Improving Health for All Training Series ...

Improving Health for All Training Series Implementation and Evaluation of an Adapted Training Series: A Riverside County Success Story Table of Contents

A Riverside County Case Study Introduction

Why this training series How to use this guide

Adapting a Training Series: How to Begin A. B. C. D. E.

Obtaining Department Buy-in Adapting the PH 101 Dialogue Series Training and Recruitment of Facilitators Implementation and Logistics Evaluation

Lessons Learned and Successes

Outline of the County of Riverside DOPH Discussion Series: Improving Health for All Additional Resources:

County of Riverside Department of Public Health, Health Equity Website:

http://www.healthyriversidecounty.org/Programs/HealthEquity.aspx

Riverside County Department of Public Health

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A RIVERSIDE COUNTY CASE STUDY: Riverside County is the fourth largest county in California spanning 200 miles across and over 7,200 square miles. The County is the same size as the State of New Jersey and shares borders with Imperial, Orange, San Diego and San Bernardino Counties and the State of Arizona. Within the last decade, the County has experienced a 44% population increase, placing the County in fifth place for growth in the US. Today, Riverside County has more than 2.2 million residents, with more than 55% identifying non-white.

INTRODUCTION Riverside County has experienced significant demographic changes in the last twenty-five years. These changes reflect diversity in residents across cultural, experiential, social, and socioeconomic backgrounds. Many of these populations have differing beliefs about health, disease, and treatment. These populations are also more likely to be burdened with higher rates of death, disease, disability, and tend to receive inadequate or substandard healthrelated services.

The County of Riverside Department of Public Health (DOPH) established the Health Equity Committee in 2008. Since its inception, the Health Equity Committee has had a goal to educate staff on health equity, social justice, cultural competency, and discrimination. Its aim is to ensure that all staff have an understanding of the importance of the social determinants of health and their association with health equity. The decision to seek out a training program was integral in attaining the vision and mission of health for all through preventing disease and injury and improving health through partnerships by educating and empowering communities to reduce health disparities. WHY THIS TRAINING SERIES

While searching for a workforce development resource several tools and training programs were identified. One training program, in particular, covered the objectives the Health Equity Committee identified as necessary. This training series was freely available and adaptable. Alameda County Public Health Department’s (ACPHD) Public Health 101 Dialogue Series, a five-module program, included PowerPoint presentations, facilitator notes and training manuals, group exercise materials, and templates to help with logistics. DOPH’s Improving Health for All Discussions Series (IHA) is an adaptation of ACPHD’s PH 101. The following guide details the steps taken by DOPH and the recommendations for successful implementation and evaluation of a discussion series aimed to change the organizational culture of a health department.


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HOW TO USE THIS GUIDE This guide includes detailed processes followed by DOPH, including major steps taken, pitfalls, and recommendations from lessons learned. Sample presentation slides, handouts and activities, facilitators’ guides, and a draft evaluation plan are also provided as a resource.

Adapting a Training Series: How to Begin

A. Obtaining Department Buy-In Why is this important? A lack of buy-in or low interest can affect program outcomes. Participants are required to self-enroll and enrollment can be affected by staff feelings and perceptions of the training. Further, staff participation during the trainings also affects their opinions and perception of the trainings and its importance. A mission of the program developers is to “sell” the program to establish and maintain staff interest and buy-in. Over 80% of workers in the public health workforce lack formal education in public health (ASPH, 2012: http://www.asph.org/). This training series provided the opportunity to ensure that all staff have the same understanding of fundamental public health concepts. Steps DOPH has taken •

