Capacity Building in Environmental Health: Cutting Edge Training Materials Development

Johanna M. Hinman, MPH, CHESHoward Frumkin, MD, DrPH

Rollins School of Public Health of Emory University

APHA, November 2004Environment Section

Academic – Practice Partnership:

Southern Center of Excellence in Environmental Health

Practice (SCEEHP)• Cooperative agreement from CDC through ASPH • Building capacity program partners

– Academic institutions & health departments

• Common framework for developing training– 10 Essential Environmental Health (EH) Services– Core Competencies for Environmental Health

This project is supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of Schools of Public Health (ASPH). Grant Number U36/CCU300430-22.

SCEEHP Program Participants

• Trainees, by geography– Georgia – 7 districts– South Carolina – 3 districts– Tennessee – 2 districts

• Trainees, by job– District health directors– Environmental health

directors and managers– Nursing director– Community liaison– On-site wastewater

supervisor– Public health representative

• Faculty/staff– Center director/PI

• EOH department chair

– Project manager– RSPH faculty

• Instructional specialist• Health educators

– Outside experts• Social marketing• Pollution prevention• Mediation/conflict

resolution• Risk communication

SCEEHP Project Activities

• 10 training modules– On-campus and distance learning– Based on Core Competencies and Ten

Essential Environmental Health Services

• Building networks

• Evaluation

• Materials revision & dissemination

Using Essential Services & Core

Competencies to PlanAdvantages• Provides widely

accepted standards• Guides curriculum

development to support basic roles

• Encompasses broad range of skills and understanding

Challenges• Not as simple as it

sounds• Not a 1-to-1 “map”

for training• Must be careful not

to read too narrowly

Ten Essential EH Services

• Monitoring health status• Diagnosing &

investigating• Enforcing laws &

regulations• Linking people to

needed EH services• Assuring a competent

EH workforce

• Evaluating• Developing policies &

plans• Mobilizing community

partnerships• Informing, educating,

& empowering• Conducting research

Core Competencies for Effective Practice of EH

Assessment a. Researchb. Data Analysis and

Interpretationc. Evaluation

Communication a. Education b. Communication c. Conflict Resolution d. Marketing

Management a. Problem Solvingb. Economic and Political Issuesc. Organizational Knowledge and

Behaviord. Project Managemente. Computer/Information

Technology (IT)f. Reporting, Documentation,

and Record-Keepingg. Collaboration

Designing Appropriate Training

• Essential services and competencies are a framework – not a to-do list

• Remember principles of Adult Learning• Use additional educational frameworks

– Theory base– What’s already been evaluated?

Ask trainees what they need…

…Listen to the answers!

Be prepared to be flexible

Example 1• Essential Service:

– Informing, educating, and empowering people about environmental health issues

• Relevant Core Competencies: – Assessment– Management – problem solving; economic and political

issues; organizational knowledge and behavior; collaboration

– Communication – education; communication; conflict resolution

• How to train people for this???

One Essential Service =

Many Training Modules• Community Needs Assessment

– Know the community’s situation

• Environmental Justice– Understand the community’s perspective

• Environmental Health Law– Explain the practitioner’s responsibilities and roles

• Environmental Health and the Media; Risk Communication– Communicate effectively

• Mediation and Conflict Resolution – Manage and resolve conflict, build trust

SCEEHP Training Modules

1. Collecting and understanding critical environmental health data: epidemiology and environmental exposure information

2. Measuring prevention effectiveness and cost-effectiveness:

Part 1: Community Needs Assessment

Part 2: Program Evaluation

3. Environmental Health and the Media

4. Risk Communication

5. Environmental Health Law

SCEEHP Training Modules (2)

6. Environmental Justice and Litigation

7. GIS

8. Mediation and Conflict Resolution

9. New approaches to the basics and emerging issues in environmental health1. Social marketing

2. Urban planning and sprawl

3. Pollution prevention

Wrap-up of all sessions

Lessons Learned• Competition for time and attention of trainees• “Eclipse phenomenon” – bioterrorism

overshadows other responsibilities– Course proposed pre-Sept 11– Now different priorities on the job

• Tension between “old” and “new” EH– Traditional sanitarian functions– Complexities of development, preparedness, etc

• Pressing need for program evaluation skills• Need for networking among EH professionals

Lessons Learned (2)• Practitioners’ priorities differed from academics’• Unfamiliar software = real challenge, delay• Trainees prefer learning in person to online• Academic institutions provide access to

different resources – Network of specialists– Facilities (and expert designers) for training

• Challenges of nurturing networks without sustained funding

• Practitioners know the real world best!

New Teaching MaterialThe Pitch:• Culled from 10 training modules and follow-up

evaluation interviews• Assessed greatest need and greatest interest• Weighed what worked well in the classroom

(How to capture for broader dissemination?)

The Product:• Video: Environmental Health in the Context of

Litigation

Why Litigation?• Likely to affect most EH professionals at

some point• Scary but not well understood• Few/no existing educational resources on

how to work in this situation• Training session cited by participants as

eye-opening and new information• Opportunity to fill a gap with valuable

educational material

Outline & Teaching Points

• Introduction• Litigation between private parties

– Focus on doing your job well– Don’t take sides; don’t speculate

• Legal action against health departments– Immunity doctrine– Standardized procedures, good documentation can

protect you– Don’t let fear of litigation paralyze good work

• Legal action BY health departments– Public health officials can use legal action to

accomplish public health objectives

The Cast• Faculty host

– Department chair, environmental & occupational health, star of screen & classroom

• Attorneys– Specialist in environmental litigation– Activist and specialist in environmental justice– County attorney

• Health department environmental health professionals– Local district-level– Senior staff and front-line inspector

The Script• Began with the best clips from training session

– Recorded panel of attorneys– Included prepared statements and Q&A with

training participants

• Informal interviews with attorneys, health department staff, CDC Public Health Law program staff– Key teaching points– Key misconceptions among health departments

• Revision, revision, revision

Coming soon, to a screen near you…

Swimming With Sharks

Environmental Health in the Context of Litigation

Filmed on location in Atlanta, GA

Contact:

Johanna M. Hinman, MPH, CHES

Jhinman@sph.emory.edu

Howard Frumkin, MD, DrPH

Medhf@sph.emory.edu