Competencies for Applied Epidemiologists in Governmental Public Health Agencies

1. Competencies for Applied Epidemiologists in Governmental Public Health Agencies Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists

3. Overview Background Goals and Rationale Methods Organization of the Competencies Validation of the Competencies Applied Epidemiology Competencies Uses and Dissemination

4. Background

5. Definition of Epidemiology Epidemiology is �the study of the distribution and determinants of health-related states and events in specific populations, and the application of this study to control of health problems.�* Epidemiology is one of the core sciences of public health *Last JM. A Dictionary of Epidemiology. 4th edition. New York: Oxford University Press, 2001:62.

6. Definition of Epidemiologist A person who investigates the occurrence of disease, injury or other health-related conditions or events in populations to describe the distribution of disease or risk factors for disease occurrence for the purpose of population-based prevention and control. � CSTE Workforce Summit, January 2004 An epidemiologist is trained to look for patterns in populations and interpret what it means. Sometimes they are referred to as �disease detectives� or �population doctors,� however this personification portrays only a limited role compared to the broad range of talents and skills a public health epidemiologist may demonstrate. Public health epidemiologists who work in local, state, and federal health agencies are critical for the detection, control and prevention of major health problems in the community. Epidemiologists are responsible for elucidating and communicating risks, and recommending actions to prevent and control a host of serious threats to public health from acute and chronic diseases and other conditions. An epidemiologist is trained to look for patterns in populations and interpret what it means. Sometimes they are referred to as �disease detectives� or �population doctors,� however this personification portrays only a limited role compared to the broad range of talents and skills a public health epidemiologist may demonstrate. Public health epidemiologists who work in local, state, and federal health agencies are critical for the detection, control and prevention of major health problems in the community. Epidemiologists are responsible for elucidating and communicating risks, and recommending actions to prevent and control a host of serious threats to public health from acute and chronic diseases and other conditions.

7. Definition of Competency A competency is an action-oriented statement that delineates essential knowledge, skills, and abilities in the performance of work responsibilities. A competencies is describable and observable. � Center for Public Health Practice, Rollins School of Public Health, 2002 A competency is defined here. Competencies are important for clarifying the knowledge, skills, and abilities for work performance, and to help identify gaps that can be addressed by training. Reference: Nelson JC. Essien JDK., Loudermilk R. Cohen D. The Public Health Competency Handbook: Optimizing Individual & Organization Performance for the Public�s Health. Atlanta, GA: Center for Public Health Practice of the Rollins School of Public Health, 2002. A competency is defined here. Competencies are important for clarifying the knowledge, skills, and abilities for work performance, and to help identify gaps that can be addressed by training. Reference: Nelson JC. Essien JDK., Loudermilk R. Cohen D. The Public Health Competency Handbook: Optimizing Individual & Organization Performance for the Public�s Health. Atlanta, GA: Center for Public Health Practice of the Rollins School of Public Health, 2002.

8. Problem Insufficient number of public health epidemiologists �Epidemiologists� without adequate training Lack of clear career ladders for epidemiologists Independent, uncoordinated efforts to define the field National efforts focused only on academic epidemiology What were the compelling reasons for developing Competencies for Applied Epidemiologists? Several challenges are listed here, including an insufficient number of epidemiologists (as documented by several CSTE surveys and other sources), persons holding the title of epidemiologist without adequate training, and a lack of clear career ladders for career progression. Further, attempts to better define the epidemiologic field in the past have been uncoordinated and primarily focused on academic epidemiology.What were the compelling reasons for developing Competencies for Applied Epidemiologists? Several challenges are listed here, including an insufficient number of epidemiologists (as documented by several CSTE surveys and other sources), persons holding the title of epidemiologist without adequate training, and a lack of clear career ladders for career progression. Further, attempts to better define the epidemiologic field in the past have been uncoordinated and primarily focused on academic epidemiology.

9. Goals and Rationale

10. Goals and Objectives of the AECs Goal to improve the practice of epidemiology in public health agencies. Objectives to create a comprehensive list of competencies that: Define the discipline of applied epidemiology; and Describe what knowledge, skills, and abilities four levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks. Thus CDC and the Council of State and Territorial Epidemiologists embarked on developing standards for epidemiologists that would accomplish these objectives.Thus CDC and the Council of State and Territorial Epidemiologists embarked on developing standards for epidemiologists that would accomplish these objectives.