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Educating and Motivating the Development Team. Members of the health equity committee, public health administration, the County’s health officer, and representatives from the County’s Executive Office attended a showing of the Race: Are We So Different? exhibit showcased in Riverside County. This visit included a tour and presentation from renowned Anthropologist and past President of the American Anthropological Association, Dr. Yolanda Moses of the University of California at Riverside (UCR). At this presentation Dr. Moses stressed to the administrators and health equity committee members the importance of organizational transformation and workforce development. This experience was energizing for the Department and ignited the launch of the training series and many additional health equity efforts. Meet with Administrators. After the identification of the PH 101 Dialogue Series, representatives from the health equity committee presented an overview of the training series to the Director of Public Health in order to garner feedback and get


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the green light to begin adaptation. This step helped give the Committee confidence in their work, knowing the departments’ leadership was informed and supportive. Use Data. Health equity committee members presented to department managers opening dialogue around social determinants of health and health disparities in Riverside County. Presenters used data to illustrate large disparities that exist among the County’s residents and discussed the association with poor social determinants. Additional presentations to managers outlined the vision for organizational change and the use of the PH 101 dialogue series to initiate this transformation. Communicate with Staff. In honor of National Public Health Month, module 1 of the training series was launched. The Director of Public Health emailed a letter to all staff introducing the training series and inviting staff to participate in an awareness survey. This letter illustrated administration’s commitment to the mandatory training program. This type of support has been found to be instrumental in the implementation of the training series. Enlist Mandatory True “Believers”. It is required that each branch maintains membership on the Health Equity Committee. This has been challenging. It is important that those who participate are active and engaged. They must also be motivated to increase health equity. Participation from all branches is ideal, however; forced participation does not provide positive results. Spread the Word. Presentations at staff meetings have been conducted to stimulate interest, conversations around health equity, and to garner feedback from staff about the training series. These have been successful and have been opportunities to recruit committee members and program developers. DOPH RECOMMENDATION:

Involve the Chief. It is recommended that chief administrators have an active role and participate in goal setting, prioritizing, and launching of an effort such as this. Additional recommendations include a diverse committee, including staff across department branches, job classifications, and cultural experiences. Communication is key. Share as much information as possible and as often as possible. A constant feedback loop is integral to the development and improvement of the material.

B. Adapting the PH 101 Dialogue Series Why is this important?

Different Counties and jurisdictions have different populations, histories, and needs. Public health departments across the nation are at different levels of understanding of the Riverside County Department of Public Health

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relationship between health and social factors. ACPHD’s PH 101 and DOPH’s Improving Health for All Discussion Series are available and adaptable resources for all agencies and departments. These materials must be tailored to meet the unique needs of your jurisdiction. Steps DOPH have taken •

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Form a curriculum development team. Within DOPH this group, the curriculum committee, is comprised of a diverse cross-section of staff representing all department branches, job classifications, expertise, and demographics. The team must have champions. Participants must be able to commit significant time to researching and developing/adapting the materials. The module development process can be challenging, heated, and arduous at times. This is a long process and team members can get burned out. In Riverside County the process of reviewing all of the modules and the accompanying materials, as well as the adaptation of the ACPHD module 1 took nearly a year and a half. This length of time may not be necessary for adapting all the materials. The development of a timeline for the review and adaptation of materials should be in place at the start of the process. This will allow for realistic goal setting as well as prevent any delays in program launch and implementation. Develop your vision Our vision, Public Health: Improving Health for All a. To build a public health workforce able to address health inequities b. To create learning activities that foster a deep understanding of the social determinants of health

Our vision of the training modules has evolved over time as our understanding of health inequities and the social determinants of health has become more sophisticated. DOPH moved away from the traditional training mantra of attaining behavior change to more of an organizational transformation led by a change in understanding and the fostering of open dialogue.

Consult with the experts. Consult with jurisdictions that are already engaged in the activities that you are interested in doing. For DOPH, this process began with lots of questions and many anxieties. The curriculum -committee contacted to the developers of the ACPHD PH 101 dialogue series. Conference calls were scheduled between the ACPHD team and DOPH’s health equity committee and staff development office. On these calls discussions included descriptions of material and content, training goals and objectives, program evaluations, training logistics, and facilitator preparation. As additional questions arose ACPHD was available to DOPH


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as a resource. This relationship eased some of our challenges of implementation by preparing our team for potential pitfalls.

