Recruitment of qualified Title V staff and subsequent retention is important to the Bureau of Family Health (BFH). Retaining knowledgeable, dedicated program staff over the course of the five-year state action plan and across funding cycles makes delivery of Title V programming more consistent and effective. These efforts occur in alignment with the 10 Essential Public Health Services and Core Services, and the MCH Leadership Competencies. The BFH is adapting its workforce development efforts toward a transformative approach: building a workforce able to respond to challenges at both the community and state-level, addressing the root causes of health inequities, and ensuring that staff are continuously learning. The BFH encourages staff to participate in professional development opportunities as part of its retention efforts.

Each division within the BFH identifies such opportunities relevant to the topic area(s) in which program staff work. Additionally, Title V program staff often facilitate professional development workshops and offer technical assistance or other trainings to their grantees and local Title V staff in order to build capacity and support personnel across the state. BFH continues adapting and implementing innovative strategies to foster a culture of equity, inclusion, and collaboration. The COVID-19 crisis imposed unique program delivery challenges to maintain adequate services aimed at improving the health of mothers, birthing people, children, and families. The BFH staff attended and offered virtual training options as well as limited in-person trainings and conferences. Trainings and conferences offered intersectional cultural/linguistic competence skills, data management, systemic anti-racial dismantling, health equity, meaningful engagement, and as well as policy/system capacity building.

In 2021, the Division of Newborn Screening and Genetics (NSG) planned to provide a statewide training for audiologists. As a result of the COVID-19 pandemic, the training was postponed and in response the Infant Hearing Screening Advisory voted to host the training remotely. The training is currently being developing into an online learning module to be housed on TRAIN PA, Pennsylvania’s gateway to the TRAIN Learning Network. The trainings are anticipated to be available in fall 2022. Throughout 2022, NSG will continue to provide staff with the opportunity to attend topical conferences, including the NewSTEPs New Disorders and Short-Term Follow-up Virtual Meeting, the Association of Public Health Laboratories Newborn Screening Symposium, and the North American Cystic Fibrosis Conference. In addition, the NSG will continue to participate in topical webinars hosted by various organizations related to dried blood spot, hearing, and critical congenital heart defects screening, in addition to breastfeeding and neonatal abstinence syndrome.

The Division of Child and Adult Health Services (CAHS) will offer training to grantees on long-acting reversible contraception (LARC), upon request. During the past year, there were no requests for LARC trainings, which may be a result of the COVID-19 pandemic. All field staff in the Safe and Healthy Homes Program (SHHP) completed at least one professional development course during 2021 even as the grant ended on June 30, 2021. To ensure that the needs of all populations are being met through the services offered by the Department, all Personal Responsibility Education Program (PREP) and Sexual Risk Avoidance Education (SRAE) providers required to annually attend a one-day LGBTQ cultural competence training. The pandemic also impacted these trainings, which mostly took place virtually. LGBTQ cultural competency trainings will continue to be facilitated by Persad Center through 2022 and will provide opportunities to identify resources for LGBTQ youth, evaluate cultural competency of the organization, answer questions from staff, problem solve challenges, celebrate successes, and discuss unmet needs that have emerged through the delivery of services. Going forward a new training provider may need identified as the Persad Center’s contract with the Department has ended.

