Community College Public Health: Developing a Comprehensive 2-Year Degree Program

607868PHPXXX10.1177/2373379915607868Pedagogy in Health PromotionBeebe et al. research-article2015 Descriptive Best Practices Community College Public Health: Developing a Comprehensive 2-Year Degree Program Samantha A. Beebe, MS, MPH, CHES 1, Carolyn Bortz, MSN, EdD 1, and John K. Leiser, PhD 1 Pedagogy in Health Promotion: The Scholarship of Teaching and Learning 2016, Vol. 2(1) 54 59 2015 Society for Public Health Education Reprints and permissions: sagepub.com/journalspermissions.nav DOI: 10.1177/2373379915607868 php.sagepub.com Abstract The Healthy People 2020 initiative outlines the U.S. Department of Health s vision for improving the health of all Americans and recognizes the ability of community colleges to aid in accomplishing this vision by providing cost-effective, comprehensive public health education. Developing a 2-year degree program in public health is not without its challenges, including ensuring that the curriculum is broad enough in scope to serve as a foundation for students continuing in their education and content-rich enough to train them adequately to enter the workforce with the associate degree. Here, we present the efforts to meet these challenges in the establishment of an associate of applied science degree in public health. We review the development of both the public health core curriculum and the courses designed to meet the learning outcomes of that curriculum. We present an example of an articulation agreement with a 4-year university and lay-out potential future directions of the associate program. Keywords associate of applied science, professional preparation public health In its Healthy People 2020 initiative, the U.S. Department of Health and Human Services outlined its vision for improving the health and quality of life of all Americans. Explicit in the program s mission is an increase [in] public awareness and determinants of health, disease, and disability... with a goal to create... environments that promote good health for all (U.S. Department of Health & Human Services, 2015). The ability to meet the goals of Healthy People 2020 relies on the existence of a well-trained and educated public health workforce. The training of public health professionals has traditionally been the purview of graduate schools (Kirkwood & Riegelman, 2011). More recently, undergraduate institutions have begun to respond to student interest in the field by offering baccalaureate degrees in public health and related disciplines (Peterson, Albertine, Plepys, & Calhoun, 2013). The burgeoning field of public health education has not gone unnoticed by the U.S. Department of Health and Human Services or by the American Association of Community Colleges, both of which realize the significant role that community colleges can play in providing opportunities to students. For instance, the American Association of Community Colleges reports that more than 45% of U.S. college undergraduates are enrolled in courses at one of the nation s more than 1,100 community colleges (American Association of Community Colleges, 2015), and Healthy People 2020 recognized the ability of community colleges to provide cost-effective and comprehensive public health education. Indeed, Public Health Infrastructure Objective PHI 6.1 sets to increase the proportion of 2-year colleges that offer public health or related associate degrees (U.S. Department of Health & Human Services, 2015). Community colleges are uniquely poised to offer public health education in a way that satisfies the vision of the Healthy People 2020 program. That is, community colleges provide quality education to diverse student populations in an open-access environment with strong ties to the local communities they serve. Additionally, community colleges offer affordable education to traditional and nontraditional students alike in a manner that allows reciprocal movement of students into the workforce and professionals into the classroom (Kirkwood & Riegelman, 2011). Despite the advantages of community colleges for students, development of an associate degree program in 1 Northampton Community College, Bethlehem, PA, USA Corresponding Author: Samantha Beebe, Northampton Community College, Monroe Campus, 2411 Route 715, Tannersville, PA 18372, USA. Email: sbeebe@northampton.edu

Beebe et al. 55 public health is not without its challenges. First, the close relationship between the community college and the broader community must be considered. Stakeholders in the associate degree program must provide insight into their expectations of program graduates. The role of the public health workforce needs to be clarified, and the broader community must be familiarized with the public health mission. Second, the 2-year degree must provide students with an education that is both broad enough in scope to serve as a foundation for continuing in their education and content-rich enough to train them adequately to enter the workforce. The Institute of Medicine s Global Forum on Innovation in Health Professional Education recommends that such a program complement the traditional public health core knowledge base with an infusion of interprofessional education and practice (Institute of Medicine, 2013). The task is to combine core curriculum education with experiential learning and a capstone experience within the confines of the 2-year degree. Here, we present the efforts to meet these challenges in the establishment of an associate of applied science degree program in public health at Northampton Community College, Bethlehem, Pennsylvania. We review the development of both the public health core curriculum and the courses designed to meet the learning outcomes of that curriculum. We present an example of an articulation agreement with a 4-year university and lay out potential future directions of this program. Curriculum Development Northampton Community College (NCC) launched its Public Health program in the fall 2014 semester with 17 enrolled students; development of the program had clearly begun sometime well before that date. The framework for the program drew heavily on the critical component elements