Introduction: Workforce Development Plan (WFDP) Training and development of the workforce is one part of a comprehensive strategy toward agency quality improvement. Fundamental to this work is identifying gaps in knowledge, skills, and abilities through the assessment of both organizational and individual needs, and addressing those gaps through targeted training and development opportunities. Workforce Development in public health encompasses those efforts to improve health outcomes by strengthening the public health workforce through training and skills building. The following organizational competencies are grounded in the Council on Linkages between Academia and Public Health Practice: June 26, 2014 (Council on Linkages or COL) competency set and were revised by DPHSS Quality Improvement Council to meet the needs of the agency. This plan serves as the foundation of the Department of Public Health and Social Services (DPHSS) ongoing commitment to the training and development of its entire workforce. Agency Profile: Department of Public Health and Social Services (DPHSS)

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 1 | P a g e

Mission, Vision, and Strategic Priorities

Mission The mission of the Department of Public Health and Social Services is “To assist the people of Guam in achieving and maintaining their highest levels of independence and self-sufficiency in health and social welfare”. Vision Empowered people of healthy minds and bodies living in a safe environment throughout their lifetime. Strategic Priorities DPHSS developed an Organizational Strategic Plan (OSP), 2015-2017 which includes six (6) priorities. The goal of the DPHSS OSP is to enhance the agency’s capacity to contribute to improving the health of our island community and markedly reducing its physical and socio-economic burden from disease and ill health through action along six priorities:

Tier 1:

Tier 1 Priorities 1. Workforce development to best meet Guam’s health needs; Workforce development 2. Information Technology (IT) systems that are modernized IT modernization and support and supported to ensure efficient communications;

Organizational structure and processes 3. Organizational structure and process that maximize the agency’s capacity for meeting its mission; Tier 2: Tier 2 Priorities 4. Enhancements in the regulatory framework to create a Regulatory framework health promoting policy environment; Client-centered initiatives 5. Client-focused initiatives that deliver people-centered public health and social services; and, Sustainability 6. Sustainability in designing the health system to meet the population’s health needs.

Action across these six priorities is expected to lead to a strong, equitable, accountable, efficient, sustainable, and resilient health system that delivers quality health services to the entire Guam community, leading to optimal health outcomes and high-quality health care. The first three priorities are considered the most urgent, and action is needed from the outset. Thus, these priorities are the starting point for the process of change within DPHSS, and are considered Tier 1 priorities. The last 3 priorities require the strengthening of the Tier 1 priorities first; therefore, action for these priorities will have to occur after the Tier 1 priorities have been addressed.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 2 | P a g e Governance and Organization The Guam DPHSS was created by 5 Guam Code Annotated (GCA), Government Operations, Chapter 3, Departments of the Government, Article 1, §3111. The Director of DPHSS is appointed by the Governor with the advice and consent of the Guam Legislature. DPHSS is organized into five service divisions including General Administration, Public Health, Environmental Heath, Senior Citizens, and Public Welfare. These divisions are further organized into bureaus, programs, and sections as applicable. An organizational chart can be found in Appendix A. This plan was developed with a focus on the Divisions of Public Health (DPH) and Environmental Health (DEH). The WFDP was further updated to incorporate the following three divisions: Divisions of General Administration (DGA), Division of Senior Citizens (DSC), and Division of Public Welfare (DPW). DPHSS administers programs and services by promoting primary care, environmental health, welfare and social services, and senior services. DPHSS has oversight over the Guam Community Health Centers (Northern and Southern Regional Community Health Centers), that are multi-specialty primary care clinics. Other chief programs include administering to the island’s residents and households by providing healthcare, welfare benefits, and program assistance, such as Medically Indigent Program (MIP) and Medicaid; licensing of child care facilities and foster care homes; child protective services; administration of health and sanitary certificates; immunization shots; dental services; issuance of birth and death certificates; marriage licenses; reporting of communicable diseases; services for Woman, Infant, & Children (WIC); and administration of the Title X of the Older Americans Act, to include adult protective services, Medicare and community support services. Location & Population Served Located in the Western Pacific Ocean, Guam is the largest and southern-most island in the Mariana Islands archipelago. According to the 2010 U.S. Census, Guam had a population of 159,358 with an estimated projection of 168,322 by 2020. Guam houses several U.S. military bases, which make up nearly thirty percent of the island’s total land area. According to the data from the Guam State Data Center, Bureau of Statistics and Plans, the population for 2016 for Military Active Duty and Family Members was 5,572 active duty members and 7,235 family members. In addition, the relocation of U.S. Marines from Okinawa, Japan to Guam will increase the military’s presence on-island. The anticipated “military buildup” is expected to increase the number of active duty members by 5,000 Marines by 2020 to 2025. Per military officials, Guam will see an increase in more jobs as construction projects begin for the military buildup.

Guam also serves as a critical transportation hub for neighboring islands and parts of Asia, which has led to population growth over the last decade. Families from neighboring islands have relocated to Guam seeking greater socio-economic opportunities and health services. Guam’s military presence and location in the Pacific Ocean have contributed significantly to the island’s changing demographics, as well as its public health issues.

In 1986, the Compact of Free Association (CoFA) was enacted. The CoFA is an agreement between the U.S. and the Federated States of Micronesia (FSM), the Republic of Marshall Islands (RMI) and the Republic of Palau. The compact agreement allows for citizens of these freely associated states to enter and reside indefinitely in the U.S. It also allows compact migrants to enter the U.S. (including all U.S. States, Territories, and possessions) to work and establish residence indefinitely. According to the Compact Impact Report, the Government of Guam expended $142.3 million in FY 2016 for providing educational and social services to migrants from the Freely Associated States to Guam. The cost for providing healthcare and welfare services made up $17.1 million. In 2023, the CoFA is up for renegotiation.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 3 | P a g e Table 1: Population by Election District, Guam 2010

Table 2: Population by Ethnic Origin or Race, Guam 2010

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 4 | P a g e Learning Culture Learning at DPHSS is a continual process with the intent to positively impact the overall operations, performance and morale among the Department’s workforce. The foundation of DPHSS’s learning culture is three-fold: 1) To provide and/or support necessary trainings and educational opportunities to ensure a competent and effective workforce; 2) Translate knowledge to action through the sharing of new ideas and approaches within the Department to promote organizational transformation; 3) Continually assess training and development needs and availability to ensure the Department’s workforce remains dynamic and capable of accommodating the changing public health environment. Through the development of this plan, DPHSS will focus on meeting additional training and educational needs of the Department in an effort to improve in our programs and services that we provide to our island community.

Funding and Locations To achieve its mission, As of December 2018, DPHSS has 438 Full-Time Employees (FTE) positions based out of 8 locations: Northern Regional Community Health Center (NRCHC) in Dededo, Central Public Health in Mangilao, Southern Regional Community Health Center (SRCHC) in Inarajan, Woman, Infant, and Children (WIC) Office in Tiyan & Santa Rita, Terlaje Building in Hagatna, Castle Mall in Mangilao, and Environmental Public Health Laboratory in Dededo. The fiscal year 2017 operating budget was $62,659,461 (general funds) and $6,194,646 (special funds). Employee Manual The DPHSS Employee Manual (June, 2015) informs departmental staff of the policies, rules and procedures applicable to the DPHSS. This plan complements the Training and Development Guidelines and Policy of the Government of Guam, Department of Administration Handbook. A draft Training and Development Policy for DPHSS has been developed; it is the intent of DPHSS to finalize the Training and Development Policy in the future. The Major Plans The Major Plans for public health accreditation include a Community Health Assessment (CHA), Guam Community Health Improvement Plan (CHIP), Organizational Strategic Plan (OSP), Quality Improvement Plan (QIP), 2019-2022, Emergency Operations Plan, Performance Management System, and Organizational Branding Strategy. Community Health Assessment (CHA), 2014-2018 The CHA identified ten health priorities. These priorities were selected by community participants representing all sectors of government, health professional organizations, coalitions, councils, community-based organizations and others. It provides a baseline health profile for Guam and documents the process for selection of community health priorities, which will serve as a starting point for a continuous health improvement planning process.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 5 | P a g e Guam Community Health Improvement Plan (CHIP), 2015-2020 The Guam CHIP was developed using the data collected through the CHA. The CHIP closely aligns with other agency plans and national priorities which aim to address health outcomes and improve access to care through policy and measurable action. The three Strategic Priorities: 1. Vaccine Preventable Diseases 2. Diabetes and Cardiovascular Disease 3. Cancer (Lung and Cervical) DPHSS Organizational Strategic Plan (OSP), 2015-2017 The DPHSS OSP Tier 1 priorities is organized into three main areas: Priority 1: Develop Workforce, Priority 2: Modernize Information Technology (IT) and Support Systems, and Priority 3: Improve Organizational Structure and Processes. Workforce development is identified as one of the Tier 1 strategic priorities of the OSP. The goal of the OSP is to enhance the agency’s capacity to contribute to improving the health of the community and reducing the burden from disease through action. The strategic plan also outlines the strategies developed to address workforce development priorities that include succession training; developing Standards of Practice (SOPs); working with higher education institutions on curriculum development, and reviewing/updating job specifications. Therefore, as new public health systems and approaches are implemented, the training and curriculum component of this plan will be updated accordingly. The plan also includes activities and timelines for implementation. DPHSS Quality Improvement Plan (QIP), 2019-2021 The DPHSS QIP is a written document that includes workforce development initiatives which will be organized by the Department’s Quality Improvement Council (QIC) members represented across all five divisions. The purpose of the QIP is to establish a framework of the Department’s quality improvement efforts and to provide a structure for developing, monitoring, evaluating, and promoting quality improvement activities aimed at improving performance throughout DPHSS.

Emergency Operations Plan The Public Health Emergency Preparedness (PHEP) Program is responsible for overseeing all emergency preparedness and response activities for the department. Performance Management System (PMS) and Organizational Branding Strategy (OBS) The PMS and OBS are both major plans for accreditation. The DPHSS is going to develop both major plans as part of accreditation.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 6 | P a g e Ongoing Efforts All five Divisions have ongoing efforts relative to capacity building, training and professional development that is being monitored at their respective division levels; some examples of these efforts are discussed below. However, the monitoring of these efforts and opportunities at the department-level should be strengthened as it is crucial to ensuring the Department’s workforce development goals are met.

