Laurie Walkner: ... can kind of give us that background on how did we get here.Thank you Lina.

Lina Tucker Reinders: Thanks Laurie, and Laurie, you forgot to introduce yourself, so Laurie Walkner, with University of Iowa College of Public Health and the Midwestern Public Health Training Center. Thanks for organizing this for us Laurie, and supporting this work. So, Iowa Public Health Association - we're a state affiliate of APHA, American Public Health Association, and back when the pandemic started, I remember having discussions with my boards, with my colleagues, like what is our lane, what is our role during the pandemic? We're not direct service providers, we're not going to be vaccinating people. We'll obviously amplify messages and such, but it quickly became apparent that one of our very important roles was going to be to support our colleagues who were on the front line, who were on that invisible front line, who were taking the heat when it came to explaining, educating, enforcing local mitigation strategies and all that. One of our roles kinda became cheerleader-in-chief, right, and supporting our colleagues who were doing such great work, but a lot of invisible work. And kinda making sure that their voices were being amplified, that their needs were being met, that they were being represented collectively at the state level, to be that liason between state policy, local policy, and all that. Within that role, we started to recognize signs of burnout, signs of stress. I mean, I don't have to share with you all, you all lived it, right, so we started looking at ways we could support the workforce. Some of the things we did fairly early on were just connecting people, creating forums for directors to talk with one another, to share their experiences across the state, for our members to just get together socially, virtually of course, and connect. I think that helped but there is still more work that needs to be done. It's one thing to be the cheerleader-in-chief, but when we are seeing data now that shows us what we are all feeling, what we are all knowing about the levels of burnout, about the levels of languishing - which I think is the new word we are using - as well. When we're seeing risks of attrition and people leaving the workforce, we knew we needed to do something more, more structured, more systematic, long-term, and develop those partnerships. We've always been strong partners with University of Iowa College of Public Health and the Midwestern Public Health Training Center, and so last summer when the MMWR article came out that showed just the high rates of anxiety, depression, even suicidal ideation amongst public health workers, Laurie and I very quickly knew we had to do something and we put together something fairly quickly, a workshop for public health leaders in the state to come together to talk about what they were experiencing, what they were feeling, and what we can do to support them as leaders who would then not only have to take care of themselves but take care of their teams. So we put together a workshop in August and committed to this being the start, not the end. We've been working these months since then to learn as much as we can. Part of what that learning revealed to us was that there was not a lot of data, there's not a lot of examples of work to support the mental health needs of the public health workforce. There's a lot when it comes to healthcare, there's a lot to support docs and nurses and pharmacists and healthcarew workers. Some of those models are applicable but we all know that there is unique experiences and challenges to working in public health, particularly local public health as well. Our mission now is kind of two-fold with this project. One, to support the workforce, the current acute needs of the workforce, to support the future workforce so that we still have one, make sure that we mitigate attrition and maximize retention of the staff that we have, and make sure our students - you know, we're seeing record numbers of students enrolling in public health programs - we want them to stay in the field, stay in our state. Then, we also want to contribute to the evidence base. That's part of our responsibility is to make sure that what we create, what we design from learning along the way gets documented and contributes back to colleagues in Iowa, outside of Iowa so we can all learn from this and grow together. I think with that, that's kind of just the background. In full disclosure, we're learning as we're going, so we're building as we're going because this is such a new area of work. So, the more feedback you all can give us on what the needs are and how we can support those needs and bridge these gaps, the better. So, thank you for being here today. 

