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ASTHO Profile data shows how public health agencies are adopting AI, revealing policy gaps, workforce challenges, and uneven use across states.

Learn how to implement key approaches to strengthen economic supports for families, which is crucial to preventing ACEs, suicide, and overdose.

Defining Clear Roles and Responsibilities for Effective Public Health Plans Defining Clear Roles and Responsibilities in Public Health Sara Bell, Marta McMillion Executive Summary Public health plans often stall not because of weak strategy but because roles, decision-making authority, and accountability are unclear. Without clear ownership, teams may hesitate, duplicate efforts, or lose momentum. This resource provides practical tools to help teams move from planning to action with clarity and consistency. It is designed to help public health agencies define roles, clarify decision-making authority, and strengthen accountability to support effective implementation of organizational plans: Ownership and Role Clarity: Introduces the RACI model to define who is responsible for tasks, accountable for outcomes, and engaged in the work. This helps reduce confusion and improve coordination across teams. Decision-Making Authority: Focuses on identifying who has authority to make decisions and how decisions are communicated. Tools like decision-making charts and the DACI model help clarity ownership and prevent delays. Accountability Mechanisms: Outlines formal approaches (e.g., project tracking, performance management) and informal approaches (e.g., peer accountability, leadership modeling, team norms) to reinforce follow-through and transparency. Putting It Into Practice: Provides actionable strategies such as assigning implementation champions, using short-cycle check-ins, embedding progress reporting, and strengthening team culture. It also emphasizes adapting over time and celebrating progress to sustain momentum. By clarifying ownership, decision-making, and accountability, teams can create more coordinated and effective implementation processes that turn plans into action. Introduction It’s not uncommon for public health plans to stall during implementation due to unclear roles and responsibilities. Without defined ownership, decision-making authority, and mechanisms for accountability, teams may hesitate, duplicate effort, or disengage. This resource provides tools and strategies to support health departments and their partners in clarifying ownership, navigating decision-making, and reinforcing follow-through. Ownership and Role Clarity Use the RACI model to define who is responsible for each aspect of your implementation plan, as illustrated in Table 1: R = Responsible — Who is doing the work? A = Accountable — Who owns the outcome? C = Consulted — Who should be asked for input? I = Informed — Who needs to be kept in the loop? Table 1 - Resource - Defining Clear Roles and Responsibilities for Effective Public Health Plans Decision-Making Authority Understanding who has formal and informal decision-making power is essential in cross-functional and collaborative environments. To support this process, consider reviewing ASTHO’s Charter Template and Guide, which includes a structured approach to documenting governance, decision-making norms, and communication practices across implementation teams. Additionally, when collaborating with internal teams, across departments, or even external organizations, a Memorandum of Understanding (MOU) can be a helpful tool to formalize shared expectations. MOUs clarify roles and responsibilities, outline how communication and decision-making will occur, and document commitments in a way that supports transparency and accountability. A well-structured MOU typically includes the purpose of the partnership, the scope of work, responsibilities of each party, communication channels, and points of contact, helping key partners stay aligned as work progresses. Decision-making authority is often overlooked during implementation planning, yet unclear or misaligned authority can create barriers that impede progress. Teams can create a Decision-Making Agreement Chart (illustrated in Table 2) to help proactively identify key decisions, clarify ownership, and support smoother implementation. Table 2 - Resource - Defining Clear Roles and Responsibilities for Effective Public Health Plans(2) Finally, the DACI Model (Driver, Approver, Contributor, Informed) offers another helpful framework for clarifying decision-making roles. Similar to RACI, DACI emphasizes who is driving the decision process, who is the final approver, who contributes input, and who should be informed. Accountability Mechanisms Reinforce follow-through on implementation work with a mix of formal and informal approaches. Formal Approaches Project tracking