Public health workforce

A checklist for establishing a scaled-up public health workforce for COVID-19 contact tracing.

Checklist

1. Staffing needs and resources

• Estimate staffing needs and resources for scaled contact tracing.

• 1.a Core contact tracing staff

  • Case Investigators

  • Contact Tracers

  • Contact Tracing Team Leads

Important parameters to consider:

• Number of staff needed for case investigation. This includes: locating and interviewing cases; determining infectious period; eliciting contacts; providing instructions for isolation; referring to social/medical services.

• Number of staff needed for contact notification. This includes: notifying contacts about exposure; providing instructions about quarantine; referral for testing; referral for social/medical/human services.

• Number of staff needed for case and contact follow-up. This includes: daily check-in; responding to questions; referral to services.

• Number of staff needed to supervise/manage the contact tracing staff.

• Consider current and projected needs; to ensure staffing will meet needs throughout the local epidemic, use upper estimates.

• 1.b Additional workforce needs

  • Program Director

  • Cluster Outbreak Investigators/Field Epidemiologists

  • Care Resource Managers

  • Data Managers

  • Self-Isolation and Self-Quarantine Monitors

  • Clinical Consultants

  • “Runners” to deliver care package materials

Cluster and outbreak investigation workforce estimation:

• Estimate number of clusters or outbreaks that may need to be investigated and controlled simultaneously.

  • Consider current and projected needs; to ensure staffing will meet needs throughout the local epidemic, use upper estimates.

• Estimate the number of staff needed to investigate and control clusters and outbreaks.

  • Multiply the expected number of clusters or outbreaks needing simultaneous investigation and control by the number of investigators per team (for example, three people per investigation team).

  • Consider redirecting existing Field Epidemiologists, or other contact tracing and outbreak investigation and response staff, to fill this role.

Workforce estimation calculators:

• CDC: COVIDTracer 1.0

• Johns Hopkins Bloomberg School of Public Health: Contact Tracing Evaluation and Strategic Support Application (ConTESSA)

• Resolve to Save Lives: Contact tracing staffing calculator

• George Washington Mullan Institute: Contact tracing workforce estimator

2. Current workforce assessment

• 2.a Assess the current workforce available to fill contact tracing roles.

  • Understanding the human resources already available to support the surge contact tracing workforce will inform hiring needs.

  • The workforce can come from a variety of existing sources and will depend on available budget and hiring authority. Consider:

    • Public health professionals working in other areas of the health department or in other private or organizations or public agencies may be available to support

    • Local, state, and federal employees may be available for redirection

    • National guard or other volunteers may be interested in willing to support contact tracing

  • Integrating contact tracing staff into existing public health infrastructure will support a sustainable contact tracing program. Consider filling staffing needs with existing public health staff that already perform contact tracing activities.

  • Existing staff (or new, if needed) can support program administration, including Finance personnel, and information system management, including Information Technology/Systems Managers and Informaticians

  • Match knowledge and skills of individuals with key contact tracing roles and provide training can support workforce expansion. In addition to specific health public experience and expertise, look also at transferable skills when recruiting to scale up contact tracing workforce.

• 2.b Describe gaps in the available workforce.

Existing public health staff that can fill contact tracing roles:

• Case Investigators: Disease Intervention Specialists (DIS), Public Health Associate Program (PHAP) Assignees, Public Health Nurses, Epidemiologists

• Contact Tracers: Disease Intervention Specialists (DIS), Public Health Investigators, Public Health Associate Program (PHAP) Assignees, Public Health Nurses, Epidemiologists

• Contact Tracing Team Leads: Supervisory Public Health Nurses, Senior Epidemiologists

• Cluster Outbreak Investigators/Field Epidemiologists: Infection Control Practitioners (Nurses or Physicians), Hospital Acquired Infection Practitioners (Nurses or Physicians), Hospital Epidemiologists, Occupational Health Liaisons, Field Epidemiologists

• Care Resource Coordinators: Patient Navigators, Linkage to Care Specialists, Disease Intervention Specialists (DIS)

• Data Managers: Epidemiologists, Data Managers, Public Health Informatics Specialists

• Self-Isolation and Self-Quarantine Monitors: Community Health Outreach Workers

• Clinical Consultants: Practicing Registered Nurses, Public Health Nurses, Nurse Practitioners, Physician Assistants, Physicians

3. Organizational chart

• Determine who will be responsible for supervising staff by job title, and organize core contact tracing staff into teams, as appropriate.

