The Legal Epidemiology CompetencyModel Version 1.0Competencies are the knowledge and skills that workers need to perform their work well—a setof statements that workers and employers can use to define their accomplishments and workgoals. 1 A competency model is a list of competencies, organized into groupings or domains,which describes the range of skills needed for satisfactory to exceptional employeeperformance. Some governmental agencies refer to these as “core competencies.”The goal of the Legal Epidemiology Competency Model (LECM), presented in Figure 1 (below), isto offer guidelines for minimum competencies in legal epidemiology, 2 including research andtranslation knowledge and skills required of public health practitioners, lawyers, and policyexperts working in state, tribal, local, or territorial health departments.Background and PurposeThe LECM is neither comprehensive nor prescriptive; in most cases, competencies used fromthis model to create job-related standards will depend on the practitioner’s area of study.Rather, the aim of this project is to present a user-friendly model of specific skills andknowledge necessary to effectively develop, implement, or oversee legal epidemiology studies.Developed by the Public Health Law Program (PHLP) in the Centers for Disease Control andPrevention (CDC), the LECM has the promise to 1) provide a common language to describe thecritical skills and knowledge of practitioners engaged in the scientific study of law as a factor inthe cause, distribution, and prevention of disease and injury; 2) drive the development of legalepidemiology-focused curricula, scholarly support, and additions to the literature; and 3) guidethe development of products related to public health law research and training under federalcapacity building cooperative agreements, and similar funding opportunities.Competency Models—Communicating Industry’s Education and Training Needs: Competency Model Developmentand Use: A Technical Assistance Guide, Competency Model Clearing House (2015).2Legal epidemiology is the scientific study of law as a factor in the cause, distribution, and prevention of diseaseand injury. See Scott Burris, Marice Ashe, Donna Levin, Matthew Penn, & Michelle Larkin, A TransdisciplinaryApproach to Public Health Law: The Emerging Practice of Legal Epidemiology, 37 Ann. Rev. Pub. Health 135 (2016).1

Many experts and organizations have supported the development of the LECM. Amultidisciplinary Expert Review Workgroup assisted the CDC team with the elements includedin this final draft, providing suggestions and comments. The Public Health Foundation (PHF)guided the model’s validation and provided feedback on the framework of the draft model,project methodologies, and competency development process. PHF also developed targetedcommunications materials from this work. In May 2017, PHF hosted a virtual town hall meetingfocused on the draft LECM that was attended by more than 130 people. During and after thismeeting, participants could provide input on the draft LECM. That feedback is reflected in thisversion of the LECM.Ideally, the LECM will be the standard used by practitioners to ensure that legal epidemiologydeliverables, including trainings, are competency-based. For instance, under an umbrellacooperative agreement managed by CDC’s Office for State, Tribal, Local and Territorial Support(OSTLTS), ChangeLab Solutions has developed a series of competency-based legal epidemiologytrainings using the previous version of the LECM as a guide. These free, on-demand trainingsare available on the Public Health Law Academy website.Other anticipated uses of the LECM include Updating and revising job descriptions by employersCareer planning and self-assessment by employeesCareer guidance and exploration for studentsDeveloping Competency-based training and learning outcome objectivesDeveloping, evaluating, and planning curriculaKey Assumptions About the LECMThe LECM is meant to reflect the practice of legal epidemiology. As such, PHLP and the ExpertReview Workgroup understood that certain assumptions must be made about competencydevelopment in a transdisciplinary, cross-cutting, emerging field: Legal epidemiology recognizes that generating, analyzing, and communicatinginformation about law through quantitative and qualitative analysis is essential to thepromotion of population health.Legal epidemiology practitioners, including non-attorneys, should possess basiccompetencies in public health law, 3 including understanding the process for creatingand implementing law and policy, as well as basic principles of administrative andconstitutional law. An understanding of these basic principles is essential todemonstrating competency in legal epidemiology.These competencies do not limit the practice of legal epidemiology; they are meant toreflect basic competencies at three tiers of practice within each domain, but not all ofthe necessary skills for every job would be represented in the model, and every personworking in the field would not necessarily need all of the competencies listed. As such,The Public Health Law Competency Model describing these competencies can be found on CDC’s Public HealthLaw website.32

