Matern Child Health J (2015) 19:271–279 DOI 10.1007/s10995-014-1551-7
NOTES FROM THE FIELD
Training Maternal and Child Health Epidemiologists: Leaders for the Twenty First Century Arden Handler • Jaime Klaus • Kristin Rankin Deborah Rosenberg
•
Published online: 2 July 2014 Springer Science+Business Media New York 2014
Abstract This paper reports on the structure, implementation and outcomes of the Maternal and Child Health (MCH) Epidemiology (MCHEPI) program at the University of Illinois School of Public Health (UIC-SPH) and discusses the successes and challenges in developing MCH Epidemiology leaders for the local, state, and national public health workforce. The MCHEPI program at UICSPH offers both the MPH and PhD degree and is based on six key components: integration across school divisions, competency-based training, tailored curricula, practica/ dissertations with public health agencies, personal leadership training and development, and socialization. Based on data from the 1998–2012 cohorts, all former and current MCHEPI MPH students (n = 28) have participated in practica with local or state public health agencies and former and current MCHEPI doctoral students at the dissertation stage (12 out of 15) have partnered with local, state or national public health agencies in conducting their dissertations. The alumni of the MCHEPI MPH program (n = 25) appear to serve in higher level positions in their second compared to their first placements post-graduation. All MCHEPI doctoral alumni (n = 8) serve at the emerging senior level or senior scientist level upon graduation, in local, state and federal agencies, or in academe. Explicit linkage of MCHEPI students to practice through tailored
A. Handler (&) J. Klaus Division of Community Health Sciences, University of Illinois School of Public Health, 1603 W. Taylor, Chicago, IL 60612, USA e-mail: [email protected] K. Rankin D. Rosenberg Division of Epidemiology-Biostatistics, University of Illinois School of Public Health, 1603 W. Taylor, Chicago, IL 60612, USA
curricula, practica, and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important to the generation of epidemiology leaders for the MCH workforce. Leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH epidemiology training programs. Examining the trajectories of emerging leaders over time is essential for evaluating the true success of Maternal and Child Health Bureau workforce and training investments. Keywords MCH epidemiology Leadership training MCH public health workforce
Background During the 1990s and the first decade of the twenty-first century, state and many local (particularly urban) health agencies, as recipients of Title V/Maternal and Child Health Block Grant funds, were actively engaged in making the transition from the delivery of personal health services to carrying out the core functions of public health [1]. Making this shift required these agencies to redefine their missions, to hire individuals with different types of skills and abilities, to retrain and/or provide additional training to current staff, and to commit themselves to data based decision-making in all aspects of the Maternal and Child Health (MCH) planning cycle. In order for state and local MCH agencies to carry out these population focused responsibilities, there has been a parallel effort to increase their capacity to successfully collect, analyze and generate information based on data. One key strategy as part of this effort has been the implementation of the CDC/HRSA
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MCH Epidemiology Program which has been assigning MCH epidemiologists to state public health agencies (and later to local efforts) since 1986 [2]. These individuals serve as senior scientists to provide state and local MCH agencies with the analytic leadership necessary to engage in data based decision-making to promote the health of the MCH population [2, 3]. Several years into the second decade of the twenty first century, the field of MCH and in particular, the Title V/MCH Block Grant programs that serve women, children and families, face numerous challenges. At a time when governmental public health agencies at every level are faced with shrinking budgets and resources, they are being asked to focus on systems development and a population based approach as they simultaneously attempt to respond to changes in the health care landscape brought on by the Affordable Care Act of 2010 [4]. These challenges increase the need for an MCH Epidemiology (MCHEPI) workforce trained in new approaches to surveillance, program monitoring and evaluation, as well as data reporting and analysis, using both new technology and state of the art methodological approaches. As the work of MCH epidemiologists has become more vital to the efforts of state and local MCH agencies, the field of MCH epidemiology has grown and matured. In 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment of MCH Epidemiology capacity and recommended that each state have a minimum of one doctoral level MCH epidemiologist serving as a lead epidemiologist with adequate MCHEPI support [5]. In 2009, CSTE released a National Assessment of Epidemiology Capacity which included a Supplemental Report on Maternal and Child Health Epidemiology Capacity [6]. This report again recommended that at a minimum, every state should have a lead MCH epidemiologist with both scientific and administrative authority to oversee and coordinate data gathering, analysis, interpretation, and translation to public health practice; at least one epidemiologist with doctoral level training; and, sufficient and well-trained professional support staff. Finally, in 2011, Rosenberg et al. [7] released a report on MCHEPI functioning in state health agencies which among other recommendations, emphasized the importance of advanced training for MCH epidemiology staff. The Maternal and Child Health Program (MCHP) at the University of Illinois School of Public Health (UIC-SPH) has a long-standing history of and commitment to enhancing the capacity of the MCH public health workforce [8, 9]. In response to the needs for enhanced analytic capacity expressed above, in Fall 2000, UIC-SPH officially launched an MCH Epidemiology program at the MPH and PhD levels. The purpose of this paper is to report on the structure, implementation, and outcomes of the MCH
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Epidemiology program at UIC-SPH and to discuss the successes and challenges in developing MCHEPI leaders for the state and local as well as national public health workforce.
Components of Training in MCH Epidemiology at UICSPH The MCHEPI Program at UIC-SPH is a joint effort of two academic divisions: the Maternal and Child Health Bureau (MCHB)/Health Resources and Services Administration (HRSA) funded MCHP in the Community Health Sciences (CHS) division, and the Epidemiology section of the Epidemiology-Biostatistics (EPID-BSTT) division. To bolster the MCHEPI Program, since 2000–2001, UIC-SPH has had five successive MCHEPI doctoral grants from MCHB/ HRSA. (Note: MCHB has provided MCHEPI-focused doctoral supplement grants to MCH Programs in Schools of Public Health since 2000–2001; eight SPHs currently have such grants). The MPH and PhD MCHEPI degree programs at UICSPH incorporate core elements that anchor the programs in both academe as well as within public health practice with the intent of developing MCH Epidemiologists who will pursue leadership roles at multiple levels in public health agencies. The key components of the MCHEPI degree programs at UIC-SPH are described below and are displayed in Table 1: integration across school divisions, competency-based training, tailored curricula, practica/ dissertations with public health agencies, personal leadership training and development, and socialization. Integration Across Two Divisions within the UIC School of Public Health As stated above, the MPH and PhD degree programs in MCHEPI are jointly implemented by two divisions within UIC-SPH. Implementation across two divisions is achieved by the designation of MCHEPI core faculty in each division, the joint recruitment and review of applications to the programs, as well as joint curriculum development and supervision of students’ academic progress and experiences. While this interdisciplinary administrative configuration is not typical for UIC-SPH, it provides a model for students of the partnership between MCH programs and MCH epidemiology that takes place in state and local public health agencies. MCH Epidemiology Leadership Competencies According to Handler et al. [3] the MCH epidemiologist ‘‘uses the tools, framework and population-based focus of
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Table 1 Key components of MPH and PHD MCHEPI degrees at UIC-SPH Key component
MPH
PhD
Integration across UIC-SPH divisions: MCH/CHS and Epidemiology
Students can be admitted through either division and core faculty are from both divisions.
Students can be admitted through either division and core faculty are from both divisions.
