III.E.2.b. State MCH Capacity to Advance Effective Public Health Systems

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

2020 and 2021 have been challenging years for staff retention and workforce development. The Department of Health has significantly increased its staffing to respond to COVID-19 related needs, and has had a significant change in senior leadership, with the appointment of Dr. Umir Shah as Secretary of Health. This has had many trickle-down effects on all programs, including Title V. Initially, many staff were activated for temporary incident management and response assignments, taking them temporarily away from their regular work and some staff members chose to move into long-term COVID-19 project positions. Now those activations and longer term COVID-19 assignments have sun-setted, and we are juggling the return of staff to former positions.  While we continue to manage COVID-19 waves and disruptions, most of our energy is dedicated to recovery efforts, recognizing that the pandemic has exacerbated challenges for our maternal, child, and adolescent health populations.

The total number of DOH full-time equal (FTE) positions funded by MCHBG federal funding is 18.79 FTE. This represents 40 to 45 individuals, as multiple sources fund most positions. This is an increase from last year’s level of 17.76 FTE (portions of 40 positions). Title V activities are the predominant focus of the Office of Family and Community Health Improvement, shown in the attached organization chart.

Recruitment and Retention

Our division and office leadership teams focus on employee retention and succession planning. When we have a position vacancy, we consider whether to fill it as it is currently organized and funded, or whether a long-term workforce strategy might warrant a change.

Learning and advancement opportunities are readily available, and we encourage and support employee development. Some examples include:

We promote and use the Association of Maternal and Child Health Programs (AMCHP) and National MCH Workforce Development Center (WDC) workforce development resources. MCH staff have participated in the AMCHP Leadership Lab development series. Staff have successfully submitted program practices to the AMCHP Innovation Station (now known as Innovation Hub), and they use this resource to learn from other organizations’ best practices. A team of eight, including the Title V MCH Director and Children and Youth with Special Health Care Needs (CYSHCN) Director, participated in the 2020 WDC Strategic Skills Institute sessions. In the previous WDC Strategic Skills Institute, three staff and a local health jurisdiction (LHJ) representative attended and used their experience to launch a health equity pilot project with LHJs, leading to the inclusion of health equity as a regular component of the LHJ contracts and statements of work. We also promote AMCHP’s new MCH Essentials Series and MCH Navigator learning resources to MCH staff.  Both the MCH Director and the CYSHCN Director completed applied for and completed the 2021 Leader to Leader cohort, which included several hours of mentorship and training in many things related to the MCHBG.

Over the past several years, DOH has adopted “outward mindset” as our core culture and performance strategy, and we have incorporated it into our agency strategic plan as one of four key transformation areas. This concept is based on “The Outward Mindset: Seeing Beyond Ourselves; How to Change Lives and Transform Organizations,” a book by the Arbinger Institute. Our mindset is the lens through which we see our work, our relationships, and the world. Outward mindset training asks participants to shift from focusing on their own goals and objectives to having an outward mindset, with a focus on the organization as a whole. It helps individuals change the way they work with and relate to people and see how their behaviors and actions affect others. In addition to improving the internal organizational culture, this training seeks to improve the way we collaborate with others and provide services to the public. All DOH employees participate in outward mindset training, and supervisors attend outward leadership training.

In addition to Outward Mindset training, staff are offered an array of training and engagement opportunities related to diversity, equity, and inclusion.  Several MCHBG-supported staffing completed the People’s Institute Undoing Institutional Racism training, while others participated in learning cohorts focused on improving equity in our contracting and funding. 

Washington’s Learning Management System offers training opportunities on a broad range of topics including leadership training, facilitation skills, and communication. DOH requires specific mandatory training courses for all employees and for supervisors and managers, but a majority of the course offerings are elective and available to complete at will.

The University of Washington’s Northwest Center for Public Health Practice (NWCPHP) provides training, research, evaluation, and communications services to support public health organizations, particularly those in Alaska, Idaho, Oregon, and Washington. DOH leadership promotes NWCPHP training opportunities for employee professional development. In past years Title V staff have attended the NWCPHP Leadership Institute, a nine-month program that includes both on-site and distance learning. NWCPHP also offers a yearlong Public Health Management Certificate program. They facilitate a Learning Laboratory, which supports local health departments transitioning from clinical services to more population-based strategies that address the social determinants of health. NWCPHP’s “Hot Topics in Practice” monthly webinar series provides interactive learning and discussion of issues currently affecting public health practice. Topics covered over the past year include:

• Connecting Work to Wellness
• Building Trust in Local Public Health
• Managing Infodemics and Conspiracy Theories
• Vaccines, Public Health, and the Media
• Public Health, This is Your Shot!
• Racial Justice, Healing, and Action in Tacoma-Pierce County
• Adolescent Intimate Partner Violence
• Trauma-Informed Change Management
• Alaska Tribal Perspectives on COVID-19 Vaccination Efforts