the model was created to provide a broad set of skills and should be tailored forindividual job descriptions and uses.Organization of the LECMThe LECM is organized into three major domains: 1) general legal epidemiology competencies,2) legal mapping, and 3) legal evaluation. Domain 1 focuses on cross-cutting knowledge andincludes statements related to basic research and epidemiology skills needed to conduct andtranslate both types of legal epidemiology studies. Domain 2 addresses those competenciesneeded for conducting legal mapping studies, including those related to identifying the need forand designing policy surveillance projects. Domain 3 focuses on legal evaluation and includesstatements related to designing projects that study potential associations between health andlaw.The organization of the LECM into three tiers (entry level, mid-tier, and seniormanager/principal investigator) reflects three stages of legal epidemiology career developmentand closely mirrors the three stages of public health career development, as defined by PHF’sCouncil on Linkages. This framework, depicted in Figure 2 (below), allows the competencies tobuild upon one another, supports those who are involved in legal epidemiology studies atprogressive stages of their careers, and provides guidance on identifying appropriatecompetencies for the relevant career stage. Key behaviors are also offered to reflect eachcompetency statement across each tier. Key behaviors are those associated with eachcompetency that the most competent public health practitioners will engage in whileperforming their jobs.Acknowledgments and DisclaimersThis document was developed by Montrece McNeill Ransom, JD, MPH, team lead for publichealth law training and workforce development, PHLP, OSTLTS, CDC; Tara Ramanathan, JD,MPH, team lead for research and translation, PHLP, OSTLTS, CDC; Brianne Yassine, MPH, publichealth analyst/health education consultant, PHLP, OSTLTS, CDC. Mariam Ahmed, legal intern,PHLP, OSTLTS, CDC; and Rose Meltzer, MPH student, Milken Institute School of Public Health,The George Washington University and administrative and communication intern, PHLP,OSTLTS, CDC.For further assistance with the LECM, please contact PHLP at [email protected]. PHLPprovides technical assistance and public health law resources to advance the use of law as apublic health tool. PHLP cannot provide legal advice on any issue and cannot represent anyindividual or entity in any matter. PHLP recommends seeking the advice of an attorney or otherqualified professional with questions regarding the application of law to a specificcircumstance. The findings and conclusions in this summary are those of the authors and do notnecessarily represent the official views of CDC.Published March 2018.3

FIGURE 1. Legal Epidemiology Competency Model, Version 1.0: Domains, Competencies, and KeyBehaviorsDomain 1: General Legal Epidemiology CompetenciesCompetencyStatement 1Articulate theimportance of legalepidemiology conceptsto inform health,fiscal, administrative,legal, social, andpolitical research anddiscourseCompetencyStatement 2Apply legalepidemiologyprinciples to researchstudies, fundingopportunities, andpolicy agendasTier 1Tier 2Tier 31.1.1a: Conductbackground researchon a problem in termsof public healthburden, includingburdens, disparities,and applicable lawsand policies1.1.1b: Define anddescribe basic legalepidemiologyprinciples and concepts1.1.2a: Identify keysources of data forlegal epidemiologypurposes1.1.3a: Identify needsfor health, fiscal,administrative, legal,social, and politicalresearch1.1.2b: Link legalepidemiology conceptsto existing and plannedpublic health activitiesand programs1.1.1c: Identifyopportunities toinclude legalepidemiologyprinciples in existingorganizational activities1.1.2c: Identifyopportunities toincorporate legalepidemiologyprinciples in crosssector collaborations,funding applications,and outreach1.1.3b: Explain legalepidemiology conceptsto transdisciplinarycollaborations,partnerships, and teambuilding1.1.3c: Promote legalepidemiologyprinciples and conceptsin organizationalstrategic planningprocesses and in policyagendas for federal,state, tribal, local,territorial, and globalpublic health programs,as well asnongovernmentalorganizations andacademic programsTier 3Tier 1Tier 21.2.1a: Apply basicethical and legalprinciples pertaining tothe collection,maintenance, use, anddissemination of legalepidemiology data1.2.2a: Determinestudy processes andoutcomes (timeline,Institutional ReviewBoard coordination,publications)1.2.3a: Ensure relevantapprovals are obtainedfor research studies1.2.1b: Serve as amember of atransdisciplinary legal1.2.2b: Assemble atransdisciplinary legalepidemiology research1.2.3b: Manage atransdisciplinary legal4

