Appendix D: Previous Recommendations

The Committee has produced four previous reports.  In these reports, recommendations are presented regarding the Title VII Interdisciplinary, Community-Based Training Grant Programs.  These recommendations are provided below.

First Report

1. Reauthorization of the Title VII Interdisciplinary Training Grant Programs.
2. Increasing appropriations for Title VII Interdisciplinary Training Grant Programs.
3. Encourage collaboration between Title VII Interdisciplinary Training Grant Programs and local institutions that train minority/immigrant populations, community organizations representing those who will be served, and community health centers where primary care is provided.
4. Establish a grant program for “Interdisciplinary Education Demonstration Projects” to support cooperative community-based ventures among Title VII Interdisciplinary Training Grant Programs and establish administrative “preferences and priorities” for funding programs that are truly interdisciplinary in scope.
5. Establish an Office or Division of Allied Health within HRSA.
6. Reallocate one percent of National Institutes of Health, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Food and Drug Administration, Department of Education, and Department of Labor annual appropriations to support formal collaborative programming with the Title VII Interdisciplinary Training Grant Programs.
7. The Health Education and Training Centers Programs should not be required to meet criteria for “self-sufficiency.”
8. Legislative authority for the Podiatric Medicine Program should be placed in Part D, Section 747 (discipline-specific programs for physicians). 

Second Report

1. Restructure Section 755 to specifically support allied health education and training programs (delete all other disciplines).  Additionally, Sections 792 (Health Professions Data) and 799b should be redefined to employ the new list of recognized allied health professions.  Create a new Section 756 to support chiropractic research and training in addition to demonstration projects.  Create a new Section 757 (through removal of Section 755b1j) to support behavioral mental health for graduate psychology education (Section 757a), geriatric psychology education (Section 757b), and graduate social work education (Section 757c).  Section 758 should be created for reauthorization of the Advisory Committee on Interdisciplinary, Community-Based Linkages by moving the committee authorization from Section 756 to Section 758.  Podiatric medicine should be removed from Part D Section 755b2 and placed in Part C (family medicine, general internal medicine, general pediatrics, physicians’ assistants, general dentistry, and pediatric dentistry) and receive a separate appropriation from the allied health budget. 
2. The Secretary should adopt measures to encourage collaboration among Title VII Interdisciplinary Training Grant Programs that enhances the diversity of the health professions educational pipeline, strengthens minority-serving institutions, and increases the development and exchange of culturally sensitive and appropriate health information.
3. Congress and the Secretary should take action to strengthen the capacity of the Allied Health Program in Title VII, Part D, Section 755 of the Public Health Service Act by reserving Section 755 for allied health education and training for the full range of allied health professions.  Funds should be directed to those allied health professions demonstrating workforce shortages and serving unserved, underserved, and vulnerable populations. 
4. Title VII Interdisciplinary Training Grant Programs should receive funding to partner with other agencies to educate and disseminate bioterrorism and emergency preparedness education and training.
5. The Secretary should strengthen the capacity of Title VII Interdisciplinary Training Grant Programs by creating new and enhancing existing linkages between these programs and federally qualified community health centers, rural health clinics, and the National Health Service Corps.  
6. The Secretary should appoint a member of the Advisory Committee on Interdisciplinary Linkages to the DHHS Rural Task Force.

Third Report

1. The HRSA Administrator should convene national health professions associations to develop consensus regarding core competencies and curricula for bioterrorism and emergency preparedness.
2. Federal funding should be continued for quality continuing education in bioterrorism and emergency preparedness for practicing health professionals in every State.
3. Federal funding should be available to develop new curricula or adapt existing curricula in bioterrorism and emergency preparedness for students in health professions schools.
4. Federal agencies should coordinate their efforts regarding bioterrorism and emergency preparedness and establish linkages with Title VII Interdisciplinary Training Grant Programs as well as State programs.
5. BHPr should work with other Federal agencies, such as the Office of Management and Budget and the Congressional Budget Office, to develop additional performance measures, including the use of qualitative data, for Title VII Interdisciplinary Training Grant Programs that specifically evaluate impact on the community health status and economy.
6. Develop a process for sharing data from all Title VII Interdisciplinary Training Grant Programs within BHPr, among interested Federal agencies, and across the programs.
7. Congress should appropriate funding for the purposes of evaluation, development of educational research models, and tracking long-term outcomes specific to Title VII Interdisciplinary Training Grant Programs.

