online course offering on advocacy. Advocating

for Healthy Environments and Healthy People builds on the work of the Midwest Center for

Life-Long-Learning in Public Health basic online course, Introduction to Environmental

Health Nursing. The primary audience for both these courses is nurses, although others

interested in advocacy would benefit from the course.



To address the issue of fostering interdisciplinary participation, the planning team and

presenters for the year 3 face to face training was expanded to include experts in

environmental health and occupational medicine. In addition to nurses, a physician and

toxicologists were recruited to be part of the planning team. The face to face offering was titled

more generally as follows: Addressing Environmental Contaminants and their Effect on

Human Health. The course is co-sponsored by the Center for Occupational Safety and Health

Education, the University of Michigan NIOSH Education and Resource Center. In addition,

CME and CHES credits were offered, along with contact hours in nursing. Continuing

Education Units are also offered to make the course more attractive to a broader range of

professionals. The focus of this course is on specific environmental contaminants of concern in

Michigan: lead, mold, mercury and pesticides. Presenters focus on separating myth vs. fact of

the health effects of these contaminants and address the role of the health and environmental

professional in environmental illness. Further, information about the CDC Environmental

Public Health Tracking System is also covered.



To date, all courses have included a post-course evaluation component, assessing the

effectiveness of teaching methods and material presented. Evaluation results for year 1

assessed success in meeting the course learning objectives. Face to face trainings held to

develop the online course in year 2 assessed changes in knowledge and applicability of the

training to practice. Results indicate 100% in applicability to practice and pre-post results in

five areas tested indicating between and 18% to 67% increase in knowledge. The online course

and year 3 workshop will include pre and post knowledge based tests. In addition, there are

plans to survey participants three to six months post course to help understand the impact of

the training on practice.



In year 3 MPHTC worked with state and local health nursing and environmental health

leadership to understand communication networks and to encourage nursing leadership in

Michigan to include environmental health education in key principles for training and

education. Since 1996, responsibilities for some environmental health programs were split

between the Michigan Department of Community Health (the state health department) and the





49

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





Michigan Department of Environmental Quality. Split responsibilities exist at the local level

and at the federal level, as well. This presents an opportunity to foster greater communication

and collaboration in the state between nursing and environmental health professionals.



Examples of trainings offered:

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

throughout Michigan. Materials used to develop course content included Volume 1 Case

Studies in Environmental Medicine (CSEM) as CD-ROM including 15 CSEM, including

Taking an Exposure History, Disease Clusters, Asthma, and Pediatric Environmental

Health, supplied by ATSDR.



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

on CD-ROM covers concerns on common environmental contaminants and their potential

effects on human health. Presentations include mold, lead, mercury, and pesticides, all of

which are found in the home, the community, and the workplace.



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

concern based on existing, though limited, information about contaminants in our daily

environments. Of the 20 environmental pollutants reported to the EPA in 1997, nearly 75%

were known or suspected neurotoxins; more than a billion pounds of neurotoxins being

released into the air, water and land. The key components of protecting the environment,

protecting human health and the role nurses can play as advocates are the focus on this

course. Course Objectives are as follows:

o List two environmental health competencies for nurses

o Describe ways nurses can advocate for environmental health and justice

o Describe a Michigan environmental health initiative

o Name two environmental health resources

o Utilize environmental health resources



Mid-America Public Health Training Center (MAPHTC)

Serves Illinois and Indiana



MAPHTC’s main approach to training public health nurses has been face to face trainings.

More on-line training will be incorporated into the learning management system and website is

improved and upgraded. Training sessions are now being video-recorded. The recordings will

be encoded for internet delivery and then provided through the MAPHTC web site as

competency based training courses. When participants register for training, they will be able

to take an on-line needs assessment before viewing the session, similar to what is done through

the Illinois Public Health Preparedness Center (http://www.uic.edu/sph/prepare/). The same

competency framework will be used and new competencies will be added as new courses are

added (for public health nursing and environmental health training).



The Mid-America Public Health Training Center has increased its involvement with a number

of groups in Illinois and Indiana, including the state-wide training committees, state public

health nursing associations, local health departments, Great Lakes Center for Environmental

and Occupational Health and Safety, and the Center for Advancement of Distance Education

for the training of public health nurses in environmental health. MAPHTC has partnered with





50

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





the Great Lakes Center for Environmental and Occupational Health and Safety program here

at the University of Illinois-Chicago to host several trainings.



A public health nurse who serves on Training Center advisory committees and participates in

the environmental health training program, shared that the training successfully expands the

participants’ knowledge of environmental resources on environment. She noted that local

communities look to local health departments, and frequently to public health nurses, for

information on how the environment affects individual health, as well as the health of the

community. Communities are looking to local health departments for credible information on

environmental changes, as a result of development, industrial pollution or even recreational

development, might affect their health for years to come. The training made participants more

sensitive to these issues and illustrated how they could assist individuals through careful and

purposeful assessments and interventions.



