Recruitment and retention of a qualified Title V program staff

Colorado’s MCH program is administered through the Children, Youth and Families Branch within the Prevention Services Division of the Colorado Department of Public Health and Environment. The MCH workforce within the Children, Youth and Families Branch currently consists of approximately 30 FTE. Since the last block grant submission, four new staff have been on-boarded to fill vacancies in previously existing positions and/or new positions that were created to support implementation of the 2021-2025 priorities and/or to meet other emerging programmatic needs. These positions include:

1. Maternal Health Manager
2. Maternal Data and Community Specialist
3. Fostering Access, Rights and Equity (FARE) Grant Coordinator
4. MCH Local Liaison

At the time of grant submission, there are no active MCH job postings, but there are three vacancies that are currently being reassessed to determine whether to terminate or re-design the positions.

In addition to the MCH staff in the Children, Youth and Families Branch, MCH leverages additional content expertise by funding portions of FTE within the following work units to support MCH priority implementation: the Center for Health and Environmental Data, the Office of Public Health Practice, Planning, and Local Partnerships, the Violence and Injury Prevention and Mental Health Promotion Branch, the Nutrition Services Branch, Health Services and Connection Branch and the Healthy Living and Chronic Disease Prevention Branch. The MCH Epidemiologist also hosts a summer intern annually through AMCHP’s Graduate Student Epi Program to support MCH data projects. Beyond MCH staff within CDPHE, the MCH workforce also includes a network of local MCH staff funded through MCH contracts with each of the state’s 64 local public health agencies.

In June 2019, the MCH program launched an MCH Workforce Development Section within the Children, Youth and Families Branch. This team was established to support training, consultation, coaching and communities of practice for Colorado’s MCH state and local public health workforce on cross-cutting knowledge and skills, fundamental to MCH program implementation.

The MCH Workforce Development Section is currently home to the following positions: Racial Equity Specialist, Community Inclusion Specialist, Change Specialist, Youth Development Specialist and a Section Manager. Current staff have content knowledge in racial equity, community engagement, positive youth development, change management, behavioral insights, project management, emotional intelligence, facilitation, coaching and trauma-informed systems work. Collectively, the staff have extensive experience with training and adult learning best practices. Additionally, the Section Manager and Racial Equity Specialist are on the pathway to receiving their trainer certification from the NeuroSequential Model Network, allowing them to translate a model initially developed for clinical and educational settings into public health and organizational culture contexts. They will be certified to train others in this adapted Stress-Responsive, Trauma-Informed and Staff-Resilient framework and practices. 

As the Workforce Development Section continues to develop, evolve and expand, the team has initially focused on establishing a learning infrastructure for the MCH program. Building the infrastructure started with the creation of an MCH learning framework to describe the current state of the MCH workforce, the future state and the approach to fulfilling the vision or future state. To support the infrastructure, the Workforce Development team established shared language, processes and expectations for workforce supports. This included: definitions for training, coaching, consultation and learning communities; one-pagers and visual icons for each of the strategic anchors; a communication calendar; a workforce development request system; consultation processes and office hours; an internal google group to support alignment across the strategic anchors; and an online resource hub for MCH staff that is currently in development.

Assessment of Training and Professional Development Needs

MCH Workforce Development staff has used the survey results from the 2019 Colorado MCH workforce needs assessment to inform and guide capacity building opportunities for MCH state and local staff. Aggregate survey results initially prioritized four main topics:

• Communicating and promoting the public health role in importance/integration across systems/sectors
• Racism/discrimination
• Change management
• Influencing partners and leaders

Since the 2019 workforce development survey, the Workforce Development Section has continued to partner with the Office of Public Health Practice, Planning and Local Partnerships to annually survey the workforce learning needs for all Colorado local public health agencies. This annual survey has been embedded as a part of the contracting requirements, and as such, the MCH Workforce Development Section can now track changes to workforce development learning needs over time. The survey results from 2020 and 2021 are consistent with the original results, with some slightly nuanced differences, in part as a result of refining the questions and by asking respondents to clarify “of your top three learning needs which are you most interested in learning about?” Based on survey responses, the MCH Workforce Development Section identified the greatest learning needs to be:

