Recruitment and Retention

Like most employers, the state of Missouri and the Department of Health and Senior Services (DHSS) have been affected by “The Great Resignation”. The public health sector has been especially affected by people leaving the field due to the increased work-related stress created by the pandemic. The DHSS Office of Human Resources developed a retention strategies plan, which was shared with all supervisors and managers. Strategies include reviewing recruiting/hiring practices, understanding team effectiveness, exploring flexible scheduling, and utilizing stay interviews. The state Office of Administration launched the MO Appreciation website to show appreciation to colleagues and strengthen the culture of recognition. The website, which has been designed by state team members for state team members, is a one-stop shop to provide team members access to resources, ideas, and recognition opportunities.

Although Title V MCH supported programs have experienced numerous departures over the past two years, there has been a rebound in recent months. Many vacant positions have been filled, and the new team members have been trained and are actively contributing to MCH efforts. The Title V MCH Program works closely with multiple units throughout DHSS. Many DHSS staff have worked for the Department for many years, strengthening the knowledge base, needs assessment, and expertise both in public health and MCH. Managers and supervisors are responsible for ensuring that staff are qualified, properly trained, and informed on current public health issues.

MO Careers is the state hiring platform for finding a career in Missouri government, browsing state job listings, exploring job openings for individual state agencies, applying for posted positions, viewing state benefits, and more. Ongoing expansion to MO Careers (HireTrue) has continued to evolve and change how state agencies hire and onboard new team members. Expansion of MO Careers (HireTrue) requires less staff time to move positions and applicants through the hiring process and has increased consistency and efficiency in overall hiring processes.

The following Missouri Title V Workforce Information Sheet provides additional information regarding Missouri’s Title V MCH Workforce.

Missouri Title V MCH Workforce Information Sheet

Training and Growth Opportunities

The Missouri Way training series incorporates approaches proven successful in other high performing organizations in both the public and private sectors and was established to equip state team members with tools and techniques to become the best public servants possible and to drive change for the citizens of Missouri. The training was originally designed as an intensive 3-day training program to introduce senior leaders, managers, supervisors, and other emerging leaders to tools and approaches to solve basic management challenges and improve their team’s performance. The training series has been transitioned to a new e-learning format available to all state employees. The new e-learning series is an essential part of the State of Missouri’s plan to improve its performance and develop a culture of continuous improvement. The Missouri Way objectives are to:

• Accelerate participants professional growth through individual leadership development, building new skills to lead others and lead change
• Provide department leaders the skills and shared understanding needed to improve team performance and cultivate a strong, positive work environment
• Develop needed skills amongst team members across the State of Missouri to improve government performance for our citizens

The curriculum includes sessions on change management, continuous improvement, project management, customer experience, communications, performance measures and dashboards, and building and leading and provides common approaches, tools, and vocabulary in the following learning paths:

• Advanced Teams/Lead others
• Initiative Team Boot Camp
• Facilitation for Change Agents
• Lead Change
• Lead Self
• Performance Measures and Dashboards and
• Show Me Excellence

All state employees now have access to online professional development content through MO Learning, a world-class online training platform powered by LinkedIn Learning. State employees have access to an online library of over 16,000 high-quality courses that can be accessed through office computers or on a mobile device. A wide range of course topics pertinent to professional development is available, and a list of initial course recommendations is available for team members, supervisors, and managers.

Monthly 1:1 ENGAGE meetings bring supervisors and team members together to have meaningful professional development conversations. These conversations provide an opportunity to help team members improve in their current role and position themselves for future success. ENGAGE aims to help team members understand how they are performing against expectations and improve individually and collectively. Periodic ENGAGE evaluations measure a team member's performance in three areas; delivering excellent results, going above and beyond their day-to-day role and consistently demonstrating a commitment to grow and learn.

The Quarterly Pulse Survey (QPS) provides insight on the organizational health of state agencies and guides progress on major cross-department initiatives. Through the QPS, state team members asked for more investment in professional development. The Missouri Office of Administration rolled out the NEW Professional and Leadership Development Award (PLDA) in late 2022, committing nearly $7 million dollars to reward and recognize the top performers amongst State of Missouri team members. The PLDA leverages ENGAGE to identify top performers who exhibit exemplary work in all three areas of ENGAGE performance evaluation, show dedication to State service and deserve to be recognized and rewarded. The top 10% of DHSS team members were selected to receive up to $1,500 for an approved professional development opportunity, and several MCH team members were among the recipients.

