Model Practices Database View

Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:

• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice

A new type of training program, the Massachusetts Public Health Inspector Training (MA PHIT) is an innovative, cost-effective training model which builds upon the assets of local public health professionals. Easily replicable for other communities, MA PHIT utilizes a team approach with representatives from academia, federal and state agencies such as the FDA, MA Departments of Public and Environmental Health (MDPH, MDEP), local health departments, and professional local public health associations, such as MA Environmental Health Association (MEHA), MA Health Officers Association (MHOA), and MA Association of Public Health Nurses (MAPHN). MA PHIT includes Certificate Programs in the areas of Housing and Retail Food. A Wastewater Certificate Program is in development for 2012. Future program areas include Swimming Pools and Recreational Camps. Public health professionals from municipal and state agencies charged with enforcement of health and environmental regulations in MA are the targeted participants for MA PHIT. By December 2011, the Housing Certificate Program (initiated in 2009) will have engaged five cohorts and a total of 172 trainees in classroom training. To date, 44 trainees have completed the field training with another 42 expected to finish by December 2011. 35 have successfully completed the entire program and received certificates; another 31 are expected to finish in 2011. The Food Certificate Program was piloted in 2011. Twenty trainees enrolled in, and 19 successfully completed, the classroom component. To date, six have begun the field training, with an anticipated completion date in December 2011. MA PHIT primarily addresses the public health issue of workforce competency; competency-based training that includes field experiences and problem-based learning is essential to workforce preparation. Without comprehensive, standard training requirements there can be no assurance that our workforce is capable to perform their duties. The primary goal of MA PHIT, then, is to increase the capacity of the public health workforce to comprehensively and uniformly enforce the MA State Sanitary and Environmental Codes. To attain this goal, the following objectives will be achieved: increase trainee knowledge of the MA State Sanitary and Environmental Codes, and ensure trainee ability to identify and properly document violations and correction orders.

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This goal and its objectives were seeded when a group of concerned state and local practitioners met to discuss a large training gap for housing inspectors charged with enforcement of the State Sanitary Code in MA (Minimum Standards of Fitness for Human Habitation). A team was formed to design a comprehensive, standard training course that included field training and assessment of inspector competence. The program was so successful the team decided to expand to additional areas of responsibility. MEHA and MHOA agreed to each manage one of the programs, and each contributed $4,000 for Housing Certificate Program development and pilot expenses. The New England Public Health Training Center contributed $3,000 for development and implementation of the independent (audit) housing inspection, including proctoring and grading. Once the pilot was completed, MHOA staff time to administer and manage the entire housing program is covered by trainee fees (@ $100 per day of classroom training). Once the Housing Certificate Program was designed and pilot tested, we did not need the same level of financial investment for additional series topics. For the Food Certificate Program, MEHA, MHOA, MAPHN, MDPH and FDA provided in-kind effort for program and curriculum development, and for classroom and field instruction. The Alliance paid for the reproduction of pilot course materials (@$1,000). Trainee registration fees covered registration and training facility expenses. All instructors contributed their time at no charge. We will use this same, cost-conscious business model for all future modules. Based on findings from the classroom exams and the number of trainees who successfully completed inspection reports and correction orders, trainees experienced gains in knowledge, and are able to identify and document violations, which indicate that the program is achieving its objectives. Specific factors which led to MA PHIT’s success include: • willingness of federal, state, and local practitioners to volunteer their time to develop comprehensive programs, contribute to classroom training curricula, instruct in both the classroom and the field, and donate facilities for classroom sessions and inspectional activities • a solid evaluation plan and commitment to continuous quality improvement • dedicated planning groups that continue to function as advisors, teachers and mentors • recognition of professional associations and their willingness to designate members to MA PHIT, manage program logistics, and provide financial support

Describe the public health issue that this practice addresses. (350 word limit)

