Local health departments are facing fiscal upheavals. This study assessed their current and emerging training needs through focus groups and site visits. It also sought to determine whether these needs match the training activities offered by CDC and ATSDR. Local health programs were found to need training in advocacy, evaluation, and public information. CDC, which has limited training resources, was found to have no periodic mechanisms for staying in touch with State and local training needs. Recommendations, including those for new training technology, that is, interactive software and satellite communications, have prompted CDC and ATSDR to develop training activities that dovetail with local needs.
Purpose In light of the dramatic changes occurring throughout the public health system, this evaluation had two goals: to determine the current and emerging needs of local health departments and to determine whether CDC and ATSDR training activities not only meet these needs but also anticipate future needs. Training produced and delivered by CDC, is intended to improve the performance of the public health workforce at the State and local level. Training activities provided through workshops, conferences, regional training centers, and other vehicles cover a range of scientific, technical, and managerial topics.
Background The public health system, especially at the local level, is endangered by shrinking budgets and shortsightedness about the value of public health, according to a widely respected 1988 report, The Future of Public Health, by the Institute of Medicine. The three major functions of public health--assurance, assessment, and policy development--are undergoing change. While most resources are currently devoted to delivering services--assurance activities--more emphasis is expected to be needed on assessment (i.e., investigation and surveillance of health hazards) and policy development.
Reforms are expected to induce shifts in the role of public health agencies and professionals at all levels. Public health professionals represent a variety of academic disciplines and backgrounds. They are often called on to use not only expertise in disease prevention, disability, and injury, but also broader scientific, technical, and managerial skills. In the future, local public health departments are likely to require a wider range and different emphasis of skills among workers. As key providers of training for public health departments, CDC needs current information on training needs, target audiences, topical coverage, and the adequacy and appropriateness of existing training methods.
Methods Macro Systems International conducted site visits at nine selected local health departments and, using focus groups with health department staff, identified training needs. A uniform discussion guide was used at each site to uncover training needs, training activities, and approaches that might enhance training.
Interviews were also conducted with principal management officials at each of CDC's Centers, Institutes, and Offices (CIOs). In addition to conducting interviews, researchers developed an updated training inventory and incorporated it into an on-line electronic training catalog. At the time of the study, this catalog was available to CDC staff and a limited number of public health departments.
Qualitative and quantitative analyses were performed on the data from all focus groups and interviews.
Findings Training plays an important role in the mission of all CIOs, yet the nature and content of training varied widely. In general, training appropriately emphasized assessment, but its additional emphasis on assurance contrasts with the expectation that public health is moving away from this activity.
Local health departments were found to be deficient at accurately assessing their training needs. When needs assessments were done, they tended to capture information only on current employees, not potential employees.
CDC's training in advocacy, evaluation, and public information--the areas of need identified by local health departments--tended to be irregularly offered. Advocacy is in the realm of policy development and involves building constituencies and identifying resources in the community. Training needs also exist in such topical areas as mental health, substance abuse, cancer, cardiovascular disease, food-borne illness, and lead poisoning.
CDC has limited resources to meet training needs in spite of overwhelming demands. In general, CIOs favor standup training but are unfamiliar with other potential media and approaches, such as self-study curricula, video conferences, interactive software, and satellite downlinks. Despite a preference for standup training, the majority of CIOs have taken advantage of the benefits of distance learning by offering courses through the Public Health Training Network.
Because CDC training activities rarely reach the local level, local health departments are often unaware of training opportunities. Local health departments are aware of "The Future of Public Health" framework and endorse it as a strategy. They recognize that their future lies in expanded assessment activities and policy development and that their assurance capabilities are being downsized.
The study also found a lack of periodic mechanisms for CDC to stay abreast of the training needs of local health departments.
Use of Results The study and its recommendations updated CDC's on-line training catalog and stimulated its nationwide availability. CDC also is hastening the development of a computer-based job aid that will enable CDC to be aware of the training needs of local health departments.
Other recommendations called for more resources for training activities, particularly in policy development and public information. Efficiencies could be achieved by integrating the interests of several CIOs and ensuring that all health departments have access to information about training. Curricular content and evaluation techniques need updating and improvement. More efforts should be made to assess needs and explore alternative media and advanced technology.
Publication Not yet published. Final report is available through the HHS Policy Information Center in the Office of the Assistant Secretary for Planning and Evaluation.
Agency sponsor: Centers for Disease Control and Prevention
Federal contact: Dennis McDowell
Public Health Practice Program Office
Centers for Disease Control and Prevention
1600 Clifton Road NE, MS E-20
Atlanta, GA 30333
(404) 639-3707 Fax: (404) 639-3982
Principal investigator: Thomas Chapel
Macro Systems International, Atlanta, GA