Leadership competencies
Based on ATMCH/MCH Leadership 3.0 and Alexander and Kogan (2005); align with CSTE Tier 1
Based on ATMCH/MCH Leadership 3.0 and Alexander and Kogan (2005); align with CSTE Tier 2
Tailored curricula
Emphasis on: analytic skills needed for data management, statistical programming, and epidemiology and biostatistics beyond what is required for the standard MPH in MCH
Emphasis on: advanced epidemiology, biostatistics as well as other methods courses, and application of analytic skills to the activities of MCH planning cycle
Practica/dissertation
With governmental public health agency
With governmental public health agency
Personal leadership training and development Socialization
Has been optional but is required beginning 2013–2014 cohort
Required
Group identification and meetings; attendance at MCHEPI conference; exposure to senior MCH epidemiologists
Group identification and meetings; attendance at MCHEPI conference; exposure to senior MCH epidemiologists
epidemiology to enable state or local health agencies to carry out surveillance and monitoring, assessment, planning, evaluation, policy development and advocacy.’’ The MCHEPI degree programs at UIC are based on this definition, as well as the competencies developed by the Association of Teachers of Maternal and Child Health (ATMCH) for MCH in general, the MCH Leadership Competencies (3.0) [10] and faculty knowledge of the field of MCHEPI. As such, the UIC-SPH MCHEPI degree programs are based on the MCH planning cycle, providing a firm foundation in the substantive areas of MCH, and indepth instruction in epidemiology, biostatistics, and other analytic disciplines. With the 2005 publication by Alexander and Kogan [11] of skills needed by MCH Epidemiologists in practice, the UIC MCHEPI program developed its own competencies at both the MPH and doctoral levels which are the basis of our current MPH and PhD MCHEPI curricula. Shortly after this, the CSTE published the CDC/CSTE Applied Epidemiology Competencies [12]. The CSTE competencies describe the skills needed for four levels of practicing epidemiologists working in governmental public health agencies: Entry-Level or Basic Epidemiologist (Tier 1), Mid-Level Epidemiologist (Tier 2), Senior Level Epidemiologist (Tier 3a), and Senior Scientist/Subject Area Expert (Tier 3b). Given the descriptions of each of these levels, Tier 1 is most closely aligned with the skills of our MPH MCHEPI graduates and Tier 2 is most closely aligned with the skills of our PhD MCHEPI graduates who upon graduation are moving toward becoming Tier 3 senior scientists. In 2009–2010, we performed a cross-walk of our curricula, our current MCHEPI competencies for both degrees, and the CSTE Tier 1 and Tier 2 competencies to determine whether revisions were needed. We found that both our
MCHEPI MPH and PhD curricula aligned well with the CSTE Tier 1 and Tier 2 competencies but we discovered that more Personal Leadership development training was needed; as such, we added a requirement of participation in our UIC-SPH MCH Personal Leadership Coaching program, which is described below in more detail. Tailored MCHEPI Curricula Students in the MCHEPI degrees at UIC-SPH participate in specially structured curricula focused on MCH epidemiology in practice. MPH in MCH Epidemiology Students in the MCHEPI MPH program have additional requirements beyond those required of students in the general MCH MPH program. The curriculum shares with the traditional MPH program a focus on MCH substantive knowledge and the MCH planning cycle skills (e.g., assessment, planning, monitoring and evaluation, and policy development) but places emphasis on the analytic skills needed for data management and statistical programming, and additional required classes in epidemiology and biostatistics. PhD in MCH Epidemiology The curriculum is more structured than a traditional PhD curriculum to ensure that students acquire the skills necessary for MCHEPI positions in public health practice. Students are expected to take courses in advanced epidemiology, biostatistics, and other methods courses, with an emphasis on application of analytic skills to the activities of MCH planning cycle. Three courses have been
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developed specifically for this program, all of which (despite their traditional titles) have an extensive emphasis on epidemiology in practice: Reproductive and Perinatal Epidemiology, Pediatric Epidemiology, and Advanced Analytic Methods in Maternal and Child Health. In order to make sure that our curricula remain on the cutting edge of the field, our core faculty are participants on a variety of national committees including the planning committee for the CDC/HRSA sponsored MCHEPI conference, in which emerging issues in the field are routinely discussed. Likewise, our faculty are involved in national training (HRSA/CDC efforts) of state MCH epidemiologists, and in direct response to the needs of the MCHEPI workforce, our faculty develop new in-person and on-line training modules. As such, not only do UIC MCHEPI faculty help shape the training delivered to MCH epidemiologists across the nation, they pursue their own advanced training (e.g., propensity score analysis) in order to ensure that their own skills stay on the cutting edge. Based on these efforts, new analytic methods and approaches are then routinely integrated into several of the core courses for the MCH Epidemiology students: Reproductive and Perinatal Epidemiology Methods, Pediatric Epidemiology, Advanced Analytic Methods in MCH. In addition, as needed, we invite guest speakers from other disciplines (e.g., Economics) to our core classes to ensure that MCHEPI students are exposed to a variety of methodological approaches (e.g., econometrics methods to account for selection bias). Finally, to ensure that our MCHEPI students’ content and analytic needs are met in real time as well as to ensure that the feedback of our graduates is incorporated into class and curricula changes, we regularly seek input from students at our semester get-togethers (See Socialization below). Likewise, we obtain feedback from our graduates through direct one-on-one discussions with those who are practicing MCH Epidemiologists, through alumni focus groups, as well as through our 5 year graduate survey (See 5 Year MCH Graduate Survey, below). MCHEPI Practica and Dissertations with Public Health Agencies The MPH degree in MCH Epidemiology requires students to complete practica with a governmental public health agency. The PhD program requires students to complete their dissertations in conjunction with a governmental public health agency at the state or local level and/or utilize data generated by a state or local public health agency (note: during some periods collaboration with national level public health agencies was also allowed by MCHB.). Students often select their practica sites or dissertation topics after attending the Maternal and Child Health Epidemiology Conference where they meet MCH
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epidemiologists or other governmental public health agency personnel and discover mutual interests. MPH students also often complete their practica with state or local health programs through participation in the Graduate Student Epidemiology Program (GSEP), formerly the Graduate Student Internship Program [13]. Personal Leadership Training and Development Over the last several years, the UIC–MCH Program has implemented a Personal Leadership Development and Coaching Program for all MCH students. Through group sessions and individual coaching, this program addresses the MCH Leadership (3.0) Competencies across three areas: (1) Self, (2) Others, (3) Wider Community. Overall, the program builds emotional intelligence and develops authentic leadership by increasing self-awareness and focusing on strengths, values-based decision-making, and goal-setting. This program is offered on a voluntary basis to all MCH students including MCHEPI students; however, we require MCHEPI PhD students to participate in the program during at least one of their semesters in the program. We believe that by including this Personal Leadership Coaching requirement for the doctoral students, our PhD graduates are moving closer toward the CSTE Tier 3 job functions of senior leadership and management. Starting in the 2013–2014 year, we have begun requiring all MPH MCHEPI students to participate in this program. Socialization Probably one of the most important components of the UIC-SPH MCHEPI degree programs is our effort to have MCHEPI students view themselves as part of a distinct group with direct connections to MCH Epidemiologists in public health practice. To that end, MCHEPI MPH and doctoral trainees meet face-to-face as a group once a semester to discuss issues and experiences related to the program: concerns with the curricula, the selection of practica sites and dissertation topics, and to provide feedback on activities (e.g., MCHEPI webcasts, attendance at the MCHEPI conference, practica experiences) that students participate in as part of the program. At the spring meeting each year, an experienced MCH Epidemiologist from a local, state or national public health agency is invited to share their career path and experience with the students. These get-togethers allow students, faculty, and guests to discuss issues related to working as a practicing MCH Epidemiologist and encourage identification with, and socialization into the field of MCHEPI. One of the most important activities to foster socialization into the MCHEPI field and the development of MCHEPI leaders has been our efforts to encourage all
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MCHEPI doctoral and MPH students to attend the annual MCHEPI conference by providing partial travel funds for those who want to attend. Students are encouraged to submit abstracts for oral or poster presentations. Almost all students attend the conference at least once during their training and most attend multiple times. As an adjunct to the conference, each year the UIC MCHEPI faculty host a dinner with current UIC MCHEPI students and alumni of the program; this dinner provides a link between former and current students and provides current students with an opportunity to directly dialogue with recent entrants to the MCHEPI field. This UIC MCHEPI ‘‘tradition’’ has become both a gathering at which professional and personal information is exchanged as well as a mechanism to foster career decision-making.
Strategies for Assessing the Outcomes of the MCHEPI Program at UIC-SPH In order to determine if UIC-SPH is achieving its objective to develop MCH Epidemiology leaders for the MCH public health workforce, we examine and report on data derived from a variety of tracking activities and assessments described below: •
•
•
•
Tracking of Products. On an annual basis, we collect information on all products of our MCHEPI students as well as graduates. These include their abstracts, presentations, publications, and awards. Tracking of Students and Alumni. At the simplest level, we track our students and alumni through a variety of formal and informal mechanisms. We document practica sites and dissertation topics/associated public health agencies. We maintain at least annual e-mail contact with graduates to determine their current employment or education status. MCHEPI Graduate Employers and Employees Survey. In 2009, eleven employers of ten (out of 19) MCHEPI MPH and doctoral MCHEPI alumni were surveyed. The focus was to determine their satisfaction with their MCHEPI graduate employees’ preparation and performance, their needs for new personnel in the next 3–5 years, the continuing education (CE) needs of current employees, barriers to hiring and retaining qualified personnel, as well as preferred methods of CE. MCHEPI graduates received a parallel survey to determine their assessment of whether they felt prepared for employment in the field of MCH Epidemiology. Five Year MCH Graduate Survey. In 2009, we began an annual survey of all MCHEPI graduates who graduated 5 years prior (5 Year survey is an MCHB
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requirement for all MCH graduates). These surveys provide current information about our graduates (job placement, contact information), as well as help evaluate the long term impact of the program. Questions focus on competencies achieved and relevance of graduates’ course work and practica and/or dissertation experiences for their current positions. In addition, we have been utilizing a pre and post-test competency assessment based on the MCHEPI competencies (described above) since 2007 but data collection has been uneven. Consequently, results are not reported here.
