On Your Time Local Public Health Training

State: MA Type: Model Practice Year: 2013

Since January 2010, the Boston University School of Public Health (BUSPH) has held the contract for and managed the Local Public Health Institute (LPHI) of Massachusetts. With support from both the Massachusetts Department of Public Health (MDPH) and HRSA’s Public Health Training Center Network (BUSPH is also lead agency for the New England Alliance for Public Health Workforce Development, a PHTC), the LPHI staff work with the LPHI Advisory Committee to pursue the mission: To provide and ensure a competent workforce by strengthening and sustaining the capacity of local boards of health to prepare for and respond to public health issues and emergencies and to promote the health of residents of the Commonwealth. One objective toward fulfillment of this mission is to increase LPHI’s capacity for distance education. To that end, faculty and staff have been working in partnership with Massachusetts’ state and local governmental public health practitioners to design and develop online awareness level training modules for the local public health workforce, called “On Your Time.” These trainings, when all are completed, will cover the 17 most common local health program areas, 10 cross cutting competency areas, plus topics related to the ASPH Mid-Level Emergency Preparedness Competencies. The learning objectives of each awareness module are linked back to a 2010 MA Competency Report and subsequent Gap Analysis. LPHI’s online offerings enable trainees to participate regardless of location and according to their individual schedules. According to a survey conducted by the Institute for Community Health during 2011-2012, in MA there are 3,598 Board of Health members, local health department staff, and others such as state public health and environmental protection staff, who are our target population for LPHI distance learning. Certain modules are also appropriate for the general public (e.g. Lyme Disease), and others have been expanded to meet regulatory requirements for operators (e.g. Tanning Facilities). 188 professionals (5.2%) completed at least one online training from January 2011 to June 2012. 70% distance learning participants are female, 30% male. On average, they have worked in the public health field for ten years. 26% participants are ages 20-29, 18% 30-39, 20% 40-49, 24% 50-59 and 13% 60 . 79% of participants are white, 6% black, 5% Asian, 4% Latino and 1% Native American. The desired short-term outcome of our work is increased participation in LPHI offerings across all regions. Predictably, the highest proportion of local health workers who took advantage of our online classes hailed from the most rural parts of Massachusetts (17%) while the lowest proportion (6.9%) work in the most urban area, Boston. The first module was launched in January 2011. To date, these modules have been completed: 1. Orientation to Local Public Health in Massachusetts 2. Using the Health and Homeland Alert Network 3. Massachusetts Virtual Epidemiologic Network Introduction (MAVEN)4. Recreational Waters: Swimming Pools5. Lyme Disease 6. Dealing with Stress in Disasters: Building Psychological Resilience 7. Bed Bugs 8. MAVEN – TB 9. Tanning Facilities 10. Wastewater and Title 5 11. Public Health Law and Legal Issues in Massachusetts 12. Hoarding 13. Housing 14. Emergency Preparedness in Massachusetts 15. Food Protection These online trainings also address, to date, seven cross-cutting competencies primarily at the Awareness (foundational knowledge) level: advocacy; analysis, problem solving and risk management; communication; community/public health assessment; emergency preparedness; health education; and legal issues. To meet demand for more robust content, we also developed stand-alone modules for the legal and emergency preparedness cross-cutting competencies. Evaluation findings include an increase in the number of online training participants over an 18-month period from 32 to 188, evidence we are reaching local health professionals from rural areas who typically are challenged to travel long distances to attend classroom-based trainings, and high satisfaction scores on all satisfaction-related measures. Specific factors that led to success of On Your Time include: • willingness of state and local practitioners to volunteer time to act as subject matter experts and reviewers • solid evaluation plan and commitment to continuous quality improvement • dedicated LPHI Advisory Group • contact hours that can be applied to certain credentials • certificate of completion option