Division of Public Health (DPH) The mission of the DPH is to preserve, promote, and improve the health and well-being of populations, communities, and individuals through prevention, education, treatment, and recreation. The DPH consist of the following Bureau: Bureau of Community Health Services (BCHS)  The Bureau administers federal grants such as the Diabetes Prevention and Control Program, the State Based Tobacco Prevention and Control Program and many more.

Bureau of Nutrition Services (BNS)  BNS strives to improve health and well-being through nutrition education, promotion of physical activity, and engaging with partners to develop policies and environmental changes which reduce hunger, increase breastfeeding, and decrease obesity and its associated chronic diseases throughout Guam.

Bureau of Communicable Disease Control (BCDC)  Prepares, prevents, responds and controls the spread of diseases of public health concern in Guam through surveillance, disease reporting and investigation in collaboration with health care providers and key responders for a healthier island community.

Bureau of Family Health and Nursing Services (BFHNS)  Provide community health nursing services by synthesizing nursing practice and public health practices.

Bureau of Primary Care Services (BPCS)  Aims to reduce health disparities by providing comprehensive primary health care to the underserved, indigent, and uninsured populations who are most in need of assistance and least able to find it.

Bureau of Alternative Medicine  The passage of Guam Public Law 32-237 on February 2015, legalized the medicinal use of Marijuana. The law is also known as the “Joaquin (KC) Concepcion, II compassionate Cannabis Use Act of 2013,” allowing medical cannabis to alleviate symptoms caused by their debilitating medical conditions and their medical treatments.” The passage of Public Law 33-220 on December 5, 2016, further strengthened the provisions of the Joaquin (KC) Concepcion II Compassionate Cannabis Use Act of 2013. The Chief of Public Health Office (CPHO) has been talked to oversee the Medical Marijuana Program on Guam and continues to work on its implementation. Workforce development is a common sense concept that a better-educated workforce is more likely to create success for the Guam Title V Program. Providing training and professional development opportunities for staff

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 7 | P a g e is not only used as a strategy to enhance stability in the island Maternal Child Health (MCH) workforce to back- fill turnover of skilled workers and as baby boomers retire and take a lifetime of skills with them, but is equally demanded by professionals who are new to the MCH field. In Guam, Project Bisita Home Visiting program, there are several workforce development activities for staff and parents. Project Bisita conducts professional development for all home visitors. These meetings focus on key topic areas critical to improved performance. In 2016, Guam Project Bisita Home Visiting staff attended the National Summit on Home Visiting and participated in weekly webinars from the technical assistance center for Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs. In 2016, Project Bisita staff also participated in the Healthy Moms Happy Babies Domestic Violence training. The training provided tools and resources to help home visitation staff address the complex issue of domestic violence, a federal benchmark of the program. Project Bisita managers received training on reflective supervision, a tool for relationship-based services. Through this training, the managers received strategies to help staff think about, understand, and put in perspective the information shared by families, the emotions experienced from that sharing, and the feelings generated from their own life experiences. Guam’s Title V Program is committed to using data to drive its decision-making; however, it faces some challenges in its ability to do this. The overall epidemiology capacity in Guam is lacking and has been identified as an island wide issue. A strong perception exists among epidemiologists that there is a substantial shortage in epidemiological capacity within the health workforce and health research arenas, and that there are few graduates with sufficient high-level epidemiological training to fill the educational and leadership roles that will be essential to building this capacity. The Data for Decision Making (DDM) series of courses addresses deficits in epidemiology and data related skills in the Pacific Islands workforce, and to build the data and surveillance systems of Pacific Islands health agencies. Furthermore, DDM will help to facilitate the need to build the capacity of decision makers and their advisors in participating countries to: a) identify health priorities and problems, b) identify useful information for solving those problems, c) understand how to use this information in the decision making process, and d) persuasively convey technical information on public health problems to decision makers at successively higher levels. In 2017, several employees from the five divisions, including the Title V Program Coordinator were enrolled in the DDM series of courses. Division of Environmental Health (DEH) The DEH sets forth it’s framework for evaluating and promoting quality performance by requiring a majority of its employees to possess and maintain certain professional certifications related to their position. The DEH is majority made up of Environmental Public Health Officers (EPHOs) I-III, EPHO Administrators, and the Chief EPHO which leads the DEH. All EPHO positions are required by the Division to possess certain certifications in order to maintain their position. All certifications must also be renewed throughout their employment. The Chief EPHO and the EPHO Administrator are also required by Public Law 30-138 and its amendments Public Law 31-233 to possess the Registered Environmental Health Specialist (REHS) or Registered Sanitarian (RS) credential with the National Environmental Health Association (NEHA) or an equivalent credential from any State. All certifications required by the Division and/or by Public Law are set forth to ensure the professional competency of all individuals occupying these positions. Various trainings throughout the year are also organized by the Division in order to continually promote the professional development of the EPHOs and other staff employed within the Division.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 8 | P a g e Division of General Administration (DGA) The DGA provides department wide administrative support functions to the four divisions. DGA is comprised of Financial Management Services, Management Support Services, Facilities & Maintenance, Systems and Programming Group, Health Professional Licensing Office and Emergency Medical Services. DGA also provides direct support to the Director’s Office in providing assistance to the department in terms of human resource development, Performance Management and Quality Improvement, Safety, and Equal Employment Opportunity. The Director’s Office (DO) is responsible for providing policy direction, senior management leadership and administrative guidance to the five divisions within the department. The Performance Improvement Management (PIM) office is a newly created office responsible for pursuing strategies and activities to improve the public health outcomes for all island residents through a guided and systematic approach with the ultimate goal of preparing the department for public health accreditation. Division of Senior Citizens (DSC) The mission of the DSC is to plan, coordinate, implement, and evaluate programs and services, and to identify and leverage all possible resources towards promoting, maintaining, and protecting the total well-being of older persons (senior citizens age 60 years and older), while safeguarding their dignity, integrity, independence, values, and cultures. DSC is primary responsible for coordinating all activities on Guam relating to the purposes of the Older Americans Act; serving as a primary advocate for all older persons on Guam; and assisting agencies and other entities in the development of a comprehensive and coordinated service delivery system throughout Guam. DSC is made up of four bureaus:

Bureau of Adult Protective Services (BAPS)  Protection and advocacy of our elderly and adult victims of adult abuse.  Community education and awareness of this social ill.

Bureau of Community Services (BCS)  Information, Referral and Assistance arm of the division; providing information to seniors, their families, caregivers and their friends to make informed decisions.

Bureau of Program Administration and Development (BPAD)  Contract management and compliance of contracted Home and Community Based Services.  Development and/or identification to improve and/or expand program services.  Marketing arm of the division; community resources and options.

Bureau of Administration Support (BAS)  Administrative arm of the division, support to the overall operations of the division.

Additionally, DSC provides the following services:

 Adult Day Care is located at Dededo, Barrigada, and Inarajan;  Case Management Services;

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 9 | P a g e  In-Home Services; Legal Assistance Services;  Transportation;  Elderly Nutrition Program: Congregate and Home-Delivered; and  National Family Caregiver Support Program has 12 Senior Citizens Centers (Agat, Agana Heights, Astumbo, Dededo, Inarajan, Mangilao, Merizo, Santa Rita, Sinajana, Tamuning, Yigo, and Yona/Talofofo.

Division of Public Welfare (DPW) The mission of DPW is to promote positive social conditions that contribute toward the attainment of the highest social well-being of the economically and socially disadvantaged populations within the Territory of Guam: by developing an efficient, and effective delivery system of services to eligible clients within the territory; by determining eligibility of applicants; and by administering payments and various social services to remove social barriers which prevent persons from obtaining/maintaining the basic necessities of life to include safe and decent housing, medical care, nutritious food and employment status. DPW is made up of four Bureaus:

Bureau of Economic Security (BES)  Administers the eligibility determination of the following federal and local programs: Supplemental Nutrition Assistance Program (SNAP); Cash Assistance Program (CAP); Child Care Development Fund (CCDF); Medicaid Assistance Program (MAP); Medically Indigent Program (MIP); and Administers the SNAP- Ed Program.

Bureau of Health Care Financing Administration (BHCFA)  Administers the benefits and coordination of the following programs: Medicaid Assistance Program (MAP); Children’s Health Insurance Program (CHIP); Medically Indigent Program (MIP); Enhanced Allotment Plan (EAP) Program; and Health Information Technology- Electronic Health Record (HIT- EHR), and Provider Incentive Payment.

Bureau of Management Support (BMS)  Administers Child Care Development Fund; Administers Temporary Assistance to Needy Families (TANF) JOBS Program, and SNAP Employment &Training Program; Conducts SNAP quality control; Conducts fraud investigations and collections; Oversees the SNAP Program Information, Monitoring and Management Evaluation; and Fair Hearing Coordination.

Bureau of Social Services Administration (BOSSA)  Administer Title XX of the Social Security Act, Foster Care and Adoption, Child Protective Services (CPS), and Home Evaluation and Placement Services (HEPS).