In Massachusetts there are 351 cities and towns, each with its own board of health or health department responsible for providing (or assuring access to) a comprehensive set of services defined by state and local laws and regulations. Included are more than 18 distinct program areas. Minimum workforce qualifications such as the Registered Sanitarian/Registered Environmental Health Specialist (RS/REHS) are not mandated by the state. State public and environmental health agencies have limited resources to provide training and technical assistance; they essentially have no resources to provide field training supervision or oversight of new local inspectors/sanitarians. Additionally, there is no county public health system and no direct state funding for the local public health agencies to provide public or environmental health services; agency support is primarily from local property taxes. Most local health agencies serve small populations (<50,000), and many have no paid staff or only part-time staff. The Commonwealth does not provide comprehensive training for the governmental and environmental public health workforce who serves in the regulatory arenas of housing, retail food safety, private water supplies, hazardous and solid waste, recreational waters, and on-site wastewater systems. In addition, there is not a robust pool of qualified trainers for both classroom and field training; we are especially lacking standardization processes for field trainers. Most public and environmental health laws and regulations here do not have minimum competency requirements for inspectors. As a result, there can be no assurance that our workforce is prepared or competent to perform their mandated duties. At the same time, in these challenging economic and budget-tightening times, fewer resources are dedicated to workforce development, with many local health departments unwilling to pay for more costly training options for their staff.

What process was used to determine the relevancy of the public health issue to the community? (350 word limit)

The process used to determine the relevancy of the public health issue to the community included: 1. A review of the findings of a statewide workforce assessment prepared by the Institute of Community Health for the MA Coalition for Local Public Health (CLPH) in 2006, entitled “Strengthening Local Public Health in Massachusetts: A Call to Action.” CLPH is comprised of the five statewide public health associations. One of CLPH’s three overarching recommendations in this report is “Strengthen workforce development and competency through increased training opportunities for local boards of health and staff, and through the development of minimum educational levels and credentialing for certain positions.” When asked about additional public health staff needed to meet local and state needs, 46% of local public health staff who responded to the study’s survey requested additional inspectional services staff. 2. A review of findings from the report, Stronger Partnerships for Safer Food: An Agenda for Strengthening State and Local Roles in the Nation’s Food Safety System (Michael R. Taylor and Stephanie D. David, 2009), which includes the recommendation, “State and local governments should…improve their own structures for food safety oversight, including…food safety regulatory and inspection activities.” 3. Informal interviews with professional association leadership and Bureau/Division leadership at MA Department of Public Health and City of Boston Inspectional Services Division; and 4. Analysis of evaluation results from the Housing and Food Certificate Programs pilots, described in the evaluation section below.

How does the practice address the issue?

MA PHIT addresses the issues described above by providing competency based training with minimal agency expenditures and reasonable trainee fees. Elements of all MA PHIT programs include prerequisite online modules, classroom training (lecture and case-based activities with instructor notes), pre/post-tests, field trainer preparation, supervised field inspections, final assessment of trainee competency, and program evaluation. Implementation of standard training requirements assures Massachusetts’ public health workforce is competent to perform their duties. MA PHIT trainings have a statewide geographic scope, ensuring standardized inspector qualifications and consistent inspections regardless of location. Descriptions of the two developed programs in the series follow. The Housing Certification Program is a course designed to train health and housing inspectors in the uniform enforcement of MA State Sanitary Codes 105 CMR 400.000 and 410.000: General Administrative Procedures and Minimum Standards of Fitness for Human Habitation. MHOA administers and manages the program and plans to run classroom training twice a year for 30 trainees (60 total); train a cadre of Field Trainers twice a year (10); expand the number of field trainers and their geographical representation throughout the state; hold ongoing field trainings throughout the year; and open the audit house for final inspection twice a year. MEHA administers and manages the MA PHIT Food Certificate Program, designed to promote comprehensive and uniform enforcement of MA State Sanitary Code Chapter X 105 CMR 590.000: Minimum Sanitation Standards for Food Establishments, and to meet FDA Voluntary National Retail Food Regulatory Program Standard 2: Trained Regulatory Staff. Upon successful completion of the five day classroom section, a selected group of trainees accompany Field Trainers on joint inspections (@5 – 10) depending on the trainee’s previous regulatory food inspection experience. They then complete the abbreviated Conference for Food Protection Training Plan and Log. After successfully completing the joint field training inspections, these Field Trainers complete an independent inspection under the supervision of an FDA or MDPH standardized Food Inspector. They then will act as a Field Trainers for future trainees. Due to a lack of standardized inspectors, we initially are unable to offer the field training option to all classroom trainees.

