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.  We continue to experience staffing adjustments resulting from the significant amount of staffing transition resulting from the Covid 19 response.  We have spent the past 12 months resettling and growing staff as our MCH work has expanded and are delighted to bring in people with new expertise and lived experiences. Several examples of this are:

• The Perinatal Team was pleased to welcome Shanell Brown a temporary public health nurse consultant with a strong background and interest in equity. She assists with the Birth Equity Project (BEP) supporting the BEP advisory committee, LGBTQI2S+ doula training, and projects to support black breastfeeding.
• The Adolescent and Young Adult Health Unit was thrilled to welcome two new members in the summer of 2022. Nicole Casanova, the Performance Coordinator, has experience in women’s sexual and reproductive health from both the programmatic and evaluation perspectives, designing human-centered healthcare experiences, facilitating and leading multidisciplinary teams, translating research into practice and sustaining community partnerships, specifically among underserved and underrepresented communities. Morgan Nelson, the Behavioral Health School Based Health Center Coordinator, brings with them exceptional authenticity, humility, and a well-honed sense of community engagement. They have extensive experience working on the ground in communities who have been historically and intentionally marginalized. Both Nicole and Morgan bring a deep knowledge of cultural humility and health equity, based on lived experience as well as previous community health work.
• Bella Mendez joined the Child Health team in September 2022. She received her master’s in social work from the University of Washington and specialized in the field of multigenerational practice in June 2018. Her primary interest areas include early childhood development, behavioral and community health. Bella is especially passionate about increasing access to prevention services and education for all families. She comes to PCH from the Office of Public Affairs and Equity (OPEA), where she previously worked as an equity and social justice strategist on the Community Relations and Equity team. She was born in Michoacan, Mexico, but has lived in Washington state most of her life.

As we enter into a season where Covid 19 funding sunsets, we may witness an overall shrinking of investments in public health funding, and we are trying to ready ourselves for that possibility.  

The total number of DOH full-time equal (FTE) positions funded by MCHBG federal funding is 18.72 FTE. This represents 43 individuals, as multiple sources fund most positions. This is slight decrease from last year’s level of 17.79 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.  

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:

• Building Trust in Local Public Health for Rural Communities
• Expanding Syndromic Surveillance Program through Tribal Health System Partnerships
• Thriving in Place for Older Adults
• Mental Health and the Public Health Workforce
• Rethink the Drink
• Public Health WINS for the future
• Moving Beyond Fentanyl
• Monkeypox and the Risk of New Zoonotic Threats
• Learning to Lead Adaptively

Staff participate in several other training programs, conferences, and education systems. A significant number of MCH connected staff participated in the nation AMCHP conference held virtually in 2022. The Section Manager for Thriving Children and Youth also participated in the AMCHP affiliated State Adolescent Health Coordinators meeting in Minneapolis in September 2022.

Staff have also been participating in Family Engagement in Systems Assessment Community of Practice and coaching sessions, beginning Fall 2022.

The Child Health Team completed the AMCHP Coordinated Intake and Referral Systems survey (March 2022) and in follow-up discussions internally and with AMCHP and ECCS partners. In March 2023, this team presented about the WA State ECCS initiative at the Title V - ECCS partner meeting. This was a coordinated meeting between AMCHP and the ECCS TA Center to facilitate and strengthen connections between Title V program and ECCS project staff.

For the Adolescent Health and Young Adult team, staff have participated in a number of technical assistance trainings, workgroups, and conferences including:

Technical Assistance and Training

• Webinars offered by the Reproductive Health National Training Center (RHNTC) and Mathematica, focused on adolescent sexual health and program evaluation
• Tribal Public Health Partnerships (3-part series offered by DOH Tribal Relations)
• DOH Equity and Social Justice Office Hours
• Healthy Native Youth Community of Practice webinars
• Completed trainings/education materials provided by NNSAHC’s website - Home - National Network of SAHC (nnsahc.org)
• Institute for Healthcare Advancement Health Literacy Specialist training
• Adolescent Pregnancy Prevention (APP) topical training
• Adolescent Brain Development and Trauma
• Office of Population Affairs (OPA) affinity group serving Tribal communities
• SBHC small workgroup calls
• NPM 10 - Adolescent well visit workgroup calls
• Bimonthly State Adolescent Health Coordinators Calls for Regions 8, 9, and 10
• Healthy Students Promising Futures peer collaboration and workgroup meetings focused on expanding Medicaid in schools.
• HCA Children and Youth Behavioral Health Work Group – School-based Behavioral Health and Suicide Prevention
• Washington State Public Health Associaton Conference 2022
• OPA Innovation Exchange (Washington, DC) 2023-presentation
• AMCHP 2023 (virtual)-poster presentation
• Annual Conference on Adolescent Health (AHI, virtual) 2023-presentation
• Tribal Public Health Conference (Durant, OK) 2023-presentation
• School-Based Health Alliance Conference-presentation
• Washington School Health Summit