Despite the challenges of holding and attending workforce development activities during the COVID-19 pandemic, the Division of Community Systems Development and Outreach (CSDO) staff attended a wide range of trainings and events to maintain and increase their knowledge base. Staff who oversee the Traumatic Brain Injury Programs attended the National Association of State Head Injury Administrators conference, the Brain Injury Association of Pennsylvania’s conference, and the Administration of Community Living TBI Stakeholder meeting in 2021 and will attend them in 2022 and 2023. Attending these conferences will increase knowledge of brain injury and best practices in prevention and treatment. Staff assigned to the Specialty Care Programs (SCP) will attend trainings related to implementing systems level change and supporting cross-systems collaboration to enhance technical support to SCP grantees. CSDO staff attended events focused on improving the CSHCN system of care in 2021 and will continue these workforce development opportunities in 2022 and 2023. Events included the PA Community on Transition Conference, the PA Community Alliance Summit, the Disability and Mental Health Conference, and the Special Needs Unit Training Day. Some of these events included presentations on CSDO’s CSHCN programming. Staff will attend trainings related to programs that are new or are undergoing changes, including the Male Involvement Initiative. The Male Involvement Initiative training for youth and advocates, entitled “Make a Difference”, was postponed from 2020 to 2021 and held virtually. An in-person training occurred in 2022 titled “Fit to Lead” and included topics on leadership, team building, and integrity for high school and college student-athletes. There are no current plans for a conference in 2023. Similarly, the Parent Education and Advocacy Leadership training for youth with special health care needs, entitled “Bring Your Voice: Share Your Vision”, was held virtually in 2021 after having been planned to be in-person in 2020. Another virtual conference titled “Health Matters: Healthcare & Services for Children with Disabilities & Special Healthcare Needs” was held in 2022. There are no current plans for a conference in 2023. The CSDO staff will take part in training opportunities intended to improve their ability to identify systematic issues and develop programming to address the issues. Opportunities will be provided for BFH staff to attend trainings presented by CSDO grantees, which will provide information related to condition-specific populations, public health concerns experienced by each population, and best practices related to service provision. In addition, CSDO plans to host an annual symposium. Offered for the first time in 2019 and delayed due to the COVID-19 pandemic, the 2022 CYSHCN Symposium recentered the conversation around a well-functioning system. CSDO is planning a 2023 symposium to include topics of traumatic brain injury and healthy relationships, among others.

The Division of Bureau Operations (DBO) will continue to support and provide training opportunities and technical assistance for BFH staff and grantees on a variety of topics as outlined in the narrative below. DBO attended conferences, such as the 2021 Family Voices Virtual Family Engagement Convening annual family engagement conference. BFH staff will continue to explore external opportunities for enhancing knowledge and skills associated with family engagement strategies. DBO will continue to develop and lead workforce development activities throughout the BFH.

In addition to the division-specific professional development activities described above, several staff from each division typically have the opportunity to attend and/or present at the annual Association of Maternal and Child Health Programs (AMCHP) and American Public Health Association (APHA) Conferences in order to build new skills and expand their knowledge of best practices that can be incorporated into BFH programming. Staff also attended, both virtually and in-person, the Health Equity Summit hosted by the DOH Office of Health Equity in conjunction with the American Lung Association in April 2022 that focused on various current and emerging topics such as rural health equity, disability equity, and pathways to prevention.

In January 2021, the Department of Health (DOH) formally adopted a duty statement around health equity that has been added to all employee’s position descriptions. This statement holds staff responsible to “demonstrate awareness of the vulnerable populations the organization serves by identifying, providing, and advocating for resources, services, communication methods, and policies that would help those populations achieve health equity”. The Office of Health Equity will be working with the Health and Human Services Delivery Center to offer health equity training to ensure a well-trained and prepared workforce is maintained. The DOH Antiracism and Health Equity Task Force, Support and Training subcommittee, formed in May 2021, continues to work and collaborate on the development of training and training resources to assist the DOH workforce, including the BFH to build capacity to meet this deliverable.

The Department is also exploring new mechanisms for recruiting and retaining qualified public health staff. The Department is in the process of updating its workforce development plan for the 2022-2027 period. Given that the BFH must adhere to the Department’s recruiting policies and procedures, innovations in recruitment and retention could be beneficial to the BFH and, by extension, to the state’s Title V program. The BFH aligns its workforce development activities with the Department-level initiatives whenever feasible. The BFH’s staffing structure is also dictated by the framework established by the Department. The Organizational Structure section of the Needs Assessment Summary (III.C.2.b.ii.a.) describes the staffing structure of the state’s Title V program. The organizational charts for the BFH and the Department are also included with the Application as supporting documents.

As the BFH has adapted to the transformed Title V block grant structure and reporting requirements, it has become apparent that workforce development needs to move beyond program and discipline specific trainings for BFH staff and grantees. The BFH will continue to augment the trainings and development opportunities discussed above with bureau-wide trainings to enhance staff understanding of public health concepts, health equity, MCH Leadership Competencies and their application to programming, as well as to the community and systems they impact, and the root causes of health inequities.

Internal surveys of BFH staff conducted as part of the internal capacity assessment in 2021 and in 2022 suggest capacity building on decision making, program development based on data and evidence, change management, and data and data disaggregation is still warranted and desired. Additionally, given the high percentage of new BFH staff at the programmatic level, continued training and opportunities for professional development on these topic areas may benefit all staff, including those who have worked in public health but are new to Title V and public health programming.