In an effort to meet the goals in their division strategic plan, DPW continues to work on the following initiatives:

Continuous staff training on existing and new mandates Strengthen program monitoring QC/Supervisory review of eligibility applications

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 10 | P a g e Implementation of approved waiver to streamline the welfare application process Pre-payment and post-payment utilization review of medical claims Health provider outreach Work beyond office hours to meet providers/clients expectations Implementing pilot projects such as the TANF Pay for Performance

BES promotes healthy families through program access and support services. In fiscal year 2016, the bureau interviewed 100,132 applicants and processed 66,231 applications for public assistance. BES applied and implemented the following approved waivers in an effort to improve program access:

 Able-Bodied Without Dependents Waiver (ABAWD) - allowed ABAWD population of Guam to participate under the SNAP program without having to meet the 20 hours per week work requirements due to lack of sufficient jobs in the island.  Application Reinstatement Waiver – Reinstatement of application after denial because of failure to submit additional required documents or information within 10 days from the date of request. This waiver allows the applicant not to file a new application if the household takes the required action needed within 30 days of the effective date of ineligibility and the household’s certification period has not expired.  Face-to-Face Interview Waiver- allowed the eligibility staff to conduct telephonic interview on disabled clients and clients without transportation  24-month Certification Waiver – approved by FNS Region IX, awaiting approval from USDA

Furthermore, Quality Control reviews captures the timely processing and issuance of SNAP and Fair Hearings are made available to all clients for all public assistance programs should they wish to dispute an action taken on their application or program benefits. There is no accreditation process required within DPW programs; however each program’s requirement has state plans that outline our goals and objectives.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 11 | P a g e Workforce Profile This section provides a description of our current and anticipated future workforce needs. Workforce Demographics 2017-2018

Category As of June 2017 As of December 2018

Total # of Employees: 414 438 Gender: Female: 321 344 Male: 93 94 Total # of Employees: 414 438 Age: <20: 0 0 20 – 29: 24 23 30 – 39: 64 77 40 – 49: 118 117 50 – 59: 133 146 >60: 75 75 Total # of Employees: 414 438 Employees by Division: DPH 230 DPW 146 DEH 26 DGA 26 DSC 10 Total # of Employees 438

Primary Professional Disciplines/Credentials:

*Administration 0 70 Building Maintenance 10 9 Cashier 3 2

Claims Processing and Utilization Review Officer 3 5

Claims Specialist 6 11 *Clerical 90 52 Coordinator 66 66 Dental Officer 1 1 Dental Specialist 2 2

Developmental Disability Aide 2 3

Eligibility Specialist 25 25

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 12 | P a g e Environmental Public Health Officer 10 14

Health Educator 9 6 Homemaker 6 6 Information Technologist 2 3 Investigator 8 9 Laboratorian 9 5 *Leadership/Administration 21 6 Management Analyst 5 6 Nursing 37 27 Nutrition Assistant 14 17 Nutrition Specialist 3 3 Pharmacist 2 1 Physician 14 15 Planner 1 1 Public Information Officer 1 1 Quality Control Reviewer 5 5 Social Workers 36 35 Supervisor 18 15 Technician 5 15 Territorial Epidemiologist 0 1 Territorial Registrar 0 1 Total # of Employees: 414 438 Retirement Plan:

Defined Contribution (NEW PLAN): 309 273

Defined Benefit (OLD PLAN): 102 54 Defined Benefit 1.75 0 82 Defined Benefit Non-Base 0 29 Other: 3 0 Total # of Employees: 414 438 Retirees Per Year: 2011 11 2012 17 2013 19 2014 14 2015 8 2016 10 2017 19 2018 12 Total # of Retirees 110 2017 2018

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 13 | P a g e Percentage eligible for retirement within the next 20% of 414 = 82.8 (83) 15% of 438 = 65.7 (66) few years (Employees <5 years from Retirement)

Source: Guam DPHSS Personnel Office/Department of Administration: Updated Workforce Demographics December 2018

Footnote: Primary Professional Disciplines/Credentials: *2018 Administration: Administrative Aide, Administrative Assistant, Administrative Officer, Community Health Chief Executive Officer, Communicable Disease Control Program Administrator, Community Health & Nursing Service Administrator, Customer Service Representative, Environmental Public Health Officer Administrator, Human Services Program Administrator, Personnel Officer, Public Health Laboratory Administrator, Public Health Nutrition Administrator, Safety Officer, Social Service Licensing Officer, Community Program Aide, Nurse Aide, & Public Health Aide *2018 Clerical: Clerk, Clerk Typist, Data Control Clerk, Medical Recork Clerk, Messenger Clerk, & Supply Clerk *2018 Leadership: Acting Director, Administrative Services Officer, Chief Environmental Public Health Officer, Chief Human Services Administrator, Chief Public Health Officer, & Senior Citizens Administrator,

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 14 | P a g e The following tables illustrate various categories of the DPHSS workforce 2017-2018 Table 1: DPHSS WFDP 2017-2018, Breakdown of Total # of Employees: Per Year DPHSS WFDP 2017-2018 Breakdown of Total # of Employees: Per Year

TOTAL NUMBER 438 (2018)

TOTAL NUMBER 414 (2017)

400 405 410 415 420 425 430 435 440 Total Number (2017) Total Number (2018) Total # of Employees: 414 438

Table 2: DPHSS WFDP 2017-2018, Breakdown by Gender DPHSS WFDP 2017-2018 Breakdown by Gender

438 TOTAL # OF EMPLOYEES: 414

94 MALE: 93 Gender

344 FEMALE: 321

0 50 100 150 200 250 300 350 400 450 500 Count

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 15 | P a g e Table 3: DPHSS WFDP 2017-2018, Breakdown by Age Group DPHSS WFDP 2017-2018 Breakdown by Age Group

438 Total # of Employees: 414

75 >60: 75

146 50 – 59: 133

Age 117 40 – 49: 118

77 30 – 39: 64

23 20 – 29: 24

0 <20: 0

0 50 100 150 200 250 300 350 400 450 500 Count

Table 4: DPHSS WFDP 2017-2018, Breakdown of Employees by Division DPHSS WFDP 2018 Breakdown of Employees by Divison

250 230

200

146 150 Count 100

50 26 26 10 0 DPH DPW DEH DGA DSC Divison

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 16 | P a g e Table 5: DPHSS WFDP 2017-2018, Breakdown by Primary Professional Disciplines/Credentials

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 17 | P a g e Table 6: DPHSS WFDP 2017-2018, Breakdown by Retirement Plan DPHSS WFDP 2017-2018 Breakdown by Retirement Plan

438 TOTAL # OF EMPLOYEES: 414

0 OTHER: 3

29 DEFINED BENEFIT NON-BASE 0 Defined Benefit 1.75 82 Started effective

Retirement Plan Retirement DEFINED BENEFIT 1.75 0 January 01, 2018

54 DEFINED BENEFIT (OLD PLAN): 102

273 DEFINED CONTRIBUTION (NEW PLAN): 309

0 100 200 300 400 500 2018 2017 Count

Table 7: DPHSS WFDP 2017-2018, Breakdown of Retirees per Year DPHSS WFDP 2011-2018 Breakdown of Retirees per Year Total # of Retirees: 110 20 19 19

18 17

16 14 14 12 12 11 10 10 8 8 Numberof Retirees 6

4

2

0 2011 2012 2013 2014 2015 2016 2017 2018 Per Year

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 18 | P a g e

Table 8 (a): DPHSS WFDP 2011-2018, Total # of DPHSS Employees/Year

DPHSS WFDP 2011-2018 Breakdown by Year Total # of DPHSS Employees/Year

Year 2011 2012 2013 2014 2015 2016 2017 2018

Total # of DPHSS 261 279 305 332 378 392 415 438 Employees

Table 8 (b): DPHSS WFDP 2011-2018, Total # of DPHSS Employees/Year

DPHSS WFDP 2011-2018 Breakdown by Year Total # of DPHSS Employees/Year

2018 2017 2016 2015

Year 2014 2013 2012 2011

0 100 200 300 400 500 Number of Employees

Source: Guam DPHSS Personnel Office/Department of Administration, December 2018

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 19 | P a g e Table 9: DPHSS WFDP 2011-2018, Classification Breakdown by Nature of Action

NATURE OF ACTION 2011 2012 2013 2014 2015 2016 2017 2018

Competitive Limited 4 2 4 7 5 4 5 2 Term Appointment Contractual Unclassified 7 3 8 4 8 3 10 5 Limited Term 3 2 5 7 5 10 9 16 Appointment Probation (New) 29 14 28 23 46 17 29 18 Reappointment 1 0 1 0 0 0 2 0 Reemployment 12 1 2 0 2 2 3 2 Resignation / 20 22 27 19 21 23 31 18 Separation Retirement 11 17 19 14 8 10 19 6 Temporary 1 2 3 2 1 3 1 6 Appointment Unclassified 6 1 3 2 2 3 2 0 Appointment

Source: Guam DPHSS Personnel Office/Department of Administration, December 2018

DPHSS WFDP 2011-2018: Classification Breakdown Nature of Action

Table 1: DPHSS 2011 Nature of Action

Unclassified Appointment 6

Temporary Appointment 1

Retirement 11

Resignation / Separation 20

Reemployment 12

Reappointment 1

Probation (New) 29

Limited Term Appointment 3

Contractual Unclassified 7

Competitive LTA 4

0 5 10 15 20 25 30 35 2011

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 20 | P a g e

Table 2: DPHSS 2012 Nature of Action

Unclassified Appointment 1

Temporary Appointment 2

Retirement 17

Resignation / Separation 22

Reemployment 1

Reappointment 0

Probation (New) 14

Limited Term Appointment 2

Contractual Unclassified 3

Competitive LTA 2

0 5 10 15 20 25 2012

Table 3: DPHSS 2013 Nature of Action

Unclassified Appointment 3

Temporary Appointment 3

Retirement 19

Resignation / Separation 27

Reemployment 2

Reappointment 1

Probation (New) 28

Limited Term Appointment 5

Contractual Unclassified 8

Competitive LTA 4

0 5 10 15 20 25 30 2013

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 21 | P a g e

Table 4: DPHSS 2014 Nature of Action

Unclassified Appointment 2

Temporary Appointment 2

Retirement 14

Resignation / Separation 19

Reemployment 0

Reappointment 0

Probation (New) 23

Limited Term Appointment 7

Contractual Unclassified 4

Competitive LTA 7

0 5 10 15 20 25 2014

Table 5: DPHSS 2015 Nature of Action

Unclassified Appointment 2

Temporary Appointment 1

Retirement 8

Resignation / Separation 21

Reemployment 2

Reappointment 0

Probation (New) 46

Limited Term Appointment 5

Contractual Unclassified 8

Competitive LTA 5

0 5 10 15 20 25 30 35 40 45 50 2015

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 22 | P a g e

Table 6: DPHSS 2016 Nature of Action

Unclassified Appointment 3

Temporary Appointment 3

Retirement 10

Resignation / Separation 23

Reemployment 2

Reappointment 0

Probation (New) 17

Limited Term Appointment 10

Contractual Unclassified 3

Competitive LTA 4

0 5 10 15 20 25 2016

Table 7: DPHSS 2017 Nature of Action

Unclassified Appointment 2

Temporary Appointment 1

Retirement 19

Resignation / Separation 31

Reemployment 3

Reappointment 2

Probation (New) 29

Limited Term Appointment 9

Contractual Unclassified 10

Competitive LTA 5

0 5 10 15 20 25 30 35 2017

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 23 | P a g e

Table 8: DPHSS 2018 Nature of Action

Unclassified Appointment 0

Temporary Appointment 6

Retirement 6

Resignation / Separation 18

Reemployment 2

Reappointment 0

Probation (New) 18

Limited Term Appointment 16

Contractual Unclassified 5

Competitive LTA 2

0 2 4 6 8 10 12 14 16 18 20 2018

DPHSS Future Workforce According to input provided by the DPHSS Personnel Officer, approximately 15% of the staff is eligible for retirement in the next 5 years (August, 2018). This may result in a future workforce that includes young, new professionals and systems that may need to be put in place (i.e. cross training, succession planning, written policies and protocols, standards of practice, etc.) to capture institutional knowledge. Although some divisions have already started having their staff prepare their Standards of Practice (SOPs), it has yet to be implemented throughout the entire department. Similar to a job description, an SOP is a written document that outlines the employee’s job duties. This document can also serve as a resource for new employees who may be hired to fill a vacancy left by staff due to resignation or retirement. Succession planning is essential in any organization. It helps to sustain and maintain continuity of operations due to job vacancies as a result of resignation or retirement by providing a plan and process for addressing the transition that will occur when staff leave due to resignation or retirement. The QIC has not addressed succession planning or cross training in the workforce development plan. This may be considered as a goal for future QIC projects. Emerging issues such as Zika virus, teen suicide, sexual orientation and gender inequity, compact impact, military buildup, emergency preparedness, and medical marijuana, among others, will affect the department’s workforce and will be dictated by future mandates or public health concerns/threats. Some of these emerging issues are discussed below.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 24 | P a g e