ResponsivenessThe public health issue that this practice addressesThe Commonwealth, comprised of 351 cities and towns, many small with little to no paid staff and each with its own board of health or health department, does not provide comprehensive training for the local governmental public health workforce that serves in the regulatory arenas (e.g., housing, food safety, private wells, hazardous/solid waste, and wastewater) nor to those who provide population based surveillance, case investigation, disease prevention and health promotion services. In addition, there is not a robust pool of qualified trainers for either classroom or field training. Most MA public and environmental health laws and regulations do not have minimum competency requirements for regulatory staff. As a result, there can be no assurance that our workforce is aware or competent to perform their mandated duties. A 2006 report by the MA Coalition for Local Public Health identified local public health workforce competency gaps, and led to a subsequent MA Local Public Health Institute Competency Report. These analyses made clear that workforce development was a critical public health issue in Massachusetts. At the same time, large geographic distances coupled with concerning trends like budget cuts and staffing shortages at the local level and scheduling challenges presented significant obstacles to local public health professionals when it came to accessing classroom training. Since the report, as we experience even more challenging economic and budget-tightening times, fewer resources are dedicated to workforce development, with many local health departments unable to pay for training for their staff. More broadly, there is concern about the performance of the public health workforce, and a documented need for competency-based training (Chandler, T. et al, 2008; Gebbie, K.M.,Turnock, B.J., 2006; Harun, M.H., 2002.; Koo, D. Miner, K., 2010; Wright, K., 2000) to improve the ability of practitioners to address complex demands for critical public health services. Fortunately, tremendous technological resources exist that address these obstacles and allow LPHI to offer a convenient, no-cost avenue for training using online technology. This bolsters the competency level of the workforce by enabling them to provide the residents of their communities the Ten Essential Services of public health The process used to determine the relevancy of the public health issue to the communityThe process used to determine the relevancy of the public health issue to the community included: 1. A review of the findings of a statewide workforce assessment prepared by the Institute of Community Health for the MA Coalition for Local Public Health (CLPH) in 2006, entitled “Strengthening Local Public Health in Massachusetts: A Call to Action.” CLPH is comprised of the five statewide public health associations. One of CLPH’s three overarching recommendations in this report is “Strengthen workforce development and competency through increased training opportunities for local boards of health and staff, and through the development of minimum educational levels and credentialing for certain positions.” 2. A review of the Local Public Health Institute of Massachusetts Competency Report February 18, 2010 (Rev. October 2010, December 2010,, a model for local public health competencies based on specific programs within local public health agencies as well as a set of cross-cutting competencies. The Competency Report was the basis for the Gap Analysis that followed. The distance learning and five other objectives for LPHI in turn were created as a means to fill the identified gaps. 3. Review of the Association of Schools of Public Health Public Health Preparedness and Response Core Competency Model (2010, 4. Review of the CDC’s Public Health Preparedness Capabilities report (2011, 5. Informal interviews with professional association leadership and Bureau/Division leadership at MA Departments of Public Health and Environmental Protection 6. Analysis of evaluation results, described in the evaluation section below. 7. Literature review, fall 2012. How the practice addressed the issueLPHI’s online modules address the issues described above by providing competency based training primarily at the awareness level at no charge for trainees. Greater flexibility and affordability make distance learning a more attractive option for professional development for local professionals and their supervisors, as does the opportunity to earn continuing education credits. On Your Time access to standardized materials also levels the playing field across the state regardless of whether or not an individual works in a rural, suburban or urban community – and regardless of the caliber or content preferences of a particular instructor. To facilitate use of the modules by groups and ensure a more equitable, standard presentation of highly vetted course content, LPHI staff creates a Facilitator’s Guide (available as a PDF within the module). The Guide provides guidelines for how to conduct the training in a classroom setting for those individuals who prefer the face to face learning environment. LPHI recommends that a facilitator be identified who can adapt the guidelines and/or incorporate his/her own training methods to best meet the needs of any given group of trainees. Throughout the guide, there are additional points of discussion to better illustrate the information on each webpage. Module design supports continuing education, including options for Certificates of Completion, by allowing for issuance of continuing education credits for the following credentials: MA Registered Sanitarian (RS), National Environmental Health Association (NEHA) Registered Environmental Health Sanitarian/RS (REHS/RS), MA Certified Health Officer (CHO), and MA Registered Nurse (RN). Each module is also designed to be a user-friendly online reference manual for local public health practitioners, with links to statutes and regulations that explicitly outline roles, responsibilities and authority of local public health. Carefully selected