Is the practice new to the field of public health? If so, answer the following questions.

Yes

What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review.

Team members from state and local health agencies in MA charged with enforcement of these regulations, and state agency and academic members who traditionally train local health professionals, knew of no such training for housing inspectors. The same key constituent interviews as those described above with state association members, MDPH staff and others reinforced that the plan for MA PHIT was a new approach to addressing the issue of local public health workforce competency. There are existing classroom trainings (National Center for Healthy Homes http://www.healthyhomestraining.org/, credentials (Healthy Homes Specialist http://www.neha.org/credential/HHS/index.htm) and many Home Inspector courses but none address the scope and responsibilities of the MA State Sanitary Code 105 CMR 410.000. For retail food protection programs, while FDA does have a standardization process for food inspectors, only a few standardized inspectors work for MDPH. MDPH has limited capacity to field train and standardize the work of local inspectors. Additional program areas (wastewater, swimming pools, recreational camps for children) have similar issues. Team members were also unable to locate any best practices or models for conducting group inspections of homes or food establishments; therefore, the team created and pilot tested the methods and materials for such inspections (referred to as an audit or independent inspection). Pilot testing of both housing and food audit facilities yielded a wealth of quality improvement ideas; as a result, those inspections are much more structured and have worksheets and supplemental handouts to manage the inspection workflow and grading of final assignments.

How does this practice differ from other approaches used to address the public health issue?

Traditionally in Massachusetts, training is classroom-based, and content experts are asked to present on a specific topic to an audience. There is no actual competency-based curriculum and no uniformity or consistency in content or approach. Most classroom-based training: • Are nonstandard and lacking in elements such as learning objectives, instructor notes, handouts, exercises, resources and references, assessments, and/or evaluations • Are designed to address only a particular element of an environmental or public health program area or a “hot topic” • Are dependent on an individual speaker and, so, are not replicable • Are only offered one time or on a sporadic schedule. MA PHIT differs from these traditional approaches in that it: • Uses federal, state, and local practitioners to donate time and work as part of a team to design and deliver a uniform, comprehensive training program • Uses professional associations to contribute financially to, and manage, the program • Requires completion of prerequisite online training (such as ORAU) prior to attending the classroom sessions, which covers program area background information and science topics • Identifies and trains local health professionals to act as Field Trainers • Has a ‘final exam’ that is hands on and graded • Includes a thorough evaluation and quality assurance plan • Creates a curriculum and standardized training which transcends that of any one instructor or trainer • Is adaptable to other inspection modules and replicable for other communities.

Is the practice a creative use of an existing tool or practice? If so, answer the following questions.

What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?

What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review.

How does this practice differ from other approaches used to address the public health issue?

If this practice is similar to an existing model practice in NACCHO’s Model Practices Database (www.naccho.org/topics/modelpractices/database), how does your practice differ? (if, applicable)

Who were the primary stakeholders in the practice?

Academia, professional associations, and governmental public and environmental health agencies (local, state, federal)

What is the LHD's role in this practice?

The LHD’s role in MA PHIT is extensive. In fact, MA PHIT depends on the stewardship of local public health professionals who provide their services in-kind – even training people outside their jurisdiction. Local health professionals (members of MHOA, MEHA and MAPHN) are included as team members for program development and content delivery. This includes Agents, Directors, Sanitarians, Inspectors, and Public Health Nurses. The MA PHIT Housing and Food Teams currently include representatives from health departments of the following cities and towns: Beverly, Boston, Hudson, Medford, Newton, Salem, Saugus and Wellesley. Members of each MA PHIT Team assist with program design, classroom and field curriculum development, field trainer training, classroom and field instruction, quality improvement and ongoing program implementation. Team members identify and recruit additional instructors such as other local and state practitioners, content expert consultants, legal experts (judges and clerk magistrates), BUSPH students, and even a restaurant owner. Field trainer qualifications are drafted by each Team, and reviewed and endorsed by MEHA and MHOA. The professional associations also play a role in marketing and identifying potential field trainers. Once trained, these field trainers volunteer their time (in their own community or the trainee’s community) to instruct in the field. Our partners also donate facilities such as a house or commercial kitchen for the final inspections, and serve as proctors, actors/role players, and facilitators.

