With 283 employees and an annual budget of $95 million, the Family Health Services Division (FHSD) is one of the largest divisions in the Hawaii State Department of Health (DOH). FHSD staff have varied professional experience and training. Very few FHSD program staff have formal training in public health. Most have program management experience or subject matter knowledge in their respective areas.

Workforce development opportunities for staff are funded by or through federal grants that support travel to national conferences, access to subject matter experts, research, technical assistance (TA), and state peer networking. State funded staff generally have less access to these resources.

As part of the 2020 needs assessment Hawaii reviewed the results from the Hawaii State Department of Health (DOH) national Public Health Workforce survey (PH WINS). The 2017 survey results, conducted nationally by the Association of State and Territorial Health Officials (ASTHO) and the de Beaumont Foundation, were released in 2019. The survey helps public health agencies understand workforce strengths, gaps and opportunities to improve skills, training and employee engagement.

Similar to national findings, Hawaii public health workers have high job satisfaction (80%), low pay satisfaction (50%), and slightly better than average satisfaction with the organization (65%). Nearly, 60% of workers report intent to leave with roughly half those due to retirement. The top three areas for employee engagement reflect the strong mission-driven purpose of public health workers:

• Recognizing the importance of the job (94%)
• Willingness to do the best work possible (93%)
• Understanding how the work relates to the department’s larger goals (88%)

The top three opportunities to improve employee engagement were:

• Improving communication between senior leadership and workers (43%)
• Assessing training needs (42%)
• Encouraging and rewarding creativity and innovation (40%)

There were five areas that emerged for training needs:

• Systems and strategic thinking (54%)
• Budget and financial management (52%)
• Developing a vision for community health (48%)
• Change management (46%)
• Cross-sector partnerships (42%)

Overall, recommendations for DOH improvement were:

• succession-planning
• assessment and investment in training
• workplace policies/practices that support employee engagement and organizational satisfaction

The de Beaumont Foundation conducted a separate analysis of the responses for FHSD since the Division represented 10% of total department responses. Although the numbers were too small to be conclusive, the results largely reflected those of the DOH.

FHSD worked with the DOH Administrative Deputy to present the survey results to the DOH management team. The PH WINS findings were to be used to create a departmental initiative addressing workforce development needs including promoting the 2020 PH WINS with employees. However, this effort was delayed due to other department priorities including the DOH response to the COVID pandemic. The 2020 PH WINS survey was also postponed due to COVID.

FHSD uses Title V as an opportunity to build public health capacity for program staff. In 2015, FHSD formalized a Title V Leadership Committee to guide and support the Title V reporting process. The Committee is comprised of program staff leading efforts for the Title V NPM/SPM, FHSD management, neighbor island nurses, Division epidemiology/data staff, and a representative from Hilopaa Family to Family Information Center (HF2FIC) and MCH LEND faculty. HF2FIC’s participation ensures family perspectives are considered in decisions regarding Title V planning. MCH LEND’s participation allows Title V to leverage training resources/faculty from the Hawaii LEND program.

The Committee serves as a unique platform to promote Division wide collaboration. The meetings are used to share information, resources, identify needs/problems, develop and implement new ideas and innovations. There are few forums to support this type of cross-program discussion.

In FY 2018, FHSD partnered with Dr. Jeanelle Sugimoto-Matsuda, to provide TA for program staff to address the new Title V guidance focus on planning, evidence-based practices, and evaluation. Dr. Sugimoto-Matsuda is a faculty member with the University of Hawaii, Office of Public Health Studies. Trained in public health and translational research, she brings formal background in assessment and evaluation methods. With this TA, FHSD priority leaders developed logic models for each national and state priority area. Through the logic models staff were able to review program progress, achievement of short- and long-term outcomes (evidence-based strategy measures), and align strategies with Title V performance and outcome measures.

The logic models are particularly helpful with refining and updating the plan strategies and strategy measures based on progress made. The Georgetown University Evidence Center also used the logic models to assist with evaluation of Hawaii strategy measures. The logic models are included in the 5-Year state plan narratives and the Supporting Documents. The logic models were used to collect input on Title V activities as part of the needs assessment.

