Public health practitioners can use Behavior Over Time (BOT) graphs to spur discussion and systems thinking around complex challenges. Multiple large systems, such as health care, the economy, and education, affect chronic disease rates in the United States. System thinking tools can build public health practitioners’ capacity to understand these systems and collaborate within and across sectors to improve population health. BOT graphs show a variable, or variables (y axis) over time (x axis). Although analyzing trends is not new to public health, drawing BOT graphs, annotating the events and systemic forces that are likely to influence the depicted trends, and then discussing the graphs in a diverse group provides an opportunity for public health practitioners to hear each other’s perspectives and creates a more holistic understanding of the key factors that contribute to a trend. We describe how BOT graphs are used in public health, how they can be used to generate group discussion, and how this process can advance systems-level thinking. Then we describe how BOT graphs were used with groups of maternal and child health (MCH) practitioners and partners (N = 101) during a training session to advance their thinking about MCH challenges. Eighty-six percent of the 84 participants who completed an evaluation agreed or strongly agreed that they would use this BOT graph process to engage stakeholders in their home states and jurisdictions. The BOT graph process we describe can be applied to a variety of public health issues and used by practitioners, stakeholders, and researchers.
Purpose The National Maternal and Child Health Workforce Development Center at UNC Chapel Hill (the Center), funded by the Maternal and Child Health Bureau, provides Title V state/jurisdiction leaders and staff and partners from other sectors with opportunities to develop skills in quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care to leverage and implement health transformation opportunities to improve the health of women and children. Description Since 2013, the Center has utilized a variety of learning platforms to reach state and jurisdiction Title V leaders. In the intensive training program, new skills and knowledge are applied to a state-driven health transformation project and include distance-based learning opportunities, multi-day, in-person training and/or onsite consultation, as well as individualized coaching to develop workforce skills. Assessment The first intensive cohort of eight states reported enhanced skills in the core areas of quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care which guided changes at state system and policy levels. In addition, teams reported new and/or enhanced partnerships with many sectors, thereby leveraging Title V resources to increase its impact. Conclusion The Center's provision of core workforce skills and application to state-defined goals has enabled states to undertake projects and challenges that not only have a positive impact on population health, but also encourage collaborative, productive partnerships that were once found to be challenging-creating a workforce capable of advancing the health and wellbeing of women and children.
BackgroundInjuries involving career-technical-vocational education (CTE) are reported to the New Jersey Safe Schools Program online reporting system, the only U.S. State law-based surveillance data for young workers (ages twenty-one and younger), a susceptible, vulnerable adolescent sub-population.MethodsWe examined potential associations between socioeconomic status (SES) indicators and high school student injuries reported between 12/1998-12/2013, excluding injuries acquired by staff members. Associations between DFG score—a proxy for school/district SES—and variables relating to reported injuries, including severity, injury type, injury cause, body parts injured, injury treatment setting and demographics were examined with chi square test (X2) for independence and logistic regression. To assess potential associations between SES and personal protective equipment (PPE), data were stratified by 2003–2008 and 2008–2013, given mandated payment by employers of PPE for employees.ResultsStatistically significant associations were found between SES and injury cause [X2 = (7, 14.74), p = 0.04] and SES and injury treatment setting [X2 = (1, 4.76), p = 0.03]. Adjusted odds ratio suggested students from low SES schools were at a higher odds of being treated at a hospital emergency department (ED) than students from high SES schools (95 % CI 1.3–4.3, p < 0.01).ConclusionsThese findings indicated low SES schools/districts have increased odds of being treated at ED, after controlling for injury severity. Future research should focus on implications such associations have on health care access and insurance for young workers and their families. With small sample sizes representing lower DFG scoring (SES) schools/districts, additional efforts should be enacted to increase injury reporting in these schools/districts.
BackgroundNew Jersey Department of Education (NJDOE) requires by law for accidents/incidents (injury) involving career-technical-vocational education (CTE) students and staff to be reported within five business days to the NJ Safe Schools Program (NJSS) using an online surveillance system. NJ public schools and charter schools (CS) through school districts (SD) or county offices report school data annually to NJDOE, including per pupil spending (PPS). In this study, we examined potential associations of PPS with several variables on injury in NJ: injury cause, injury location on the body, injury type, injury severity, use of PPE, and location of treatment for injury.MethodsPPS data for December 1998–June 2015 from CTE SDs (one per NJ county, n = 21), four CS SD and eight county special services districts were analyzed. T-test examined potential differences in PPS regarding injury severity and use of personal protective equipment (PPE). Stepwise logistic regression assessed potential associations between PPS and various injury surveillance variables.ResultsThere were more CTE injuries reported among SD with lower PPS than among SD with higher PPS. Relatively less severe injuries, e.g., bruise/bumps and cuts/lacerations, more often occurred at schools and SD with higher PPS. Conversely, relatively more severe injuries, e.g., fractures, more often occurred at schools and SD with lower PPS.ConclusionFuture research should further investigate disparities regarding younger worker injuries reported within school-based career-technical-vocational education programs by PPS and other factors like sex or gender, severity, safety training provided and work experience at time of injury.
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