The Management Academy for Public Health: a new paradigm for public health management development.

Research has established a need to develop management skills among public health professionals. The University of North Carolina-Chapel Hill created the Management Academy for Public Health as a pilot program for this specialized training need. This article describes why a management academy for public health managers was formed, its curriculum and instructional methods, and the evaluation findings from its first year. The program sponsors hope to effect individual and organization level change, eventually leading to improved community health. Results suggest that this innovative program gives public health professionals needed skills and improves their job performance.     

Training health professionals and lay volunteers to deliver cholesterol screening and education programs

The National Heart, Lung, and Blood Institute of the National Institutes of Health launched the National Cholesterol Education Program (NCEP) in 1985. With the goal of reducing the prevalence of elevated blood cholesterol in the United States, the NCEP aims to raise awareness and understanding in both health professionals and the general public of high blood cholesterol levels as a risk factor for coronary heart disease. Public interest in blood cholesterol measurement has created an enormous market for cholesterol screening and education programs. The importance of quality screening and educational services was recognized by the NCEP, which has urged the training of all personnel involved in public cholesterol screenings. This paper presents models for training lay volunteers and health professionals to deliver quality public screening programs for high blood cholesterol that are consistent with NCEP recommendations. Blood cholesterol screening, counseling, and referral (SCORE) programs are key intervention strategies of the Pawtucket Heart Health Program (PHHP), a cardiovascular disease prevention research program in Pawtucket, RI. This paper describes the PHHP volunteer training and certification program for cholesterol SCOREs and the demographics of screening volunteers. With the goal of improving the quality of cholesterol screening and education programs nationally, the Cholesterol Training Center (CTC) was established in 1988. Using models established by PHHP, the center developed training workshops to help health professionals initiate, update, expand, or enhance training for cholesterol screening and education programs. CTC training protocols and the characteristics of workshop participants are described, and the workshops' effects on participants' knowledge and self-sufficiency are discussed.     

Transfer of behavioral intervention technology to a sexually transmitted disease clinic.

This article describes the authors' approach to introducing a behavioral counseling intervention into a local health department STD clinic setting. The goal of the intervention was to change the sexual practices of clients with STDs. The project was a collaborative effort with a local health department, school of public health, and a community training organization. The authors used an organizational change framework for implementing the intervention.     

Exploring a public health perspective on pedestrian planning

A pedestrian plan is a public document that explains a community's vision and goals for future pedestrian activity. This study explored whether involvement by public health professionals in the development of pedestrian plans was associated with certain characteristics of the plan (vision, goals, identified programs, and evaluation). This study identified, collected, and analyzed content of all pedestrian plans in North Carolina through 2008. Among the 46 plans, 39% reported involvement by public health professionals in their development. Overall, 72% of pedestrian plans included a vision statement; health was mentioned four times and quality of life was mentioned five times. Slightly more than half (52%) of the plans included goals to improve public health. Plans that involved public health professionals more often included the type of physical activity, safety, or education program. Only 22% of all pedestrian plans included a proposal to evaluate their implementation. Plans that included public health professionals were less likely to include an evaluation proposal (11%) compared with those that did not involve public health professionals (21%). Public health professionals are encouraged to seek involvement in the pedestrian planning process, particularly in the areas of health program development, implementation, and evaluation.     

Early Childhood Vision Screening in Hawai‘i Utilizing a Hand-Held Screener

The goal of early childhood vision screening is to detect subnormal vision and amblyopic risk factors that threaten visual development so that treatment can be initiated early to yield the highest benefit. Hand-held, portable, instrument-based vision screening devices can be used in children as young as 6 months of age. We assessed the feasibility of hand-held photoscreeners to screen for vision disorders in pre-school children in Hawai‘i. A total of 137 preschool children on O‘ahu in the “Tutu and Me”/Partners in Development program were screened at 6 different locations using the Plusoptix S12 hand-held photoscreener. Once technical issues were resolved, screening was fast and well tolerated. Possible vision abnormalities were found in 11 of the 137 children (8%). Poor compliance for follow-up with formal vision examination limited our ability to confirm these abnormalities. We conclude that photoscreening has the potential to facilitate early childhood vision screening in Hawai‘i. The optimal referral criteria for use in Hawai‘i will need to be determined after considering the age of the screening population and the available medical resources in Hawai‘i. Early detection of treatable eye disorders has far-reaching benefits for the visual development and long term health and well-being of children. A comprehensive early childhood vision screening program in Hawai‘i utilizing automated hand-held photoscreeners may have public health value. Such a program should integrate referral to an eye care professional for confirmation and management of vision disorders of at-risk children found on screening.     

