Successes & Challenges Amy B. Sloane, BA,1 ...

2 downloads 0 Views 397KB Size Report
the North Carolina Division of Public Health and the North ... North Carolina Institute for Public Health, Gillings School of Global Public Health. University of North ...
Initial training on a statewide electronic surveillance system for childhood blood lead: Successes, challenges, and lessons learned 1

1

2

2

Amy B. Sloane, BA, Adrienne Joines-Michalek, MPH, CHES, William David Brown, MPA, REHS, Talytha Moore, BS, 2 3 1 1 Tena Ward, BA, Allison M. Connolly, MA, MPH, Rachel A. Wilfert, MD, MPH, CPH, Jennifer A. Horney, PhD, MA, MPH, CPH 1

2

3

UNC Center for Public Health Preparedness; North Carolina Department of Environment and Natural Resources; North Carolina Division of Public Health

Background The North Carolina Electronic Disease Surveillance System (NC EDSS) is a centralized Web-based system intended to improve the timeliness, reliability, and accuracy of communicable disease reporting in North Carolina. The North Carolina Division of Public Health (NC DPH) contracted with the UNC Center for Public Health Preparedness (UNC CPHP) to develop and deliver training on NC EDSS to local health department (LHD) staff. By late 2008, all 85 LHDs transitioned from an existing paper-based system to NC EDSS for reporting general communicable diseases, sexually-transmitted diseases, and tuberculosis. NC DPH assisted the North Carolina Department of Environment and Natural Resources (NC DENR) in developing the North Carolina LEAD Surveillance System (NC LEAD) for the Childhood Lead Poisoning Prevention Program. NC LEAD uses the same software as NC EDSS to consolidate all blood lead test results for children, property investigations, remediation activities, and monitoring into a single independent database. In 2010, NC DPH and NC DENR contracted with UNC CPHP to develop and deliver training on NC LEAD to clinical and environmental health LHD staff. Priority was given to LHDs with 3 or more blood lead poisoning cases in 2006-2008. Other LHDs were invited to attend as space was available.

Curriculum Development A curriculum development team with subject matter experts from NC DENR, NC DPH and UNC CPHP met 1-3 times per week from February to April 2010 to discuss how to represent clinical and environmental health LHD staff work processes in NC LEAD. The team designed 2-day classroom and 90-minute synchronous Web training curricula.

Results

Classroom Training

Successes & Challenges

From May to August 2010, 12 regional 2-day trainings were conducted in computer labs (mostly at community colleges). The first 5 trainings occurred in a 1-month “pilot” period while curriculum and evaluation instruments were revised.

167 persons from 68 LHDs attended an NC LEAD classroom training. 76 persons from 40 LHDs attended an NC LEAD Web training.

Trainings were delivered by a UNC CPHP instructor with assistance from 2-3 subject matter experts from NC DENR or UNC CPHP.

98% of trainees (n=95)* completed Day 1 evaluations; 96% (n=45)* completed Day 2 evaluations.

Clinical staff attended Day 1 of classroom training; environmental health staff attended both Day 1 and Day 2. Day 1 focused on the basic features of NC LEAD from a clinical perspective. Day 2 focused on applying the basic features of NC LEAD to environmental health investigations. Below: sample slide from Web training

Above: workbook activity from classroom training

Web Training In July 2010, 4 synchronous 90-minute Web trainings were conducted using GoToWebinar®. Trainings were delivered by a UNC CPHP instructor; a subject matter expert from NC DENR reviewed available resources and answered questions. All LHD staff who completed a classroom training were invited to attend a Web training. The first half of the training reviewed key features for all users, while the second half was specific to environmental health.

Evaluation *Evaluation results exclude data from the “pilot” trainings. No evaluation data was collected for Web training.

