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Access these key resources for addressing the intersection of ACEs, suicide, overdose, and mental health-related concerns.

Adverse Childhood Experiences Adverse childhood experiences (ACEs) are potentially stressful or traumatic incidents that harm social, cognitive, and emotional functioning and undermine the safe, stable, nurturing relationships and environments children need to thrive. ASTHO works with state, territorial, and freely associated state health agency leadership, their staff, and cross-sector partners to strengthen jurisdiction-level infrastructure to elevate ACEs prevention. ASTHO also aims to increase knowledge and inspire ACEs programmatic, legislative, and leadership staff to establish policies upstream. Visit ASTHO's ACEs prevention web pages on policy, partnerships, and data to learn more. The Suicide, Overdose, and Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) helps local, state, and territorial health agencies better understand their capacity to address suicide, overdose, and ACEs. This is crucial because prevention involves cross-sector collaboration targeting factors at the individual, relationship, community, and societal levels. website

This Adverse Childhood Experiences Capacity Assessment Tool (ACECAT) roadmap provides concrete steps to completing the ACECAT asynchronously and helps health agencies identify opportunities to work on this public health issue to maximize resources and impact.

The Suicide, Overdose, and Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) helps local, state, and territorial health agencies better understand their capacity to address suicide, overdose, and adverse childhood experiences (ACEs). Prevention of these health issues involves cross-sector collaboration targeting factors at the individual, relationship, community, and societal levels.

Cross-Sector Partnerships to Prevent Adverse Childhood Experiences ASTHO fosters cross-collaboration through various activities focused on assessing, building, and sustaining partnerships. By building strong partnerships, ASTHO leverages partners to gain insight and bridge the gap in expertise. website

Use this interactive tool to identify opportunities to improve your department's suicide prevention programs.

Certain demographics have higher rates of suicide or suicide attempts than the general U.S. population. Public health professionals and partners can use this resource to identify data sources, measures, and strategies for suicide prevention among these disproportionately affected populations.

ASTHO provides capacity building and technical assistance to health agencies to build strong, evidence-based overdose and substance use prevention programs.

Opioid Preparedness: Disruptions in Access to Controlled Substance Medications ASTHO, with support and collaboration from CDC’s Opioid Rapid Response Program (ORRP), helps its members by conducting scenario-based preparedness exercises with health agency staff and diverse partners to support planning for and responding to disruptions in access to prescribed controlled substance medications, including but not limited to opioids, medications for opioid use disorder (MOUD), benzodiazepines, and other prescribed medications that require continuity of care. What are Disruptions? Overdoses involving prescription opioids, heroin, and synthetic opioids have increased nearly sixfold since 1999. In 2020, the United States saw the greatest number of overdose deaths ever recorded as the social and economic conditions associated with the COVID-19 pandemic converged. A disruption is any event that halts the ability of a patient to access prescribed controlled substance medications or MOUD, including a provider’s death or retirement or a regulatory/licensing action against a prescriber. or MOUD, including a provider’s death or retirement or a regulatory/licensing action against a prescriber. These events can be especially dangerous for displaced patients, who face increased risk of negative physical and mental health effects including feelings of abandonment, depression, and symptoms of withdrawal. In the absence of continued care, patients experiencing untreated pain or withdrawal may turn to the illicit drug market, putting them at increased risk for overdose. Furthermore, with the changing landscape in the illicit market, disruptions have become a more urgent; pressing issues such as fentanyl and counterfeit prescription pills have created a more deadly supply. What is the Opioid Rapid Response Program? The Opioid Rapid Response Program (ORRP) is an interagency, coordinated federal effort to help mitigate overdose risks and support continuity of care among patients who lose access to a prescriber of opioids, MOUD, or other controlled substances (e.g., benzodiazepines). ORRP is managed by the Centers for Disease Control and Prevention (CDC) in partnership with the US Department of Health and Human Services Office of Inspector General (HHS OIG). Opioid Preparedness Exercises ASTHO’s preparedness tabletop exercises will aim to provide information and build knowledge about opioid closure events, facilitate important planning discussions among key state agencies and organizations, and provide a structure for developing and/or refining a written response protocol. These exercises are based on the Homeland Security Exercise and Evaluation Program (HSEEP) tabletop exercise model—a discussion-based scenario that facilitates conceptual understanding, identifies strengths and areas for improvement, and/or achieves changes in perceptions about plans, policies, or procedures. The time commitment is two hours per session, for a total of four hours. Exercise participants have included state and local health department and behavioral health agency staff, peer recovery specialists, first responders, physicians, linkage-to-care coordinators, drug overdose prevention specialists, hospital systems, private payers and Medicaid, primary care associations, and community health center associations, among others. website no

Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) provides coroners, medical examiners, toxicologists, forensic pathologists, and public health personnel opportunities to learn and share their overdose investigation expertise with peers across the United States and territories. Coroners and medical examiners are called after a fatal overdose to investigate the cause and manner of death. Public health agencies and practitioners use this mortality data to better understand trends in fatal overdoses and to inform the allocation of resources, such as fentanyl test strips and naloxone in states with high rates of overdose deaths.  Project ECHO: Overdose Fatality Investigation Techniques (OD-FIT) is a collaboration between ASTHO and the Centers for Disease Control and Prevention (CDC) to provide coroners, medical examiners, toxicologists, forensic pathologists, and public health personnel with an opportunity to learn and share their overdose investigation expertise with peers across the United States and territories. By strengthening the medicolegal death investigation system, state and territorial health agencies can improve the accuracy and reliability of overdose death data to benefit public health and safety programs, law enforcement investigations, and upstream prevention strategies.  Project ECHO OD-FIT consists of live online sessions featuring didactic presentations followed by case study discussions. Didactic recordings and accompanying resources from the most recent series can be found below. website no False

Adolescent and School Health Explore ASTHO's adolescent and school health resources, as it works to advance evidence-based school health strategies. Adolescence is a critical period for physical, mental, and social development, with school playing a central role in shaping young people’s well-being. The experiences students have and the supports they receive in school settings have lasting impacts on academic success and lifelong health. To advance evidence-based school health strategies, ASTHO works closely with state and territorial health agencies who are uniquely positioned to lead these efforts — through their ability to convene partners, align funding, collect and use population-level data, and translate evidence into action. ASTHO’s work focuses on policy, systems, and environmental approaches that strengthen partnerships across public health, education, Medicaid, and community-based organizations, while centering youth voices. Through technical assistance, capacity building, and peer-to-peer learning, ASTHO helps jurisdictions build sustainable approaches that support healthy, inclusive school environments. It supports agencies in leveraging their leadership to ensure schools are not only places of learning but environments that actively promote health, belonging, and opportunity for all students. article

Behavioral Health: Women, Children, and Families association of state and territorial health officials, astho, substance use disorder during pregnancy, maternal depression, perinatal depression, opioid use during pregnancy, postpartum depression screening, adolescent mental health  ASTHO works with state and territorial health agencies to increase access to behavioral health services for pregnant and postpartum individuals experiencing substance use and mental health challenges.  ASTHO works with state and territorial health agencies to increase access to behavioral health services for pregnant and postpartum individuals experiencing substance use and mental health challenges. We also work to support these populations through the full range of subsequent outcomes, including prenatal exposure such as neonatal abstinence syndrome. These complex issues require working across agencies, provider groups, communities, and social services to improve prevention, treatment, and care for families who experience mental health concerns and substance use disorder. Learn more about our work below. Related topics: Adverse Childhood Experiences Risk-Appropriate Care website

Contraception Access Association of state and territorial health officials, astho, public health, Arnold ventures, reproductive health, contraception, contraception access, improve health, increase access, contraception access learning community, public health workforce, telehealth, state health agency, health equity, sexually active High-quality reproductive health services improve health outcomes through preconception, prenatal, and interconception care. They also increase access to education and contraception for people of reproductive age to enable responsible and respectful sexual activity as well as safeguard and promote healthy lives throughout the lifespan. ASTHO collaborates across states and territories to improve capacity to increase access to contraception. Representatives from six state health agencies and their partners are currently participating in the ASTHO Contraception Access Learning Community (CALC), funded by Arnold Ventures. Under this learning community, participants receive support as they navigate programmatic and policy issues surrounding access to contraception including funding, expanding telehealth, creating service equity, and supporting the state and territorial workforce. Using individualized workplans and personalized strategies, learning community teams address gaps in contraceptive access throughout their states to provide better care across the lifespan. As part of the CALC, ASTHO is producing a series of written publications and online learning opportunities to further solidify knowledge on key topics related to contraception access. website