  • A maximum of eight team members plus a team leader is suggested.

  • Include epidemiologists (or staff responsible for complex investigations) in each unit.

  • Size of team recommendation is based on best practices for productive workgroup sizes and to enable necessary oversight and support for contact tracing team members.

4. Recruitment

• 4.a Identify the best personnel mechanism and recruitment processes to use for filling each type of position (e.g., permanent employee, part-time employee, contractor, volunteer).

  • Partnering with a private organization, such as a local university or non-profit organization, to manage hiring and/or workforce operations may be quicker and easier than doing this through health department mechanisms.

  • Consider communities and populations disproportionately impacted by COVID-19 and hiring from within these communities. Consult with community-based organizations and community leaders who have earned local community trust.

  • If working with a network of volunteers, ascertain their commitment to ensure a reliable workforce; if reliable, consider leveraging their existing infrastructure for personnel onboarding and management.

  • Consider how to handle staffing when contact tracing needs change, for example using hourly wages and reserving the right to reduce or scale hours as needed.

  • See CDC staffing guidance for health departments.

• 4.b Identify or develop descriptions and qualifications for each position; write job descriptions.

  • Sample job descriptions

    • Program Director

    • Contact Tracing Team Lead

    • Case Investigator

    • Contact Tracer

    • Self-Isolation and Self-Quarantine Monitor

    • Care Resource Coordinator

    • Clinical Consultant

• 4.c. Identify or develop processes and tools for assessing applicant qualifications and rating applicants. (See Sample Contact Tracing Staff Supervision Tool)

  • Where available, adapt existing processes and tools.

• 4.d. Work with human resources to develop mechanism(s) for processing applications.

• 4.e. Implement recruitment processes.

5. Workforce onboarding and training

• 5.a Identify or develop materials and processes for contact tracing staff orientation.

  • Include orientation to the organization, contact tracing in general, and to the contact tracing program.

  • Consider different training needs for existing staff and new hires. For example, existing staff may need a refresher on the Incident Command System (ICS) or preparedness activities within their agency.

  • See CDC COVID-19 Sample Training Plans, Guidance, and Resources

• 5.b Identify training needs to develop knowledge and skills required for each type of contact tracing position.

  • Training should explicitly include:

    • Privacy protection training

    • Cultural competency – especially related to low SES and the challenges related to complying with orders for isolation and quarantine

    • Importance of data collection and entry for data quality and timeliness

• 5.c Identify or develop training methods, curricula, tools, and materials for each type of contact tracing position.

  • Collaborate with public health partners to communicate additional training needs and leverage existing training materials.

  • Consider how completed training activities will be documented to ensure workforce competency and qualifications (e.g., post-test scores, role plays, supervised calls).

Adapt existing training resources:

• ASTHO/NCSD: Making Contact: A Training for COVID-19 Contact Tracers

• CDC: COVID-19 Sample Training Plans, Guidance, and Resources

• Johns Hopkins University: COVID-19 Contact Tracing (Coursera course)

• South University: COVID-19 Contact Tracing Course

• Public Health Foundation’s TRAIN Learning Network: Catalog of COVID-19 contact tracing courses

6. Workforce management system

• Establish a management system for contact tracing staff.

• 6.a. Identify or develop protocols for each type of contact tracing position.

• 6.b. Identify or establish criteria, measures, and expectations for evaluation of workers in each type of contact tracing position.

  • Virtual coaching and mentoring are suggested to provide opportunities for continuous quality improvement.