of undergraduate degrees in public health (Wykoff, Petersen, & Weist, 2013) as well as on the notion that community college graduates have a strong general education background (e.g., Staley & Trinkle, 2011). Using the elements as a guide, core threads of competency began to emerge as the central courses of the program were considered. The core threads that were initially chosen for incorporation into program courses included the following: health education, assessment, intervention, evaluation, data collection, health communication, diversity, cultural competency, social determinants of health, and advocacy. As the central program courses were being envisioned, community stakeholders and representatives from local public health agencies were invited to participate in framing the program as members of an advisory board. Specifically, advisory board members were asked to review the core threads of competency relative to a program prototype and to evaluate the program prototype relative to course sequence, academic content, and curricular rigor. The board members were prompted to emphasize in their review the expectations they would have of graduates entering the workforce. While advisory board response to the program prototype was overall favorable, it became apparent that different stakeholders had very different expectations of NCC s graduates. For example, some board members representing the local medical community suggested that the program contain separate, specific courses on oral health, mental health, women s health, pharmacology, and/or environmental health. Other board members were broader in the scope of their expectations but asked that the courses within the program incorporate clinical skills, such as collection and monitoring of vital signs, medication reconciliation, medication compliance, diet and nutrition recommendations, and an understanding of the primary care system in order to prevent hospital readmissions. These advisors seemed to prefer a program that would emphasize a more individual and biomedical approach to human health rather than the traditional population health approach of most public health programs. Despite the differences in their specific priorities, advisory board members did agree on the fundamental skills and knowledge base that they wanted to see in program graduates. Board members emphasized the importance of training in the following: written and oral health communication, working with diverse patients, understanding health disparities and social determinants of health, theories of health behavior change, proper advocacy for patients, management of chronic disease, health across the lifespan, the interpretation of data, the importance of collaboration, and health education. These concepts aligned well with the core threads that had been identified, and the suggestions evolved into the program learning outcomes for the new major (Table 1). The advisory board members also agreed on the importance of a capstone experience that cross-cut aspects of the curriculum, as reflected in the program narrative for the major as it appears in NCC s catalogue (Table 2). Course Development Expansion of the core threads into the program learning outcomes and the consensus among stakeholders for the need of a capstone experience created an ideal topdown scenario for developing the course structure for the major. That is, the notion was to use the newly devised program outcomes as a guide for adopting certain existing courses into the major and for designing appropriate new courses rather than to craft the program learning outcomes from a mosaic of already existing courses. In this way, we were able to utilize some of the

56 Pedagogy in Health Promotion 2(1) Table 1. Public Health Learning Outcomes. Graduates of the program will 1. Analyze the assessment, planning, implementation, and evaluation of health education interventions and public health programs 2. Identify individual, community, and organization health infrastructure 3. Analyze, disseminate, and integrate health research and statistics into health promotion 4. Utilize effective public health specific concepts for communication in written and oral format 5. Compare public health initiatives in a variety of diverse settings within community health models 6. Describe the leading causes of morbidity, mortality, and health disparities 7. Define the role of prevention and community collaborations in promoting healthy communities 8. Discuss local, regional, national, and global population health 9. Create and apply a health education intervention including planning, implementing and evaluating Table 2. Program Narrative. Program features This program is designed to provide our graduates with a solid foundation of knowledge and skills crucial to employment within the Public Health arena. Students will explore an evidence-based approach to improving population health and sustaining those changes through core concepts such as health promotion, health education, health communication, health literacy, advocacy, cultural competency, health disparities, diversity, assessment, planning, implementation, evaluation, community engagement, and policy change. During the final capstone course, Public Health Field Experience, students will have the opportunity to broaden their public health perspectives and gain experience in applying the theory and content learned in their public health coursework. It is expected that the field experience will afford students the opportunity to interact and collaborate with public health professionals and participate in actions that constitute public health. Integral to closing the loop on the learning process is the opportunity for students to reflect on the field experience. Students will meet weekly in a seminar format class focused on sharing, comparing, and contrasting the different infrastructures and approaches they are observing and experiencing at each field location. College s existing course offerings to satisfy certain program and general education outcomes while developing new courses specific to public health. To satisfy the new program learning outcomes, a total of eight courses were developed to span the four