Examples of trainings offered:

• Core Curriculum in Environmental Health

• Illinois Leadership Society Annual Nurses Update

• Illinois Rural Health Association (exhibit)

• Resources for Incorporation of Environmental Health into Undergraduate Curriculum

• Healthy Mothers, Healthy Babies, Healthy Environments: A Nurse's Role in Assessing

and Addressing the Health Risks to Mothers and Babies from Environmental Exposures

– This conference will target professional nurses employed in clinical practice settings,

particularly, but not limited to those who practice in Labor, Delivery, Postpartum and

Newborn Nursery, student nurses and visiting public health nurses. Occupational health

nurses, midwives and health educators will likewise benefit from the program content.

The goal of this project is to develop the four basic competencies in environmental

health for the nursing workforce. Regional nursing leaders in environmental health will

act as planning committee members and presenters during the day long conference.

After attending the conference, nurse attendees will be better risk communicators to

their patients and will be better able to advocate for change necessary for safer, healthier

environments.

• Environmental Health for Children in Illinois



Mid-Atlantic Public Health Training Center

Serves Maryland, Delaware, and the District of Columbia



Mid-Atlantic PHTC’s Environmental Health Nursing Project is comprised of an Environmental

Health Nursing Educational Team (EHNT). The group includes public health nurses, nurse

practitioners, and others with an interest in participating in projects aimed at training other

nurses. All have formal training and/or research and educational experience in occupational/

environmental health.



The goal of the project is to develop trainings based on environmental health competencies for

the nursing workforce, specifically in the areas of:

1. knowledge and awareness of scientific principles of environmental health;

2. taking exposure histories and making referrals;

3. understanding the roles of advocacy, ethics, and risk communication; and





51

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





4. understanding policy and legislation related to environmental health.

In addition to reaching the current public health nurse workforce, the project also reaches the

future public health nurse workforce through course lectures and other trainings conducted by

the EHNT members for students at the Hopkins School of Nursing.



The EHNT has developed a series of six seminars with the Maryland Center for Environmental

Training (MCET) at the College of Southern Maryland. This seminar series was held in FY

2004. Topics included indoor air quality, fire protection, drinking water treatment methods

and ergonomics for nursing home workers. A member of the project actively worked with The

Safety Council of Maryland, Inc. to develop two presentations for the Delaware affiliate, served

on the planning committee for the Maryland Conference on Safety, Health and Environment

that took place April 28, 2004, and has attended meetings of the Maryland Conference of Local

Environmental Health Directors to determine objectives of this organization and identify

potential educational topics for nurses in the region. Faculty of the EHNT presented at the

Maryland Association of School Health Nurses conference on the topic of “Take Home Toxins.”

Meetings have been held with members of the Calvert County Health Department to assess

their training needs related to environmental health topics. As a result, resource packets will be

developed for County Public Health Departments.



Examples of trainings offered:

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

partnership with the Maryland Department of Local Environmental Health Directors,

the Maryland Department of Health and Mental Hygiene, the Maryland Department of

the Environment, the Johns Hopkins Environmental Health Resource Center and the

Center for Excellence in Environmental Health Practice, the Principles of

Environmental Health provided an introduction the concepts and principles of

environmental health for public health practitioners. This training was designed

primarily for sanitarians in training who are preparing the State of Maryland

Registered Sanitarians exam. This was a two week course covered the following topics:

o Perspective of Environmental Health for Maryland

o Board of Environmental Sanitarians

o General Health & Scientific Concepts

o Occupational Health & Safety

o Program Planning and Legal Aspects

o Water & Waste Water

o Waste Management

o Water

o Recreation

o Vector and Pest Control

o Radiation

o Hazardous Materials Management

o Air Quality and Noise

o Housing and Institutions

o Food

o Emergency Preparedness

The Mid-Atlantic PHTC plans to continue offering this course and expand its scope to

beyond the focus of Maryland-based sanitarians. Mid-Atlantic PHTC understands that





52

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





trainings of this kind are in demand by those who plan to take the registered sanitarian

exam. We hope to be able to translate much of this information to distance learning

format so that a broader audience can be reached.

• Pesticides and Public Health: Identifying the Threat, Treating the Problem

• The Air in Schools: State of the Science Indoor Air Quality Management

• Terrorism Response and Preparedness Within and Around Buildings

• Uniting the Healthcare Community in Times of Need

• Introduction to Weapons of Mass Destruction and Preparedness

• Terrorism Response and Preparedness: What You Need to Know

• Biological, Chemical, and Radiological Weapons of Mass Destruction

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

Bloomberg School of Public Health serves as the virtual center for the new National

Health Homes Training Center and Network (HHTC). The HHTC was established to

“develop and disseminate training that integrates knowledge from the disciplines of

health, housing, and the environment and is focused on improving the health and safety

of housing.” The target audience for such trainings is environmental health specialists,

community-based nurses, code inspectors, asset managers, architects/engineers, and

community organizers.



