Workforce Development 

State: FL Type: Model Practice Year: 2018

FINAL VERSION The Florida Department of Health in Leon County is in North Florida. The county encompasses 702 square miles and within it is the city of Tallahassee which serves as the capital of Florida. The population for the county is 287,822. Tallahassee is home to two major universities, Florida State University (FSU) and Florida Agricultural and Mechanical University (FAMU). FSU has a student population of 40,255 and FAMU has a student population of 11,848. Despite having two public health programs in Leon County, maintaining a competent public health workforce is an ongoing challenge. The twin problems of noncompetitive salaries and loss of institutional knowledge due to an aging workforce, spurred leadership at Department of Health in Leon County (DOH - Leon) to create an infrastructure to connect students with experienced public health professionals, tap into faculty expertise from the universities and increase productivity for local public health. This infrastructure was created as part of an academic health department agreement between DOH-Leon, FSU and FAMU in January 2016. Goal: Increase formal involvement of FAMU and FSU health sciences, medical, public health and other programs in the Academic Health Department partnership. Objective: Address each partner's objectives as it relates to educating students and the provision of public health services to residents of Leon County. Objective: Expose students to public health practice. Objective: Increase the number of students upon graduation that obtain employment in a governmental public health setting. On June 3, 2014, the health department hired a new Health Officer that is employed by FSU College of Medicine and contracted with Florida Department of Health. The vision that the Department of Health in Leon County could become an academic health department took hold and in January 2016 an agreement was signed by FSU College of Medicine, FAMU Center for Health Equity in the College of Pharmacy and DOH-Leon to officially be an academic health department. In the summer of 2014, a senior manager began the process of cultivating relationships with academic programs at both universities. We had in place rotations from FSU and FAMU College of Nursing. Senior manager met with the public health programs at both schools to begin discussions about placement of interns and explored the possibility of partnering with other academic programs at the universities for internships and student rotations. Definitions: Interns Bachelor and Master level students that are in a program with specific requirements for hours, projects, goals and objectives. This also includes nurse practitioner students that need to complete a preceptorship. Student rotations These are students in a clinical program such as nursing. They come to the health department for two days a week for a semester and work in specific clinical areas of the health department. Clerkships- These are 3rd year medical students that spend two weeks shadowing staff in community health. DOH-Leon guidelines for internships, student rotations and clerkships were developed and an affiliation agreement was completed and signed by both parties. Students that were interested in interning scheduled an appointment to meet with DOH-Leon staff, complete an application packet and fingerprinting. During the interview, they were asked questions on their areas of interest, future, and the requirements of their programs. The health department staff discussed opportunities with them and, based on mutual consensus, arrived at a match. The objectives listed above were met. Since 2014 there has been an expansion of DOH-Leon internships with several different academic programs participating. We have been able to employ some of the students that have completed internships at DOH-Leon and others have taken positions at DOH-headquarters (also in Leon County). The objective of increasing the knowledge base of our staff about public health fundamentals was fulfilled through an FSU public health 101 course to regional public health staff that included DOH-Leon. Factors that have led to the success of this practice include an interdisciplinary approach that yields a diverse and rich public health workforce. Programs such as social work, urban and regional planning, business, public administration and health care management lend new perspectives and creativity to the local public health team. A commitment of a senior management staff person with strong ties to the community and academic partners to oversee this initiative was instrumental. A defined process and use of a continuous quality improvement approach for recruitment, selection, and orientation helped this initiative to be successful.