11. Rationale for Competency Development Standardization of skill levels for hiring Method to evaluate, reward, and promote workers Road map for training existing workforce Guidelines for academia Improved ability to define the field Utility for future certification processes The various rationales for this activity are listed. Note that CDC and CSTE are not �telling� academia what to do, but rather informing them what public health practitioners found to be useful skills!The various rationales for this activity are listed. Note that CDC and CSTE are not �telling� academia what to do, but rather informing them what public health practitioners found to be useful skills!

12. Methods

13. Competency Development Method Reviewed existing competencies/framework Expert Panel�cross-cutting representation Subgroups: Leadership group Review panel Consultant/editor Assessment and validation Summer 2005�Tier 2 Competencies Early 2006�Tier 1, 2, 3a and 3b Competencies Quantitative and qualitative comments To develop a comprehensive set of epidemiology competencies, an expert panel of epidemiologists working in local, state, and federal health agencies, academia, and industry was convened by CDC and CSTE. The panel reviewed existing public health competencies, including those developed by the Council on Linkages between Academia and Public Health Practice (COL) and determined that more specific competencies were required for the unique aspects of applied epidemiology. The expert panel, which had crosscutting representation and the key subgroups listed, met several times between October 2004 and May 2006 and participated in numerous conference calls. Two surveys to engage a larger audience were conducted. In the summer of 2005, the draft tier 2 competencies (those aimed at midlevel non-supervisory epidemiologists) were evaluated using a web-based survey of local, state, federal, and academic epidemiologists� comments and feedback were evaluated and appropriate changes made prior to the next round of surveys. In early 2006, feedback regarding competencies for all tiers was solicited from epidemiologists at all levels, as well as from partner organizations and others. In addition, state epidemiologists from three states encouraged all epidemiologists employed by the state and local health departments to respond to the second assessment, to ensure representation from local public health. To develop a comprehensive set of epidemiology competencies, an expert panel of epidemiologists working in local, state, and federal health agencies, academia, and industry was convened by CDC and CSTE. The panel reviewed existing public health competencies, including those developed by the Council on Linkages between Academia and Public Health Practice (COL) and determined that more specific competencies were required for the unique aspects of applied epidemiology. The expert panel, which had crosscutting representation and the key subgroups listed, met several times between October 2004 and May 2006 and participated in numerous conference calls. Two surveys to engage a larger audience were conducted. In the summer of 2005, the draft tier 2 competencies (those aimed at midlevel non-supervisory epidemiologists) were evaluated using a web-based survey of local, state, federal, and academic epidemiologists� comments and feedback were evaluated and appropriate changes made prior to the next round of surveys. In early 2006, feedback regarding competencies for all tiers was solicited from epidemiologists at all levels, as well as from partner organizations and others. In addition, state epidemiologists from three states encouraged all epidemiologists employed by the state and local health departments to respond to the second assessment, to ensure representation from local public health.

14. Four Tiers of Practice Tier 1�entry level or basic Tier 2�mid-level Tier 3a�supervisory Tier 3b�senior scientist The workgroup defined four levels of practicing epidemiologists and developed competencies for each tier.The workgroup defined four levels of practicing epidemiologists and developed competencies for each tier.

15. Differentiating Between Tiers Example: Surveillance Evaluation Tier 1 (entry-level or basic epidemiologist): Support evaluation of surveillance systems Tier 2 (mid-level epidemiologist/team leader): Conduct evaluation of surveillance systems Tier 3 (senior-level epidemiologist): a. Supervisor/Manager�Ensure evaluation of surveillance systems b. Senior Scientist (PhD)�Design and conduct evaluation of surveillance systems To better understand the difference in competence expected based on tier, here is an example. For surveillance, an entry level epidemiologist might support surveillance evaluation activities, a midlevel epidemiologist would conduct activities, a supervisor would assure that activities are being performed appropriately, and a senior scientist would be expected to design and conduct such activities. Thus, higher levels of responsibility and skill are expected as one moves from tier one to tier three.To better understand the difference in competence expected based on tier, here is an example. For surveillance, an entry level epidemiologist might support surveillance evaluation activities, a midlevel epidemiologist would conduct activities, a supervisor would assure that activities are being performed appropriately, and a senior scientist would be expected to design and conduct such activities. Thus, higher levels of responsibility and skill are expected as one moves from tier one to tier three.

