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Impact of the NACCHO Retail Program Standards Mentorship Program on Retail Food Regulatory Programs

Chang, Amy MS

Journal of Public Health Management and Practice: January/February 2018 - Volume 24 - Issue 1 - p 90–92
doi: 10.1097/PHH.0000000000000740
News From NACCHO

National Association of County & City Health Officials, Washington, District of Columbia.

Correspondence: Amy Chang, MS, National Association of County & City Health Officials, 1201 Eye St NW, Fourth Floor, Washington, DC 20005 (achang@naccho.org).

The author declares no conflicts of interest.

The US Food and Drug Administration's (FDA's) Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards) “serve as a guide to regulatory retail food program managers in the design and management of a retail food regulatory program and provide a means of recognition for those programs that meet these Standards.”1 The Retail Program Standards aims to support retail regulatory agencies in preventing foodborne illnesses and deaths in local communities across the United States by providing the sector with the foundation for the continuous improvement of food safety regulatory programs. In addition, the advancement of processes driving the way foods are prepared and served within the nation's food industry assists in the fight against foodborne illnesses.

There are 9 Retail Program Standards, including the following:

  1. Standard 1: Regulatory Foundation;
  2. Standard 2: Trained Regulatory Staff;
  3. Standard 3: Inspection Program Based on Haz-ard Analysis and Critical Control Points (HACCP) Principles;
  4. Standard 4: Uniform Inspection Program;
  5. Standard 5: Foodborne Illness and Food Defense Preparedness and Response;
  6. Standard 6: Compliance and Enforcement;
  7. Standard 7: Industry and Community Relations;
  8. Standard 8: Program Support and Resources; and
  9. Standard 9: Program Assessment.

Since 1999, the FDA has strongly encouraged jurisdictions that regulate food service and retail food establishments to enroll in the Retail Program Standards. Today, the FDA provides resources and guidance to more than 770 jurisdictions, including more than 600 local health departments that are implementing the Retail Program Standards.

Local health departments play a major role in ensuring the food people eat every day is safe. At least 77% of the 2800 local health departments in the United States educate, inspect, or license retail food establishments.2

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Introduction to NACCHO's and FDA's Retail Program Standards Mentorship Program

In collaboration with the FDA, the National Association of County & City Health Officials (NACCHO) established a mentorship program in 2012 to support retail food regulatory programs in implementing the Retail Program Standards. The program provides peer-to-peer assistance and intensive technical support to ensure entities facilitate the standards efficiently and effectively. Experienced retail food regulatory program staff advise newer agency representatives on how to get started, overcome challenges, and best apply the Retail Program Standards to further their food protection programs. Participants also gain insight into developing and implementing policies and procedures, completing self-assessments, and conducting verification audits. Since inception, more than $1.4 million have been invested in the mentorship program, which has been used to provide 124 awards to retail regulatory food programs. As a result of this program's continued growth, participants now include local health departments from all across the nation. Compared with the inaugural cohort of 9 local health departments, the program has nearly tripled in size, now engaging 31 agencies in the sixth and most recent cohort.

The mentorship program period usually lasts 9 to 10 months; however, participants often have 7 to 8 months to make progress on their work plan after refining and finalizing their goals and objectives with their mentors. Upon completion, participating agencies typically achieve all or the majority of their goals. In addition, as a result of the mentor-mentee relationship, program participants are able to foster meaningful relationships to help them sustain efforts on the Retail Program Standards in the future.

To better understand the impact of the Retail Program Standards and the mentorship program on participating retail food regulatory programs, NACCHO conducted a retrospective survey and a review of final reports collected from the first 5 mentorship program cohorts.

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Methods

In 2017, NACCHO developed and administered an electronic assessment to 64 individuals representing enrolled agencies within the first 5 cohorts of the mentorship program. In conjunction with a review of 93 final reports submitted by participants from the first 5 cohorts, NACCHO sought to explore the following 4 factors:

  1. Retail Program Standards impact on retail food regulatory programs;
  2. The mentorship program's impact on (i) retail food regulatory programs, conformance with the Retail Program Standards; (ii) retail food regulatory programs, communication with their governing entity regarding their retail food program; and (iii) retail food regulatory programs, meeting Public Health Accreditation Board requirements; and (iv) retail food regulatory program staff;
  3. Success stories with the mentorship program and Retail Program Standards; and
  4. Challenges with the mentorship program and Retail Program Standards.
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Findings and Results

The assessment had a response rate of 67%. Of the 43 respondents, 32 individuals were mentees, 7 were mentors, and 4 were both mentees and mentors.

NACCHO collected the final reports from 93 participants from the first 5 cohorts of the mentorship program. Among the final reports submitted, 64 were from mentee agencies and 29 were from mentor agencies.

NACCHO asked respondents 6 overarching questions about the impact of the Retail Program Standards on their health departments. When asked whether making progress on or achieving the Retail Program Standards allowed for better identification of retail food program areas in which their agencies can have the greatest impact on retail food safety, 95% of the respondents (n = 41) answered “strongly agree” or “agree.” Nearly 90% of respondents (n = 38) answered that they “strongly agree” or “agree” that participating in the Retail Program Standards enabled staff to promote wider application of effective risk factor intervention strategies in their agencies.