semesters in which students would be expected to enroll to complete the Associate of Applied Science degree (Table 3). The courses that were designed initially were consistent with those prescribed by the Association for Prevention Teaching and Research and the Association of American Colleges and Universities for 2-year public health degrees (Riegelman, Albertine, Persily, Kaelin, & Cashman, 2008). These courses, including Introduction to Public Health, Introduction to Epidemiology, and Introduction to Global Health, were intended to anchor the public health curriculum, providing students with a solid foundation on which to build their studies. Five additional courses were then developed to expand the content of the introductory courses and to introduce and/ or reinforce concepts and skills that were considered vital for graduates of a 2-year public health program. In this way, each of the program learning outcomes was addressed in multiple courses with emphasis on applied outcomes occurring late in the major (Table 3). An important consideration in designing the new courses within the major was the sequence in which the courses would be offered to students (Table 4). That is, we wanted each course not only to stand on its own but also to relate to previous and subsequent courses. The intention was that the relationship among courses would be explicitly bolstered where possible by cross-course projects. For example, students in Introduction to Epidemiology could design and administer a campus climate survey that related to that course s learning outcomes. The results of the survey would steer health promotion projects that students would later develop in Community Health Practice and Public Health Education Communication in Semester 4. Another vital component of individual course design and course sequence was the inclusion of interprofessional educational experiences; teaching students to recognize the benefits of teamwork and to be effective team members is crucial in the public health field (e.g., Suiter, Davidson, McCaw, & Fenelon, 2015). The World Health Organization recognizes the importance of interprofessional training in creating a practice-ready workforce prepared to respond to local health needs. While NCC s Public Health program is in its formative years, interdisciplinary learning experiences are being emphasized throughout the curriculum. For example, students enrolled in statistics courses are being sought to guide data analysis for Introduction to Epidemiology students. Likewise, students in NCC s Radio-TV major are being enlisted to help Public Health Education Communication

Beebe et al. 57 Table 3. Course Descriptions and Program Learning Outcomes Covered. Course # Course title Course description Program learning outcomes PUBH 101 PUBH 102 PUBH 103 PUBH 201 PUBH 202 PUBH 203 PUBH 204 PUBH 205 Introduction to Public Health Introduction to Epidemiology Social and Cultural Perspectives of Health Introduction to Global Health Public Health Across the Lifespan Public Health Education Communication Community Health Practices Public Health Field Experience This course will provide students with an overview of the population health approach to public health. Students will learn about evidence-based public health tools to explain the impact of chronic and noncommunicable diseases, communicable diseases, determinants of health, and the environment on the health of populations. Students will examine public health issues and determine how to effectively assess options for interventions to promote health and improve health outcomes. This course includes a review of public health policy, health care systems, and the roles of health professionals. The course covers applications of epidemiologic methods and procedures to the study of the distribution and determinants of health and diseases, morbidity, injuries, disability, and mortality in populations. Students will be introduced to epidemiologic methods for the control of conditions such as infectious and chronic diseases, mental disorders, community and environmental health hazards, and unintentional injuries. Other topics include quantitative aspects of epidemiology, for example, data sources, measures of morbidity and mortality, evaluation of association and causality, and study design. This course is designed to develop basic literacy regarding social and cultural ideals that influence health status and public health interventions. Students will be introduced to an ecological, multilevel theory of health, to illustrate how health is molded by various health determinants, including biology, individual behavior, social relationships, social stratification, institutions, communities, culture, the physical environment, policies, and globalization. Students will examine the causes and mechanisms in which health disparities occur and which populations are most at risk, leading to a greater understanding of the role of cultural competence in public health. The course will introduce students to the critical links between global health and social and economic development. Students will have a basic overview of the determinants of health and how health status is measured. Students will review the burden of disease, risk factors, and key measures to address the burden of disease in cost-effective ways. Communicable and noncommunicable diseases, as well as environmental, behavioral, and cultural influences, will be discussed. Global partnerships and advances in science to improve outcomes will also be addressed. This course is designed to provide evidence-based research of trends and developments in health throughout the life span, dealing with the prenatal period through senescence. The course will examine the health profiles of infants and small children (birth to 14 years), adolescents and young adults (15-24 years), adults (25-64 years), and older adults (65 years and older). This course will be conducted in a seminar format to foster a collaborative learning environment. This course will provide students with a practical approach to understanding and applying principles of communication to a range of public health issues. Students will employ these concepts and skills for