UDOH senior level managers lead the work of planning, implementation, evaluation, data analysis capacity, including recruitment and retention of qualified program staff. MCH has approximately 43 full-time employees; 20 paid with Block Grant (BG) dollars for a total of 15.5 FTE. CSHCN has approximately 95 employees; 25 paid with BG dollars for a total of 12 FTE. The Bureau of Health Promotion has approximately 11 employees paid with BG dollars for a total of 4.3 FTE. UDOH staff are experienced and well-seasoned professionals. In addition, both MCH/CSHCN collaborate with staff at the Local Health Department level who work to improve the health of MCH/CSHCN populations.

The MCH/CSHCN workforce in Utah is broad and diverse. When recruiting and hiring for vacancies most positions are relatively easy to fill, such as managers, health education specialists, epidemiologists, etc. Because salaries in the private sector are higher than state government, the more difficult positions to hire are RN’s, APRN’s and other licensed professionals. The difficulty in finding candidates is the inequities of salaries in the private sector are so much higher than in state government. The incentive for a medical professional to work for the state is the 8-5 Monday to Friday work schedule, paid holidays, and benefits, not because of compensation. Innovations in staffing structures/financing are limited.

Retention and recruitment of qualified staff is of utmost importance. All Bureaus working on Title V activities encourage or provide regular educational sessions and empower the Program Managers to understand systems change and ways to move forward to ensure the mission to serve women, infants, children with special health care needs, children and families continues. The Bureaus also provide continual education for self-improvement along with skill development in order to be more efficient and work collaboratively while maintaining a positive culture and climate.

All professional staff are required or encouraged to attend at least one professional conference or training each year. Out of state travel is allowed, but the UDOH administration typically only allows 2-3 staff to travel to the same out of state conference. Attendance and traveling becomes problematic when there are up to six staff who should attend the meeting. Starting March 2020, during the COVID-19 outbreak, all travel has been discontinued but all MCH/CSHCN staff are using virtual technology to participate in meetings and learning opportunities. With all national conferences going virtual this year there are staff who are “attending” that normally would not. An example is the WIC Director who is planning on attending the AMCHP conference this fall.

Workforce development and coordination with the Integrated Services Program. This program holds weekly training, problem solving, and program evaluation meetings with in-house program staff and the care coordinators contracted through four local health departments. ISP and LHD staff attend the Utah Children’s Care Coordination Network (UCCCN) meeting. This multi-organizational group pairs care coordinators, nurses, practice managers, and clinical providers in a multi-disciplinary environment to learn about supports, services, and specialists around the state; share care coordination tips and best practices; and pursue group collective knowledge for solving concerns on challenging patient and family situations. UCCCN coordinates tele-learning technology which provides a virtual “face to face” environment in which all parties learn and share information. ISP clinical staff (APRN and psychologist) participate in weekly ongoing autism spectrum disorder training from specialists at the University of Utah through Project ECHO, a distance learning technology. Starting March 2020, the ISP program has solely utilized technology to serve the children with special health care needs and their families to protect the community from the COVID-19 outbreak.

The CSHCN Bureau supports Utah Regional Leadership Education in Neurodevelopmental and Related Disabilities (URLEND) Training Programs to train future leaders in MCH and CSHCN. The Utah Early Hearing Detection and Intervention (EHDI) program is involved with URLEND. The EHDI Program Manager, Dr. Stephanie McVicar, has been one of the Audiology Core Faculty since 2011 and Infant-Pediatric Audiology (IPA) program coordinator from 2011-2019. The Joint Commission on Infant Hearing 2007 Position Statement specifically addressed the critical need for “training professionals with pediatric specific and discipline-appropriate knowledge and skill to work with infants, children, and families….” and the IPA supplemental grants to LEND programs were awarded in 2009 to fulfill this need.

The URLEND IPA program specifically addresses Utah training gaps through a combination of interdisciplinary didactic training, intensive clinical opportunities, and targeted leadership experiences. Responding to the aforementioned shortage of qualified infant and pediatric audiologists, the URLEND IPA program’s goals are 1) Increase the number of pediatric audiologists with clinical and leadership skills, who will deliver interdisciplinary care to infants and young children with hearing loss, especially those children with comorbidities (autism spectrum disorders and other developmental disabilities (ASD/DD)); and 2) Improved capacity for the URLEND region to screen, treat, and follow-up on infants and young children confirmed to have HL and those with HL and ASD/DD.