Emerging Issues Zika Virus Guam has generally been free of mosquito-borne disease since the 1960s, and all reported mosquito-borne illnesses on Guam have been from individuals coming to the island after being infected from their travel in foreign countries where these diseases are endemic. Guam has been fortunate that no mosquito-borne diseases have become established despite the island’s proximity to these endemic countries. However, that may be short- lived. Transmission of the Zika virus, and the possible effect on babies born on Guam, is a major concern for Guam DPHSS. Guam has a high volume of travelers between Guam and many of the affected areas in Asia and the Pacific. Zika virus outbreaks have occurred in the neighboring island of Yap, and more recently in Kosrae, both in the Federated States of Micronesia, and in the Republic of the Marshall Islands. The frequency and ease of travel of visitors and residents from these neighboring islands and other countries with ongoing outbreaks increase the risk of importation of the Zika virus. DPHSS is proactive in surveillance and in ensuring the public has information on the risks for individuals traveling to areas of the world with active Zika transmission, prevention of Zika transmission through sexual contact, and of safe and effective ways to decrease the risk of bites from mosquitos carrying the Zika virus. The DEH has recently built the Guam Environmental Public Health Laboratory (Guam EPHL). The Guam EPHL is still in its infancy stages but is currently building its capacity to eventually be the regions only lab and resource in regards to vector surveillance and control. The DEH is currently collaborating with the Pacific Island Health Officers’ Association (PIHOA) and the Centers for Disease Control (CDC) for its capacity building. Teen Suicide The death of any child under any circumstance is extremely devastating to families and the community. However, when a child takes their own life, there is an even greater impact to families and communities. Nationally, suicide is the second leading cause of death for youth ages 10-24 (Centers for Disease Control and Prevention, 2015). On Guam, suicide has consistently been in the top five causes of injury-related death among 15-19 year old youth. Within the last year, there has been an increase in suicide deaths among teens and young adults on Guam. One of the problems is getting psychiatric counseling when it is needed. For teenagers, depression is considered a major - if not the leading - cause of teen suicide. Factors and risks contributed to youth suicide are academic pressure, alcohol consumption, the loss of a valued relationship, frequent change of residency, and poor family patterns. Gay teens or those unsure of their sexual identity are more likely to commit suicide, particularly if they have suffered bullying or harassment. In the United States, about 60 percent of suicides are carried out with a gun so risk of suicide increases in households with a firearm. Sexual Orientation and Gender Inequity Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals are at increased risk for some adverse health conditions compared to their straight peers. Past public health efforts have primarily focused on disparities related to sexual behavior, such as HIV infection. Recently, there has been a growing recognition of health disparities among sexual minorities that are associated with social stigma and discrimination.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 25 | P a g e In the last few years, the LGBT community has experienced historic political shifts from marriage equality to greater employment protections. However, despite the attention and focus on rights and marriage equality, the health and mental health needs of the LGBT community is lacking greater attention, affecting gaps in the social service delivery system in responding to the unique needs of the LGBT community as a culturally and socially vulnerable minority group. LGBT populations appear to be at a higher risk than their straight peers for some chronic conditions, such as asthma, disability, and arthritis. Although gay men have a reduced risk for obesity compared to straight men, lesbian women may be at an increased risk for obesity compared to straight women. There is also some evidence that LGBT populations may experience more discrimination when accessing healthcare services and may be less likely to have health insurance than their straight peers. Consequently, LGBT populations may under- utilize certain health care services, such as cancer screenings. DPHSS needs to be standard-bearers of health equity inclusive of sexual orientation and gender equity for all populations served by our programs. Creating a safe environment can encourage LGBT individuals to come in for care and assistance, and communicate to their community their positive experience with DPHSS. Health Professional Shortage Area (HPSA) /Medically Underserved Area (MUA) The Health Resources & Services Administration (HRSA) has calculated an Index of Medical Underservice (IMU) score for communities across the U.S. The IMU score calculation includes the ratio of primary medical care physicians per 1,000 persons, the infant mortality rate, the percentage of the population with incomes below the poverty level, and the percentage of the population older than 64. IMU scores range from zero to 100, where “100” represents the least underserved and “zero” represents the most underserved. An area can receive a federal HPSA designation if a shortage of primary care, dental care, or mental health care professionals is found to be present. The U.S. Department of Health and Human Services recently designated Guam as a Health Professional Shortage Area (HPSA) as well as a Medically Underserved Area (MUA). HPSA status is granted to areas that demonstrate a need in one or more of the following categories: primary care (including family and general practitioners, pediatricians, obstetricians, and general internists in allopathic or osteopathic practice), mental health, and dental care. Guam has also gained designation as a MUA, which now provides an option for stateside doctors to work off a portion of their medical education loans by serving as a physician on Guam. Guam has a mix of public and private providers, including 4 large private primary care and multi-specialty clinics (all located centrally within a few miles of the hospital), about a dozen private practice clinics, and a privately owned birthing center. There are more than 300 physicians, 28 dentists, 6 personal and family counselors, and 11 optical centers. More than 20 pharmacies are available, as well as 2 private laboratories that serve the island. Despite a relatively high number of licensed physicians on the island, Guam is considered a Health Professional Shortage Area and Medically Underserved Area by HRSA. This is especially true in the areas of obstetrics and pediatrics; there are only 15-18 of each practicing on Guam, which is far from enough given the very high birth rate on the island. Also, the lack of specialists and the remoteness of the island means that the primary care physicians must take over those functions too, thus exacerbating the lack of accessible primary care. This shortage of specialty care extends to most fields, including orthopedics, dermatology, neurology, critical care, and cardiology. In other areas, such as neurosurgery, allergy/immunology, gastroenterology, and pediatric

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 26 | P a g e subspecialties, there is no on-island care available at all. Thus all physicians must maintain high skill levels, despite a lack of easily accessible continuing medical education. When addressing health disparities, it is important not to overlook the mental health of a population. Most of the work done on Pacific areas is not specific to Guam, but remains the best approximation until more focused research is done in Guam. Pacific island areas have substantially fewer per capita mental health providers than urban areas. Moreover, providers with higher level of specialization in the area of mental health and with greater expertise are extremely scarce in these areas. One important factor in addressing mental health service delivery in Guam is that there is little to no community based research specific to the region. Studies have been generally limited to descriptive studies of the Pacific without comparison groups or using national data as the comparison. These types of studies are very limiting in the depth of data that may be gleaned. This includes lack of data concerning the availability of and access to mental health providers in the area, as well as less salient reasons why mental health services are not sought. Compact Impact In recognition of the possible adverse impact to Guam's economy of providing health care, education, job training and public assistance to the peoples of foreign nations not domiciled on Guam, Congress promised to appropriate sums to cover costs incurred by Guam resulting from any increased demands placed on educational and social services by immigrants from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau (collectively known as the Freely Associated States, or FAS). Annual reports are to be submitted to the Secretary of the Department of the Interior who “shall review and forward any such reports to the Congress with the comments of the Administration,” pursuant to Public Law 106-504. The number of Micronesian migrants living on Guam has increased 66% between 2000 and 2010 according to recent census data. Hosts to migrants from Freely Associated States have argued that funding from the federal government to pay for services provided to migrants, from education to healthcare, falls short of the actual cost. This leaves the local government to fund the difference. Federal officials have questioned the estimate of the incurred, asking how migrants who contribute to the local community are accounted for. Social Media

The revolution of social media has allowed people to change the way they communicate and how they find and share information. Prior to social media, communicating and sharing information was done physically. With advances in technology, sharing information to the world to view can be done easily and instantly. Social media provides an easy way to share information and seek entertainment, has very few restrictions on creatively expressing oneself, and is an alternative way of socializing. Social media’s impact on the political, business, and socialization arena has been influential and far-reaching. The internet is a facilitator for social media. The most far-reaching influence is the ability to learn, connect, make new friends, market and sell products, and perhaps inspire elections and political mass movements throughout the world.

There are some negative effects of social networking that include privacy, productivity, cyber bullying, and online harassment. The age group of 12-21 years access social media more than other age groups. Social media has the power to influence youth, and is a very powerful temptation. Research shows that 2 in 3 youth feel pressure to look good; and 1 in 3 youth have been bullied online.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 27 | P a g e Social media is addictive. Writing posts and receiving positive reinforcement from others is addictive and research reveals that teens can show symptoms similar to drug withdrawal when they take time off from their social media connection.

According to The New York Times, kids from ages eight to 18 spend more than seven and a half hours a day on electronic devices. This has led to teens receiving insufficient sleep, which can further lead to developing many mental health issues such as anxiety and irritability. Spending too much time on devices can affect the development of critical social skills. The games played by youth on social media make violence seem normal. Perhaps this may contribute to the recent news of shootings and other crimes committed among youth.