Judging the Outcomes of the MCHEPI Program at UIC-SPH We report here on the progress and experiences of all 28 MPH students and 15 doctoral students (n = 43) who have participated in the MCHEPI program at UIC-SPH over the last decade or more (enrollees from 1998 through 2012 cohorts). Full details about these students and graduates and their productivity are provided in Tables 2, 3, 4 and Appendix A (available at http://www.uic.edu/sph/mch/ documents/AppendixA-MCHEPIPracticaandDissertation ProjectsMay2014.pdf). Becoming an MCHEPI leader is dependent on acquiring a variety of leadership and analytic skills including the ability to translate data into information and to disseminate findings. Table 2 provides information on the academicassociated productivity of our doctoral students/alumni enrolled from 1998 (see explanation below) until 2012 and MPH students/alumni enrolled from 2000 until 2012. These data suggest that productivity increases considerably after graduation; however, for MPH students in particular, presentations or publications after graduation often reflect work conducted during the degree program. For both MPH and doctoral graduates however, more detailed data (not shown) reveal that not all are equally presenting at scientific meetings and publishing; this disparity usually reflects differences in their current job responsibilities (i.e., practice versus academe). The key measures of success of MCHEPI programs are practica placements, dissertation partners (i.e., governmental public health agencies whose data are utilized by students with varying degrees of direct interaction with agency personnel), and job placements after graduation. Tables 3 and 4 present a summary of the data from MCHEPI students and graduates whose matriculation year was 2000–2012 with two exceptions; two PhD students who matriculated in 1998 and 2000 were heavily involved in the MCHEPI coursework and approach and although they were not officially MCHEPI students, data reflecting
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Table 2 The number of presentations and publications produced by UIC-SPH MCHEPI students and alumni (1998–2012 Cohorts) MPH students
MPH alumni
Doctoral students
Doctoral alumni
Combined: Various authors/presentersa
Total
Presentations
0
43
21
108
13
185
Publications
0
18
6
64
8
96
a
Two or more MCHEPI alumni/students worked together to generate these products
Table 3 Race/ethnicity and practica/dissertation partners of current students and alumni of the UIC-SPH MCHEPI program (enrolled in 1998–2012) MPH students and alumni (n = 28)
PhD/DrPH students and alumni (n = 15)
#
%
#
%
White, non-hispanic
19
67.9
6
40.0
African american
5
17.9
6
40.0
Race/ethnicity
Hispanic
1
3.6
0
0.0
Asian
3
10.7
3
20.0
Practicum site (MPH)/dissertation partner (doctoral)a Local health agency
16
57.1
3
20.0
State health agency
10
35.7
3
20.0
Federal health agency
2
7.1
6
40.0
MPH Masters in Public Health a Three current doctoral students are not in the dissertation proposal stage yet and are not included
their experience is included here as well. Table 3 provides information on the race/ethnicity of current students and alumni of the program, as well as the types of health agencies, local, state or federal, with which MPH students participated in practica and doctoral students conducted dissertations. Table 4 provides information on post-graduation educational or employment experiences of alumni of the program. In Appendix A (See url above), we provide the details on which these summary tables are based. As seen in Table 3, participants in our MCHEPI degree programs have been racially and ethnically diverse: 32 % of MPH and 60 % of doctoral students have been of color although this has mainly been African-American rather than Latina students. (Note: recruitment efforts are carried out within the program, within the SPH divisions, and at the School level; while there is a stated and operational commitment to diversity at UIC-SPH, we have been more successful at recruiting African-American students into the MCHEPI program, partly because we work closely with Howard University, which hosts an MCHB pipeline program). As can also be seen, all MPH students in the UICSPH MCHEPI program have participated in practica with local or state public health agencies and all doctoral students have conducted their dissertations with local, state, or national health agencies. While the projects that the MPH
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students have participated in are not listed in these tables, they range from linking the Kentucky birth and death data to examine racial disparities in infant deaths to an analysis of the Minnesota Student Survey to draft an issue brief comparing children with special health needs and their same aged peers on mental health and risk behaviors; these efforts clearly contribute to increased capacity at the host agencies. Doctoral dissertations have often focused on the use of innovative analytic methods with existing MCH data (e.g., Applying Multifactorial Population Attributable Fractions (PAFs) to the problem of Childhood Overweight; Identifying Maternity Care Practices that Mediate Racial Disparities in Breastfeeding Duration and Exclusivity). Although there are no comparison data available, the data in Table 4, and Appendix A (See url above) suggest that direct exposure to public health practice during graduate training (all of our students’ practica or dissertations are with governmental public health agencies) appears to be associated with participation in public health practice after graduation. Among all graduates with listed positions in Appendix A (See url above), 11 of the 33 graduates (33 %) have a first or second position with a governmental public health agency. However, for doctoral graduates, the degree program for which we receive direct funding for MCHEPI training, 5/8 or 63 % have a first or second position with a governmental public health agency. With regard to their roles in their post-graduation employment, the alumni of the MPH program appear to serve in higher level positions in their second compared to their first placements post-graduation. To date, upon graduation, all of our doctoral graduates entered positions at the emerging senior level or senior scientist level in local, state and federal agencies or in academe. Currently, two of UIC’s MCHEPI graduates are state MCH Epidemiologists, and two are CDC MCH Epidemiologists. These data also demonstrate that there are many opportunities to apply advanced analytic skills in MCH practice in a variety of organizations (agency names noted in Appendix A; See url above), not only in public health agencies. Nine of our MCHEPI graduates, although not directly employed in MCH Epidemiology positions in governmental public health agencies are using their MCHEPI skills to contribute to projects such as the implementation and analysis of the Illinois Youth Risk Behavior Survey, the conduct of the National Children’s
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Table 4 Employment and/or educational characteristics for first and second placements post-graduation among UIC-SPH MCHEPI program alumni Level
MPH alumni (n = 25)
Site/role
First placement
Second placementa
#
%
#
%
Local health agency
1
4.0
2
8.3
State health agency
3
12.0
2
8.3
Federal health agency
0
0.0
0
0.0
University
13
52.0
8
33.3
Hospital/healthcare system
4
16.0
9
37.5
4
16.0
3
12.5
Site
Other
b
Role
Doctoral alumni (n = 8)
Research associate or
9
36.0
2
8.3
Epidemiologist/analyst
10
40.0
6
25.0
Research manager
1
4.0
6
25.0
Emerging senior level or senior level Scientist
1
4.0
2
8.3
Clinician
3
12.0
4
16.7
Student
1
4.0
4
16.7
#
#
1
1
2
2
2
2
2
3
0
0
1
0
2
0
0
0
0
0
6
8
0
0
0
0
Site Local health agency State health agency Federal health agency University Hospital/healthcare system Otherb Role Research associate or project Manager/coordinator Epidemiologist/analyst Research manager Emerging senior level or senior level Scientist Clinician Student
a
One MPH alumnae reported no employment for the second job placement so is not shown b
Includes school system, and for-profit and non-profit agencies
Study, and the analysis of data for Text4Baby at the national level. Three of our MPH graduates are currently obtaining their PhDs in MCH Epidemiology; two of these individuals initially became CSTE fellows after receiving their MPH degrees. Finally, these data indicate that becoming a leader in the field of MCH Epidemiology is not always a ‘‘one-stop’’ process with graduates moving on to gain more training as Epidemic Intelligence Service (EIS) officers, CSTE fellows, and/or returning to graduate school on their way to more permanent leadership positions. To obtain a more detailed understanding of the postgraduation experience of our MCHEPI students, in 2009 we began surveying our MCHEPI graduates who had graduated 5 years prior (5 Year survey). Overall since 2009 (distributed five times), a total of eight MPH graduates (out of a possible 13) and five doctoral graduates (out of a possible five) have responded to the survey. Sixtyseven percent of these graduates are working in academe or for public health agencies and are engaged in applied analytic work or research in MCH utilizing epidemiology or evaluation skills. Ninety-two percent report that the education that they received at UIC has been extremely relevant to the work they have been doing since they graduated, and 100 % of them consider themselves to be MCH leaders. In 2009, we also surveyed eleven employers of ten MPH and doctoral MCHEPI alumni (out of 19) who were both working and agreed to provide their employers’ contact information. Six of the eleven employers replied. Three of the six were very satisfied with the individuals they hired from UIC and three were pretty satisfied [1] or satisfied [2]. Employers believed that graduates of the UIC-SPH MCHEPI program were most prepared in the areas of data management and linkage, data analysis and interpretation, data reporting, translation and dissemination, with relative areas of weakness in grant-writing and advocacy (note: five of the six respondents coded their response to employee’s skills in ‘‘advocacy’’ as not applicable.) Fifteen (out of 19) MCHEPI alumni were given a companion survey to the Employer Survey, (Note: we did not include the three individuals who completed the 2009 5 Year survey so as not to confuse these individuals with two surveys; in addition, one alumna could not be located). Eight of the 15 alumni who received the Employee companion survey completed it. These alumni stated that overall (rating of 4.38/5 with 5 = the most prepared) they were prepared to perform in their position after graduation. They reported that they were most prepared in the areas of data analysis, leadership, and values/ethics, with relative areas of weakness in grant-writing and advocacy; these responses closely matched those of their employers. In addition, seven out of
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the eight (87.5 %) respondents had attended the MCHEPI conference since they graduated.