Midwest Center for Life-Long Learning in Public Health (MCLPH)

Serves Minnesota, Wisconsin, and North Dakota



MCLPH has used several approaches to help educate and inform nurses about Environmental

Health Nursing issues. During the past two years, information was distributed about training

opportunities at exhibits throughout the region; collaborative partnerships were developed

with nurse leaders in faculty positions in Schools or Departments of Nursing at Universities;

and an online module was created to introduce nurses to Environmental Health Nursing

concepts and principles; and provided guest lectures for undergraduate nursing students and

degree completion RNs to discuss the opportunities for integration of key environmental

health concepts in the practice of nursing.



Exhibits



Promotion of the online module and information about environmental health nursing has

reached over 3,000 nurses and/or health and safety professionals. Exhibits were conducted at

the Minnesota Environmental Health Association Conference, Minnesota Public Health

Association Annual Meeting/Conference, Minnesota Pollution Control Agency Conference, and

Minnesota Safety Council, Wisconsin Association of Local Health Departments and Boards and

Dakota Conference on Rural and Public Health in Bismarck, North Dakota.



Collaboration



Nurse leaders from the University of Minnesota; University of North Carolina; and The Johns

Hopkins University provided a review of the Introduction to Environmental Health Nursing

module. To assist with piloting and dissemination of information about the module, three

nursing faculty (Metropolitan State University, St. Paul, MN; University of North Dakota-







53

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





Grand Forks; University of Wisconsin – Green Bay) were appointed to the interdisciplinary

Advisory Cooperative of the Midwest Center for Life-Long-Learning in Public Health with the

designated role of Environmental Health Nursing Liaison.



Online Module



“Introduction to Environmental Health and Nursing”, an online module, is accessible at no

charge for those who are taking the course without continuing education credit. Those taking

it at no cost were asked to complete a series of pre-test/post-test questions so that evaluation in

knowledge acquisition could be measured. This study, conducted by a candidate in the dual

degree program of the UMN School of Public Health, Environmental Health Major and the

School of Nursing, Public Health Nursing (MPH/MSN) was recently completed, and

publication of a manuscript outlining the findings is being developed.



From the range, mean and median scores indicate that nurses completing the module

increased their knowledge base about environmental health to some degree. While some

completed the online module as part of their course requirements, others responded that they

accessed the module due to “curiosity, general interest, an interest in improving their

professional practice, and/or to improve a course they offered. Comments from these nurses

identified an unintended outcome: greater familiarity and comfort in accessing timely

information on the Internet. This may have implications for those evaluating the

appropriateness of the Internet as a means to quickly communicate with specific groups of

professionals. To date, over 700 nurses and other professionals have accessed the module.

Seven additional modules were developed in 2004. Each module provides three hours of

continuing education and has been

approved by the American Association of Occupational Health Nurses, Inc.

(AAOHN), an accredited approver by the American Nurses Credentialing

Center's Commission on Accreditation. These modules can be accessed on the Midwest Center

for Life-Long-Learning in Public Health website at www.publichealthplanet.org.



Presentations



Environmental Health Nursing is not a traditional aspect of undergraduate nursing curricula,

but informing nurses of this specialty is key to attracting new professionals to the field. For

this reason, guest lectures to undergraduate nursing students represent a values mechanism

for informing and influencing this next generation of practitioners. Three hundred eighty-five

student nurses have been reached through this mechanism. Presentations were well received.

Course offerings now use the online module and taped resources rather than guest lectures to

advance this activity within undergraduate programs. Materials produced by ATSDR have

been furnished to complement electronic media.



Examples of trainings offered:

• Introduction to Environmental Health Nursing

• Introduction to Environmental Health Nursing- online module

• Minnesota Environmental Health Association (exhibit)

• Minnesota Pollution Control Conference (exhibit)

• Minnesota Public Health Association (exhibit)





54

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





• Minnesota Safety Council (exhibit)

• MN DOH, Division of Community Health Services Annual Conference (exhibit)

• University of Minnesota School of Nursing presentation



New England Public Health Workforce Development Alliance

Serves Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont



The New England Alliance for Public Health Workforce Development employs a broad range of

training and education strategies that improve the capacity of the public health workforce in

each New England State: Massachusetts, Vermont, New Hampshire, Maine, Rhode Island and

Connecticut. Though the public health delivery systems are organized very differently in each

state (ranging from a dozen state district offices in one state to over 300 local health offices in

another), public health nurses are at the forefront of local public health practice. The specific

types of essential services provided by nurses vary from state to state, but in most jurisdictions

nurses have responsibility for environmental health assessment and associated activities.