Tax Cuts and Jobs Act Congress passed the Tax Cuts and Job Act on December 20, 2017. This legislation was designed to cut taxes on individuals and business, stimulate the economy, and create jobs. Guam mirrors the federal tax code. The cuts all taxpayers to keep more of their money, and thus reduce revenues to the Government of Guam that could be used for operations. The Tax Cuts are projected to cost the government of Guam an estimated of more than $50 million dollars in revenues in 2018. With fewer revenues, government of Guam agencies will have reduced budgets, and the effects of reduced budgets mean less money to hire workers needed to achieve agency goals and objectives.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 28 | P a g e Competencies & Education Requirements A motivated, competent and prepared workforce It is the goal of DPHSS to provide continuous education and training to staff in order to become a stronger public health workforce for Guam to address these issues. We expect that our future workforce will be motivated, competent, and prepared in public health practice. Through training and staff development, the DPHSS workforce will be knowledgeable about evidence-based public health practices and stay abreast of innovative approaches to effectively address and improve health outcomes of Guam’s population. The three priorities identified in the OSP also help to prepare our Department for the future workforce. (Workforce Development, Information Technology (IT) Modernization & Support, and Organizational Structure & Processes). Action across these priorities is expected to lead to a strong, equitable, accountable, efficient, sustainable, and resilient health system that delivers quality health services to the entire Guam community, leading to optimal health outcomes and high-quality health care. DPHSS is committed to embracing an organizational culture of continuous learning and development of all staff and the effective application of those skills to become a stronger public health workforce for Guam. The purpose of this Plan is to provide the framework on how this can be achieved.

Core Competencies The delivery of quality public health services requires diverse knowledge, skills, and abilities (KSAs) of the public health workforce. Core competencies are a set of skills essential for a broad practice of public health and are used by the public health workforce. DPHSS uses a tri-level framework of competencies to ensure all staff are capable of carrying out their roles to fulfill the Department’s mission. Public Health Core Competencies and Organizational Competencies are the focus of this document.

Organizational

Public Health Core

Profess ional

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 29 | P a g e Figure 1: DPHSS Selected Competency Levels

The following are the Public Health Core Competencies:

PUBLIC HEALTH CORE Competency Statement COMPETENCIES CATEGORY

Communicates in writing and orally with linguistic and cultural proficiency (e.g. use age- appropriate materials, incorporating images) Conveys data and information to professionals and the public using a variety of approaches (e.g., reports, presentations, email, letters, pamphlets, PSAs, websites, as COMMUNICATION needed) SKILLS Builds and maintains customer satisfaction with the products and services offered by the organization AND/OR Seeks to resolve confrontations and disagreements constructively AND/OR Diplomatically handles challenging or tense interpersonal situations.

Describes the concept of diversity as it applies to individuals and populations (e.g., language, culture, values, socioeconomic status, geography, educations, race, gender, CULTURAL age, ethnicity, sexual orientation, profession, religious affiliation, mental and physical COMPETENCY abilities, life experiences) SKILLS Addresses the diversity of individuals and populations when implementing policies, programs, and services that affect the health of a community.

Describes the programs and services provided by governmental and non- governmental organizations to improve the health of a community. (e.g., You are able to provide general information about your program and other programs within and outside the agency.) COMMUNITY Collaborates and engage with community partners to improve health in a community DIMENSIONS OF (e.g., participates in committees, shares data and information, connects people to PRACTICE SKILLS resources, participating in outreach events) Provides input for improving programs and services Knowledgeable and correctly informs the public about policies, programs, and resources that improve health in a community

Describes how public health sciences (e.g., biostatistics, epidemiology, environmental PUBLIC HEALTH health sciences, health services administration, social and behavioral sciences, and SCIENCES SKILLS public health informatics) are used in the delivery of the 10 essential public health services.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 30 | P a g e Adheres to organizational policies and procedures Provides information for proposals for funding (e.g., federal, local government agencies)

FINANCIAL Promotes cooperation and commitment within a team to achieve goals and PLANNING AND deliverables MANAGEMENT Motivates colleagues for the purpose of achieving program and organizational goals SKILLS (e.g., participating in teams, encouraging sharing of ideas, respecting different points of view) Uses evaluation result to improve program and organizational performance Describes the organizational structures and functions of the agency/program

Incorporates ethical standards of practice (e.g., Public Health Code of Ethics) into all interactions with individuals, organizations, and communities Identifies internal and external facilitator and barriers that may affect the delivery of the 10 Essential Public Health Services (e.g., using root cause analysis and other quality improvement methods and tools, problem solving) LEADERSHIP AND Describes needs for professional development (e.g., training, mentoring, peer SYSTEMS advising, coaching) THINGKING SKILLS Participates in professional development opportunities Describes the impact of changes on organizational practices Describes ways to improve individual and program performance Focuses on results and desired outcomes and how best to achieve them. Gets the job done.

PUBLIC HEALTH Assume responsibility for taking specific actions that further organizational mission or PREPAREDNESS population health in the presence of a public health emergency AND EMERGENCY RESPONSE

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 31 | P a g e Training Needs & Result The Public Health Workforce Training Needs Assessment Survey was designed to identify and prioritize training and development initiatives for DPHSS employees. The survey was based on a set of twenty-four organizational competencies that were identified by the QI Council. The first assessment tool 2017 was distributed to DPHSS DPH and the DEH staff beginning June 26, 2017 through July 7, 2017 via Survey Monkey. A total of 122 out of 260 employees responded with a response rate of 47%. The second assessment tool was distributed to DPHSS DGA, DSC, and DPW last February 12th, 2018 at 8:00 am until Friday, February 23rd, 2018 at 5:00 pm. A total of 31 respondents out of 182 employees participated during the survey 2018 with a response rate of 17%. A total of 153 respondents out of 438 employees took the survey with a total of 35% from survey set 2017 & 2018.

Competency-Based Training Needs There were twenty-four organizational competencies assessed, the three were listed in the table below were identified as being of highest need. Figure 1: Survey Set 2017 Rank Competency Competency Statement Category

Financial Planning and *Provides information for proposals for funding (e.g., federal, local government 1 Management agencies) Skills

Identifies internal and external facilitators and barriers that may affect the Public Health 2 delivery of the 10 Essential Public Health Services (e.g., using root cause analysis Sciences Skills and other quality improvement methods and tools, problem solving)

Leadership and 3 Systems Describes ways to improve individual and program performance. Thinking Skills

Figure 2: Survey Set 2018 Rank Competency Competency Statement Category

Financial Planning and *Provides information for proposals for funding (e.g., federal, local government 1 Management agencies) Skills

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 32 | P a g e Leadership and Describes needs for professional development (e.g., training, mentoring, peer 2 Systems advising, coaching) Thinking Skills

Financial Planning and 3 Describes the organizational structures and functions of the agency/program. Management Skills

Training Motivators In addition to the competency-related questions, respondents were asked “What motivates you to participate in trainings?” Responses were rated on a scale of 1 (Low Motivation) to 4 (High Motivation). The statements are ranked according to weighted average in the table below. Figure 1: Survey Set 2017 Training Motivators (Rating Score)

*Increasing my competency in public health practice (3.60)

*Accomplishment of the mission of the agency (3.58)

Personal satisfaction (3.50)

Professional networking opportunity (3.50)

Personal career advancement (3.45)

Maintain a license and/or certification for my job (3.32)

Figure 2: Survey Set 2018 Training Motivators (Rating Score)

*Accomplishment of the mission of the agency (3.74)

*Increasing my competency in public health practice (3.71)

Personal satisfaction (3.71)

Professional networking opportunity (3.68)

Personal career advancement (3.55)

Maintain a license and/or certification for my job (3.32)

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 33 | P a g e Training Barriers Respondents were asked, “What prevents you from participating in training?” and to rate how much of a barrier each statement posed on a four-point scale of 1 (Not a Barrier) to 4 (Very Much a Barrier). The statements are ranked in the table below by weighted average. Figure 1: Survey Set 2017 & 2018 (same result) Barriers to Training

Agency and/or grant budget restrictions

Time away from work

Individual/personal cost

Preferred Training Delivery Methods Respondents were asked to rate their interest in several training delivery methods on a four-point scale from 1 (Not Interested) to 4 (Very Interested). The responses are shown in the table below and are ranked according to weighted average. Figure 1: Survey Set 2017 & 2018 (same result) Training Delivery Methods

Face-to-face

Online - self study

Blended (online and face-to-face)

Health Equity Training The Guam Office of Minority Health (GOMH) is a program within DPHSS. GOMH exists to eliminate racial and ethnic disparities, with a focus on under-served and under-represented communities. Guam has a very rich and diverse multi-lingual and multi-cultural community. In order to make health and social services successful for service providers, GOMH offers “Culturally and Linguistically Appropriate” (CLAS) Trainings to government and non-government entities. The GOMH Program works in cross-collaboration with government agencies, the private sectors, and with stakeholders in the promotion and provision of CLAS Trainings. This training uses local and regional applications of cultural and linguistic competence to increase the quality of services to diverse populations and those who may be under-served or under-represented.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 34 | P a g e Proposed Strategies to Address Training Needs In order to address training needs of DPHSS staff, the QIC has made the following recommendations to minimize the barriers to training identified from the training needs assessment. These recommendations should be assessed during the planning phases of trainings and professional development opportunities. Barriers to Training Recommendations to Address Training Barriers

Agency and/or grant Partner with another agency to offer training, create offerings in-house, pool budget restrictions grant funds to bring in outside instructors, offer webinars, and utilize POLHN training room etc.

Time away from work Offer in-house training and/or webinars for staff, and schedule staff development activities

Individual/personal cost Develop training budget, subsidize training-related fees, i.e., CEU's, Increase per- diem, and develop in-house check list

The following strategies are recommended based on the results of the training needs assessment and the agency’s capacity level. These strategies serve as initial priorities for DPHSS relative to training and development of the workforce. Included for each strategy is a timeline and responsible parties.