Discussion
The primary mission of the MCHEPI program at UIC-SPH is the development of leaders in Maternal and Child Health Epidemiology who are trained and groomed to join the MCHEPI workforce at multiple levels depending on their skills and experience. To that end, the UIC-SPH program has implemented a series of curricular components which the data reported here suggest have been mostly successful in their intent of producing practice focused MCH epidemiologists. While we are unable to directly tease out which curricular component is the most important, we believe these components act synergistically to inspire students to join the field of MCHEPI and connect them to the MCHEPI practice community when they leave the program. Importantly, these data suggest that the path to MCHEPI leadership is not necessarily linear: graduates of MCHEPI training programs may weave in and out of the public and private sector as well as move from fellowships to employment to school and back again on their path to leadership. That there is movement of emerging leaders along a trajectory is a critical point. Expectations that individual MCHEPI graduates will immediately seek and obtain positions in governmental public health agencies, although highly desirable, is not always realistic. In addition, governmental public health agencies often have barriers to hiring even if positions are desired or open, particularly at a competitive salary level and with the appropriate title/position in the organizational hierarchy [14, 15]. However, we expect that over the long term, it is likely that many of these graduates of our (and other) MCHEPI training programs will join and contribute to the governmental public health enterprise at one level or another. The data reported here are in line with national data which suggest that leadership training in MCHEPI appears to be having an impact on the field. Based on the 2009 CSTE data cited above, although there are many state and territorial jurisdictions without a doctoral level trained MCH epidemiologist, as of 2009, 46 % of jurisdictions in fact had such an individual, which is the highest percentage of any public health epidemiology specialty area [6]. We expect that the current percent is likely somewhat higher unless state budget cutbacks have inhibited the growth of these positions; unfortunately, this information is not available. According to Phillips et al. [16], the increased MCH epidemiology capacity in states and territories is attributable to multiple efforts including short and long-term training of health department staff, the promulgation of
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internships and fellowships, as well as the commitment by MCHB to invest in doctoral level training of MCH Epidemiologists. While the MCHB investment in MCHEPI doctoral training for each program recipient is not large (approx. $26,000–$27,000 a year per School of Public Health), this small amount of seed funding has clearly provided the impetus to provide not just financial support to doctoral students interested in reproductive/perinatal/ pediatric epidemiology, but to develop MCHEPI programs in Schools of Public Health that leverage MCHB’s support in order to insure the development of practice- focused MCH epidemiologists. While the training and development of individual MCHEPI leaders is key to increasing analytic capacity in state and local governmental public health agencies, as pointed out by Rosenberg et al. [17] ‘‘building scientific capacity in states is not just a matter of hiring and training more senior epidemiologists’’. According to Rosenberg, epidemiologists face organizational barriers to using their advanced analytic skills; she suggests that to truly build analytic capacity in an agency requires strategies that also support agency level change to collect high quality data, to facilitate its utilization, and to support the translation of data into information for program planning and policy development. In fact, being an MCHEPI leader means having the skills to advocate for, organize, and ensure the implementation of those strategies. As we articulate the future training needs of the MCH workforce during this time of transformation of the health care system, we must communicate the importance of enhanced analytic skills, including the leadership skills required specifically to affect change in the data infrastructure of public health agencies. Analytic capacity training, both graduate and continuing education, must be embraced as an indispensable partner to training in areas such as quality improvement and systems integration, two foci of the new MCHB funded MCH Workforce Development Center at the University of North Carolina. This assessment has several limitations. First and foremost, we are only reporting on the impact of the MCHEPI Leadership training at one School of Public Health. It is likely that other schools have used other approaches and have also been successful in placing their graduates within the MCHEPI workforce. In addition, even with our presentation of findings from the UIC-SPH MCHEPI program, we do not present data from a comparison group of students who were not exposed to the MCHEPI program. Based on data we collect for the MCHB (not shown), we can report that most of our students in the MCH (nonMCHEPI) Program at UIC-SPH also join the MCH workforce. However, very few initially obtain positions as MCH Epidemiologists because their analytic skill level is not as developed as the students trained in MCHEPI and
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because they are not directly connected to the MCHEPI field. Finally, for some of our data collection methods, those responding may be those most likely to be engaged in the MCHEPI workforce. As such, we may be overestimating the impact of our MCHEPI Program. While this may be the case, we believe that the use of multiple data sources to describe the outcomes of our program strengthens our findings.
Conclusion Training the next generation of MCHEPI professionals, many of whom will become leaders in the field, serving at the highest levels (i.e., senior scientists) is a multi-faceted process. Our experience with the development and implementation of the MCHEPI program at UIC-SPH suggests that explicit linkage of MCHEPI students to practice through tailored curricula, practica and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important for the generation of epidemiology leaders for the MCH workforce. Our experience also suggests that leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH Epidemiology training programs. Examining the trajectories of emerging leaders over time is essential to evaluating the true success of MCHB workforce and training investments.
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4.
5.
6.
7.
8.
9.
10.
11.
12.
13. 14.
References 1. Dievler, A., Grason, H., & Guyer, B. (1997). MCH functions framework: A guide to the role of government in maternal and child health in the 21st century. Maternal and Child Health Journal, 1(1), 5–13. 2. Rochat, R., Atrash, H., & Handler, A. (1999). Developing maternal and child health epidemiology capacity in state health departments. Journal of Women’s Health and Gender-based Medicine, 8(9), 1135–1139. 3. Handler, A., Geller, S., & Kennelly, J. (1999). Effective MCH epidemiology in state health agencies: Lessons from an
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evaluation of the maternal and child health epidemiology program. Maternal and Child Health Journal, 3(4), 217–224. Kaiser Family Foundation (2013). Forum on health reform. Summary of the Affordable Care Act. April 25 2013. http://kff. org/health-reform/fact-sheet/summary-of-new-health-reform-law/. Council of State and Territorial Epidemiologists. (2002). National assessment of epidemiologic capacity in maternal and child health: Findings and recommendations, Atlanta, Georgia: CSTE. Council of State and Territorial Epidemiologists. National assessment of epidemiology capacity. Supplemental report: Maternal and child health epidemiologic capacity: Findings and recommendations. http://www.cste.org/2009mcheca.pdf. Rosenberg, D., Herman-Roloff, A., Kennelly, J., & Handler, A. (2011). Factors associated with improved MCH epidemiology functioning in state health agencies. Maternal and Child Health Journal, 15, 1143–1152. Handler, A., Rosenberg, D., Monahan, C., Kennelly, J. (1998). Analytic Methods in Maternal and Child Health. Maternal and Child Health Bureau, HRSA, DHHS. Handler, A., Kennelly, J., & Rosenberg, D. (2001). Building the analytic capacity of the state maternal and child health workforce-a history of the hrsa/mchb academic partnership. Journal of Public Health Management and Practice, 7(4), 83–90. MCH leadership competencies workgroup. MCH leadership competencies. Version 3.0. http://devleadership.mchtraining.net/ mchlc_docs/mch_leadership_comp_3-0.pdf. Alexander, G., & Kogan, M. (2005). The expanding role of mch epidemiologists: evolving job description, tasks and skill areas, and sources of training support. (editorial). Maternal and Child Health Journal, 9(2), 121–123. Council of State and Territorial Epidemiologists. Competencies for applied epidemiologists in governmental public health agencies. http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/Work force/AECSummaries.pdf. Graduate student epidemiology internship. http://www.mchb. hrsa.gov/researchdata/mchirc/gsip/index.html. NACCHO. (2005). The local health department workforce: Findings from the, national profile of local health departments study. Washington, D.C.: National Association of County and City Health Officials. 2007. ASTHO. (2007). State public health workforce survey results. Arlington, VA: Association of State and Territorial Health Officials. 2008. Phillips, G., Sappenfield, W., Handler, A., & Kogan, M. (2012). Promoting a trained MCH epidemiology workforce in state public health agencies through strategies developed from continued partnerships. Maternal and Child Health Journal, 16, S376–S380. Rosenberg, D., Barfield, W., Rankin, K., & Kroelinger, C. D. (2012). Increasing scientific and analytic capacity In states: extending epidemiology collaborations beyond traditional workforce development. Maternal and Child Health Journal, 16, S193–S195.