Funding resources provided by the interagency agreement between the HRSA and ATSDR

have helped the New England Alliance for Workforce Development respond to the need to

train nurses to become more equipped to address current and growing environmental health

issues.



The state public health nurses associations provide direct access to the majority of practicing

nurses in the public systems throughout the New England region. For example, in 2004 the

New England Alliance supported and contributed to the 1st New England Public Health

Nursing Conference – Health, Nursing and the Environment: Strengthening the Relationship

to Protect & Improve the Public’s Health. The planning committee was made up of

representatives from local and state level public health professionals to leaders from schools of

nursing in New England. This venue is bringing nationally and regionally recognized speakers,

e.g. Kristine Gebbie and Stephanie Chalupka, to provide state of the art information and

training to nurses and other environmental health workforce members from New England. The

Alliance helped to design the training, cover expenses and in some cases provide “mini

scholarships” that provided access to nurses and practitioners from the farthest locations. All

participants received practice resources including a current edition of the handbook, Pediatric

Environmental Health, to take back to their practice sites.



The New England Alliance, with partial support of interagency agreement between HRSA and

ATSDR, also developed Foundations for Local Public Health Practice: Tools Needed to Get the

Job Done, in direct response to many requests from local public health workers,

representatives of professional public health associations, local public health coalitions and

health department leadership from several states. This course offers a cross-disciplinary

perspective that focuses on both nursing and local environmental issues and serves as a solid

foundation for other more advanced trainings in several related public health areas.



The primary impact of the environmental health nursing initiative has been the provision of

more training to more nurses through increased collaboration among state nursing

associations, state health departments and schools of nursing on environmental health

matters. As a result, local health public health nurses have enhanced knowledge, skills,







55

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





competencies that should improve job performance that leads to better protection of the

public’s health.



Examples of trainings offered:

• Orientation to Leadership Guide and Resource Manual and BT Preparedness

• Strengthening Ourselves: Building Competency for Preparedness and Prevention

• Foundations for Local Public Health Practice: Tools Needed to Get the Job Done-

developed in direct response to many requests from local public health workers,

representatives of professional public health associations, local public health coalitions

and health department leadership from several states. This course offers a cross

disciplinary perspective that focuses on both nursing and local environmental issues and

serves as a solid foundation for other more advanced trainings in several related public

health areas.

• Health, Nursing, and the Environment



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

Serves New York and New Jersey



The NYNJ-PHTC has offered in-person Environmental Health Nurse (EHN) training

opportunities through a course entitled Environmental Health Training for Nurses and Other

Members of the Public Health Workforce. Trainings have evolved from an exclusively didactic

lecture approach to one integrating hands-on learning activities and a train-the-trainer

component. In 2002, four lectures were offered that were facilitated by a nurse and member of

the University of Medicine and Dentistry of New Jersey School of Public Health faculty.

During year two, the trainings were offered at 7 locations throughout New York State, New

York City, and New Jersey, and included application of case studies as a training activity. In

year three, nurses who were trained as trainers during previous year's program served as

facilitators for the training sessions.



Data has been collected on training impact. Preliminary review of the impact surveys indicates

that attending the Environmental Health Nurse training has resulted in increased knowledge

of the overall discipline of environmental health. More specifically, there is an increased

knowledge of environmental health concepts and available resources, and participants' levels

of interest in the subject matter has increased. Among the gains, the course has been credited

with reinforcing both the need to conduct environmental health exposure assessments as part

of an overall patient history and assessment, and the necessity of identifying populations

susceptible to environmental exposures.



Several new leaders and partnerships have emerged each year. Approximately ten nurses were

hired as nurse training consultants who disseminated information on behalf of the NYNJ-

PHTC for year three programming. Additionally, since bringing this program to the states of

New York and New Jersey, a variety of partnerships and/or networks have been strengthened

or developed:



• The New York City Department of Health and Mental Hygiene (NYCDHMH) solicited the

NYNJ PHTC to offer the EHN training as one training option at their annual back to school

workshops for their public health school nurses. As a result of this service and partnership,





56

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





the NYCDHMH endorsed the center's needs assessment survey and arranged for

dissemination among their public health school nurses.



• The Director of Nursing at Felician College of Nursing attended the EHN training where she

was informed about the UMNDJ-SPH monthly Public Health Seminar Series (PHSS). In an

effort to offer her nursing students exposure to "real world public health," one of her classes

attended several PHSS as a group; she also instituted completion of the center's on-line PH

101 module as part of her class requirement.



• Nurses who attended EHN trainings are part of a "network" of nurses who are kept

informed about NYNJ PHTC developments and other public health nursing news via email

communication.