Competency Competency Strategy Timeline Responsibility Category Statement

Provides  Assess availability of local and  TBA  DGA, DPH, Financial information for regional trainings and preferred DEH, DSC, & Planning and proposals for training method of staff DPW in Management funding (e.g.,  Secure resources needed to collaboratio Skills federal, local provide trainings n with QIC  Provide trainings and evaluate (2017 & 2018) government agencies) training outcome

Identifies internal  Assess availability of local and  TBA  DPH/DEH in and external regional trainings, and preferred collaboratio Public Health facilitator and training method of staff n with QIC   Sciences Skills barriers that may Secure resources needed to *Proposed affect the delivery provide training Plan (2017) of the 10 Essential  Provide training and evaluate Public Health training outcome Services

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 35 | P a g e  Assess availability of local and  TBA  DPH/DEH, in Leadership Describes ways to regional trainings and preferred collaboratio and Systems improve individual training method of staff n with QIC Thinking Skills and program  Secure resources needed to  *Proposed provide trainings Plan (2017) performance  Provide trainings and evaluate training outcome *Describes needs for  Assess availability of local and  TBA  DGA, DSC, & Leadership professional regional trainings and preferred DPW in and Systems development (e.g., training method of staff collaboratio Thinking Skills training, mentoring,  Secure resources needed to n with QIC provide trainings (2018) peer advising, coaching)  Provide trainings and evaluate training outcome  Assess availability of local and  TBA  DGA, DSC, & Financial *Describes the Planning and regional trainings and preferred DPW in organizational training method of staff collaboratio Management structures and  Secure resources needed to n with QIC Skills functions of the provide trainings (2018) agency/program.  Provide trainings and evaluate training outcome

Workforce Development Goals

The DPHSS Strategic Plan prioritizes Workforce Development as a Tier 1 Priority. The following objectives were developed to provide a framework for sustaining a competent and capable workforce and an effective learning culture to meet Guam’s health needs. Ultimately, establishing a Performance Improvement Management Office (PIMO) to oversee the Department’s training and professional development efforts was identified by the QIC to be a major component of the following workforce development goals.

Priority: Workforce Development to meet Guam’s health needs

Objective Strategy Measure Responsibility

By the end 2018, assess the Implement an agency-level Assessment Personnel Officer, feasibility of: a) creating training database to track conducted; findings QIC, PIMO, Division Performance Improvement all staff trainings in presented to DPHSS Heads Management Office and, b) collaboration with each leadership; action manage a training database Division Head (or their items developed to track all staff trainings designee) and develop action items to address findings

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 36 | P a g e By mid-2019, finalize and Implement an agency-wide Training and Personnel Officer, implement a departmental training and development development policy QIC, PIMO training and development policy to serve as the finalized policy that outlines required foundation of the trainings Workforce Development Plan

By the end 2019, all DPH and Develop a competent Completed individual Personnel Officer, DEH employees will have an DPHSS workforce development plans Employee and individual professional Supervisor development plan (as part of the performance review process) and a training log

By mid-2019, establish a Foster a DPHSS learning Needs assessment Personnel Officer, baseline of agency-wide culture that listens to and conducted across all QIC, PIMO training needs using DPHSS proactively addresses divisions Training Needs Assessment employee needs Tool

By the end of 2019, draft a Develop an agency-wide Draft of agency-wide Personnel Officer, workforce development plan Workforce Development Workforce QIC, PIMO that includes all DPHSS Plan Development Plan divisions developed

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 37 | P a g e Curricula & Training Schedule

DPHSS strives to meet the health needs of Guam through a competent and efficiently performing workforce. To achieve this, opportunities for training and workforce development are created by assessing the needs of the agency’s workforce; ensuring such opportunities are delivered in a timely manner; and conducive to the learning of the DPHSS workforce. A table containing required trainings for DPHSS staff is listed in Appendix C. The following action steps were prioritized by the QIC to ensure these trainings and workforce development opportunities are delivered efficiently and evaluated for effectiveness regularly. Action Step 1: Ensure employees attend all required trainings  Have sign-in sheets at the beginning of each training;  Attendance monitored by DPHSS PIMO in collaboration with each Division Head Action Step 2: Periodically assess the training needs of DPHSS workforce  Distribute DPHSS Training Needs Assessment tool to all staff;  Share results to DPHSS leadership Action Step 3: Establish a schedule of trainings available to DPHSS staff  Make a tentative schedule of trainings available on DPHSS website;  Announce via email one month prior to scheduled training Action Step 4: Ensure all trainings are evaluated for effectiveness  Utilize DPHSS Training Evaluation Form at the conclusion of each training;  QIC and PIMO will analyze the outcome of each training and assess for overall quality Based on the results of the training needs assessment, the leading priority areas focus on financial planning and management skills, public health sciences skills, and leadership and systems thinking skills. These areas are also included in Appendix C and should be revised based on periodic training needs assessments.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 38 | P a g e Implementation & Monitoring

Introduction This section provides information regarding communication, evaluation, tracking and monitoring, and review of the plan. Communication Sharing of information within DPHSS workforce is essential to the agency’s culture of learning and staff development. It is the intent of QIC, PIMO, and the Personnel Officer to ensure this Plan and opportunities for training and development are communicated to leadership, staff, and stakeholders through the following avenues: • Posted on the DPHSS website at dphss.guam.gov;  Emails;  Social Media such as Facebook at https://www.facebook.com/guamdphss; • Included in new employee orientation handbook; and • Hardcopies of the plan and other training-related information made available for staff access at the PIMO.

Training Evaluation Evaluation of all trainings sponsored or facilitated by DPHSS will be conducted using a standardized form (See APPENDIX D). Areas of evaluation include if training objectives were met, effectiveness of overall training and trainer(s), delivery and open-ended questions for participants to provide feedback about the weaknesses and strengths of the training as well as how the training will be applied in the participant’s work environment. Tracking The DPHSS PIMO will facilitate the tracking tools of trainings completed by department staff in collaboration with each Division Head (or their designee) to ensure efficient documentation will include names, dates, times, locations and collection of supportive documents, and completion of transcripts, and records/logs updated annually. In addition, the DPHSS PIMO will maintain a repository of courses and trainings available to department staff on the DPHSS website at dphss.guam.gov. Registration information will be communicated by PIMO to prospective training participants. Roles and Responsibilities DPHSS leadership, QIC, PIMO, and Personnel Officer will collaborate to ensure all program managers and supervisors are equipped with the knowledge and tools related to workforce development such as: recruitment process, work planning and performance evaluation, etc. Program managers and supervisors must orient their staff regarding this Plan, the DPHSS OSP, and provide support toward learning opportunities for the staff’s professional growth and development. Lastly, all staffs are responsible for understanding the availability and resources to identify trainings; the schedule of required trainings; informing their program manager/supervisors of needed trainings; and other professional development opportunities to include an individual development plan in collaboration with their program manager/supervisor.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 39 | P a g e The DPHSS PIMO and Personnel Officer will collaborate with the QIC to ensure updates are made to this plan as needed and communicated to agency leadership and staffs. Review and Maintenance Review and/or revision of this plan shall be conducted at least once annually by the Performance Improvement Management Officer, HR Personnel Officer and the QIC. Furthermore, a department-wide assessment of training needs should be carried out periodically and should precede any major revisions to this plan.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 40 | P a g e APPENDIXES: A-E

APPENDIX A: FY 2018 DPHSS Organizational Chart

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 41 | P a g e APPENDIX B: Competency Statements Ranked by Negative Score The survey included two self-reported assessment measures: 1) importance to job, and 2) personal ability. These self-reported assessment measures were collected for each of the 24 organizational competencies. In addition to the competency-related questions, employees were asked to rate their level of motivators and barriers for participation in training, and preferences for course delivery methods. The survey was adapted from the Allen County Public Health Workforce Training Needs Assessment tool (see Appendix E). Methods Need Score: A need score was calculated for each competency statement as the personal ability score minus the importance to job score (using the weighted averages for calculation). The need score could range from -3 to +3 with a negative score indicating a potential need for training. A table outlining the Competency Statements ranked by their negatives scores are in Appendix B. Influencing Factors: Respondents rated motivators for participation in training, barriers to participating in training and preferred course delivery methods. Responses for these categories were rated on a four-point Likert scale. Table 1: Survey Set 2017

Competency Statement: Survey Set 2017 Score

1 Provides information for proposals for funding (e.g., federal, local government agencies) -0.42

2 Identifies internal and external facilitator and barriers that may affect the delivery of the -0.40 10 Essential Public Health Services (e.g., using root cause analysis and other quality improvement methods and tools, problem solving)

3 Describes ways to improve individual and program performance. -0.35

4 Describes the impact of changes on organizational practices. -0.32

5 Communicates in writing and orally with linguistic and cultural proficiency (e.g. use -0.31 age- appropriate materials, incorporating images)

6 Uses evaluation result to improve program and organizational performance. -0.31

7 Addresses the diversity of individuals and populations when implementing policies, -0.30 programs, and services that affect the health of a community.

8 Knowledgeable and correctly informs the public about policies, programs, and -0.30 resources that improve health in a community.

9 Provides input for improving programs and services. -0.29

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 42 | P a g e 10 Describes needs for professional development (e.g., training, mentoring, peer advising, -0.28 coaching)

11 Participates in professional development opportunities. -0.28

12 Describes how public health sciences (e.g., biostatistics, epidemiology, environmental -0.27 health sciences, health services administration, social and behavioral sciences, and public health informatics) are used in the delivery of the 10 essential public health services.

13 Assume responsibility for taking specific actions that further organizational mission or -0.26 population health in the presence of a public health emergency.

14 Collaborates and engage with community partners to improve health in a community -0.25 (e.g., participates in committees, shares data and information, connects people to resources, participating in outreach events.)

15 Conveys data and information to professionals and the public using a variety of -0.24 approaches (e.g., reports, presentations, email, letters, pamphlets, PSAs, websites, as needed.)

16 Describes the programs and services provided by governmental and non-governmental -0.23 organizations to improve the health of a community. (e.g., You are able to provide general information about your program and other programs within and outside the agency.)

17 Focuses on results and desired outcomes and how best to achieve them. Gets the job -0.23 done. AND/OR Takes personal responsibility for the quality and timeliness of work, and achieves results with little oversight AND/OR Builds constructive working relationships characterized by a high level of acceptance, cooperation, and mutual respect.

18 Motivates colleagues for the purpose of achieving program and organizational goals -0.22 (e.g., participating in teams, encouraging sharing of ideas, respecting different points of view)

19 Describes the concept of diversity as it applies to individuals and populations (e.g., -0.21 language, culture, values, socioeconomic status, geography, educations, race, gender, age, ethnicity, sexual orientation, profession, religious affiliation, mental and physical abilities, and life experiences).

20 Promotes cooperation and commitment within a team to achieve goals and -0.20 deliverables.

21 Describes the organizational structures and functions of the agency/program. -0.17

22 Incorporates ethical standards of practice (e.g., Public Health Code of Ethics) into all -0.16 interactions with individuals, organizations, and communities.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 43 | P a g e 23 Builds and maintains customer satisfaction with the products and services offered by -0.10 the organization AND/OR Seeks to resolve confrontations and disagreements constructively AND/OR Diplomatically handles challenging or tense interpersonal situations.