• Communicating the value of public health’s role across sectors
• Community Inclusion
• Racial Equity
• Influencing Partners and Leaders
• Navigating Change
• Moving Upstream

In addition to highlighting local public health agencies' top learning needs, the survey also painted a picture of significant local staff shortages, burnout and overwhelm. This is critical to understand, since neuroscience demonstrates that cognitive learning cannot happen while in a state of pervasive stress and overwhelm. This undoubtedly poses an operational challenge for a team charged with supporting the learning and development of public health staff. To address this barrier in a neurobiologically sensitive way, MCH Workforce Development team has prioritized the intentional integration of “stress-responsive, trauma-informed and staff-resilient” strategies into processes and communications, as well as grounding staff in the science of both stress and regulation. These strategies are informed by the Neurosequential Model, various mind-body practices that promote regulation, as well as coaching and strategies for navigating change and conflict in culturally responsive and relevant ways.

The initial 2019 survey results also indicated a strong desire for alignment and cohesion across implementation efforts for the seven MCH priorities. Strategic anchors were identified as a mechanism to foster alignment in how staff identifies, pursues and creates change within and across the priority areas. These anchors guide MCH priority co-leads and implementation teams in selecting and implementing strategies, as well as measuring impact.

The strategic anchors that state and local public health staff identified as most critical are: Racial Equity, Community Inclusion and Moving Upstream. The following are examples of how the MCH Workforce Development team supported the knowledge, understanding and operationalizing of the three strategic anchors:

• Community Inclusion Learning Community
• Strategic anchor intro presentation at Local Planning and Partnership Call
• Moving Upstream Learning Community
• MCH Digest Strategic Anchor article
• Racial Equity Learning Community
• Local learning community anchor discussion
• Language Justice state learning community
• An overview of the MCH Strategic Anchors
• A Moving Upstream Matrix tool
• State-level Strategic Anchor evaluation Final Report
• PSD Community Engagement Toolkit
• Community Engagement 101 Training
• State-level Strategic Anchor planning guidance

These resources, and others, will be available via the MCH Workforce Development Hub that is currently in development and will be launched in the winter of 2022-23.

During this reporting period, the MCH Youth Development Specialist, who also serves as the state’s designated MCH Adolescent Health Coordinator, continued to lead the positive youth development statewide training system. In 2010, positive youth development (PYD) was launched in Colorado and, in 2013, it was written into legislation that led to Colorado’s Statewide Youth Development Plan. The plan called for an increase in the number of youth-serving professionals and organizations operationalizing positive youth development strategies. Through the statewide training system, youth-serving professionals receive training on adolescence, as well as shared language around positive youth development. The ultimate goal of the training is to support a systemic approach for how programs, practices and policies that impact youth health and well-being are developed and implemented. In partnership with other funding opportunities, there are now over 160 trainers across the state. These local and regional trainers, which include MCH and other CDPHE staff, have provided trainings around the state since 2013. In response to the pandemic, CDPHE trainers successfully transitioned to hosting trainings via online platforms and found ways to better reach communities virtually. In addition to communities hosting their own local PYD trainings, CDPHE provided 12 virtual PYD 101 training to over 120 participants across the state. In addition, the demand for the PYD Training of Trainers increased and the Youth Development Specialist met this need by hosting five virtual PYD Training of Trainers sessions during this reporting period. The adaptations made to both of these trainings over the past two years have increased accessibility for small organizations, especially those outside of the Denver Metro area, and assisted MCH staff in effectively meeting the on-going demand. 

The website for Positive Youth Development continues to serve as a tool for youth serving professionals, parents and decision-makers. Over the course of the next year, the Youth Development Specialist will partner with the Workforce Team’s Strategic Anchor leads to curate resources that support communities in increasing their awareness of, and navigating conversations related to, programmatic barriers that may be preventing equitable engagement of and outcomes for youth in their community.