Again, preliminary qualitative results from the impact survey reveal changes in nursing at

three levels: practice, training, and policy. At the practice level, there has been an overall

increased insight into the impact of environmental factors on health, which subsequently has

led to increased assessment of patient populations, especially pediatric and susceptible

populations such as farmers and those living in close proximity to farms. Participants report

that they apply the concepts learned in the EHN training more regularly in their daily practice.

Nurses also reported an increase in their abilities to identify environmental health issues

among their patients.



From a training perspective, students of the EHN trainings have opted to disseminate this

material in a variety of ways. For example, some report preparing synopses of the training and

sharing the material with their colleagues in written form and at in-service trainings and staff

meetings. One nurse presented highlights of this training to high school teachers at an in-

service training prior to the start of school last fall. Others reported integrating various aspects

of this course into nursing school curricula. Integration of an environmental health exposure

assessment was the most frequently cited addition to nursing school curricula. One nurse

respondent even cited using her EHN take home materials to help review for the Certified

Occupational Health Nurse exam.



The EHN curriculum has successfully been integrated into new nurse-hire

training/orientation, and has influenced the updating of one respondent’s organization's initial

assessment practice. The resulting policy requires nurses to assess environmental factors at

each new home visit and/or as part of all patient assessments. Other training attendees have

been successful at updating their organization's initial assessments and integrating the

concepts learned into their organization's practice.



As previously stated, a variety of policy changes have resulted or are being considered. These

include augmenting nursing school curricula with NYNJ PHTC training material, adding

components of the curriculum to new hire orientation, and modifying patient initial

assessment procedures.



Pre and post tests were administered at all of last year's trainings. However, they were utilized

for the edification of students and no quantitative analysis was conducted. The impact survey

respondents reported increases in their knowledge and awareness. Specific areas of knowledge





57

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





gain were reported in the following topic areas: communicable diseases, cultural competency,

indoor air quality, lead, MSDS, PCBs, principles of adult learning, process of cross

contamination and routes of transmission, sanitation, and an overall increase in knowledge in

environmental health.



The availability of this training has served several purposes for the New York-New Jersey

region's nursing workforce. For some, new material has been introduced; for others a refresher

was provided, and for others the materials reinforced or validated their current practice.

Numerous respondents reported that attending this training resulted in increased confidence

in their knowledge base and that they feel this training is important to nurses without a formal

public health background. If the training had never existed, there would not be a cohort of

nurses who have received specialized training in critical environmental health issues. In

addition, certain networks and collaborations would not have been established. Finally, a

segment of the patient population, the recipients of these nurses’ services, would not be privy

to the benefits of their continuing education activities in nursing practice.



Pacific Public Health Training Center (PPHTC)

Serves California and Hawaii



An extensive survey conducted for the PPHTC by Loma Linda University among approximately

7,000 nurses in California and Hawaii demonstrated that the #1 environmental interest or

concern among nurses in California and Hawaii was dealing with food borne illnesses. Follow

up work with small groups of nurses in Hawaii confirmed the survey’s results. In response,

PPHTC has developed and presented food borne illnesses trainings in California.



In addition, the PPHTC has developed a “roadshow” training approach by traveling to several

counties in California to deliver trainings in order to reach more practicing nurses.



Examples of trainings offered:

• Environmental Health Nursing “Roadshow”- ½ day training delivered to public health

nurses and environmental health specialists; travels to various counties in California

• Environmental Health Nursing for Public Health Nurses

• Mold, Management and the Media

• 16th Annual Pacific Nursing Research Conference

• Food-borne Illnesses Conference

• Introduction to Core Functions

• Core Functions and Cultural Competency

• Core Functions and Public Health

• Public Health and Disaster Preparedness



Pennsylvania & Ohio Public Health Training Center (POPHTC)

Serves Pennsylvania and Ohio



POPHTC Environmental Education of the Nursing Workforce project targets nurses and other

professionals such as health educators, environmental health specialists, and teachers

employed in schools, public health departments, and other agencies that protect and promote







58

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





the public’s health. Both Registered Nurses and Registered Sanitarians/Environmental Health

Specialists are targeted with promotional materials for the resources and face-to-face training

programs. Continuing education credit is offered for professional groups in Ohio. Examples

and Web resource demonstrations from both nursing and sanitarian perspectives are used in

the training programs. Case studies used are relevant to both professional groups and dialog is

encouraged between groups during training activities. This collaborative participation in

environmental health education sessions helps to foster the interdisciplinary approach

necessary in public health practice.



The goal of the POPHTC project was to develop competencies for the nurses and other

cooperative professional workforces in the area of environmental health. The professional

networks of POPHTC's staff, advisory group, and partnering local agencies in both states will

be vehicles for disseminating information and marketing materials and for providing training.

Positive professional working relationships with public health associations, state health

departments and the academic institutions in Pennsylvania and Ohio provided linkages to both

subject matter experts and to the intended audiences.