Contraception Access Learning Community: Resources Association of state and territorial health officials, astho, public health, contraception access, contraception access learning community, needs assessment, family planning, health equity, reproductive justice, reproductive health, telehealth, improve access ASTHO is producing a series of written publications and online learning opportunities as part of the Contraception Access Learning Community. The virtual learning resources include webinars highlighting emerging topics related to expanding access to contraception. Some of these webinars are part of series focused on a specific topic area and paired with written resources; others are standalone, addressing one topic. Guest speakers on these webinars include state health agency staff, clinical experts, researchers, and policymakers. The written publications highlight key considerations and emerging topics in contraception access. website no

Video Transcript: Innovative State Approaches to Pharmacist-Prescribed Contraception SOPHIA DURANT: Hello, everyone! Welcome! I'm showing one past the hour, so we're going to be getting started. So welcome to this webinar! It's hosted by the Implementing Pharmacists Prescribed Contraception Learning Community. My name is Sophia Durant, I'm a Senior Analyst of Family and Child Health at the Association of State and Territorial Health Officials, or ASTHO. A few brief housekeeping items. This webinar will be recorded and be made publicly available on ASTHO's website. The recording and slides will also be emailed out to all registered participants within a week or two. For those of you who aren't familiar with ASHO's work in this space, ASHO kicked off an implementing pharmacists' prescribed contraception Learning Community in April of this year. This learning community is really focused on technical support and capacity building for a group of four jurisdictions as they develop sustainable strategies for pharmacist-prescribed contraception implementation. This includes really thinking about how do we build workforce capacity, what does reimbursement look like in a sustainable way, and what does patient awareness look like. A big focus of our project is really bringing together stakeholders from the pharmacy field, and also the sexual and reproductive health partners. And with this grant, we produce publicly available materials, like this webinar, to promote improved public health through advanced contraception access. And if you're interested in learning more on this project, feel free to send us an email at contraceptionaccess at astho.org. And we will be putting that email in the chat as well. I wanted to review, what we're going to be spending our time on today. So, I'll be doing a brief overview from a national perspective about pharmacists prescribed contraception, and look at some key policy and implementation trends. And then I'll be facilitating a roundtable discussion, with our panelists about each of their own state's approach to implementing pharmacist-prescribed contraception, and what sort of innovative strategies that they've been using. And we'll also be holding a bit of time at the end of our discussion with panelists for a Q&A from the audience. So, with that being said, I am going to jump into just a quick level set, so we're all coming into this discussion with a little bit of a shared understanding of pharmacist prescribed contraception, or PPC. PPC refers to a policy approach that allows pharmacists to assess a patient and directly provide contraception, without the patient first needing a prescription from another clinician. In other words, the pharmacy becomes an access point both for assessment and direct access to contraception. And this matters because pharmacies tend to be more accessible than clinics. Most Americans live within 5 miles of a pharmacy, so pharmacists prescribed contraception leverages a place people already go to expand access to contraception. And this access point is especially critical now. Federal and state actions have taken steps that limit or remove sexual health services for many communities. And even before the current political climate, access barriers for contraception were incredibly common. One study found that 29% of women who tried to obtain hormonal contraception encountered difficulties getting an initial prescription or refills. And this study specifically refers to accessing contraception through a healthcare provider, like a primary care doctor or an OBGYN. We also know that structural disparities remain. throughout public health, but especially around contraception access. So, some communities face far steeper hurdles in accessing contraception, and one recent Kaiser Family Foundation analysis found that 3.8 million women of reproductive age with incomes under the federal poverty level live in counties with no or low access to publicly funded clinics providing contraceptive care. That means that there are a lot of women who are in low income who don't have easy access to clinics to provide contraceptive care. And about half, 1.8 million, live in states without pharmacists prescribing laws. This tells us that pharmacists prescribed contraception can help close these geographic and policy gaps in accessing contraception. So, pharmacists prescribed contraception have gotten increasingly popular over the past decade. As of June of 2025, over 30 