16. Organization of the Competencies

17. Competency Framework for Public Health Professionals Assessment and Analysis Basic Public Health Sciences Communication Community Dimensions of Practice Cultural Competency Financial and Operational Planning and Management Leadership and Systems Thinking Policy Development/Program Planning Source: Council on Linkages between Academia and Public Health Practice The workgroup used the competency framework developed by the Council on Linkages between Academia and Public Health Practice (core competencies for public health professionals); the COL core competencies in all 8 domains were assumed to apply to epidemiologists. However, the workgroup outlined AECs that were more detailed and specific to epidemiology practice. The workgroup used the competency framework developed by the Council on Linkages between Academia and Public Health Practice (core competencies for public health professionals); the COL core competencies in all 8 domains were assumed to apply to epidemiologists. However, the workgroup outlined AECs that were more detailed and specific to epidemiology practice.

18. Competency Construct I. Skill Domain Area 1. Competency A Subcompetency Sub-subcompetency/learning objective Sub-subcompetency/learning objective Subcompetency Subcompetency Competency B Subcompetency Subcompetency Each AEC Skill Domain has between one and nine competencies and may have numerous sub- and sub-sub-competencies Each AEC Skill Domain has between one and nine competencies and may have numerous sub- and sub-sub-competencies

19. Skill Domain 1: Assessment and Analysis Tier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data collection, dissemination, and use Manage data Analyze data Summarize results, and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs As an example, the next few slides will display the structure of the competencies beginning with Skill Domain 1 (Analytic/Assessment) for Tier 2 (mid-level) epidemiologists. There are nine competencies for skill domain one, analytic/assessment. As an example, the next few slides will display the structure of the competencies beginning with Skill Domain 1 (Analytic/Assessment) for Tier 2 (mid-level) epidemiologists. There are nine competencies for skill domain one, analytic/assessment.

20. Skill Domain1:Assessment and Analysis Tier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data collection, dissemination, and use Manage data Analyze data Summarize results and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs If we choose to look specifically at the �Conduct surveillance� competency �If we choose to look specifically at the �Conduct surveillance� competency �

21. Example: Assessment and Analysis Tier 2 Subcompetencies Conduct surveillance Design surveillance for particular public health problem Identify surveillance data needs Implement new or revise existing surveillance system Identify key findings Conduct evaluation of surveillance systems �we find that within �Conduct surveillance�, there are five sub-competencies as shown, which make up the competency �conduct surveillance.�. �we find that within �Conduct surveillance�, there are five sub-competencies as shown, which make up the competency �conduct surveillance.�.

22. Example: Assessment and AnalysisTier 2 Subcompetencies Conduct surveillance Design surveillance for particular public health problem Identify surveillance data needs Implement new or revise existing surveillance system Identify key findings Conduct evaluation of surveillance systems For a particular Sub-competency, like �identify surveillance data needs��For a particular Sub-competency, like �identify surveillance data needs��

23. Example: Assessment and Analysis Tier 2 Sub-subcompetencies Identify surveillance data needs Create case definition Describe sources, quality and limitations of surveillance data Define data elements to be collected or reported Identify mechanisms to transfer data from source to public health agency Define timeliness required for data collection Determine frequency of reporting Describe potential uses of data to inform surveillance system design Define functional requirements of supporting information system �there are several sub-sub competencies which together define the sub-competency. �there are several sub-sub competencies which together define the sub-competency.

