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

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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”

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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!

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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).

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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

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Integration that Worked! ASI bridged:
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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

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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

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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

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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)

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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”

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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

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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

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Structure of training may need to shift
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The great aim of education is not knowledge, but action. -Herbert Spencer
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Page last reviewed: March 5, 2014

Content source: National Center for HIV, Viral Hepatitis, STD, and TB Prevention