The FFY 2021-2025 Title V MCH State Action Plan includes the development and implementation of a Title V Core MCH, health equity, and racial justice training plan. The goal is to build core competencies of internal program staff and external contractors to increase knowledge and awareness of the basic principles of MCH, health equity, and racial justice. The trainings will impart practical skills to apply this understanding across all programs, practices, and interventions. The MCH Director provides presentations to internal and external partners on core MCH content. The MCH Director also serves as the state Public Health Nursing (PHN) Manager and facilitates public health nursing workforce development and other public health nursing initiatives. This includes providing PHN consultation and presentations and managing the PHN Discussion Listserv, which allows public health nurses to share messages, announcements, events, etc. and/or pose questions pertinent to public health nursing.

For many years, the Missouri Council for Public Health Nursing was organized within the DHSS and provided leadership, expertise, and advocacy related to public health nursing practice, standards, and issues. In 2022, the Section for Public Health Nursing (SPHN) was established within the Missouri Public Health Association (MPHA) to address issues that impact public health nursing within the public health system. The SPHN includes representation from the DHSS, local public health agencies (LPHAs), nursing academia, and other public health related organizations. The SPHN will continue providing leadership, expertise, and advocacy related to public health nursing practice, standards, and issues. The MCH Director serves as a member of the SPHN Executive Committee, and several other MCH team members are active members of MPHA and SPHN. The MPHA and the DHSS, along with other public health organizations, sponsor an annual public health conference, allowing program staff to network with LPHA and other public health partners and grow their expertise to serve as a resource in regards to issues that impact the MCH population. Two PHN awards are given annually during the conference to celebrate and acknowledge the great work of Missouri’s Public Health Nurses and recognize a public health nurse and public health nursing leader.

The Family Partnership Parent and Caregiver Retreat provides an opportunity for families to network with one another, discover resources to assist their family, enrich their leadership and partnering skills, and plan a vision for their family’s future. The retreat is a free event designed for Missouri parents, legal guardians, and caregivers of children, youth, and young adults with special health care needs. The Bureau of Special Health Care Needs plans to host a Retreat in FFY 2023. Related information can be found in the Children with Special Health Care Needs (CSHCN) Annual Report under NPM #11 Medical Home.

To improve capacity, Title V MCH Program partners attend national trainings such as the AMCHP conference, CityMatCH Leadership and MCH Epidemiology Conference, MCH Partnership Technical Assistance meetings, and other MCH conferences, summits, symposiums, etc. Participation in Collaborative Improvement & Innovation Networks (CoIIN) and National MCH Workforce Development Center Cohorts are encouraged, when applicable. Regional and statewide trainings, such as biannual regional public health meetings and the annual Missouri Public Health Conference, are available to program staff, LPHAs, and other community stakeholders to provide an opportunity to network and learn new information relevant to the MCH population. Program staff also attend trainings specific to their program areas. Although the merit of in-person convenings cannot be underestimated, the increase in virtual and hybrid conference and training opportunities allows a greater number and diversity of team members to participate and benefit.

Missouri was well represented at the 2023 AMCHP Conference, with 17 DHSS team members (15 in person, 2 virtually), three youth reps, and one mother with lived SUD experience attending, along with various other MCH partners. Some team members chose to use their PLDA to attend. A MCH community of learning, launched after the AMCHP Conference, will support individual and collective learning and provide an ongoing forum for MCH team members to share information and resources gained from conferences, webinars and other professional development opportunities.

Missouri participated in the 2022 MCH Roundtable hosted by the National Governors Association (NGA) Center for Best Practices. The roundtable consisted of state leaders, MCH organizations and federal partners. The MCH Director joined the roundtable to share strategies and lessons learned from impacts of the COVID-19 pandemic on Missouri’s MCH programs, discuss MCH policy issues including workforce, community supports, mental health, child care, etc., and offer important insights for the development of a NGA publication with policy considerations for state leaders.