systems: Use project management platforms to assign tasks and deadlines. You don’t need a fancy paid option; often, tools made available through your organization or free options are just what you need. Regular status reports: Include updates in recurring meeting agendas or distribute monthly progress reports. Performance management: Use your organization’s performance management system to monitor progress. Review data regularly to inform course corrections. Routine working meetings: Come together as a team to work on the item at hand in a shared environment to help with focus. Visual management: Use dashboards, charts, or simple visual trackers to display progress and milestones. These tools make dense information easy to interpret at a glance, promote transparency, and help communicate progress to a broad range of audiences, including those less involved in day-to-day implementation. Informal Approaches Peer accountability: Set up buddy systems or peer-review structures to create shared ownership. Leadership modeling: Encourage leaders to publicly share their own progress or reflect on implementation challenges to foster openness. Norms and expectations: Co-develop shared group norms (e.g., communicating back to teams as a liaison, circling back with homework done/reaching out to the lead in advance with delays, sharing responsibility for facilitating or notetaking), and revisit them during team check-ins. Putting It Into Practice Clarifying ownership and ensuring accountability aren't one-time activities — they require ongoing practices that reinforce role clarity, build mutual trust, and promote follow-through over time. The following strategies can help implementation teams embed accountability into their daily work and cross-functional collaboration Assign Implementation Champions Designate a person or small team to lead implementation for each major goal or strategic area. Assign champions thoughtfully, with attention to role clarity, capacity, and opportunities to rotate responsibilities over time. This champion doesn’t do all the work but ensures tracking of progress, elevation of barriers, celebration/acknowledgement of milestones, and adjustments when needed. Rotating champions can help distribute ownership, reduce fatigue among highly engaged team members, and infuse fresh energy and perspective into the work. Use Short-Cycle Check-Ins Break down implementation into manageable intervals. Check in every 30, 60, or 90 days to revisit responsibilities, track progress, and realign if roles or context shift. Consider identifying a secondary point of contact or back-up lead during these check-ins to support continuity if the primary lead is unavailable. This builds agility and accountability without being overwhelming. <!-- ASTHO’s “Operationalizing Goals to Maximize Public Health Planning” offers additional guidance and strategies for keeping plans actionable. --> Embed Progress Reports Into Team Culture Make accountability visible. Use shared reporting templates, dashboards, or standing agenda items to make progress transparent. Consider spotlighting wins or learning moments during regular meetings to reinforce shared responsibility. You might also establish time for site visits or rounding practices, creating opportunities for teams to share their successes visually and in person. These face-to-face exchanges help celebrate progress, surface challenges, and strengthen connections across teams. Strengthen Team Culture Through Shared Roles Team norms around shared facilitation, rotating notetaking, and collective problem-solving can reinforce a culture of inclusion, empathy, and ownership. Rotating responsibilities builds appreciation for the complexity of project management, ensures everyone has a voice, and reduces reliance on a single point person to carry the process forward. Visualize Roles in Real-Time Use visual tools like RACI charts or decision maps during meetings to remind everyone who owns what. When teams use these actively, there is a shift from documentation to facilitation. Normalize Course Correction Implementation rarely goes as planned. Normalize the practice of revisiting roles, responsibilities, and accountability practices. Discuss openly: Is this still working? Do we need to redistribute roles? Are our accountability methods inclusive and effective? Celebrate Successes and Small Wins Build in time to recognize progress along the way. Celebrating achievements — whether completing a key deliverable, reaching a milestone, or modeling collaborative problem-solving — helps sustain momentum and morale. These moments reinforce accountability by reminding teams that their efforts matter and that consistent progress, even in small steps, leads to long-term success. Reviewed by - DeNubila, Myers, Rakotoniaina, Westermann <!-- OE22-2203 PHIG --> article yes