Career paths to public health: programs at the Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention offers training in specific, critically needed disciplines such as epidemiology and laboratory sciences, frequently through experiential, on-the-job service and learning fellowships. The agency also provides a more general exposure to public health as a field, often for younger participants, through shorter-term internships. In addition, other programs provide opportunity for exposure to public health thinking and public health problems in an academic setting as early as elementary school. Although a primary purpose of these programs, especially the experiential fellowships and internships, is to attract young people to public health careers, a secondary goal, particularly for the younger students, is to foster an awareness and concern regarding their personal health. The Career Paths to Public Health Program focuses on students and teachers from elementary to undergraduate schools and builds on CDC's existing postgraduate training programs. The program enhances student interest in the practical uses of mathematics and science and introduces them to the exciting work of public health. These activities also provide a nexus for working with both traditional partners in academia and public health and new academic partners to foster programs of mutual interest.     

Service-learning: an integral part of undergraduate public health

In 2003, the Institute of Medicine (IOM) described public health as "an essential part of the training of citizens," a body of knowledge needed to achieve a public health literate citizenry. To achieve that end, the IOM recommended that "all undergraduates should have access to education in public health." Service-learning, a type of experiential learning, is an effective and appropriate vehicle for teaching public health and developing public health literacy. While relatively new to public health, service-learning has its historical roots in undergraduate education and has been shown to enhance students' understanding of course relevance, change student and faculty attitudes, encourage support for community initiatives, and increase student and faculty volunteerism. Grounded in collaborative relationships, service-learning grows from authentic partnerships between communities and educational institutions. Through emphasizing reciprocal learning and reflective practice, service-learning helps students develop skills needed to be effective in working with communities and ultimately achieve social change. With public health's enduring focus on social justice, introducing undergraduate students to public health through the vehicle of service-learning as part of introductory public health core courses or public health electives will help ensure that our young people are able to contribute to developing healthy communities, thus achieving the IOM's vision.     

Training Primary Care Physicians for Local Health Authority Duties in Texas

Only one fourth of Texas counties have a local health authority (LHA) or health district. Primary care physicians in the remaining counties could be trained in public health basics by providing an online LHA training course and courses at annual meetings of the Texas Medical Association and the Texas Academy of Family Physicians.The Texas Department of State Health Services should develop a web portal for LHAs. The Texas Association of Local Health Officials should also provide automatic limited membership for LHAs.These initiatives would provide public health training to primary care physicians and would greatly improve availability of public health services for the citizens of Texas.The US Department of Health and Human Services recently identified priority drivers of public health quality and outcomes. One of these priority drivers is “workforce and education,” developing and sustaining a competent public health workforce by “ensuring that educational and skills content are appropriately aligned with core and discipline-specific competencies.”1^(p4) As members of the public health workforce, local health authorities (LHAs) have the responsibility to connect the health of individuals to public health services in the communities which they serve. The role of the LHA is essential to assuring a vision of healthy people in healthy communities. This analytic essay describes a collaborative approach to facilitate clinician education and lifelong learning, contributing to the national goal of population health improvement.     

Eliminating disparities: empowering health promotion within preventive medicine

The estimated 800,000 U.S. deaths in 1990 related to behavioral decisions challenge physicians to better assist behavioral change through expanded health promotion activities. Based on the format guidelines of this special issue, this brief paper first examines the current and optimal roles of health promotion within Preventive Medicine, including five physician roles for improving modifiable public health-risk behavior burdens: (1) preventive services clinician, (2) health promotion researcher, (3) educator-communicator, (4) systems manager, and (5) health promotion advocate. After presenting a new vision statement, this paper proceeds to discuss the opportunities and barriers, including system, clinician-office, and patient factors, to attaining this new vision of empowering health promotion within Preventive Medicine. Finally, all physicians are invited to engage in a threefold strategic plan for change through at least one of five action items: (1) health promotion advocacy, (2) health promotion research, (3) public communication, (4) protocol dissemination and implementation, and (5) Preventive Medicine training.     

Emergency preparedness training for public health nurses: a pilot study

The Columbia Center for Public Health Preparedness, in partnership with the New York City Department of Health, recently developed an emergency preparedness training program for public health workers. A pilot training program was conducted for a group of school health nurses and evaluated using a pre/posttest design. A surprising finding was that 90% of the nurses reported at least one barrier to their ability to report to duty in the event of a public health emergency. The most frequently cited barriers included child/elder care responsibilities, lack of transportation, and personal health issues. These findings suggest that it may be prudent to identify and address potential barriers to public health workforce responsiveness to ensure the availability of the workforce during emergencies.     

Beyond informatics: an electronic community infrastructure for public health.

Public health agencies are in the early stages of building an electronic infrastructure that will link them to each other and eventually to the "information superhighway." Emphasis in planning and development is on data systems and the information and training services that can enhance essential public health services. This article argues for a larger vision of the potential of electronic networks for public health. It discusses the health and other challenges facing public health, the limitations of conventional efforts, and the emerging consensus on public health core functions. Finally, it examines current and potential uses of information technology. The article concludes by proposing that the public health community should develop a collaborative and inclusive vision of public health in an electronic world and provide guidance and support for agency implementation to ensure a stronger system that can meet the health and health equity challenges ahead.     

