6

Breakout Session: Moving Toward a Population Health Workforce Exercise¹

INSTRUCTIONS

Workshop participants were invited to participate in an interactive exercise related to the population health workforce. The activity involved considering workforce development in the context of larger strategies related to social determinants of health. Marthe Gold from The New York Academy of Medicine facilitated the exercise; the in-person participants were assigned a topic of school absenteeism, food security, or affordable housing and divided into groups of five to six people. A brief case study was provided for each topic. Each group was instructed to identify a facilitator to manage the conversation and a scribe to write down key points of discussion. Next, the activity required that each group identify an “honest broker” who would be likely to convene a group in the community on the selected topic. One group member would play the role of the convener, and other group members were asked to take on the roles of other community stakeholders who would be interested in addressing the issue.

Gold asked participants to consider the strategies and tactics related to training and workforce development that could be used to address the issue provided and to identify potential stakeholders and payers. Participants were specifically directed to consider potential funding sources for

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¹ This section describes the discussions that occurred during the breakout session. Statements, recommendations, and opinions expressed are those of individual participants and should not be construed as reflecting any group consensus.

the recommended strategies and tactics, including whether new funds would be needed or if a cross-sector partner would provide funding. Each group was asked to complete a worksheet identifying the issue, convener, partners, potential strategies, and tactics. Appendix D presents the instructions for the small group exercise, the three scenarios, and the worksheet.

Gold shared a conceptual model describing pathways to health equity (see Figure 6-1) that was published in a prior National Academies report (NASEM, 2017). She noted that a goal of the exercise was to consider how to use workforce strategies to promote equity within communities, as described in the model. Gold also referenced Figure 1-1, demonstrating that training runs along a continuum from formal and structured to informal and unstructured. That figure provides examples of types of training at multiple points along the continuum.

DISCUSSION

After 40 minutes of small group discussion, the workshop participants reconvened to share key takeaways from each group’s conversation. A representative from one of two groups focused on school absenteeism spoke first. As was explained, the scenario involved a school with a high rate of chronic absenteeism. The group identified the school to be the reluctant convener, but not the funder, as schools already have a

lot of responsibilities. Additional partners identified include employers, banks, legislators, school resource officers, student attendance support staff, public housing providers, school athletics, and local government. The group focused on upstream factors and recommended a multigenerational approach involving parents and caregivers as well as students, noting that if caregivers feel supported, they are more likely to be able to support the children. Specific strategies identified based on the experience of group members included having a community bank invest in a pilot in one school and work to get other businesses involved, having the school convene the partners previously identified to discuss the problem and identify solutions, and holding focus groups to learn from the community regarding levers that could address the underlying causes of absenteeism. An additional strategy was to have the county executive declare school absenteeism a priority. In response to a question from Gold regarding how the group specifically addressed training needs, it was noted that there was discussion about training for school staff on absenteeism, and they determined that training for existing staff would likely be more effective than hiring new staff.

A second group addressing school absenteeism was led by Lisa Kaplowitz, a physician in a job transition who was returning to local public health. Kaplowitz explained that her group spent time discussing the reasons for absenteeism, including violence, homelessness, and health issues, and how each of these reasons could bring additional partners to the table, including law enforcement, homeless shelters, school nurses, health care providers, and parents. The group pointed to the need to improve communication among the diverse group of partners and suggested that community health workers (CHWs) could play a role in educating diverse stakeholders about the issues, potential solutions, and partners who would be most trusted in delivering them. It was also suggested that absenteeism could present a workforce issue for major employers in the area if it was keeping parents at home. Additional support and funding could come from the major employers and the hospital, which could use community benefit funds to address the problem.

The representative from the group focused on affordable housing explained that their scenario involved a community with high rates of displacement and residents who are rent burdened, creating a need to address affordable housing. Partners identified included the local government housing authority, health care institutions, philanthropy, state-based organizations, community-oriented organizations, advocacy groups, faith-based community representatives, and academic experts. The group selected a local philanthropic group to serve as the neutral convener, as this group could likely address the interests of the people at risk. One workforce-specific strategy that the group discussed was training for

housing authority and hospital staff on how to bring a social determinants lens to their work. It was also noted that the high cost of housing could be a workforce issue for the health care system because there is often poor job satisfaction and high turnover when health care employees cannot afford to live near their workplace. Another strategy was to fund an epidemiologist to provide information to the housing authority on the connection between social determinants of health and health outcomes.

Michael Rhein from the Institute for Public Health Innovation (IPHI) reported for the group focused on food insecurity, explaining that his group’s scenario involved a town experiencing food insecurity issues that was interested in developing a comprehensive plan to address the issue. He likened this scenario to IPHI’s work involving a public health entity as the convener of a nonincorporated multi-sectoral coalition, which the group termed the Food Equity Council. One strategy the group suggested was to work with school administrators to adopt the community eligibility provisions of Title I. The group recommended providing advocacy training for parents, teachers, and community members along with issue training for the public health community, school community groups, and school administrators on the importance of addressing food insecurity and potential actions. Following the adoption of any policy change, the group recommended additional training on policy implementation and a communications campaign for educators and school staff. An additional strategy was to lead a campaign to bring a full-service grocery store back to the neighborhood; the scenario noted that one had recently closed. Workforces involved with this strategy could include traditional governmental public health planners, the economic development sector, and community members. Tactics involved advocacy training and workforce development training for CHWs, who could lead the advocacy campaign for the store in collaboration with other community residents. There was also a suggestion that the public health sector receive training on economic development and potential financing mechanisms for the new store and that the economic development sector receive training on the role of food access in ensuring healthy and prosperous communities.

In closing, Gold acknowledged that while it may have been difficult for workshop participants to identify numerous workforce or training strategies in the limited time for the exercise, the activity helped them consider the information presented at the workshop.