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ENVIRONMENTAL HEALTH
COMPETENCY PROJECT:
Recommendations for Core Competencies for Local Environmental Health
Practitioners
American
Public Health Association
National Center for Environmental Health,
Centers for Disease Control and Prevention
May
2001
ACKNOWLEDGEMENTS
We are grateful to the
numerous organizations and agencies that provided information from the field
and contributing to the development of this report. These individuals contributed a considerable amount of time and
energy to the project.
In addition to the
organizations mentioned in the report, we’d like to thank Dr. Thomas A. Burke,
Larry Gordon, and Petrona Lee for their inspiration and contributions. We would like to express deep gratitude to
the staff of the organizations who provided support. Special thanks are given to Annette Ferebee, Julie Desai, Heidi
Klein, and Gilah Langner.
This project would not have
been possible without the support of the National Center for Environmental
Health at the Centers for Disease Control and Prevention. We especially want to
acknowledge the work of Patrick Bohan, RS, MS, MSEH whose foresight made this
project a reality.
For additional information about this project, please email EHSB@cdc.gov.
Table of Contents
EXECUTIVE SUMMARY
PART I: SETTING THE STAGE
A. Introduction
B. Background
C. Terms and Target Audience
D. Definitions of Competencies
E. Basic Assumptions
PART II: RECOMMENDED COMPETENCIES
A. Assessment
B. Management
C. Communication
PART III: TRAITS AND CHARACTERISTICS OF AN EFFECTIVE ENVIRONMENTAL HEALTH PRACTITIONER
PART IV: NEXT STEPS
PART V: APPENDICES A-G
Appendix A: Expert Panel Members
Appendix B: Summary of Expert Panel Discussion
Appendix C: Typical Responsibilities of Environmental Health and Protection Programs
Appendix D: Technical Competencies Covered in NEHA’s
Registered Environmental Health
Specialist/Registered Sanitarian (REHS/RS) Exam
Appendix E: Content Areas of NEHA’s REHS/RS Exam
Appendix F: Setting the Context: Environmental Health Practitioner Competencies
Appendix G: Resources
Executive
Summary
In February 2000, environmental
health experts from 13 national environmental/health organizations came
together in Washington to begin the work of defining core competencies for local
level environmental health practitioners.
APHA’s Public Health Innovations Project, with funding from the National
Center for Environmental Health (NCEH) at the Centers for Disease Control and
Prevention (CDC), convened the meeting.
The expert panel members and several federal agency representatives met for two days to identify the core competencies local environmental health practitioners needed to be effective in their work. The following 14 core competencies reflect the outcome of that meeting. The competencies are grouped into the three primary functions of an environmental health program – assessment, management and communication.
A. AssessMENT
· Information
Gathering: The capacity to
identify sources and compile relevant and appropriate information when needed,
and the knowledge of where to go to obtain the information.
· Data Analysis and Interpretation: The capacity to analyze data, recognize meaningful test results, interpret results, and present the results in an appropriate way to different types of audiences.
· Evaluation: The capacity to evaluate the effectiveness or performance of procedures, interventions, and programs.
B. ManageMENT
· Problem Solving: The capacity to develop insight into and appropriate solutions to environmental health problems.
· Economic and Political Issues: The
capacity to understand and appropriately utilize information concerning the
economic and political implications of decisions.
· Organizational Knowledge and Behavior: The capacity to function effectively within the culture of the organization and to be an effective team player.
· Project Management: The capacity to plan, implement, and maintain fiscally responsible programs/projects using appropriate skills, and prioritize projects across the employee's entire workload.
· Computer & Information Technology: The capacity to utilize information technology as needed to produce work products.
· Reporting, Documentation, and
Record-Keeping: The capacity to
produce reports to document actions, keep records, and inform appropriate
parties.
· Collaboration: The
capacity to form partnerships and alliances with other individuals and
organizations in order to enhance performance on the job.
C. CommunicatION
· Educate: The capacity to use the environmental health practitioner’s
front-line role to effectively educate the public on environmental health
issues and the public health rationale for recommendations.
· Communicate: The capacity to
effectively communicate risk and exchange information with colleagues, other
practitioners, clients, policy-makers, interest groups, media, and the public
through routine activities, public speaking, print and electronic media, and
interpersonal relations.
· Conflict Resolution: The
capacity to facilitate the resolution of conflicts within the agency, in the
community, and with regulated parties.