Building Core Policy Skills: A Discussion Guide for STI Prevention Efforts Building Core Policy Skills for STI Prevention Efforts JoAnne Deehr, Lana McKinney Get insight into the ASTHO Policy Academy On Demand training, with practical examples and reflection questions focused on real-world STI prevention challenges. This discussion guide provides insight into and builds on the ASTHO Policy Academy On Demand training — deepening participant engagement through practical examples and reflection questions focused on real-world STI prevention challenges. While the training provides foundational understanding of the policy development process and how it supports programmatic work across health departments, this guide helps translate those concepts into practice by: (1) prompting discussion, (2) exploring implementation scenarios, and (3) connecting policy tools to day-to-day decision-making in STI prevention efforts. Module 1 – What Is Policy? This module provides a foundation for understanding how policy serves as a tool for public health intervention and establishes a foundational understanding of the policy development process. It covers the spectrum of policy actions, from formal state laws to agency-level protocols. Question 1: How can internal policy tools (e.g., updated clinical protocols or statewide guidance for universal prenatal syphilis screening) help to create near-term protection while considering broader legislative or payer policy changes, and how do these different policy levers compare in speed and impact? Question 2: When you think about a change, like expanding prenatal syphilis screening or covering at-home STI test kits, what parts do legislation drive versus internal agency policy or payer rules? Which decisions occur at the federal, state, and local levels, and how do those layers of authority influence what can be changed through legislation versus agency or payer policy? Module 2 – Problem Identification Effective policy begins with using data to understand and define a public health problem and its impact on specific communities. This module focuses on using surveillance to explore the problem that you can use policy to address and tools you can use to analyze the root causes of the problem. Question 1: When confronted with rising STI rates or screening gaps, how do you integrate quantitative data (surveillance, claims, lab metrics) with qualitative input (provider or community feedback) to define the problem? And what additional information would strengthen your analysis? Question 2: If you apply a root-cause method like the "5 Whys" to rising STI rates or missed prenatal screening, what are underlying drivers that might emerge? How would you determine whether the root cause is workflow, funding, access, or policy structure? Module 3 – Interested Parties Engagement and Education Policy development is a team sport. This module focuses on identifying internal and external partners, from community-based organizations to legislative leaders needed to move a policy forward. Question 1: When advancing policies related to STI testing access, congenital syphilis prevention, confidentiality protections, or Medicaid coverage, which interested parties must be engaged for approval, implementation, and community uptake? How do responsibilities differ between those who make policy decisions (e.g., legislators, Medicaid leadership) and those who operationalize them (e.g., clinics, maternal and child health programs, community partners)? Where might you find champions on the issue, coordination challenges, competing priorities, or confidentiality concerns that create friction? Question 2: In a medication shortage where prioritization decisions are required, how would you include perspectives of highest-risk patients and frontline providers? How might priorities differ among payers, clinicians, and community organizations? Module 4 – Policy Analysis This module examines the legal frameworks that empower health departments to act. It introduces methods for evaluating which policy options are legally sound within a specific jurisdiction. Question 1: When using an impact matrix to compare policy options — such as screening requirements, coverage mandates, or partner services expansion — why is it important to include the “status quo” as a baseline? How does that help you weigh feasibility, cost, impact, and potential unintended consequences? Question 2: When weighing the status quo against a proposal, such as at-home STI testing coverage, how would you assess long-term health impact, tradeoffs, operational feasibility (e.g., provider capacity, lab processing, reimbursement workflows) and possible unintended consequences? What sources of evidence would guide your decision-making? Module 5 – Policy Strategy and Design Translating data into a compelling narrative is key to building support for a policy. This module covers how to tailor messages for different audiences, including the media and policymakers. Question 1: When developing and thinking of pitching a policy like at-home STI testing coverage, which partners could help sell the proposal, and how would you address real world implementation constraints? Question 2: When communicating urgency around medication prioritization during a national shortage, which messaging strategies are most effective? What supporting policy elements (e.g., provider guidance, prioritization protocols, or reporting expectations) should be built in from the start to make the strategy workable? Module 6 – Policy Authorization and Enactment This module focuses on the formal process of moving a policy from a proposal to an official law or regulation. It includes navigating the legislative calendar and understanding the rulemaking process. Question 1: What concerns might arise when proposing coverage mandates or new screening requirements, and how would you address them proactively? Question 2: If you were advancing a policy such as expanded prenatal screening requirements or broader congenital syphilis prevention efforts (i.e., closing gaps between screening, treatment, and postpartum follow-up), which key decision-makers would need to be engaged? At what level of government (federal, state, or local) do they operate, and how would that distribution of authority shape your strategy and cross-program collaboration (e.g. maternal and child health, Medicaid, community organizations)? Module 7 – Policy Implementation Enactment is only the first step; implementation involves turning policies and/or laws into functional programs. This module covers the creation of guidance documents and the training of staff to ensure a policy’s success. Question 1: After a policy like expedited partner therapy is approved, what operational steps (i.e., training, workflow updates, and coordination) are required for successful rollout? Question 2: What behind-the-scenes barriers — such as low provider awareness of new requirements (e.g., expedited partner therapy authorization or prenatal screening mandates) or limited public awareness of benefits like at-home STI test coverage — most often undermine implementation and how can early coordination, promotion, and targeted communication address them? Module 8 – Developing the Evaluation Process Plan The final module focuses on measuring whether a policy achieved its intended health goals. It emphasizes using data to refine and improve policies over time. Question 1: Following implementation of policies related to screening access, congenital syphilis prevention, confidentiality, or Medicaid continuity, what indicators would signal success? What frontline feedback would inform policy refinement? Question 2: What indicators would show at-home testing policies are reaching the high-need groups, and how would you respond if the impact differs from what is expected? article yes