Consult with Employee Assistance Services Team. Members of the curriculum committee and staff development office met with the Director of the County’s Employee Assistance Services (EAS), a doctoral-trained clinical psychologist, and members of the EAS team. EAS are experts in training and employee relations, and helping employees and their families with personal and work-related concerns. EAS reviewed the training materials, helped training facilitators and have participated in modules. This support ensured that if the sensitive topics triggered difficult feelings among DOPH staff, the EAS team was prepared to provide immediate response and support.

Know your staff. The collection of baseline information from department staff is important for the measurement of changes in knowledge, attitudes, and behaviors. In order to facilitate an organizational change, material adaption had to reflect where DOPH staff were in their acceptance of a new standard. A. Program Inventory. Branch managers were surveyed to share what their programs were currently doing to address health disparities. Managers described their programs, the activities and the funding sources. This allowed for a baseline measure of department program strategies to reduce health disparities. B. Preparing staff for the program. In a memo to all staff, the department announced the launch of the Public Health: Improving Health for All Discussion Series (IHA). The Director of Public Health outlined the aim of the discussion series and asked that all staff complete a survey to obtain baseline awareness of topics covered in the training.


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Memo to all staff from DOPH Director of Public Health

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Training coordination. The implementation of a training series of this magnitude is a large undertaking. DOPH administrators made an important decision to reinstitute, after budget cutbacks, a team of individuals who specialize in workforce development to ensure successful launch and implementation.

DOPH RECOMMENDATIONS: •

Have a Development Team. You will not succeed unless you have a dedicated team that consistently and frequently meet to work on material development.


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Assess and Alert your Staff. Both the program inventory and the baseline survey are two examples of methods DOPH used to gather a baseline assessment of staff knowledge as well as starting the conversation about the importance of health equity. This is the first step to involve all staff in this large effort. Departments must inform staff and start the conversation.

Create Deadlines. Allow for a reasonable amount of time to develop a departmentwide training series. A draft development timeline which includes the length of planned time to research, review and adapt materials is essential. Ideally, a 6-month timeline for the review, adaptation, and implementation of each module is reasonable. Allow the program and vision to evolve. Objectives can change over time.

C. Training and Recruitment of Facilitators Why is this important? Facilitators sell the program and its mission. When facilitators are comfortable and have command of the subject matter, it is evident in the participants’ engagement. DOPH has been fortunate to draw from a pool of facilitators with broad ranges of facilitation experiences. Many of the topics being discussed can be uncomfortable for facilitators and they may have very little experience addressing these social issues. Training ensures consistency and quality of messaging across facilitation styles, as well as equips the facilitator with the skills necessary to lead conversations around sensitive topics such as race and discrimination.

All facilitators have volunteered to add this activity to their responsibilities. Recruitment is important in maintaining a substantial number of capable volunteers. It also guards against fatigue and burn out. All facilitators have other duties and requirements of their workplace positions. A large number of interested facilitators create a well-rounded facilitation schedule. Steps DOPH have taken •

Who are the facilitators? Program session facilitators come from a variety of backgrounds and disciplines. All facilitators have an interest in health equity and are enthusiastic to communicate the message of social justice and equity. Session facilitators include a range of staff from office assistants to deputy directors of public health. There is every attempt to maintain a mix of genders, cultural and


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ethnic backgrounds, job positions, sexual orientation, and public service experience.

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Pairing of novice facilitators with experienced facilitators. Inexperienced facilitators are always paired with one or two experienced facilitators. Novice facilitators are never paired with other inexperienced facilitators. Initially, new facilitators are invited to observe at least two sessions before they participate. The topics and number of facilitations change with experience. As experience level increases facilitators are asked to facilitate a greater number of sessions and may move on to facilitate more challenging conversations.