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



• On-line listing and links to ATSDR and other environmental resources

• Face-to-face training delivery with a Train-the-Trainer approach



Resources and events are promoted through professional association listservs and exhibits,

Training Center distribution lists and advisors, and electronic messages to local health

agencies.



Course evaluations have been collected for each training session to determine the participants’

perceived ability to perform the stated objectives pre-and post training, including after six-

months (this evaluation follows an established POPHTC evaluative procedure).



Examples of trainings offered:

• Environmental Assessment for Public Health Nurses and Environmental Specialists-

face-to-face training provided by the Pennsylvania & Ohio PHTC using an

interdisciplinary approach to train nurses and environmental specialists

• Environmental Education for the Nursing Workforce: Bringing Education and Practice

• Fundamentals of Environmental Health for Public Health Nurses and Sanitarians



South Central Public Health Training Center (SCPHTC)

Serves Alabama, Arkansas, Louisiana, and Mississippi



SCPHTC activities associated with the environmental health nursing project include:

• Conducting a one year follow-up evaluation study to assess the extent to which the

knowledge, skills, and abilities associated with the Health Risk Assessment and Taking

an Exposure History course transfer to improved job performance.

o A competency-based survey was developed to gather both quantitative (e.g.,

performance ratings) and qualitative (e.g., explanations of changes in on-the-job

behavior) data regarding workplace behaviors





59

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





o One hundred forty-six public health practitioners who completed the training

were surveyed; twenty-six public health practitioners completed the survey.

o The findings of the evaluation suggest that successful completion of the Health

Risk Assessment and Taking an Exposure History course results in enhanced job

performance with respect to environmental health issues confronted by many

public health professionals.

• Receiving supplemental funding to conduct a Delphi study among primary health care

professionals. The health care professionals evaluated an environmental health web-

based toolkit of training materials. This project was conducted in collaboration with the

Texas Public Health Training Center and ended fall 2003.



Examples of trainings offered:

• Risk Assessment and Taking Exposure History

• Introduction to Health Assessment and Taking an Exposure History

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

Education (ASTDHPPHE 20th National Conference on Health Promotion and Health

Education) in New Orleans.



Southeast Public Health Training Center (SPHTC)

Serves Kentucky, North Carolina, South Carolina, Tennessee, Virginia, West Virginia



SPHTC focuses on life long learning for public health nurses. The center developed and

facilitates a network of public health nursing faculty from all BSN programs in the state. This

committee works with local nursing directors to develop public health field placements for

nursing students to recruit and prepare them for careers in public health nursing. Particular

emphasis is placed on recruiting nursing students from Historically Black Colleges.



SPHTC began a network of public health nursing faculty that is linked to local nursing

directors. They are all, in turn, linked to the resources of the SPHTC, specifically, and the North

Carolina Institute for Public Health in general. This has already had the impact of providing

nursing faculty with resources that improve teaching, but also has become an avenue for

sharing “best practices’ on how to create meaningful public health clinical experiences for

nursing students. Exemplar clinical placement programs are currently underway in several

counties with local nursing schools. This network is critical for building a culture of

collaboration rather than competition.



This network is an important avenue for institutionalizing environmental health in nurse

training and education as part of the HRSA/ATSDR initiative. The network has an active

listserv and held a state-wide educational conference on the future of public health nursing in

the state, which focused on environmental health.



The Southeast Public Health Training Center has benefited from the association with ATSDR is

many ways. Through partnership with ATSDR SPHTC has been able to institutionalize

environmental health content into established required public health nursing courses aimed at

history-taking and assessment skills such as Adult Physical Assessment and Child Health

Screening and school nurse training. The nurses completing Adult Physical Assessment and

Child Health courses provide the majority of history-taking and physical assessments of health





60

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





department clients, especially in underserved areas. They are a natural target audience for this

type of training. The goal is to teach public health nurses the importance of identifying and

reporting environmental health risks among their patient populations and in their

communities. Environmental health materials have also been incorporated into Introduction

to the Principles and Practice of Public Health Nurses, which is required of all new public

health nurses with two or three year degrees.



A second target is school nurses. The North Carolina Annual School Nurse Conference attracts

upwards of 400 nurses each year. SPHTC presented to this audience in 2003 and 2004. The

focus has been on providing nurses with tools, such as the “I Prepare” cards, ATSDR

newsletters, and/or case studies appropriate for the specific audience from the ATSDR “Case

Studies in Environmental Medicine.”



The public health nurses in NC reflect the vast spectrum of practicing public health nurses and

future public health nurses as well as nursing faculty. While ATSDR’s priority is working public

health nurses, SPHTC feels strongly that the entire continuum of nurses must be addressed to

assure that new public health nurses are prepared for the role. For this reason, some of the

focus is on nursing students and nursing faculty.



SPHTC has introduced ATSDR material into classrooms in nursing schools across North

Carolina through the newly created network of community health nursing faculty teaching.

