Healthy Arizona Worksites Program: Developing Partnerships At The State Level

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As an entrepreneur and businesswoman for more than 20 years, Sherry Haskins has firsthand insight into the needs and challenges of employers. When she became Program Manager of the Healthy Arizona Worksites Program (HAWP) in 2015, Haskins embraced the program’s goal of “helping Arizona employers successfully implement evidence based worksite wellness initiatives to improve the health of their employees and businesses.”

With a focus on training, technical assistance (TA), and diverse partnerships, Haskins and her team have expanded HAWP and built a culture of workplace health in Arizona. HAWP now provides Arizona employers of all sizes with free training, TA, tools, and resources to design, implement, and evaluate worksite wellness programs. HAWP also helps bring Arizona businesses together for peer-to-peer activities so they can share experiences and learn from one another.

HAWP Background

HAWP began in 2012 and was originally modeled after the Centers for Disease Control and Prevention (CDC) Total Worker Health^® training, which integrates health protection efforts with interventions to improve worker health and well-being. In 2015, Maricopa County entered into a five-year Inter-Governmental Agreement (IGA) with the Arizona Department of Health Services (ADHS) to support HAWP staff and general program needs. Leaders of both agencies agreed that the Phoenix based Maricopa County Department of Public Health (MCDPH) should administer HAWP statewide, in part because the county is home to nearly 60 percent of the state’s population and the majority of its businesses.

Funding

Various funding streams help ensure HAWP’s sustainability. These include:

• ADHS’s five-year Inter-Governmental Agreement: This baseline funding comes from Arizona’s cigarette and tobacco excise taxes, a portion of which supports the dissemination of tobacco prevention and cessation information to Arizona businesses.
• ADHS’s Healthy Arizona Policy Initiative: Maricopa County receives funding through the initiative to promote policy, systems, and environmental changes to improve population health. HAWP uses these funds to promote worksite interventions.
• CDC State Public Health Actions Grant: Also known as DP13-1305, a portion of this funding allocated from ADHS enabled HAWP to distribute lactation accommodation toolkits to businesses throughout the state.
• Arizona Partnership for Immunization: HAWP uses this funding to disseminate vaccine information to participating employers statewide.

Key Staff

Haskins directs HAWP from the Office of Worksite Health Innovation, within MCDPH. HAWP staff members include one Worksite Policy Analyst, one Administrative Assistant, and one Marketing Coordinator, each of whom have other responsibilities in addition to HAWP. Haskins also contracts with a professional trainer to extend the program’s reach and enable the staff to focus on program administration. In addition, 11 of Arizona’s 15 county health departments have HAWP-trained staff to support employers locally.

HAWP Components

HAWP does not provide monetary incentives to participating employers. Its staff, contracted trainer, and diverse partners offer free support, tools, and recognition focused on the benefits of workplace wellness to employers and employees. HAWP provides the following:

• Trainings and technical assistance build employers’ capacity to start or enhance their workplace health programs.
• Access to the CDC Worksite Health ScoreCard, helping businesses to assess their own programs.
• Tools and resources to help employers build and implement worksite improvement plans.
• A recognition program promotes and honors healthy worksites.

Trainings And Technical Assistance
HAWP 101 and 202

HAWP 101 is the starting point for Arizona employers to participate in the workplace health program. The free 4½ hour in-person training prepares employers to design and implement evidence-based worksite health initiatives. HAWP’s contracted trainer delivers HAWP 101 seminars to individual employers and business groups throughout Arizona. Once they complete the training, participants have access to toolkits and HAWP’s Worksite Health Improvement Planning Tool.

HAWP 101 trainings have reached greater worksites and individuals in recent years (Figure 1) through expanded partner engagement and increased awareness from the program’s Healthy Arizona Worksite Award, which recognizes business wellness efforts. The number of trainings more than doubled from 2013 (nine trainings) to 2017 (23 trainings). In the same time span, the number of unique worksites grew from 69 to 279, and the number of individuals trained went from 97 to 396.

Haskins and the HAWP team help businesses not only to start workplace health

programs, but to maintain and enhance them. HAWP also offers a 202-level series of trainings and webinars to support employers with more mature worksite wellness programs. HAWP 202 includes titles such as “Mobilizing Peer Support for Wellness” and “Champion Skills for Wellness Cultures.”