24 Adheres to organizational policies and procedures. -0.10

Table 2: Survey Set 2017

Competency Statement: Survey Set 2018 Score

1 Provides information for proposals for funding (e.g., federal, local government agencies) -0.47

2 Describes needs for professional development (e.g., training, mentoring, peer advising, -0.46 coaching)

3 Describes the organizational structures and functions of the agency/program. -0.45

4 Describes how public health sciences (e.g., biostatistics, epidemiology, environmental -0.43 health sciences, health services administration, social and behavioral sciences, and public health informatics) are used in the delivery of the 10 essential public health services.

5 Uses evaluation result to improve program and organizational performance. -0.42

6 Focuses on results and desired outcomes and how best to achieve them. Gets the job -0.37 done. AND/OR Takes personal responsibility for the quality and timeliness of work, and achieves results with little oversight AND/OR Builds constructive working relationships characterized by a high level of acceptance, cooperation, and mutual respect.

7 Identifies internal and external facilitator and barriers that may affect the delivery of -0.35 the 10 Essential Public Health Services (e.g., using root cause analysis and other quality improvement methods and tools, problem solving)

8 Describes the impact of changes on organizational practices. -0.35

9 Describes the concept of diversity as it applies to individuals and populations (e.g., -0.33 language, culture, values, socioeconomic status, geography, educations, race, gender, age, ethnicity, sexual orientation, profession, religious affiliation, mental and physical abilities, and life experiences).

10 Addresses the diversity of individuals and populations when implementing policies, -0.32 programs, and services that affect the health of a community.

11 Participates in professional development opportunities. -0.32

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 44 | P a g e 12 Collaborates and engage with community partners to improve health in a community -0.30 (e.g., participates in committees, shares data and information, connects people to resources, participating in outreach events.)

13 Knowledgeable and correctly informs the public about policies, programs, and -0.30 resources that improve health in a community.

14 Incorporates ethical standards of practice (e.g., Public Health Code of Ethics) into all -0.28 interactions with individuals, organizations, and communities.

15 Assume responsibility for taking specific actions that further organizational mission or -0.27 population health in the presence of a public health emergency.

16 Describes ways to improve individual and program performance. -0.23

17 Adheres to organizational policies and procedures. -0.20

18 Communicates in writing and orally with linguistic and cultural proficiency (e.g. use -0.19 age- appropriate materials, incorporating images)

19 Describes the programs and services provided by governmental and non-governmental -0.19 organizations to improve the health of a community. (e.g., You are able to provide general information about your program and other programs.)

20 Promotes cooperation and commitment within a team to achieve goals and -0.16 deliverables.

21 Motivates colleagues for the purpose of achieving program and organizational goals -0.16 (e.g., participating in teams, encouraging sharing of ideas, respecting different points of view)

22 Provides input for improving programs and services. -0.15

23 Conveys data and information to professionals and the public using a variety of -0.13 approaches (e.g., reports, presentations, email, letters, pamphlets, PSAs, websites, as needed.)

24 Builds and maintains customer satisfaction with the products and services offered by -0.13 the organization AND/OR Seeks to resolve confrontations and disagreements constructively AND/OR Diplomatically handles challenging or tense interpersonal situations.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 45 | P a g e APPENDIX C: Required and Needed Trainings

Point of

Topic Description edule Contact Resources

(POC) Target Sch Audience Categories Competency Training Type Training

Cultural POC: Al *Culturally diversity and Silverio,

and competency/De Office Linguistically scribes ways to of Appropriate PIM Office; Office of Minority Health improve Minorit Services

individual and Classroom y Health

(CLAS) All Employees program date n from one year at 638- Training performance 7474. of hire for new employees of hirefor new Cultural Competency Skills Cultural Competency Withi

Health POC:

Insurance Dr. Portability Privacy and Kaneshi PIM Office; Chief Public Health Office; and security ro at https://www.hhs.gov/hipaa/index.html/

Accountabilit Annually

Classroom 735-

y Act (HIPAA) All Employees 7167. Training DPHSS Required Training DPHSS Training Required Please

refer to the PHEP Progra IS 100.c m

Introduction Training

PIM Office; PHEP Program; Guam Homeland to the & Incident Security; Incident Exercise command https://training.fema.gov/is/courseoverview. Command Online Staff.

employees aspx?code=IS-100.c

System, ICS POC: All Employees 100 Jon Lujan or Tricia Shimizu Public Health Emergency Preparedness Public Emergency Health Within one year from date of hire hire for new date of Withinfrom one year @ 735- 7306

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 46 | P a g e Please refer to

the PHEP Progra National m Incident Training

Management PIM Office; PHEP Program; Guam Homeland &

System Incident Security; Exercise (NIMS) IS command https://training.fema.gov/is/courseoverview. Online Staff. 700.B An aspx?code=IS-700.b

POC: All Employees Introduction Jon to NIMS Lujan or Tricia Shimizu Public Health Emergency Preparedness Public Emergency Health @ ext. 306 Please refer to

the PHEP Progra m

Training Active & PIM Office; Guam Homeland Security;

Active shooter Shooter Exercise https://www.dhs.gov/active-shooter- preparedness

Training lassroom Staff. preparedness C

POC: All Employees Jon Lujan or Tricia Shimizu Public Health Emergency Preparedness Public Emergency Health @ ext. 306 Based

on DOA Strategies in Training

Anger controlling Schedul PIM Office; Dept. of Administration Management aggression/ang e

er Classroom

Availabi All Employees lity

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 47 | P a g e Based

on DOA Workplace Training

Bullying bulling Schedul PIM Office; Dept. of Administration Prevention prevention e Classroom

Availabi All Employees lity

Based Effective

on DOA communication Training

Communicati in the Schedul PIM Office; Dept. of Administration on Skills workplace, e building rapport Classroom

Availabi All Employees with consumers lity Communication Skills

Based

on DOA Training

Customer Customer Schedul PIM Office; Dept. of Administration Service service skills e Classroom

Availabi All Employees lity Communication Skills

Based

on DOA Reducing stress Dealing with Training

and avoiding Difficult Schedul PIM Office; Dept. of Administration conflict with People e difficult people Classroom

Availabi All Employees lity

Based

Domestic on DOA Domestic violence Training

Violence prevention; Schedul PIM Office; Dept. of Administration Prevention support services e Classroom

navigation Availabi All Employees lity

Based PIMO; Guam Behavioral Health and Wellness Substance on

Drug-Free Center: abuse GBHWC Workplace http://gbhwc.guam.gov/services/prevention-

awareness Schedul Employees Classroom and-training

e All

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 48 | P a g e Availabi lity

Based Methods to

on DOA recognize, Violence in Training

evaluate and

the Schedul PIM Office; Dept. of Administration respond to Workplace e

workplace Classroom

Availabi All Employees violence lity Based

on PIMO; Guam Behavioral Health and Wellness Safe Talk GBHWC

Suicide Center: (Suicide Schedul alertness http://gbhwc.guam.gov/services/prevention- Prevention) e

Classroom and-training

Availabi All Employees lity Based

on DOA Prevention and Sexual Training

handling of Harassment Schedul PIM Office; Dept. of Administration sexual Prevention e

harassment Classroom

Availabi All Employees lity Based

on DOA How to Training

Stress effectively deal Schedul PIM Office; Dept. of Administration Management with pressure e

and stress Classroom

Availabi All Employees lity

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 49 | P a g e

During

Public health In- basics, quality Processi New

improvement, ng for Employee PIM Office and Personnel Officer Person

departmental - all new Orientation mission and In employ vision ees with All Employees HR Communication, Cultural Communication, Cultural Competency, Quality Improvement Competency, Improvement Quality

POC:

Orientation to Bertha yees PIMO

10 Essential the 10 Essential Taijeron https://www.cdc.gov/nphpsp/essentialservices.ht Services of Public Health Online at 735- ml

Public Health Services ublic Health P

7125 All Emplo Sciences Skills

Provides Key information for POC: Functions of proposals for Bertha

Public Health funding (e.g., Taijeron PIM Office

Financial federal, local Online at 735-

Management government 7125 All Employees

agencies) Management Skills Financial Planning Financialand Planning

During

Describes the In- DPHSS organizational Processi

Organization structures and ng for PIM Office and Personnel Officer Person

al Structure functions of the - all new and Function agency/progra In employ m. ees with All Employees HR Cultural Competency Skills Cultural Competency

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 50 | P a g e

POC: *Culturally Bertha and Taijeron Linguistically Describes ways at 735- Appropriate to improve

7125/P Services individual and OC: Al

(CLAS) program Silverio, PIM Office; Office of Minority Health Training performance/C Office (Note: CLAS ultural diversity Classroom

of All Employees Training item and Minorit #1 will satisfy competency y Health this at 638- requirement)

7474. Thinking Skills LeadershipSystems and

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 51 | P a g e APPENDIX D: DPHSS Training Evaluation Form

DPHSS TRAINING EVALUATION FORM Name / Title: Date & Location: Name of Trainer/Facilitator: Strongly Disagree Neutral Agree Strongly Rating: Disagree Agree OBJECTIVES As a result of this training, I am able to: (objective #1) (objective #2) (objective #3) TRAINING The topics covered were relevant to my work The level of the training met my expectations The materials/resources provided were appropriate The content was organized and easy to follow The training objectives were met The time allotted for the training was adequate I feel I am committed to applying what I learned to my job INSTRUCTOR/FACILITATOR The instructor/facilitator was knowledgeable about the training topics The instructor/facilitator provided adequate responses to questions DELIVERY The delivery of this training via (format) was appropriate The meeting room and facilities were adequate and comfortable In what way(s) could this training be improved? What did you like most about this training?

How will you apply what you learned in this training to your work?

THANK YOU FOR YOUR FEEDBACK!

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 52 | P a g e APPENDIX E: Training Needs Assessment Survey

Survey Set 2017 Hafa Adai!

Thank you for agreeing to complete your division’s Public Health Workforce Training Needs Assessment. This survey includes questions addressing organizational competencies, motivators and barriers for participation in training, and preferences for course delivery methods. This information will be used to identify and prioritize training and development initiatives within your division.

The survey will take approximately 10-15 minutes to complete and is entirely confidential. No personal identifiers will be collected and results will be reported in summary. In addition, your participation is voluntary. If you choose not to finish the survey, you may exit at any time.

