Real World Feedback: How Well Did the Virtual Training Academy Prepare California's COVID-19 Contact Tracing Workforce?

To effectively respond to the COVID-19 pandemic, California had to quickly mobilize a substantial number of case investigators (CIs) and contact tracers (CTs). This workforce was comprised primarily of redirected civil servants with diverse educational and professional backgrounds. The purpose of this evaluation was to understand whether the weeklong, remote course developed to train California's CI/CT workforce (i.e., Virtual Training Academy) adequately prepared trainees for deployment. From May 2020 to February 2021, 8,141 individuals completed the training. A survey administered ~3 weeks post-course assessed two measures of overall preparedness: self-perceived interviewing proficiency and self-perceived job preparedness. Bivariate analyses were used to examine differences in preparedness scores by education level, career background, and whether trainees volunteered to join the COVID-19 workforce or were assigned by their employers. There were no significant differences in preparedness by education level. Compared to trainees from non-public health backgrounds, those from public health fields had higher self-perceived interviewing proficiency (25.1 vs. 23.3, p < 0.001) and job preparedness (25.7 vs. 24.0, p < 0.01). Compared to those who were assigned, those who volunteered to join the workforce had lower self-perceived job preparedness (23.8 vs. 24.9, p = 0.02). While there were some statistically significant differences by trainee characteristics, the practical significance was small (<2-point differences on 30-point composite scores), and it was notable that there were no differences by education level. Overall, this evaluation suggests that individuals without bachelor's degrees or health backgrounds can be rapidly trained and deployed to provide critical disease investigation capacity during public health emergencies.

Virtual Trainings Effectively Prepared the Public Health Workforce to Support Schools During the COVID-19 Pandemic in California in 2021.

CONTEXT: School closures in California due to COVID-19 have had a negative impact on the learning advancement and social development of K-12 students. Since March 2020, the achievement gap has grown between high-income and low-income students and between White students and students of color. PROGRAM: In November 2020, a team from the California Department of Public Health, University of California, San Francisco, and University of California, Los Angeles, developed the School Specialist training for local health department and state employee redirected staff to the COVID-19 response to equip them to support schools as they reopen. IMPLEMENTATION: A pilot of the virtual School Specialist training was carried out in December 2020, which informed subsequent biweekly half-day virtual trainings. The training consisted of lectures from experts and skill development activities led by trained facilitators. EVALUATION: The objectives of the evaluation of the training were to understand whether (1) knowledge of key concepts improved from pre- to posttraining; (2) confidence in skills central to the role of a School Specialist improved from pre- to posttraining; and (3) course learners who were activated to work as School Specialists felt the training adequately prepared them for the role. The School Specialist training team sent pre- and posttraining surveys to learners between February 8 and May 18, 2021. Of the 262 learners who responded, a significant improvement was seen in knowledge, with a mean score increase of 15.6%. Significant improvement was also observed for confidence, with a 20.1% score improvement seen posttraining. DISCUSSION: Overall, the School Specialist training was shown to be effective in increasing knowledge and confidence in preparation for School Specialist deployment. Adequate training and partnerships for local health department and school staff are critical to keep K-12 students safe and to reduce the learning achievement gap during the ongoing COVID-19 pandemic.

Establishment and Evaluation of a Large Contact-Tracing and Case Investigation Virtual Training Academy.

During the COVID-19 pandemic, the Virtual Training Academy (VTA) was established to rapidly develop a contact-tracing workforce for California. Through June 2021, more than 10 000 trainees enrolled in a contact-tracing or case investigation course at the VTA. To evaluate program effectiveness, we analyzed trainee pre- and postassessment results using the Wilcoxon signed-rank test. There was a statistically significant (P < .001) improvement in knowledge and self-perceived skills after course completion, indicating success in training a competent contact-tracing workforce. (Am J Public Health. 2021;111(11):1934-1938. https://doi.org/10.2105/AJPH.2021.306468).

California's COVID-19 Virtual Training Academy: Rapid Scale-Up of a Statewide Contact Tracing and Case Investigation Workforce Training Program.