local and national resources are included, and participants are encouraged to revisit the module repeatedly. Access to “standard” training modules assures Massachusetts’ public health workforce is aware of their duties and responsibilities, meaning each program module contains in this order: Title and Credits; Introduction, Learning Objectives; Background (Science and Health); Administration Authority including Regulations, Laws, Inspection Tools and Equipment, Enforcement and Summary of Standards; and Resources.InnovationEvidence based strategies used in developing this practice.Evidence-based strategies used as a basis for developing On Your Time include Best Practices in Online Teaching Strategies (Hanover Research Council) , Ten Core Principles for Designing Effective Learning Environments (J. V. Boettcher) , and Guiding Principles for Distance Learning (American Distance Education Consortium) . On Your Time is a creative use of an existing practice: distance learning. In fact, there is an abundance of online trainings for the public health workforce, such as those available from other PHTCs, CDC, FEMA, and other professional organizations such as the National Environmental Health Association (NEHA). 1 Hanover Research Council (2009), Best Practices in Online Teaching Strategies. Washington, DC. 2 Boettcher, J. V. (2007). Ten Core Principles for Designing Effective Learning Environments: Insights from Brain Research and Pedagogical Theory. (February 16, 2009). 3 American Distance Education Consortium (ADEC) 2002 Guiding Principles for Distance Learning This practice is a creative use of an existing tool or practice? If so, answer the following questions. Process used to determine that the practice is a creative use of an existing tool or practiceThe Office of Public Health Practice conducted a literature review to better understand the current landscape regarding the use of distance education for the local public health workforce. We found few mechanisms exist to ensure that online education related to public health is accurate, up-to-date, competency-based, and tied to state-specific laws and regulations in which practitioners work. Variability also exists in the quality, structure, content, and usability of available online training despite what is known about the effective components of such training, such as an easy to follow structure (Ballew, P. et al., 2012; Chaney, B.H. et al., 2009) with clearly defined goals and objectives (Giguere, P, Minotti, J., 2003), a table of contents, and easy navigation between web pages (Claus, JM et al., 2008). The literature suggests that online training should offer interactivity and links to supportive tools and resources (Ballew, P et al 2012; Bryan, R.L. et al., 2009; Chaney, B.H. et al., 2009; Claus, J.M. et al., 2008; Giguere, P, Minotti, J., 2003) and a balance between graphics and words (Claus, JM et al., 2009). Training should account for the preferences of adult learners (Koo, D, Miner, K., 2010) who generally favor short, self-paced, asynchronous non-degree continuing education programs and who are less confident using online chat rooms, discussion boards or video technology (Zusevics, K.L. et al, 2009). LPHI designed its distance education modules to be responsive to these findings in a holistic approach not found anywhere else within the public health arena. How this practice differs from other approaches used to address the public health issueTraditionally, workforce training has been classroom-based, and dependent on a subject matter expert to deliver content specific to an audience. Most classroom-based trainings: • Are nonstandard and lacking in elements such as learning objectives, instructor notes, handouts, exercises, references, assessments, and/or evaluations• Are dependent on an individual speaker and, so, are not replicable• Are only offered one time or on a sporadic schedule. At the same time, many online trainings are often simply a PowerPoint presentation, a videotaped lecture, or an archived webinar – not designed to create an interactive, engaging experience for the trainee. They also rarely adapt facilely to a classroom setting. Our approach differs in that we: • Work as a team with state and local practitioners, many who volunteer their time and expertise, to develop relevant content - a more cost-effective and sustainable approach • Develop standardized modules that are engaging (video, audio, downloadable handouts), interactive (quizzes, flash cards and other activities), and easy to use • Offer choices (earn contact hours – or refer to the modules as a resource as needed) • Are responsive to a Competency Report which identifies discrete Program Areas and cross-cutting competencies. • Include a thorough evaluation and quality assurance plan • Create a curriculum and standardized training which transcends that of any one instructor or trainer • Offer the full module package including a Facilitator’s Guide which adapts online modules for classroom training, and CDs to ensure those without high-speed internet can have equitable access to the material. We did not find a comparable workforce development model practice in NACCHO’s Model Practice Database, nor in our literature search have we found models anywhere in the country that incorporate our full suite of features and standard and highly vetted methodology.