How to Craft Evidence-Based Messaging for the Prevention of Adverse Childhood Experiences How to Craft Messaging for ACEs Prevention Learn how to craft effective, evidence-based messaging to prevent ACEs — with steps and examples to guide your work. Getting Started When it comes to developing strategic messages, public health professionals must first identify the problem they are working to solve. Often, we think about problems in big, broad terms — this can make it hard to know what specific action(s) to take to solve them, especially when working to address complex problems like adverse childhood experiences (ACEs). Consider a common public health challenge: lack of coordinated and aligned prevention efforts among like-minded organizations in a community. While everyone is working toward similar goals, limited time and resources mean this lack of coordination can reduce overall impact. Simply naming “lack of coordination of prevention” as the problem, however, isn’t very helpful — your colleagues may not know what you’re asking them to do differently. To move from a vague concern to an actionable solution, you must narrow the problem. To do this, you might explain that organizations aren’t consistently communicating about what prevention programs they offer or approaches they implement. Digging further, the issue becomes not just misalignment but the lack of a regular, structured process for sharing updates. That clarity leads to a concrete ask: “We’d like to set up a monthly call where we each share program updates so we can coordinate efforts and maximize impact.” This final framing is strong because it identifies a specific, practical solution and serves as a clear foundation for effective messaging, plus next steps. Once you identify the actions to solve the problem at hand, you’re ready to think about the overall strategy. This resource walks you through several easy steps to outline your approach. Your Turn 1 - Resource - How to Craft Messaging for ACEs Prevention Using a Simple, Successful Formula The formula for a successful message is simple and helps you get to the core of your message: Name the problem or issue to be addressed. Talk about why it matters. Tell people what should be done and who should do it. Bonus: Use data to drive your message home. Put it all together. Step 1: Name the Problem You need to clearly state your concern: what the problem is and how you see it affecting people — but keep it short. Resist the urge to say everything. Instead, focus on the aspect of the problem that your proposed solution will address. Establish a general understanding of the issue and its impacts as they relate to ACEs. Example Consider, under the umbrella of ACEs prevention, the topic of reducing the cost of child care. Let’s name the problem: The high costs of child care contribute to economic pressures and stress for caregivers, leaving children at risk of experiencing maltreatment. Your Turn 2 - Resource - How to Craft Messaging for ACEs Prevention Step 2: Explain Why It Matters Using shared values in your messaging to describe why you care can help you make the case for your solution and connect with your target audience. Remember, values statements should indicate why you — and, ideally, your target — should address the problem at hand. What happens if nothing is done? And why does that matter? Example With our example, in working to reduce the cost of child care, this explanation might be: We must take action to support families because their well-being (mental, financial, etc.) as well as their children’s well-being are at stake. Your Turn 3 - Resource - How to Craft Messaging for ACEs Prevention Step 3: Emphasize the Solution Drawing from your overall strategy, keep your focus on the solution or the change you want to see, and name the person, group, or entity that needs to implement this change. It’s best to answer with a specific, feasible solution that is usually an incremental step toward the larger goal or vision. And it’s especially important to name who needs to take action, so that they are aware of what is expected of them. Name the solution you want to see. Example Continuing with our example, a solution to reducing the cost of child care might be: Our state legislature is currently considering a bill to subsidize child care cost in our area. Subsidized child care for families can reduce caregiver stress and increase their ability to provide financially for their families and spend time with their developing children. Your Turn 4 - Resource - How to Craft Messaging for ACEs Prevention Step 4: Drive Your Message Home with Data “Social math” is the practice of translating statistics and other data so that they become interesting, meaningful, and understandable by most people— unlike infographics, which use visuals (e.g., charts and graphics) to present data. Consider social math that can help you make your case. Example In our ongoing example, the following data and social math can help relay importance and meaning: Estimates show the annual national average price of care for one child in 2019 being between $9,200 and $9,600. In other words, families spend on average about $800 every month for child care — similar to a second rent payment. Your Turn 5 - Resource - How to Craft Messaging for ACEs Prevention Step 5: Bring It All Together as One Cohesive Message You can think of the final message as an answer to the question, “How does reducing ACEs lead to healthier outcomes and thriving communities?” Example The final message for our example could be: One of the greatest costs to young families is child care, with the estimated annual national average price of care for one child in 2019 between $9,200 and $9,600. In other words, one family will spend on average about $800 every month for child care — similar to a second rent payment. And these costs increase for every additional child in the household. Child care subsidies can reduce caregiver stress and lower the risk of child maltreatment by minimizing persistent concerns about child care, providing a source of emergency child care when needed, and improving the economic lives of families. We can support children and families by reducing the financial burden of child care, opening up opportunities to remain employed and receive other community or medical support they need. Your Turn 6 - Resource - How to Craft Messaging for ACEs Prevention Additional Resources ASTHO Strategic Public Health Messaging Drives Change Public Health & Crisis Communications Resource Hub State/Territorial Policy Considerations for Preventing Adverse Childhood Experiences CDC Beyond the Headlines: Media Communications Training Berkeley Media Studies Group Worksheet: Message Development (PDF) Media Advocacy Worksheet: Overall Strategy Layers of Strategy (PDF) Using Social Math to Support your Policy Issue ACEs in the News: How Can Advocates Communicate More Effectively About Childhood Trauma? 5 Ways to Create Compelling Messages About Childhood Trauma Using Data Issue 24: Adverse Childhood Experiences in the News: Successes and Opportunities in Coverage of Childhood Trauma Frameworks Institute Impact Spotlight: Framing Child Wellbeing CA Surgeon General's Campaign Brings Attention to Toxic Stress and Adverse Childhood Experiences (ACEs) Changing the Narrative Together: Three Effective Strategies for Talking about Youth Mental Health Moving from Crisis Toward Opportunity: Framing Social Media and Youth Mental Health Toolkit The Impact of Strategic Framing on Early Childhood Advocacy Efforts in Colorado Framing Fundamentals: What is Framing? #FastFrames Series Reviewed by - Maffey article yes

