Environmental Health Employee Training Program

State: CO Type: Model Practice Year: 2013

Tri-County Health Department (TCHD) is a local health department that serves Adams, Arapahoe and Douglas Counties in Colorado, whose combined population totals more than 1.3 million. In 2011, 26TCHD Environmental Health (EH) Field Staff from four field offices conducted 14,337 inspections in the core EH programs which includes retail food, childcare, body art, pools, and onsite wastewater treatment systems, investigated 1,418 complaints involving a variety of environmental health related issues, and investigated 146 disease related complaints and outbreaks. TCHD’S Environmental Health field staff is the target population of the training program. Field staff are generalists, requiring them to be competent in all of the core programs and general knowledge of other EH programs such as vector surveillance, solid and hazardous waste, water quality, industrial hygiene and land use, including a working knowledge of the associated state statutes, regulations, departmental policies and procedures in the application of public health enforcement actions, as well as education for facility owners, managers, employees, and members of the general public. Because of the need to develop a competent workforce in the application of these varied public health activities with the intent to help prevent communicable disease and minimize environmental impacts, a rigorous one-year training program was developed by TCHD over 25 years ago. This was done to ensure that new staff was versed in the knowledge required to complete their job functions effectively and efficiently, while providing an exceptional service to the community. TCHD’s training program differs from others offered through past NACCHO award submissions and that of other local area health department’s training programs through its use of a one-year long training program, and on the job approach, offering multiple contexts and environments for the employee to experience and shadow, enabling the ability of the development of competency in the field, regardless of background experience. The training program consists of orientations with program leads and senior staff (Environmental Health Specialist (EHS) III and supervisors), who thoroughly review the regulations, principles of the EH program policies and procedures, and state statutes with the new employee. A training manual was developed over the years for the guidance of new staff through the training period in each of the EH programs that TCHD provides. The training program and training manual are constantly evolving with guidance from both internal and external stakeholders. More currently, it has been focused to provide a public health impact through its ability to meet and sustain the standards of the goals of “Healthy People 2020” and the “Essential Service #8,” to assure a competent public health and personal health care workforce from the “Ten Essential Services,” as identified by the Council on Linkages Between Academia and Public Health Practice. The training program is assembled through specific achievement milestones to demonstrate competency, enabling the ability for other health departments to adapt the training program and manual to their own needs. The training period is distributed across the year in two, three, and six month sections over a twelve month period. As with all of the programs, the employee is expected to reach a goal of competency, which is demonstrated through the successful completion of a staff standardization process. This standardization process occurs (1) through the standardization of new field staff by internal state standardized staff and requires observation of the new field staff in their conduction of the inspection, as well as a review of the final inspection report written by the new field staff, as with the retail food program, or (2) through inspection observation and discussion with the program lead or Field Supervisor. The first two months of the training program are dedicated to the orientation in the retail food program, including facility inspections, mobile, and temporary food inspections. The EHS III and the supervisor monitor the new field staff’s progression through the training period by obtaining feedback from the inspectors that are shadowed, as well as from the new field staff member themselves to ensure that the standardization process will be a success at the end of the two month period. Training activities for months two through twelve include the remainder of the EH programs (retail food enforcement process, institutions and public accommodations, childcare, pools, vector surveillance, disease prevention, etc.) and involve a similar process previously described depending on the depth and involvement of staff in those programs. The six to twelve month training objectives involve the participation of new field staff in plan reviews, tours of partner agencies, as well as meeting with internal and external agency leaders.  