Letter of Support from Public Health Director. After the recruitment of the first set of facilitators the Director of Public Health sent a letter to all facilitators thanking them for their time and commitment and reinforcing the importance of the obligation to eliminate health inequities.


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Memo to all facilitators from DOPH Director of Public Health

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Have a Staff Development Team. Our Staff Development team has taken on the tremendous task of seeing this discussion series through fruition. They are responsible for scheduling all training sessions, enrolling participants, recruiting facilitators, managing equipment and materials, and all other important logistical items. The Staff Development Officer screens all new facilitators including observing their first session before they are scheduled to facilitate any additional sessions.

Employee Assistance Services. The Director of EAS helped guide leadership and facilitators in navigating through difficult conversations. The Director, a trained clinician, held a training session for facilitators which focused on conversations about race and racism. Resource materials were provided and activities were conducted to prepare facilitators about emotional reactions and responses they may encounter from participants as they discuss race and a history of institutional racism in the US.

Rehearse. All facilitators must participate in pilots and dry-runs for each module. Through this participation facilitators become more familiar with the material and the way the material should be conveyed. Pilots and dry-runs are also opportunities for facilitators and curriculum developers to celebrate the success of material development. Facilitators’ Meetings. Meetings for all facilitators are held quarterly. These meetings allow for sharing successes and discussion of challenges experienced. Facilitators work together to develop solutions to the challenges. This is also an opportunity for facilitators to build a strong supportive community and remind them that they are a part of a larger effort.

Alameda County (ACDPH) Site Visit. This visit was scheduled specifically to allow lead facilitators to participate in module three, Undoing Racism, a module that discusses race in the US. During this visit, DOPH facilitators participated in module three and debriefed with Alameda County facilitators. This improved DOPH facilitator confidence in discussing sensitive topics.

RECOMMENDATIONS: •

Administrator Recognition. It is critical that administrators recognize the work of the facilitators. This acknowledges that administrators understand and support the


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level of dedicated effort. This further allows an opportunity for administrator to restate the vision of the discussion series. Have a Staff Development Team. We recommend that you have a Staff Development Team. The logistics of implementing a training of this size and magnitude require the organizational expertise and time from a group specializing in workforce development.

• Mandatory Rehearsals. It is mandatory that facilitators attend the rehearsals and

all administrators attend at least one. DO NOT MOVE FORWARD until upper level administrators have participated in a rehearsal. All administrators should give their feedback before the module is launched for all staff.

D. Implementation and Logistics Why is this important?

There are many logistical challenges to launching a training of this magnitude. To be successful, developers should create a plan including a timeline, budget, and a messaging/communication campaign. If done haphazardly or if disorganized this could lead to the program’s failure.

If you want staff to take the program seriously you must be well organized. Staff need to feel that this is not just another training. The implementation of the program must be smooth if you want staff to be fully engaged. This is a department-wide effort aimed at organizational change and should reflect the cultural shift in the way public health works in the community and strives for social justice and equity. Steps DOPH have taken •

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Training is Mandatory. The discussion series is a requirement for all DOPH staff. This is inclusive of all of the chief administrators for the department. More than 900 DOPH employees, across 7,200 square miles have participated in the discussion series. The trainings are blended, with a mix of staff across all disciplines and job classifications. Department administrators, inclusive of the Director of Public Health and deputies, are in the first sessions of each blended module. Diverse Facilitation. DOPH schedules a cross-section of staff with a diverse team of facilitators. When the diversity of facilitation cannot be guaranteed, the session is canceled and rescheduled. DOPH has found that diversity not only adds to the dialogue but also ensures that all participants feel more comfortable about their own participation.


