Developing the public health workforce through community-based fieldwork

Abstract

A skilled public health workforce is critical to assure the public’s health. Recent scholarship has highlighted the benefits of practice-based fieldwork to train the public health workforce. This scholarship has highlighted these benefits primarily through quantitative evaluation. DePaul University’s Master of Public Health (MPH) Program provides practice-based education and training to enable students to develop key competencies in public and community health. A key component of the MPH Program is a 9-month practicum experience. This practicum experience requires students to (1) Complete at least 250 h of fieldwork at a local health organization and (2) write a capstone thesis about their practicum project. In this themed issue, seven MPH Program students provide empirical papers, describing their practicum project and the competencies they gained. These empirical papers build upon existing scholarship on practice-based fieldwork and aim to advance academic and community efforts to assure a skilled public and community health workforce.

Keywords:

• Competency-based education
• public health
• service-learning

Public health has been described as both a science and an art, aimed at protecting and promoting health—including physical, mental, and social health (Winslow, 1920; World Health Organization, 1948). Public health targets groups and populations—rather than individuals—through varied initiatives, including, the provision of health services, the implementation of public policies, and the conduct of scientific research (CDC Foundation, 2019; Riegelman & Kirkwood, 2015). These types of public health initiatives have enabled accomplishments that include, controlling infectious diseases such as cholera, promoting oral health through fluoridating drinking water, and implementing social campaigns to curb the deleterious effects of smoking (Centers for Disease Control and Prevention, 1999).

These accomplishments have required the efforts of a skilled public health workforce—a diverse group made up of governmental and nongovernmental professionals, including, epidemiologists, public health physicians and nurses, behavioral health professionals, and public health educators. Ensuring a competent public health workforce has involved several collaborative efforts. In 1982, the Health Resources and Services Administration (HRSA), highlighted shortfalls in the size of the public health workforce, in a landmark report, Public Health Personnel in the United States, 1980 (U.S. Department of Health & Human Services, 1982). Further, HRSA cited the importance of training practices intended to promote a skilled public health workforce. Although this report presented a troubling reality for public health, report recommendations were not immediately taken (Turnock, 2016).

Less than a decade later, The Institute of Medicine (1988) released a report called, The Future of Public Health. The report described public health as being in a state of “disarray,” and recommended that public health focus on three core functions: assessment, policy development, and assurance. During the 1994 health care reform efforts by the Clinton administration, the Working Group on the Core Functions of Public Health established ten “Essential Services of Public Health” (Harrell & Baker, 1994). This list of essential services aimed to clarify public health’s role—to policymakers and the general public—and added specificity to the core functions of Assessment (e.g., essential service 1, “Monitor health status to identify and solve community health problems”), Policy Development (e.g., essential service 3, “Inform, educate, and empower people about health issues”), and Assurance (e.g., essential service 9 “Evaluate effectiveness, accessibility, and quality of personal and population-based health services”). These essential services represent the focus of public health professionals today. Table 1 provides the three core functions and their related essential services.

Table 1. Core functions and essential services of public health.

Core function	Essential service (system management and research occur across all core functions and essential services)
Assessment	1. Monitor health status to identify and solve community health problems
	2. Diagnose and investigate health problems and health hazards in the community
Policy development	3. Inform, educate, and empower people about health issues
	4. Mobilize community partnerships and action to identify and solve health problems
	5. Develop policies and plans that support individual and community health efforts
Assurance	6. Enforce laws and regulations that protect health and ensure safety
	7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
	8. Assure competent public and personal health care workforce
	9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
	10. Research for new insights and innovative solutions to health problems

Note. Adapted from “The Public Health System & the 10 Essential Public Health Services,” by the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, retrieved from https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html.

Academic institutions have played a key role in assuring a skilled public health workforce. Academic public health programs use a variety of approaches to educate and train the public health workforce—one of which is practice-based fieldwork which contributes to what is known as a “practicum experience.” In a recent evaluation of a practicum experience, Villanueva, Hovinga, and Cass (2011) evaluated a 7-month, problem-focused practicum for masters-level students at a public health agency. Results from this evaluation show that students were better able to collaborate with community organizations and solve public health problems. Additional evaluations of public health practicum experiences triangulate this, showing that students can master public health skills and experience professional growth (Ceraso, Swain, Vergeront, Oliver, & Remington, 2014; Gregorio, DeChello, & Segal, 2008).

These previous studies show the effectiveness of practicum experiences using quantitative approaches. However, few studies provide an in-depth, empirical description of practicum experiences. In this themed issue, recent public health graduates provide an in-depth description of their practicum experiences (n = 7) as well as the competencies they gained. The practicum experience required students to (1) Complete at least 250 h of fieldwork at a local health organization, under the guidance of a site supervisor, and (2) Write a capstone thesis about their experience that documents the public health competencies gained.

