Model Practice: Student Interview Teams

Introduction

State and local public health agencies are the frontline for disease surveillance and response activities.12 A 2010 survey of state foodborne disease programs identified the need for additional staff to reach full capacity.3 Patients with foodborne diseases are the best source of information about what they've eaten that may have transmitted their illnesses. Detailed interviewing of cases as soon as possible after their illnesses is recognized is the key to implicating food vehicles. Such interviewing is labor-intensive, so insufficient capacity can directly affect the completeness and timeliness of individual case investigation and outbreak response activities and the ability to participate in multijurisdictional activities. This decreases the effectiveness of detecting, responding to, and controlling multijurisdictional outbreaks.45

To address capacity needs, specifically the need for additional interviewing capacity, state and local health departments have collaborated with academic institutions to recruit students preparing for careers in public health as temporary surge capacity or as an integrated component of their surveillance and outbreak response teams. Student teams have improved the ability to respond to and solve outbreaks in some jurisdictions, while providing the students with real-world public health experience. As of 2010, approximately 25% of accredited schools of public health reported having established some form of student response team.6 Please see Appendix D for a list of peer-reviewed publications describing student response teams.

In some state and local health departments, student volunteers have provided short-term surge capacity during specific events or responses. In other jurisdictions, including eight FoodCORE centers, paid standing teams of students have contributed to daily disease surveillance and response activities of the health department in addition to providing surge capacity for specific investigations and events. Including students in routine activities provides a more well-rounded experience and valuable training for students. For example, routine interviewing provides opportunities to practice and improve interviewing skills outside of an acute response when resources and time to train may be limited.

Little information is found in the published literature about establishing and maintaining student-based teams within public health agencies. The FoodCORE Model Practice: Student Interview Teams is intended to describe the practices used in FoodCORE centers to establish, implement, and maintain teams of students for public health surveillance and response activities, focusing on illnesses likely transmitted via food. The specific roles and responsibilities of student teams vary across jurisdictions and include conducting routine case-patient interviews, assisting with surge capacity during a response to a specific outbreak or event, data entry, and special projects.

This model practice describes successful strategies for incorporating student interview teams into a state or local health department. Appendix A provides a checklist of tasks for establishing and operating a student team. Appendix B provides additional details regarding implementation and management of student teams by various FoodCORE centers. Appendix C provides a list of trainings available for interviews. Appendix D provides a list of peer-reviewed publications describing student response teams.

Establishing a student team

When establishing a student team to work with a health department, there are numerous logistic considerations. Student teams have been established at central health department offices or at universities that work in close collaboration with the health department in order to integrate students into routine activities. A main point of contact or a coordinator should be designated at the health department and at partner universities. These roles are critical to facilitate the process of starting a team, ongoing identification of interested students, and the day-to-day management and maintenance of a team.

Students should be hired into paid positions. This ensures that students are invested in the work, enhances reliability and retention of team members, and serves to integrate students into routine health department activities. Hiring mechanisms vary by jurisdiction; FoodCORE centers have hired students as:

• Temporary health department staff
• Part-time staff or through job-sharing of a full-time position
• Paid interns
• Contract employees with universities or other groups

If multiple hiring options are available, selecting the most flexible option is generally best for establishing and maintaining a student team. To streamline hiring efforts, human resources staff should be engaged early to determine specific hiring mechanisms and requirements.

Regardless of the mechanism, students are paid an hourly wage for their activities with the health department. FoodCORE funding provided specifically for student teams varies by center and depends on a number of factors, including the number of students. The average funding for student positions is $50,000 with a range in funding from $16,000 – $92,000, where the higher funding levels provide support for a larger student team. In addition to the costs associated with paying students (wage, indirect and administrative costs) there are also other costs and considerations associated with training and supervising students and managing the team, as described below.

Before hiring students, it is important to plan for dedicated office space, computers, computer software, phones, and supplies that student teams will need. Consideration should be given to where student interviewers will work so that conducting interviews will not disrupt, or be disrupted by, other health department work. Having student interviewers work together in a common space can facilitate exchange of ideas, mentorship among the students, and building a team atmosphere. To help bring on students, centers work proactively with human resources (or a similar department) staff to ensure all necessary paperwork and requirements are completed before students start working.