The Workforce Section Manager and MCH Youth Specialist have engaged in conversations about long-term sustainability of the PYD training system, and have engaged numerous potential partners with an existing infrastructure for both housing and facilitating PYD across Colorado. These partners include programs internal to CDPHE, programs within the Colorado Department of Human Services, as well as non-profit organizations. Over the next year, the Youth Development Specialist will identify a sustainable option, facilitate discussions for creatively funding a training system that is now integral to youth-focused work in Colorado and successfully transition the infrastructure, resources and responsibilities to a new backbone organization for the training system. 

Innovations in Staffing Structures, including key partnerships that enhance the capacity of Title V  

MCH Workforce Development staff continue to explore opportunities to leverage existing and future resources to collaboratively support workforce development. MCH Workforce Development staff continue to connect and collaborate with organizations, such as the de Beaumont Foundation and the National MCH Workforce Development Center for purposes of both learning and alignment. The MCH Workforce Development Section Manager stays connected with these and other workforce leaders from across the country as the current co-lead for the AMCHP Workforce Leadership Development Committee. In addition, she was requested to participate in AMCHP’s strategic planning for the workforce development pillar. The Workforce Development Section Manager also participates on the Advisory Committee for the Rocky Mountain Public Health Training Center. The Youth Development Specialist participates on the State Youth Council of the Colorado Workforce Development Council as a public health representative and a youth development subject matter expert to inform new youth-focused initiatives.

In response to the annual workforce survey feedback indicating staff overwhelm and burnout, the Workforce Development Section received training from the Neurosequential Network in the spring of 2022 on their trauma-informed framework. The information gleaned from the training will support the integration of a stress-responsive, trauma-informed and staff-resilient systems approach into the MCH program. After vetting numerous organizations and frameworks, the Neurosequential Model in Education framework has the most people-friendly and accessible content and is a framework already familiar to some of Colorado’s local public health agency partners. MCH Workforce Development staff has a contract with the Educational Access Group to adapt the content for increased relevance to the public health sector and workplace settings. In the upcoming year, the Workforce Development team will integrate this content to train state and local MCH staff in operationalizing a trauma-informed approach into program policies and practices. This training will enable the MCH workforce to understand stress and trauma and recognize how it can be reduced or reinforced, in both subtle and overt ways. Integration of the approach will guide the MCH program in supporting psychologically safe, diverse, inclusive and engaging environments that will ultimately retain staff and lead to more meaningful and relevant state and local strategy development and implementation across the MCH program. 

Over the past year, the MCH Racial Equity Specialist and MCH Workforce Section Manager have hosted 15 workshops on the individual and interpersonal skills necessary for building a stress-responsive, trauma-informed and staff-resilient workforce. The audiences for these workshops have varied, and included MCH staff and partners from the Children, Youth and Families Branch,  the Health Promotion and Chronic Disease Prevention Branch, the Department’s BIPOC Employee Resource Group, the Children’s Hospital Colorado Pediatric Residency Program, a statewide juvenile justice convening conference, and multiple programs within two large local public health agencies.  The evaluations of these initial workshops demonstrate a high need and interest in staff having the time to understand the science of stress that they are so intimately familiar with, learn and practice regulation strategies and be given the time to slow down to promote self-care. 

The ability to navigate change is not only a strategic public health skill, but also a critical skill for navigating and mitigating stress. Over the past year, the MCH Change Specialist has developed a deep understanding of the intersections of change management, behavioral insights and project management, to provide MCH staff with the tools and processes that support navigating change and complex issues with greater ease. To build staff skills and confidence in navigating change, the MCH Change Specialist developed a Project Exploration Workbook that integrates the three frameworks, in addition to the MCH Strategic Anchors to help staff operationalize the concepts in their implementation efforts.