Responsiveness:The field of EH is a subset of the Public Health system and is completely interwoven in many areas. As such, the EH division, as part of the TCHD agency and a purveyor of public health services endorses, as a guiding principle, the goals of “Healthy People 2020” and the “Ten Essential Services” identified by the Council on Linkages Between Academia and Public Health Practice. Healthy People 2020 is a vision created by professionals from inside and outside of the government in both public health and academia, that sets objectives which aim to prevent disease and promote heath in our Nation. The vision incorporates measurable objectives that can be used to assess the satisfaction of the overarching goals to increase life quality and longevity and eliminate health disparities. The themes of the objectives of both environmental health and food safety, outlined as topics that are part of Healthy People 2020, are addressed through the training program. The development of a competent staff in all areas of environmental health ensures a more reliable approach to the identification and mitigation of physical, chemical, and biological hazards that the public could potentially be exposed to. Using a combination of both education and enforcement activities is key to developing both community and facility awareness of public health issues and is a central theme to many of the EH programs; the development of the knowledge of what proportion of these strategies should be used is dependent on a solid training program to provide a backbone of knowledge and experience to help guide employees through a myriad of different situational contexts. The approach taken by TCHD to achieve to goals of Healthy People 2020 and the specific objective of food safety, also coincides with the desire of TCHD to achieve the goals of the CDC Winnable Battle in Food Safety through the development of competent staff that have the capability of identifying areas for improvement in the facilities that are inspected, carrying with them an arsenal of educational outreach and guidance, in the hopes of reducing foodborne related illnesses in our communities. Evolving from the Public Health Faculty/Agency Forum, which made recommendations for the improvement of educational goals of public health related fields to reflect more current and emerging issues, leaders from national organizations that represent both the public health and academic communities formed The Council on Linkages Between Academia and Public Health Practice. Recognizing the need for practice-specific training, The Council developed ten essential services that are critical to public health services. These core competencies represent a set of skills, knowledge, and attitudes necessary for the broad practice of public health. They transcend the boundaries of the specific disciplines within public health and help to unify the profession. TCHD’s training manual and training program are designed to develop Essential Services #8 Core Competencies in new TCHD employees, whether they are new to the field of EH or just new to TCHD, and ensure they are proficient in delivering TCHD programs and services in the community. TCHD has developed a Core Competencies Resource to provide a career path for staff interested in developing themselves beyond an entry-level position. With the ultimate goal of helping to reduce the burden of disease in our communities through a combination of both education and regulatory activities, the training manual and training program aim to develop competence as well as confidence in new employees, and continue to help guide existing employees. The training manual and training program have been developed to provide staff with the means to increase and strengthen the EH Division’s infrastructure to carry out the Ten Essential Public Health Services. It follows the national guidelines from “Healthy People 2020.” The objective of the training program is to provide staff with tools and resources for personal and career enrichment and development, increasing their responsibilities and value to the agency, thus providing a path for career advancement. Through the training program EH Management and supervision will assess individual staff development plans and provide guidance to increase staff capacities in each of the core competencies as part of the performance evaluation process. Increasing core competencies in the individual builds on the division’s level of core competencies and the ability for the agency to carry out the Ten Essential Public Health Services.   Innovation The evidence-based strategy used in developing the training program for the Department comes from the recognition of the need for improvement in public health education for those in the practicing sector through the “Ten Essential Services” identified by the Council on Linkages Between Academia and Public Health Practice. This need for improvement for more real-world training for public health professionals was documented by the Institute of Medicine’s 1998 report, The Future of Public Health (, as well as in NACCHO’s 2005 National Profile of Local Health Departments study ( /profile/upload/LHD_Workforce-Final.pdf). This practice is a creative use of an existing tool or practice Both “Healthy People 2020” and the “Ten Essential Services” practices were used to improve and update the training program. Both are included in NACCHO’s Toolbox. The approach to implementing the tool was unique and innovative in the target area because it focused on building on the background general biology and/or environmental health science knowledge that both new and current staff bring to our department, allows them to develop their skills with more seasoned employees in a variety of contexts and environments throughout the jurisdiction the Department covers, and provides a resource that staff can continually come back to in their own development as they progress through their careers. The training program gives staff the tools and resources for personal and career enrichment and development, increasing their responsibilities and value to the agency, thus providing a path for career advancement, while at the same time meets the “Health People 2020” objectives through a commitment to assessment of staff capacities and providing a means to develop and increase the Core Competencies of division staff. Specific timelines are used in the development of new staff through the training period to meet competency goals in all of the EH programs. The program is designed to ensure that the new hires get through the training program in one year, allowing the right amount of time to focus on each program section in their development. Our approach is more schematically laid out with specific time lines that our staff need to meet for all of our EH programs. We feel that the training program provides new trained staff with a complete training of all aspects of the program; statutes, regulations, policy and procedures, philosophy, tutorial questions of the program, equipment list etc. While other model practices propose classroom training to accomplish the core competency and essential service goals, a classroom model is limiting. The limits imposed by budgeting time for classroom training for employees who already have high workloads to contend with due to a decrease in the ability to budget for more employees, restricting the amount of time that can be spent in the classroom. Classroom training also sidesteps an important condition of learning: the application of knowledge in real-world scenarios with varied and often unpredictable contexts. The training program developed by TCHD provides the best of both worlds: real-world, hand’s on approach that NACCHO (2005) noted most local public health departments prefer, offering a wide variety of contexts and environments for the employee to train in and shadow, enabling the ability to hire and train new employees with limited environmental health background and develop their competency to perform independently and consistently in the field, and encouraging the use of outside resources (classroom trainings) to fill in the gaps in field experiences.  