Between 2009 and 2020, the URLEND program has had 43 long-term trainees successfully complete the IPA strand. The URLEND-IPA program consists of more than 300 hours of LEND and IPA curriculum, split amongst didactic, leadership and clinical training. Trainees complete MCH Competency Self-Assessment Surveys both pre and post training and demonstrate improved knowledge, clinical, leadership and research skills regarding IPA and related MCH competencies (culturally sensitive, community based, family centered) care. These trainees also participate in monthly hearing screenings conducted with the Utah EHDI program at the South Main Clinic, one of Salt Lake City’s Community Health Centers serving mainly low-income Hispanic families.

The EHDI program hosts an annual statewide training conference with representatives from all birthing hospitals in Utah, including infant and pediatric audiologists. In September 2019, the State EHDI Conference was held with 50 attendees.  The theme for the 2019 training conference was “Just-In Time for Families”.  This all-day conference featured Justin Osmond as the keynote speaker with a talk entitled, “I may have a hearing loss but my hearing loss doesn’t have me”.  Additional seminar topics included Family Experiences; Screening Equipment, Protocols and Techniques; Ask the EHDI Team; HiTrack for Audiologists; CMV Documentation; Where is the Gap? An Analysis of those who declined Early Intervention; and Medical & Audiological Management of Microtia/Atresia/Middle Ear Fluid.  This conference was unique in that instead of hosting the event at the Utah Department of Health CSCHN building, it was held in partnership with the Utah State Office of Rehabilitation, Division of Services for the Deaf and Hard-of-Hearing, at their Sanderson Community Center of the Deaf and Hard-of-Hearing. It was a great way for attendees to experience all that the Sanderson Center has to offer and vice-versa. Providing educational opportunities for Utah’s infant and pediatric audiologists is crucial to a successful EHDI program.

During 2019-2020 URLEND project year. The CSHCN Bureau also participated in a Foster Care initiative in evaluating transition planning for youth to adulthood. This project was structured through the University of Utah, South Main Clinic in Salt Lake City who is a main provider for services to children and youth in Utah’s Foster Care System and primary care services to women, men and children during all stages of life. South Main also has an obstetrics/gynecology clinic and a Teen Mother and Child Program to help promote health during pregnancy. The URLEND project research will assist in supporting the new five-year goals for CSHCN under the NPM of Transition.

While there are seasoned MCH staff in Utah, there is much work to be done to raise self-reported skill proficiency levels. In 2018, a survey of state and local health department MCH staff was conducted to identify workforce development needs. A total of 63 responses were received with 33 (57%) from UDOH staff. Respondents were asked to identify primary work responsibilities. The top seven identified primary responsibilities reported by over 40% of respondents include data collection and analysis (52%), program management (50%), program evaluation (48%), assessment, planning, and policy (45%), link clients with health care (43%), surveillance (43%), and public education about MCH (41%). Only 21% report workforce development as a primary responsibility. Seventy percent of supervisors report that they use one or more workforce development assessment tools, with 61% reporting that they assess training needs every year.

Supervisory respondents ranked the MCH Leadership Competencies according to their perception of greatest training need (1) and lowest training need (12). The table below shows average and ranking broken out by LHD and UDOH staff.

The majority (68%) of survey respondents agree or strongly agree they have the organizational capacity to provide staff training that is accessible, topically applicable, and/or otherwise appropriate to their training needs.

Organizations use numerous methods to provide or facilitate staff development and training opportunities. Survey respondents indicated the top three preferred methods for providing trainings include: 1) National conferences/meetings, skills building sessions (CityMatCH, APHA, etc.), 2) One to three-day intensive training sessions with 25-50 trainees, and (tied) 3) Webcasts AND Blended learning (in person and distance methods). The top three barriers in accessing training were: 1) Cost of continuing education programs, 2) Difficult to take time away from work, and (tied) 3) Difficult to take time away from home/family/community AND Lack of adequate staffing to cover while training.

