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Slide Set J: Workforce Development and Training

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 Workforce Development & Training

Jeanne Marrazzo
Mark Thrun

Steering Committee Co-Chairs: 
National Network of 
STD/HIV Prevention Training Centers 

August 2007
Slide 1

Workforce Development & Training
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 Today’s Discussion
Working concept of “training” & why it’s fundamental to integration
Background on National Network of STD/HIV Prevention Training Centers (NNPTC)
Success in integrated efforts to train: inter-disciplinary content; novel delivery methods (web-based); Ask-Screen-Intervene Curriculum
Specific challenges to workforce development in the integration realm
- Training on content, & training on how to integrate
Culture of training needs to accommodate a shift from “disease” to “client”
Slide 2

Today's Discussion
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 Workforce Development and Training: Translating Research into Practice & Policy
“Assuring a Competent Workforce”

Research / Science > Translation and Dissemination < Practice

Builds capacity to deliver services at the client level!
Slide 3

Workforce Development and Training: Translating Research into Practice & Policy
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An Example of Workforce Development Integration: The National Network of STD/HIV Prevention Training Centers 
18 regional centers in network: 1 in Washington, 1 in California, 2 in Texas, 1 in Alabama, 1 in Florida, 1 in Maryland, 2 in Colorado, 3 in New York, 1 in Missouri, 1 in Ohio, 1 in Massachusetts

www.stdhivpreventiontraining.org 
Slide 4

An Example of Workforce Development Integration: The National Network of STD/HIV Prevention Training Centers
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 NNPTC: 3 Parts

Part 1: Clinical training on STD/HIV prevention, diagnosis, and treatment
Additional focus on viral hepatitis
Active collaboration with local TB training efforts

Part 2: Behavioral training on STD/HIV prevention interventions (DEBI) and necessary foundational skills

Part 3: Clinical and behavioral training related to partner counseling and referral services

www.stdhivpreventiontraining.org
Slide 5

NNPTC: 3 Parts
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The NNPTC Mission: The Text

Dedicated to increasing the knowledge and skills of health professionals in the areas of sexual and reproductive health
Provides health professionals with a spectrum of state-of-the-art educational opportunities, including experiential learning with an emphasis on prevention. 
Slide 6

The NNPTC Mission: The Text
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 The NNPTC Mission: The Reality

Making & maintaining links between research, policy, and practice require an active training partner to help translate advances in these areas to effect change in practice
Slide 7

The NNPTC Mission: The Reality
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 NNPTC Integrative Capacity Enhanced by  Broad Expertise & Communication

Within NNPTC: 
Combine clinical and educational expertise
Parts cross-pollinate for curriculum development
Ex: Development & teaching of viral hepatitis & HIV prevention curricula 

Screenshot: Hepatitis Web Study
www.hepwebstudy.org
www.hivwebstudy.org
Slide 8

NNPTC Integrative Capacity Enhanced by Broad Expertise & Communication
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NNPTC Contributions Are Enhanced by Strategic External Collaborations

The “4TC” group: with AIDS Education Training Centers; Reproductive Health Training Centers; Addiction Technology Transfer Center
State and Local Health Departments; Community Based Organizations; Professional Medical Organizations 
Joint meetings and strategic planning 
- Quadrant and center-wide advisory committees
Development of uniform assessment instruments for joint training events 
Slide 9

NNPTC Contributions Are Enhanced by Strategic External Collaborations
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NNPTC Contributions Are Enhanced by HIV-STD Expertise

Training on 
- Advancing HIV testing in medical care settings
- Rapid HIV testing, opt-out testing, and effective linkage to care and prevention program for persons newly diagnosed with HIV infection
- Partner management in HIV+
- STD-HIV interactions and role of primary HIV infection/STD coinfection as major player in HIV incidence
Development and diffusion of the national Ask, Screen, Intervene (ASI) training course, an integrated STD/HIV prevention curriculum to enhance prevention in HIV cares settings 
Slide 10

NNPTC Contributions Are Enhanced by HIV-STD Expertise
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Incorporating HIV Prevention into the Medical Care of Persons Living with HIV

Ask/Screen/Intervene

Developed by:
The National Network of STD/HIV Prevention Training Centers, in conjunction with the AIDS Education Training Centers 
Slide 11

Incorporating HIV Prevention into the Medical Care of Persons Living with HIV
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CDC  Recommendations

Developed by CDC, HRSA, NIH, HIVMA, with evidence-based approach
Intended for those providing medical care to HIV-positive persons

Screenshot: MMWR Incorporating HIV Prevention into the Medical Care of Persons Living with HIV 
Slide 12

CDC Recommendations
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 ASI Curriculum Content

Module 1: Risk Screening: for Behavioral Risks and STDs
Module 2: Universal Prevention Messages & Addressing Misconceptions
Module 3: Tailored Behavioral Interventions
Module 4: Partner Counseling & Referral Services
Slide 13

ASI Curriculum Content
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Ask, Screen, Intervene

Between May 2005 and March 2006:

52 regional training of other trainers
Over 110 direct trainings
Over 3,700 providers trained 
Slide 14

