Leveraging External Training Resources
These Programs Can Assist with Limitations, Challenges
BY AURORA B. LE, JANELLE RIOS, SCOTT J. PATLOVICH, ROBERT (BOB) J. EMERY, RACHEL BROWN, MATTHEW HUGHES, AND SHAWN GIBBS
Above: 40-hour HAZWOPER training, May 2024, Edinburg, Texas. Photos courtesy of the P2R Consortium.
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Training is a fundamental part of ensuring worker health and safety, particularly during response to disasters, biological hazards, and emergencies when the hierarchy of controls’ gold standard of elimination is not always possible. Substitution and engineering controls can be similarly difficult to implement during these types of events. When occupational and environmental health and safety professionals must rely on administrative controls, especially training, they are often faced with limitations related to time, capacity, resources, expert knowledge, or finances. Experts from programs under the National Institute of Environmental Health Sciences (NIEHS) outline federally sponsored resources for practitioners charged with training workers—no matter the topic.
INTRODUCING THE NIEHS WTP
The NIEHS Worker Training Program (WTP) was established under Section 126(g) of the Superfund Amendments and Reauthorization Act of 1986 to provide training and education for workers who may encounter hazardous materials and waste and those who are involved in emergency response. In 1992, the NIEHS established an interagency agreement with the U.S. Department of Energy (DOE) that called for training for workers within and around DOE sites. The WTP currently has five major programs: the Hazardous Waste Worker Training Program (HWWTP), the HAZMAT Disaster Preparedness Training Program (HDPTP), the Environmental Career Worker Training Program, the NIEHS/DOE Nuclear Worker Training Program, and the Small Business Innovation Research E-Learning for HAZMAT Program. Since its creation, the NIEHS WTP has trained more than five million workers in the U.S. and surrounding territories on various occupational health topics.
The NIEHS WTP is committed to improving the health and well-being of workers and ensuring that workplace conditions are safe. Although the core of its training curriculum is focused on hazardous waste workers, the breadth of its worker training populations is wide, encompassing workers in many industries and settings such as healthcare, labor unions, manufacturing, oil and gas, beauty services, small businesses, and food service. The NIEHS WTP also trains waste workers, gig economy workers, disaster volunteers, transportation workers, and public health practitioners as well as individuals in tribal nations and at all levels of governments and municipalities. Importantly, the program also trains other OEHS professionals.
From the perspective of the nonprofit organizations that are WTP grant recipients, the program serves in a multi-purpose role best described as convener, collaborator, curricula collector, and problem solver. As a convener and curricula collector, one of its priorities is to develop and deliver best-practice and evidence-based training courses with qualified, culturally and linguistically competent trainers and subject matter experts. This means that training curricula are offered in multiple languages. As a collaborator, another priority is to maintain and enhance the capabilities of its grantee network with a wide-reaching cadre of trainers with models including train-the-trainer and peer training. As a problem solver, the WTP excels in its ability to adjust to national training needs as demonstrated through its response to national and regional events such as the 9/11 attacks on the World Trade Center, weather events such as Hurricanes Katrina and Harvey, and the Norfolk Southern train derailment in East Palestine, Ohio.
Over the years, the NIEHS WTP has helped ensure not only that workers performing critical roles are trained to do tasks safely, but that communities can benefit from having properly trained workers to mitigate and manage risks. Due to the ever-changing dynamics of the workplace and the evolving methods needed to ensure worker health and safety, the NIEHS WTP has been preparing to address the continued impact of climate change, increasing inclement weather events, heat stress, and infectious disease outbreaks in communities.
Hurricane Beryl aftermath, July 2024, Houston, Texas. Photos courtesy of the P2R Consortium.
ADAPTING TO CHALLENGES
With its robust curricula catalog, which is publicly available online, the NIEHS WTP provides several training resources in response to current and ongoing challenges in the OEHS and public health spaces. For example, during the first year of the COVID-19 pandemic, grantees of the NIEHS WTP (PDF) were able to pivot traditionally in-person courses to online synchronous and asynchronous courses. In the first critical months of the pandemic, from January to August 2020, the WTP collectively trained more than 24,000 workers on infectious disease awareness, nearly 4,000 on hazardous waste operations, over 1,700 on infectious disease operations, over 1,500 on infection control risk assessment, and more than 2,500 on related topics like airborne transmission, resiliency, and personal protective equipment. Later, as the transmission and case fatality rates of COVID-19 began to decrease nationwide, NIEHS WTP grantees transitioned again, this time to hybrid courses taught in person and online, which allowed trainers to transfer critical hands-on skills while reducing in-person exposure time.
Another challenge that the NIEHS WTP is working to address is the opioid overdose epidemic in the U.S., which has led to rising opioid-related deaths since 1999. Workers in high-risk occupations or who work in hazardous environments encounter significant injury risks that may lead to opioid or other substance use, misuse, overdose, or death. Therefore, the NIEHS WTP created an awareness-level training tool on the prevention of occupational exposure to fentanyl and other opioids as well as additional training addressing the impact of the opioid crisis on workers, the workplace, and the community. Qualitative and quantitative evaluation data collected about this training and published in the journal Workplace Health & Safety demonstrates its effectiveness in increasing knowledge and awareness of opioid use and addiction prevention.
