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. This has had multiple trickle-down effects on all programs, including Title V. Many staff members have been activated for temporary incident management and response assignments, taking them temporarily away from their regular work. In addition, as new response and recovery teams have been developed, a number of staff members have chosen to move into long-term COVID-19 project positions, leaving six Title V position vacancies. However, COVID-19 response has also offered opportunities for many staff members to learn more about the specific needs of the state’s maternal and child populations and practice new skills in response.

The total number of DOH full-time equivalent (FTE) positions funded by MCHBG federal funding is 18.76 FTE. This represents 40 individuals, as most positions are funded from multiple sources. This is an increase from last year’s level of 17.55 FTE (portions of 35 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 prioritize employee retention and succession planning. When we have a position vacancy, we consider whether to fill the position 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.

• 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. After a pause due to the COVID-19 response, training sessions have resumed and are now provided online.

• 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 managers will complete 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.

• 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 and facilitation training that is available in short segments; both for supervisors and for those who lead external, community efforts is a need within the Thriving Children and Youth section.

• Linkage of Essentials for Childhood child abuse and neglect prevention work funded by CDC with MCH theory of change, including state performance measures, evidence-based strategy measures, strategies, and objectives. In the Technical Assistance section, we mention our plan to request consultant assistance in this area.

• Continued training around telehealth and teleintervention. A recent needs assessment conducted by the Early Hearing-loss Detection, Diagnosis and Intervention (EHDDI) program to better understand barriers to EHDDI services during the COVID-19 pandemic revealed that parents were reluctant to receive early intervention services virtually. Training and education may assist providers and families to better utilize teleintervention when necessary or preferred.

• On examination of the MCH Navigator report on workforce needs in Washington, we will encourage our MCH staff to pursue several specific training resources through the navigator, including the Policy 101 portal, strategies for implementing health equity, and implementation briefs.

Innovations in Staffing Structures and Key Training Partnerships

We are widening our scope of partners to learn from and involve in program planning. We have added three community partners from diverse geographic regions and a key private foundation partner, and are in the process of adding parents and caregivers to our cross-sector Essentials for Childhood Steering Committee. We had an opportunity this year to include the LHJs directly in contributing to an “Inventory of What Works” for child abuse and neglect prevention and building family resilience. We also added multiple partners from specific communities through our Vroom parenting program grant dissemination. See Child Health Annual Report for more information.

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

The statewide Critical Congenital Heart Disease (CCHD) Workgroup is hosted by the Genetics program. This is a group of statewide stakeholders who meet periodically to work on challenges, gaps and barriers to effective CCHD screening and diagnoses in Washington.

The Genetics program compiles a biannual hospital report sent out to all birthing hospitals and midwifery clinics on the status of CCHD diagnoses in Washington. These infants are diagnosed through a variety of ways, including prenatal testing and newborn screening. The reports contain data on the diagnoses, as well as narratives provided by clinical experts on the best adherence practices to the screening algorithm, and other practices that reinforce the training needed to detect CCHD among newborns in Washington.

The Genetics program maintains a webpage of comprehensive resources to families and providers of persons with Down syndrome. This is updated annually.

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.