Food Safety
Primary StakeholdersAlthough external stakeholders (inspected facilities, members of the public, partner agencies) are used indirectly to shape the training program and training manual their feedback on the expectations of the Department and the performance of staff in the field, a majority of the stakeholders in the development of TCHD’s training program is internal. LHD roleThe Department has a direct role in the development of the training program. With the aid of management, field supervisors, input from individuals from other divisions within the agency (Emergency Preparedness, Nursing, Epidemiology, Planning, and Communication), program leads, as well as feedback from trainers and recent trainees, all acting as internal stakeholders in the planning and implementation of the training program, the EHS III’s convene yearly to update the training program and training manual. Allowing members of the EH Division across the hierarchy, as well as with interdivisional divisional input, increases the opportunity for innovation in creating an effective training program and training manual that only helps to increase the proficiency of staff, both new and old. This accomplishes the goals of the Department, as well as those of “Healthy People 2020” and the “Ten Essential Services”. During the training process, new staff also have the opportunity to interact with both internal and external stakeholders through the requirements of the different program orientations, such as orientations with program leads, with leaders in different agency divisions, as well as interaction with external partners through tours of their facilities, or during ride-along activities. Close functional relationships have been formed with many different agencies throughout TCHD’s jurisdiction requiring their expertise, collaboration, and technical guidance on both routine and more out-of-the-ordinary investigations, complaints, and inspections. These relationships have a community and partnership building effect as they help to improve and broaden an understanding of public health issues from a systems perspective, using multiple vantage points and areas of expertise, while also enabling a community based, interagency approach to problem solving in the communities that we all aim to serve. Lessons learnedWorking with municipalities and other government agencies also helps to remove a barrier to communication: the lack of understanding of what a health department’s role is, both in the broader sense, as well as in relation to context specific scenarios. The result is reciprocal; the more TCHD interacts with other stakeholders to build and develop rapport as well as develop an understanding the agency’s capabilities, the greater the potential for collaboration on current and future projects. The training program, and more specifically, the training manual, identifies the appropriate agencies to contact as well as their potential role in collaboration activities.   TCHD strives for a well-trained and educated workforce. Our training consists of a twelve month program where employees are trained to perform inspections and investigations in the core programs. Each of our EH offices has an EHS III and a Field Supervisor that is tasked with the administration and oversight of the training program. The training for each program begins with the trainee attending an orientation provided by the program lead, EHS III or Field Supervisor. After the orientation, the trainee shadows the field staff, and when comfortable, performs the inspections while the field staff observes the trainee’s progress. The final step is the standardization inspection(s). If the employee passes the standardization process, they are approved to perform inspections and investigations in that program. Our training program builds upon itself by honing skills such as communication and documentation skills, inspection procedures and experience. An important piece of the training program is our EH Training Manual. Our training manual includes program specific information, including a list of the state statutes, program philosophy, regulations, policies and procedures, list of equipment, resource agencies, forms, and handouts for the program. The training manual is updated on a yearly basis by each of the EHS IIIs with input from program leads and is reviewed by EH management. Any regulation, policy or program changes throughout the year are incorporated into the training manual so the document remains current. Consistency amongst our staff is of the upmost importance and a well-trained staff is necessary to achieve this goal. Our training materials are used to provide a training resource for new staff and to provide guidance to existing staff. Each trainee must pass a standardization process before they perform work in any of the EH programs. All retail food inspectors, including the field supervisors, are re-standardized every three years. As noted previously, management is able to query retail food inspections from our database to obtain data on the frequency of violations that each inspector marks and compare them amongst all inspectors. Feedback and training is provided to inspectors whose inspections fall outside of the norm. To ensure new staff members meet their training expectations, there are training progress charts in the training manual that staff track their daily training activities and document their training inspections. This enables us to track the number and kinds of inspections staff have been trained on. In addition, new staff has a 3 month, 6 month and 12 month evaluations that are conducted by the supervisors and written objectives are provided to the employee. Each new employee is required to meet 13 training objectives within the first year. By providing objectives, oversight by an EHS III and a training schedule, the 12 month timeframe for training is achieved for each new employee. All new employees follow the same training outline for each program. The employee attends a first round orientation with the program lead for each EH program. During this orientation, the employee is presented with regulations, policies and procedures, program forms, and the basic philosophy for the program. The next step is for the new employee to shadow staff for a set time period or a specific number of inspections. Next the employee will go through a standardization process with a standardizer, supervisor, team lead or EHS III to assess the employee’s ability to perform inspections