Laurie Walkner: Thanks Lina. Just to build off of that a little bit, once we did the workshop, we were brainstorming how to keep this work going, and it just coincided with IDPH having some funding so that we could continue on with this work. One of the first things we started to gather is assessment. What's really needed? Let's understand this a little bit deeper and get it from all of you so that we can start to develop some initiatives to help support the workforce. Back in December we did a survey, a mental health needs assessment of the public health workforce just in the state of Iowa. Jonathan is going to give us a little bit of information on what those survey results looked like, and then hopefully we can give back to you, you can use the slides, and get more access to these results in the future. So, Jonathan - oh no, wait a minute, I'm sorry. I think I skipped ahead. So, Jonathan will be doing that, but before Jonathan does that, we're going to hear from Bethany who has been working with us over the past few months on starting this Iowa Public Health Workforce Development Coalition, which does kind of look at all the needs and give us an opportunity to leverage resources and to give us a guidance on not only mental health but also other aspects of workforce development. So I'm going to turn it over to Bethany right now, if you're ready to go Bethany.

Bethany Snyder: Yes, thank you. I think Lina gave a great overview of how we got here and how much mental health challanges will be impacting the workforce of public health in Iowa. So, for the last few months I've been working with a small group of experts, of public health practitioners across the state on thinking about what we need to make sure we have a strong and stable and flourishing public health workforce for the future. So, we're right at the beginning of this work, we've only met a couple times, but we're hoping by the end of this year, beginning of next year, we will have something that public health practitioners like yourself can use, that our lawmakers and decision-makers can look to that says this is the roadmap we need to have to make sure we have a strong and thriving public health workforce in the future. Over the next few months we'll be meeting, there will be opportunities for you to share into this work. We'll be at the Public Health Conference [of Iowa] in May. I'm sure there will be other - we'll have some surveys or other ways for you to contribute to this work. There will be opportunities for you to weigh in on work that has been done, so please make sure you are getting the updates from IPHA. They will be sharing that. Also, you can just reach out to me, I'll put my email in the chat. If there are other ways that you want to contribute to this project, we'd love to hear from you. So, thank you. Lina, is there anything you want to add to that?

Lina Tucker Reinders: I think you did a great summary of where we're at and where we want to go. We really want this to be a robust process that delivers us... We're not creating a strategic plan for public health in Iowa. We know that each team around that state is doing that on their own, but what we really want to do is to move the entire workforce and our stakeholders, get them to see that public health is bigger than the pandemic, it's bigger that immunizations, that we really need to focus on those public health 3.0 skills in order to support Iowa and to support our workforce and retain those students here in Iowa, and to keep the great folks we have that are dedicated to public health in the profession. We want to create kind of a roadmap, a plan - we're not quite sure the correct noun yet. As public health leaders are justifying their workforce development plans, they can point back to this statewide effort to say this is how this fits in, this is why this is important.

Laurie Walkner: Okay, thank you Bethany, thanks Lina. So, I kinda jumped ahead and gave it away but yes, Jonathan is going to help us here and go over some of those results and show us the data, what that data looks like. So, Jonathan, I'm going to turn it over to you.

