Abstract
The Association of Schools and Programs of Public Health’s Framing the Future Task Force and the League for Innovation in the Community College (the League) cosponsored the Community Colleges and Public Health report. The report recommends that community colleges consider offering public health associate degrees and academic certificate programs including two prototype curricular models developed with support from the Office of the Assistant Secretary for Health of the U.S. Department of Health and Human Services. These include Public Health: Generalist & Specializations and Health Navigator. Each model includes 30 semester hours of coursework in public health core, required courses, experiential learning, and electives along with content outlines for public health core and specialty coursework. The report has been approved by the Association of Schools and Programs of Public Health’s Board and widely disseminated by the League. The League is currently implementing a planning and recognition process to encourage community colleges to plan associate degree and academic certificate programs consistent with the report including both prototype curricular frameworks. The Public Health: Generalist & Specializations is designed for transfer to bachelor’s degree programs in general public health, health education, health administration, and environmental health. The Health Navigator programs are designed for employment as community health workers, health care/patient navigators, and/or health insurance navigators. The rapidly expanding job market for these fields is discussed as well as the recommendation that these associate degrees be planned to enable transfer to bachelor’s degree programs in health education. Implications for the future of the health education profession are also addressed.
Background
The Community Colleges and Public Health (CC&PH) report of the Association of Schools and Programs of Public Health (ASPPH) Framing the Future Task Force was approved in November 2014. The report was sponsored by the ASPPH and the League for Innovation in the Community College (the League), which represent over 800 of the 1,100 community colleges in the United States. The Board of the Society for Public Health Education (SOPHE) and its CC&PH Task Force collaborated in the development of the report including producing content outlines for specialty courses in health education (Riegelman, Wilson, Dreyzehm, & Huffard, 2014).
The SOPHE Community College Task Force and the SOPHE Board have endorsed the development of Health Navigator programs that allowed articulation of association degree programs with bachelor’s degree programs in health education. The SOPHE Board has also approved continued collaboration with the League as it pursues implementation of the CC&PH report.
The CC&PH report recommends that community colleges with a mission to provide health professions education develop one or both of the following types of programs.
Public Health: Generalist and Specializations: The report recommends that community colleges with a mission to education health professionals develop generalist or specialty programs in health education, environmental health, and/or health administration designed as associate degrees for transfer to bachelor’s degree programs in these three fields.
Health Navigator: The report recommends that community colleges develop associate degree and academic certificate programs leading to employment as community health workers, patient navigators, and/or health insurance navigators. The report also endorses the recommendation from the SOPHE Community College Task Force that these associate degrees be designed to allow transfer to Health Education Specialist bachelor’s degree programs. The recommendation for an associate degree or academic certificate program is based on the perception that graduates with content as well as process preparation are needed to accomplish the goals of the health navigation profession as well as being accepted as part of the health team. This requires a 30 semester credit hour program as part of a 60-semester credit hour associate degree or a 30 semester credit hour academic certificate program.
The interest in health education and health navigator curricula in community colleges is based on the rapid expansion in bachelor’s degree program in public health including those in health education leading to eligibility for the Certified Health Education Specialist (CHES) examination. A study reported in Public Health Reports indicates that Public Health bachelor’s degrees have grown over 400% in the last two decades and that Health Education Specialist bachelor’s degree graduates represent the largest number of bachelor’s degrees (Leider et al., 2015).
In addition, Health Navigator programs in community colleges are increasingly positioned to provide employment opportunities. New opportunities for reimbursement under Medicaid, new positions in federally funding community health centers, the 30-day Medicare readmission rule, and opportunities provided under the Affordable Care Act have all provided employment opportunities for those with academic training in health navigator programs (Riegelman, Wilson, Dreyzehm, & Huffard, 2014). In addition, a number of these graduates may seek to continue their education at the bachelor’s degree level in Health Education Specialist programs.