The public health problem that is being addressed is recruiting and retaining a public health workforce. In 2005, the NACCHO National Profile of local health departments reported that 65% of local health departments' top executives were over the age of 50. As the public health force retires, it is imperative that steps be taken to not only preserve the historical knowledge but also to bring a young, vibrant, competent workforce into public health. Lending additional credibility to the issue of an impending public health workforce crisis, ASTHO's State Public Health Worker shortage report (2015) predicted that up to 45% of public health employees would be retiring in the next 5 years. Clearly, there is a need to recruit and train students and foster a bridge to the workplace, as hospitals and other businesses have done for years. In the past, the health department has utilized social work interns sporadically in our social services section. We never had a process in place for accepting interns from public health or other disciplines. We had clinical rotations with schools of nursing, nutrition and dental hygiene. Throughout the health department there was a reluctance from managers and supervisors to host interns and student rotations. People were on guard and fearful that it would take too much time to have students and they did not see the benefit. A part of the process was demonstrating to staff how properly supervised students could assist them in reaching their goals. Another component was to show the staff that they had a wealth of information and expertise to share. The current practice of recruiting interns from a variety of disciplines allows an introduction of new people to the field of public health and an opportunity to recruit competent, creative people to the workforce. The innovative practice with this program is the scope of academic programs, beyond public health, that were invited to participate in our field experience. Recruitment has expanded to elevn different disciplines and six universities. Student support has increased the labor pool and allowed DOH-Leon to complete projects that may have not, otherwise, been possible. Long-term, the health department has been able to employ some of the students that have completed internships. The academic health department (AHD) is a model that was used to create this practice. Senior management participated in AHD webinars and conference calls to learn more about how to operationalize the model. The AHD model has been focused mainly on relationships between health departments and schools of public health and public health programs. DOH-Leon looked at the model and expanded it to multiple disciplines. Since 2015 we have offered internships from the following areas: public health, nursing, medicine, dental, business, social work, healthcare management, urban and regional planning, information technology, public administration, and journalism. The AHD model/framework is a concept vs. an evidence based practice at this time. There is an associated research agenda on the Public Health Foundation website under the Council on Linkages that is being used to develop the evidence for AHDs. Our experience tells us that the AHD model fosters very close relationships between the local health department and participating universities, creating the surge capacity for important public health work such as community health assessments and health impact assessments.
Goal: Increase formal involvement of FAMU and FSU Health Sciences, medical, public health and other programs in the Academic Health Department partnership. Objective: Address each partner's objectives as it relates to educating students and the provision of public health services to residents of Leon County. Objective: Expose students to public health practice. Objective: Have students upon graduation obtain employment in a public health setting. Steps that were taken to implement the program starting in Fall, 2014 were: - Contact professors, department heads and university programs to discuss public health and opportunities to collaborate. - Talk with health department staff, supervisors and managers to discuss their needs and to explain how students could be a benefit. - Review volunteer policies, and forms. - Participate in AHD webinars and conference calls and learn about what an academic health department is. - Complete affiliation agreements with the academic programs. - Review the requirements for internships for the different academic programs. - Set up schedules for clinical rotations with the FSU, FAMU, TCC nursing and dental hygiene programs. - Set up 3rd year clerkship rotation with FSU College of Medicine. Once this was completed we worked with the universities to have them advertise” opportunities at the health department for internships. Each department did it in different ways, some sent it out to their students via their list serves, others had binders set up for students to look for opportunities. As soon as the universities did this the health department started receiving calls. We provided internships for students during the following semesters: Fall (August), Spring (January), and Summer (May). We would begin the recruitment process at least two months prior to the following semester. During 2014, we had four affiliation agreements with two universities and as of today, we have 13 program affiliations with six universities within Florida and out of state. We have experienced online programs throughout the U.S. contacting us for opportunities for students that are becoming nurse practitioners. In the Spring of 2015 the Health Department was contacted by FAMU College of Public Health and asked us if we would consider being a part of the Pathways to Practice Scholars Field Placement Program during the summer. We agreed to this and began the process with them and the Region IV Public Health Training Center to interview and accept a student scholar. This partnership has continued and we have been honored to have a Pathways to Practice scholar each summer since 2015. Through the CDC website, the senior manager intern coordinator learned about the CDC Public Health Associate program. In January 2016, DOH-Leon applied to become a host site. We were accepted and in October, 2016 and received our first CDC PHAP associate for two years. Both programs are integral in meeting our objectives of exposing students to public health practice and students obtaining employment in the public health field. Since 2014 we have been able to offer 62 internships, clerkships to students. There are a variety of academic programs that we have worked with. These include: - Social Work - Public