Jonathan Platt: Great, thanks Laurie. Thanks everyone for being here today. So, like Laurie said, I'm an epidemiologist so I'm just going to go through the quantitative results of the survey that was sent out last December, and just sort of give you a high-level summary and then an update as to when and where you'll be able to access the data in much more detail. This slide just, again, sort of gives a national picture of the critical need to understand and prioritize the mental health and wellbeing of the US public health workforce. The text here is data from the last two years and before even, but really highlighting high levels of anxiety and depression, poor mental health days among the public health workforce. The bar chart on the right you can see, this is just broken up by essential worker and non-essential worker during the pandemic, showing really very high levels of anxiety and depressive disorder, the use of substances to cope with stress and emotions related to COVID-19 directly, as well as seriously considering suicide and suicidal ideation in the past thirty days. So, really a substantial mental health burden being faced by the public health workforce, and essential workers more broadly in that chart. Again, what was mentioned before, one of the largest consequences of these challenges is this feeling of burnout and languishing within the public health workforce and employment. Symptoms of burnout reported by as much as two-thirds of the sample in these studies. As a result of that, intention to leave one's current organization, either leave public health altogether, or move somewhere else, has been increasing really steadily since 2014, and is even higher today and over the past few years. The map here just shows sort of the national widespread nature of this particular problem, showing 181 state and local public health department leaders that have left their position, resigned, retired, or been fired during the pandemic including quite a few in the state of Iowa. Next slide, please. So with that the survey that was sent out to hundreds of public health employees throughout the state, and was completed by 360 total public health employees, many of which I hope are on this call today, representing mostly local health departments. The survey itself was designed to include Likert scale questions, you know, rate on a scale of one to five for example, as well as many open-ended responses, allowing people to give, you know, more qualitative and more free response types of questions and feedback, mostly covering the challenges that were faced in their employment and their workforce and workplaces as a result of the pandemic, as well as other challenges that might have been experienced, and suggestions for ways forward. So, I've been trying to synthesize this. The results here are just the beginning, but the sample itself was completed by mostly white heterosexual women with a college or graduate education. Ages 34 to 55 was the majority of the sample and most were also not in supervisory positions. And just this map, to show you, there was a pretty good distribution and response from all 6 public health regions throughout the state. Next please. So not surprisingly, one of the main themes that came up over and over was this idea of burnout, this issue of burnout being experienced by the workforce around the state. There are many different definitions and ways of thinking about burnout, but this is just one from the WHO, which defines that as a result of chronic workplace stress that has not been successfully managed. They include 3 different dimensions of burnout here, the first being feelings of energy depletion or exhaustion, and the responses that we got, the language that we got from survey responses included words such as stress, anxiety, trauma, PTSD, overworked, difficulty in maintaining mental health generally. The second dimension was feelings of reduced professional efficacy. So, we had responses, including language like having no impact on the public and underappreciation from leaders and the public, feelings of ineffectiveness or not feeling valued or appreciated and also a feeling of being left out of key discussions at the state level, lack of communication from leadership outside of public health, and so on, language like that. The third dimension, is an increased mental distance, or negative and cynical feelings toward one's job, the sort of sense of resignation, or, you know, languishing language, like being underpaid or staying in one's job only for benefits or loan forgiveness, the ability to use PTO as well as this other theme of, you know, the overemphasis of politics in public health, the disconnect between politics and science in decision-making, and the feeling generally that working in governmental public health has become less desirable during the pandemic. Next, please. Some of the factors that were identified, they were asked about, that contributed to burnout and sort of the challenges that individuals faced in their jobs. We sort of grouped them into 2 different themes or 2 different areas, the first being stress and trauma-type exposures.Of course, the Covid-19 pandemic broadly, was endorsed, or was reported by just about three-fourths of the sample and the associated challenges due to that of course. Another major one was the lack of work-life balance, reported by almost two-thirds of the sample. And then as well, there were challenges more broadly related to discrimination on racial, gender, sexual orientation and disability status that are reported less prevalently but are still substantial challenges, and I think should be a part of discussions and what's to come from this. The second theme, second area, was a general lack of support, both from political perception in the state, as well as among the public. You can see high, highly prevalent, for both of those. Also half of the sample reported feeling a lack of support in their everyday work environment. Finally, those who were having mental health challenges or feeling that burden reported a feeling of stigma around those challenges that they were dealing with. Next please. I think most alarmingly, this came up already, but the idea that all of these challenges, and what people are facing in their day-to-day lives over the past 2 years and beyond have really increased and are really highlighted by this fact that two-thirds of the sample reported having been thinking about reevaluating their career since the pandemic. This came up and was sort of discussed in many different ways but I think mostly people were considering leaving public health or current public health jobs because of the negative experiences that they have been having. So really an alarming need to be addressed. Yeah, that's sort of the summary that I wanted to give. And then finally, this is just a screenshot of what will soon be posted on the website that we have, and will be more or less a live document where you can explore the data in more detail. And, you know, copy and paste the figures that are there for your own use, for dissemination, and further discussions. But just a heads up for that, it will be coming very soon. Thanks.