Each of these seven articles is authored by the (former) MPH Program student who completed the practicum (and for three of these articles, their practicum site supervisor served as a co-author). The articles are adaptations of their written capstone thesis. These seven practicum experiences occur across the three core functions (assessment, policy (and program) development, and assurance). In each article, the (former) MPH Program student author describes their practicum project and how it was guided by a theory or framework. The authors reflect on the essential services that the practicum project involved and how the overall practicum experience helped facilitate their entry into public health practice. Although these studies are most relevant to public health, they can be applicable to teachers, trainers, and supervisors who are overseeing fieldwork in community settings, across any discipline.

Focus of this themed issue

The lead author of each article describes her or his practicum project and the competencies developed. Projects span all three core functions of public health. Two projects involved assessment, two involved policy (or program) development, and three involved assurance. In the first article, Niemet and Rice describe an effort to “monitor health status to identify and solve community problems” (essential service 1). For Niemet (the practicum student), this meant developing a survey that assessed the needs of lesbian, gay, bisexual, transgender, and queer (LGBT) older adults. This survey informed the development of culturally competent programming at the Federally Qualified Health Center (FQHC), where she had her practicum experience. Niemet comments on the importance of building consensus among staff at the FQHC, and the importance of learning about the historical context of the LGBT movement, as well as the importance of cultural competence in carrying out her work.

In the second article, Zepeda Orozco and Manger describe another practicum focused on “monitor[ing] health status,” which also took place at an FQHC. For her practicum, Zepeda Orozco aggregated data from medical charts to develop a Hepatitis C patient registry. This project supported the development of workflows in the FQHC and positioned the center to request funding for Hepatitis C-related work in the future. Zepeda Orozco describes the importance of working with the Hepatitis C Virus Care Team at the FQHC, to develop the registry and draft a supporting protocol—an experience that shaped her professional development as a public health practitioner.

Within the core function of policy (and program) development, two projects aimed to “inform, educate, and empower people about health issues” (essential service 4). In the third article, Akufo describes the development of a 6-week health education curriculum to promote healthy eating and physical activity among Hispanic youth. This project required her to conduct a health assessment questionnaire and a focus group with youth, to guide the design of the program. Akufo highlights the importance of communicating effectively—specifically with the target audience of Hispanic youth, in her development of this health education curriculum.

In the fourth article, Ibrahim Puri describes her practicum project that also aimed to “inform, educate, and empower people.” She adapted a program to educate Home Care Aides (HCAs) about nutrition. The program consisted of a 2-day training session for HCAs to ensure they have the knowledge and skills to provide healthy and nutritious foods to the older adults they serve. Ibrahim Puri describes the importance of cultural competence in developing program materials. Further, she reflects upon the social inequities that exist between the HCAs and their older adult clients, as the majority of HCAs are black and risk the potential loss of employment when conflicts arise with clients.

The third core function is assurance—two articles address essential service 9, “evaluate effectiveness, accessibility, and quality of personal and population-based health services.” The fifth article by Day and colleagues involves a description of her practicum project, conducting a formative evaluation of a community-based gardening education program, which takes place in urban schools. Specifically, Day examined the implementation of the program model and the variation in implementation across five schools. This formative evaluation involved conducting qualitative interviews with program stakeholders. Day describes the opportunity the practicum provided her, to move beyond evaluation theory to evaluation practice. Further, she reflects on the practicum experience as one that required strengthening communication skills, specifically, listening with cultural humility.

In the sixth article, Ostrander and Carlberg-Racich describe a project to “evaluate effectiveness, accessibility, and quality” related to a Syringe Access Program (SAP). Specifically, their evaluation uncovered aspects of the SAP the participants found most useful. Ostrander (the practicum student) conducted this evaluation in a participatory fashion, capturing participant voice with a mixed-methods survey. The results of this survey helped the SAP better understand how to program clients to perceive core services. The authors have also shared these findings with other community stakeholders doing similar work. Ostrander describes the importance of collaborative efforts for supporting marginalized groups, as a key lesson learned.

Finally, in article seven, Craig conducted a systematic review of the literature to examine the effects of physical activity on weight status, BMI, and fitness among children with an autism spectrum disorder. This effort relates to essential service 10, “research for new insights and innovative solutions to health problems.” Craig’s systematic review involved searching databases to identify articles that would inform his practicum site—a pediatric health organization. Craig describes the process of sharing the results of his systematic review with key stakeholders in the community, and the opportunity to learn from experts who had affiliations with his practicum site. His work helped advance research and practice in promoting physical activity among special populations.

Conclusion

Thirty years after the Institute of Medicine’s (1988) report, The Future of Public Health, described public health in a state of “disarray,” Leider, Coronado, Beck, and Harper (2018) concluded that the public health workforce is shrinking at the federal, state, and local levels. One contributing factor to the shrinking public health workforce is older members (baby boomers) retiring. As this occurs, younger members of the public health workforce must be ready to step into these positions, to promote and protect the public’s health. This younger workforce will be expected to navigate complex systems to address issues such as racism and poverty, which perpetuate and exacerbate health inequities (Public Health Learning Network, 2008). As noted by Glynn, Jenkins, Ramsey, and Simone (2019), many of these systems may be outside the realm of public health practice or across multiple systems, making leadership and strategic skills that can be developed through field-based practicums, particularly important.