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Use Dry-Runs and Pilots. These can help catch any last minute issues with the material and how it is presented. Dry-runs allow for interruption during the facilitation to garner suggestions. Dry-runs are used to revise the materials, its activities, and timing. This is the opportunity for facilitators to practice the materials and decide of this is a module that they are interested in facilitating. It is required that all facilitators attend the dry-runs, while 2-3 facilitators volunteer to lead the module. The pilot is held after changes are made from the dry-runs. Once the curriculum committee incorporates feedback from the dry-runs, the pilot is launched. The pilot is the first uninterrupted session and provides an opportunity to identify any final concerns. All participants are asked to complete and evaluation at the end of each session. Plan for Scheduling and Facilities Management Challenges. Initially implementation is challenged with trying to get a large number of staff scheduled and successfully through the modules. Spacing, equipment, and room availability can be a logistical nightmare. Upon the initial launch, more staff registered than we had the capacity to serve. Due to successful planning, DOPH has been able to successfully train all department staff despite challenges. New challenges have emerged. Most staff have completed the launched modules. DOPH is now attempting to ensure participant diversity as well as full training sessions with fewer staff needing the training.

Constant Feedback. DOPH views the modules as dynamic documents. We often review and update the modules. As an example, DOPH recently underwent organizational changes. This required significant changes to the training material. As the sessions are held, participants are asked to provide feedback and suggestions upon the conclusion of the session. The information obtain is used to enhance the material. Use the Resource of a Public Information Officer. DOPH has been fortunate to have a public information officer (PIO) on staff to communicate health messages on behalf of the department. The DOPH PIO has more than 20 years of experience as a reporter and is also a module facilitator. The PIO is also responsible for developing and disseminating a public health newsletter as well as health equity website management. Developing a Supervisor and Manager’s Toolkit. Our managers and supervisors


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had a lot of anxiety about managing their staffs’ emotions and concerns after participation in the modules. Out of this concern and our relationship with EAS, a toolkit is being developed for DOPH supervisors and managers. This toolkit is to assist them in the continuance of the conversations outside of module participation. Still under development, this new resource will be available when completed. •

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RECOMMENDATIONS: Mandate Training Participation. Trainings should be mandatory for all staff regardless of position. DOPH staff report that they appreciate sharing in a session with their managers and directors. It has also been reported that staff believe managers get out of trainings or somehow experience a different training if it is not witnessed by staff. A blended training environment allows for the sharing of different perspectives and facilitates discussion. This blending is inclusive of job classifications, demography, discipline, and length of service.

Have Diverse Facilitation Teams. To the best of your ability, have a diverse team of facilitators. This diversity can include gender, race and ethnicity, sexual orientation, age, and many other factors. Due to the nature of the conversations generated we strongly recommend focusing on race and ethnicity as a diversifying factor. Use Rehearsals. The use of dry-runs and pilots is imperative to the development and successful implementation of the module and its materials. Not only is this important to strengthening of the module, but it created ownership of the module. Those facilitators who participate in the development, revision, and dry-runs of modules are more comfortable with the material, which becomes evident in their facilitation.

Have a Staff Development Team. We recommend that you have a Staff Development Team. The logistics of implementing a training of this size and magnitude require the organizational expertise and time from a group specializing in workforce development.

E. Evaluation

Why is this important? The purpose of the IHA training series is to foster a dialogue to spur an organizational transformation. To determine if the discussion series is meeting the programmatic goals and objectives, the program and its impact must be measured. Program evaluation provides justification for the investment of time and resources and allows for opportunities Riverside County Department of Public Health

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for program improvement. Steps DOPH have taken •

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Process Evaluation. This evaluation has been used to monitor the development and workgroup progress to determine if the program has been implemented as planned. DOPH’s curriculum committee has been instrumental in the completion of this form of evaluation. With frequent meetings, the committee reviews meeting activities and presentation drafts, monitors launch timelines, analyzes and reviews program surveys, and monitors successive completion of the modules.