THE P2R CONSORTIUM
The Prevention, Preparedness, and Response (P2R) Consortium is an awardee of the NIEHS WTP with current core partners at the University of Texas Health Science Center at Houston, Texas A&M University, and the University of Utah. Established in 2010, the consortium aims to enhance the public’s health and well-being by producing knowledgeable and confident workers empowered with skills to keep themselves and their coworkers safe from occupational injuries and illnesses. It comprises dedicated experts in risk management and safety disciplines critical to the nation’s health and well-being and is guided by an external advisory board tasked with ensuring that the training programs address current workforce needs.
The consortium’s training efforts are intended to decrease downtime due to injuries, thereby improving work site management and operations. Its programs also seek to build resilience, in part by improving communities’ capacity to respond to natural and human-caused emergencies, including respiratory disease mitigation. Networking opportunities held during, immediately before, and after training events help to promote increased communication.
Training Programs
The P2R Consortium includes two primary programs, HWWTP and HDPTP, as well as a supplemental program. The HWWTP, launched in 2010, focuses on mitigating chemical and other hazards in routine work settings and in response to unintentional releases. The cornerstone of this training program is the 40-hour Hazardous Waste Operations and Emergency Response (HAZWOPER) course. The second primary program, the HDPTP, was launched in 2015 to promote emergency preparedness of high-risk industries. The HDPTP places special emphasis on building the capacity of vulnerable communities to respond to environmental and work-related threats. Among the popular courses in this program are the Community Emergency Response Team (CERT) course, CERT Hybrid, CERT Train-the-Trainer, Stop the Bleed, infectious disease and bloodborne pathogens courses, and Neighborhood Emergency Response Program (NERP) courses.
The P2R Consortium’s supplemental program, the El Paso COVID-19 Recovery Training Program, is supported by temporary funding. The project team’s aim was to develop a novel approach to deliver custom site-specific training in strategies to mitigate COVID-19 risks among vulnerable workers in El Paso County, Texas. During the program, the team found that more than 90 percent of participants were characterized as being at “high” or “very high” risk of disease transmission per OSHA guidelines, with their risk status primarily driven by frequent or close contact with customers or contact with many customers. Team members created an easily deployable hazard classification tool for infectious disease risk to generate risk profiles for work sites, then combined the resulting profiles with the hierarchy of controls to develop individual and actionable transmission mitigation plans. The program also trained local community health workers who were bilingual in English and Spanish to help recruit small business partners and execute on-site risk assessments. These efforts led to the recruitment of more than 100 small businesses. Following the recruitment and training phases of the project, the team was able to conduct another phase of outreach to measure the program’s impact. The team also held a focus group with all participating community health workers to capture their experiences and suggestions for future similar training programs. While the El Paso COVID-19 Recovery Training Program ended on May 31, the team is still analyzing the results and impact of its novel training program.
Disaster Preparation, Response, and Recovery Through the Years
Following are some examples of the P2R Consortium’s work to help communities prepare for, respond to, and recover from disasters in the Houston, Texas, area and beyond—including efforts in partnership with OSHA, FEMA, and other NIEHS WTP grant recipients. Click or tap on the timeline to view a larger version in your browser.
Training Quality
The P2R Consortium adheres to the NIEHS Minimum Health and Safety Training Criteria, which include five core principles: accuracy, credibility, comprehensiveness, clarity, and practicability. The criteria outline principles for quality control that help consortium training meet a high standard, which contributes to demand among returning participants. (Further information about the criteria can be found on the NIEHS website.) The consortium’s most valuable assets, however, are its trainers, who are praised in post-course evaluations for their knowledge, competence, and relatability.
Community Reach
Consortium training courses reach a diverse audience. Since its inception, the P2R Consortium has trained 95,889 workers across the continental U.S., with 1,803 courses totaling 12,444.5 contact hours of training and counting. In the first half of this year alone, the consortium trained workers in myriad industries and areas such as higher education (safety professionals, lab technicians, faculty, staff, and students, for example), nail salons, aviation mechanic shops, agriculture, state and local government (including environmental quality regulators), utility and power companies, oil and gas, environmental waste management, general manufacturing, disaster response and recovery (including volunteers), environmental sciences, emergency response, public health, retail, food service, and wastewater treatment.
Another example of the P2R Consortium’s broad reach is its hybrid CERT program, which delivers Federal Emergency Management Agency (FEMA) CERT training content using online learning and live training sessions. The hybrid CERT program supports municipalities across the U.S. in multiple languages, including English, Spanish, and Mandarin. The consortium partners with several federal, state, and local government organizations to deliver this training, including the State of California Office of Emergency Management, Listos California Emergency Preparedness, and the Utah Division of Emergency Management. This program was rolled out nationwide in September 2020 and currently includes more than 300 participating local CERT programs in over 40 states, with a total of 31,995 community responders trained so far.