Learn how to implement key approaches to strengthen community and home environments, which is crucial to preventing ACEs, suicide, and overdose.

Learn how to implement key approaches to lessen the impact of & prevent future traumatic experiences, which is crucial to preventing ACEs, suicide, & overdose.

FAQ for Preparing for CBRNE Emergencies at Mass Gatherings FAQ for Preparing for CBRNE Emergencies at Mass Gatherings Kelsey Tillema, Adrianna Evans Learn how to prepare for Chemical, Biological, Radiological, Nuclear, and Explosive events with this handy FAQ. As the United States prepares to host multiple high-profile or international mass gathering events in the coming years, preparedness professionals should revisit and strengthen plans to address complex and high-impact threats. Among the most critical are Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) hazards — a grouping of high-consequence threats with potential to significantly impact public safety and health: Chemical agents (toxic chemicals, nerve agents). Biological agents (harmful bacteria, viruses). Radiological materials (accidental or intentional dispersion of radioactive material, including from nuclear power plants). Nuclear incidents (nuclear detonations). Explosives (intentional or accidental blasts). Human health could be greatly impacted, with the potential for the following consequences: Acute injuries (burns, trauma, poisoning, radiation sickness) and mortality, along with other long-term conditions (cancer, organ damage, etc.). Psychological impacts such as PTSD, anxiety, and depression, among other long term mental health impacts. Strain on health care and public health systems, including disruptions to hospital services and the supply chain. As jurisdictions prepare for the 2026 FIFA World Cup and future mass gathering events, this resource serves as a broad overview of the roles and responsibilities of public health in relation to a CBRNE incident. This information is not comprehensive but is intended to provide consideration and further resources for planning efforts. article yes

Engage in meaningful dialogue in island grantor/grantee relationships, with support from these sample questions and comments.