Fourth Report

Cross-Cutting Recommendations

1. Congress should reauthorize the Title VII Interdisciplinary, Community-Based Training Grant Programs.
2. The Secretary and Congress should require Federal agencies, including the Department of Labor, the Department of Education, the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and others to establish formal funding-based links with HRSA to leverage the resources of the Title VII Interdisciplinary, Community-Based Training Grant Programs and to enhance their reach in the recruitment, training, and retention of the health workforce across the nation.
3. The Secretary and Congress should encourage linkages and collaboration between the National Advisory Committee on Interdisciplinary, Community-Based Linkages and U.S. Department of Health and Human Services (DHHS), HRSA, BHPr and national advisory committees and commissions addressing similar topics.

Cultural Competence and Diversity

4. The Secretary and Congress should include legislative language, applied uniformly, that requires Title VII Interdisciplinary, Community-Based Training Grant Programs to address cultural competency.
5. The Secretary and Congress should include legislative language requiring Title VII Interdisciplinary, Community-Based Training Grant Program grantees to address, as appropriate, faculty development in cultural and linguistic competence.  This training should be done in partnership with students, when possible.
6. The Secretary and Congress should strengthen HRSA reporting requirements to include, where appropriate, collection of qualitative and quantitative data relating to the cultural competence efforts of Title VII Interdisciplinary, Community-Based Training Grant Programs.
7. The Secretary and Congress should through legislative language require Title VII Interdisciplinary, Community-Based Training Grant Program grantees, where appropriate, to conduct program evaluation to support the development of evidence-based strategies for the incorporation of cultural competence efforts in health professions education and training.
8. The Secretary and Congress should appropriate funding incentives to health professions education and training programs focused on culturally relevant health promotion and disease prevention activities targeting diverse, unserved, underserved, vulnerable, and disadvantaged populations.
9. The Secretary and Congress should encourage Title VII Interdisciplinary, Community-Based Training Grant Program grantees to form partnerships with providers at the State and local level to prepare a culturally competent and diverse workforce.

Health Disparities

10. The Secretary and Congress should through legislative language mandate that HRSA reporting requirements include, where appropriate, collection of qualitative and quantitative data relating to efforts carried out by Title VII Interdisciplinary, Community-Based Training Grant Programs to contribute to a reduction in health disparities.  Linkages should be established that provide access to other HRSA data sources related to health disparities to enhance assessment and evaluation activities of Title VII Interdisciplinary, Community-Based Training Grant Program grantees.
11. The Secretary and Congress should through legislative language, applied uniformly, require Title VII Interdisciplinary, Community-Based Training Grant Programs to address the recognition and elimination of health disparities.
12. The Secretary and Congress should through legislative language require Title VII Interdisciplinary, Community-Based Training Grant Programs to provide educational and clinical experiences for students, faculty, and/or practitioners that increase awareness and demonstrate how appropriate, evidenced-based interventions can be used in combination with other measures to identify and lessen health disparities unique to their region or local area.
13. Congress should restore funding for Title VII Interdisciplinary, Community-Based Training Grant Programs to FY 2003 funding of $89.7 million.  Further, the Committee encourages Congress to consider additional funding of $50 million for these programs to enable programmatic growth to further the reduction of health disparities through the continued preparation of a diverse health workforce.
14. Congress should appropriate $2 million to HRSA to conduct a study to investigate community health workers/patient navigators in terms of: 1) utilization and cost effectiveness; 2) education and training expectations including career advancement pathways; 3) roles and responsibilities; and 4) their contributions to the reduction of health disparities.