This local group, as well as the nationally recognized body the Association of Community

Health Educators, (ACHNE), as well as the American Public Health Association Public Health

Nursing Section, are all struggling to translate the “core competencies of public health nursing”

into vital curriculum for both undergraduate and graduate nurses. The newly formed

community health faculty network has been formed to share resources such as the Basic

Environmental Health Module and Risk Communication and the activities of the

Environmental Health Nursing Initiative. There is strong interest in partnering with public

health nursing directors around collaborative research, and environmental health issues,

particularly lead poisoning in children, is a North Carolina legislative priority.



Over the course of these initiatives, SPHTC learned a great deal about nursing and

environmental health and continued to modify trainings accordingly. The first lesson is that it

is not enough to teach about environmental health assessments. Public health nurses have a

fairly good understanding of this process; however, several participants noted concern about

efforts to follow-up on environmental risks and getting no help. Consequentially, SPHTC now

collaborates with local environmental health officers in order to provide better information on

dealing with environmental exposure concerns and communicating risk appropriately.



In dealing with school nurses SPHTC found that it is difficult for many nurses to get past the

environmental risks within the walls of their own schools. Rather than teaching about

environmental risks in the community, the trainings provide tools relating to such issues as

dealing with molds and toxins found within school buildings.



The biggest impact of SPHTC efforts has been a greater understanding of environmental risks.

The Training Center now gets more requests for specific training. The North Carolina Public

Health Association has requested regional trainings on the environmental impact of





61

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





methamphetamine labs. In addition, the annual North Carolina Public Health Nursing

Academic and Practice Summit focused on environmental health.



The collaboration between the SPHTC and ATSDR has created an important momentum in

North Carolina and has resulted in increased demand for training. In addition, SPHTC staff

has become very knowledgeable about environmental health issues and more practitioners are

contacting SPHTC as a resource. SPHTC also saw an increased interest in environmental

health nursing training from the other states in the SPHTC region. In June 2004 SPHTC

sponsored an all-day Environmental Health Law training for local health departments in

Virginia that focused on local health directors and nursing directors. This interdisciplinary

training is designed to help more public health leaders to be able to deal with environmental

risks identified in their health departments.



Examples of trainings offered:

• Incorporation of environmental health information into assessment courses for public

health nurse screeners, such as adult and child health assessment: These are 4-8 week

courses taught through videoconferencing and hands on practice and followed by a six-

month clinical practicum. Completion of these courses allows public health nurses to

perform clinical functions that they could not do with a nursing degree alone.



• Statewide videoconference in North Carolina on Community Environmental

Assessment/Risk Communications: This will be an interactive videoconference at 15

sites located in health departments in North Carolina. A form of this conference was

proposed last year, but focused more on patient assessment, and there seemed to be

little interest. This year we plan to partner with the NC Center for Public Health

Preparedness. The first half will focus on basic data collection and the second will focus

on risk communication using CDCynergy materials. I PREPARE cards will be

disseminated.



• Online Basic Environmental Health Module- in development: This module is part of an

overall training center initiative to develop basic core concepts modules. The need for

basic training in environmental health has been identified as a need throughout the

training center region.



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

Especially Environmental Health



• Include an environmental health speaker or disseminate resources through exhibit

booths at:

o NC Nurse Administrator Meeting

o NC Public Health Association Meeting

o NC School Nurse Conference 26th Annual Minority Health Conference,

o “Health and the Environment”









62

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





Texas Public Health Training Center (TPHTC)

Serves Texas



TPHTC uses multiple approaches to connecting with the target audience. In order to

effectively reach participants across the State, environmental health training has been

presented using live, interactive telehealth conferencing technology to broadcast to multiple,

geographically-diverse sites. With the goal that participants be able to attend a site within a

100 mile radius, this type of broadcast has provided training opportunities to groups that

might otherwise be isolated due to distance.



In addition, TPHTC has responded to that segment of the target audience that resists web-

based training due to comfort level or lack of easy computer access. By offering self-

instructional materials in a hard-copy format, participants have a choice of training modalities

that meet individual needs.



In order to foster interdisciplinary training, all training opportunities focusing on

environmental health issues were marketed to a broad audience of health professionals

including practicing nurses in a wide range of job categories, nurse practitioners, physicians,

and public health professionals.



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



• Calls and emails from across the state indicate that participants want additional training

sites and/or downloadable capability at the work site. TPHTC partnered with the Texas

Association of Local Health Officials to pilot a conference that could be broadcast to all

participating health departments in the State, making the conference available to many

public health practitioners at the work site.



• The response rate from the TPHTC marketing strategy indicated a significant need in

the predominantly rural areas of the state for non-computer-based training materials

and marketing strategies. TPHTC continued to offer this training modality as an option.