24. Validation of the Competencies

25. Validation Process 2005: Web survey for Tier 2 only 76%�98% of respondents supported competencies 2006: Web survey of complete competency set, Tiers 1�3 Three states targeted for >75% participation 80% of respondents self-identified as Tier 1 and 2 75% worked in state or local agencies Review panel reviewed comments and recommended appropriate changes The 2005 survey of Tier 2 competencies included 380 respondents, mostly self-identified as tier 2 (43%) and tier 3 (45%). 54% of respondents worked in a state public health agency, 23% at the federal level, and 16% at the local level. Respondents offered strong support for the competencies. Quantitative and qualitative feedback were reviewed in detail and adjustments made by the workgroup. During second validation process of all three tiers, three pilot states (CT, KY, TN) were targeted for 75% participation of all of each state�s epidemiologists. Representatives from these three states participated in a conference call with CSTE to understand the process and then coordinated participation within their own state. 420 responses were noted, with improved representation of tier 1 and local agency epidemiologists, as noted. The 2005 survey of Tier 2 competencies included 380 respondents, mostly self-identified as tier 2 (43%) and tier 3 (45%). 54% of respondents worked in a state public health agency, 23% at the federal level, and 16% at the local level. Respondents offered strong support for the competencies. Quantitative and qualitative feedback were reviewed in detail and adjustments made by the workgroup. During second validation process of all three tiers, three pilot states (CT, KY, TN) were targeted for 75% participation of all of each state�s epidemiologists. Representatives from these three states participated in a conference call with CSTE to understand the process and then coordinated participation within their own state. 420 responses were noted, with improved representation of tier 1 and local agency epidemiologists, as noted.

26. Limitations to Validation Process Surveys not systematic Respondents self-reported tier level and other identifying data, thus room for bias Questions asked about only the major competencies in each skill domain No subcompetency or sub-subcompetencies evaluated in survey Surveys targeted specific states for high percentages of return, thus it was not a random sampling of all epidemiologists in all states. However, CDC and CSTE sought input from numerous public health partner organizations. Surveys targeted specific states for high percentages of return, thus it was not a random sampling of all epidemiologists in all states. However, CDC and CSTE sought input from numerous public health partner organizations.

27. Does Everyone Have to Be Competent in ALL Competencies? Yes and No (it depends) an epidemiologist�s favorite answer!

28. Does Everyone Have to Be Competent in ALL Competencies? Mastery of the competencies develops over a continuum of applied epidemiology practice, not a single point in an individual�s career Infectious disease, chronic disease, maternal and child health, and environmental epidemiology may emphasize different competency areas The expert panel intentionally created broad competencies that would cover the discipline of applied epidemiology, which itself is broad and diverse. CDC and CSTE intend that all persons practicing applied epidemiology�including persons who may not have the title of epidemiologist but whose job requires the use of epidemiologic methods�gain competence in all of the defined skill domains commensurate with the duties assigned. However, every applied epidemiologist is not expected to be equally competent in all areas. The expert panel intentionally created broad competencies that would cover the discipline of applied epidemiology, which itself is broad and diverse. CDC and CSTE intend that all persons practicing applied epidemiology�including persons who may not have the title of epidemiologist but whose job requires the use of epidemiologic methods�gain competence in all of the defined skill domains commensurate with the duties assigned. However, every applied epidemiologist is not expected to be equally competent in all areas.

29. Applied Epidemiology Competencies �It�s about time! And now, here are the AECs And now, here are the AECs

30. Competency Skill Domains Assessment and Analysis Basic Public Health Sciences Communication Community Dimensions of Practice Cultural Competency Financial and Operational Planning and Management Leadership and Systems Thinking Policy Development The eight skill domains, which provide the framework for the Applied Epidemiology Competencies, are listed here. Tier two (midlevel epidemiologist) competencies are defined for each skill domain on the following slides (please refer to the complete AEC document for sub and sub-sub competencies)The eight skill domains, which provide the framework for the Applied Epidemiology Competencies, are listed here. Tier two (midlevel epidemiologist) competencies are defined for each skill domain on the following slides (please refer to the complete AEC document for sub and sub-sub competencies)

31. 1: Assessment and AnalysisTier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data collection, dissemination, and use Manage data Analyze data Summarize results, and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs There are nine major competencies in the Assessment and Analysis skill domain. Each competency is further defined by sub-competencies and sub-sub-competencies that can be viewed within the full competency document online.There are nine major competencies in the Assessment and Analysis skill domain. Each competency is further defined by sub-competencies and sub-sub-competencies that can be viewed within the full competency document online.