analyzing and evaluating current public health communication campaigns. Students will create health communication campaign products in both written and oral format. This course will be conducted in a seminar format to foster a collaborative learning environment. This course is designed to study the theories and principles of public health promotion at the community level. Students will examine the assessment of population health and the planning, implementation, and evaluation of health programs in community settings. Students develop and enhance their skills by designing and implementing a health promotion program in the college community. This course will be conducted in a seminar format to foster a collaborative learning environment. This course is designed for Public Health majors as a preprofessional field experience to broaden the student s public health perspectives and provide experience in applying the theory and content learned in their public health coursework. It is expected that the field experience will afford students the opportunity to interact and collaborate with public health professionals and participate in actions that constitute public health. Integral to closing the loop on the learning process is the opportunity for students to reflect on the field experience. Students will meet weekly in a seminar format class focused on sharing, comparing, and contrasting the different infrastructures and approaches they are observing and experiencing at each field location. 1-9 1-9 1-9

58 Pedagogy in Health Promotion 2(1) Table 4. Suggested Course Sequence. Course code Course title Credits First semester ENGL 101 English I 3 CMTH 102 Speech Communications 3 MATH 150 Introduction to Statistics 3 BIOS 204 Human Anatomy and Physiology I 4 PUBH 101 Introduction to Public Health 3 Second semester ENGL 151L English II 3 BIOS 254 Human Anatomy and Physiology II 4 SOCA 103 Principles of Sociology 3 PUBH 102 Introduction to Epidemiology 3 PUBH 103 Social and Cultural Perspectives of Health 3 Third semester PSYC 103 Introduction to Psychology 3 PHIL 202G Ethics and Moral Problems 3 PUBH 201 Introduction to Global Health 3 PUBH 202 Public Health Across the Lifespan 3 CISC 101 Introduction to Computers 3 Fourth semester PUBH 203 Public Health Education Communication 3 PUBH 204 Community Health Practices 3 PUBH 205 Public Health Field Experience 5 Elective 3 Total credits 61 students with the development and production of their media projects. Such relationships, akin to modified learning communities, benefit all students involved and prepare public health students to apply their coursework to practice. During the fourth semester of study, public health majors will have the opportunity to broaden their health perspectives and gain experience in applying the knowledge and skills they acquired through the program s capstone course, Public Health Field Experience. Throughout this course, students will work with different public health professionals to observe team-based and interprofessional care, to participate in public health decisions and actions, and to reflect on the material they learned throughout the major. Students will meet weekly in this seminar-format class that emphasizes sharing, comparing, and contrasting the different public health infrastructures and approaches they will observe during their field experiences. Articulation Agreements The associate of applied science program was designed to provide a broad first- and second-year course of study in public health to serve as a foundation for transfer into 4-year college and university health programs. Currently, a program-to-program articulation agreement is in place between East Stroudsburg University of Pennsylvania (ESU) and NCC that will allow students who complete the AAS in Public Health to move as juniors into a BS in Public Health major. ESU and NCC have had a long-standing relationship, and ESU accepts more NCC transfer students than any other 4-year college or university. Therefore, we considered it paramount that a credit-for-credit transfer opportunity with ESU be developed for our public health graduates. A number of other local colleges and universities are in the process of reviewing the AAS curriculum; initial feedback is favorable, and we anticipate similar articulation agreements. Future Directions As the program builds on its solid framework of common threads, interprofessional experiences, and seamless articulation, we envision opportunities to offer online or hybrid versions of core public health courses. Such online courses will broaden the reach of the program by providing students with flexible course offerings. The addition of a Community Public Health Specialized Diploma or Certificate under this umbrella of programs will also be explored to allow stackable credentialing to individuals already employed in health care or individuals who already possess undergraduate degrees. Additionally, we realize that public health is not limited by distance; the human population is a global population, and population health is a global issue. Success in the public health field relies on an appreciation of and respect for the social and cultural differences inherent in each population. Younes and Asay (2003) propose that as educators, we are obliged to provide experiences that expose our students to the diversity of the world. To address the need of global awareness and diversity in public health, NCC has begun to develop a relationship with institutions in Denmark that NCC students will use as short-term international study experiences. Site visits and initial partnership design meetings were conducted in March 2015. The idea is that the international program will involve numerous workshops with both public and private public health organizations and educators. A key component of the collaboration will involve peer-to-peer instruction between NCC students and Danish public health students, combined student field trips, and reciprocal lectures of visiting faculty. The goal is to offer this opportunity to students in the program as early as March 2016. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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