Section III.E.2.b.i. MCH Workforce Development

Recruitment and retention of qualified staff

The North Dakota Department of Health and Human Services (NDDHHS) offers challenging and enjoyable work opportunities and a full range of employee benefits including a fully-paid health insurance plan, paid leave and a retirement plan. In addition, the department has a reputation for being family-friendly and accommodating with flexible work schedules. Infant-at-work, everyday casual dress, and worksite wellness policies are attractive recruiting and retention tools. NDDHHS policies for reimbursement for professional licensures and tuition reimbursement are also positive recruiting and retention tools. As a result of COVID-19, staff are allowed, and have been encouraged, to continue telecommuting full-time, with the ability to “hotel” on site as needed. These policies have increased job satisfaction, work productivity and morale. An Employee Assistance Program is also available for staff that need support.

About 70% of Title V program staff have five or more years of experience working in maternal and child health (MCH) programs at the state-level, compared to about 68% last year and 75% the year before. This is attributed to a trend of staff retainment. Those with less than five years’ experience have strong health care backgrounds working within health systems or for non-profits (e.g., March of Dimes). 

Training and growth opportunities

State Title V staff are able to avail themselves of various professional development opportunities in order to build their capacity as part of the maternal and child health (MCH) workforce. State staff have many strengths including passion, dedication, and knowledge to ensure families receive high quality services; strong interpersonal abilities required for partnership building, collaboration and integration; and the capability to manage multiple priorities. To address specific training needs, state Title V staff develop career aspiration and professional development goals that identifies training opportunities to enhance needed knowledge and skills as part of their annual performance review process.

Leadership and professional development are key initiatives for North Dakota Governor Doug Burgum. The state hired a firm to help build a more formal culture for leadership training for the state based on John Maxwell’s 5-levels of leadership and the behaviors of a cohesive team. A series of Leadership Everywhere trainings have been developed to strengthen personal leadership skills and to support the ability to better serve North Dakota citizens.

In December 2019, Title V staff completed the MCH Navigator on-line self-assessment. This self-assessment provides an opportunity for professionals to reflect on competency-based strengths and areas to grow in order to identify learning needs and reinforce new skills to improve performance. A North Dakota Workforce Snapshot was provided by MCH Navigator that supplied information regarding North Dakota’s MCH workforce composition and learning needs. In line with national data trends, North Dakota MCH staff had identified cultural competency as the largest gap in knowledge and skills, along with family-professional partnerships. Also consistent with national data trends, policy had the lowest knowledge and skills scores across competencies.

In May 2021, a proposal was received to initiate a formal Academic Health Department partnership between the former North Dakota Department of Health’s (NDDoH) MCH program and the North Dakota State University (NDSU) Department of Public Health (DPH) to enhance the knowledge and skills of the current MCH workforce, build workforce capacity, and facilitate collaboration across the academic and practice communities. This partnership provided much needed support to address MCH leadership’s key concerns, departmentally and statewide, regarding the low percentage of MCH staff with formal public health training, low levels of preparedness to meet local and state MCH needs, limited access to expertise for quality community-based or applied public health research, and the need for MCH innovation among public health professionals in academic and practice environments. To effectively build MCH workforce and innovation capacity in North Dakota, NDSU DPH required two formally trained MCH faculty with research expertise. By August 2022, these faculty had successfully developed and implemented an eight credit MCH Certification Program. Credits from this MCH Certification Program can be applied to a Master of Public Health (MPH) degree. NDSU DPH will additionally commit a dedicated percentage of time supporting the data analysis and research needs of North Dakota’s MCH programs.

Regular meetings with NDSU have continued throughout the year. Staff are working diligently to complete the MCH curriculum, and courses for the new MCH Certificate program will be offered in Fall of 2023. NDSU personnel have also discussed the possibility of offering additional training opportunities (e.g., webinars, books clubs) for Title V staff who may have been hesitant about registering for a full college-level course.

Over the past several years, the Healthy and Safe Communities (HSC) Section Director who also oversees Title V programming (as part of the Public Health Division’s leadership team), had the opportunity to participate in quarterly, Extended Cabinet Leadership (XCL) Team meetings organized and presented by Governor Doug Burgum and his staff. The objectives for the XCL team are focused on connection, learning and development as leaders.

Workforce development to advance the capacity of local staff is also important. To build capacity of the local workforce, State Title V staff provide technical assistance with program implementation on an ongoing basis.

Innovations in staffing structures and workforce financing

NDDHHS has a tuition reimbursement policy that may pay up to 80 percent of tuition and fees depending upon budget availability. The college course must be directly job related and have a stated public health purpose or benefit. This policy makes it more attainable for staff to consider enrolling in the program and advancing their learning and education. Currently, one MCH staff has submitted their application for acceptance into the fall 2023 Public Health Certificate Program. In addition to supporting state MCH staff to enroll into the MCH Certificate Program, the program is being widely announced and promoted statewide. At least one other MCH staff member has submitted their application to complete their graduate degree, starting in the Fall of 2023.

Title V and all of NDDHHS are also committed to promoting health equity. Gaps in health outcomes between populations can be addressed through improvement of quality of care, increased cultural competency, and a comprehensive health equity strategy. Since the Health Equity/MCH Partnership Coordinator, Krissie Guerard, was hired August 1, 2018, the Community Engagement Unit (formerly the Health Equity Office) has continued to grow. In an effort to address overall needs in health equity for the entire NDDHHS, Krissie’s role was transformed to focus full-time as the Community Engagement Director, while the Community Engagement Assistant Unit Director participates in MCH work activities in the women’s health domain.

The Community Engagement Assistant Unit Director’s full-time equivalent (FTE) Public Health Specialist position was added in March 2020 in partnership with the HIV/STD/TB/Viral Hepatitis Program. This shared position between two sections and supervised by the Community Engagement Director, dedicates .5 time to the HIV/STD/TB/Viral Hepatitis Program and .5 to MCH. Current MCH activities of this position include health equity (oversight of the New American/Foreign Born/Immigrant (NFI) Advisory Committee), maternal mortality and other women’s health initiatives.

Key components of the MCH grant include promoting health equity and reducing disparities in health through a comprehensive needs assessment process. Hence, this position is located within the NDDHHS Public Health Division’s HSC Section. The Community Engagement Unit reports directly to the HSC Section Director who also oversees all units responsible for MCH programming. This is vital to address and coordinate efforts that improve health outcomes for North Dakotans.

A summary of MCH and CSHCN workforce, including those serving in leadership roles, tenure of staff, and projected shifts in the workforce over the next five years is included in Section V. Supporting Documents.