Leveraging the NIH Bookshelf to Showcase Health Agency Research Island Areas Workgroup, Data Capacity Subgroup Learn how to submit your health agency research to the NIH Bookshelf to increase visibility and expand reach. If you’re looking to strengthen ties with the academic community and increase the visibility of your public health agency’s published population health reports, consider submitting them to the National Institute of Health’s Bookshelf platform. This free, searchable collection feeds into the PubMed database and accepts “gray literature,” or research produced outside of traditional commercial or academic publications. It is a great opportunity for public health agencies to expand their reach. Application and Review Process Submit content Initial screening Scientific review Technical review Publication Before submitting your content, make sure it meets Bookshelf requirements: Is your content: Full text (a full report, not just an abstract or data) with an executive summary or abstract? Aligned with at least one of the subjects priotitized by Bookshelf? Written in English? Accessible via a PDF/Word Document or online via a web link? While drafting the document, did you undergo some sort of peer review process? (E.g., an advisory council reviewed, offered feedback, and approved the final draft.) The peer review process must be publicly documented within the content, in a separate document, or via a description on the website. If you answered yes to the previous questions, follow these steps to apply: Download and complete the application for a single title or application spreadsheet for multiple titles. Complete publisher information sheet (if you are new to submitting to Bookshelf). Email your application to bookshelf@ncbi.nlm.nih.gov. Other information you will include in your application: Title of content. PDF/Word Document or URL where content can be accessed. Publishing information (name, management, qualifications, policies). Short author/editor biographies or CVs (1-2 pages). Resources for writing a professional CV (PH resume and examples). Copyright information. Abstract or summary. If you have questions about the application process or the suitability of your content, please contact bookshelf@ncbi.nlm.nih.gov. Note: If you have been publishing related content for at least two years, Bookshelf may review your content as a collection. This means any future materials may be added to the collection without an additional application. Once you have submitted your content: Initial Screening: Bookshelf staff checks that your application is complete and meets the minimum submission requirements. If Bookshelf staff have questions, they will contact you. Be ensure the project point of contact is responsive to inquiries, as timely responses are critical to moving your application forward without delays. If all submission requirements have been met, your content will move into the Scientific Quality Review. Scientific Quality Review: Bookshelf staff will assess whether your content meets the platform’s scientific standards (e.g., whether its content is substantive and valuable). Your content will either pass or fail this review; there is no opportunity to revise in response to feedback. If rejected, you may resubmit the content after two years. If your content passes this review, it will move to the technical review. Technical Review: Bookshelf staff will assess whether your content meets the platform’s technical requirements (e.g., an XML document with proper formatting and accessibility). This is typically the longest stage of the process, as there can be some back and forth between Bookshelf staff and applicants, as applicants strive to address any technical issues with the content. An applicant can contract with a commercial vendor to produce the necessary XML document, if needed. If your content is accepted: Bookshelf will give you an opportunity to preview the content. Make sure you’re comfortable with how the content looks, as this preview represents how the content will look on the platform. Ensure there are no typos or formatting issues! Sign the participation agreement, discussing questions with NIH Bookshelf staff as relevant. Celebrate your success, and share the link with peers and partners! Additional Resources from NIH How to Include Content in Bookshelf: Summarizes the Bookshelf application process. Bookshelf Copyright Notice: Summarizes relevant copyright restrictions that apply to Bookshelf. NLM Retention Policy: Summarizes the National Library of Medicine’s retention policies, which apply to Bookshelf. Background This product was created by the Island Areas Workgroup (IAW) — Data Capacity Subgroup. Established in October 2021, IAW brings together representatives from island jurisdictions, federal agencies, and trusted partners to address key administrative challenges impacting health outcomes in island jurisdictions, including efforts to strengthen procedures and organizational policies affecting health financing, data capacity, and workforce development. The Data Capacity Subgroup drafted this resource to support territorial and freely associated state public health leadership and researchers in their efforts to expand the reach of local population health data and research. OE22-2203 and PW-24-0080 article yes

Wildfire and Wildfire Smoke Guidance and Resources ASTHO and various public health agencies list of wildfire resources and guidance. Following the 2023 wildfire smoke events that impacted several states in the Midwest, Northeast, and Mid-Atlantic, as well as the devastating wildfires that impacted Hawaii, ASTHO developed a document that included a list of federal, state, and partner organization resources on wildfire smoke information and how to message that information to the public to support public health officials, clinicians, schools, and communities. These include air quality data, health guidance, masking and ventilation tips, and communication tools to protect specific groups, pets, and outdoor workers. Get the Resource (PDF) article yes

This worksheet provides actionable steps for public health agencies improve their recruiting and hiring practices, and to bolster the public health workforce.