Nearly 15% of clinical staff had previously attended an NC EDSS training for communicable diseases or sexually transmitted diseases. On both days of training, trainees consistently rated the following parts of the training as the most useful: 1. hands-on/practice time on computer, 2. “knowledgeable” and “patient” instructors, and 3. training exercises and tools. At the end of Day 1, trainees rated their competency on all learning objectives as 3.4 (out of 4.0) or higher. At the end of Day 2, 60% of environmental health trainees felt either “competent” or “very competent” about using NC LEAD in their jobs, and 33% felt “somewhat competent.”

Instructors Delivery Methods/ Technologies Training Exercises/ Content Training Time/Length

Logistics/Administration

Day 2

Significant resources (see below) are required to successfully develop, deliver, and evaluate a statewide training to 2 distinct groups of LHD staff over a short time period.

While it is too early to provide statistics on NC LEAD use by LHDs or individual staff, anecdotal evidence shows that the NC LEAD Help Desk is being used as a resource, and that clinical staff are using the system more regularly than environmental health staff.

Trainees would benefit from separate trainings based on computer skills, work roles, and LHD experience.

A short time period was available for curriculum development, which took more time than anticipated due to NC LEAD complexity, child blood lead reporting requirements, and non-training NC LEAD demands on NC DENR subject matter experts. NC DENR continued to learn about NC LEAD software and decide on policies and procedures during curriculum development. The combination of clinical and environmental health staff on Day 1 of classroom training resulted in the environmental health staff having to learn about basic NC LEAD features through clinical examples. Knowledge among NC DENR subject matter experts providing assistance during trainings was inconsistent.

Hands-on computer scenario-based training exercises relevant to trainee work roles foster software learning. Supplemental tools in both paper and Web formats assist trainees with varying learning preferences. Attendance of NC DENR subject matter experts assisted LHD staff in understanding the practical benefits and implications of NC LEAD for their jobs. Curriculum Development , Training, and Evaluation Resources • Funding (NC DENR, NC DPH) • Subject matter experts (NC DENR, NC DPH, UNC CPHP) • Time (NC DENR, NC DPH, UNC CPHP, LHD staff) • Travel (NC DENR, NC DPH, UNC CPHP, LHD staff) • Clear communication among agencies (NC DENR, NC DPH, UNC CPHP, LHDs) • Development of training agenda, learning objectives, scenario-based exercises, supplemental tools, software examples, instructor presentations, and evaluation (NC DENR, NC DPH, UNC CPHP)

• Software knowledge acquisition (NC DENR, NC DPH, UNC CPHP, LHDs) • Identification of priority LHDs and staff, availability for training, and support from upper management (NC DENR) • Coordination of training schedule (NC DENR) • Reservation of computer labs/ facilities (NC DPH) • Registration and lunch logistics (UNC CPHP) • Printing and assembly of training materials (UNC CPHP) • Evaluation analysis and reporting (UNC CPHP)

UNC CPHP is dedicated to improving the capacity of public health agencies and their staff through research, educational programs, and technical assistance. We respond to partneridentified needs and utilize our expertise to improve public health programs and systems. This project was conducted in cooperation with the North Carolina Division of Public Health and the North Carolina Department of Environment and Natural Resources.

Planned Action/ Transfer Expectations

Day 1

Over 4 months, subject matter experts from 2 state agencies and 1 academic institution collaborated to produce classroom and Web training curricula for 2 groups of trainees with very different work roles.

Most LHDs did not begin using NC LEAD until 2-3 months after the classroom training, so trainees could not immediately implement their new skills. This delay likely contributed to a loss of knowledge and competency. The Web training curriculum was designed to fill this gap.

Average ratings of training aspects reported by trainees on both days of classroom training

Lessons Learned

1

1.5

2

2.5

3

3.5

4

strongly disagree - - - > strongly agree

UNIVERSITY OF NORTH CAROLINA CENTER FOR PUBLIC HEALTH PREPAREDNESS North Carolina Institute for Public Health, Gillings School of Global Public Health University of North Carolina at Chapel Hill Campus Box 8165 Chapel Hill, NC 27599-8165 cphp.sph.unc.edu [email protected] 919-843-5561 fax 919-843-5563