The Workforce Development team continues to receive internal and external requests to support teams and processes through thoughtful facilitation. Being able to hold difference, simultaneously address power dynamics, and serve as an engaging yet neutral facilitator, is a critical public health skill, especially when there is a prioritized focus on equity, diversity and inclusion. The Youth Development Specialist, will begin to transition her skill sets currently utilized in the Positive Youth Development Trainings and Training System, and focus them on building the capacity of others to facilitate dialogue and engagement across sectors and with the community. As the MCH Facilitation Specialist, she will not only build the capacity of others through training, consultation and coaching, but will also be available to serve as a neutral facilitator for MCH staff and partners. 

The Workforce Development Team continues to strategically connect the dots between MCH-specific workforce development and the Division and Department’s equity and  community engagement efforts. The Workforce Development Section has also begun to leverage training areas of focus promoted by the Colorado Department of Personnel Administration, such as Creating Psychological Safety in the Workplace. These areas of connection are critical for all state and local MCH to know and understand in order to drive systemic change towards meaningful programmatic impacts. The following are examples of the team’s collaboration and connections across the Division and Department:

• The Racial Equity Specialist and Workforce Section Manager have been invited to serve on the Core Team for the Department’s new EDI committee.
• The Change Specialist will continue to lead the Department’s Behavioral Insights Community of Practice
• The Community Inclusion Specialist will continue to co-lead the Community Engagement Subcommittee for Colorado’s Equity Alliance. This group recently adopted the MCH Community Inclusion slidedeck as their onboarding tool for the subcommittee.
• The Youth Development Specialist continues to co-lead one of the Department’s Employee Resource Group’s and has led the development of the leadership networking series, Table of Ten.
• The Community Inclusion Specialist and the Youth Development Specialist engaged in the Prevention Services Division’s Community Engagement workgroup, and provided leadership in developing the Division’s Community Engagement Toolkit, that has since been adopted by the entire Department.
• The Workforce Development Team is currently partnering with the Office of Human Resources, the Director of Culture, Strategy, Equity and Innovation, and the Department’s Senior EDI Officer to coordinate and leverage MCH learning opportunities and expertise to inform, influence and engage with the Department’s workforce revitalization efforts.
• The Racial Equity Specialist and Workforce Section Manager facilitated workshops for the Colorado Department of Human Services, including their Extended Executive Leadership Team and the Office of Community Partnerships. 
• The Community Engagement Specialist led a Community Engagement skills-building session at the 2022 annual AMCHP conference.
• The Workforce Development Team led a skills-building workshop at the 2022 Public Health Improvement Training’s  annual conference on building workforce capacity.

To meet the increasing needs of the MCH workforce, the MCH Workforce Development Team will continue to grow their expertise in their specific content areas of focus, as well as complementary areas, including:

• Trauma-Informed Systems
• Creating Psychological Safety in the Workplace
• Story-telling (as a mechanism for qualitative data collection and dissemination)
• Embodiment and mindfulness practices
• AORTA’s Facilitate for Freedom Fundamentals Training - a training to develop anti-oppression facilitation skills

Over the course of the next year, the MCH Workforce Development Team will continue curating resources and learning opportunities for MCH staff and partners to deepen their learning, skills and abilities to operationalizing the prioritized A few of these opportunities include:

• Plan and coordinate MCH program learning communities.
• Coordinate Children, Youth and Families Branch culture-building efforts to support the development of an inclusive workplace.
• Host ongoing strategic anchor learning opportunities for local public health agencies about how to apply the anchors to MCH work.
• Host a series of workshops focused on the individual, interpersonal and systems strategies needed to create and practice a stress-responsive, trauma-informed and staff resilient workplace culture. 
• The Strategic Anchor leads will host bi-monthly office hours, to support state and local MCH staff in embedding the anchors throughout their plans, as well as problem-solving barriers and concerns to operationalizing the anchors. 
• Provide individualized consultation on the MCH strategic anchors for state and local staff implementing MCH action plans.
• Curate a Community Inclusion series to support MCH staff and partners in developing the engagement skills necessary for authentic community engagement.
• Develop facilitation learning opportunities and resources focused on building skills for anti-oppression facilitation skills.