Respondents were also asked about plans to retire or leave the organization. Retirement: 90% of respondents are planning to retire in 2021 or later. Leaving organization in next year: 84% are not planning to leave their organization.

A very strong majority of respondents feel that they have leadership development opportunities, that they can grow professionally, that their organization supports leadership opportunities, they are prepared to take on current and future leadership challenges, they feel they are leaders, and they actively pursue learning and professional growth opportunities. The weakest areas identified in the leadership questions are that they have no professional development plan that supports their growth and they do not seek out leadership opportunities.

Responses from the survey will guide strategy development for strengthening the infrastructure of the state and local MCH/CSHCN. An MCH workforce development plan for Utah has been drafted with goals to increase communication, create a supportive work environment, identify and provide training opportunities, and track and evaluate provision of workforce development opportunities.

This past year, MCH Workforce Development “training pages” were created that provide an “at a glance” menu of training opportunities for staff and LHD’s to use during the year for the AMCHP Workforce and Leadership Development website, the MCH Navigator website  and Advancing Health Transformation (also from the MCH Navigator site). The pages outline the Training Purpose, a What/How to use, Topics, Format of Training and Examples of Specific Training Available (See Appendix C). These will be included into LHD contracts for the upcoming year, with an expectation that staff will participate in at least one training opportunity from these resources, or another MCH/CSHCN training opportunity of their choice. In addition, these resources will be provided to the MCH/CSHCN staff for use throughout the year.

In 2019, the UDOH conducted an employee satisfaction survey. The survey asked questions about Bureau specific positions and then UDOH organization satisfaction. Results were distributed to Bureau Directors to examine employee responses. The UDOH encouraged Bureau Directors to use the data to identify areas where satisfaction could be improved upon. The responses to the survey were mostly positive. Questions were scaled (1-5) with (5 being most satisfied).  The MCH/CSHCN Bureau Director’s found question responses regarding direct Bureau work scored in the 3.5-5 range and UDOH Executive Leadership question responses scored in the 3-4 range. Both MCH/CSHCN Bureau Directors reviewed the UDOH satisfaction survey feedback. Highlights of the report (not all-inclusive) for the MCH/CSHCN Bureaus are as follows:

Overall, staff comments suggested improvements could be made regarding Executive Leadership’s UDOH communication, process improvements, recognition and pay. Employees voiced to Bureau leadership a desire for improvement of transparency and clearer communication from UDOH leadership.

Starting March 2020, when the world experienced the COVID pandemic the UDOH and Bureaus adapted to the workforce needs, work environment and efficiencies immediately by all employees moving to teleworking. Teleworking was implemented to ensure safety of our employees and MCH/CSHCN customers served throughout the State. Transitioning to telework and telehealth services has been challenging due to the new service delivery system but we have found through surveying customers the platform has mostly worked to keep them connected to services. 

The UDOH and Bureaus need to continue to research methodologies to address the need for direct clinical care assessments, treatments, and other duties which cannot be performed with telehealth. Since March, MCH/CSHCN have implemented informal surveys asking employees satisfaction with the telework and telehealth platform and feedback suggests workforce satisfaction and productivity has improved.

Each Bureau Director meets weekly with Program Managers as a team and then individually to ensure Programs are functioning as efficiently as possible and with leadership support. Additionally, the State Human Resource Department is offering monthly “Off the Shelf Series Virtual Classes” on telework challenges and ways to improve work efforts. This series educates employees and creates a forum for discussion with other State employees. Additionally, the State of Utah has a statewide wellness council who encourages each Department and Division to participate. Every month employees receive an invitation to participate in health and wellness activities to improve their wellbeing. For example:

 Week 1: Modify your routine for the “new normal” whether it’s back to school or work.

Week 2: Create healthy habits to help get you through the pandemic – bolster your immune system with proper nutrition, exercise and rest.

Week 3: Adjust your schedule: time management tips for our current condition.

Week 4: Self-care for you and caring for others: manage fears and anxiety and find ways to lend a hand to those in need.