Case investigation (CI) and contact tracing (CT) are key to containing the COVID-19 pandemic. Widespread community transmission necessitates a large, diverse workforce with specialized knowledge and skills. The University of California, San Francisco and Los Angeles partnered with the California Department of Public Health to rapidly mobilize and train a CI/CT workforce. In April through August 2020, a team of public health practitioners and health educators constructed a training program to enable learners from diverse backgrounds to quickly acquire the competencies necessary to function effectively as CIs and CTs. Between April 27 and May 5, the team undertook a curriculum design sprint by performing a needs assessment, determining relevant goals and objectives, and developing content. The initial four-day curriculum consisted of 13 hours of synchronous live web meetings and 7 hours of asynchronous, self-directed study. Educational content emphasized the principles of COVID-19 exposure, infectious period, isolation and quarantine guidelines and the importance of prevention and control interventions. A priority was equipping learners with skills in rapport building and health coaching through facilitated web-based small group skill development sessions. The training was piloted among 31 learners and subsequently expanded to an average weekly audience of 520 persons statewide starting May 7, reaching 7,499 unique enrollees by August 31. Capacity to scale and sustain the training program was afforded by the UCLA Extension Canvas learning management system. Repeated iteration of content and format was undertaken based on feedback from learners, facilitators, and public health and community-based partners. It is feasible to rapidly train and deploy a large workforce to perform CI and CT. Interactive skills-based training with opportunity for practice and feedback are essential to develop independent, high-performing CIs and CTs. Rigorous evaluation will continue to monitor quality measures to improve the training experience and outcomes.

A Program for Local Health Departments to Adapt and Implement Evidence-Based Emergency Preparedness Programs.

The goal of this project was to enhance the capacity of local health departments to translate and implement evidence-based programs in emergency preparedness by using the Getting To Outcomes approach. Our evaluation determined that local health department staff reported improved capacities. A "Getting To Outcomes Guide for Community Emergency Preparedness" guidebook was produced and is available online.

A first aid training course for primary health care providers in Nagorno Karabagh: assessing knowledge retention.

INTRODUCTION: Conflict in the South Caucasus' Nagorno Karabagh region has damaged health facilities and disrupted the delivery of services and supplies as well as led to depletion of human and fixed capital and weakened the de facto government's ability to provide training for health care providers. PROBLEM: In response to documented medical training deficits, the American University of Armenia organized a first aid training course (FATC) for primary health care providers within the scope of the USAID-funded Humanitarian Assistance Project in Nagorno Karabagh. This paper reports the follow-up assessments conducted to inform policy makers regarding FATC knowledge and skill retention and the potential need for periodic refresher training. METHODS: Follow-up assessments were conducted six months and 18 months following the FATC to assess the retention of knowledge, attitudes, and self-reported practices. Eighty-four providers participated in the first follow-up and 210 in the second. The assessment tool contained items addressing the use and quality of the first aid skills, trainee's evaluation of the course, and randomly selected test questions to assess knowledge retention. RESULTS: At both follow-up points, the participants' assessment of the course was positive. More than 85% of the trainees self-assessed their skills as "excellent" or "good" and noted that skills were frequently practiced. Scores of approximately 58% on knowledge tests at both the first and second follow-ups indicated no knowledge decay between the first and second survey waves, but substantial decline from the immediate post-test assessment in the classroom. CONCLUSION: The trainees assessed the FATC as effective, and the skills covered as important and well utilized. Knowledge retention was modest, but stable. Refresher courses are necessary to reverse the decay of technical knowledge and to ensure proper application in the field.

Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh.

INTRODUCTION: Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities. CASE DESCRIPTION: Nagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles. DISCUSSION AND EVALUATION: A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor. CONCLUSIONS: Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.

Development of a training curriculum for public health preparedness.

We describe the development of a 2-day training curriculum in emergency public health to improve the competency of public health personnel to prepare for, and respond to, both natural and human-caused disaster hazards. The training is conducted in a face-to-face setting and content is mapped to recognized emergency preparedness competencies for public health workers. The training materials are uniquely structured to the specific hazards, demographics, resources, and local emergency response agencies for each jurisdiction. This training program incorporates a series of challenging interactive scenarios that reinforce decision making in a public health emergency. Pretesting and posttesting are used to evaluate knowledge gained by participants. This interactive approach aligns with the principles of adult learning, and training evaluations indicate that this method is an effective integration of process and content.