Health - Urban & Regional Planning - Business - Nursing - Health Care Management - Medicine - Public Administration - Information Technology We also have rotations through the health department for several programs. These include both FSU and FAMU Colleges of Nursing, and TCC Dental Hygiene school. The FAMU College of Nursing have their seniors complete a rotation with our school health, STD and HIV programs each Fall. They have asked us to expand this and have it available in the Spring semester as well, this will begin Spring 2018. We provide a rotation for the FSU College of Nursing Vulnerable population clinical lab where nursing students spend twelve weeks at DOH-Leon and rotate through Environmental Health, STD, HIV, Tobacco, WIC, Breast and Cervical Cancer Prevention and clinic. Dental hygiene students are assigned to the DOH-Leon dental clinic (Molar Express) and are providing hands on supervised services each semester. These rotations give an additional 60 students the opportunity to be exposed to public health practice. The criteria for inclusion in the DOH-Leon internship program is as follows for all students: 1) must be part of an academic program that includes internships 2) must be referred by a professor from their department 3) must complete the Florida department of Health volunteer application 4) must complete and pass the fingerprinting and background check. The cost of fingerprinting is $30.00 per student and has been absorbed by DOH-Leon 5) must complete an interview with the senior manager intern coordinator and discuss their expectations 6) prior to starting, must complete a half day orientation that includes an introduction to the health department, information security and confidentiality training, and safety training and 7) complete any specific trainings required to for their program area. For example, in the HIV area all interns complete the HIV 500/501 training. Because the health department utilizes TRAIN we can offer students opportunities to complete many trainings online. We also recognize the importance of conferences and in person trainings and have that available for students as well. An example of this is our Human Trafficking training, which is offered in the spring of each year for health professionals and invited students. There are many different stakeholders involved that make this practice successful. The universities initial role was to collaborate to make this practice happen. This was achieved via phone calls, meetings, emails with professors, department chairs and their liaisons. They then took an active role working with the health department staff to have affiliation agreements in place and signed. It was also important for them to review their internship guidelines, goals and objectives. We worked together for the success of the students, the health department and the academic programs. It also became important to the universities to have the health department staff be a part of their accreditation processes and curriculum development. The stakeholders at the health department are the staff. Staff must see that they have a vital role in exposing and training current students to be the face of public health in the future. They need to feel empowered to share the institutional knowledge they have with students. It takes a commitment of staff, supervisors and management for this to happen and be successful. The total estimated cost of this program is $12,600/year and includes the cost of fingerprinting ($600/year) plus 400 hours/year in staff time ($12,000 including the coordinator). Staff time is spent in maintaining relationships, providing a field experience for students, staff and university personnel.
Goal: Increase formal involvement of FAMU and FSU Health Sciences, medical, public health and other programs in the Academic Health Department partnership. Objective: Address each partner's objectives as it relates to educating students and the provision of public health services to residents of Leon County. (Objectives included public health field experience and exposure to the essential public health services for students and this was met 100% for students who completed the internship (58/60)) Objective: Expose students to public health practice. (Done for 60 students over three years) Objective: Have students upon graduation obtain employment in a public health setting. (9/18 survey respondents are working in governmental public health setting at this time) DOH-Leon conducted an evaluation of its Internship Program to make improvements that will lead to a well-rounded program. A survey via Survey Monkey was sent out to interns who completed the program to determine the effectiveness of the program and impact on their career. Assisting students to choose their career path is a goal of the health department. One way of achieving this goal is to allow them to choose their interest or rotate throughout the department. The interns completed their internship in the following areas of interest: Social Services, Community Health, Business, HIV, Program Administration, Epidemiology, STD, and Refugee Health. Data was collected and analyzed using Survey Monkey. Each intern was queried to reveal their area of interest, experience in the program, and recommendations for improvements. Thirty-nine interns received the survey, and 18 completed it (46%). Overall, the internship received positive feedback. Ninety-nine percent of those responding believe the internship assisted in shaping their career. Per Juan Lopez, MD, I had a wonderful time rotating with you all at the health department and would certainly consider that a pivotal experience in my choosing a community mental health focus for my psychiatry residency”. Many of the interns upon completing the program were ready to move forward in the field of public health, and nine are currently working in the public health industry. The recommendations from the interns will be used to make improvements to the program. In conclusion, an effective internship program is an important part of a student's career, because he/she will gain firsthand knowledge of their chosen career field. It is also a chance for the student and the organization to work together to create a stronger internship program through learned experiences. Moving forward, all interns will receive a detailed job description with objectives explaining their assignments and/or project. More hands on or interactions with the community will be incorporated into the program. A request for longer internship hours will be taken into consideration and discussed with future students and their faculty advisors to coordinate with their class schedules.