Foundation and Core Public Health Curriculum in Community Colleges
The CC&PH report recommends that community colleges offer foundational and core public health curriculum that prepared students for associate degrees. The curriculum for the foundational and core curriculum is intended to be consistent with the ASPPH Critical Component Elements of an Undergraduate Major in Public Health (Association of Schools and Programs of Public Health, 2012). These Critical Component Elements have been incorporated into the Council on Education for Public Health’s accreditation criteria for undergraduate majors in Schools and Programs as well as for the rapidly growing number of “stand-alone” undergraduate programs in colleges and universities without graduate education in public health.
The recommended three-semester credit hour foundational and core courses are as follows:
Human Health/Personal Health and Wellness: An introduction to the underlying science of human health and disease, including opportunities for promoting and protecting health across the life span. The course should include a population health as well as an individual health focus.
Overview of Public Health: An introductory course in public health and health care systems utilizing the framework developed by the Association of American Colleges and Universities in collaboration with public health organizations (Association of American Colleges & Universities and Association for Prevention Teaching and Research, 2008).
Health Communications: An introductory course in the application of communications to public health and health care delivery. The content outline for this course was reviewed by the SOPHE Community College Task Force.
Health Education Specialization in Community Colleges
Thirty semester credit hour specialty curricula in health education, health administration, and environmental health were developed in collaboration with the respective academic organizations. The SOPHE Community College Task Force designed and the SOPHE Board approved the following three semester credit hour courses as part of the 30 semester credit hour specialization program in Health Education:
Introduction to Health Education: An overview course consistent with the introductory health education curriculum being recommended by SOPHE. This course is designed to be taken as a prerequisite to the following two courses.
Accessing and Analyzing Health Information: An introductory health information course emphasizing health information concepts and skill development as well as evidence-based thinking.
Public Health Advocacy and Leadership in Action: An advocacy and leadership development course designed to articulate with Health Education Specialist bachelor’s degree programs.
Course content outlines for each of these courses are included in the CC&PH report. SOPHE recommends that the instructor for these courses should have a minimum degree of Master in Health Education and/or be certified as an entry-level or advanced-level health education specialist (CHES/MCHES).
Experiential Learning: Service learning or other experiential learning in the community should be a requirement of the degree. Experiential learning should include supervised curriculum with learning outcomes and opportunities for reflection.
Electives: Nine semester credit hours chosen from a wide range of potential electives with emphasis on broad population issues such as health and diversity and global health. A public health preparedness course should also be offered.
The Health Education specialty courses have been recommended by the SOPHE Community College Task Force and the SOPHE Board with the intent of transferring coursework to Health Education Specialist bachelor’s degree programs leading to eligibility for the CHES examination.
Health Navigators Associate Degrees and Academic Certificate Programs
“Health Navigator” is the term being used by the League and the ASPPH to describe the academic degrees and certificate programs that they recommend be offered by community colleges. The report outlines a 30 semester credit hour curriculum including course content outlines that may be incorporated into an associate degree or offered as an academic certificate program.
These associate degrees and academic certificate programs are designed to prepare students to work in jobs with titles including community health worker, patient navigator, and health insurance navigator. Health Navigator academic degree and certificate programs can be designed to be compatible with a wide range of health systems, state regulations, and approaches to delivery of health services.
The recommendations of the CC&PH report for Health Navigator associate degrees and academic certificate programs parallel those for the Public Health: Generalist and Specializations associate degree. Students would pursue either the Health Navigator or the Public Health: Generalist and Specializations program. Specifically for the Health Navigator curriculum, the report recommends the following:
Foundational and Core Public Health courses: (a) Human Health/Personal Health and Wellness, (b) Overview of Public Health, and (c) Health Communications—the same courses as recommended for inclusion in the Public Health: Generalist and Specializations associate degrees.
Experiential Learning: Programs should include experiential learning (e.g., service learning, job shadowing, and/or other forms of experiential learning). Experiential learning should be focused on one or more of the three areas of Health Navigator employment (i.e., Community Health, Health Care Delivery, and/or Health Insurance). Experiential learning should include a supervised curriculum with learning outcomes and opportunities for reflection.