Laurie Walkner: Thanks, Jonathan. Do we have a few minutes, Kaci and Kathleen, that we could take a few quick questions about the data if anyone has.. 

Kaci Ginn: I don't see any hands raised right now, but if anyone wants to chime in, feel free to raise your hand, and we'll promote you, or you can put anything you'd like in the chat and we'll respond to it. 

Lina Tucker Reinders: I know we have several colleagues from outside of Iowa on the call today, and welcome and thanks for joining us. We should say that the survey instrument that we developed is one that we are happy to share. We know that these struggles are not unique to Iowa, and we want to contribute to learning everywhere. So if you are interested in the survey instrument, just send us a note and we will share that out.

Laurie Walkner: And maybe we can get that posted, Jonathan, along with the report. Okay, all right. We can entertain, Kaci, questions as they come up if you want to interject as we go along, but I think what we're gonna do.. because we need to probably press on with the time. The next part of this is, what did we do with the results? So we took time, we have a small group that we have been convening over the last few months to try to understand what those survey results look like, and then what can we do? How can we react upon that? And we kind of tried to carve out what this really looks like into different buckets. It emphasizes the individual and interpersonal wellness strategies. It also looks at public health leadership and organizational approaches and policy with really that foundational goal of developing a supportive workplace, building towards an organizational culture of health and wellness. We've been doing some systems practice work, and we know that through that systems practice work, we've been collecting stories - as Lina has, and Sharon and others have been collecting stories, in listening sessions - and know that, you know, we really need to start and take care of the workforce before we can continue on, or as we continue on. And so looking at those 3 different buckets and trying to carve some things out, we decided that a mental health and wellness series we could be offering up that really emphasizes the impacts of the adverse life effects, some coping strategies, normalizing conversations about mental health and trauma, using the employee assistance program, self-care, creating boundaries, so that would all be tied up into a series of webinars. And then another area to concentrate on is we're kind of calling it learning in practice, or developing a learning cohort of leadership to really try to think about, okay, how can we engage? How can we learn from each other? Everybody's at different levels within your organizations, looking at mental health, and so how can we model wellness behaviors, work-life balance, communication, more of the team-building, trauma-informed supervision, services to alleviate compassion fatigue and burnout. And what do those workplace policies in place for employees look like? And then in the last pot we looked at advocacy and policy. We have included Jill Krueger, who actually reached out to us because of the survey. She had gotten a glimpse of that and contacted Lina. Jill Krueger is with the Network for Public Health Law, and we also reached out to Denise Hill, who is a professor from Drake University. Jill had reached out and said that she is reviewing policies and practices at the organizational level, the local, state, and national level that support trauma-informed approaches. So I know that Jill is on today, but I also know that her audio is not on and video. So even if we open her up she's not able to interact but if you want to put something in the chat, Jill, that you want us to share, we would be happy to do that. I don't know, Kaci, if you're seeing anything else from Jill but I'm not, if you can please jump in here. Okay, so Jill put in the chat that "looking forward to being part of the work on behalf of the Network for Public Health Law. We'll be providing support related to legal strategies to support mental health and well-being in the public health workforce, and that may include things like identifying policy options, including policies to become a trauma-informed health department as we had said, technical assistance related to HR policies, such as eligibility for employee assistance programs, analysis of which policies are within the authority of the health department itself, and which would require action by policymakers at the local or state level, innovative examples to support mental health of the public health workforce from other communities and states." So, thank you, Jill, and we know that there's a lot going on within the state of Iowa. We know that nationally there's a lot of programs and other support activities that are going on. So we're trying to keep our eyes open with that lens and then trying to build off of that for what we can do as cohorts in the state of Iowa. So that's kind of the priorities and the strategies for this particular initiative. I think for the sake of time, we can go ahead and go into the next part of the presentation, which is really more of the interaction and hearing from everyone.