Ask, Screen, Intervene
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Ask, Screen, Intervene: Collaboration among trainers
Collaborative effort within NNPTC:
All 3 parts represented: Clinical, Behavioral, PCRS
Included experts in science and experts in training

Collaborative effort with AETC:
AETC actively involved in development
Assisted directly with recruitment of faculty and course delivery

Collaborative effort with CDC:
Active consultation with developers of guidance
Direct involvement of training branch staff 
Slide 15

Ask, Screen, Intervene: Collaboration among trainers
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 Ask, Screen, Intervene: Collaboration with medical professionals

Collaborative effort with HIVMA:
“Prevention in Care” packets: all members
IDSA Symposia – 2005, 2006, 2007

Collaborative effort with AAHIVM:
Regional trainings
Evaluation initiative

Collaboration locally with managed care organizations and private providers
Slide 16

Ask, Screen, Intervene: Collaboration with medical professionals
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ASI: Self-evaluation of Clinician Trainees
Chart showing 84.7% of Clinician Trainees found the information conveyed in Ask, Screen, Intervene training useful to their practice as somewhat high to very high. Simultaneous self-rating of skills demonstrated substantial improvements in knowledge and intention measuring items (for all items, p < 0.001). 
Slide 17

ASI: Self-evaluation of Clinician Trainees
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 Integration that Worked! ASI bridged: 
STD and HIV
CDC and HRSA via NNPTC and AETC’s
Prevention and care
Clinical & behavioral interventions
Clinician & PCRS
CDC funded training program and private medical societies 
- AAHIVM sponsorship of regional trainings
- HIVMA/IDSA ongoing sponsorship of national trainings
- HIVMA sponsorship of mailing of prevention in care package to private clinicians
Slide 18

Integration that Worked! ASI bridged:
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Workforce Development and Training: Translating Research into Practice & Policy
“Assuring a Competent Workforce”

Research / Science > Translation and Dissemination < Practice

Builds capacity to deliver services at the client level! 
Slide 19

Workforce Development and Training: Translating Research into Practice & Policy
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 Two Realms of Workforce Development and Training
Integrated training – 
Including aspects of HIV, TB, STD, Hepatitis in currently developed curricula and new courses yet to be developed

Training on integration – 
Building of integrated programs; Sharing of model practices; Technical assistance for program integration
Slide 20

Two Realms of Workforce Development and Training
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 Big picture training issues

Different diseases, sites of practice, practitioners, and models of care 

Gap between science of HIV/TB/STD/Hepatitis and practice (efficacy to effectiveness)
Efficacious interventions may not always be effective in the real world if not translated with fidelity

Some funding streams separate training & technical assistance

Needs for basic program support training (program specific training alone may not be sufficient) 
E.g. client-centered counseling, group facilitation, community assessment, and program evaluation
Slide 21

Big picture training issues
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 Outside input needed to support workforce development

Need input from broad representation:
- Researchers, training entities, and service providers (bridging efficacious with effective):
- Clinical and behavioral scientists
- HIV, STD, TB, hepatitis care providers
- HIV/STD, TB, hepatitis, substance use, pregnancy prevention programs
- Organizations representing PH, medical providers, etc (e.g. NCSD, NASTAD, HIVMA) 
- Correctional facilities
- Immunization programs
Slide 22

Outside input needed to support workforce development
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 Current training partners will need to further collaborate

Establish stronger cross-fertilization within funded training partners regarding:
- STD/TB/Hep screening considerations in HIV prevention training and various combinations including joint training   
- Behavioral interventions (esp. prevention counseling and group level interventions) in STD or other clinical settings
- Expand beyond traditional target audiences
(Continued) focus on primary prevention: 'We can't treat our way out of this epidemic' 
Encourage enhanced training collaborations with private and other sectors (e.g. corrections, managed care organizations, emergency departments, FQHC’s, etc)
Slide 23

Current training partners will need to further collaborate
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Training needed on integration itself

Service providers and administrators will need 
- Technical assistance
- Workforce sharing ideas
- Help disseminating best practices or model examples
- Basic understanding of other diseases they may need to educate or screen on
Work force development requires increasing knowledge, but also shifting attitudes regarding prevention and care, clinical and behavioral “areas” 
Slide 24

Training needed on integration itself
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Culture of training may need to shift
Where possible, integrate training and technical assistance activities.
Increase formal communication among CDC programs and external training partners that conduct trainings:  
- Recognize that there are numerous entities that conduct training activities
- Ensure consistent message delivery, reduce duplication of services, and streamline national coordination efforts
- Consider advisory board involving key partners
Pilot programs to highlight needed key collaborations 
Slide 25

Culture of training may need to shift
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Structure of training may need to shift
Develop a different structural approach in collaborating with organizations providing clinical and/or prevention services to enhance likelihood that training and capacity building efforts will result in measurable changes 
- Move from traditional focus on curricula-based training courses to addition of technical assistance services to increase program capacity building for integration
- Continue to shift training to point of care
- Take advantage of new technologies – web, etc 
Slide 26

Structure of training may need to shift
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 The great aim of education is not knowledge, but action. -Herbert Spencer
Slide 27

The great aim of education is not knowledge, but action. -Herbert Spencer
PDF File or PPT File

 
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