County-Level Technical Assistance Partnerships

Staff implementing the Healthy Arizona Policy Initiative in Arizona’s outlying county public health departments help extend HAWP’s reach by providing workplace health locally. County health departments receive funding through the initiative to increase physical activity, improve access to care, or promote workplace wellness. Nine of Arizona’s 15 health departments use Healthy Arizona Policy Initiative funds to focus on workplace wellness. In this way, Haskins and her team can rely on HAWP-trained county staff to host events and provide local assistance to worksites as part of their Healthy Arizona Policy Initiative implementation.

Healthy Arizona Worksite Award Application Support

Each year HAWP offers multiple “Getting It Done” workshops to help employers become recognized Healthy Arizona Worksites. HAWP staff provide guidance, tools, and resources needed to navigate each step in the process, from CDC Worksite Health ScoreCard completion and worksite health improvement plan development to the award application.

CDC Worksite Health ScoreCard

HAWP offers a link to its online version of the CDC Worksite Health ScoreCard on its “Getting Started” webpage. The ScoreCard allows employers to assess the evidence-based health promotion interventions at their worksites. HAWP and county health department staff offer to help employers complete the ScoreCard and use results to develop workplace health improvement plans.

Haskins has seen a sharp increase in the number of employers that completed the Worksite Health ScoreCard since she came on board in 2015 (Figure 2). She credits co-promotion by partners and publicity from the HAWP award with helping to boost employer participation.

Online Tools And Resources

Aware that many employers may be too busy to attend in-person trainings and events, Haskins and her team have posted tools and resources on HAWP’s website. This program feature helps extend HAWP’s reach and enables employers across the state to access, start, and grow their workplace health initiatives.

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  The Getting Started webpageexternal icon is an easy place for employers to take their first steps. With links to training events, the CDC Healthy Worksite ScoreCard, and the worksite health improvement plan, the website answers, “What’s in it for me?” Employers can also sign up for email updates on resources, award application deadlines, and learning opportunities.

• The events calendarexternal icon provides frequent entry points for employers, from in-person trainings to topical webinars. HAWP partners with various organizations to develop and deliver relevant training events.
• The Worksite Health Improvement Planexternal icon enables employers to define goals, develop measureable objectives, select evidence-based interventions, identify communications activities, establish a timeline, and determine evaluation criteria.
• The Healthy Arizona Worksite Awardexternal icon criteria and application are available online for employers seeking recognition for their wellness programs.

These and other online resources automate parts of HAWP’s program, such as onboarding and ScoreCard completion. If employers need any assistance, such as building an improvement plan or applying for the award, Haskins and HAWP staff, county health departments, and key partners are ready to help.

Healthy Arizona Worksite Award

HAWP recognizes employers that use evidence-based strategies to support the health and well-being of their employees and their families. The award process also helps frame the entire program from HAWP 101 to recognition,(Figure 3) and helps motivate employers. Awards (copper, silver, gold, and platinum) recognize four increasingly rigorous levels of criteria. Employers at the gold level, for instance, must evaluate their initiatives. Employers at the newly created platinum level must demonstrate that their wellness efforts reach the community beyond their own worksites. In 2017, 148 employers earned HAWP recognition.

Haskins noted that partners play a key role in HAWP’s recognition program. For example, the Salvation Army Ray and Joan Kroc Center hosted the Fourth Annual award ceremony in May 2018. The Arizona Partnership for Immunization, whose information HAWP distributes to participating employees, provided food and beverages for the event.

“Our recognition program is a huge contributor to engagement,” Haskins said.

The Value Of Partnerships

Haskins recognizes multisector partnerships as a key to HAWP’s success. She networks strategically at every conference, training, and meeting she attends. She finds mutually beneficial ways to partner with just about any organization to support and expand HAWP’s impact.

For instance, numerous organizations promote and host HAWP 101 trainings, including Phoenix FitPHX, Dignity Health Medical Center, the Pima County Health Department, and the Arizona Multihousing Association. Haskins said partners hosted about 95 percent of all HAWP trainings in 2017. In some cases, HAWP also co-promotes its partners’ training opportunities, or incorporates HAWP trainings into partner events.

HAWP’s partnership with the Greater Phoenix Chamber of Commerce Foundation is an example of a win-win relationship. The Chamber Foundation focuses on workforce development and has its own workplace health promotion program called Wellness AtoZ, which complements HAWP. Employers can participate in both programs. The Chamber Foundation has helped introduce “employers of influence” to HAWP and welcomes HAWP’s participation in its quarterly wellness forum, enabling Haskins and the HAWP team to promote the program to more employers.

