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South Carolina Levels Up Public Health Leadership With New Program Avalon Warner-Gonzales Learn in this blog post how South Carolina’s Department of Public Health is fostering strong leaders with a new public health leadership development program. CDC’s Public Health Infrastructure Grant (PHIG) is a substantial investment in public health infrastructure, supporting initiatives in health departments across the nation to develop cutting-edge programs and bolster department operations. The South Carolina Department of Public Health (SCDPH) used this funding to pilot Leading the Way, a program that provides leadership development and network building for SCDPH staff. ASTHO spoke with Cynthia Naasira Taylor, coordinator for Leading the Way, about the program and its inaugural cohort. What inspired SCDPH to create the Leading the Way program? We created the program to address a gap in leadership development opportunities for the department. Staff developed a pilot that met the same requirements as the state Associate Program Manager program and included additional wrap-around leadership sessions. The staff who developed the pilot then presented it to the Executive Leadership Team, who approved using PHIG funding to formalize the program. Leading the Way is designed to develop, connect, and challenge SCDPH leaders to grow and improve key leadership skills while building strong, effective professional networks. Following the theme of “iron sharpens iron,” the program underscores self-improvement, education, and teamwork. The program envisions leaders coming together, rubbing blades (experiences, knowledge, strategies), forging alliances (networking, building relationships), and making their edges (competencies, skills) sharper and more efficient. How did PHIG support the development of the program? We used the PHIG funding to establish a dedicated staff position for formalizing and implementing the program, which has been critical to its success. We were able to bring in experts in team leadership, presentation mastery, and strength-based leadership to facilitate three primary leadership workshops. We were also able to provide one-on-one feedback sessions for cohort members, acquire supplies, and secure spaces for the workshops and graduation ceremony. Olivia Gomez - SC Leadership Program Tell us a little more about the inaugural cohort. The 2024 cohort is a well-rounded group of individuals who are directors, managers, nurse consultants, and program administrators. There is also a training instructor, microbiologist, intervention specialist, nutritionist, and nutrition educator. These individuals work across many fields throughout the department, including finance, IT, health equity and inclusivity, public health laboratories, and more. What were the goals of the program, and what activities supported those goals? Leading the Way is a seven-month program designed to challenge, stretch, and propel participants into their next level of leadership with four goals: Attain the Associate Public Manager Certification by completing classes offered by the SC Department of Administration. During the classes, participants receive in-depth training on coaching skills and techniques, supervisory skills, and goal setting and productivity training. Increase participants’ knowledge and competency of key leadership skills through workshops and activities. Activities include: a Team Players Style Survey to assess the participants’ natural team tendencies; the Teams Presentations Project in which the cohort—divided into four teams—researched, developed, designed, and facilitated presentations on current and relevant issues in public health; and a Networking with the Boss event during which participants networked with each other’s managers and directors. Advance strength-based leadership principles. Individuals complete the StrengthsFinder 2.0 online personality/behavioral assessment and receive personal feedback on their results from a licensed professional behavioral coach. The cohort received training on the CliftonStrengths domains and themes, how to implement strength-based leadership in their own professional growth, and how to promote strength leadership in their teams. Increase leadership competencies and strategies through networking opportunities. The Iron Sharpens Iron sessions provided a framework for cohort members to connect and identify competencies and strategies to integrate into the workplace. The cohort had the opportunity to bring awareness to challenges and best practices in their respective areas, and how they can solve problems in other areas across the state. What are your biggest takeaways and lessons learned from this first cohort? Without the PHIG funding for the program and for dedicated staff, we would not have been able to successfully launch the first official cohort. Even with the dedicated funding, it was a feat—while we were developing the program, we were also undergoing a significant agency restructure as the former SC Department of Health and Environmental Control split into SCDPH and the SC Department of Environmental Services. Our first cohort of participants and program staff demonstrated remarkable resilience and dedication throughout the program as they juggled it with the restructuring, their regular duties, and personal responsibilities. As program manager, I learned the importance of bridging new connections with agency leaders during the development phase. I also learned to allow the cohort space to dance to their own tune and let the rhythm of the group evolve naturally. The reward is seeing a cohesive band of leaders emerge and continue their relationships after graduation. Marcus Lara - SC Leadership Program Have you seen any early impact of the program? Since graduating, the cohort has continued to stay connected. They have established a dedicated Teams channel to continue collaborating and sharing experiences. Cohort members reached out to the facilitator for a workshop they attended on self-care and mental health to schedule a more robust session for later this fall, demonstrating their continued commitment to their mutual development. We’ve seen two cohort members receive promotions to director positions immediately following graduation. One of the recently promoted graduates manages a newly organized team. She wanted to charter her group and I offered to provide information. Since then, I’ve worked together with her team and facilitated several meetings to help them build their team charter. So, our connections have grown stronger since the inaugural program’s culmination. Adrienne Whitney - SC Leadership Program Looking ahead, how do you anticipate leveraging PHIG funding to support future efforts in South Carolina? The original pilot cohort identified the need for an agency mentoring program and created an outline for such a program. We are now in the process of developing an agency-wide mentoring program. The PHIG-funded position created for managing Leading the Way was also budgeted to develop the mentoring program. Additionally, PHIG funds have been allocated for tuition assistance. While this has been a necessary benefit to employees and the agency to fill critical positions, we have realized that this educational pathway is just one approach to ensuring a robust, qualified, and diverse public health workforce. SCDPH would like to use PHIG funds to support staff interested in pursuing shorter-term educational offerings such as certifications in public health, project management, human resources, and more. Kristen Smith - SC Leadership Program OE22-2203 PHIG article yes