Health Workforce

15. The Secretary and Congress should encourage Title VII Interdisciplinary, Community-Based Training Grant Programs to enhance the use of information technology (IT), tele-education, and telehealth in education and training strategies in order to reach and retain health care professionals in remote and underserved areas.
16. The Secretary and Congress should include legislative language that requires Title VII Interdisciplinary, Community-Based Training Grant Programs to utilize strategies to promote effective participation and representation by members of underrepresented racial/ethnic groups to increase the diversity of the health care workforce and reduce health disparities and to improve recruitment, retention, and distribution of the health care workforce.
17. The Secretary and Congress should require the HRSA Administration to change the application review and progress report review criteria to emphasize the use of strategies aimed at increasing the diversity, recruitment, and retention of the health care workforce.
18. The Secretary and Congress should include legislative language that requires Title VII Interdisciplinary, Community-Based Training Grant Programs to design education and training programs that promote effective participation and representation by members of multiple health professions disciplines and their effective interdisciplinary interaction on behalf of patients, special populations, and/or diverse communities.
19. The Secretary and Congress should include legislative language requiring Title VII Interdisciplinary, Community-Based Training Grant Programs to incorporate geriatric education and training in their programs and activities and encouraging collaboration with Geriatric Education Centers to improve the skills and knowledge of the workforce in the care of our aging population.
20. The Secretary and Congress should expand the Geriatric Academic Career Awards Program by allocating increased funding and legislating increased authority to include other doctoral-level health professions disciplines that care for aging populations and to provide mid-career awards to create academic leaders in geriatrics.
21. The planning committee for the “BHPr All Grantee” meeting in June 2005 should consider creating a venue to explore strategies to share information, data, and resources among BHPr grantees.
22. Congress should expand the legislative authority of the Chiropractic Demonstration Projects Program to establish and include training programs to integrate chiropractic health care with other Title VII Interdisciplinary, Community-Based Training Grant Programs.

Health Workforce Pipeline

23. Funding should be appropriated to support a HRSA consensus conference to include, at a minimum, Title VII Interdisciplinary, Community-Based Training Grant Programs, the National Health Service Corps, and Division of Health Care Diversity and Development Programs.  The purpose of the conference will be to identify successful and effective program models that encourage, on an ongoing basis, children and young adults to consider a broad range of health careers.
24. Make a statutory change to all Title VII Interdisciplinary, Community-Based Training Grant Programs to permit, but not require, a portion of grant dollars to be utilized to focus on pipeline programs encouraging young people to enter a full range of health careers.
25. The Secretaries of DHHS, Education and Labor should convene a meeting to develop collaborative approaches across their Departments to recruit, educate, and retain greater numbers of children and young adults (K-20) into the health professions.  Special emphasis should be placed on program models that target students from disadvantaged and underrepresented backgrounds.
26. The Committee encourages linkages and collaborations with DHHS, HRSA, BHPr, Department of Labor, Department of Education, professional associations, and national committees and commissions that are addressing Kids into Health Careers.
27. An additional scholarship and/or loan repayment program should be established through BHPr that is based on community needs and workforce assessment and would apply to the full range of health professions not currently supported by BHPr funding mechanisms.  Based on the large number of health professions involved, the Committee recommends starting with an appropriation of $10 million.
28. Additional funding should be allocated to Title VII Interdisciplinary, Community-Based Training Grant Programs to support their efforts in the development and maintenance of academic enrichment programs for students in the health professions pipeline. 

Faculty Development

29. The Secretary and Congress should authorize and fund institutions with accredited health professions programs to meet the costs of projects to:
    • Plan and develop interdisciplinary faculty development programs to include 1) post-doctoral fellowships, 2) scholarship, teaching, and service training for junior faculty, and 3) mentoring and retention support through demonstration models; and
    • Provide financial assistance to fellows and faculty enrolled in such programs.
30. The legislative language relating to geriatric faculty as currently enacted in Section 753 should be revised.
    • Revise 753(b) to read:  Geriatric Training Regarding Physicians, Dentists, and Behavioral Health Professionals, including social workers and nurses.
    • Revise 753(b)(3)(A)(iii) to read: have completed graduate medical education or doctoral training in behavioral and mental health services, including social workers and nurses.
    • Revise 753(b)(4)(c) to read: The term "graduate and post-doctoral training in behavioral and mental health services" means training experiences that include graduate training resulting in a PhD., an internship accredited by the American Psychological Association, and post-doctoral training that qualifies a person for designation as a health service provider.