Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). Setting: United States. Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. Main Outcome Measures: LHDs decision to seek PHAB accreditation. Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.

Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs. Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs). Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.

Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

No description available.

background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. This study seeks to identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. . LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. “Micropolitan” includes census tracts with towns of 10,000 - 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. Predictors included variables related to rurality, governance, funding, and workforce. findings: From a sample of 448, approximately 6% of LHDs surveyed had submitted their letter of intent or full accreditation application. Over two-thirds were not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2) were associated with higher likelihood of seeking PHAB accreditation. conclusions: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges. Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

Background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Research Objective: To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. Of particular interest is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Data Sets and Sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study (2013 Profile Study). The 2013 Profile Study includes a core questionnaire (core,) that was sent to all LHDs, and two modules, sent to a sample. Variables were selected from the core and module one for this project. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes for the zip code of the LHD address. “Micropolitan” includes census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. Study Design: Cross-sectional. Analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. The variable for PHAB accreditation decision was created from the 2013 Profile Study question, “Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?” LHDs that selected “My LHD has submitted an application for accreditation” or “My LHD has submitted a statement of Intent” were coded as “Seeking PHAB Accreditation.” LHDs that selected “My LHD has decided NOT to apply for accreditation” or “The state health agency is pursuing accreditation on behalf of my LHD” were coded as “Not Seeking PHAB Accreditation.” Predictors included variables related to rurality, governance, funding, and workforce. Findings: From a sample of 448, approximately 6% of LHDs surveyed had either submitted their letter of intent or full accreditation application. Over two-thirds were either not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2), and higher per capita revenue (aOR=1.02, 95% CI: 1.01, 1.02) were associated with higher likelihood of seeking PHAB accreditation. Conclusions: Specific geographic, governance, leadership, and workforce factors were associated with intention to seek accreditation. Implications: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges (e.g., lower levels of staffing and funding). Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

No description available.

The main topic in the licensing debate is whether licensing affects construction quality. Available literature and previous studies indicate that it does not. The real question is not whether licensing improves quality, but whether the improving quality is the actual purpose of licensing. There is little information available on the purpose of licensing as defined by state licensing departments as well as a general lack of information on how states evaluate whether licensing is fulfilling the intended purpose. In order to effectively resolve some of the issues surrounding the construction licensing debate, the true purpose of licensing and the methods used to evaluate licensing must be defined by state licensing departments, not the industry. The sharing of such information could lead to better construction regulations, improved evaluation techniques, further research, and ultimately, a resolution of the licensing debate. State licensing departments indicated the purpose of licensing as well as methods of evaluating licensing currently used by state licensing departments. Contrary to popular thought, the true purpose of residential general contractor licensing (as defined by state licensing departments) is not to improve construction quality but to protect the consumer's health and life. The license debate will continue as long as there exists a discrepancy between what the industry thinks is the purpose of licensing (improve quality) and what the purpose truly is (protect the consumer). If the main purpose of licensing is, as the states expressed, to protect the consumer, then policy must reflect that idea. Protecting the consumer can be accomplished through mandatory building code inspections without a barrier to entry such as licensing. The information gained from the study provides a foundation for further research on licensing issues that will benefit the construction industry, the economy, and society alike.

Over the last two decades there has been heightened interest in redefining faculty scholarship in higher education (Boyer, 1990). Trends have included the development of cultural frameworks for understanding how disciplines and institutions influence faculty work and how socialization processes impact academic career development. Despite the fact that the number of occupational therapy practitioners who have pursued doctoral training in pursuit of an academic career has failed to keep up with the need for qualified faculty, academic interest in developing disciplinary scholars to build the knowledge base of professional practice has been slow to develop. Furthermore, leadership interest in guiding the development of future faculty by studying how current occupational therapy faculty members are developing as scholars has been limited (AOTA, 2003). The purpose of this study was to develop a framework for describing scholarship in occupational therapy faculty members. A theoretically grounded case study design guided the selection of two occupational therapy departments, representing both a research university and a master’s college. Narrative data from occupational therapy faculty members in these institutions provided in-depth perceptions of how faculty members in diverse institutional settings develop a professional identity. Rich understandings of how clinical and academic socialization processes converge as faculty members in academic departments integrate competing influences from the academic culture, the institutional culture, and the professional culture to prioritize faculty work roles. The study revealed that although occupational therapy departments are succeeding within their institutional contexts, personal faculty priorities as clinicianteachers and institutional missions that create an imbalance in roles that favor teaching, continue to disadvantage certain faculty sub-cultures from evolving as disciplinary scholars. The implications of the failure of occupational therapy faculty members to adapt the researcher role as part of a professional identity include barriers to the development of disciplinary knowledge to support practice, and to the development of successful faculty careers that can be advanced in any institutional environment. The study identified a critical role for program leadership to act as change agents within departmental cultures to balance the need for productive disciplinary scholars, as well as effective clinician-teachers.