Through individual meetings with program staff throughout the year, Dr. Sugimoto-Matsuda provided valuable TA to strengthen staff public health knowledge and skills. SSDI grant funds supported Dr. Sugimoto-Matsuda’s TA services.

The Title V Review exemplifies the type of innovation that typically emerges from the Title V Planning Committee. As part of Hawaii’s grant presentation, a short video is used to succinctly present the Hawaii Title V priorities, accomplishments, challenges and plans. The video is well received at the Reviews and was also highlighted in a 2018 AMCHP conference panel presentation on communications. Other states continue to contact Hawaii to access the latest video and use the same video software for their Title V reviews.

Title V continues to use national MCH and AMCHP professional development resources including the MCH Workforce Development Center (WDC). Staff participated in two WDC cohorts to date. Hawaii participated in the Spring 2019 WDC cohort focusing on building transition efforts. The Hawaii cohort team provided state-funded CSHN staff access to travel and TA opportunities largely reserved for federally-funded grant staff. The team also used the opportunity to establish collaboration between the Hawaii CSHN and adolescent health programs.

Hawaii continues to use national TA from the MCH Evidence Center, AMCHP webinars, and MCH Bureau Learning labs to inform Title V efforts especially for the 2020 needs assessment. These TA opportunities help develop staff capacity and provide an opportunity to share Hawaii’s issues with other states and national centers.

Another workforce development effort supported by FSHD is the Hawaii Public Health Training Hui (HPHTH) steering committee. The HPHTH is a group of individuals and organizations established to provide statewide leadership, coordination, and collaboration to meet identified common public health training and TA needs. FHSD’s Rural Health coordinator serves on the HPHTH steering committee that provides general oversight and direction for the annual training series. Training topics are based on surveys disseminated online to employees in both the public and private sectors and guidance from the Western Region Public Health Training Center which funds the Hui. In 2019, the HPHTH completed seven online public health trainings on Advanced Care Planning, Opioid Treatment and use in Hawaii, Vaping 101, Native Hawaiian Health, Professional Ethics Guiding Dementia Care, and Getting Ahead of Holiday Stress. Training sessions are recorded and posted on the HPHTH website https://www.hiphi.org/phth/.

FHSD programs also support training for the MCH workforce statewide. Several federal grants include workforce development as a key strategy/activity including:

• Maternal Infant Early Childhood Home Visiting grant supports monthly training for the Hawaii Home Visiting Network
• Early Childhood Comprehensive Systems (ECCS) grant supports training for providers on developmental screening tools and protocols and other infant/toddler health and safety conferences
• Hawaii Medicare Rural Hospital Flexibility Program grant is used to conduct training on healthcare quality improvement for healthcare professionals and operational and financial performance improvement for Critical Access Hospitals
• Family Planning shares resources from the National Family Planning Training Centers to local providers via quarterly meetings, webinars, and conference calls
• The State Office of Rural Health sponsors numerous training projects including the annual Healthcare Workforce Summit and telehealth training through Project ECHO
• A consortium of Title V programs support the Parent Leadership Training Institute

Programs also conduct presentations about health topics and Title V services. Examples include:

• Genetics offers webinars on current issues in genetics to providers
• The Child Abuse and Neglect (CAN) Prevention program conducts presentations on Adverse Childhood Experiences, Trauma-Informed Care, Protective Factors to prevent CAN
• WIC staff conducted breastfeeding training seminars to community providers
• Adolescent Health partners with community health workers and youth service providers to promote healthy youth development and adolescent wellness visits

Programs may also sponsor annual conferences for providers to receive updates on research, best practices, and data. Examples include:

• Annual DOH Rape Prevention and Education Sexual Violence Prevention Meeting
• Hawaii State Rural Health Association Annual Conference
• Early Intervention Stakeholder Conference
• Hawaii Home Visiting providers Meetings
• Hawaii Mortality Review Trainings/Summit