Lesson #1: Demand for internships exceeds capacity at DOH-Leon thus creating a competitive environment for students. The requests coming from students exceeds our ability to place them. We have a certain number of programs and can only handle a set number of students. There have been times that the health department works with students to do their internships on a different semester then they originally had anticipated. Students have learned that it is competitive and that it is best to inquire early. An example of this is with the student nurse practitioner program. Students are requesting preceptorships a year in advance. Lesson #2: Coordination of the all aspects of the program is key to success. The application process can take up to three weeks to have completed with each student. It involves the student completing the application, setting up an interview, having the fingerprinting completed and returned, orientation and placement. Students have learned that waiting until the last moment to complete the process is not in their best interest. Lesson #3: Recognize current reality at DOH-Leon and adjust expectations accordingly in order to meet student and staff objectives. The senior manager coordinator has learned that it is wise at times to step back and, dependent on what is taking place at the health department, consider suspending a program area from having students some semesters. Examples that impact this are maternity leave, retirements, staff turnover/new supervisor etc. Lesson #4: Participating academic institutions need to have affiliation agreements in place prior to the start of the academic year so that they are eligible to place students at DOH-Leon. This has been a work in progress and we have learned that we must begin this process at least a semester ahead to have everyone's signatures in place prior to the students starting. We have had some difficulty with this and have been flexible with this. If it is in process, we still have allowed the students to intern. We have also learned that different academic programs have different levels of expectations for internships. There are some programs that because of their accreditation standards have defined hours, goals, and objectives that must be met. Other programs are new to offering internships and do not have set expectations. We are working with different academic programs to share with them what other programs have in place. Lesson #5: Consider standardized affiliation agreements with academic institutions. As we are reviewing affiliation agreements for the future we are evaluating the possibility to have one affiliation agreement for each university. Having one for each academic department is a time consuming process. Lesson #6: Partner collaboration is instrumental in having a successful program. The cultivation, growing and maintaining of the partner contacts is vital to the program. This is very time consuming, but beneficial. One of the many benefits gleaned through the process is that the health department can be a partner in curriculum development and accreditation and the academic institutions can support health department accreditation as well through participation in site visits. Involvement of the academic partners in community health assessment (door to door surveys) and health impact assessments has been a benefit from the relationships. The Florida Department of Health estimates the cost savings at $20.51 an hour for non-licensed volunteers. Based on the interns we have had since 2015 we see a cost savings of over $80,000. This is the equivalent of one senior management position with benefits. There is stakeholder commitment to sustain and expand this practice. We will be looking at ways for this practice to be a funded position. One idea is that the universities partially fund the position. At this time the position is just one of the many job responsibilities of a senior manager at the health department. If we are to expand the program, we would have to reevaluate this and see what resources the universities can offer to assist. Within the health department we have recently included our contract manager as a part of the process. This position is responsible for tracking all the affiliation agreements, obtaining the needed signatures and maintaining a data base of timeframes for the agreements.
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