Strengthening Leadership, Risk Communications, and Preparedness in the Islands Strengthening Public Health Preparedness in the Islands Sidnie Christian, Alyssa Boyea Key strategies in on leadership, risk communications, and preparedness, can help island jurisdictions prepare for and respond to emerging public health threats. ASTHO convened a two-day, in-person workshop in Honolulu from June 25 – 26, bringing together public health preparedness staff from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaiʻi, the Republic of the Marshall Islands (RMI), and Palau, as well as federal partners from CDC, the Department of Homeland Security, and the Administration for Strategic Preparedness and Response. The workshop focused on leadership and workforce development, risk communications, administrative preparedness, and more to support island areas as they prepare for and respond to natural disasters and other emerging public health threats, of which emerged key learnings that can benefit all island jurisdictions. Leadership and Workforce Development Leading through change requires transparency, trust, and collaboration. Planned change involves assessing readiness for change, identifying resources needed, securing buy-in, and determining a path forward. However, sometimes change can leave little to no time for preparation. Island jurisdictions have encountered challenges in the face of change, with many workshop participants sharing firsthand challenges around retaining institutional knowledge, infrastructure, and receiving assistance from the mainland United States in a timely fashion. As such, change readiness, succession planning, and effective change management practices are of utmost importance in the islands. Key recommendations and takeaways include: Utilizing a reputable framework, such as Kotter 8-Step Change Model, is pivotal for improving change readiness and change management. Change management frameworks and methods can assist with different types of change including structural change, strategic operational change, people-centric change, etc. Trust is hard to build, but easy to lose. Participants spoke about characteristics of high trust relationships including open communication, consistency, good judgement or expertise, and cultural sensitivity, while low trust relationships characteristics include lack of communication, inconsistency, and lack of teamwork. Succession planning is important to ensure institutional knowledge and capabilities remain in the wake of staff turnover or retirement. Identifying the necessary expertise, skills, and capabilities for each role is vital in the case of unplanned changes in staffing. Promising practices include annual review of critical positions, conducting talent calibration sessions, defining action plans, and obtaining buy-in from leadership and relevant partners. Risk Communications The island jurisdictions face emergencies that require creative response efforts. Both Hawaiʻi and RMI demonstrated innovative approaches in risk communications during COVID-19, finding success in forming critical partnerships, utilizing trusted voices within the community, and bridging communication gaps: Hawaiʻi utilized social media to showcase individuals such as doctors, pastors, social media influencers, and even local sports teams getting vaccinated, and utilized trusted voices to deliver messages. Additionally, they translated their materials into three languages (Marshallese, Samoan, and Hawaiʻian), modeling that no one gets forgotten, the true meaning of “ohana.” RMI created a working group with a mix of partners that curated press releases, educational materials, and sitreps, and served as a liaison between RMI Ministry of Health and Human Services and the community. It also partnered with several media outlets (e.g., radio stations, local papers, and other private sectors) and utilized mass text messaging to spread information quickly. The latter proved to resonate with most island jurisdictions who struggle with staying connected to hard-to-reach populations, namely those in more rural and disconnected communities. RMI was able to connect with these populations through WhatsApp to keep them updated throughout the COVID-19 response. Administrative Preparedness Improving administrative preparedness plans and processes ensure timely and efficient access to needed resources for a public health response. Most workshop