32. 2: Basic Public Health SciencesTier 2 Competencies Use knowledge of causes of disease to guide epidemiologic practice Use laboratory resources to support epidemiologic activities Apply principles of informatics, including data collection, processing, and analysis, in support of epidemiologic investigations

33. 3: CommunicationTier 2 Competencies Prepare written and oral reports and presentations that communicate necessary information to professional audiences, policy makers, and the general public Demonstrate the basic principles of risk communication Incorporate interpersonal skills in communication with agency personnel, colleagues, and the public Use effective communication technologies

34. 4: Community Dimensions of PracticeTier 2 Competencies Provide epidemiologic input into epidemiologic studies, public health programs, and community public health planning processes at the state, local, or tribal level Participate in development of community partnerships to support epidemiologic investigations Skill domain four, Community Dimensions of Practice, fosters engagement with the community in epidemiologic practice Skill domain four, Community Dimensions of Practice, fosters engagement with the community in epidemiologic practice

35. 5: Cultural CompetencyTier 2 Competencies Describe population by various parameters Establish relationships with groups of special concern Design surveillance systems to include underrepresented groups Conduct investigations using languages and approaches tailored to population Use standard population categories or subcategories when performing data analysis Use knowledge of specific sociocultural factors in the population to interpret findings Recommend public health actions that would be relevant to the affected community

36. 6: Financial and Operational Planning and Management Tier 2 Competencies Conduct epidemiologic activities within the financial and operational plan of the agency Assist in developing fiscally sound budget Implement operational and financial plans Assist in preparing proposals for extramural funding Use management skills Use skills that foster collaborations, strong partnerships, and team building to accomplish epidemiology program objectives

37. 7: Leadership and Systems ThinkingTier 2 Competencies Support epidemiologic perspective in agency strategic planning process Promote organization�s vision Use performance measures to evaluate and improve program Promote ethical conduct Promote workforce development Prepare for emergency response The six competencies for skill domain seven are invaluable for workplace morale, measuring workplace achievement, and coordination in the event of an emergency.The six competencies for skill domain seven are invaluable for workplace morale, measuring workplace achievement, and coordination in the event of an emergency.

38. 8: Policy Development Tier 2 Competencies Bring epidemiologic perspective in development and analysis of public health policies Finally, the last skill domain is aimed at incorporating epidemiologic findings into public health policy decisionsFinally, the last skill domain is aimed at incorporating epidemiologic findings into public health policy decisions

39. Uses and Dissemination How can the Applied Epidemiology Competencies be used? �How can the Applied Epidemiology Competencies be used? �

40. Intended Uses of the Competencies Practitioners Assess current skills Create career development plans Plan specific training and educational activities The AECs define the competencies needed to practice epidemiology in government public health agencies. The intended uses vary by category of user and include the following: Practitioners - For practicing epidemiologists, they are helpful to assess and develop skills o Assessing current skills o Creating career development plans o Planning specific training and educational needs The AECs define the competencies needed to practice epidemiology in government public health agencies. The intended uses vary by category of user and include the following: Practitioners - For practicing epidemiologists, they are helpful to assess and develop skills o Assessing current skills o Creating career development plans o Planning specific training and educational needs