All respondents answered that they “strongly agree” or “agree” that the Retail Program Standards assisted their agencies in identifying program areas most in need of additional attention regarding retail food safety. In addition, more than 85% of respondents (n = 37) answered that they “strongly agree” or “agree” that the Retail Program Standards served as a means of justification for agency leadership (eg, Board of Health, executive management) related to decisions for maintaining or increasing food safety program budgets.

More than 85% of the respondents (n = 37) answered that they “strongly agree” or “agree” that the Retail Program Standards improved industry and consumer confidence in their retail food protection programs.

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Mentorship Impact on Participants

On the basis of the final reports submitted by members of the first 5 cohorts, all mentees made significant progress toward their work plan's goals and objectives and more than half met their entire work plan's goals and objectives. Common work plan items included meeting components of standard(s), meeting a specific standard, conducting a self-assessment, developing improvement plans, and conducting verification audits. Many mentees (n = 24) were newly enrolled in the Retail Program Standards and decided to conduct an initial self-assessment. Other popular Retail Program Standards included Retail Program Standard 2: Trained Regulatory Staff (n = 19) and Retail Program Standard 7: Industry and Community Relations (n = 11). Throughout all 5 cohorts, participants voiced their challenges with conformance to Retail Program Standard 8: Program Support and Resources due to their agency's lack of resources and funding to meet the Standard. Only 1 participant chose to work on this Standard.

In addition to meeting or making significant progress toward meeting the Retail Program Standards, both mentees and mentors stated that their staff benefited from participation in the program. Other benefits included the following:

  1. A deeper understanding of the benefits related to making progress toward meeting the Retail Program Standards;
  2. Recognition of participants within their agency as subject matter experts on the Retail Program Standards;
  3. Ability to network and interact with other health departments in the mentorship program;
  4. Ability to identify and pursue additional resources available to help conform Retail Program Standards;
  5. Increased staff skills learned through attending trainings at FDA courses and seminars, HACCP training, and association conferences;
  6. Knowledge on improving interactions and relationships with retail food industry; and
  7. Improved public speaking skills from presenting and discussing the Retail Program Standards.

The final reports also included numerous success stories about the positive impact the mentorship program and the Retail Program Standards have had on their retail food programs. Through participation in the mentorship program, respondents indicated they were able to do the following:

  1. Connect with a peer network to support their work on the Retail Program Standards;
  2. Provide food safety training to the public;
  3. Provide evidence of the need for additional food safety program staff;
  4. Apply for additional funding opportunities for the Retail Program Standards;
  5. Use funding for inspectional supplies and equipment needed for the Retail Program Standards and retail food safety program;
  6. Gain staff buy-in and support for the Retail Program Standards; and
  7. Develop and/or improve standardized inspection procedures and policies.
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Long-term Impact of the Mentorship Program

In the 2017 assessment, NACCHO asked mentorship participants about the impact of the mentorship program on their retail food protection program since their participation in the program. The results demonstrate that participants in the mentorship program were able to achieve conformance to 1 or more Retail Program Standards and others continue to progress toward full conformance of 1 or more Retail Program Standards. Retail Programs Standards 2 and 9 were the most popular Retail Program Standards included in participants' work plans. The next most popular standard was Retail Program Standard 7, with 8 respondents stating that they were able to conform to it.

All respondents answered that they either “strongly agree” or “agree” that the mentorship program has stimulated quality and performance improvement opportunities within their agencies. Furthermore, participants indicated that the program helped their agencies in better identifying strengths and weaknesses in their retail food program. When asked whether the mentorship program helped their agencies better communicate about the retail food program with their Boards of Health or governing entities, 84% of participants (n = 36) responded that they “strongly agree” or “agree.” More than half of participants (n = 24) reported that they “strongly agree” or “agree” that the mentorship program helped their agency meet requirements of the Public Health Accreditation Board.

All mentees stated that participating in the mentorship program has helped their agency achieve or make significant progress on the Retail Program Standards and that NACCHO staff provided helpful guidance, resources, and materials during the program.

Participation in the mentorship program enabled 86% of respondents (n = 37) to continue working on the Retail Program Standards after the mentorship program ended. In addition, 88% of respondents (n = 38) stated that their agency has used resources and contacts from the mentorship program to continue work on the Retail Program Standards.

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Conclusion

The results of the survey and final progress reports from the first 5 cohorts illustrate that the NACCHO mentorship program has successfully increased local health departments' participation in and conformance with the Retail Program Standards. The benefits of the mentorship program extend well beyond the mentorship program period for many of the participants. The program has also met the FDA's goal of strengthening the role of local health departments' regulatory programs, which protect retail food in the United States.

NACCHO is continuing to partner with the FDA to administer the mentorship program. In the sixth cohort, NACCHO opened the program to all retail food regulatory programs, including the addition of state, territorial, and tribal programs.

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References

1. Food and Drug Administration. Voluntary National Retail Food Regulatory Program Standards Web page. http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/ProgramStandards/default.htm. Accessed September 6, 2017.
2. National Association of County & City Health Officials. 2016 National Profile of Local Health Departments. Washington, DC: National Association of County & City Health Officials; 2017. http://nacchoprofilestudy.org/chapter-7. Accessed September 6, 2017.
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