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Training Maternal and Child Health Epidemiologists: Leaders for the Twenty First Century Arden Handler • Jaime Klaus • Kristin Rankin Deborah Rosenberg
•
Published online: 2 July 2014 Springer Science+Business Media New York 2014
Abstract This paper reports on the structure, implementation and outcomes of the Maternal and Child Health (MCH) Epidemiology (MCHEPI) program at the University of Illinois School of Public Health (UIC-SPH) and discusses the successes and challenges in developing MCH Epidemiology leaders for the local, state, and national public health workforce. The MCHEPI program at UICSPH offers both the MPH and PhD degree and is based on six key components: integration across school divisions, competency-based training, tailored curricula, practica/ dissertations with public health agencies, personal leadership training and development, and socialization. Based on data from the 1998–2012 cohorts, all former and current MCHEPI MPH students (n = 28) have participated in practica with local or state public health agencies and former and current MCHEPI doctoral students at the dissertation stage (12 out of 15) have partnered with local, state or national public health agencies in conducting their dissertations. The alumni of the MCHEPI MPH program (n = 25) appear to serve in higher level positions in their second compared to their first placements post-graduation. All MCHEPI doctoral alumni (n = 8) serve at the emerging senior level or senior scientist level upon graduation, in local, state and federal agencies, or in academe. Explicit linkage of MCHEPI students to practice through tailored
A. Handler (&) J. Klaus Division of Community Health Sciences, University of Illinois School of Public Health, 1603 W. Taylor, Chicago, IL 60612, USA e-mail: [email protected] K. Rankin D. Rosenberg Division of Epidemiology-Biostatistics, University of Illinois School of Public Health, 1603 W. Taylor, Chicago, IL 60612, USA
curricula, practica, and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important to the generation of epidemiology leaders for the MCH workforce. Leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH epidemiology training programs. Examining the trajectories of emerging leaders over time is essential for evaluating the true success of Maternal and Child Health Bureau workforce and training investments. Keywords MCH epidemiology Leadership training MCH public health workforce
Background During the 1990s and the first decade of the twenty-first century, state and many local (particularly urban) health agencies, as recipients of Title V/Maternal and Child Health Block Grant funds, were actively engaged in making the transition from the delivery of personal health services to carrying out the core functions of public health [1]. Making this shift required these agencies to redefine their missions, to hire individuals with different types of skills and abilities, to retrain and/or provide additional training to current staff, and to commit themselves to data based decision-making in all aspects of the Maternal and Child Health (MCH) planning cycle. In order for state and local MCH agencies to carry out these population focused responsibilities, there has been a parallel effort to increase their capacity to successfully collect, analyze and generate information based on data. One key strategy as part of this effort has been the implementation of the CDC/HRSA
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MCH Epidemiology Program which has been assigning MCH epidemiologists to state public health agencies (and later to local efforts) since 1986 [2]. These individuals serve as senior scientists to provide state and local MCH agencies with the analytic leadership necessary to engage in data based decision-making to promote the health of the MCH population [2, 3]. Several years into the second decade of the twenty first century, the field of MCH and in particular, the Title V/MCH Block Grant programs that serve women, children and families, face numerous challenges. At a time when governmental public health agencies at every level are faced with shrinking budgets and resources, they are being asked to focus on systems development and a population based approach as they simultaneously attempt to respond to changes in the health care landscape brought on by the Affordable Care Act of 2010 [4]. These challenges increase the need for an MCH Epidemiology (MCHEPI) workforce trained in new approaches to surveillance, program monitoring and evaluation, as well as data reporting and analysis, using both new technology and state of the art methodological approaches. As the work of MCH epidemiologists has become more vital to the efforts of state and local MCH agencies, the field of MCH epidemiology has grown and matured. In 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment of MCH Epidemiology capacity and recommended that each state have a minimum of one doctoral level MCH epidemiologist serving as a lead epidemiologist with adequate MCHEPI support [5]. In 2009, CSTE released a National Assessment of Epidemiology Capacity which included a Supplemental Report on Maternal and Child Health Epidemiology Capacity [6]. This report again recommended that at a minimum, every state should have a lead MCH epidemiologist with both scientific and administrative authority to oversee and coordinate data gathering, analysis, interpretation, and translation to public health practice; at least one epidemiologist with doctoral level training; and, sufficient and well-trained professional support staff. Finally, in 2011, Rosenberg et al. [7] released a report on MCHEPI functioning in state health agencies which among other recommendations, emphasized the importance of advanced training for MCH epidemiology staff. The Maternal and Child Health Program (MCHP) at the University of Illinois School of Public Health (UIC-SPH) has a long-standing history of and commitment to enhancing the capacity of the MCH public health workforce [8, 9]. In response to the needs for enhanced analytic capacity expressed above, in Fall 2000, UIC-SPH officially launched an MCH Epidemiology program at the MPH and PhD levels. The purpose of this paper is to report on the structure, implementation, and outcomes of the MCH
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Epidemiology program at UIC-SPH and to discuss the successes and challenges in developing MCHEPI leaders for the state and local as well as national public health workforce.
Components of Training in MCH Epidemiology at UICSPH The MCHEPI Program at UIC-SPH is a joint effort of two academic divisions: the Maternal and Child Health Bureau (MCHB)/Health Resources and Services Administration (HRSA) funded MCHP in the Community Health Sciences (CHS) division, and the Epidemiology section of the Epidemiology-Biostatistics (EPID-BSTT) division. To bolster the MCHEPI Program, since 2000–2001, UIC-SPH has had five successive MCHEPI doctoral grants from MCHB/ HRSA. (Note: MCHB has provided MCHEPI-focused doctoral supplement grants to MCH Programs in Schools of Public Health since 2000–2001; eight SPHs currently have such grants). The MPH and PhD MCHEPI degree programs at UICSPH incorporate core elements that anchor the programs in both academe as well as within public health practice with the intent of developing MCH Epidemiologists who will pursue leadership roles at multiple levels in public health agencies. The key components of the MCHEPI degree programs at UIC-SPH are described below and are displayed in Table 1: integration across school divisions, competency-based training, tailored curricula, practica/ dissertations with public health agencies, personal leadership training and development, and socialization. Integration Across Two Divisions within the UIC School of Public Health As stated above, the MPH and PhD degree programs in MCHEPI are jointly implemented by two divisions within UIC-SPH. Implementation across two divisions is achieved by the designation of MCHEPI core faculty in each division, the joint recruitment and review of applications to the programs, as well as joint curriculum development and supervision of students’ academic progress and experiences. While this interdisciplinary administrative configuration is not typical for UIC-SPH, it provides a model for students of the partnership between MCH programs and MCH epidemiology that takes place in state and local public health agencies. MCH Epidemiology Leadership Competencies According to Handler et al. [3] the MCH epidemiologist ‘‘uses the tools, framework and population-based focus of
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Table 1 Key components of MPH and PHD MCHEPI degrees at UIC-SPH Key component
MPH
PhD
Integration across UIC-SPH divisions: MCH/CHS and Epidemiology
Students can be admitted through either division and core faculty are from both divisions.
Students can be admitted through either division and core faculty are from both divisions.