41. Intended Uses of the Competencies Employers Create career ladders for employees Develop position descriptions and job qualifications Develop training plans for employees Assess epidemiologic capacity of an organization Educators Design education programs that meet needs of public health agencies Incorporate critical elements of epidemiologic practice into existing coursework Employers - For employers, they help differentiate between skill levels of individuals, making the hiring, evaluation, and promotion of personnel less subjective. They also help the organization develop training strategies that will meet the needs of employees better. o Creating career ladders for employees o Developing position descriptions and job qualifications o Developing training plans for employees o Assessing epidemiologic capacity of an organization Educators - For educators, curriculum can be mapped to competencies to produce graduates who are equipped with skills that meet the needs of public health agencies. o Designing education programs that meet the needs of public health agencies o Incorporating critical elements of epidemiologic practice into existing coursework CDC and CSTE anticipate the AECs will be used as the basis of instructional competencies for training government epidemiologists and as the framework for developing position descriptions, work expectations, and job announcements for epidemiologists practicing in public health agencies. Once public health agencies have used these for a period of time, CDC and CSTE will evaluate the utility and effectiveness of the competencies as part of an ongoing process of updating and improving the AEC. Employers - For employers, they help differentiate between skill levels of individuals, making the hiring, evaluation, and promotion of personnel less subjective. They also help the organization develop training strategies that will meet the needs of employees better. o Creating career ladders for employees o Developing position descriptions and job qualifications o Developing training plans for employees o Assessing epidemiologic capacity of an organization Educators - For educators, curriculum can be mapped to competencies to produce graduates who are equipped with skills that meet the needs of public health agencies. o Designing education programs that meet the needs of public health agencies o Incorporating critical elements of epidemiologic practice into existing coursework CDC and CSTE anticipate the AECs will be used as the basis of instructional competencies for training government epidemiologists and as the framework for developing position descriptions, work expectations, and job announcements for epidemiologists practicing in public health agencies. Once public health agencies have used these for a period of time, CDC and CSTE will evaluate the utility and effectiveness of the competencies as part of an ongoing process of updating and improving the AEC.

42. Dissemination Oral presentations at meetings Downloadable documents: CSTE website: www.cste.org/competencies.asp CDC website: www.cdc.gov/od/owcd/cdd/aec/ Quick reference fact sheets One-page executive summary and complete preface document Fact sheets for each tier To get the word out regarding the AEC�s, CSTE and CDC have given oral presentations, similar to this one, at several national and international conferences since 2005. You can find the full document and supplemental materials on the CSTE and CDC websites. Reference sheets and tier-specific documents are also available online. To get the word out regarding the AEC�s, CSTE and CDC have given oral presentations, similar to this one, at several national and international conferences since 2005. You can find the full document and supplemental materials on the CSTE and CDC websites. Reference sheets and tier-specific documents are also available online.

43. Dissemination Online competency toolkit for users PowerPoint presentations Interactive quiz Engage users in the field of epidemiology Introduce users to the AECs Epidemiology position descriptions Training resource guide AEC brochure Evaluation checklists In conjunction with CDC, CSTE has developed a �toolkit� for competency related individual and organizational uses. The toolkit can be downloaded from the CSTE and CDC websites. In conjunction with CDC, CSTE has developed a �toolkit� for competency related individual and organizational uses. The toolkit can be downloaded from the CSTE and CDC websites.

44. Dissemination Special Issue of Public Health Reports: Competency-Based Epidemiologic Training in Public Health Practice March/April 2008 Commentaries on the need for competencies and their uses Development of the AECs Competency-based applied epidemiology training Innovative partnerships between academia and practice Evaluation of epidemiology training programs A Supplemental Issue of Public Health Reports (March/April 2008) includes an article describing the development process and the AEC�s themselves .A Supplemental Issue of Public Health Reports (March/April 2008) includes an article describing the development process and the AEC�s themselves .

45. Dissemination Public Health Literature Editorial: Professional Competencies for Applied Epidemiologists: A Roadmap to a More Effective Epidemiologic Workforce by Guthrie�S.�Birkhead, MD and�Denise�Koo, MD, MPH Journal of Public Health Management & PracticeNovember/December 2006� Volume 12�Number 6 Pages�501�-�504

46. Online Resources: www.cdc.gov/od/owcd/cdd/aec/ www.cste.org/competencies.asp Complete competency documents One page competency summaries by tier Competency toolkit Competency self-assessment Summary of training resources Competency PowerPoint slide sets Sample position descriptions Publications related to competencies Contents of the toolkit also available from CSTE: 770-458-3811 Finally, the CDC and CSTE websites host significant information related to the Competencies, including the �toolkit� Some components of the toolkit are listed here. Copies of the toolkit may be obtained by contacting the CSTE National Office at 770-458-3811 Finally, the CDC and CSTE websites host significant information related to the Competencies, including the �toolkit� Some components of the toolkit are listed here. Copies of the toolkit may be obtained by contacting the CSTE National Office at 770-458-3811