participants are currently in the process of updating existing administrative preparedness plans, while some are working with other departments to create and implement new plans. Attendees discussed key partnerships for collaboration including other departments, Medical Reserve Corps, and other volunteer organizations. One common key challenge that emerged was around staffing (e.g., finding qualified people to fill vacancies, hiring process issues, making sure positions are competitive, etc.). To address this issue, island jurisdictions can work closely with other departments or jurisdictional agencies to streamline current processes, establish memorandums of understanding with different partners/facilities to assist with emergency procurement, and ensuring staffing vacancies are competitive and match public health classifications. Disease Forecasting A survey on state and territorial expertise and needs for infectious disease forecasts, models, and other outbreak analytic techniques—implemented by ASTHO with support from CDC’s Center for Forecasting and Outbreak Analytics—revealed that respondents from island jurisdictions experienced several barriers that led to limited use of infectious disease forecasts to inform communication and decision making. Challenges noted include limited software access, limited disease modeling capacity or skills, and lack of uniform reporting systems. Through a discussion-based exercise, workshop participants shared their challenges and considerations for ASTHO and CDC to assist with disease forecasting in the island jurisdictions moving forward. Challenges include but are not limited to: Delays with sending samples to labs and receiving results in a timely manner. Without timely results, it is challenging to take swift action. Lack of staff / staff wearing many hats with limited capacity. In most cases, there is no specific communication plan for disease forecasting within the departments. Communication can be challenging without clear processes and channels. Participants noted the desire for additional disease forecasting training and opportunities for collaboration. They suggested an integrated training session with island epidemiologists and other relevant staff to enhance disease forecasting knowledge and communication, as well as strengthen collaboration. Preparing for and Responding to Climate Events From hurricanes to typhoons to volcanic eruptions, the island jurisdictions are no strangers to the effects of changing climate. Willliam “Brandon” Aydlett, science and operations officer at the National Weather Service, and Shelbi Davis, Senior Analyst on the Environmental Health team at ASTHO, offer the following recommendations to island jurisdictions for preparing and responding to unprecedented climate events, as discussed with workshop participants: Create or update standard operating procedures for various climate related responses unique to the island. Always prepare for a category higher storm than is expected. Consider conducting regular vulnerability assessments to better understand areas where the island or its people may be most susceptible to adverse health impacts from climate events. Jurisdictions can learn from one another and find a sense of camaraderie in their preparedness efforts, much like the workshop participants. For example, one island jurisdiction noted that they currently do not have a warehouse to store equipment but are working on a plan to secure one; another jurisdiction, having recently revamped their warehouse, noted that they could assist their island neighbor in this endeavor and provide lessons learned as well as strategies to help secure a warehouse that will fit their needs. Looking Toward the Future Sharing lessons learned with one another and reflecting on how to apply those learnings in respective communities is crucial. Workshop participants shared their intent to share and utilize resources and information shared throughout the workshop with their leadership and team to begin implementing in their jurisdictions, as well as using strategies and skills learned to enhance partnerships. To all the participants and our Hawaiʻian hosts, we say mahalo. Related Resources Modernizing Infrastructure and Facilities for Readiness and Response | ASTHO PH-HERO Workforce Resource Center | ASTHO ASTHO STAR Center | ASTHO Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response | JPHMP article yes