Electives: The six semester credit hours of elective coursework are designed to provide students and institutions with considerable flexibility in designing programs to meet institutional priorities, local workforce needs, state certification requirements, and bachelor’s degree transfer requirement. Local job markets may focus on specific diseases such as diabetes, cancer, cardiovascular disease, or HIV, or defined population such as the elderly, maternal, and child.
In addition, the report recommends the following required Health Navigator courses beyond the core:
Prevention and Community Health
Health Care Delivery
Health Insurance
Accessing and Analyzing Health Information
Course content outlines for each of these courses are included in the CC&PH report.
The SOPHE Board has chosen to actively participate in the development of health navigation education to help clarify the relationships between certified health educators and the health navigators and help ensure the quality of the health navigation education. In addition to preparing graduates for entry-level positions, based on the recommendation of the SOPHE Community College Task Force and the SOPHE Board, the CC&PH report states:
The Health Navigator program competencies most closely align with the Health Education profession. Health Education specialists and those with a Health Navigator degree have complementary roles in strengthening individual and community capacity through patient and community education, patient navigation, referrals, social support, advocacy, and other activities. Health Educators will often supervise the development and delivery of programs and services provided by those with a Health Navigator degree. . . . The Introduction to Health Education and the Public Health Advocacy and Leadership in Action courses are recommended by the Society for Public Health Education for transfer to a bachelor’s degree in Health Education. These courses should ideally be available as electives for students who intend to transfer to a Health Education bachelor’s degree program. (Riegelman et al., 2014, p. 7)
Plans for Implementation
The SOPHE Board has approved continued active participation in implementing the CC&PH report in collaboration with the League. In January 2015, the League disseminated a “call for planning” to all of the over 1,100 community colleges in the United States. Approximately 20 community colleges are participating in the call for planning and are developing plans for implementation. Community colleges are strongly encouraged to collaborate with bachelor’s degree programs. Community colleges are being encouraged to consult with bachelor’s degree programs into which their students are most likely to transfer and ideally develop articulation agreements. The “call for planning” includes the following components:
For community colleges that commit to planning public health programs consistent with the CC&PH report, the League is sponsoring a series of educational webinars. A webinar presented by SOPHE focused on Health Education.
Opportunities for advice and consultation is being provided to community colleges that wish to develop specific types of associate degree and certificate programs.
Up to 10 recognition awards are being presented to community colleges that successfully complete the planning process at the Leagues’ Innovations meeting in March 2016.
The League is seeking funding to support the implementation and evaluation of demonstration programs. The community colleges receiving recognition awards will have priority for this support if funding is available.
SOPHE’s Community College Task Force is continuing its active role in encouraging and facilitating the development of Health Education curricula in community colleges. Individuals who wish to participate and/or contribute idea should contact Elaine Auld, Executive Director of SOPHE, at
Impact on the Health Education Profession
Implementation of the recommendations of the CC&PH report could have important implications for the future of the Health Education profession. First, the student body for Health Education bachelor’s degrees could be greatly expanded once pathways are established articulating community college associate degree programs in health education with bachelor’s degree programs leading to eligibility for the CHES examination. Efforts to ensure smooth articulation are needed including distribution of model articulation agreements supported by SOPHE. These agreements must be flexible enough to accommodate differing state and educational system requirements.
The growth of Health Navigator programs in community colleges provides opportunities for Health Educators to help define the relationship between certified health educators and associate degree trained health navigators, whether they are called community health workers, patient navigators, health insurance navigators, and so on. The recognition of health education as a distinct profession that works closely with and may supervise health navigators can most easily be addressed if health education specialists are directly involved in providing consultation and assistance to community colleges which are developing health navigator programs.
The engagement of SOPHE in the design of health education and health navigator programs in community colleges and the continued support and involvement of the SOPHE Board bodes well for the future relationship between associate degree and bachelor’s degree programs.
Footnotes
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Richard Riegelman is an author and series editor for Jones and Bartlett Learning, including a new Health Navigation series that is developing textbooks designed for Health Navigator programs.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.