Similarly, the BFH also intends to continue building capacity among grantees who administer Title V-funded programs across the state. While grantees indicated in the 2018 interim needs assessment that they had built capacity that would allow them to identify evidence-based practices, some indicated that additional technical assistance is needed for them to access data and effectively evaluate their programs.

DBO will continue to offer training to BFH staff and grantees to support program decision-making and implementation. Training topics may include public health problem solving concepts, data use, evidence-based practices, quality improvement, and program evaluation.

In 2021, DBO staff provided training to staff and to grantees, entitled “Pennsylvania Title V MCH Block Grant Performance Measure Framework”, aimed to build the capacity of the MCH workforce to apply the Title V performance measure framework to programming. This training provided an overview of public health principles, Title V and the Performance Measure Framework, developing SMART (specific, measurable, attainable, relevant, and time-bound) goals, and disaggregating data. The BFH aims to integrate the collection of more evaluation measures into its grant agreements and, for everyone to understand the need and benefit of these changes to effectively serve the MCH population, must begin training staff and grantees around how to collect and analyze data, develop enhanced process and outcome measures, and use these tools to inform program decisions and improve program effectiveness. A similar training was conducted for staff and grantees in 2022. DBO also conducted Data and Data Disaggregation training for staff in 2021.

Additionally, in February and April 2021, the BFH held informational meetings with the Children’s Hospital of Philadelphia (CHOP) Leadership Education in Adolescent Health (LEAH) fellows program and the joint CHOP and Children’s Hospital of Pittsburgh (CHP) Leadership Education in Neurodevelopmental Disabilities (LEND) fellows program respectively. These meetings served as an opportunity to share programs and initiatives that are taking place within the BFH and learn from the CHOP and CHP fellows first-hand accounts of what is taking place with patients and the communities they live in and identify opportunities for further partnership and training. The BFH hosted another meeting with the LEAH fellows in March 2022 and plans to host a meeting with the LEND fellows later in 2022.

Surveying BFH staff will occur at least annually to determine internal staff capacity and training needs around the aforementioned topics. A series of comprehensive internal staff capacity and training surveys were conducted in 2021 to inform trainings and existing workforce capacity efforts, including the weekly resource email. Additionally, the creation of a resource library is ongoing, compiling literature and other supplemental resources to be used by BFH staff. This will potentially be made available to grantees as well.

Since the pilot in June 2020, the BFH continues to produce a weekly resource email (WRE) which includes a combination of the following: live webinars and trainings, recorded webinars and trainings, articles, reports, tools, and upcoming national health observances that are relevant to public health, leadership building, health equity, behavioral health, and the maternal child health population. This resource email has become a staple within the Bureau as it strives to highlight upcoming events, recent reports, and tools for each population domain. Anecdotally, staff have shared that the trainings and resources are beneficial and aid in furthering their understanding of various topic areas, programs, or issues. Staff have forwarded the email on to grantees, and state and community partners as they see fit. Partners include OCDEL, MMRC members, among others.

In May 2021, the BFH began using a Department Constant Contact account to implement the WRE. Constant Contact is an online email platform which allows for the easy creation and dissemination of content that also captures analytics. Through this platform, the BFH can better measure the success of the WRE. Emails are curated and disseminated weekly. On average 27% of staff open the WRE and on average 28% of the resources are accessed or clicked on through their weblink. There are slight variations from week to week, as content is new each week along with other variables including, staff schedules and workload, priorities, and the overall need to utilize the resources. PDFs of all the WRE’s are housed in a centralized folder accessible to staff at any time.

To learn more about the perceptions around the bureau’s weekly resource email, staff were surveyed in May 2021 to determine if they have utilized any of the resources that are shared through the weekly resource email. Of the respondents, 86% (32 staff), shared that they have utilized resources shared within the weekly resource email and 57% (21 staff) shared that they felt the resources were very beneficial or beneficial, while 27% (10 staff) responded neutral, and 16% (6 staff) responded somewhat beneficial to the same question. Given the challenges of the past year, it was important to understand if staff were able to continue building their capacity and increase their understanding or skills by participating in virtual or web-based workforce development activities. When asked, 95% of those who responded (35 staff) shared that they continued to build their capacity by participating in trainings and most shared they have participated in MCH trainings on various topics, including but not limited to adolescent health, CSYCHN, health and racial equity, implicit bias and microaggressions, the collection, utilization and analysis of data, and conferences or skills institutes while teleworking.