DELPH scholars discuss the important role of Community Health Workers (CHWs) in the public health workforce, the need for support, recognition, and investment in their development, and the importance of sustainable funding for CHW programs across the United States.

DELPH Reflections: A Journey Towards Creating a More Equitable and Just Democracy Fredrick Echols DELPH has helped public health professionals reflect on their purpose, cultivate compassionate leadership, understand system dynamics, and build a community of advocates to create a more equitable and just democracy. As an African-American male living in the United States, I have encountered numerous obstacles in life, particularly in my efforts to reform systems that fail to support marginalized and vulnerable populations. These systems have had devastating effects on myself and other individuals belonging to Black, Indigenous, and People of Color (BIPOC) communities as they restrict access to essential health and social services. As a Black physician and public health professional, I continue to encounter this stark reality that engenders a sense of hopelessness in communities across the United States. These systems obscure their true intentions and deceive individuals into believing that they operate in the best interest of marginalized populations while perpetuating inequitable and disparate health outcomes. In consideration of these personal and professional experiences, the Diverse Executives Leading in Public Health (DELPH) program has played a significant role in shaping my career and purpose: Fostering Critical Reflection: It provided me with a journey that encouraged me to think critically about my future and how I can leverage my platforms and relationships to help propel the public health ecosystem toward a system that embraces the humanity of all individuals and prioritizes uplifting and empowering the most vulnerable and marginalized populations. Important note: That said, the presence of silos, political posturing, and missed opportunities due to inefficient and ineffective operational practices resulting from insufficient fiscal investment continue to plague the public health ecosystem—limiting its ability to make strides toward a system that wholeheartedly supports the pursuit of health equity and social justice. Cultivating Compassionate Leadership: The program also provided access to experts and public health thought leaders who helped my colleagues and I understand the evolution of health and social service delivery in the United States (particularly for indigent populations), increase our capacity to embrace divergent thinking, and engage in constructive dialogue. The availability of such a space provided us with an opportunity to establish a secure and conducive environment, one that upheld the virtues of compassionate leadership and fostered effective relationship building. Our ability to engage with stakeholders, both like-minded and those with differing opinions, was characterized by a spirit of intentional listening that sought to comprehend their perspectives. Through this, we were able to create an atmosphere that supported open dialogue and nurtured mutual understanding. Understanding System Dynamics: The experience has enriched my comprehension of the intricacies that drive the amplification of inequality and the resulting health disparity gaps that are pervasive among communities and individuals across the nation. The knowledge thus obtained is of paramount importance to ensure my competency in identifying and avoiding perpetuating the issues that I aspire to address. This, in turn, will prevent any inadvertent harm to the communities I seek to uplift and empower. Building a Community of Advocates: Moreover, the program has enabled me to connect with individuals who are unwavering in their commitment to upholding justice. Despite our diverse backgrounds, we set aside cultural differences to work toward a common goal: the accessibility of quality healthcare and the delivery of justice for all humanity. The DELPH program's fundamental principles and culturally sensitive support structure have played an instrumental role in shaping my professional growth as a public health expert. As I chart the course for my future professional endeavors, I intend to leverage the lessons learned and the tools provided by DELPH to strengthen the public health ecosystem. My ultimate goal is to foster collaboration across various segments of society to create a more equitable, just democracy. The DELPH program has equipped me with invaluable knowledge and skills that will enable me to make meaningful contributions to society's betterment. For this, I express my profound gratitude to the Association of State and Territorial Health Officials, the Morehouse School of Medicine's Satcher Leadership Institute, and CDC for their unwavering commitment to advancing BIPOC leadership in public health. Their steadfast support for this program has enabled me and countless others to acquire the skills and knowledge necessary to effectively lead and drive the transformative change that public health requires. I sincerely appreciate their continued investment in this vital initiative, which has empowered many to become the change agents that public health needs. website yes