Leadership competencies
Based on ATMCH/MCH Leadership 3.0 and Alexander and Kogan (2005); align with CSTE Tier 1
Based on ATMCH/MCH Leadership 3.0 and Alexander and Kogan (2005); align with CSTE Tier 2
Tailored curricula
Emphasis on: analytic skills needed for data management, statistical programming, and epidemiology and biostatistics beyond what is required for the standard MPH in MCH
Emphasis on: advanced epidemiology, biostatistics as well as other methods courses, and application of analytic skills to the activities of MCH planning cycle
Practica/dissertation
With governmental public health agency
With governmental public health agency
Personal leadership training and development Socialization
Has been optional but is required beginning 2013–2014 cohort
Required
Group identification and meetings; attendance at MCHEPI conference; exposure to senior MCH epidemiologists
Group identification and meetings; attendance at MCHEPI conference; exposure to senior MCH epidemiologists
epidemiology to enable state or local health agencies to carry out surveillance and monitoring, assessment, planning, evaluation, policy development and advocacy.’’ The MCHEPI degree programs at UIC are based on this definition, as well as the competencies developed by the Association of Teachers of Maternal and Child Health (ATMCH) for MCH in general, the MCH Leadership Competencies (3.0) [10] and faculty knowledge of the field of MCHEPI. As such, the UIC-SPH MCHEPI degree programs are based on the MCH planning cycle, providing a firm foundation in the substantive areas of MCH, and indepth instruction in epidemiology, biostatistics, and other analytic disciplines. With the 2005 publication by Alexander and Kogan [11] of skills needed by MCH Epidemiologists in practice, the UIC MCHEPI program developed its own competencies at both the MPH and doctoral levels which are the basis of our current MPH and PhD MCHEPI curricula. Shortly after this, the CSTE published the CDC/CSTE Applied Epidemiology Competencies [12]. The CSTE competencies describe the skills needed for four levels of practicing epidemiologists working in governmental public health agencies: Entry-Level or Basic Epidemiologist (Tier 1), Mid-Level Epidemiologist (Tier 2), Senior Level Epidemiologist (Tier 3a), and Senior Scientist/Subject Area Expert (Tier 3b). Given the descriptions of each of these levels, Tier 1 is most closely aligned with the skills of our MPH MCHEPI graduates and Tier 2 is most closely aligned with the skills of our PhD MCHEPI graduates who upon graduation are moving toward becoming Tier 3 senior scientists. In 2009–2010, we performed a cross-walk of our curricula, our current MCHEPI competencies for both degrees, and the CSTE Tier 1 and Tier 2 competencies to determine whether revisions were needed. We found that both our
MCHEPI MPH and PhD curricula aligned well with the CSTE Tier 1 and Tier 2 competencies but we discovered that more Personal Leadership development training was needed; as such, we added a requirement of participation in our UIC-SPH MCH Personal Leadership Coaching program, which is described below in more detail. Tailored MCHEPI Curricula Students in the MCHEPI degrees at UIC-SPH participate in specially structured curricula focused on MCH epidemiology in practice. MPH in MCH Epidemiology Students in the MCHEPI MPH program have additional requirements beyond those required of students in the general MCH MPH program. The curriculum shares with the traditional MPH program a focus on MCH substantive knowledge and the MCH planning cycle skills (e.g., assessment, planning, monitoring and evaluation, and policy development) but places emphasis on the analytic skills needed for data management and statistical programming, and additional required classes in epidemiology and biostatistics. PhD in MCH Epidemiology The curriculum is more structured than a traditional PhD curriculum to ensure that students acquire the skills necessary for MCHEPI positions in public health practice. Students are expected to take courses in advanced epidemiology, biostatistics, and other methods courses, with an emphasis on application of analytic skills to the activities of MCH planning cycle. Three courses have been
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developed specifically for this program, all of which (despite their traditional titles) have an extensive emphasis on epidemiology in practice: Reproductive and Perinatal Epidemiology, Pediatric Epidemiology, and Advanced Analytic Methods in Maternal and Child Health. In order to make sure that our curricula remain on the cutting edge of the field, our core faculty are participants on a variety of national committees including the planning committee for the CDC/HRSA sponsored MCHEPI conference, in which emerging issues in the field are routinely discussed. Likewise, our faculty are involved in national training (HRSA/CDC efforts) of state MCH epidemiologists, and in direct response to the needs of the MCHEPI workforce, our faculty develop new in-person and on-line training modules. As such, not only do UIC MCHEPI faculty help shape the training delivered to MCH epidemiologists across the nation, they pursue their own advanced training (e.g., propensity score analysis) in order to ensure that their own skills stay on the cutting edge. Based on these efforts, new analytic methods and approaches are then routinely integrated into several of the core courses for the MCH Epidemiology students: Reproductive and Perinatal Epidemiology Methods, Pediatric Epidemiology, Advanced Analytic Methods in MCH. In addition, as needed, we invite guest speakers from other disciplines (e.g., Economics) to our core classes to ensure that MCHEPI students are exposed to a variety of methodological approaches (e.g., econometrics methods to account for selection bias). Finally, to ensure that our MCHEPI students’ content and analytic needs are met in real time as well as to ensure that the feedback of our graduates is incorporated into class and curricula changes, we regularly seek input from students at our semester get-togethers (See Socialization below). Likewise, we obtain feedback from our graduates through direct one-on-one discussions with those who are practicing MCH Epidemiologists, through alumni focus groups, as well as through our 5 year graduate survey (See 5 Year MCH Graduate Survey, below). MCHEPI Practica and Dissertations with Public Health Agencies The MPH degree in MCH Epidemiology requires students to complete practica with a governmental public health agency. The PhD program requires students to complete their dissertations in conjunction with a governmental public health agency at the state or local level and/or utilize data generated by a state or local public health agency (note: during some periods collaboration with national level public health agencies was also allowed by MCHB.). Students often select their practica sites or dissertation topics after attending the Maternal and Child Health Epidemiology Conference where they meet MCH
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epidemiologists or other governmental public health agency personnel and discover mutual interests. MPH students also often complete their practica with state or local health programs through participation in the Graduate Student Epidemiology Program (GSEP), formerly the Graduate Student Internship Program [13]. Personal Leadership Training and Development Over the last several years, the UIC–MCH Program has implemented a Personal Leadership Development and Coaching Program for all MCH students. Through group sessions and individual coaching, this program addresses the MCH Leadership (3.0) Competencies across three areas: (1) Self, (2) Others, (3) Wider Community. Overall, the program builds emotional intelligence and develops authentic leadership by increasing self-awareness and focusing on strengths, values-based decision-making, and goal-setting. This program is offered on a voluntary basis to all MCH students including MCHEPI students; however, we require MCHEPI PhD students to participate in the program during at least one of their semesters in the program. We believe that by including this Personal Leadership Coaching requirement for the doctoral students, our PhD graduates are moving closer toward the CSTE Tier 3 job functions of senior leadership and management. Starting in the 2013–2014 year, we have begun requiring all MPH MCHEPI students to participate in this program. Socialization Probably one of the most important components of the UIC-SPH MCHEPI degree programs is our effort to have MCHEPI students view themselves as part of a distinct group with direct connections to MCH Epidemiologists in public health practice. To that end, MCHEPI MPH and doctoral trainees meet face-to-face as a group once a semester to discuss issues and experiences related to the program: concerns with the curricula, the selection of practica sites and dissertation topics, and to provide feedback on activities (e.g., MCHEPI webcasts, attendance at the MCHEPI conference, practica experiences) that students participate in as part of the program. At the spring meeting each year, an experienced MCH Epidemiologist from a local, state or national public health agency is invited to share their career path and experience with the students. These get-togethers allow students, faculty, and guests to discuss issues related to working as a practicing MCH Epidemiologist and encourage identification with, and socialization into the field of MCHEPI. One of the most important activities to foster socialization into the MCHEPI field and the development of MCHEPI leaders has been our efforts to encourage all
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MCHEPI doctoral and MPH students to attend the annual MCHEPI conference by providing partial travel funds for those who want to attend. Students are encouraged to submit abstracts for oral or poster presentations. Almost all students attend the conference at least once during their training and most attend multiple times. As an adjunct to the conference, each year the UIC MCHEPI faculty host a dinner with current UIC MCHEPI students and alumni of the program; this dinner provides a link between former and current students and provides current students with an opportunity to directly dialogue with recent entrants to the MCHEPI field. This UIC MCHEPI ‘‘tradition’’ has become both a gathering at which professional and personal information is exchanged as well as a mechanism to foster career decision-making.