Another aspect of the BFH staff engagement includes regular all staff meetings. Staff meetings are held quarterly to conduct workforce development activities, provide updates, and highlight work taking place in each of the divisions. In 2021, a few highlights included updates and education on the PA State Health Assessment (SHA) where Maternal and Infant Health serves as a key theme and the release of the SHA indicator’s dashboard; and updates regarding the Interventions to Minimize Preterm and Low Birth Weight Infants Using Continuous Improvement and Teen Outreach Programs.

A quarterly newsletter was introduced in 2021 to share information, spotlight a division quarterly, and highlight new and ongoing initiatives within the Bureau. The newsletter is also disseminated via Constant Contact. On average, 54% of staff open email and 40% of staff access the PDF version of the newsletter.

As described in the Cross-Cutting section, the BFH also plans to offer training to increase understanding of the social determinants that greatly influence the health of populations and further increase understanding on health disparities and health equity. As a result of the February 2019 BFH Workforce Development Survey, it was identified that most staff did not feel that they could describe the limitations/gaps of Title V programming or apply behavioral models in the design of interventions for MCH populations. Although the survey results suggest that staff felt most confident in their understanding of health disparities and social determinants of health as they relate to MCH, these areas were also identified by staff as their highest priority areas for ongoing training. Additionally, the BFH’s Health Equity Committee (HEC) will continue collaborating with BFH workforce development efforts to increase staff capacity to reduce health disparities and promote health equity in the population served by Title V. Throughout 2022 and 2023, the BFH will work to identify additional training resources related to health equity, social determinants of health and cultural competency and anticipate offering in-person staff trainings. Careful consideration as to how best approach the topics of racial equity and health equity as training topics in both in-person and virtual settings. The virtual series of introductory health equity trainings, “Exploring the Social and Structural Determinants of Health” from the Mid-Atlantic Regional Public Health Training Center and “Health Equity and Environmental Justice 101” from the Colorado Department of Public Health and Environment (hosted on TRAIN PA), taken by staff in 2022 precede more advanced in-person trainings expected be shared with staff throughout 2022 and 2023.

The BFH continues to take advantage of opportunities to further staff’s capacities around these complex and systemic issues. In March 2021, a diverse team of members from across the Bureau participated in the National MCH Workforce Development Center and the Maternal Health Learning and Innovation Center Virtual Spring Skills Institute “Strengthening Skills for Health Equity”. The team left the trainings with increased knowledge, skills, and action steps to strengthen the BFH programs. During the Spring Skills Institute, the BFH health equity journey was presented as part of the peer learning. Additionally, BFH staff participate on the PA Title V team for the AMCHP Healthy Beginnings Cohort, sharing skills and resources with both AMCHP and our community partner, Healthy Start of Pittsburgh.

In 2021, a small team, including program managers and directors, the bureau director, and members of the HEC participated in the Pennsylvania Department of Health’s Office of Health Equity Anti-Racism Institute, alongside 200 other state staff from other agencies. This workshop served to promote the work of dismantling systemic racism by equipping participants with learning, tools, and a professional network to be effective change agents for antiracism on an interpersonal, institutional, and structural level. This team is currently exploring how the racial equity work will align with the health equity work and overall systems change efforts within the Bureau. To ensure that the antiracism work did not end at the conclusion of this workshop and that it permeates throughout each individual action and program, the Department established an Antiracism and Health Equity Task Force in May 2021 to continue the momentum started through the Anti-Racism Institute. BFH staff participate on the Task Force and its subcommittees, including the Training and Support subcommittee, to leverage ideas and resources that are offered, but also to ensure alignment with Departmental workforce development and training efforts.

In 2020, DBO released a request for applications (RFA) to solicit applications from institutions and organizations to be funded to develop and deliver online and in-person educational sessions. The overall goal of this funding was to improve the capacity around public health concepts and topics, including health equity and social determinants of health among Bureau staff, grantees, and partners. Applications for this funding announcement were due October 2020 with the intent to begin funding one applicant by January 1, 2021. However, during contract negotiations with the selected applicant, BFH staff identified additional workforce development needs, including a process to better facilitate the transfer of learning, that needed to be addressed in the work statement. As a result, the RFA was withdrawn to be revised to better reflect the capacity building needs of the Bureau and its partners. The updated RFA will include a deliverable to achieve a multi-layered learning agenda, which will facilitate learning that impacts systems change and addresses the updated 10 Essential Public Health Services. The Bureau plans to release the workforce development RFA in 2022 with services beginning in early 2023.