Island Areas Workgroup: Methodology for Annual Reports Island Areas Workgroup Overview The Island Areas Workgroup (IAW) seeks to improve health outcomes for U.S. territories and freely associated states (T/FAS) through local and federal departmental coordination and administrative change. It brings together leaders from island jurisdictions, federal agencies, and partners to find solutions that can optimize the procedures, organizational policies, and programmatic structures surrounding island health programming. It is hosted by the Island Support Team at the Association of State and Territorial Health Officials, a nonprofit membership organization whose members include the chief health officials of the U.S. states, Washington, D.C., territories, and freely associated states. IAW maintains three subgroups focused on health financing, data capacity, and workforce. These subgroups are responsible for creating deliverables each IAW year, which runs from November to October. Subgroups typically contain island health agency staff, U.S. federal agency staff, non-profit partners, and academic partners. Process: Creating IAW Reports Priority Selection: In the first few months of each IAW year, IAW subgroups discuss and vote on where to devote their energy over the coming nine months. Each subgroup is responsible for creating a deliverable — such as a report — by October of the following year. Research, Drafting, and Review: When a subgroup chooses to produce a report… ASTHO staff lead the research process, which has included surveys and informational interviews, as well as analyses of publicly available data. Subgroup members guide data collection and participate in surveys/interviews as appropriate. ASTHO presents draft reports back to the subgroup approximately three months before the end of the IAW year. The goal of subgroup review is to ensure accuracy and representativeness, and to generate recommendations based on research findings. Subgroup members review and share feedback on the reports during subgroup meetings. Subgroup meetings typically include 15-25 people representing island health agency staff, federal agency staff, and nonprofit/academic organizations. Subgroup members self-select into their subgroup and are united by a shared vision of improving administrative and operational policies at the local and federal levels to improve island health outcomes. Reports also circulate via email to all subgroup members, allowing participants to provide private feedback to the ASTHO team or reply all with more public commentary. This subgroup repeats this process for subsequent report drafts, as relevant. Subgroup participants review and clear the final report, with final approval from subgroup leaders (who are not ASTHO staff). After the subgroup approves the report, ASTHO’s Content Development team copy edits and provides editorial feedback as appropriate. Sample: Review Process for the October 2024 Report, “Addressing Island Participation in Six Priority Federal Public Health Datasets: Report Addendum” As of December 2024, there were 56 participants in the IAW Data Capacity Subgroup. These participants self-selected into the group with a common interest in strengthening island-relevant data structures. The group consists of: 19 island representatives, with at least one representative from each of the eight T/FAS. These representatives work in the public health agency or partner agency (e.g., Ministry of Finance) in these jurisdictions and are involved in collecting and reporting data. 28 federal representatives, with participants from various departments and agencies involved in maintaining or reviewing federal public health datasets, including HHS, DOI, EPA, GAO, and Census. Nine academic or nonprofit representatives who collectively represent three academic institutions and four nonprofits. These partners use island data and/or offer technical assistance to support island data capacity. From December 2023 through March 2024, the subgroup brainstormed, discussed, and ultimately voted on where to devote its energy during the third year of IAW (November 2023 through October 2024 ). The group elected to research barriers affecting island participation in six federal public health datasets: the National Vital Statistics System, the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, the National Notifiable Disease Surveillance System, the Pregnancy Mortality Surveillance System, and the National Youth Tobacco Survey. From March – August 2024, research proceeded through several avenues: Subgroup participants provided feedback on island participation in each dataset in monthly subgroup meetings and email. Additional 1:1 informal interviews with CDC and partner staff addressed knowledge gaps identified among subgroup members. Outside monthly meetings, ASTHO staff led the research into administrative requirements associated with each dataset, including an analysis of public information on the CDC website, publications featuring that dataset, and outreach to administrative staff associated with each dataset. Drafting and review of the final report: The IAW data capacity subgroup received a first draft of the report in August. They provided feedback during the monthly meeting and via email, with prioritized T/FAS representative feedback to ensure report accuracy. Members could share feedback anonymously (to the group, not to ASTHO) via email, while discussions during meetings provided opportunities for public feedback. The IAW data capacity subgroup received the second draft of the report in September, and gathered feedback via email and over the course of two additional meetings. Subgroup leadership approved the final report (i.e., Janis Valmond, MS, MPH, DrPH, CHES®, Deputy Commissioner of the USVI Department of Health, and Ted Trimble, MD, MPH, Senior Advisor for Global HPV and Cervical Cancer Control, Center for Global Health, National Cancer Institute, NIH) in October 2024, and presented to the full IAW at the Year 3 Closeout Call on Oct. 7, 2024. ASTHO published the report on its website later that month. article yes

Learn how public health and WIC partnerships are critical to addressing syphilis and congenital syphilis rates in this resource.