What is the role of stakeholders/partners in the planning and implementation of the practice?

MA PHIT is a collaborative effort of Boston University School of Public Health (BUSPH), the Alliance, Food and Drug Administration (FDA), Local Public Health Institute of MA, MDEP, MDPH, MAPHN, MEHA, MHOA and the local communities described above. These under-resourced federal and state agencies dedicate valuable time to this program as they grasp its significance to local practitioners and the field at large. MA PHIT also has receive enthusiastic support from facility operators and local housing authorities, who have donated space for the audit inspections, and by restaurant owners, lawyers, judges and clerk magistrates, who have participated in the classroom trainings. The work group for each program meets regularly to develop and review content, then implement, evaluate and improve the training. All stakeholders are involved in the planning and implementation of the practice. Specifically, they developed qualifications for field trainers, support staff volunteering as instructors during normal business hours, allow staff acting as field trainers to spend more time conducting inspections so they may train visiting inspectors, allow inspectors from other communities to accompany their staff for training, attend post class meetings to review evaluations, suggest appropriate modifications and provide technical support, provide advertising for the program, and provide sites for final audits/inspections. Of special note is the role of the MA Environmental Health Association and MA Health Officers Association. An affiliate of the National Environmental Health Association, MEHA’s goal is to provide quality training and educational programs while also providing the opportunity for members to meet and exchange ideas and information with other professionals in the field of Public and Environmental Health. MHOA’s mission is to assist and support staff of local health departments in meeting their statutory responsibilities to the public through programs of education, technical assistance, representation, and resource development, and by providing educational and informational programs to the general public on public health topics. Both professional associations represent the local public and environmental workforce in MA, and each agreed to pilot test and administer a MA PHIT program. MHOA took the lead on Housing, and plans to also administer Wastewater. MEHA took the lead on Food.

What does the LHD do to foster collaboration with community shareholders?

Describe the relationship(s) and how it furthers the practice's goals.

As active members of statewide associations like MHOA, MEHA and MAPHN, Massachusetts’ local health departments are able to leverage resources at all levels of government in a time of shrinking public health budgets. They work with various stakeholders in their communities to bring quality, standardized training to local health inspectors. These partnerships enable cost-effective implementation of all program components including planning, teaching, field training, auditing, as well as securing training facilities and inspectional units. Locally elected government officials, as community stakeholders, allow their health department staff to participate in MA PHIT programs to further the important goal of public health in this difficult budgetary climate. These stakeholders seek competently trained professionals to enforce state and federal rules and regulations, as well as to train the public on various public health issues. The MA PHIT program is designed to provide proper and appropriate training to those professionals. It is the local, state, and federal public health staff who is fostering this training program on those officials’ behalf. Local health department team members within the MA PHIT programs also collaborate with local businesses and trade associations (such as food establishments and property owners) in presenting the field training sessions.

Describe lessons learned and barriers to developing collaborations

Barriers to developing collaborations involve time and resources (a lack of both). Governmental public health agencies are reducing their workforces and are expected to do more with fewer resources and shrinking budgets. By combining resources of funded training programs (such as the HRSA Public Health Training Centers)with professional associations who share a mission to train and educate the workforce, we were able to implement a new type of training program, and to expand it, on what we consider a 'shoestring' budget. Specific factors which led to MA PHIT’s success include: • willingness of federal, state, and local practitioners to volunteer their time to develop comprehensive programs, contribute to classroom training curricula, instruct in both the classroom and the field, and donate facilities for classroom sessions and inspectional activities • a solid evaluation plan and commitment to continuous quality improvement • dedicated planning groups that continue to function as advisors, teachers and mentors • recognition of professional associations and their willingness to designate members to MA PHIT, manage program logistics, and provide financial support

Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.

Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).

List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)

The goal of MA PHIT is to increase the capacity of the local public health workforce to comprehensively and uniformly enforce the MA State Sanitary and Environmental Codes. Although the goal and objectives are consistent for all program units (e.g., housing inspections, food establishment inspections), the desired outcomes and data collection tools for each unit are tailored to the relevant codes, background science, necessary inspection skills, and documentation procedures for each unit. Objective #1 is to increase knowledge of the unit-specific (e.g., housing, food establishment) MA State Sanitary and Environmental Codes among trainees who complete classroom training. Objective #2 is to ensure trainee ability to identify and properly document violations on an inspection report and to write correction orders. Objective #3 is to ensure capacity to assess and improve the program’s reach and quality.

• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.

Objective 1

Objective #1 is to increase knowledge of the unit-specific (e.g., housing, food establishment) MA State Sanitary and Environmental Codes among trainees who complete classroom training. The performance measure (outcome) is an increase from pre-test to post-test in the number of correct responses to exam questions. The data collected related to the performance measure involves a written exam that is administered by the course instructors before classroom training and again after classroom training is completed. Graded exams are aggregated and tracked by BUSPH’s program evaluator. Evaluation results Based on findings from the classroom exams for the food and housing inspection units, trainees experienced gains in knowledge, thus meeting the performance measure. Feedback: The pre/post exam findings are reviewed to determine if improvements are needed in the exam questions (i.e., the majority of participants answer correctly at both pre and post-test thus indicating that the question assesses what may be considered general knowledge among trainees) or classroom content (i.e., several participants answered correctly at pre-test but incorrectly at post-test which may indicate that something occurred in the classroom training that confused participants and caused them to select an incorrect answer at post-test). Evaluation of the pre/post exam findings is critical during a unit’s pilot phase to ensure our ability to effectively evaluate changes in trainee knowledge in subsequent iterations of the unit. Findings from the pilot of the food inspection unit indicate that modifications in the classroom exam questions are necessary to ensure a better assessment of impact on trainee knowledge. Findings related to objective #1 and the associated performance measure are shared with course instructors, staff responsible for management/oversight of training at BUSPH, the professional associations and community stakeholders described above and the Alliance funding agency (HRSA).

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Objective 2

Objective #2 is to ensure trainee ability to identify and properly document violations on an inspection report and to write correction orders. The performance measures (outcome) are: (1) a 100% pass rate for all trainees who complete an inspection form and corrective order; and (2) 100% of course graduates report that training has had a positive impact on their ability to comprehensively and uniformly enforce the MA State Sanitary and Environmental Codes and provide examples to demonstrate how the program improved their individual capabilities. The data collected for performance measure #1 are derived from an inspection form and corrective order that trainees complete following an audit (i.e., real life inspection scenario). The documentation is then graded by course instructors, aggregated and tracked by BUSPH’s program evaluator, and a pass/fail rate is determined. Those who do not pass the first time are provided a second opportunity to complete the audit and associated assignment. Beginning in 2012, the data for performance measure #2 will be gathered through qualitative interviews with a sample of program completers from each unit between two and three years after successfully completing respective units. Evaluation results: To date, 35 trainees have completed the audit (and related inspection forms/correction orders) in the housing unit and 100% have successfully passed. Another 31 are expected to finish by the end of 2011. Even in the short time-frame since the food inspector program was piloted, 6 of 6 trainees successfully completed the final assessment (inspection report). Feedback: Findings related to objective #2 and the associated performance measures are shared with course instructors, staff responsible for management/oversight of training at the Boston University School of Public Health, the professional associations and community stakeholders described above, and the Alliance funding agency (HRSA).