Challenges

Information Management

Since its inception, HAWP has relied on multiple systems to manage program information. Years of data about participating employers, partner engagement, trainings offered, technical assistance provided, ScoreCard results, and award levels were stored on several different platforms. Haskins and her team found it was becoming cumbersome to manage the information, track employer and partner engagement, and use data to create monitoring reports.

To resolve this issue, in 2018 Haskins partnered with the Western Region Public Health Training Center at the University of Arizona College of Public Health to brainstorm ideas on capturing the HAWP data more efficiently. The Office of Performance Improvement within MCDPH stepped in to provide support with an information technology specialist. Together they developed a centralized database system that now enables HAWP to easily store, track, and report on all aspects of its program.

Employer Engagement

Getting employers to invest in workplace health can be challenging. As Jennifer Mellor of the Greater Phoenix Chamber of Commerce Foundation said: “Big employers feel like they already have programs. Small employers feel like they can’t do it.” To encourage employers to take the first step, HAWP promotes the business case for worksite wellness and leverages influential partners to build a statewide culture of health.

For example, Haskins engaged several of Arizona’s state employee benefit trusts—organizations that pool and manage employee benefit and health promotion programs. She knew that each benefit trust could reach multiple government agencies and affect thousands of employees. At one meeting, Haskins presented data to the Arizona Metropolitan Trust Board of Directors, showing that healthier employees cost less. She explained how evidence-based worksite wellness programs could ultimately save health care costs and stretch employee dollars for benefit coverage. The board agreed and HAWP began helping the trust’s contracted wellness vendor improve programs for state employees. This key partner now hosts trainings, promotes HAWP to its members, and helps attract more participating employers.

Looking Ahead

Reaching Rural Worksites

Haskins wants to make it easier for rural employers and businesses to participate in HAWP. She worked with the Western Region Public Health Training Center as well as the MCDPH Workforce Development Officer to identify the components needed to develop and host a virtual worksite wellness training. The virtual training is now being developed by a contractor, however, the online version won’t replace the in-person training. “There is value in the relationships and partnerships that come from the in-person trainings,” Haskins said. But the online training will give easy, on-demand access to rural employers across Arizona.

HAWP School Employee Wellness

Schools in Arizona have expressed a need for workplace health training tailored to a nontraditional worksite. In response, Haskins and the HAWP team customized a version of HAWP 101 for the school setting. HAWP will pilot its School Employee Wellness training with the Mesa Public School district to incorporate feedback before offering it statewide when funding becomes available.

Advice For Other State Health Departments

Haskins provides the following recommendations for other state-level workplace health programs.

• Provide training and technical assistance. Use a dedicated trainer to schedule and deliver workplace health trainings to employers. Coordinate with partners (for instance, chambers of commerce, business groups, and major health systems) to host and co-promote training opportunities.
• Collaborate with local public health agencies. Train staff at county or city health departments to promote the state’s worksite health program by assisting employers with scorecards and providing TA to local businesses as needed.
• Develop strong and diverse partnerships. Embrace the common goal to improve health in the workplace and community, identify mutually beneficial roles to play, and support each other in that effort. Seek partners from other sectors.
• Recognize achievement. To reward employer participation in workplace health programs, create a tiered, criteria-based award program, help employers apply, and recognize the winners with an event and public communications.
• Make the program convenient. Offer materials, toolkits, and resources online in an easy-to-follow, graduated process. Tying the process to worksite recognition awards helps organize the steps employers should be taking.
• Engage and promote employers of influence. Identify and recruit major, respected employers at every size to participate in the state’s workplace health program. Publicize their participation to help attract more businesses.

Recommendations For Action

This case study illustrates how just one state is advancing workplace health. The following recommendations and resource links can support efforts to build or enhance statewide workplace health programs.

• Cultivate diverse, multisector partners who can help promote the state program, host trainings, convene employers, or sponsor recognition events.
• Search CDC’s list of workplace health organizations to identify potential partners. The list includes national nonprofit associations, state and national wellness coalitions and councils, state and federal agencies, and other groups supporting workplace health with resources, networking, training, technical assistance, or recognition.
• Encourage employers to use the CDC Worksite Health ScoreCard, a free online tool to assess their worksite health programming and readiness.
• Design and develop a comprehensive information management system to track and report on data on participating employers, trainings, Worksite Health ScoreCard results, partners, and healthy worksite award levels.