State MCH State CSHCN Local Medicaid

MCH Leadership Skills Training Institute: Year 2000 Assessment of Training Needs

The respondents were given a list of graduate-level skills and competencies and asked to rate these in order of importance. These skills are those that may be considered important for successful participation in the workplace and are needed by those who are graduates of MCH-funded training programs. The skills listed include:

• Scientific and Philosophical Basis of MCH: human growth and development, population health, history and philosophy;

• Core Public Health Skills: biostatistics, epidemiology, environmental health, social and behavioral sciences, health administration;

• Data, Analytic, and Epidemiology Skills: data systems design, data collection, analysis and interpretation, study design, data-based decision making;

• Program Management and Administration: program planning, development, implementation and evaluation, budgeting, administration, personnel management, quality improvement;

• Policy and Advocacy Skills: coalition building, the legislative process, policy analysis/development/enactment;

• Leadership and Systems Development Skills: organization and financing of MCH policies and programs, an MCH vision, service integration, strong interpersonal skills;

• Advanced Clinical and sub-specialty skills; and,

• Crosscutting issues: ethics, cultural competency, family-centered, community based, coordinated service systems.

A scale, ranging from 1 ("least important") to 5 ("most important"), was used to record the responses. For each skill category, Table 5 provides the mean score for the reported perceived importance of graduate training. For all agency types, clinical skills were reported to be the least important of all graduate-level skills and the following skills categories were consistently ranked as the highest in terms of importance for graduate training:

• Leadership and Systems Development Skills;

• Program Management and Administration; and,

• Core Public Health Skills.

Table 5 Perceived Importance of Graduate Training in Specific Skills Areas by Agency Type

SKILL AREAS	State MCH	State CSHCN	Local	Medicaid
Leadership and Systems Development Skills	91.3	85.7	84.4	64.3
Program Management and Administration	95.7	95.2	75.6	89.6
Core PH Skills	95.6	76.2	80.1	79.3
Data, Analytic, and Epidemiology Skills	95.6	71.5	66.3	79.3
Policy and Advocacy Skills	89.1	95.2	69.5	72.4
Cross-cutting issues	73.9	90.4	71.9	51.7
Scientific and Philosophical Basis	73.1	76.2	63.8	62.1
Clinical Skills	15.6	33.3	55.5	24.1

Note: Percentages indicate combines ratings of “4” and “5” on a scale of 1 (“least important”) to 5 (“most important”).

[Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

Respondents were asked the extent to which their agency was able to find qualified applicants possessing the skills that are critical to effectively serve the MCH population. The scale for recording the responses ranged from 1 (“easy to find”) to 5 (“unable to find”). Medicaid agencies reported the least difficulty finding potential employees with needed skills for open positions (Table 6). Roughly half of all State MCH, CSHCN, and Local agencies had some difficulty in finding skilled professionals. State CSHCN agencies appeared to have the most difficulty in finding professionals with needed skills; almost 16 percent of reporting CSHCN agencies were unable to find professionals with the needed skills.

Table 6 Mean Availability of Professionals with Needed Skills by Agency Type

	State MCH	State CSHCN	Local	Medicaid
Mean	3.50	3.63	3.45	3.29
Median	4	4	4	3
Mode	4	3	4	3
% “5” *	4.5%	15.8%	10.0%
% “4” and “5”	54.5%	52.6%	52.1%	41.7%

(*) Note: Scale ranged from 1 (“easy to find”) to 5 (“unable to find”) [Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

Respondents were also asked to indicate their agency’s unmet critical need for clinical and public health professionals with graduate-level education on a scale of 1-5, 1 being “least critical” and 5 being “most critical”. By agency type, Table 7 presents the combined percentage for values 4 and 5 (those indicating the highest two levels of unmet need) for clinical professionals. For MCH agencies, the highest unmet critical need areas for clinical graduate education were genetics (61.4%), dentistry (47.7%), health education (45.4%) nutrition (44.2%) and nursing (42.3%). For CSHCN agencies, the higher unmet clinical need areas were medicine (64.7%), dentistry (57.1%), nursing (55.5%), physical therapy (50%) and early childhood education (50%). Nursing was the highest clinical area of unmet need for Local agencies, followed by nutrition (46.4%) and health education (45.1%). Dentistry (61.9%), health education (50%) and nursing (45%) were the most prominent unmet clinical need areas for Medicaid agencies.

Table 7 Critical Unmet Need Areas for MCH Graduate Education

Clinical Professionals and Skills	State MCH	State CSHCN	Local	Medicaid
Medicine	30.2%	64.7%	29.7%	25.0%
Physician Assistant	4.7%		10.6%	13.0%
Nurse Midwifery	16.3%	18.8%	19.1%	15.0%
Nurse Practitioner	18.6%	37.5%	39.9%	28.6%
Nursing	42.3%	55.5%	56.0%	45.0%
Genetics	61.4%	47.1%	24.8%	23.8%
Dentist	47.7%	57.1%	35.5%	61.9%
Audiology/Speech Pathology	16.7%	37.5%	13.7%	33.3%
Occupational Therapy	7.1%	43.8%	12.7%	16.6%
Physical Therapy	11.9%	50.0%	13.4%	21.7%
Psychology	20.4%	43.8%	16.4%	22.7%
Social Work	29.5%	47.1%	21.6%	40.9%
Early Childhood Education	34.0%	50.0%	25.0%	33.3%
Health Education	45.4%	31.3%	45.1%	50.0%