It is also important to determine requirements for student supervision and how that supervision will be accomplished. For example, in some centers, a health department staff member may have to be on-site for students to work during weekend or evening hours. As described in the "Initial Case-Patient Interviewing" model practice, attempts to interview case patients should be made at different times of day, with at least one attempt during evening or weekend hours, to improve the chance of reaching them. Therefore, it is important to discuss how scheduling and supervision will be coordinated within the health department. Determining this before students begin work will allow teams to be up and running more quickly after students are hired.

Various avenues can be used to identify potential student team participants, but engaging academic partners is a key component of recruitment. FoodCORE centers have recruited graduate and undergraduate public health and nursing students, pre-med students, and students from other disciplines such as infectious disease or microbiology, as well as some doctoral students. Students have been successfully recruited through:

• Courses or seminars at nearby universities or colleges (e.g., guest lectures, adjunct faculty, etc.)
• Contacts (e.g., faculty members and advisors) at nearby universities or colleges
• Student associations
• Listservs and career center websites to announce opportunities
• Master of Public Heatlh (MPH) program orientation events and career days
• Students who proactively contact the health department inquiring about available opportunities

Recruitment is a recurrent or ongoing process as students complete their studies. Ideally students will be available to participate for at least one full year during their studies. Centers have recruited students at different points in their studies, which can be beneficial. For example, first-year MPH students may have the opportunity to be part of the team for more than one year. To ensure continuity, FoodCORE centers have found it beneficial to have new students overlap with more experienced students, when possible.

The implementation process for teams varies across FoodCORE centers, especially between centralized and decentralized jurisdictions. In decentralized jurisdictions the state health departments have to work in close collaboration with local health departments (LHDs) to determine how students will be incorporated into the workflow. When central student teams were established in decentralized states, the state health departments first informed their LHD partners of the availability of student interviewers to help supplement interviewing capacity. Then, the state health departments and LHDs collaborated to develop mutually agreeable processes for assigning interviews to students and exchanging interview data and findings between the central team and local officials.

In some FoodCORE centers this led to the development of several options for workflow and data exchange from which LHDs could select. Some LHDs have chosen to have all identified cases automatically interviewed by a central student team, with data made available to the LHD upon completion of an interview. Others have opted to retain initial interviewing responsibility, granting permission for interviews by the central student team on a case-by-case basis.

FoodCORE centers found that bringing LHDs onboard for using a new student team often took months. It can be very helpful to begin the process of engaging LHD partners even before student team members are hired. Many FoodCORE centers started with just one or two participating LHDs. Through continued diplomacy and outreach and as participating LHDs shared their positive experiences, additional LHDs began to engage with the state and use the student interview team. A strong feedback mechanism is needed so state and local partners can easily discuss what works well with the student team as well have opportunities to make any procedural changes to improve the collaborations.

Training

Training is essential in building a student team that completes high quality, consistent interviews. Training should encompass information about foodborne diseases, surveillance, and outbreak response. Many training materials have already been developed; FoodCORE provides a list of available trainings and other resources (Appendix C) from FoodCORE centers. In addition to technical skills trainings, students should be trained on the specific jurisdictional structure, processes, and protocols. This should include details about the system(s) used to identify cases for interviewing as well as where information from interviews should be submitted or stored. This aspect of the training should cover all systems, resources, and contacts that the students will need to understand and use when completing interviews. Additionally, students should be trained to follow all standard operating procedures of the health department, especially those that address data and patient confidentiality.

Training should cover interviewing techniques and all applicable privacy rules and interview logistics, including:

• The protocol for follow-up if a case-patient is unavailable, including whether or not a voicemail or other message should be left for a case-patient, and if yes, what the message should cover, including contact information for call-backs
• Which educational materials are available to direct case-patients to, or to send to case-patients
• What a student interviewer should do when interviewing a case-patient who should be excluded from work or day care
• What a student interviewer should do if a case-patient has not been notified of their diagnosis before being contacted for the interview

Health department staff should ensure that while performing public health work, students also further their knowledge of the diseases and epidemiologic methods to which their work applies.

