With so many government public health workers retiring and not enough new ones poised to replace them, there will be an estimated shortage of over 250,000 workers by 2020. Furthermore, Hispanics, American Indians and Alaska Natives, and African Americans are underrepresented in this already-depleted public health workforce. In response to the need for a larger and more diverse workforce, the federal Office of Minority Health (OMH) began the Youth Health Equity Model of Practice (YHEMOP). Community Science was contracted by OMH to evaluate the YHEMOP—a new initiative that seeks to diversify and educate future generations of public health leaders and practitioners.
As part of the YHEMOP, OMH supports the placement of Health Equity Fellows (students enrolled in higher education studies, hereafter referred to as fellows) to assist in meeting the needs of diverse organizations with short-term health equity projects. The goal is to increase fellows’ understanding of principles related to health disparities and social determinants of health, and ultimately increase the number of students who enter public health and social-service-related professions. Fellows are placed at sites, ranging from federal agencies and regional health equity councils to city health departments and local nonprofits. As part of their placement, fellows have an on-site mentor and participate in check-in calls. These check-in calls happen both with the entire cohort and one on one between individual fellows and implementation support staff. Additionally, fellows participate in interactive webinars with leaders in the field. During these webinars, fellows not only learn more about health equity and the different types of jobs that are available in the public health field, but they also get to speak candidly with a prominent person of color in the field about their career path. At the end of their placement, fellows also complete and deliver a final presentation on their health equity project.
The hallmark of the YHEMOP is that it is designed to be mutually beneficial to the students and the placement sites. These undergraduate and graduate fellows undertake meaningful work that assist their sites with both special projects and ongoing tasks that focus on various health equity issues. As the evaluator, Community Science has four goals: 1) to evaluate the effectiveness of the YHEMOP on fellows’ knowledge acquisition, attitudes, and motivation toward a career path focused on health disparities and social determinants of health; 2) to document promising practices of implementing the YHEMOP; 3) to capture the current needs of health and human service organizations pertaining to capacity building and whether YHEMOP is helping to meet those needs; and 4) to provide OMH with guidance on how to improve procedures and protocols so that the YHEMOP is ready to be scaled up. This developmental evaluation approach involves consistent communication with both OMH and the implementation partner, as well as collecting data from multiple stakeholders over time.
In the first year of implementation, pre- and post-placement survey data was collected from fellows. Additionally, fellows completed an assessment form following each of three webinars. A sample of mentors and fellows was interviewed after the completion of the placement, and those fellows will be interviewed again in the summer of 2017—12 months after the start of their placement.
To date, the YHEMOP has yielded positive results for both fellows and mentors. The majority of fellows were either very satisfied or satisfied with their overall YHEMOP experience. The major goals of increasing knowledge of health disparities and motivation to pursue a career in the field were partially met. Fellows significantly increased their knowledge of health disparities over the course of their placement. While fellows did not report greater motivation to pursue a career related to health disparities, they did report gaining clarity regarding their career. From pre- to post-placement, fellows improved in skill-based knowledge (problem solving, creativity/ innovation, information technology application), written communication, and leadership. The most consistent gains were made in knowledge related to professionalism—clarity of career goals, professional networking, work ethic, self-direction, ethics/social responsibility.
In addition to the positive outcomes fellows experienced, mentors noted a number of benefits to hosting a YHEMOP fellow. The majority of placement sites indicated that their organization lacked the personnel and/or financial resources to tackle their available health equity projects. Though fellows were helpful, they were rarely assigned to tasks that would not have been completed in their absence. Most often, fellows supplemented sites’ personnel needs by assisting with projects that would have otherwise been done by an already overloaded staff member.
Even with such positive outcomes, there were a few areas in need of improvement. Three major recommendations came out of this evaluation process. First, the program needed to expand its recruitment process. Given that this was the first year of the program, the YHEMOP was not well known and relied on existing relationships to recruit fellows. A more concerted marketing and recruitment effort was recommended moving forward. Second, the evaluation noted a lack of interaction between fellows. Fellows were placed with mentors nationwide but were clustered in the DC metropolitan area. Some fellows reported feeling isolated from their peers and not really understanding what other fellows were doing. Finally, the evaluation suggested that fellows would benefit from more opportunities to reflect on their experiences.
Since its inception, the YHEMOP program has grown exponentially. The program received over 800 applications for summer 2017 and placed 32 fellows, as compared to receiving a few dozen applications in the summer of 2016 and placing 18 fellows. The program now has a functional website, an updated toolkit for mentors, and has added cohort-wide update calls as well as additional one-on-one calls to help fellows stay connected to each other and the program. In just one year, the YHEMOP program has grown and adapted to be attractive to a wider number of applicants and to better serve the needs of both fellows and mentors. With such a strong start in its first year, the YHEMOP program is poised to make a difference in the future diversity of health leadership and continue to highlight the importance of health equity.
As the YHEMOP moves into its third year and seeks to truly be a model of practice, the next steps include how to model this program in other agencies. The next steps for this program include: 1) refine ways to ensure that projects are connected to the missions of the placement sites; 2) revise the application to ensure fellows can be assessed in a holistic way; 3) refine the application review and matching processes for fellows and placement sites; and 4) create procedures and protocols for all major elements of the program (e.g., the process of choosing presenters for the webinar, suggestions to help build the peer network of fellows). Continuous learning and improvement through the YHEMOP not only nurtures current fellows, but has the potential to foster some best practices that can help create a model for other organizations to use, and ultimately scale up enough to have a substantial effect on the diversification of the field.