47. The Driving Force of the AECs:Leadership Group Conveners: Denise Koo, MD, MPH�Centers for Disease Control and Prevention Matt Boulton, MD, MPH�University of Michigan School of Public Health and CSTE Co-Chairs: Gus Birkhead, MD, MPH�New York State Department of Health and CSTE Kathy Miner, PhD, MPH, CHES�Rollins School of Public Health, Emory University Consultant and Editor: Jac Davies, MPH�CSTE Consultant and Editor, formerly with Washington State Department of Health The group of individuals responsible for the development of the AECs is listed here along with their professional affiliation. Panelists represented are listed with their organizational affiliation during the development process. Some panelists are no longer with the organization listed. The group of individuals responsible for the development of the AECs is listed here along with their professional affiliation. Panelists represented are listed with their organizational affiliation during the development process. Some panelists are no longer with the organization listed.

48. The Driving Force of the AECs:Expert Panelists Kaye Bender, RN, PhD, FAAN�University of Mississippi Medical Center School of Nursing Roger H. Bernier, PhD, MPH�Centers for Disease Control and Prevention Mike Crutcher, MD, MPH�Oklahoma State Dept Health Richard Dicker, MD, MSc�Centers for Disease Control and Prevention Gail Hansen, DVM, MPH�Kansas Department of Health and Environment Richard Hopkins, MD, MSPH�Centers for Disease Control and Prevention Sara Huston, PhD�North Carolina Division of Public Health Miriam Link-Mullison, MS, RD�Jackson County Health Department Hal Morgenstern, PhD�University of Michigan School of Public Health Lloyd Novick, MD, MPH�Onondaga County (New York) Department of Health Len Paulozzi, MD, MPH�Centers for Disease Control and Prevention William M. Sappenfield, MD, MPH�Centers for Disease Control and Prevention Greg Steele, DrPH, MPH�Indiana University School of Medicine Lou Turner, DrPH, MPH�North Carolina State Laboratory of Public Health Mark E. White, MD�Centers for Disease Control and Prevention CDC and CSTE wish to thank to the expert panelists who helped develop the competencies along with their organizational representation during the development process. The group of individuals responsible for the development of the AECs is listed here along with their professional affiliation. Panelists represented are listed with their organizational affiliation during the development process. Some panelists are no longer with the organization listed. CDC and CSTE wish to thank to the expert panelists who helped develop the competencies along with their organizational representation during the development process. The group of individuals responsible for the development of the AECs is listed here along with their professional affiliation. Panelists represented are listed with their organizational affiliation during the development process. Some panelists are no longer with the organization listed.

49. The Driving Force of the AECs:Review and Other Panelists Review Panelists: James Gale, MD, MS�University of Washington Kristine Gebbie, DrPH, RN,�Columbia School of Nursing Maureen Lichtveld, MD, MPH�Centers for Disease Control and Prevention Kristine Moore, MD, MPH�University of Minnesota Art Reingold, MD�University of California at Berkeley CSTE National Office Staff: Pat McConnon, MPH, Executive Director LaKesha Robinson, MPH Jennifer Lemmings, MPH CDC and CSTE also wish to thank to the review panelists who helped develop the competencies along with their organizational representation during the development process and finalization of the AEC documents. The review panelists were also considered a part of our expert panel. Finally, development of the competencies was completed with support from the CSTE National Office StaffCDC and CSTE also wish to thank to the review panelists who helped develop the competencies along with their organizational representation during the development process and finalization of the AEC documents. The review panelists were also considered a part of our expert panel. Finally, development of the competencies was completed with support from the CSTE National Office Staff

50. Partner Organizations American Public Health Association (APHA) Association of Schools of Public Health (ASPH) Association of State and Territorial Health Officials (ASTHO) National Association of County and City Health Officials (NACCHO) Finally, CDC and CSTE would like to thank our partner organizations who reviewed and provided significant feedback during the development process.Finally, CDC and CSTE would like to thank our partner organizations who reviewed and provided significant feedback during the development process.

51. For more information Contact CSTE: 770-458-3811 Visit the following websites: www.cste.org www.cdc.gov/od/owcd/cdd/aec/ Please contact the CSTE National Office for additional information Please contact the CSTE National Office for additional information