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Objective 3:

Objective #3 is to ensure capacity to assess and improve the program’s reach and quality. The performance measure is the availability of data to determine a) whether the program is being implemented as intended and attracting and educating the target audience; b) how satisfied trainees are with classroom training, the inspection workshops, and instructors; and c) how the course can be improved. The data collected: Attracting and educating the target audience (i.e., new or experienced local public health staff who conduct/will conduct inspections) requires that the program is implemented as intended (i.e., two cycles of each unit per year in different areas of the state that engage 20 or more trainees, all of whom successfully complete training within two years of their respective start date). Therefore, data on the location of training; number of program units offered and trainees per unit cohort who start/complete training components; and descriptive data on participants (e.g., professional role, work setting, years in practice) are collected by the program’s management staff at BUSPH. The staff access descriptive data about trainees that are provided when trainees register for training. All of these data are provided to the program evaluator to use in assessing the need for and recommending strategies to improve the quality of the program. To assess trainee satisfaction with various aspects of training, trainees complete self-administered evaluation forms following the classroom training and field experience. Trainees assess the extent to which they agree with a number of statements about each component of training using Likert scales and yes/no responses. Trainees also provide suggestions for improvements in response to open-ended questions. Instructors disseminate and collect the evaluation forms, which are anonymous. The evaluator analyzes the data and recommends QI efforts as appropriate. Starting in 2012, the evaluator will conduct interviews with a sample of program completers from each unit between two and three years after completing their respective units to understand how the training program content can be improved to prepare trainees for the real world inspection situations they confront in the years after completing the program. Also beginning in 2012, the evaluator will conduct interviews and/or surveys to understand why some program participants do not complete the program within the two year time limit for program completion.

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Findings will be used to improve the program and enhance the ability of trainees to successfully complete their training. Evaluation results To date, two units have been developed: The Housing Certificate Program and the Food Certificate Program. Since 2009, the MA PHIT Housing Certificate Program has taken place in five different geographic areas of the state and has been successful in attracting the target audience. By December 2011, the program will have engaged five cohorts and a total of 172 trainees in classroom training (note: not all classroom trainees plan to participate in field training; some want awareness level training only). To date, 44 trainees have completed the field training components with another 42 expected to finish by December 2011. 35 have passed the audit house and received certificates; another 31 are expected to finish by the end of 2011. Trainees were very satisfied with the classroom training, and the need for QI has been minimal. Although overall ratings have been positive, trainee ratings and comments suggest that modifications in the field inspection component of the program are necessary. Trainees also indicated the overall training was valuable, and they would recommend it to a colleague. The Food Inspector Certificate Program was piloted in 2011. Twenty trainees enrolled in, and 19 successfully completed, the classroom component. To date, six have begun the field training, with an anticipated completion date in December 2011. Overall satisfaction with the program components was high, and trainees indicated that the training was valuable and that they would recommend it to a colleague. Although ratings were positive, instructors were encouraged to review participant feedback and incorporate suggestions for improving their teaching and the inspection portion of training. Because the first round of interviews with completers and non-completers will not occur until 2012, interview data are not yet available. Feedback: The capacity for assessing and improving the quality and reach of the program exists. The data are provided to instructors and administrative staff at BUSPH so that QI efforts can be undertaken. Based on the data collected to date, minimal QI efforts are necessary. However, instructors are in the process of reviewing the feedback and modifying the field inspection component as necessary.

What are the specific tasks taken that achieve each goal and objective of the practice?

As progress is made toward the program objectives and as we roll out additional program units (e.g., wastewater, tanning salons), we will advance toward our goal: To increase the capacity of the local public health workforce to comprehensively and uniformly enforce the MA State Sanitary and Environmental Codes. The strategy for achieving objective #1 (to increase trainee knowledge of the MA State Sanitary and Environmental Codes) involves classroom training specific to each program unit. To date, classroom trainings on housing and food inspections have been developed and a unit on wastewater is currently in development. The tasks involved in implementing the strategy include convening the planning group, comprised of staff from the federal and state public health and/or environmental health agencies and representatives of the professional local public health associations; developing classroom content and materials; developing unit-specific evaluation tools; piloting and evaluating the classroom training; and improving the classroom training as necessary. The strategy for objective #2 (to ensure trainee ability to identify and properly document violations and write correction orders) involves trainee accompaniment on inspections with a field trainer and a final audit in which trainees must identify and document code violations and create correction orders. The first implementation task involves the identification of inspectors who can serve as the initial field inspection trainers. After a successful iteration of each unit, program completers are eligible to attend a session to prepare them to be field trainers. From that point on, only program graduates who have had training on how to be a field trainer can serve in the role. The implementation steps are the same for each unit and have been utilized for the housing and food inspection field training to date. The strategy involved in objective #3 (to ensure capacity to assess and improve the program’s reach and quality) involves the creation, testing and refinement of data collection tools. The tasks include drafting of tools by the evaluator, use of tools during the pilot phase, analysis of findings by the evaluator, and sharing of findings and recommendations with the instructors who then implement changes accordingly.