· Marketing: The capacity to articulate basic concepts of environmental health and public health and convey an understanding of their value and importance to clients and the public.
Identifying these core competencies is just the first step. They are viewed as a “work in progress” and feedback from the field is welcome.
Part I: Setting the stage
A. INTRODUCTION
The goal of this project is to provide
broadly accepted guidelines and recommendations to local public health leaders
for the core competencies needed by local environmental health practitioners
working in
local health departments (LHDs) to strengthen their capacities to
anticipate, recognize, and respond to environmental health challenges.
This report is based on a meeting, held
February 28 through March 1, 2000, in Washington, D.C., and on subsequent
discussions with partner organizations and representatives. The meeting was convened to build on existing
work in the field of environmental health competencies and to outline the core
competencies needed to effectively carry out environmental health programs at
the local level. These competencies
complement the technical competencies developed by the National Environmental
Health Association (NEHA) and are
considered necessary regardless of the setting---rural or urban---for
environmental health practitioners in LHDs.
Environmental health is a key component of public health. Local environmental health practitioners are the "front-line troops" in the public health battle to prevent disease. Yet many people working in LHDs have no formal training in environmental health or public health. By attempting to identify the core competencies necessary for effective environmental health at the local level and beginning to develop consensus on their acceptance, we can strengthen the environmental health infrastructure and build the capacity of local programs.
|
Environmental Health and Protection Environmental health and protection is the art and science of protecting against environmental factors that adversely impact human health or the ecologic balances to long-term human health and environmental quality, whether in the natural or human-made environment. These factors include, but are not limited to air, food and water contaminants; radiation, toxic chemicals, wastes, disease vectors, safety hazards, and habitat alterations. (The Future of Environmental Health, JEH, Vol. 55, No. 4, 28-32, 1993) |
B. Background
Sponsored by the American Public Health Association (APHA) and the National Center for Environmental Health (NCEH) of the Centers for Disease Control and Prevention (CDC), the Environmental Health Competency Project convened an Expert Panel, comprising a wide variety of environmental and public health associations and organizations. The 13 panelists (Appendix A) represent the following national organizations: The American Academy of Sanitarians (AAS), the Association of Environmental Health Academic Programs (AEHAP), the Association of Public Health Laboratories (APHL), the Association of Schools of Public Health (ASPH), the Association of State and Territorial Health Officials (ASTHO), the Council of State and Territorial Epidemiologists (CSTE), the International Association for Food Protection (IAFP), the National Association of County and City Health Officials (NACCHO), the National Association of Local Boards of Health (NALBOH), the National Conference of Local Environmental Health Administrators (NCLEHA), the National Rural Health Association (NRHA) and NEHA. Participating federal agencies included the Agency for Toxic Substances and Disease Registry (ATSDR), the U.S. Department of Agriculture's Food Safety and Inspection Services (USDA), the U.S. Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Health Resources and Services Administration (HRSA).
Before the meeting, members of the Expert Panel responded to a short questionnaire about competencies. The facilitator used these responses to gain an understanding of panelists' opinions about potential competencies, identify areas of agreement and disagreement among panelists, and focus meeting activities. The goal of the meeting was to provide the foundation for a preliminary list of core competencies for local environmental health practitioners and to delineate areas of consensus among Expert Panelists. The panelists were then encouraged to take the recommendations report back to their affiliated organizations and begin assessing, modifying, and encouraging support for the competencies. A summary of the Expert Panel discussion is located in Appendix B.
The Environmental Health Competency Project contributes to the development of an overall public health infrastructure, in concert with other programs now being implemented, such as the Healthy People 2010 Infrastructure Initiative, the National Public Health Performance Standards Program, and the Public Health Workforce 21st Century Agenda. All of these efforts are laying important groundwork to help move the public health community toward greater excellence in public health practice.
C. Definitions
The target audience for these recommendations is environmental health practitioners who work in LHDs. For this project, an environmental health practitioner is defined as a person working in an environmental health position in a LHD who has at least an undergraduate degree with one to four years of experience.
A LHD is defined as a statutorily designated agency of local government charged with delivering identifiable health services designed to prevent or solve public health problems. Nearly 3,000 LHDs, as defined above, exist in the United States. Most have a broad range of environmental health responsibilities, including food safety, drinking water safety, solid and liquid waste disposal, hazardous waste disposal, vector control, and institutional health. (See Appendix C)
A primary objective of environmental health programs is to prevent death and illness from environmentally related disease and injury. The ability to anticipate, recognize, and respond to environmental health threats is necessary to achieve this objective. Recent widely publicized outbreaks of illness---caused by Cryptosporidium in the Milwaukee water supply, the emergence of Escherichia coli O157:H7 in food, and hantavirus in the rodent population---only underscore the need for environmental health programs that are adequately staffed and capable of anticipating and responding quickly and with flexibility to environmental health threats. This includes addressing emerging environmentally related public health problems.