Primary stakeholdersThis is a collaborative effort of Boston University School of Public Health (BUSPH), the New England Public Health Training Center (New England Alliance for Public Health Workforce Development), and the Local Public Health Institute of MA. Primary stakeholders are state and local public health practitioners. The LPHI Advisory Committee has representation from MA Environmental Health Association (MEHA), MA Health Officers Association (MHOA), MA Association of Public Health Nurses (MAPHN), MA Association of Health Boards (MAHB) Western MA Public Health Association (WMPHA), MA Department of Environmental Protection, MA Department of Public Health (MDPH), MA Public Health Association, and academia. These under-resourced local and state agencies dedicate valuable time to this program as they grasp its significance to local practitioners and the field at large.   LHD's roleThe LHD’s role is extensive. In fact, module development and annual review depends on the stewardship of local public health professionals, many of whom provide their services in-kind (although limited funds are sometimes available). Local health professionals from all regions of the state comprise 11 of the 18 members of the LPHI Advisory Committee and are included as team members for content development and review. They are invited to include other practitioners beyond the Advisory Committee and these have included Health Agents, Commissioners, Directors, Sanitarians, Inspectors, and Public Health Nurses. One of our primary authors is Michael Blanchard, MS, REHS/RS, Director of the Milton, MA Board of Health and Treasurer of the MA Environmental Health Association. Mr. Blanchard has considerable experience in local public health and has taken the lead on developing content for modules covering Nuisance Control, Bathing Beaches, Recreational Camps for Children, and Drinking Water. Stakeholders/partnersSubject matter experts (SME) and other public health professionals are involved from the initial prioritization of training development to content development and final review of the module. See Section 7 below for descriptions of these steps. Module development and review utilizes a team approach with representatives from academia, state and local health and environmental agencies, and professional association members acting as subject matter experts, content developers, and module reviewers. Module development team members represent: • MA Departments of Public Health and Environmental Protection • Local boards of health and health departments • Professional local public health associations: MEHA, MHOA, MAPHN, MAHB and WMPHA • BUSPH faculty and staff As active members of the LPHI Advisory Committee and statewide associations listed above, Massachusetts’ local health departments are able to leverage resources at all levels of government in a time of shrinking public health budgets. They work with various stakeholders in their communities to bring quality, standardized training to local health workers. These partnerships enable cost-effective implementation of all program components. Locally elected government officials, as community stakeholders, allow their health department staff to complete online modules to further the important goal of providing the ten essential public health services in this difficult budgetary climate. These stakeholders seek competently trained professionals to enforce state and local rules and regulations, as well as to educate the public on various public health issues. The online modules are designed to provide uniform and appropriate training to those professionals. It is the local and state public health workforce that is fostering this training program on those officials’ behalf. Lessons learned Barriers to developing collaborations involve limited time and resources. Governmental public health agencies are reducing their workforces and are expected to do more with fewer resources and shrinking budgets. By combining resources of funded training programs (such as the HRSA Public Health Training Centers) with professional associations who share a mission to train and educate the workforce, we were able to implement a unique distance learning program, and to expand it, on what we consider a 'shoestring' budget. Specific lessons learned include: 1.) The importance of identifying and engaging SMEs from the beginning and throughout the development process. A SME should serve not only as a one time provider of materials and module content, but maintain involvement in the development process and vetting of the module. Their involvement ensures the final product reflects the standard of practice and day to day work of public health professionals. 2.) We have also learned to use a SME as the primary author to draft the module content. This primary author is usually a local or state public health practitioner, who can provide important perspective when it comes to applying regulations, laws and tools, and enforcing standards to practice. We originally used BUSPH MPH students in this role and they lacked the experience to properly focus the module content. 3.) The value in having a defined and monitored online module development process that allows us to keep partners aware of the progress and at what points along the continuum they need to be involved. Weekly meetings are held at BUSPH for the development team and LPHI Advisory Committee is informed of progress monthly. 4.) The necessity for each module to contain uniform, consistent information that is fully described in a standard table of contents. This has helped primary authors draft new modules, and it benefits trainees by allowing them to find information quickly, especially when using the modules as a reference manual.   ImplementationThe protocol for achieving our objective is to standardize online module development and implementation into the following areas: Prioritization, Development, Posting, Evaluation, and Quality Improvement. The following table details these tasks. Step Elements Description 1 Prioritization Training topics come from the 2010 Competency Report. LPHI Advisory Committee members, with feedback from their constituents, prioritize 6-8 modules for development each year. 2 Development SMEs identified BUSPH identifies a module development team consisting of primary and contributing authors, contributors, and reviewers. BUSPH also searches for, and shares with the team, any existing training materials or content available on the training topic. 