epidemiology researchteamCompetencyStatement 3Communicate legalepidemiology findings,methodologies, andrecommendations tolay and professionalaudiences1.2.1c: Collaborateacross relevantdisciplines toeffectively use theresources allocated forspecific legalepidemiology studies1.2.1d: Draft studydocumentation,including scopinginformation and legalepidemiology researchprotocols, codebooks,and data sheetsTier 11.3.1a: Contribute toresearch papers,articles, reports, orabstracts1.3.1b: Createaudience-appropriateoral and visualpresentations1.3.1c: Communicatelegal epidemiologymethods and analysesfor feedback andcritique1.3.1d: Identifyactionable next stepson the basis of legalepidemiology findingsto advance healthoutcomesCompetencyStatement 4Tier 11.4.1a: Documentevidence about theteam across disciplines,including assignment ofroles andresponsibilities1.2.2c: Assign availableresources to activitiesneeded to support highquality legalepidemiology researchepidemiology researchteam1.2.2d: Recommendstudy documentationprocesses to finalizecoding schemes andresearch protocols1.2.3d: Oversee thecompletion of studydocumentation1.2.3c: Allocate fundingfor legal epidemiologystudies within new orexisting programsTier 2Tier 31.3.2a: Author researchpapers, articles,reports, and abstracts1.3.3a: Conceptualize astrategy for thedevelopment anddissemination ofwritten, oral, andgraphic materials1.3.2b: Recommendaudience-appropriatecommunicationmethods for thedissemination of legalepidemiology materials1.3.2c: Identifyopportunities todisseminate methodsand processes forcritique1.3:3b: Participate inpeer review of findingsby soliciting andreceiving feedback1.3.2d: Developrecommendations fromresearch relevant todiverse audiences1.3.3c: Partner withstakeholders to ensurethat legal epidemiologyfindings are used toinform public healthpracticeTier 2Tier 31.4.2a: Recognizeneeds for legal1.4.3a: Monitor andevaluate legal5

Analyze the use oflegal epidemiologyfindings to informhealth, fiscal,administrative, legal,social, and politicalactivitiesinfluence of legalepidemiology studies ininforming the ongoingdebate on or reform ofrelated laws or legalmechanismsepidemiology studiesto inform ongoingdebate and reform ofrelated laws or legalmechanismsepidemiology findingsfor their effectivenessand impact1.4.3b: Identifyopportunities forreplication, update,and/or expansion ofexisting legalepidemiology studies6

Domain 2: Competencies for Legal Mapping StudiesCompetencyStatement 1Identify opportunitiesfor legal mapping toinform the process,nature, and impact ofpolicies and laws onpublic healthTier 1Tier 2Tier 32.1.1a: Obtain initialhealth- and law-relatedbackgroundinformation2.1.1b: Identifyapplicable current lawsand policies on an issue2.1.2a: Selectjurisdictions,populations, oroutcomes to analyze2.1.2b: Determine datasources withinformation needed foranalysis2.1.2c: Compare theproblem to gaps incurrent understandingwith input from asubject matter expert2.2.1d: Defineobjectives and scope ofthe studyTier 22.1.3a: Set researchpriorities such astopics, types of studies,and outputs2.2.2a: Developmethods andinstruments forcollecting valid andreliable legal or healthdata2.2.2b: Consult withstakeholders,accrediting bodies, andother partnersregarding legalmapping standards,measures, and metrics2.2.3a: Confirm theappropriateness of thelegal mapping studyscope and codingsystem with subjectmatter experts2.2.3b: Strategize aresearch agenda acrossmultiple legal mappingstudies2.1.1c: Describe thestatus of the legal andpolicy frameworksurrounding an issueCompetencyStatement 2Develop policysurveillance or legalassessment studies toaddress specificresearch questions2.1.1d: Draft a problemstatement throughbackground researchTier 12.2.1a: Collect laws orpolicies iterativelyusing online searchplatforms on the basisof background research2.2.1b: Generatesearch string, variablesof interest, definitions,and coding system onthe basis of initialreview of collectedinformation2.1.3b: Gather inputfrom partners andactivities in the field tofinalize a researchquestion2.1.3c: Determine thefeasibility of studyobjectivesTier 32.2.2c: Assign tasks toteam members on thebasis of administrativerequirements andresources7