All section managers completed a three-part tribal history and engagement training provided by the DOH Tribal Relations Director. The DOH State Tribal Public Health Partnerships series offers a workforce development opportunity to help employees understand Native American tribal sovereignty, the policy and program infrastructure for government-to-government relationships with tribes at the federal and state levels, and how DOH uses its consultation/collaboration procedure to fulfill its responsibilities under RCW 43.376 regarding government-to-government relations with Indian tribes.  Section managers also collaborated with the Tribal Relations Director to develop a tribal engagement manual for use throughout the agency.  OFCHI offered to provide a pilot testing space for this manual.

Ideally, each employee develops an individual training plan with their supervisor as part of their annual performance development plan. In addition to the learning resources mentioned in this section, it can also include attendance at local and national topical training sessions and conferences, as resources allow. Examples include the AMCHP Conference and the American College of Medical Genetics and Genomics Annual Meeting. Some employees maintain professional association memberships that relate to their field of work. Equity training and interactive staff development help create positive teaming and high morale/productivity.

Current and Anticipated Training Needs

The following needs have been identified by specific work groups:

• Leadership coaching and mentorship, for navigating challenging workloads and team dynamics. Foundational Public Health Services orientation and technical assistance, for internal and external partners, including local public health MCH leaders

• Continued training around telehealth and teleintervention, particularly for our EHDDI program and partners and our Sexual and Reproductive Health program and partners.

• Federal and state policy training on rulemaking and the role of federal decisions on state level legislation. 

• Equity and social justice training, including how to center community expertise in program planning and funding distribution, as well as diversity in staffing.

Innovations in Staffing Structures and Key Training Partnerships

We are widening our scope of partners to learn from and involve in program planning, including the creation of a few regularly scheduled meetings specifically focused on cross-walking and leveraging of work.  For example, we have begun meeting monthly with colleagues at the Department of Children, Youth and Families regarding alignment between our MCHBG, Essentials for Childhood initiative, Early Childhood Comprehensive System work, and the statewide Early Learning Coordination Plan (led by DCYF).  Similarly, we have begun meeting monthly with the WA Chapter of the American Academy of Pediatrics to collaborate around community health workforce investment in the pediatric and perinatal provider settings.  We have expanded our partnership with the Health Care Authority, which administers Medicaid, to determine how we can align the MCHBG with policy initiatives (like the recent expansion of Medicaid coverage through one year postpartum) and systems improvements (like determining funding mechanisms for community health workers and doulas).  Finally, we have dedicated participation on a variety of legislatively mandated workgroups, including the Children and Youth Behavioral Health Workgroup and the Dismantling Poverty workgroup, both of which provide opportunities for our agency to promote the unique health needs and challenges of the maternal, infant, child, and adolescent health populations.

Staff facilitate several different coalitions in the state, all of which provide rich collaborative learning environments and opportunities for unique partnership engagement.  Under the leadership of our new Thriving Children and Youth Section Manager, we have continued to expand state and local partners to the Essentials for Childhood steering committee, and have reconvened our Data Workgroup, which is focused on expanding our understanding of resiliency as it relates to mitigation of trauma impact. 

We continue to contract with the University of Washington (UW) to host the Washington State EHDDI Learning Community (WSELC), which provides training and technical assistance to individuals who perform newborn hearing screening, pediatric audiologists, and professionals involved in early intervention services for children who are deaf or hard of hearing and their families. We also convene the EHDDI Advisory Group, which is dedicated to identifying gaps in services and supports for families experience hearing loss, and addressing these gaps through partnership expansion, policy improvement, and streamlining care across childhood.  Similarly, we host the statewide Critical Congenital Heart Disease (CCHD) Workgroup which is focused on challenges, gaps, and barriers to effective CHHD screening and diagnoses in Washington.

We regularly bring on practicum students to assist with gathering information, evaluation, quality improvement activities, and education/outreach.

We use a variety of strategies to communicate information, training opportunities, and news to the broader Title V workforce and partners in Washington. For example, the Genetics program publishes its bimonthly eBlast that goes out to a listserv of genetic providers statewide who work on genetics across the lifespan, including pregnant women, infants, and children. The eBlast contains information on current trainings, programs, relevant information on policies, legislation, education, and job postings for genetic services positions in Washington (sent in by partners). Our Community Consultants send communications related to their specific programs to LHJs, and the Family Engagement Coordinator sends communications to the Washington Statewide Leadership Initiative collaborative. Title V staff convene regular online meetings with our CYSHCN Communications Network, several perinatal health groups, LHJs, and others to exchange information and updates about emerging issues and best practices.