To address workforce development, the School Health Program is leveraging CDC Workforce Development funding to:

1)  Offer an opportunity for 220 eligible school nurses to sit for the national exam to become Nationally Certified School Nurses (NCSN) during the 2023-24 school year;

2)  Develop online learning modules to address the unique needs of medically fragile students attending school;

3)  Offer 10 school districts an opportunity to: assess their school health policies and practices for physical and mental health using the CDC and AAP endorsed program, “Enhancing School Health Services through Training, Education, Assistance, Mentorship and Support,” and then develop action plans to address the gaps identified  (School districts are required to collaborate with their LPHA and a community health provider.);

4)  Provide training and resources for school districts to participate in the MOKIDS TEAMS ( Missouri- Keeping Infectious Diseases out of Schools Training, Education, Assistance, Mentorship and Support) so that parents, community members and school staff have an increased understanding of infection control and confidence in the school as a safe place to learn; this program is unique to Missouri - Missouri requested and received permission from the AAP to adapt the existing TEAMS framework to look at infection control and disease prevention;

5)  Partner with ACIP to develop a Missouri KIDS TEAMs Tool kit with modules for a variety of stakeholders on infection control and communicable disease prevention; and

6)  Provide funding for 60 small, rural public school districts without services of a registered professional nurse to have an in-depth assessment and virtual support for school health services.

Innovations in Staffing Structures and Workforce Financing

The SHCN Family Partnership is funded primarily through the Title V MCH Block Grant and secondarily through the HRSA Universal Newborn Hearing Screening and Intervention Program Grant. Title V MCH funds four Family Partners, and the HRSA grant provides funding to employ two additional Family Partners who are parents of children who are deaf or hard-of-hearing (FP-DHH) to support Missouri families involved in the early hearing detection and intervention (EHDI) process. More information on this can be found in the CSHCN NPM #11 Medical Home Annual Report.

Title V MCH team members serve as preceptors for undergraduate and graduate nursing and public health student intern experiences, with the students completing a capstone project in MCH and/or epidemiology. In addition to presenting to public health graduate students on Missouri’s Title V MCH Services Block Grant Program and the Life Course Perspective, the MCH Director serves on the Advisory Council for the Saint Louis University Center of Excellence in Maternal and Child Health Education Science and Practice. The Center of Excellence provides MCH scholars with exceptional academic, research, leadership and practical and real world public health training. The MCH Director collaborated with an assistant professor of nursing at Missouri State University and a doctorally-prepared local public health nurse leader and Community Outreach Specialist to query community/public health nurses about their experiences utilizing the Council of Public Health Nursing Organizations Community/Public Health Nursing Competencies during the Covid-19 pandemic. Study design and findings were presented at the 2022 Public Health Conference and have been submitted for publication in a peer-reviewed journal.

To conduct a comprehensive review of FTE linkages to grant requirements and assess staffing needs, available resources, and Personnel Services appropriations, DCPH leadership engaged managers across the Division to detail FTE linkages across a number of categories. Using a Linkage Tool, FTEs were categorically assigned to categories based on statutory and regulatory mandates, grant requirements, grant deliverables, grant objectives and strategies/activities, and requirements of subcontractors. The completed Linkage Tools were then used to prioritize FTEs to reflect grant needs and public health transformation efforts. Managers were also asked to forecast what each FTE may look like in 2023 and 2025 and to present ideas for how to decrease the number of FTEs needed through implementing contracts for services, new technology, and other operational innovations for human resource efficiency.

The FFY 2021-2025 Title V MCH State Action Plan priorities and national and state performance measures are forecasted to remain essentially unchanged through September 30, 2025, requiring adequate Title V MCH leadership as well as support and MCH program FTEs to accomplish the strategies and meet the objectives and evidence-based strategy measures included in the State Action Plan and to meet HRSA/MCHB Title V MCH deliverables. Many of the programs and FTEs supported by Title V MCH funding are also supported by other short-term grants, and, in many instances, those programs and FTEs are integral to the Title V MCH State Action Plan and will rely on Title V MCH funding for ongoing support.

Local Public Health Agency (LPHA) Workforce

In 2021, with 113 of 115 LPHAs reporting, 16 reported reducing the number of days open to the public, 27 reported laying off staff and closing internal home health services. Decreased funding and the COVID-19 pandemic were cited as the primary reasons for these changes in staffing, hours of operation, and provision of services. In addition, these LPHAs noted that recruitment of new staff has been significantly challenging citing increase in demand for nurses as well as higher wages and sign-on bonuses available from other organizations such as hospitals. From August 20, 2021 to May 5, 2023, 28 LPHA Administrators vacated their positions, representing 24% of the 115 LPHA administrator positions across the state.