CompetencyStatement 3Analyze laws,policies, and politicaland programmaticpriorities usingevidence-based orempirical guidelines(including healthrelated principles ortrends, stakeholderor special interests,and other keydevelopments orconcerns)CompetencyStatement 4Validate andsynthesize resultsthat compare andcontrast meaningfulvariations in law andpolicy related tohealthTier 1Tier 2Tier 32.3.1a: Apply a codingsystem to collectedlaws and policies usingan iterative process2.3.2a: Standardizeprocedures andsystems to ensurequality and consistencyof coding2.3.1b: Quantifyvariations in laws orpolicies betweenjurisdictions or overtime2.3.1c: Use relevantdatabases to track andassess legal and policyinformation2.3.2b: Compareresearch findings withstudy objectives andoutcomes2.3.3a: Monitorprogress and provideobjective feedback onresearch strategy usinginstitutional knowledgeand experience2.3.3b: Collaboratewith partners to reviewlegal mapping studymethodology,progress, and findings2.3.3c: Pursueopportunities forinnovation andenhancement ofmethods or use of newtechnology orresourcesTier 12.4.1a: Resolveambiguities anddiscrepancies in legalmapping data2.4.1b: Identify trendsin legal mapping2.4.1c: Summarizefindings from the legalmapping study2.3.2c: Identifyopportunities forinnovation andenhancement ofmethods or use of newtechnology orresources for legalepidemiology studiesTier 22.4.2a: Check thevalidity and reliabilityof legal mapping data2.4.2b: Confirmresearch findings andlimitations of legalmapping study2.4.2c: Draftconclusions from legalmapping studies on thebasis of the currentlegal, public health,and political contextTier 32.4.3a: Ensure that thelegal mapping studydesign, process, andfindings have met theoriginal researchobjectives2.4.3b: Confirmconclusions in thecontext of currentknowledge andinformation from thefield8

Domain 3: Competencies for Legal Evaluation StudiesCompetencyStatement 1Identify opportunitiesfor a legal evaluationstudy to addressexisting legal, health,or other issuesCompetencyStatement 2Design a legalevaluation to studypotential associationsbetween law andhealthTier 1Tier 2Tier 33.1.1a: Identify legalevaluation needs onthe basis of gaps inexisting evidence(literature, legal data,and other evidence)3.1.2a: Assess theutility of legalevaluation strategies toaddress identified gaps3.1.3a: Gather supportfor legal evaluationfrom internal andexternal stakeholdersin the field3.1.1b: Identify datasources and analyticaltools relevant tostudying researchpriorities3.1.2b: Determine therelevance ofinterventional,infrastructural, orintersectional laws tothe identified researchpriorities3.1.3b: Establishresearch priorities onthe basis of thepotential for improvingpopulation health,socioeconomic orcultural disparities, andthe public healthsystem3.1.1c: Determineprerequisites for studydevelopment (e.g.,legal mapping datasets,needs for particularexpertise)3.1.2c: Identifyresources in light of theneed and the feasibilityof the research,including extramuralfunding and staff andstakeholderinvolvementTier 23.1.3c: Obtain andallocate resources forconducting a legalevaluation3.2.1a: Propose optionsfor a research planincorporating legalevaluation theory3.2.2a: Operationalizekey constructs andconcepts in a draftlegal evaluationresearch plan3.2.1b: Identify legalevaluation studydesigns with proximaland distal impacts oflaw3.2.2b: Develop a logicmodel incorporatingproposed legalevaluation studydesigns to inform thelegal evaluationresearch plan3.2.2c: Secureapprovals for the legalevaluation3.2.3a: Finalize theresearch plan,including engagementwith potentiallyunderrepresented orunderprivilegedpopulations3.2.3b: Finalize a logicmodel, incorporatingthe mechanismsthrough which the lawcan deter, encourage,or compel healthrelated behaviors3.2.3c: Develop afiscally sound budgetthat will support theTier 13.2.1c: Follow legal andethical principles indesigning the studyTier 39