Upon completion of every session all participants complete an evaluation of facilitators, the space, and the materials. A brief “hot wash” is conducted at the close of the program session where participants are asked to share their feelings about the module, specifically what they liked and disliked. Impact evaluation. DOPH is currently developing pre and post measures to answer research questions pertaining to the goals and objectives of the discussion series. Several scales are being tested to measure knowledge, self-efficacy, attitudes (normative and semantic differential), and behavioral intentions.

Outcome Evaluation. It is not expected that staff within their respective programs would begin working differently. However, it is expected that with the new direction the County of Riverside Department of Public Health is embarking upon, a cultural shift in the way public health “does business” with other public entities and community-based organizations will take place. An organizational assessment will be conducted to determine if branches in the Department have begun to incorporate the information learned from participating in the training.

DOPH administered a survey to all branch managers where they were asked (a) to list the top five health disparities they are addressing within their branches and divisions, (b) to identifying how they are addressing health disparities within their programs, and (c) to share if they are currently receiving funding specific to addressing health or health care disparities. If they are receiving funding they were solicited to share the funding source. A follow-up measure will be administered after the launch of the last module. RECOMMENDATIONS: Do not back into program evaluation. During the program development phase, an Riverside County Department of Public Health

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evaluation plan should also be completed. When program objectives and components are developed the research questions should be formulated. The evaluation approach should include the use of program goals and objectives to guide the development of measurement tools and activities. DOPH’s draft evaluation plan is available upon request.

Lessons Learned and Successes •

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DOPH administration has been very supportive. This effort has been a “grassroots style” bottom up approach. The committee’s inception began with staff interest. All department branches were requested and required by administration to have an active presence on the health equity committee. DOPH administration has taken the role of removing barriers and not creating them, however, the anxiety surrounding the lack of direct control is clear and present. Administrators have maintained faith in the process and not tried to control it, however, they remain in a role where they represent the department and may need to make decisions that affect what and how the program moves forward, remaining in line with the mission and vision for the department. Administrator support garners buy-in and support from all other branches. We have found that administrators, at times, have had to illustrate an overzealous enthusiasm towards to the program to get all staff to realize their support is unwavering.

Administrative changes have made efforts challenging. DOPH has recently experienced reorganization which pulled people from the department, placed additional duties on participating health equity committee members and increased the number of competing priorities for staff and administrators.

Race and racism are extremely difficult discussion topics for most. The sensitive nature of this topic and the accompanying discussions evoke fear. Facilitators’ interest in this module was much lower than the other modules. This decreased interest resulted from general anxiety about how to facilitate this difficult discussion and some facilitators felt they were “non-experts” by way of their cultural background.

Participant response cannot be predicted or prevented but you can prepare. DOPH was very fortunate to have established a relationship with Employee Assistance Services. This helped in facilitation training. Facilitators must be comfortable with


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the material. If that is not the case it is evident to the participants and can affect participant response and the facilitators’ ability to response to unanticipated questions. Administrators should also be aware of facilitation and programmatic limits. There is no way to control for all events, but administration can assist in preparation.

The building of our champions came out of the participation in the module development. These individuals were vested in the module and were more eager to facilitate the modules they worked on. They were also more invested in the module’s success and worked to really convey the modules message throughout the department.

Constant recruitment of facilitators is necessary. There is natural attrition and burn out. A substantial amount of energy needs to be directed towards their recruitment and orienting. Everyone’s opinion is valued, although a final decision must be made. You can attempt to give everyone’s opinion value, but this behavior may impede progress. There has to be strong leaders on the development team who make a final decision.

No matter how much we strive for diverse facilitation, it is much harder to manage. Cancelation due to not meeting our facilitation goals in theory would be effective; however, the impact can be devastating for larger departments and a re-scheduling challenge for staff development.