states, along with Washington, D.C, have passed legislation allowing pharmacists prescribed contraception. And policy that permits pharmacists prescribed contraception can look… can look a little different based on the state. There are a couple different pathways that states can use, and I'm gonna briefly touch on what those different pathways look like. So one of those pathways is a collaborative practice agreement, or a CPA. A CPA is a signed partnership with a prescriber that lets an individual pharmacist furnish contraception under specific agreed-upon protocols. Another pathway to pharmacist-prescribed contraception is a standing order, and this is a statewide clinician-signed directive that's usually signed by the state health authority's medical director. That allows pharmacists to dispense certain contraceptives to certain patients without a specific prescription for each patient. Another pathway is a statewide protocol, which empowers pharmacists to prescribe and dispense contraception under rules set by a board of pharmacy. It's sort of similar to a standing order, but it's not tied to a certain prescriber, like the standing order is. And then finally, there's the standard of care model, which is similar to independent prescriptive authority. And this expands a pharmacist's scope so that they can independently prescribe within defined clinical conditions using their professional judgment that aligns with the medical standards, rather than having to prescribe certain medications on a specific drug-by-drug basis. So those are some of the… levers the policy mechanisms used to create pharmacists prescribed contraception within different jurisdictions, but passing a policy that legalizes pharmacists prescribed contraception is just the first step. Implementing pharmacist-prescribed contraception can be really difficult. Due to policy, administrative, clinical, and logistical barriers. A diverse set of public health agencies, private entities, and healthcare professionals must work collaboratively to successfully implement a pharmacist-prescribed contraception program that meets the needs of pharmacists, patients, and the wider community. And this slide really walks us through some of the common barriers we hear around implementing pharmacist-prescribed contraception. So, those barriers include reimbursement, workforce readiness and training, and then public awareness. And I'll briefly touch on each of these barriers a little bit more. We routinely hear from pharmacists and other key stakeholders that identify payment for services as a key barrier to widespread implementation and uptake of pharmacists' prescribed contraception programs. Many pharmacists report resistance to participating in pharmacist-prescribed contraception without mechanisms in place that reimburse them for all of the relevant services they provide. So, specifically for the cost of counseling and the assessment services, as well as the cost of the medication and the standard dispensing fee. On top of that, pharmacists have also raised concerns about reimbursement rates for services, and a need to make sure that those are on par with other healthcare providers who also are prescribing contraception. Another group of barriers around pharmacist-prescribed contraception is related to workforce readiness and training. Once a… pharmacist-prescribed contraception policy is enacted, pharmacists and pharmacy leaders must be able to promptly and clearly inform the pharmacy workforce what the law permits, what required steps need to happen, and where to find guidance. And there's often a delay between when the policy is passed in legislation and when the answers to all of those questions happen. So, what are the required steps often has to come in the form of regulations from a state health agency. And sometimes that can take a while to be created. On top of that, standard and accessible training on pharmacist prescribed contraception usually needs to be developed for each state. And made available to pharmacists, and being able to be scaled out and maintained over time often presents challenges. Additionally, workflow considerations can impact implementation. Pharmacists prescribed contraception must integrate into existing workflows, including scheduling, privacy and space considerations. Standardized screening tools, documentation, and critically, billing workflows. Thinking through what codes pharmacists can use, what payer policies exist around pharmacist credentialing and enrolling as providers, and other revenue cycle processes. Finally, thinking through public awareness can also be a barrier to implementation. There's this balance between education and awareness campaigns. If done too early into pharmacist prescribed contraception's implementation, there's this risk that not enough pharmacists will be offering services, which could confuse and turn away potential patients from seeking out that service in the future. However, if education campaigns are doing too late, pharmacists may question the worth of offering a service if there isn't a patient demand to meet that service. Despite these barriers, many states are implementing pharmacist-prescribed contraception successfully. Research tells us the pharmacist-prescribed contraception is a safe and effective way to increase access while reducing cost. It also reaches

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