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There is a strong need to prepare the environmental health workforce to address the complex environmental health problems facing the nation in the 21st century. |
Although this report is targeted to LHDs, the panel recognizes that many people work in environmental health positions in agencies other than local public health. The competencies developed in this report may apply to these people.
D. Definition of Competencies
For this project, the panel
defined a competency as:
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a cluster of related knowledge, skills, and attitudes that affect a major part of one’s job (a role or responsibility), that correlates with performance on the job, that can be measured against some accepted standards, and that can be improved via training and development. (Parry, S.R. “The Quest for Competencies.” Training, July 1996, p. 50) |
This project builds on the extensive groundwork in this field during the past few years. Examples of recent work on competencies include: The Public Health Functions Workgroup Project, sponsored by the U.S. Department of Health and Human Services (DHHS), Competency-Based Curriculum Work Group; The National Public Health Performance Standards Program, a collaborative effort by NACCHO, NALBOH, ASTHO, PHF, and APHA and CDC; The Crossroads Colloquium: An Examination of the Educational Needs for Environmental Health and Protection; The Public Health Faculty/Agency Forum sponsored by DHHS and CDC; and NEHA's Committee on the Future of Environmental Health.
A basic assumption of this project is that environmental health practitioners have the technical competency to do their jobs. NEHA's Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS) exam provides a measure of the technical skills essential for the environmental health practitioner. Appendix D lists the technical competencies covered in NEHA's REHS/RS exam; Appendix E lists the content areas covered.
Among the foundational elements of core competencies, the Expert Panel emphasized the following:
·
Environmental
health practitioners should understand basic public health principles, and the
interdisciplinary nature of environmental health.
·
Environmental
health practitioners should understand environmental protection and
environmental health principles and practices.
·
Environmental
health practitioners should understand basic government functions.
·
Environmental
health practitioners should understand and be sensitive to the different
cultures found in their institutions and communities.
Fourteen core competencies for environmental health practitioners are presented below, based on the work done by the Expert Panel at its February meeting and by subsequent revisions and incorporated comments by the panel. The competencies are grouped into the three primary functions of an environmental health program.
A. Assessment
Information Gathering Data Analysis & Interpretation Evaluation B.
Management
Problem Solving Economic & Political Issues Organizational Knowledge & Behavior Project Management Computer & Information Technology Reporting, Documentation, and Record‑Keeping Collaboration C. Communication
Educate Communicate Conflict Resolution Marketing |
Note: Discussion was extensive about cultural
sensitivity as a competency. All
participants thought
issues of culture are important to being
effective, and although not an explicit
competency, cultural
sensitivity was considered part of all that
is done in environmental health and protection. It includes,
but is not limited to: understanding the dynamics of cultural
diversity (race, ethnicity, and socio-economics);
linking with others disciplines inside and outside the agency to enhance the
receptivity of the
workplace to a multicultural environment; acting with sensitivity and
understanding; and developing and
adapting approaches to problems that take into account cultural differences.
A.
Assessment
A1.
Information Gathering: The
capacity to identify sources and compile relevant and appropriate information
when needed, and the knowledge of where to go to obtain the information.
Examples:
·
Literature search in response to a request
for information.
·
Consult
with experts in the field, such as toxicologists, epidemiologists, forensic
specialists, and/or environmental engineers.
·
Identify,
locate and use appropriate reference material (statutes, regulations, reference
books, journals).
A2.
Data Analysis and Interpretation: The capacity to analyze data,
recognize meaningful test results, interpret results, and present the results
in an appropriate way to different types of audiences.
Examples:
·
Read
and summarize technical papers, understand tabular and graphical presentations
of data, and translate them for a non-technical audience, for example,
translate data from papers published in academic journals into public
information materials.
·
Analyze
data generated internally using simple statistics (e.g., percentages, averages,
medians).
·
Understand
how statistical surveys are performed and what results mean.
·
Communicate
results to a variety of audiences, using appropriate media.
A3. Evaluation: The capacity to evaluate the effectiveness
or performance of procedures, interventions, and programs.