3 Module content received and reviewed Authors follow a standard Table of Contents when drafting the content (as a word document). BUSPH staff and faculty review the word document, edit accordingly, and send out for review to the identified team. Depending on the topic, this can have multiple iterations. 4 Module drafted w/ Softchalk© BUSPH E-Learning Specialist uploads the word document to the Softchalk© software for online publishing. Layout of content conforms to a standard design per LPHI's Style Guide. 5 Softchalk© interactivity integrated Once content is loaded, interactivity is built into each module. 6 Facilitator’s Guide drafted BUSPH staff drafts a Guide, using a template with: standard instructions; teaching tips; facilitator notes; supplemental activities; and discussion topics. 7 Module draft reviewed and edited Development Team vets the draft module and Facilitator's Guide and BUSPH incorporates edits. 9 Additional module elements drafted BUSPH staff draft pre/post test questions and map the cross cutting competencies. 10 Copy reviewed and edited All elements are sent to an editor for review and BUSPH incorporates edits. 12 Full package reviewed and finalized LPHI Advisory Committee reviews the entire package (online module, Facilitator's Guide, pre/post-test questions, table of cross competencies). BUSPH incorporates final edits. 14 Posting BUSPH staff posts and markets the module and links to the LPHI learning management system. 15 Master CD produced BUSPH provides a CD of the module if the trainee does not have access to high speed internet. 16 Evaluation and Quality Improvement Annual review and analysis of evaluation data Time frameOn average, it takes 77 hours over three to six months to develop one module. The first module was posted in January 2011, the 15th in June 2012. We have several more in cue for development and production.Lessons learned Lessons learned with regard to On Your Time implementation are the same as those delineated in section 5 above with regard to collaboration, as the implementation process is a collaborative process. Additionally, direct marketing with emails and newsletters to local public health practitioners and attendance at conferences to promote workforce development have increased significantly the online registration (146) and completion of the modules (112) in the past four months (July-October 2012). Cost of implementationOn Your Time development costs $3000 – $5000 for each module, not including the annual software license fee of $695 (total, not per module). Where possible, we retain student assistance to provide background research and to work as E-Learning Specialists. This provides students a valuable experience while keeping costs down. Although there is an upfront cost, the products are quite sustainable (see section 8). Specific budget line items include: • Primary author (if their services are not voluntary) for an estimated 30 hours for content development • E-Learning Specialist for an estimated 20 hours to develop the Word document into a Softchalk© module and to edit the module after reviews • Technology Expert for an estimated 5 hours to connect the modules to the Learning Management System and place it on the server. Education Expert for an estimated 10 hours to review learning objectives and module content, design pre/post assessments, and map to cross cutting competencies • Editor for an estimated 5 hours to provide text and activity edits • Administrator for an estimated 5 hours to manage the development and evaluation process • Evaluator for an estimated 2 hours to analyze annually compiled assessment and evaluation results • Additional expenses such as the production of CDs where high speed internet access is unavailable
Central to the mission of LPHI is the delivery of effective competency-based training to the local public health workforce. Given geographic distances, staffing shortages and scheduling challenges faced by this workforce when it comes to accessing classroom training, achieving the LPHI mission requires that LPHI has sufficient capacity to deliver online training. Therefore, one of the primary program objectives for LPHI is to increase capacity for distance education. The primary performance measure related to the objective is the number of trainings or programs with a distance learning component offered by the LPHI each year, and tracking change over time. The LPHI Program Manager tracks the number of online modules and reports the data to the LPHI evaluator. Simply possessing the capacity to deliver training online is not sufficient. To assess the value of the LPHI’s distance learning capacity, LPHI collects two additional performance measures. By capturing data on public health roles and geographic location through online registration for the modules, we are able to assess whether LPHI is reaching a variety of public health practitioners and trainees in all regions of the state through its online trainings. Additionally, trainees who wish to receive a certificate of completion and contact hours are required to complete pre and post tests as a means to assess impact of the training on their knowledge, their perceived ability to achieve module-specific learning objectives, and their evaluation of several aspects of the training. All of these data are downloaded from the online system and analyzed by the LPHI evaluator. The evaluator reports on all three performance measures in the LPHI annual report and makes recommendations for quality improvement as necessary. The report is shared with the LPHI funder and LPHI Advisory Group and is available to the public on the LPHI website. Objective 1:Increasing capacity for distance education. The first online module was posted in Jan. 2011; by Oct. 2012 there are 15 with plans for another five by the end of 2012. 