Training formats vary across centers and with the number of students being trained. FoodCORE centers have found it beneficial to develop a written student training manual so that students have an easily accessible reference. These manuals are most effective when they are routinely updated to incorporate feedback from experienced students and any procedure or policy changes. Eliciting and incorporating student feedback help tailor the training manual to answer specific questions that incoming students are likely to have about their roles, responsibilities, and the workflow. Ideally, new students will overlap with experienced students so that the more experienced students can help train and mentor the new students.

Some FoodCORE centers have also incorporated shadowing of existing interviewers (more experienced students or staff) and direct observation and feedback for new interviewers as they become more practiced. In some centers, new interviewers also conduct practice interviews before conducting interviews with patients. These types of hands-on trainings can help solidify learning, provide additional opportunities to address any questions, and solicit student feedback.

Maintenance strategies

Once an interviewing team is established and the students are trained and ready to fully participate, ongoing maintenance and management activities include:

Team oversight by a public health professional

Reviewing interviews conducted by the students as well as review of other work activities to provide constructive feedback allows for ongoing quality assurance and improvement.

Student evaluations

Reviewing and evaluating student performance allows health department staff to coach students and to identify any need for refresher trainings.

Scheduling

FoodCORE centers have found various solutions to coordinating schedules for multiple students to ensure coverage during business and non-business hours. Many have used shared calendars (e.g. Google calendar, or a shared Outlook calendar for all students), which allow both students and team managers to see who is available or scheduled for interviewing. During an acute outbreak response, shared schedules can also facilitate staffing for surge capacity. Some FoodCORE centers have incorporated a student team leader position that helps with team management and scheduling activities. This position can function on a rotation schedule so that the workload and experience can be shared among the students.

Team meetings

Centers have found that having regularly scheduled meetings with the student team members and supervisors or coordinators are valuable for discussing any issues, concerns about specific cases or outbreaks, and other items that affect the students and their assigned activities.

Activities beyond interviewing

In most FoodCORE centers, student activities extend beyond interviewing case-patients. Depending on the needs and protocols in the jurisdictions, training requirements, and availability, FoodCORE students also assist with routine core surveillance activities and help to conduct outbreak-specific activities. For example, in some FoodCORE centers students have been able to participate in conducting analytic studies, data entry and analysis, retail food sampling, and on-site inspection or assessment activities.

FoodCORE centers have also engaged students in special projects, depending on existing needs and interests, including surveillance evaluations and other analytic projects. In some centers students are able to leverage their experience to meet field experience or practicum requirements of their degree program or in completing a thesis project.

Evaluation

Periodic evaluation of both the students and management of the team helps facilitate process improvement and future success. Evaluation should include providing individual feedback to the students and eliciting feedback from the students. The frequency of student evaluation and solicitation of feedback varies by center and by how long a student has participated, but should be undertaken at least as frequently as there is turnover. Ideally, students can give and receive feedback on an ongoing, continuous basis as part of their routine activities.

Centers use formal and informal evaluation processes ranging from day-to-day discussions, to more formal evaluation exercises such as exit interviews. Their evaluation techniques include quantitative and qualitative components to monitor and improve efficiency and quality of the students' work. Feedback from students is used to guide changes for training and day-to-day activities that can improve workflow and the student experience.

In some of the centers, more formal evaluations have included the use of pre- and post-tests when training students. Some centers have also tracked information for individual students such as the number of interviews conducted over time, completeness of the interviews, and the number of different investigations in which they have participated. These data can be shared with the students during a formal review.

Many of the centers have also found it beneficial to track information about their student teams over time, including the number of students who have participated and what positions or opportunities students take when leaving the team.

Appendices

Appendix A: Checklist for Establishing a Student Interview Team

Appendix B: Implementation Details by FoodCORE Center

Appendix C: Trainings Available for Interviewers

Appendix D: Peer-reviewed Publications Describing Student Response Teams