Examples:
·
Evaluate
the agency's procedures against a given set of standards, such as state
requirements.
·
Evaluate
the results of particular interventions, such as providing information to
a group of restaurant managers to
resolve food service problems, and determine what improvements have been made
after a specified time.
·
Evaluate
the overall environmental health program in which the practitioner is working,
in terms of inputs (such as number of inspections, number of hotline calls
processed) or outcomes (real-world results, progress).
Note: Solo environmental health practitioners may have more occasions
to undertake program evaluations than do practitioners working in larger
agencies.
B.
Management
B1. Problem Solving: The capacity to develop insight into and appropriate solutions to environmental health problems.
Examples:
·
Determine
the nature of a problem in broader context by asking appropriate questions and
reviewing documentation.
·
Clearly
articulate problem.
·
Take
appropriate measures to resolve the problem and/or present a range of solutions.
·
Collaborate
in decision-making process.
B2.
Economic and Political Issues: The capacity to understand and
appropriately use information about the economic and political implications of
decisions.
Examples:
·
Understand
and maintain awareness of basic economic issues, for example, in interacting
with small business owners and communities.
·
Understand
local history and community demographics, as well as cultural and political
issues and sensitivities.
·
Enforce
regulations equitably and consistently--but with an awareness of the political
realities of the work.
·
Develop
and present options and recommendations that demonstrate an understanding of
economic and political conditions in an effort to find appropriate solutions
and prioritize actions.
· Understand the economic and political underpinnings
and implications of broader agency priorities/decisions.
B3.
Organizational Knowledge and Behavior: The capacity to function
effectively within the culture of the organization and to be an effective team
player.
Examples:
·
Understand
the formal legislative/administrative system within which the agency operates.
·
Be
aware of internal agency functions, priorities, and dynamics.
·
Identify
and recognize how agendas are set and
pursued and how they affect public health.
·
Inform
supervisor and other appropriate persons about political issues as they arise.
B4. Project Management: The capacity to plan, implement, and maintain fiscally responsible programs and projects using skills and prioritize projects across the employee's entire workload.
Examples:
·
Formulate
goals and objectives. Understand what's necessary to get things done,
internally and externally.
·
Design
action steps using a variety of resources.
·
Establish
appropriate timelines and deadlines.
·
Balance
the workload when involved in multiple projects.
·
Measure
outcomes for the program.
· Understand and work effectively within the constraints of fiscal realities.
·
Manage
programs within budgetary constraints.
·
Prioritize
budget decisions.
·
Monitor
expenditures and revenues.
·
Recognize
and pursue opportunities for external funding.
·
Understand
the agency's finance system, including purchase requisitions, purchase orders,
unencumbered and encumbered funds, allocations, and budget revision.
B5.
Computer/Information Technology: The capacity to use information
technology as needed to produce work products.
Examples:
·
Use
software available within the agency to perform research, record keeping,
communication (e.g., e-mail, word processing programs), data analysis, and
interpretation (including simple spreadsheet programs), and reporting tasks.
·
Use
Web-based applications, such as searching and retrieving information.
B6.
Reporting, Documentation, and Record-Keeping: The capacity to produce reports to document
actions, keep records, and inform appropriate parties.
Examples:
·
Generate
an inspection report.
·
Produce
a periodic (e.g., quarterly) activity report.
·
Generate
a progress report for a grant.
·
Maintain
organized, accurate, and up-to-date files and records (electronic and/or hard
copy).
·
Prepare
evidence for court cases.
B7.
Collaboration: The capacity to form partnerships and
alliances with other individuals and organizations to enhance performance on the
job.
·
Identify
key persons in organizations, community, and media. Networks can be internal to the agency, (e.g., with
epidemiologists; public health nurses, and educators; in-house laboratories;
plumbing, electrical, and building inspectors) community-wide, (e.g., with
nongovernmental organizations, industry, academia, labs) or within the
government's public health/environmental protection system (EPA, CDC, other
federal agencies; state offices such as State Engineer, Attorney General; and
local agencies).
·
Cultivate
effective links and partnerships by using communications skills; maintaining
regular/periodic contact; participating in practitioner organizations; and
providing reciprocal help, service, and support.
C. Communication
C1.
Educate: The capacity to
use the environmental health practitioner’s front-line role to effectively
educate the public on environmental health issues and the public health
rationale for recommendations.