188 professionals (5.2%) completed at least one online training from January 2011 to June 2012. Objective 2:Reaching a variety of public health practitioners and trainees in all regions of the state through its online trainings. Through its distance education offerings, LPHI reached public health practitioners in all regions of Massachusetts with the greatest numbers coming from Western Massachusetts, an area of the state where access to training had historically been impeded by the time and travel needed to access classroom education. The modules have been utilized by all types of public health practitioners, including public health nurses (12.8%), health directors/agents (10.6%), sanitarians/inspectors (12.2%), and Board of Health members (4.3%). The remaining trainees included administrative assistants, emergency services and emergency preparedness personnel, nursing students, public safety officers, school nurses, and public health students.Objective 3:Assessing impact of the training on their knowledge, their perceived ability to achieve module-specific learning objectives, and their evaluation of several aspects of the training. Based on data from the same 18-month period, trainees were satisfied with the modules. Using a five-point Likert scale to assess their agreement with a number of statements about training (1=strong disagreement to 5=strong agreement), the data showed very high rates of satisfaction with module-specific content, the level of difficulty and technical information, use of quiz questions as a method for engaging participants in learning, the resources provided, and the overall experience. Trainees also expressed strong agreement that they would recommend the modules to those who are new to public health as well as those who have been working in the field for some time. For all modules, mean scores for each satisfaction measure were 4.0 or greater. Google Analytics is used to track unique and returning hits to the modules’ webpages. Our online modules registered 3,192 unique hits over the course of the period January 1, 2011 to June 30, 2012. This indicates that the modules are being used as an online resource and reference manual. Ultimately, the primary level outcome (LPHI as a whole) we seek is improved cross-cutting, program area and emergency preparedness competencies among the local public health workforce who have received training from LPHI. The secondary level outcome is improved agency performance in areas related to competencies in which agency personnel were trained by LPHI. To those ends, BUSPH will continuously work to improve the distance education experience by using quality improvement recommendations from participant and instructor evaluations of our online courses.
Stakeholder commitment There is sufficient stakeholder commitment not only to sustain the Program but to grow it. We are planning to complete the 17 program areas and 10 cross cutting competency modules by the end of 2013 (Topics include Medical and Biological Waste, Hazardous Waste, Vaccine Management, Recreational Camps for Children, Air Quality and Indoor Ice Rinks, Animal Control, and Solid Waste) and to add modules that focus on emergency preparedness capabilities (specifically, Community Preparedness, Information Sharing, Medical Countermeasure Dispensing, and Public Health Surveillance and Epidemiological Investigation). The enthusiastic involvement of state and local practitioners and the active role that the statewide professional organizations have taken, and will continue to take, will ensure sustainability. Senior leadership at the state public health and environmental departments has committed staff to act as subject matter experts and content reviewers. In times of shrinking resources, they see this collaborative project as a way to fulfill their training missions for the many state regulations that delegate enforcement to the local boards of health and health departments. The leadership groups of the professional associations enthusiastically promote involvement within their membership and have followed through with a commitment of time. That level of support is expected to continue, especially as evaluation results support the modules’ effectiveness. We will continue to maintain an Advisory Committee that is representative of the diversity of local health throughout the Commonwealth. BUSPH will keep Advisory Committee members engaged with the online modules development process. Advisory Committee members and their constituents will continue to review, edit and provide comments and suggestions as new modules are developed. We will brainstorm with the Advisory Committee and MDPH to identify emergency preparedness training needs and where online modules can fill the gap. SustainabilityTo sustain and grow the program over time, we will: • Leverage training grant resources to support the development of new modules and to ensure quality improvement of elements of the existing programs • Continue to work with state and local agency practitioners and BUSPH faculty, staff, and students to develop new, and review existing, modules • Continue to engage the professional associations - dedicated to training and educating the public health workforce –in prioritizing module development and identifying subject matter experts • Continue to evaluate all elements and actively engage in quality improvement methods • Offer certification contact hours and Certificates of Completion • Develop and post Facilitator’s Guides for alternative delivery methods • Continue to promote the need for workforce development of public health professionals both broadly and to municipal leaders such as Town Managers, Mayors, and Boards of Selectmen To further ensure sustainability, certain On Your Time modules are pre-requisites for other performance level trainings (such as the MA Public Health Inspector Trainings in Housing and Food Protection and Psychological Resilience: Training the Trainers), incorporated as required elements into the Foundations for Local Public Health Practice course, and available to operators for evidence of adequate training and knowledge (e.g. Tanning Facilities). Additional modules to be completed in the months ahead include Bathing Beaches, Body Art, Drinking Water and Private Wells, Emergency Preparedness at Home, Health Promotion, Nuisance Control, and Public Health Workforce Protection. We are confident the On Your Time model is sufficiently sustainable to ensure these modules will be developed as planned, and LPHI will continue to provide critical distance learning opportunities for the local public health workforce for years to come.