What was the timeframe for carrying out these tasks?

The development of unit-specific classroom content takes between six and 12 months. During that time, the planning committee also identifies initial field trainers, and the evaluator develops the evaluation tools for the pilot phase. Students who successfully complete the pilot classroom training go on to the field inspection component of the program. Meanwhile, the evaluator analyzes the pilot data and reports the findings and recommendations to the instructors who make changes, as appropriate, for the next iteration of classroom training. Once the majority of trainees successfully complete the field training component of the program, the evaluator analyzes the evaluation findings, and the instructors improve the component as necessary. Among the program graduates, a few may elect to complete the train-the-trainers class to prepare them to become field trainers. Once a unit is piloted and improved, it is offered twice a year (spring/fall). Evaluation continues to ensure our ability to continuously improve each program unit and to understand the impact of the program on trainee knowledge and skills. For example, the housing inspection unit was piloted in 2009 and then offered twice in 2010 and so on. A new unit of training is implemented every year. Following the 2009 development of the housing unit, the food inspection unit was developed and piloted. Over the next five years, units will be developed (one per year) on regulatory program areas such as wastewater, swimming pools, recreational camps for children, tanning salons, and indoor ice rinks.

Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured.

There is sufficient stakeholder commitment not only to sustain the MA PHIT Program but to grow it. As described in the Implementation Strategy, each MA PHIT program requires six to nine months to develop and pilot test, with full implementation following within six to twelve months. Since 2009, two programs have been pilot tested and operationalized (Housing, Food) and one (Wastewater) is in development with pilot testing planned for 2012. An additional program is planned for each of the following years; suggested topics include Recreational Waters/Swimming Pools, Recreational Camps for Children, Indoor Ice Rinks, and Tanning Establishments. The enthusiastic involvement by state and local practitioners and the active role that the professional organizations (MEHA, MHOA, MAPHN) have taken, and will continue to take, will ensure sustainability. Senior leadership at the state public health and environmental departments has committed staff to act as subject matter experts, content developers, classroom instructors, and field trainers. In times of shrinking resources, they see this collaborative project as a way to fulfill their training missions for the many state regulations that delegate enforcement to the local boards of health. The leadership groups of the professional associations enthusiastically promote involvement within their membership (as planning group members, instructors, field trainers, and trainees) and have followed through with a commitment of time, and in some cases, dollars. That level of support is expected to continue, especially as evaluation results support the program’s effectiveness.

Describe plans to sustain the practice over time and leverage resources.

To sustain and grow the MA PHIT program over time, we will: • Leverage training grant resources to support the development of new programs in the series and to ensure quality improvement of elements of the existing programs • Continue to work with professional associations - dedicated to training and educating the public health workforce - to operationalize and manage the programs • Continue to evaluate all elements and actively engage the planning teams in quality improvement methods • Charge trainees a reasonable fee for expenses related to the training and offer certification contact hours and Certificates of Completion • Rely on donated space for classroom and field training As described above, we do not need the same level of financial investment for additional series topics as was required for the design and piloting of the Housing Certificate Program. MA PHIT partners will continue to provide in-kind effort for program and curriculum development, classroom and field instruction, and course material reproduction. Facilities for classroom sessions and inspectional activities will continue to be donated to the program. Modest trainee registration fees will cover registration and training facility expenses. We also believe MA PHIT’s track record of proven and future successes, coupled with its adaptability and replicability, will attract additional resources.

2012 Model Practice Application (Public)