Strategies for Assessing the Outcomes of the MCHEPI Program at UIC-SPH In order to determine if UIC-SPH is achieving its objective to develop MCH Epidemiology leaders for the MCH public health workforce, we examine and report on data derived from a variety of tracking activities and assessments described below: •
•
•
•
Tracking of Products. On an annual basis, we collect information on all products of our MCHEPI students as well as graduates. These include their abstracts, presentations, publications, and awards. Tracking of Students and Alumni. At the simplest level, we track our students and alumni through a variety of formal and informal mechanisms. We document practica sites and dissertation topics/associated public health agencies. We maintain at least annual e-mail contact with graduates to determine their current employment or education status. MCHEPI Graduate Employers and Employees Survey. In 2009, eleven employers of ten (out of 19) MCHEPI MPH and doctoral MCHEPI alumni were surveyed. The focus was to determine their satisfaction with their MCHEPI graduate employees’ preparation and performance, their needs for new personnel in the next 3–5 years, the continuing education (CE) needs of current employees, barriers to hiring and retaining qualified personnel, as well as preferred methods of CE. MCHEPI graduates received a parallel survey to determine their assessment of whether they felt prepared for employment in the field of MCH Epidemiology. Five Year MCH Graduate Survey. In 2009, we began an annual survey of all MCHEPI graduates who graduated 5 years prior (5 Year survey is an MCHB
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requirement for all MCH graduates). These surveys provide current information about our graduates (job placement, contact information), as well as help evaluate the long term impact of the program. Questions focus on competencies achieved and relevance of graduates’ course work and practica and/or dissertation experiences for their current positions. In addition, we have been utilizing a pre and post-test competency assessment based on the MCHEPI competencies (described above) since 2007 but data collection has been uneven. Consequently, results are not reported here.
Judging the Outcomes of the MCHEPI Program at UIC-SPH We report here on the progress and experiences of all 28 MPH students and 15 doctoral students (n = 43) who have participated in the MCHEPI program at UIC-SPH over the last decade or more (enrollees from 1998 through 2012 cohorts). Full details about these students and graduates and their productivity are provided in Tables 2, 3, 4 and Appendix A (available at http://www.uic.edu/sph/mch/ documents/AppendixA-MCHEPIPracticaandDissertation ProjectsMay2014.pdf). Becoming an MCHEPI leader is dependent on acquiring a variety of leadership and analytic skills including the ability to translate data into information and to disseminate findings. Table 2 provides information on the academicassociated productivity of our doctoral students/alumni enrolled from 1998 (see explanation below) until 2012 and MPH students/alumni enrolled from 2000 until 2012. These data suggest that productivity increases considerably after graduation; however, for MPH students in particular, presentations or publications after graduation often reflect work conducted during the degree program. For both MPH and doctoral graduates however, more detailed data (not shown) reveal that not all are equally presenting at scientific meetings and publishing; this disparity usually reflects differences in their current job responsibilities (i.e., practice versus academe). The key measures of success of MCHEPI programs are practica placements, dissertation partners (i.e., governmental public health agencies whose data are utilized by students with varying degrees of direct interaction with agency personnel), and job placements after graduation. Tables 3 and 4 present a summary of the data from MCHEPI students and graduates whose matriculation year was 2000–2012 with two exceptions; two PhD students who matriculated in 1998 and 2000 were heavily involved in the MCHEPI coursework and approach and although they were not officially MCHEPI students, data reflecting
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Table 2 The number of presentations and publications produced by UIC-SPH MCHEPI students and alumni (1998–2012 Cohorts) MPH students
MPH alumni
Doctoral students
Doctoral alumni
Combined: Various authors/presentersa
Total
Presentations
0
43
21
108
13
185
Publications
0
18
6
64
8
96
a
Two or more MCHEPI alumni/students worked together to generate these products
Table 3 Race/ethnicity and practica/dissertation partners of current students and alumni of the UIC-SPH MCHEPI program (enrolled in 1998–2012) MPH students and alumni (n = 28)
PhD/DrPH students and alumni (n = 15)
#
%
#
%
White, non-hispanic
19
67.9
6
40.0
African american
5
17.9
6
40.0
Race/ethnicity
Hispanic
1
3.6
0
0.0
Asian
3
10.7
3
20.0
Practicum site (MPH)/dissertation partner (doctoral)a Local health agency
16
57.1
3
20.0
State health agency
10
35.7
3
20.0
Federal health agency
2
7.1
6
40.0
MPH Masters in Public Health a Three current doctoral students are not in the dissertation proposal stage yet and are not included
their experience is included here as well. Table 3 provides information on the race/ethnicity of current students and alumni of the program, as well as the types of health agencies, local, state or federal, with which MPH students participated in practica and doctoral students conducted dissertations. Table 4 provides information on post-graduation educational or employment experiences of alumni of the program. In Appendix A (See url above), we provide the details on which these summary tables are based. As seen in Table 3, participants in our MCHEPI degree programs have been racially and ethnically diverse: 32 % of MPH and 60 % of doctoral students have been of color although this has mainly been African-American rather than Latina students. (Note: recruitment efforts are carried out within the program, within the SPH divisions, and at the School level; while there is a stated and operational commitment to diversity at UIC-SPH, we have been more successful at recruiting African-American students into the MCHEPI program, partly because we work closely with Howard University, which hosts an MCHB pipeline program). As can also be seen, all MPH students in the UICSPH MCHEPI program have participated in practica with local or state public health agencies and all doctoral students have conducted their dissertations with local, state, or national health agencies. While the projects that the MPH
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students have participated in are not listed in these tables, they range from linking the Kentucky birth and death data to examine racial disparities in infant deaths to an analysis of the Minnesota Student Survey to draft an issue brief comparing children with special health needs and their same aged peers on mental health and risk behaviors; these efforts clearly contribute to increased capacity at the host agencies. Doctoral dissertations have often focused on the use of innovative analytic methods with existing MCH data (e.g., Applying Multifactorial Population Attributable Fractions (PAFs) to the problem of Childhood Overweight; Identifying Maternity Care Practices that Mediate Racial Disparities in Breastfeeding Duration and Exclusivity). Although there are no comparison data available, the data in Table 4, and Appendix A (See url above) suggest that direct exposure to public health practice during graduate training (all of our students’ practica or dissertations are with governmental public health agencies) appears to be associated with participation in public health practice after graduation. Among all graduates with listed positions in Appendix A (See url above), 11 of the 33 graduates (33 %) have a first or second position with a governmental public health agency. However, for doctoral graduates, the degree program for which we receive direct funding for MCHEPI training, 5/8 or 63 % have a first or second position with a governmental public health agency. With regard to their roles in their post-graduation employment, the alumni of the MPH program appear to serve in higher level positions in their second compared to their first placements post-graduation. To date, upon graduation, all of our doctoral graduates entered positions at the emerging senior level or senior scientist level in local, state and federal agencies or in academe. Currently, two of UIC’s MCHEPI graduates are state MCH Epidemiologists, and two are CDC MCH Epidemiologists. These data also demonstrate that there are many opportunities to apply advanced analytic skills in MCH practice in a variety of organizations (agency names noted in Appendix A; See url above), not only in public health agencies. Nine of our MCHEPI graduates, although not directly employed in MCH Epidemiology positions in governmental public health agencies are using their MCHEPI skills to contribute to projects such as the implementation and analysis of the Illinois Youth Risk Behavior Survey, the conduct of the National Children’s
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Table 4 Employment and/or educational characteristics for first and second placements post-graduation among UIC-SPH MCHEPI program alumni Level
MPH alumni (n = 25)
Site/role
First placement
Second placementa
#
%
#
%
Local health agency
1
4.0
2
8.3
State health agency
3
12.0
2
8.3
Federal health agency
0
0.0
0
0.0
University
13
52.0
8
33.3
Hospital/healthcare system
4
16.0
9
37.5
4
16.0
3
12.5
Site
Other
b
Role
Doctoral alumni (n = 8)
Research associate or
9
36.0
2
8.3
Epidemiologist/analyst
10
40.0
6
25.0
Research manager
1
4.0
6
25.0
Emerging senior level or senior level Scientist
1
4.0
2
8.3
Clinician
3
12.0
4
16.7
Student
1
4.0
4
16.7
#
#
1
1
2
2
2
2
2
3
0
0
1
0
2
0
0
0
0
0
6
8
0
0
0
0
Site Local health agency State health agency Federal health agency University Hospital/healthcare system Otherb Role Research associate or project Manager/coordinator Epidemiologist/analyst Research manager Emerging senior level or senior level Scientist Clinician Student
a
One MPH alumnae reported no employment for the second job placement so is not shown b
Includes school system, and for-profit and non-profit agencies