or investigations independently. Although our training process has been in place for many years, we have learned new lessons over that span of time. The most important tool we use for feedback and to make modifications to our training program is comments from new staff. The supervisors perform a survey of staff at their one year mark after they have completed their formal training program. This feedback allows us to make positive changes to the training program. A few examples of changes are for many years our retail food training process took place over three months. Several years ago, we reassessed this training period and eliminated portions of the trainings that allowed us to focus our efforts on retail food training only. Some of these modifications were the elimination of staff visiting other offices, as well as increased training time in the field. This new process allowed us to fully train our new staff in the retail program in two months. Other lessons learned have been the development of checklists that are used as training tools for new staff and inspection aides for existing staff. The development of checklists by our program leads has led to a more consistent and better trained staff, especially in programs where staff does not perform inspections or investigations on a daily or weekly basis. The cost associated with training a new employee can be estimated by calculating a percentage of time the employee is training with other staff members. The first 2 months the new staff member is always with a trained staff member. 346 hours X $18.46 = $6387.16. Over the next 10 month period it’s estimated that new staff spends approximately 30% of their time training with other staff. In addition, staff receives a raise at about the 6 month mark when they are signed off in certain training programs. 4 months X 173 hours/month X 30% X $18.46 (salaried employee) = $3832.30. 6 months X 173 hours/month X 30% X $19.84(salaried employee) = $6178.18. This amount totals $16,397.64 for the 12 month period. However, in reality, it is difficult to determine the exact amount of money that is spent training a new employee because of the time associated with existing staff providing training in the office and the field, inspection time for existing staff taking longer during training than when performing inspections on their own, indirect cost of benefits, etc.
Objective 1 is to provide a training program in each of the EH programs that the new staff are hired to work in, so they can independently perform inspections and investigations. After the training program for each EH program has been administered and the appropriate level of training has been received, the new staff member goes through a standardization process with each program lead or program standardizer to assess the staff member’s knowledge and assure their skill level has met our expectations. TCHD has two staff standardizers in our Retail Food program that are standardized through the Colorado Department of Public Health and Environment (CDPHE). If the staff member demonstrates the knowledge and skills to perform the inspection or investigation and are able to correctly document the event, they will pass the standardization process and are considered able to independently perform work in that particular program. This standardization procedure is used as a performance measure for this objective.   Objective 2 is to have a resource document available to all EH staff to refer to at any time when questions arise. Our Training Manual consists of program specific general philosophies, a reference to the state statutes, policies and procedures, and associated regulations. TCHD’s training materials include an updated memos section where interpretive memos are stored for future reference as well as a section containing updated policy decisions made by the Department or the CDPHE. Our training manual is updated on a yearly basis from updates provided by team leads, field supervisors, and EHS IIIs. Therefore, our Training Manual is a living document that is always current.   Objective 3 is to develop consistency amongst inspectors in the four EH offices. Staff accessibility to a collection of training materials, interpretive memos and evaluation through a rigorous standardization process provides the appropriate method to obtain a level of consistency amongst the 26 field staff and the 4 field supervisors. The uniform application and implementation of programs, regulations and policy and procedures throughout the three counties that our health department serves is enabled by the continued development and maintenance of TCHD’s training program.  TCHD’s current EH inspection database only allows us to query inspections in the Retail Food program. The EH management is able to query data on each field staff member and the frequency each violation is cited during inspections. When this data is trended over six months to a year, an assessment can be made to determine whether inspectors are marking violations too often or not often enough, providing opportunities for training to assist in providing consistency in the application of the regulations, as well as program policies and procedures amongst field staff and offices. TCHD is in the process of converting to a new software vendor that will allow us to query inspections and investigations in all of the EH programs that we do work in  
Stakeholder CommitmentThe EH Director and EH Management Team at TCHD are committed to the training program that we have developed over the past 25 plus years. The following statement of “Purpose” from our Training Manual provides a summary of our commitment to our training program: The training of new employees is one of the most important functions Tri-County Health Department (TCHD) performs. How well the training effort is executed will determine how well employees will perform and become an extension of the organization. The training process communicates to the employees the culture, values, beliefs, duties, roles, ethics and how TCHD would like its’ employees to represent the agency. One of the first ways this can be shared with new employees is through the agency vision, mission, and guiding principles. SustainabilityTCHD will continue to refine and improve our training program to serve our Mission to “Protect, Promote, and Improve the Health, Environment and Quality of Life of the Citizens of Adams, Arapahoe, and Douglas Counties” and provide the best local public health services possible.