MDPH Workforce Plan

Staff professional development opportunities

MDPH is committed to creating a learning culture where employees have access to resources and professional development opportunities to build competency and capacity of the agency’s workforce. There are four MDPH workforce development goals:

1. Develop and maintain a workforce with strong leadership skills
2. Provide training for staff to respond to field advancements
3. Create a framework and support for managing performance
4. Develop training and increase available learning opportunities

To achieve these goals, a variety of resources are available to MDPH staff, including Title V staff, through the Performance and Career Enhancement (PACE) system, which is used for eLearning delivery, self-paced online training, and classroom registration. Courses are offered on a range of topics including strategic thinking, business writing, time management, conflict resolution, presentation skills, interviewing, hiring, project management, and leadership. Staff are also supported to attend conferences and training programs offered through community partners, academic partnerships and public health associations. Managers and supervisors receive support through executive coaching, training, team coaching, and succession planning. One example (in which several Title V staff have participated) is MasSP (Massachusetts Aspiring Supervisor and Succession Planning), an initiative of the Executive Office of Health and Human Services. It is a year-long program that addresses the growing need for workforce planning by cultivating a highly skilled workforce that can deliver innovative solutions and approaches that will enhance service delivery.

During the COVID-19 pandemic, MDPH has transitioned to offering many of its professional development opportunities, including MasSP, virtually. Additional learning opportunities have also been organized to support staff working remotely, such as hosting and facilitating WebEx meetings, navigating change, cultivating mindfulness, and a monthly all-staff Grand Rounds highlighting MDPH projects and initiatives.

As part of its diversity plan, MDPH is committed to creating a workplace where inclusion and fairness are valued and operationalized. There are four workforce diversity goals for 2020-2021:

1. Increase the percentage of managers of color through recruitment, improved onboarding, professional development plans, and promotional opportunities.
2. Increase the percentage of employees who identify as veterans and people with disabilities.
3. Strengthen MDPH’s recruitment plan for people of color, people with disabilities, military veterans, and LGBTQ employees. 
4. As the workforce becomes increasingly more diverse, ensure that all are included and feel welcomed at MDPH.

See also the Crosscutting domain for information about efforts within BFHN and BCHAP to promote more racially equitable staff hiring and retention practices.

In FY20, the Executive Office of Health and Human Services Office of Diversity and Civil Rights offered a new training series on race and racism, including affinity group discussions for Black/African American staff, healing from racial trauma, practicing thoughtful allyship, talking about race (for managers), and strategizing and operationalizing diversity and inclusion initiatives. These Secretariat- and Department-wide efforts align with the action plan for the Title V priority to eliminate institutional and structural racism in internal programs, policies, and practices. Title V is committed to increasing employment of staff with intersectional identities, including those with disabilities and people of color, and improving staff retention by fostering a workplace culture that acknowledges and addresses the impact of systems of oppression on staff.

The AMCHP Leadership Lab, which is framed by the MCH Leadership Competencies, has played a key role in providing professional development to current Title V staff. Guided by adult learning principles, the lab provides information and resources relevant to participants’ current and future roles within Title V; develops individualized leadership plans and pairs participants with a matched mentor; challenges participants through collaborative activities and discussions; builds peer networks; and provides ongoing support from an AMCHP staff Cohort Leader. Over the past five years, Title V staff have participated in the Family Leaders Cohort, New Director Leaders Cohort, and Next Generation MCH Leaders Cohort.

The National MCH Workforce Development Center is currently supporting a strategic planning process around MCH/Title V leadership development, change management, and succession planning within the Division of Pregnancy, Infancy, and Early Childhood (DPIE). DPIE anticipates the retirement of three DPIE staff over the next several years, which require strategic planning to ensure a clear and effective succession plan and continuity of DPIE structure and programs. In addition, DPIE has been engaged in the MDPH-wide Racial Equity Movement and has been applying a healing centered focus and a stronger emphasis on family engagement. It is important that these components remain central to the Division’s work and throughout this strategic planning process.

Title V will also continue to partner with the CDC to build epidemiologic capacity in MA. Refer to MCH Data Capacity Efforts for more information.

Student internships

Title V provides practicum opportunities and mentorship for student interns from local schools of public health who help to enhance capacity to meet MCH goals and objectives. Over the past year, students supported projects including but not limited to developing best practice guidelines for use of interpreters in home visiting programs, creating an evaluation plan and conducting environmental scanning activities for the Title V health transition priority, developing a hybrid acuity tool to determine eligibility levels for CYSHN care coordination and related programs, and supporting implementation of the trauma-informed and healing-centered care priority. Beginning in July 2021, an MPH student will support the BFHN Racial Equity Steering Team (REST) in activities such as creating orientation materials for new staff and developing work plans for key aspects of REST’s work including staff engagement, partnerships and collaboration, policy implementation, and internal culture.

MA MIECHV is hosting a CDC Public Health Associate for a two-year assignment that began in October 2020. The Associate plays a key role in designing and coordinating strategies to facilitate meaningful family engagement in all aspects of the program, translating the findings from the MIECHV needs assessment into ongoing program planning and implementation efforts, and improving the cultural and linguistic appropriateness of home visiting services. The Division for Children and Youth with Special Health Needs will also host a team of two students through the National MCH Workforce Development Center’s Title V MCH Internship Program in summer 2021. The project will focus on development, promotion and evaluation of a Youth and Young Adults with Special Health Needs Health Transition Tool Kit. 