Finally, other trainings for staff have included Essentials for Childhood monthly webinar and trainings associated with a Reverse Site Visit, Healthy Outcomes from Positive Experiences (HOPE) Summit, Science of the Positive workshop (with The Montana Institute), various webinars. podcasts, readings.

OFCHI leadership convenes all managers within the Office on a quarterly basis.  In addition to providing operational updates and training, we often invite a subject matter expert to deepen our learning on issues important to how we work.  Topics have recently included equity in contracting, the intersection of historical trauma with tribal health outcomes, the history of systemic racism in the United States and influence on health of BIPOC communities, and our tribal engagement processes.  In addition to these opportunities for leaders, all staff are invited to join monthly Equity and Social Justice Office Hours, as well as Prevention and Community Health Office hours. Both of these spaces provide rich training and networking opportunities for staff.  Finally, each Fall, all staff are invited to participate in Policy 101 training, with additional deeper modules for staff expected to create draft legislation and conduct active bill review on these processes.

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 and teams, some of these are ongoing training needs:

• 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.
• Resiliency framing for maternal, child, adolescent health work.  How to implement a shift in focus from deficit models to strength and hope-based approaches
• Growing staff morale amidst staff burnout, challenging partnership relationships, navigating the increasingly complex public health landscape, and continued agency-level changes
• Results-based accountability and systems-thinking training—how to apply these approaches to complex initiatives
• Training on implementation of the Blueprint for CYSHCN
• Implementing and maintaining quality improvement efforts in clinical and non-clinical settings
• Coordinating and leveraging HRSA funded initiatives such as MCHBG, ECCS and now ECDHS
• Trainings on Adolescent Health Well Visits

Innovations in Staffing Structures and Key Training Partnerships

We have continued our intentional routine engagement with partners for shared learning and leveraging of efforts in our program planning and policy work.  These include 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 continue 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 and universal developmental screening.  We connect regularly with the Health Care Authority, which administers Medicaid, to align the MCHBG with policy initiatives (such as Medicaid expansion for additional days of inpatient substance use disorder treatment at the time of birth) and systems improvements (like determining funding mechanisms for community health workers and doulas).  Our teams also participate in several 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.  Our Community Partnership and Engagement team facilitates two important community coalitions – the Community Health Worker Leadership Committee, which advises state agencies on community-based workforce infrastructure, and the Health Equity Zone Community Advisory Committee, which directs the department on the implementation of legislation concerning the creation of health equity zones.  Our Youth Advisory Council members meet with DOH's Adolescent Health staff on a regular basis to discuss adolescent and young adult health topics; their insight helps guide public health work to make sure that Department of Health (DOH) strategies are relevant, accessible, and youth friendly. Our Birth Equity Advisory committee meets monthly to guide to development and implementation of the Birth Equity Project (BEP). This has included developing eligibility requirements for grantees and identifying new organizations to receive funding. They have partnered with the BEP evaluator to develop an evaluation framework for the program and will continue to serve as an accountability measure for grantee work.

We continue to contract with the University of Washington (UW) to host the Washington State EHDDI Learning Community (WSELC), which supports professionals across disciplines and across the state to connect, share ideas and results, and learn from each other through both in-person and virtual interactions. The WSELC aligns professionals around common goals and best practices to support children who are deaf and hard of hearing and their families. Professionals involved in this learning community include newborn hearing screeners, pediatric audiologists, family resource coordinators, and early intervention providers who serve infants born in Washington.

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.

The Genetic Services program has convened a Prenatal Genetics Task Force with the primary objective of developing comprehensive guidance for non-genetic healthcare providers offering prenatal genetic tests to their patients. This guidance includes recommendations on which tests to offer, when to offer them, and criteria for appropriate follow-up care. The Task Force comprises a diverse group of subject matter experts, including genetic counselors, family medicine and obstetrics providers, midwives, payers, and Department of Health staff.

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 host monthly topical calls for LHJ partners and quarterly networking calls for LHJ MCH leads. They also send a biweekly email with links to resources, trainings, and job opportunities.  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.