There needs to be investment balance. The investment among your development group is wonderful, but if they are too invested any required change can be difficult for some. Personal investment can keep the momentum and enhance the final product. It also maintains consistency. Too much personal investment can stifle ideas and improvements to the material. COMMUNICATION. Communication. Communication. This is extremely important and cannot be stressed enough. When there is frequent communication with staff, buy-in and interest are maintained. When DOPH experienced a lapse in communication, anxiety about the materials and activities rose.

DOPH has launched this discussion series with most staff completing modules 1 - 4. Half have completed module 5 and 6 is being launched this fall. With all of the organizational changes, the amounts of care, effort, and interest have remained high.


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Outline of DOPH Discussion Series Public Health: Improving Health for All, A Department-Wide Discussion Series Goal of the training series is to build a public health workforce able to address health inequities and the social determinants of health. Designed to: •

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increase staff awareness and knowledge in the discipline of Public Health, health disparities and the elimination of health inequities create learning activities that foster a deep understanding of the social determinants of health, and build commitment to eliminate health inequities in our diverse population

Module 1: An Overview of Public Health. A brief history of public health, the fundamentals of the public health system and the core functions and 10 essential services of public health. After this training students will be able to:

Define public health and know major events in public health history Describe 3 main organizational levels of the public health system.

Describe 3 core functions and 10 essential services of public health Understand the connection between core functions and services

Identify one current DOPH program that carries out one of the essential services and be able to identify how their position fits into the essential services of public health.

Module 2: Cultural Competency and Cultural Acceptance. A brief overview of the diversity of the Riverside County population, defines and explains culture and cultural competence, brief history of cultural competence in health care, review of federal, state and local laws and policies on cultural competency, defines cultural humility, reviews how to use cultural competency and cultural humility to enhance personal, interpersonal, program planning, organizational and policy/advocacy skills. After this training students will be able to:

Understand the difference between health inequities and health disparities. Define and describe cultural competency and the importance of cultural competency and cultural acceptance. Riverside County Department of Public Health

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Understand how to apply lessons learned from this training to improve services provided to our community.

Module 3: Deconstructing Racism. Through viewing “Race: The Power of An Illusion” students will participate in small and large group facilitated discussions on race is the US.

After this training students will be able to:

Identify the underlying social, economic, and political conditions that disproportionately privilege some groups while disadvantaging others. Identify how institutional racism impacts Riverside County residents, especially in relation to health outcomes.

Create a safe environment where Public Health Department staff can discuss concerns about and ideas for addressing institutional racism and its impact on staff, the Health Department, and the broader community. Identify possible next steps to address institutional racism at agency level

Module 4: The Social Determinants of Health. Using national, state and local data and video clips from “Unnatural Causes…is inequality making us sick?” this module defines and reviews social and health inequity and the social determinants of health and how they relate to each other. After this training students will be able to:

Increase awareness of the relationship between social determinants, social inequities, and health inequities. Learn how DOPH is taking action and finding solutions.

Module 5: Discrimination and Stigma. Introduction to the concepts of discrimination and stigma and the negative effect they have on health. Through the use of case studies among Lesbian, Gay, Bisexual, Transgender (LGBT), elder, and communities with disabilities the social determinants of health are further explored with discussions around the importance of resources and coping strategies, along with skill building opportunities for public health staff. After this training students will be able to:

Recognize and address the perceived discrimination and stigma among the Riverside County Department of Public Health

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three groups profiled.

Describe how stigmatization impacts community health.

Contribute ideas on what DOPH can do to reduce barriers faced by stigmatized groups.

Module 6: Community Capacity Building. Participants discuss the importance of building a power base of community members who can advocate for equitable distribution of resources. After this training students will be able to:

Demonstrate an understanding of the concepts of Community Engagement (CE) and Community Capacity Building (CCB), and how they can help reduce health inequities. Articulate their (participants) role in Community Engagement and Capacity Building. Discuss at least one benefit and one challenge of Community Engagement and Capacity Building. Discuss DOPH’s role in community engagement and capacity building.


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