疾病预防控制机构公共卫生医师规范化培训的内涵建设思考

规范化培训是医师,包括公共卫生医师成长的重要阶段,当前疾病预防控制机构公共卫生医师规范化培训正在进行试点,关于公共卫生医师的规范化培训应包含什么内容,以及如何进行培训,都在摸索和积累经验的过程中。文章就“规范化”为切入点,对公共卫生医师规范化培训中涉及的师资选择、教学内容、教学过程、教学主客体、教学条件、教学管理体系等内涵设计提出建议,旨在提供思路,以规范公共卫生医师规范化培训的建设。     

A conceptual model for leadership development.

Collaboration among schools of public health and national, state, and local health agencies has resulted in creation of comprehensive public health workforce education and training initiatives that offer integrated, sequential, and accessible professional development programs, including a nation-wide network of public health leadership institutes. A conceptual model for leadership development is presented. It contains seven elements considered critical for design of leadership programs in public health: capacity/competence needs; program target; area served; program content; training level; learning approach; and implementation methods. This model can be used to design leadership as well as public health workforce education and training programs.     

What does it mean to build research capacity?

The family of family medicine organizations has identified clinical and practice-based research as a high priority for our specialty. This is based on the vision that all family physicians have a role in the generation and application of new knowledge to improve the health of individuals, families, and communities. This goal can only be achieved by increasing the number of trained and experienced family medicine researchers and enhancing the value of research to practicing family physicians, their patients, and the public. To meet this goal, the Committee on Building Research Capacity of the North American Primary Care Research Group and representatives from all of the Academic Family Medicine Organizations groups developed a strategic plan. The plan focuses on the training, funding, infrastructure, and linkages required to develop new family physician researchers and to change the culture of family medicine to accept research as integral to our specialty. In addition, the plan acknowledges the need to enhance the reputation of family medicine research and increase family medicine research publications by assuring that we ask the right questions.     

The New Hampshire public health network: creating local public health infrastructure through community-driven partnerships.

In 1997, under the auspices of the Turning Point program, New Hampshire's public health stakeholders convened a strategic planning process to transform the state public health system. What emerged was a fundamental vision that the public health system could only be improved by strengthening the capacity of local communities to address local health issues. A plan was developed to create regional public health structures, in areas with no local health departments, to deliver essential public health services at the local level. Seven years later, that plan has become the New Hampshire Public Health Network. The network now covers 67% of the New Hampshire population and includes 113 (48%) cities and towns. Pre- and postevaluations to assess local public health infrastructure at the inception of the program and following 2 years of funding and technical assistance showed significant improvement in local public health capacity and performance. This article describes the development of local public health structures in New Hampshire where none had previously existed.     

海南省农村卫生扶贫建设医务人员培训项目评估研究

目的:对海南省农村卫生建设扶贫项目培训子项目进行评估,促进基层医务人员培训工作开展。方法:采用Kirkpatrick的四层次模型评估法,分为反映、学习、行为和结果四个层面对培训项目进行综合评估。结果:反映层:学员对于课程设置、环境、教学过程绝大多数表示满意;学习层:培训有一定效果,但未达到理想要求,理论水平仍较差;行为层,学员自我评价有收获,领导和同事一致认为学员水平得到提高;效果层:培训目标改变不明显,有待进一步观察。结论:培训项目获得了基层医务人员的肯定和接受,取得一定效果,但仍未达到理想水平;培训项目的组织和形式值得推广,基层医务人员培训工作任重而道远。     

Performance-based public health in Texas.

Responding to a 1987 state audit report, the Texas Department of Health began a performance-based objectives project to tie contract funds to local health departments (LHDs) to performance measures. The overall goal of the project is to improve public health practice in Texas. A major focus has been on having regional and LHD program staff develop realistic and measurable outcome and process objectives. Training on the planning and monitoring phases of the health program management cycle has been conducted, with future training planned on the evaluation phase. There are increasing reports on the value of the performance-based objectives process.     

Social inequalities in health. A partnership of research and education

The Chair on Health Inequality is one of the 12 Chairs created by the CHSRF. Resulting from a partnership between l'Université de Montréal, together with the Direction de la santé publique of the Régie régionale de la santé et des services sociaux Montréal-centre, the Chair will create a research program that will document and assess the role of public health programs based on social development in urban districts, in reducing social health inequality. This research infrastructure will support two training programs: 1) a post-doctoral training program that will introduce newly minted social science PhDs to collaborative research in public health; and 2) a professional doctorate program for public health professionals. The decision-makers and policy-makers targeted by the Chair's knowledge diffusion program are Directors of public health organizations.     

The UNC Management Academy for Public Health: how the UNC School of Public Health and the Kenan-Flagler Business School created a winning partnership.

The University of North Carolina Management Academy for Public Health is a unique training program that combines a business education with a public health focus, to enhance the performance of individual public health managers and improve organizational strength throughout governmental public health. This article considers the implications of decisions made in creating this program, which, after initial funding through the Centers for Disease Control and Prevention Foundation, is now self-sustaining through participant fees. It details the principles behind the program's design, curriculum, evaluation, and sustainability strategies; presents results of the ongoing partnership; and draws conclusions about the program's future ability to meet a national need for public health management training.     

Developing leaders in public health: the role of executive training programs

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.