Syphilis Testing in Correctional Facilities Reduces Infection Rates Learn about the importance of testing for syphilis in correctional facilities and how this can reduce rates of syphilis in this resource. Sexually transmitted infection (STI) rates in correctional facilities remain high, reflecting a broader increase in STIs across the country. These facilities, which include both jails and prisons, are recognized as key intervention points for STI testing and treatment, especially syphilis. In 2011, correctional facilities accounted for about 6% of reported syphilis cases nationwide. Increased testing for syphilis in correctional facilities is proven to significantly reduce infection rates. In addition, according to a systematic review investigating STI prevalence and management in correctional settings, facilities that implemented opt-out screening improved syphilis case detection and treatment rates compared to opt-in screening. Organizations Implementing Widespread Testing The following organizations recognize the role that correctional facilities can play in addressing public health challenges, especially for vulnerable populations. They encourage the implementation of widespread testing to reduce transmission of STIs and syphilis.   National Commission on Correctional Health Care (NCCHC)   NCCHC has issued a policy statement recommending comprehensive STI testing in correctional facilities. Their position stresses the importance of screening at intake to reduce transmission within facilities and the community as well as providing timely treatment to prevent complications. Correctional facilities should assess syphilis prevalence in their institution and community to determine if screening at intake is necessary. Universal screening should be based on local and institutional rates of early infectious syphilis, with regular updates as prevalence changes. All pregnant women must be screened for syphilis.  American Public Health Association (APHA)   APHA has called for increased STI and HIV testing in jails and prisons, recognizing that these settings are critical for addressing the spread of communicable diseases. They advocate for policies that ensure routine testing and treatment are part of standard health care services offered to incarcerated individuals, particularly in regions with high infection rates.   National Association of County and City Health Officials (NACCHO)   NACCHO calls for increased funding to support and strengthen public health efforts surrounding sexual health, including providing/supporting primary prevention interventions such as health education and condom distribution, immunizations, testing, and treatment in settings that allow access to individuals at high-risk for STIs (e.g., jails and juvenile detention facilities).   Centers for Disease Control and Prevention (CDC) CDC provides specific screening recommendations in correctional settings, particularly for syphilis. It supports universal syphilis screening in areas with high infection rates and advocates for comprehensive STI testing in correctional facilities to reduce the transmission of infections and improve public health outcomes.   World Health Organization (WHO)  WHO released “A recommended package of interventions for HIV, viral hepatitis and STI prevention, diagnosis, treatment, and care for people in prisons and other closed settings,” a policy brief which includes a specific call-out about preventing the vertical transmission of syphilis.   Effective Syphilis Testing Models  In addition to the aforementioned organizations that advocate for implementing testing in correctional facilities, a few jurisdictions have implemented models for syphilis testing:    Integration of opt-out syphilis testing upon intake: According to CDC, detecting and treating syphilis early on in correctional facilities may affect rates of transmission and prevent congenital syphilis.  To address rising syphilis rates, Palm Beach County designed and implemented an opt-out testing pilot program to screen all women entering the Main Detention Center within 48 hours of their intake. The pilot program highlighted the impact of early detection and intervention to reduce risks of transmission, including congenital syphilis in pregnant people in the justice system. In 2017, 84% of all individuals entering the state prison system in California were screened for syphilis, with 5% positive screenings among women. In response, jails have integrated routine, opt-out syphilis testing into intake procedures, which has led to early detection and treatment, especially among women.  In collaboration with the state health department, Nassau County Jail made a positive impact on syphilis morbidity in the community. The jail implemented rapid syphilis screening and treatment of inmates upon intake for those with positive tests and no record of prior treatment.  Participation in the 340B drug pricing program: Many correctional facilities partner with local health departments to implement syphilis testing and treatment programs. These partnerships often include access to federal funding through the 340B Drug Pricing Program, which helps reduce testing and treatment costs.   article yes

Strategic Planning Tools, Resources, and Considerations for Overdose Data to Action-Funded Jurisdictions ASTHO, through support from CDC's Overdose Data to Action (OD2A) award, provided technical assistance to the Nebraska Department of Health and Human Services to engage state and local health agency staff in a strategic planning process around local OD2A initiatives. Four virtual strategic planning trainings were planned by Burnight Facilitated Resources, ASTHO, and Nebraska to introduce virtual engagement techniques, tools for each strategic planning process step, and specific considerations for the OD2A award. This resource is a compilation of the tools and resources shared with Nebraska through this technical assistance. The technical assistance provided in Nebraska was designed to address OD2A Strategy 5: State and Local Integration. One way to integrate and align state and local overdose prevention and surveillance efforts is for state health departments to support local health departments in creating and implementing a strategic plan around these initiatives. These strategic plans can be tailored to specific needs and dynamics at the local level, providing opportunity to develop plans that focus on key priorities and consider local resources and expertise. This resource maps the tools introduced through the strategic planning technical assistance in Nebraska onto each of the steps followed during the series. Get the Resource (PDF) article yes

Opioid Use Disorder Tool: Supporting the Public Health Response in Maternal, Child, and Adolescent Health California health officials and partner organizations piloted a toolkit on prevention strategies and community resources regarding the effects of SUD on birthing people and their infants. Get the Guide (PDF) article yes

Health departments can use this guide to improve their public health accreditation efforts.

This resource helps public health agencies improve their planning process and quality improvement.

This worksheet provides strategies and focus areas for public health agencies to utilize to improve the well-being of their workforce and agency operation.