• 6.c. Identify or develop methods and systems for collecting data and producing reports for worker evaluation. Develop a set of performance metrics to monitor the contact tracing team as a whole in addition to individual workers.

  • Consider setting targets to encourage transparency of expectations among staff.

    Ensure the selected metrics are available for export and reporting in the tools adopted for the contact tracing workflow.

  • Include a system for tracking completed trainings.

7. Ongoing staff development

• 7.a. Plan ways in which contact tracing staff can grow, improve their knowledge, and refine their skillset. (See Key considerations for ongoing education and capacity-building for contact tracing staff)

  • Possible modes of ongoing staff development include:

    • Educational/training components of a daily or weekly team meeting

    • Online trainings and tutorials

    • Clinical supervision or case review sessions with a clinical supervisor

    • Staff evaluation/assessments

• 7.b. Identify processes to put in place for contact tracing staff who under-perform, including extra training and/or supervision, buddy system or mentoring, probation, and conditions and situations that call for termination.

8. Liability protections

• Confirm that contact tracing staff have protections of civil servants including liability protections, insurance and/or indemnity clauses.

  • Confirm staff have completed sufficient training to be competent and qualified for job responsibilities

9. Incentives and retention strategies.

• Develop a strategy for staff retention.

  • Consider financial incentives for completing so many months of service, provision of extra paid time off, process for rotating off the response for breaks.

  • Consider strategies to prevent burnout and promote mental health.

  • Consider developing opportunities or career paths for contact tracers to stay on at the health agency long-term, as available, to maintain capabilities as funding allows.

Implementation Tools

• CDC: Resources for Case Investigations and Contact Tracing (See Section 2: Contact Tracing Implementation Guides and Tools for the Public Health Workforce)

• Workforce calculators

  • CDC: COVIDTracer 1.0

  • Resolve to Save Lives: Contact tracing staffing calculator

  • George Washington Mullan Institute: Contact tracing workforce estimator

• CDC: COVID-19 Staffing Guidance for State, Tribal, Local, and Territorial Health Departments

• Massachusetts Community Tracing Collaborative Workforce Modeling and Structure Resources

  • PIH Contact Tracing Workforce Model

  • Sensitivity Analysis: Modeling a Contact Tracing Workforce

  • Workforce Estimations: Four Scenarios

• Training resources

  • CDC: Resources for Case Investigations and Contact Tracing (See Section 3: Training Resources)

  • ASTHO/NCSD: Making Contact: A Training for COVID-19 Contact Tracers

  • CDC: COVID-19 Sample Training Plans, Guidance, and Resources

  • Johns Hopkins University: COVID-19 Contact Tracing (Coursera course)

  • South University: COVID-19 Contact Tracing Course

  • Public Health Foundation’s TRAIN Learning Network: Catalog of COVID-19 contact tracing courses

  • Massachusetts Community Tracing Collaborative Training Resources:

    • MA CTC Training Approach

    • MA CTC Initial Training Overview

    • MA CTC Self-Paced Orientation Guide

    • Clinical COVID-19 Overview

    • Customer Service for Contact Tracing

    • MA CTC Initial Training Schedule

    • MA CTC Knowledge Assessment

• Sample job descriptions

  • Program Director

  • Contact Tracing Team Lead

  • Case Investigator

  • Contact Tracer

  • Self-Isolation and Self-Quarantine Monitor

  • Care Resource Coordinator

  • Clinical Consultant

• Sample Contact Tracing Staff Supervision Tool

• Key considerations for ongoing education and capacity-building for contact tracing staff

• Sample scope of work for service provider contract

• Sample contact tracing staff orientation and professional development materials (under development)

• Sample contact tracing staff evaluation criteria, measures, and expectations (under development)

LIVING DOCUMENT This playbook is a dynamic, "living" document. Global knowledge pertaining to COVID-19 is rapidly evolving. Feedback and suggestions can be sent to [email protected].