CompetencyStatement 3Collect and analyzequalitative andquantitative studydata using generallyaccepted researchmethodologiesCompetencyStatement 4Interpret results, drawconclusions, andformulate key findingstoward theimprovement of publichealthTier 13.3.1a: Collect datarelevant to an issueand appropriatelydocument the process3.3.1b: Collaboratewith team members toreview initial results3.3.1c: Ensure validityand reliability of thedata3.3.1d: Addressprinciples ofepidemiology andinformatics in datacollection and analysisTier 23.3.2a: Develop aquality control plan tostandardize analyticcodes and outputs3.3.2b: Ensurereliability andadherence tomethodology in thecollection andmanagement of data3.3.2c: Applystandardizedpopulation categoriesor variables to dataanalysisTier 1Tier 23.4.1a: Identify keyfindings and limitationsfrom the datacollection and analysis3.4.2a: Makerecommendations forthe interpretation ofdata, including, but notlimited to, authority,credibility, currency,and authenticity3.4.2b: Interpret pointestimates andconfidence intervals ofmeasures of centraltendency anddispersion, disease orevent frequency, andmeasures ofassociation and impact3.4.1b: Describepatterns or trends indata across sourcesactivities defined in theresearch plan and thatis consistent withfinancial and ethicalrulesTier 33.3.3a: Determinedeadlines and qualitytargets for analyses3.3.3b: Monitor thelegal evaluationprogress within budgetand resourcelimitations3.3.3c: Analyzeresearch results usinginstitutional knowledgeand experience on thetopic, as well asgeneral knowledge oflegal principlesTier 33.4.3a: Confirmfindings according togeographic,socioeconomic,political, or culturalfactors identifiedthrough stakeholderengagement10

FIGURE 2. Three Stages of Legal Epidemiology Career Development Professionals at a senior manager or principal investigator level Responsibilities might include for overseeing major programs or operations and setting an overallstrategy or vision for legal epidemiology related studies and projects; usually have staff who report tothem Mid-tier practitioner who is in a program management, team lead, or supervisory role Responsibilities might include developing, implementing, and evaluating a legal epidemiology studyor program Entry-level or early-career practitioners who directly implement legal epidemiology research tasks,and are not in management or supervisory positions Responsibilities might include collecting, analyzing, and coding legal data11

GlossaryAssociational studies: Scientific study of the relationship between legal data and public healthdata.Behavioral statements: Demonstrable and measurable indicators of an individual’s knowledge,skill, and ability.Codebook: A codebook for a legal dataset (also known as a data dictionary) defines thevariables and correlating values in the legal data. Codebooks for legal datasets include a briefdescription of the study and scope of data collection, any relevant technical information aboutthe files, definitions for each variable, and definitions for each possible value of the variables. 4Coding: The process of converting textual into numerical information, focusing on objectivelymeasurable features (i.e., dates, parties, and penalties). 5Investigational studies: Investigation of the relationship between legal data and governmentalfunctions, health outcomes, or cost outcomes through qualitative interviews.Legal assessments: Cross-sectional, scientific collection, and analysis of codified legal provisionsimportant to health across jurisdictions.Legal dataset: A collection of coded legal provisions for scientific analysis.Legal epidemiology: The scientific study and deployment of law as a factor in the cause,distribution, and prevention of disease and injury in a population.Legal epidemiology practitioners: Public health lawyers, public health scientists, and publichealth practitioners who study the relationship between law and population health. 6Legal epidemiology principles: The fundamental concepts of understanding, implementing, andevaluating laws to change behaviors and environment.7Legal evaluations: Comparative analyses of legal data with health, cost, or systems data.Legal mapping: Comparative law analyses on topics important to health.Policy surveillance: The ongoing, systematic collection, analysis, interpretation, anddissemination of information about a given body of public health law and policy.Protocol: A clearly defined description of the type of law to be studied, search methods fordatabases, and a coding scheme identifying features of laws. 8See Evan D. Anderson et al., Public Health Law Research: Theory and Methods (Alexander C. Wagenaar & Scott C.Burris eds., Jossey-Bass 2013).5See id.6See Burris, supra note 2.7See id.8See Anderson, supra note 4.412

Translation: The interpretation of legal expertise into actionable knowledge to guide both lawyers andnonlawyers in policy development, implementation, and advocacy. 9Scoping: A method used to define the parameters of the population, disease, and law to bestudied in order to develop effective coding schemes.9See Burris, supra note 2.13

1. A . competency model. is a list of competencies, organized into groupings or domains, which describes the range of skills needed for satisfactory to exceptional employee performance. Some governmental agencies refer to these as "core competencies." The goal of the Legal Epidemiology Competency Model (LECM), presented in Figure 1 (below), is