Through Title V MCH funding, the MCH Services Program contracts with 111 LPHAs. Although many LPHAs experienced substantial turnover throughout the pandemic, the rate of LPHA workforce turnover had decreased in the earlier part of 2022. However, the turnover rate has increased again over the last year and remained consistent with an average of two to three MCH Coordinators resigning each month. TMCH Services Program staff provide MCH orientation for new LPHA MCH Coordinators. Orientation sessions include content covering core principles of public health, MCH competencies, Life Course Perspective, the Spectrum of Prevention, contract terms and deliverables, and available resources. Prior to the pandemic, MCH Services Program staff provided approximately 8-10 orientations per fiscal year. In FFY 2022, program staff provided 42 MCH Coordinator orientation sessions, and they have already provided 24 orientations so far in FFY 2023. Program staff also provide ongoing technical assistance to the LPHAs on the MCH Services contract and work plan, MCH initiatives/activities, and broad public health and public health nursing topics. LPHA requests for technical assistance have significantly increased related to and due to the unwinding of the COVID-19 pandemic and high rates of staff turnover.

In an effort to prioritize mental health in the work place, the Title V MCH Program partnered with the MCH Services Program in August 2022, to provide a one-hour virtual professional development opportunity titled, “Managing Stress and Burnout and Increasing Resilience while Thriving at Work and in Life.” This opportunity was paired with a mental health initiative that was developed by Class #6 of the State of Missouri Leadership Academy to address prioritizing mental health wellness in the workplace for State employees. One of the solutions identified was implementing a Badge Buddy as a quick reference card attached to the employee ID. It provides a list of signs that a team member who may be struggling might exhibit and what to look for as a supervisor or peer. Resources and phone numbers are listed on the back of the card so team members can quickly and effectively provide support, even if they are not a mental health professional. After the completion of the meeting, a LPHA Badge Buddy Request Form was sent via email to all LPHAs, and 1500 Badge Buddies were provided to LPHA staff statewide. (Below is a picture of the DHSS Badge Buddy)

In January 2023, the MCH Services Program team hosted four LPHA networking meetings. Meeting content included various topics identified from feedback reported on the Annual Program Evaluation Survey sent to LPHAs. Specifically, the survey asked about training needs that would help move MCH-related work forward and were aligned with the Spectrum of Prevention framework. The sessions featured content experts who shared the evidence behind what was working well and provided tangible strategies to realize improved outcomes. 

• January 4, 2023 - Youth Engagement, Putting Education into Action (Dr. Sherri Miller, Tri-County Mental Health Services) – 83 in attendance
• January 11, 2023 -  Driving Change through Policy and Social Norms Change (Jenny Dodson-Weihl, JD, Prevention Specialist, Missouri Kids First) – 76 in attendance
• January 18, 2023 - Community Engagement and Coalition Involvement that Leads to Change (Candace Rodman and Jim Meyer, MU Extension, Community Engagement Specialist) – 71 in attendance
• January 25, 2023 - Sowing and Growing Hope in Prevention (Amber Allen, MU Extension, Field Specialist in Human Development & Family Science)– 51 in attendance

The MCH Services Program began hosting MCH Huddles with LPHA partners in November 2022. The purpose of Huddles is to help individuals and organizations work together rather than alone. Participants talk about issues they have been struggling with and compare notes about possible solutions while making a commitment to work toward improvement, specifically working to achieve MCH contract deliverables and outcomes. MCH Huddles are convened quarterly in August, November, February and May and hosted in a virtual format. (LPHAs working on the same priority health issue may be located in different geographic regions across the state.) In addition to a presentation by a content expert, each MCH Huddle includes breakout room discussions facilitated by the MCH DNCs. The breakout discussions –alternate between Huddles, based on region or priority health issue and allow LPHAs to share wins and challenges and discuss potential solutions to those challenges. 83 LPHA staff attended the MCH Huddle in November 2022 and heard Jefferson County Health Department share successes they have had with branding and digital engagement among women of childbearing age and children in their community to improve health outcomes. In February 2023, 71 LPHA staff attended, and the Tobacco Prevention and Control Program presented about providing vaping and tobacco cessation and prevention resources for children and women of childbearing age.

In an effort to continue to build rapport and trust among LPHA partners, the MCH Services Program DNCs began sending a monthly email in December 2022 to provide resources and support as a way to “check-in” with LPHA staff. This is intended to serve as a warm reminder that the program staff are available to help and do not only care about the work but also the person doing the work. The monthly email is titled “MCH Exclusive”, and the MCH DNCs take turns compiling the email content. Sections of the MCH Exclusive include: Did You Know?, News You Can Use, Q+A, Reminders, and Something to Think On.