• Feedback from the conference evaluation forms indicated a strong interest in the topic

of risk communication. Several participants suggested that this information would be

beneficial to all health professionals and would warrant a telehealth conference focusing

on this topic. The Texas Public Health Training Center initiated such a conference and

offered it three times to a total of 10 sites across Texas, targeting a broad audience of

health professionals.



• The concept of the “circles of influence” is illustrated in the following: the

announcement for the Environmental Health Update for Practicing Nurses telehealth

conference was sent to a potential participant targeted within the State of Texas; she

forwarded the email to the GIS coordinator for US EPA Region 6, who in turn posted it

to an environmental health work group list-serv; from there, it was distributed to the

Director of Border Health at the Texas Department of Health, the Assistant

Administrator at ATSDR, and a division director at the Agency.







63

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





• Registration packets were mailed to a finite number of nurses practicing in one of the 65

targeted counties. It readily became evident that registration forms were being

duplicated by the recipients and shared among their peers; registration forms from

nurses and other professionals outside the targeted geographic areas were received by

TPHTC, requesting the training educational materials.



Examples of trainings offered:

• Environmental Health for the Public Health Professional- telehealth conference

broadcast simultaneously by the Texas PHTC to participants in several cities

• Maintaining Quality of Life Conference (exhibit)

• Environmental Health Case Studies: Taking an Exposure History

• Environmental Health Case Studies: Pediatric Environmental Health

• Environmental Health Update for Practicing Health Professionals

• Environmental Health and Children



Upper Midwest Public Health Training Center (UMPHTC)

Serves Iowa, Nebraska, and South Dakota



At UMPHTC, interdisciplinary participation in trainings is fostered through promotion of the

training sessions through the professional organizations of the health professionals involved in

environmental health. The interdisciplinary approach helps bridge the gaps so often seen

between prevention and care.



This training project provided a venue for offering an integrated perspective on environmental

health to all health professionals. It provides an opportunity to cover the impact of all aspects

of the environment on the lives of citizens across the country, while bringing together the

components of prevention and acute and chronic care related to environmental health. This is

an opportunity that does not routinely exist in the health care community but is essential to

positive health outcomes.



However, to fully bridge the gaps in environmental health, consideration might be given to

including non-health related professionals who are directly impacted by environmental health

issues in fulfilling their daily responsibilities and whose professions deal directly with the

impact of the environment on those they provide services to. Examples of such professions

who might benefit from specifically developed integrated environmental health training are

EMS, Public Safety, Boards of Health and other local governmental decision makers.



UMPHTC administered a Public Health Training and Education Needs Assessment upon

completion of their first environmental health training offerings. Results from this assessment,

as well as the results from training evaluations and post-training surveys, were utilized in

determining the changes in curriculum content and what types of trainings to offer in

subsequent years.



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

following:









64

HRSA PUBLIC HEALTH TRAINING CENTERS ANNUAL REPORT 2004-2005





• 60% agreed or strongly agreed that they had a better awareness of environmental

hazards and their potential health effects.

• 30% agreed that they had engaged in activities related to policy development since they

attended the training.

• 60% have shared the information from the trainings with others, including supervisors,

students, staff in health department, etc.

• 60% said they would be interested in attending another environmental health training

session in the future.



In Iowa, 7 of 19 who attended the training practice in medically underserved areas. Fourteen

(14) of the 19 attendees were from rural communities. Subsequent training sessions were

linked to rural and underserved areas in Iowa via the Iowa Communication Network.



One attendee commented following the training, that she now knew what she needed to do

back in her community to begin the process to change policies within the local school system

regarding asthma, medication and activity requirements. Her child had nearly died when he

wasn’t allowed to use his inhaler during a gym class because of the “medication policy” of the

school but prior to the training, she did not know how to start the process of change.



Examples of trainings offered:

• Environmental Health Update for Practicing Nurses-distance learning

• Environmental Health Update for Practicing Nurses presentation

• A Practice Approach to Environmental Health Issues and Toxic Exposures



Northwest Center for Public Health Practice (NWC)

Serves Alaska, Idaho, Montana, Oregon, Washington, Wyoming



The Northwest Center for Public Health Practice continues to provide foundational

environmental health continuing education training for nurses and other health professionals.

The NWC uses several modes of delivery to ensure broad audience participation in trainings.

In 2004, several trainings were offered via distance learning, particularly by satellite broadcast,

allowing a large group of health professionals from health departments and other health

organizations to participate in the trainings.



Examples of trainings offered:

• Integrating Environmental Health into Nursing Practice- This 1-day in-person

workshop was offered in Seattle in conjunction with a June 20, 2003 American

Association of Occupational Health Nurses conference.

• Assessing Chemical Exposure

• Potable Water: A Public Health Issue

• Bridging Environmental Health and Health Promotion

• Bridging Traditional Environmental Health









65