Study, and the analysis of data for Text4Baby at the national level. Three of our MPH graduates are currently obtaining their PhDs in MCH Epidemiology; two of these individuals initially became CSTE fellows after receiving their MPH degrees. Finally, these data indicate that becoming a leader in the field of MCH Epidemiology is not always a ‘‘one-stop’’ process with graduates moving on to gain more training as Epidemic Intelligence Service (EIS) officers, CSTE fellows, and/or returning to graduate school on their way to more permanent leadership positions. To obtain a more detailed understanding of the postgraduation experience of our MCHEPI students, in 2009 we began surveying our MCHEPI graduates who had graduated 5 years prior (5 Year survey). Overall since 2009 (distributed five times), a total of eight MPH graduates (out of a possible 13) and five doctoral graduates (out of a possible five) have responded to the survey. Sixtyseven percent of these graduates are working in academe or for public health agencies and are engaged in applied analytic work or research in MCH utilizing epidemiology or evaluation skills. Ninety-two percent report that the education that they received at UIC has been extremely relevant to the work they have been doing since they graduated, and 100 % of them consider themselves to be MCH leaders. In 2009, we also surveyed eleven employers of ten MPH and doctoral MCHEPI alumni (out of 19) who were both working and agreed to provide their employers’ contact information. Six of the eleven employers replied. Three of the six were very satisfied with the individuals they hired from UIC and three were pretty satisfied [1] or satisfied [2]. Employers believed that graduates of the UIC-SPH MCHEPI program were most prepared in the areas of data management and linkage, data analysis and interpretation, data reporting, translation and dissemination, with relative areas of weakness in grant-writing and advocacy (note: five of the six respondents coded their response to employee’s skills in ‘‘advocacy’’ as not applicable.) Fifteen (out of 19) MCHEPI alumni were given a companion survey to the Employer Survey, (Note: we did not include the three individuals who completed the 2009 5 Year survey so as not to confuse these individuals with two surveys; in addition, one alumna could not be located). Eight of the 15 alumni who received the Employee companion survey completed it. These alumni stated that overall (rating of 4.38/5 with 5 = the most prepared) they were prepared to perform in their position after graduation. They reported that they were most prepared in the areas of data analysis, leadership, and values/ethics, with relative areas of weakness in grant-writing and advocacy; these responses closely matched those of their employers. In addition, seven out of
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the eight (87.5 %) respondents had attended the MCHEPI conference since they graduated.
Discussion
The primary mission of the MCHEPI program at UIC-SPH is the development of leaders in Maternal and Child Health Epidemiology who are trained and groomed to join the MCHEPI workforce at multiple levels depending on their skills and experience. To that end, the UIC-SPH program has implemented a series of curricular components which the data reported here suggest have been mostly successful in their intent of producing practice focused MCH epidemiologists. While we are unable to directly tease out which curricular component is the most important, we believe these components act synergistically to inspire students to join the field of MCHEPI and connect them to the MCHEPI practice community when they leave the program. Importantly, these data suggest that the path to MCHEPI leadership is not necessarily linear: graduates of MCHEPI training programs may weave in and out of the public and private sector as well as move from fellowships to employment to school and back again on their path to leadership. That there is movement of emerging leaders along a trajectory is a critical point. Expectations that individual MCHEPI graduates will immediately seek and obtain positions in governmental public health agencies, although highly desirable, is not always realistic. In addition, governmental public health agencies often have barriers to hiring even if positions are desired or open, particularly at a competitive salary level and with the appropriate title/position in the organizational hierarchy [14, 15]. However, we expect that over the long term, it is likely that many of these graduates of our (and other) MCHEPI training programs will join and contribute to the governmental public health enterprise at one level or another. The data reported here are in line with national data which suggest that leadership training in MCHEPI appears to be having an impact on the field. Based on the 2009 CSTE data cited above, although there are many state and territorial jurisdictions without a doctoral level trained MCH epidemiologist, as of 2009, 46 % of jurisdictions in fact had such an individual, which is the highest percentage of any public health epidemiology specialty area [6]. We expect that the current percent is likely somewhat higher unless state budget cutbacks have inhibited the growth of these positions; unfortunately, this information is not available. According to Phillips et al. [16], the increased MCH epidemiology capacity in states and territories is attributable to multiple efforts including short and long-term training of health department staff, the promulgation of
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internships and fellowships, as well as the commitment by MCHB to invest in doctoral level training of MCH Epidemiologists. While the MCHB investment in MCHEPI doctoral training for each program recipient is not large (approx. $26,000–$27,000 a year per School of Public Health), this small amount of seed funding has clearly provided the impetus to provide not just financial support to doctoral students interested in reproductive/perinatal/ pediatric epidemiology, but to develop MCHEPI programs in Schools of Public Health that leverage MCHB’s support in order to insure the development of practice- focused MCH epidemiologists. While the training and development of individual MCHEPI leaders is key to increasing analytic capacity in state and local governmental public health agencies, as pointed out by Rosenberg et al. [17] ‘‘building scientific capacity in states is not just a matter of hiring and training more senior epidemiologists’’. According to Rosenberg, epidemiologists face organizational barriers to using their advanced analytic skills; she suggests that to truly build analytic capacity in an agency requires strategies that also support agency level change to collect high quality data, to facilitate its utilization, and to support the translation of data into information for program planning and policy development. In fact, being an MCHEPI leader means having the skills to advocate for, organize, and ensure the implementation of those strategies. As we articulate the future training needs of the MCH workforce during this time of transformation of the health care system, we must communicate the importance of enhanced analytic skills, including the leadership skills required specifically to affect change in the data infrastructure of public health agencies. Analytic capacity training, both graduate and continuing education, must be embraced as an indispensable partner to training in areas such as quality improvement and systems integration, two foci of the new MCHB funded MCH Workforce Development Center at the University of North Carolina. This assessment has several limitations. First and foremost, we are only reporting on the impact of the MCHEPI Leadership training at one School of Public Health. It is likely that other schools have used other approaches and have also been successful in placing their graduates within the MCHEPI workforce. In addition, even with our presentation of findings from the UIC-SPH MCHEPI program, we do not present data from a comparison group of students who were not exposed to the MCHEPI program. Based on data we collect for the MCHB (not shown), we can report that most of our students in the MCH (nonMCHEPI) Program at UIC-SPH also join the MCH workforce. However, very few initially obtain positions as MCH Epidemiologists because their analytic skill level is not as developed as the students trained in MCHEPI and
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because they are not directly connected to the MCHEPI field. Finally, for some of our data collection methods, those responding may be those most likely to be engaged in the MCHEPI workforce. As such, we may be overestimating the impact of our MCHEPI Program. While this may be the case, we believe that the use of multiple data sources to describe the outcomes of our program strengthens our findings.
Conclusion Training the next generation of MCHEPI professionals, many of whom will become leaders in the field, serving at the highest levels (i.e., senior scientists) is a multi-faceted process. Our experience with the development and implementation of the MCHEPI program at UIC-SPH suggests that explicit linkage of MCHEPI students to practice through tailored curricula, practica and dissertations with public health agencies, and the development of an identity as a member of the MCHEPI field appear to be important for the generation of epidemiology leaders for the MCH workforce. Our experience also suggests that leadership development is a lifelong process and as such, snapshots of current students and alumni at any one point in time do not provide the entire picture of the impact of MCH Epidemiology training programs. Examining the trajectories of emerging leaders over time is essential to evaluating the true success of MCHB workforce and training investments.
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7.
8.
9.
10.
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12.
13. 14.
References 1. Dievler, A., Grason, H., & Guyer, B. (1997). MCH functions framework: A guide to the role of government in maternal and child health in the 21st century. Maternal and Child Health Journal, 1(1), 5–13. 2. Rochat, R., Atrash, H., & Handler, A. (1999). Developing maternal and child health epidemiology capacity in state health departments. Journal of Women’s Health and Gender-based Medicine, 8(9), 1135–1139. 3. Handler, A., Geller, S., & Kennelly, J. (1999). Effective MCH epidemiology in state health agencies: Lessons from an
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