Note: Percentages indicate combined ratings of “4” and “5” on a scale of 1 (‘least critical”) to 5 (“most critical”) [Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

Table 8 provides similar data for unmet critical needs for public health professionals with graduate education. MCH epidemiology was the greatest unmet need area for MCH, CSHCN, and Local agencies, whereas Medicaid’s greatest unmet area was health care administration. Other top public health professional need areas include public policy for State MCH, management for State CSHCN, and health care administration for Local agencies. A comparison of the level of critical unmet need between clinical and public health professional skill areas reveals that public health skills were ranked considerably higher than most of the clinical skill areas in terms of the need for graduate-level trained professionals.

Table 8 Critical Unmet Need Areas for MCH Graduate Education

Public Health Professional & Skills	State MCH	State CSHCN	Local	Medicaid
MCH Epidemiology	95.7%	66.6%	55.3%	57.1%
Management, Business Administration	62.3%	62.5%	40.4%	54.1%
Public Administration	53.3%	50.0%	32.3%	48.0%
Health care Administration	54.8%	58.8%	40.7%	82.6%
Public Policy	72.7%	37.5%	37.9%	58.3%

Note: Percentages indicate combines ratings of “4” and “5” on a scale of 1 (“least critical”) to 5 [Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

For each agency type, Table 9 summarizes the top five critical unmet need areas for MCH professionals with a graduate education. These need areas refer to both the need for new staff and the need for professional development of existing staff. MCH epidemiology ranked among the top five for all agencies. CSHCN and Local agencies reported relatively more critical need for clinical professional skills, whereas MCH and Medicaid respondents reported more need for public health skills related to administration, management, and policy issues. Based on additional written entries made by respondents, graduates with grant writing, contract management, and information technology skills were also needed and were among those who were the most difficult to obtain.

Table 9 Top Five Critical Unmet Clinical and Public Health Professional Needs Areas for MCHGraduate Education by Agency Type

Rank	State MCH	State CSHCN	Local	Medicaid
1	MCH Epidemiology	MCH Epidemiology	Nursing	Health Care Administration
2	Public Policy	Medicine	MCH Epidemiology	Dentist
3	Management, Business Administration	Management, Business Administration	Nutrition	Public Policy
4	Genetic Counseling	Health Care Administration	Health Education	MCH Epidemiology
5	Health Care Administration	Dentist	Health Care Administration	Management, Business Administration

[Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

 

In Table 10, the level of reported unmet need for professionals with specific public health graduate degrees is provided by agency type. More than 76 percent of responding MCH agencies and more than half of the other agencies reported it was a critical need to have employees with a general MPH. Over half of the MCH and CSHCN agencies desired MPH graduates with a MCH specialty. More than 40 percent of Local and Medicaid respondents viewed a MPH in MCH as a critical need as well.

Table 10 Critical Unmet Needs for Professionals with Specific Public Health Graduate Degrees by Agency Type
	State MCH	State CSHCN	Local	Medicaid
Public Health (MPH)	76.1%	55.6%	52.8%	56.5%
MPH specifically in MCH	65.9%	58.8%	43.2%	45.0%

[Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

The respondents were then asked to assess the actual proportion of current staff that could use and benefit from graduate education, if money and access (time and distance) to graduate education were not obstacles. Over one-third of employees in every agency were seen as potentially benefiting (Table 11). Both MCH and CSHCN agencies reported the highest average percentage of employees that could benefit from graduate education (~45%).

Table 11 Percentage of Employees Perceived to Benefit from Graduate Education
	State MCH	State CSHCN	Local	Medicaid
Mean Proportion	45.0%	44.5%	37.6%	35.7%
Range	5-100%	5-100%	0-100%	0-100%
Median	35.0%	40.0%	25.0%	25.0%
25%- 75%	25-72.5	22.5-50.0	10.0-50.0	5-55.0

[Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]

 

Several factors were reported as preventing staff from pursuing graduate education (Table 12). The following categories were reported to be the most prohibitive barriers to graduate education by all responding agencies:

The cost of graduate education programs; The loss of income while in school; The time required for completion of program.

Table 12 % of Respondents Perceiving Barriers to Pursuing Graduate Education by Agency Type
Barriers	State MCH	State CSHCN	Local	Medicaid
Distance to GE program	63.0%	68.2%	63.5%	23.3%
Cost of GE program	82.6%	90.9%	80.2%	73.3%
Ability to take time off from work	71.7%	86.4%	68.9%	56.7%
Loss of income while in school	80.4%	81.8%	71.3%	60.0%
Time required to complete program	76.1%	86.4%	61.7%	50.0%
Training programs filled/waiting lists	8.7%	22.7%	12.0%	3.3%
Other factors	15.2%	13.6%	7.2%	20.0%

[Data Source: MCH Leadership Skills Training Institute Year 2000-1 Assessment of MCH Training Needs]