Communities and recovery workers also rely on the P2R Consortium to provide disaster-related assistance. The sidebar above provides a timeline of key activities.
APPLICATIONS FOR PRACTITIONERS
OEHS practitioners may prefer internal trainers, peer trainers, and train-the-trainer models as these options are proven to be more efficacious (see related research in BMC Health Services Research). But not all organizations have the means to conduct training in a variety of topics—especially if the training is not mandated or required (for example, training for healthcare workers required by OSHA’s bloodborne pathogens standard). In that case, practitioners can leverage the NIEHS WTP grantees and their partners, located nationwide, to help fill training gaps. Many training events are offered at no cost or with minimal program fees since the WTP is federally sponsored. The National Clearinghouse for Worker Safety and Health, which is funded by the WTP, serves as a national resource for all of the program’s curricula, technical reports, and news on hazardous waste, waste operations, and emergency response.
Collaborating with stakeholders is key to delivering dynamic and impactful training. Examples of collaborations that are frequently overlooked in the OEHS space and in industry are partnerships between OEHS professionals and university-based researchers. Across the U.S., university researchers conduct cutting-edge research in areas that affect worker safety and health. University partnerships and resources within the NIEHS WTP allow for quick dissemination of information to workers, particularly for emerging topics. In instances where existing standards do not adequately address a situation and new information is needed, these subject matter experts can be called upon to quickly compile evolving research into a format that can be used by NIEHS WTP awardees and trainers to address training gaps that may arise. For example, WTP grant recipients, including the P2R Consortium, were at the forefront of the U.S. response to the 2014–2016 Ebola virus outbreak through the Ebola Biosafety and Infectious Disease Response Training federal grant. The P2R Consortium partnered with university experts who were actively participating in the U.S. Ebola virus disease response—and who had been studying these issues for decades—to develop the resources and training materials used to train non-healthcare workers across the U.S. Many of those individuals were workers who previously were never expected to encounter or respond to a potential situation involving the Ebola virus.
Universities are also home to experts in pedagogy who can help evaluate training programs before they are delivered to workers and can assist in program evaluation after training is implemented. As such, OEHS professionals who conduct training do not need to be all-knowing; they can access a national network of university-based subject matter experts.
The P2R Consortium and the NIEHS WTP have long been national training resources but may be unknown by many in the OEHS community. In a world where funding resources for OEHS programs are more restricted but hazards to worker health and safety remain ever present, we hope this article sheds light on national and regional resources to conduct robust, affordable training.
AURORA B. LE, PhD, MPH, CSP, CPH, is an associate professor of health behavior at Texas A&M University School of Public Health.
JANELLE RIOS, PhD, MPH, is a faculty associate in environmental and occupational health sciences at UTHealth Houston and principal investigator of the P2R Consortium.
SCOTT J. PATLOVICH, DrPH, CIH, CSP, CBSP, CHMM, CPH, is the assistant vice president of environmental health and safety at UTHealth Houston.
ROBERT J. EMERY, DrPH, CHP, CIH, CSP, CBSP, CHMM, CPP, ARM, is the vice president of safety, health, environment and risk management at UTHealth Houston.
RACHEL BROWN, PhD, is the project manager for the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah.
MATTHEW HUGHES, MD, MPH, is a clinical associate professor of occupational and environmental medicine and deputy director of the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah and Weber State University.
SHAWN GIBBS, PhD, MBA, CIH, is a professor of environmental and occupational health and dean at Texas A&M University School of Public Health.
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RESOURCES
BMC Health Services Research: “Evaluating a Train-the-Trainer Approach for Improving Capacity for Evidence-Based Decision Making in Public Health” (2015).
CDC: “Understanding the Opioid Overdose Epidemic.”
EPA: “The Superfund Amendments and Reauthorization Act (SARA).”
Human Resource Development Quarterly: “A Study of Best Practices in Training Transfer and Proposed Model of Transfer” (2008).
Journal of Continuing Education in the Health Professions: “The Most Effective Way of Delivering a Train-the-Trainers Program: A Systematic Review” (2012).
NIEHS: “About the Worker Training Program (WTP).”
NIEHS: “Ebola Biosafety and Infectious Disease Response Worker Training Program” (PDF).
NIEHS: “Evaluation of NIEHS Worker Training Program COVID-19 Activities” (PDF, December 2021).
NIEHS: “History and Goals: Worker Training Program.”
NIEHS: “Infectious Disease and Biological Hazards Training.”
NIEHS: “Infectious Diseases.”
NIEHS: “Minimum Health and Safety Training Criteria.”
NIEHS: “National Clearinghouse for Worker Safety and Health Training.”
NIEHS: “Opioids & Substance Use: Workplace Prevention & Response.”
NIEHS: “Who We Fund.”
NIEHS: “Worker Training Program: An NIEHS Superfund-Related Activity” (PDF, June 2024).
Workplace Health & Safety: “Improving Awareness of Workplace Opioid Use and Addiction Prevention: A Train-the-Trainer Approach” (2022).