Lastly, BFHN has developed a DrPH Fellowship for doctoral candidates to gain leadership and management experience at the state level. The Fellowship will provide an opportunity for doctoral candidates to work alongside Bureau leadership on systems level initiatives in support of statewide MCH programs. The fellow will be a member of the Bureau Leadership Team and will have the opportunity to observe, participate, and contribute to strategic planning activities, day-to-day operations and administration, and discussions around policy, legislation, and program design across the seven divisions within BFHN.   

State Innovations in Staffing Structures  

Community health workers

Community Health Workers (CHWs) are a vital component of the public health workforce in Massachusetts. MDPH estimates there are more than 3,000 community health workers in the state. CHWs contribute to improving access, use, and quality of health care, reducing costs, and reducing health inequities for all populations, including MCH. They are distinguished from other health professionals because they are hired primarily for their connection to and understanding of the populations they serve, have a distinct scope of practice, and have experience providing services in community settings.

MDPH strongly supports CHWs, provides leadership within state government for CHW workforce development, and has been the largest funder of CHW services and training in the state for decades. In addition to ongoing support of CHWs through program contracts (including MCH programs such as home visiting, childhood lead poisoning prevention, and substance use peer support), MDPH’s Office of Community Health Workers in the Bureau of Community Health and Prevention conducts capacity-building initiatives to strengthen the CHW workforce, including supporting certification for individual CHWs and approval of core CHW training programs; training and curriculum development; research and publications; and national networking and promotion of the CHW movement. MDPH also conducts regular CHW workforce surveillance to both assess the impacts of certification on the workforce and to track training needs and financing trends.

Statewide CHW certification became operational in October 2018, and the approval of core CHW training programs by the Board of Certification of CHWs in MDPH’s Bureau of Health Professions Licensure began in 2021. MDPH anticipates greater need for training and training programs will need to be approved for CHWs to qualify for state certification. There are approximately 10 training programs in MA currently offering training in the Core Competencies for CHWs, including several community colleges. MDPH’s work to advance the CHW profession has been recognized by MassHealth, which now offers funding to support core CHW training and training for CHW supervisors under its Delivery System Reform Incentive Program.

Funding for CHW salaries remains insecure and is often allocated through grants related to specific populations, diseases and conditions, although there has been some recent shift towards health care organizations supporting CHW salaries with core operating expenses. Funding priorities and amounts often change from year to year, leaving CHWs and the people they serve vulnerable. The MDPH Office of CHWs is working closely with MassHealth and other state agencies to ensure that CHWs are included under Accountable Care Organization contracts and become sustainable members of the public health and healthcare workforce. These efforts include expanding and evaluating the evidence base of CHW contributions to positive health outcomes and cost containment and educating health payers and providers about the roles and impact of CHWs and how to integrate them into healthcare and other multidisciplinary teams. The Office of CHWs convenes an Intra-Agency CHW Workgroup to coordinate policy efforts for sustainability and consistent messaging throughout MDPH. The Workgroup has revised MDPH contract language on CHWs to reflect the recent implementation of CHW certification.

During the COVID-19 pandemic, the Office of CHWs developed a resource for employers of CHWs that provides practical examples of how to engage CHWs in COVID-19 related activities that are consistent with the Massachusetts scope of practice and Core Competencies for CHWs. The resource was informed by CHWs, their program managers and partners from across the state.

Doulas

Title V is working with the Office of CHWs and MassHealth to develop certification of doulas through the CHW pathway. Doulas are trained non-medical professionals who provide perinatal emotional, physical, and educational support and patient-advocacy. Doula care is associated with improved birth outcomes (including reduced cesarean births, decreased preterm births, and decreased low birthweight infants), as well as cost savings. Community-based doulas are doulas who come from the same communities that they serve. Evidence suggests that community-based doulas may help mitigate some of the maternal health inequities women of color, especially Black women, face.

Currently, doulas are not licensed or certified by Massachusetts and there is no single accrediting body for doulas. However, there is significant overlap between community-based doulas and community health workers, suggesting that certification through the CHW pathway may be a feasible and timely option for doulas interested in becoming certified with the Commonwealth. This pathway would be quicker and potentially more feasible than creating an entirely new board for doula certification. Creating a certification pathway would help to: 1) professionalize doulas; 2) help ensure quality of care; 3) allow consumers to select doulas who have been vetted by a trusted state agency; 4) legitimatize broader insurance coverage of doula care; and 5) set up a means through which insurers may eventually reimburse doulas.

Massachusetts Health Care Workforce

The MDPH Health Care Workforce Center (HCWC) assesses the Commonwealth’s health care workforce, including the current supply and projections of key health professions. Data on health professionals’ language, role, setting and geographic distribution is tracked over time to identify gaps, project future trends, and inform resource allocation, policy and education. 

As of 2017, the most recent data available, there were 28,428 physicians in MA with an active license, with 52% reporting an MCH-related specialty (e.g. family medicine, obstetrics and gynecology, and child and adolescent psychiatry). Of these, 8.8% (3,769) are pediatricians. Although MA has the highest number of physicians per population in the United States, these providers are not equitably distributed across the state. Over one third (38%) of physicians with an MCH-related specialty practice in Suffolk County (including Boston), which is home to just 11% of the state population. Many areas, including rural communities, lack adequate access to care.

The HCWC also collects information on other health professions, such as registered nurses, dentists, licensed practical nurses, dental hygienists, physician assistants, substance use providers, and CHWs. The HCWC partners with state licensing boards to provide a comprehensive description of health workforce supply and access.

Although the health care workforce is well equipped to address the needs of its MCH population, MA is also an exporter of health workforce with a wealth of education and training programs, including seven accredited public health schools[1], four medical schools, three dental schools, and numerous training programs for other health professions. 

[1] Public Health Degree Programs in Massachusetts | List & Guide (publichealthdegrees.org)