The survey is not timed, which allows you to take as long as you need to complete the assessment. However, if you close your browser window before submitting your responses, all information you may have entered up to that point will be lost.

Please complete this survey by Friday, July 7, 2017. If you have any questions about this survey or encounter technical difficulties while attempting to complete it, please contact any of the following individuals listed below. Please click on the link to access the survey: https://www.surveymonkey.com/r/TP2P5CF Thank you in advance for your thoughtful participation.

Bertha Taijeron Program Coordinator IV Performance Improvement Management Office Division of General Administration (671) 735-7125 [email protected] Vince Aguon, MPA CDC Coordinator II Bureau of Communicable Disease Control (BCDC) Division of Public Health (671) 735-7166 [email protected] Jeffrey Pinaula Program Coordinator IV Guam Prescription Drug Monitoring Program Division of Environmental Health (671) 735-7204 [email protected]

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 53 | P a g e Survey Set 2018 Hafa Adai!

Thank you for agreeing to complete the Public Health Workforce Training Needs Assessment survey set 3 for The Department of Public Health and Social Services (DPHSS) to the following: Division of General Administration (DGA), Division of Senior Citizens (DSC), and the Division of Public Welfare (DPW) staff. The access for this survey will last for a total of 2 weeks, starting on Monday, February 12th, 2018 at 8:00 am until Friday, February 23rd, 2018 at 5:00 pm.

The survey includes questions addressing organizational competencies, motivators and barriers for the participation in training, and preferences for course delivery methods. The collected information will be used to identify, prioritize training, and development initiatives within the division.

Your participation in this research project is completely voluntary. The survey set will take approximately 10-15 minutes to complete. You may decline altogether, or leave blank any questions you don’t wish to answer, or if you choose not to finish the survey, you may exit at any time. No personal identifiers will be collected, the responses will remain confidential and anonymous and results will be reported in the summary. The survey is not timed, which allows you to take as long as you need to complete the assessment. However, if you close your browser window before submitting your responses, all information you may have entered up to that point will be lost.

Please complete this survey by Friday, February 23, 2018, at 5:00 pm. Please click on the link to access the survey: https://www.surveymonkey.com/r/3DIVSCGAPW

Thank you in advance for your thoughtful participation and for your assistance in this important endeavor!

If you have any questions about this survey or encounter technical difficulties while attempting to complete it, please feel free to contact any of the following personnel listed below:

Bertha Taijeron, MPA/MBA Program Coordinator IV Performance Improvement Management (PIM) Office Division of General Administration (DGA) Department of Public Health & Social Services (DPHSS) (671) 735-7125 [email protected]

Eirene Almanzor, MPH Public Health Advisor Division of General Administration (DGA) Department of Public Health & Social Services (DPHSS) (671) 735-7161 [email protected] or [email protected]

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 54 | P a g e Training Needs Assessment Survey

Organizational Competencies

This section of the survey addresses a set of 24 organizational competencies that are considered minimum expectations for all employees. For each competency listed below you will be asked to rate the degree to which the activity is important to your job, and your ability to perform the function. You will rate each question using a four-point scale: 1 - Low to 4 - High.

COMMUNICATION: The first two questions address communication skills.

1. Communicates in writing and orally with linguistic and cultural proficiency.

1-Low 2 3 4-High

b) Your personal ability

2. Conveys data and information to professionals and the public using a variety of approaches (e.g., reports, presentations, email, letters, pamphlets, PSAs, websites, as needed.)

1-Low 2 3 4-High

b) Your personal ability

CUSTOMER SERVICE: The following question addresses customer service skills.

3. Builds and maintains customer satisfaction with the products and services offered by the organization.

1-Low 2 3 4-High

b) Your personal ability

PUBLIC HEALTH SCIENCES: This question addresses public health sciences skills.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 55 | P a g e 4. Describes how public health sciences (e.g., biostatistics, epidemiology, environmental health sciences, health services administration, social and behavioral sciences, and public health informatics) are used in the delivery of the 10 essential public health services.

1-Low 2 3 4-High

b) Your personal ability

CULTURAL COMPETENCY: The next two questions addresses cultural competency.

5. Describes the concept of diversity as it applies to individuals and populations (e.g., language, culture, values, socioeconomic status, geography, educations, race, gender, age, ethnicity, sexual orientation, profession, religious affiliation, mental and physical abilities, and life experiences).

1-Low 2 3 4-High

b) Your personal ability

6. Addresses the diversity of individuals and populations when implementing policies, programs, and services that affect the health of a community.

1-Low 2 3 4-High

b) Your personal ability

FINANCIAL PLANNING and MANAGEMENT SKILLS: This section of the survey includes six statements on financial planning and management skills.

7. Describes the organizational structures and functions of the agency/program.

1-Low 2 3 4-High

b) Your personal ability

8. Adheres to organizational policies and procedures.

1-Low 2 3 4-High

b) Your personal ability

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 56 | P a g e 9. Provides information for proposals for funding (e.g., federal, local government agencies)

1-Low 2 3 4-High

b) Your personal ability

10. Promotes cooperation and commitment within a team to achieve goals and deliverables.

1-Low 2 3 4-High

b) Your personal ability

11. Motivates colleagues for the purpose of achieving program and organizational goals (e.g., participating in teams, encouraging sharing of ideas, respecting different points of view)

1-Low 2 3 4-High

b) Your personal ability

12. Uses evaluation result to improve program and organizational performance.

1-Low 2 3 4-High

b) Your personal ability

COMMUNITY DIMENSIONS OF PRACTICE SKILLS: The next four statements addresses community dimensions of practice skills.

13. Describes the programs and services provided by governmental and non-governmental organizations to improve the health of a community. (e.g., You are able to provide general information about your program and other programs within and outside the agency.)

1-Low 2 3 4-High

b) Your personal ability

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 57 | P a g e 14. Collaborates and engage with community partners to improve health in a community (e.g., participates in committees, shares data and information, connects people to resources, participating in outreach events.)

1-Low 2 3 4-High

b) Your personal ability

15. Provides input for improving programs and services.

1-Low 2 3 4-High

b) Your personal ability

16. Knowledgeable and correctly informs the public about policies, programs, and resources that improve health in a community.

1-Low 2 3 4-High

b) Your personal ability

LEADERSHIP and SYSTEMS THINKING SKILLS: This section of the survey addresses leadership and systems thinking skills.

17. Incorporates ethical standards of practice (e.g., Public Health Code of Ethics) into all interactions with individuals, organizations, and communities.

1-Low 2 3 4-High

b) Your personal ability

18. Identifies internal and external facilitator and barriers that may affect the delivery of the 10 Essential Public Health Services (e.g., using root cause analysis and other quality improvement methods and tools, problem solving).

1-Low 2 3 4-High

b) Your personal ability

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 58 | P a g e 19. Describes needs for professional development (e.g., training, mentoring, peer advising, coaching).

1-Low 2 3 4-High

b) Your personal ability

20. Participates in professional development opportunities.

1-Low 2 3 4-High

b) Your personal ability

21. Describes the impact of changes on organizational practices.

1-Low 2 3 4-High

b) Your personal ability

22. Describes ways to improve individual and program performance.

1-Low 2 3 4-High

b) Your personal ability

WORK ETHIC.

23. Focuses on results and desired outcomes and how best to achieve them. Gets the job done.

1-Low 2 3 4-High

b) Your personal ability

PUBLIC HEALTH PREPAREDNESS AND EMERGENCY RESPONSE.

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 59 | P a g e 24. Assume responsibility for taking specific actions that further organizational mission or population health in the presence of a public health emergency.

1-Low 2 3 4-High

b) Your personal ability

Motivators, Barriers and Preferences for Training Delivery.

What motivates you to participate in training? Please rate your level of motivation related to each of the following items on a four- point scale: 1 - Low Motivation to 4 - High Motivation.

In the space below, please provide any additional comments you have related to the questions you just answered and/or other training related needs.

1. Increasing my competency in public health practice.

1-Low 2 3 4-High

2. Personal satisfaction

1-Low 2 3 4-High

3. Professional networking opportunity

1-Low 2 3 4-High

4. Accomplishment of the mission of the agency

1-Low 2 3 4-High

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 60 | P a g e 5. Personal career advancement

1-Low 2 3 4-High

6. Maintain a license and/or certification for my job

1-Low 2 3 4-High

Barriers for Participation in Training

What prevents you from participating in training? Please rate how much of a barrier the following items are for participation in training on a four-point scale: 1 - Not a Barrier to 4 - Very Much a Barrier.

1. Individual/personal cost

1-Not a Barrier 2 3 4-Very Much a Barrier

2. Time away from work

1-Not a Barrier 2 3 4-Very Much a Barrier

3. Family commitments

1-Not a Barrier 2 3 4-Very Much a Barrier

4. Travel

1-Not a Barrier 2 3 4-Very Much a Barrier

5. Agency and/or grant budget restrictions

1-Not a Barrier 2 3 4-Very Much a Barrier

6. Desired topics not available

1-Not a Barrier 2 3 4-Very Much a Barrier

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 61 | P a g e 7. Nearing retirement

1-Not a Barrier 2 3 4-Very Much a Barrier

8. Lack of supervisor support

1-Not a Barrier 2 3 4-Very Much a Barrier

9. Lack of opportunity to apply what I have learned

1-Not a Barrier 2 3 4-Very Much a Barrier

10. In the space below please provide any additional comments you have related to barriers for participation in training.

Preferences for Training Delivery Methods

Please rate your interest in the following training delivery methods on a four-point scale: 1 - Not Interested to 4 - Very Interested.

1. CD-ROM

1-Not Interested 2 3 4-Very Interested

2. Online - self study

1-Not Interested 2 3 4-Very Interested

3. Face-to-face

1-Not Interested 2 3 4-Very Interested

4. Web-based synchronous learning (e.g. live webinar)

1-Not Interested 2 3 4-Very Interested

Guam Department of Public Health and Social Services | Workforce Development Plan: 2019-2021 62 | P a g e 5. Telephone conferencing

1-Not Interested 2 3 4-Very Interested

6. Audio/podcasts

1-Not Interested 2 3 4-Very Interested

7. Blended (online and face-to-face)

1-Not Interested 2 3 4-Very Interested

8. In the space below please provide suggestions for additional training delivery methods.

Thank you! You have completed this training needs assessment. Please click next to submit your responses.

WORKFORCE DEVELOPMENT PLAN: 2019-2021 | Guam Department of Public Health and Social Services