Examples:
·
Identify
“teaching moments” as part of regulatory function, and opportunities to share
“lessons learned.”
·
Provide
accurate information and demonstrate desired action. Present information in a culturally appropriate manner.
·
Recognize
the dynamic state of knowledge and information in the field, stay abreast of,
and appropriately use new information.
·
Emphasize
prevention, for example, in explaining to homeowners and grounds managers how
to minimize use of pesticides and fertilizers.
·
Seek
continual learning, educational, and mentoring opportunities.
C2.
Communicate: The capacity to effectively communicate risk and
exchange information with colleagues, other practitioners, clients,
policy-makers, interest groups, media, and the public through public speaking,
print and electronic media, and interpersonal relations.
Examples:
·
Handle
all forms of communication promptly, politely, and professionally. These include letter and e-mail
correspondence, telephone calls, site visits, group discussions, meetings, and
presentations.
·
Explain
complicated issues and procedures simply and accurately. Identify the target audience and deliver the
message appropriately.
·
Handle
interactions with the public and media using tactful, objective, non
confrontational, culturally sensitive language. Interactions include receiving complaints and providing feedback
to complainants, sharing information with clients and citizen groups,
motivating clients to bring about desired changes, and resolving conflicts
within a community on the use of natural resources, and presenting to a hearing
officer in court a case against a restaurant that has been closed.
·
Seek
opportunities for public speaking to broaden the audience on environmental
health issues. Examples include making
speeches to school groups on food safety or to swimming pool and apartment
building owners and managers, conducting food handler training and giving
presentations to the Chamber of Commerce.
Public speaking skills can be enhanced through a variety of resources,
including participation in Toastmasters, learning PowerPoint and other slide
presentation software, and mentoring.
C3.
Conflict Resolution: The capacity to facilitate resolution of
conflicts within the agency, in the community, and with regulated parties.
Examples:
·
Know
when conflict resolution can be used and when it cannot, either because of a
lack of authority or because of the intractable nature of the conflict. Recognize the limits of authority and
flexibility. Typical conflicts involve
complaint investigations or disagreements over a regulation, where clients
might inform the practitioner that they have conducted business a certain way
for years and see no reason to change, then announce their intention to seek
redress from elected officials.
·
Use
effective listening skills.
·
Exhibit
respect for diversity.
·
Understand
the history and context of the conflict.
·
Identify
the nucleus of problem, separate from symptoms.
·
Find
common ground and areas of agreement (as well as non-negotiable areas).
·
Determine
the willingness of the parties involved to negotiate and promote that
willingness.
·
Obtain
the necessary resources to resolve conflict (e.g., use of facilitators or
mediators).
C4.
Marketing: The
capacity to articulate basic concepts of environmental health and public health
and convey an understanding of their value and importance to clients and the
public.
Examples:
·
Articulate
the goals, purposes, problems, and needs of environmental health.
·
Provide
solutions to environmental health problems that obtain support from clients and
increase their understanding of environmental health issues and concerns.
·
Explain
the rationale for environmental health regulatory requirements and the value
produced by a healthy environment (e.g., less disease, lower health care
costs).
PART III: Traits and Characteristics of an Effective
Environmental
Health Practitioner
The group identified additional traits and characteristics thought to be common among effective environmental health practitioners. The group after identifying these traits and characteristics wanted to document them for use by managers, academicians and practitioners as important to the practice of local environmental health.
·
Positive
attitude
·
Versatility
and flexibility
·
Practical
perspective and common sense
·
Strong
principles and ethics
·
Practitioner
integrity
·
Strong
work ethic
·
Tenacity
·
Willingness
to learn
·
Focus
on fair solutions
·
Collaborative
spirit
·
Willingness
to embrace change
·
Involvement
with community
·
Calmness
during conflict
·
Understanding
of other points of view
·
Ability
to observe
·
Focus
on team accomplishments
·
Appropriate
appearance and body language
·
Ability
to lead
·
Big-picture
perspective
·
Respect
for diversity
·
Knowledge
of when to ask for help
PART IV: NEXT
STEPS
Panelists developed a list of next steps and opportunities for publicizing and using the environmental health competencies presented in this document. Panelists emphasized the importance of obtaining feedback, revising the competencies, and ensuring their use. Panelists suggested the following means of accomplishing these goals:
·
Widely
distribute this document in print and on the Internet, with links to
represented organizations.
·
Obtain
endorsement of competencies by affiliated associations. Ensure that associations distribute the
document and/or competencies to their members.