PHIG: A Transformative Infrastructure Grant for Health Equity and Inclusive Workforces ASTHO, Association of State and Territorial Health Officials, phig grant, infrastructure grant, public health, health equity, public health grant, inclusive workforce, public health infrastructure grant, health departments, public health funding, public health institutes, data systems, public health workforce, community engagement, federal grants, restrict spending, health disparities, community partnership, underserved populations, diversity equity inclusion, educational institutions, high risk and underserved, ethnic minority, rural communities, overall capacity, minority institutions Amber Williams, Lindsey Myers The Public Health Infrastructure Grant (PHIG) program provides flexible, non-categorical funding to help public health departments across the United States build their infrastructure and capacity to meet their unique needs and address barriers in health equity and workforce development. Following the COVID-19 pandemic, Congress made a historic investment in public health workforce and infrastructure, presenting a game-changing opportunity for public health transformation. In the fall of 2022, CDC rolled out a first of its kind, five-year grant program called the Public Health Infrastructure Grant (PHIG) to address critical governmental public health workforce and system improvement needs. This program is all about supporting health departments across our states, territories, and freely associated states to ensure every community has the people, services, and systems needed to promote and protect optimal health for all. Along with funding 107 health departments, CDC also partnered with three organizations: the Association of State and Territorial Health Officials, the National Network of Public Health Institutes, and the Public Health Accreditation Board to help agencies modernize data systems, recruit and retain a skilled public health workforce, and address longstanding public health infrastructure needs. Challenges in Public Health Funding and the Pivotal Introduction of PHIG The majority of public health department funding comes from topic-specific federal grants, which usually restrict spending to prescribed programmatic activities and do not allow agencies to build foundational capabilities—like improving hiring or procurement processes, communication, and community engagement. For example, while advancing health equity and addressing health disparities is often emphasized as a central goal of public health practice, many jurisdictions face barriers to fully incorporating health equity into their strategies. Additionally, the public health workforce often does not reflect the communities they serve, which can impact their ability to build community partnerships and fully respond to the needs of underserved populations. PHIG is different in that it provides flexible, non-categorical funding that health departments can use to build their infrastructure and capacity to meet their unique needs and address barriers. PHIG Impact: Advancing Health Equity and Promoting Inclusion in Public Health Agencies Many agencies are using their PHIG funding to boost efforts to tackle health disparities in their jurisdictions and promote diversity, equity, and inclusion within their agencies. Internally they are focusing on examining compensation, assessing equitable pay, developing leadership programs for staff of color, streamlining hiring processes, and assuring unbiased hiring practices. Some agencies are creating paid internships, hiring people with lived experience, and building new workforce pipelines through engagements with minority-serving educational institutions. Plus, they are training managers and staff to create more inclusive workplace environments and partner with and serve diverse communities better. Other approaches include: Taking lessons learned from other funded programs, such as the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant, to focus and build on successes. Strengthening the overall capacity of the agency to address health equity, such as by incorporating health equity into agency-wide performance improvement offices and ensuring equity principles are embedded in health assessments and strategic plans. Improving partnerships with community organizations—looking at opportunities to simplify processes; support minority-owned institutions in competing for and managing federal funding; and hiring new staff dedicated to health equity, liaisons with special populations including tribes, and community health workers. This is a remarkable time for public health. Improving public health infrastructure and strengthening the workforce will lead to better health outcomes for all. These grants are critical, providing much-needed funding and flexibility to make real progress in promoting diversity, equity, and inclusion in the workforce and ensuring health equity in public health strategies. Author card spacing 2 Related Content-Blog - DELPH Magazine 3 OE22-2203 PHIG website yes

This ASTHO blog speaks to leading by example, and gives 3 recommendations for leaders to consider in their daily work habits.

Prioritize the mental health and well-being of public health workers who face stress and burnout due to their work; read about practical strategies for improving workplace wellness and the impact of declining workforce well-being on public health initiatives.

This blog from ASTHO’s PH-HERO team touches on the importance of trauma-responsive leadership in the public health workforce.

It has never been more important for public health to better understand the disability community and quickly build skills and resources to better serve them, which makes it critical to include more people living with disabilities in the public health workforce.

As the overdose epidemic continues, it is imperative for the medicolegal death investigative community to understand the importance of continuous training and the role that accurate death certification plays in protecting the nation’s health.

Sandra Powell, deputy director of Rhode Island Department of Health, how her department was able to increase the number of permanent positions to meet critical public health needs.

As in any sector, there is often talk in the public health field of “working upstream,” or addressing problems at their source. If public health is going to be a changemaker in the world, its leaders must be equal parts nimble and innovative.

Colleen Arceneaux and Jantz Malbrue from the Louisiana Department of Health to discuss why forgoing community health worker certification was the right course of action for their state.

Avia Mason discusses three pillars for public health leadership of the future: care for yourself, communicate effectively, and convert from transactions to transformation.

This brief examines the ways states can support certification for community health workers.

An ASTHO brief on the importance of understanding moral injury and burnout, with recommendations on areas of organizational focus.

Learn how boundary spanning leadership can help develop more robust and productive public health workplaces.

Explore key actions, indicators, and supports to enhance workforce recruitment and hiring in governmental public health.

Though now an illegal practice, government contracts, policies, and practices have generally excluded women, and Black, Indigenous, and people of color. Still, practices and existing structures continue the inequitable distribution of all contracts. Governmental and non-governmental grants and funding should benefit the communities they serve while being proportionate to the communities' demographics. This is where inclusive contracting comes in.

Pharmacies have long been instrumental partners in providing lifesaving vaccines nationwide. As state and territorial health officials evaluate their COVID-19 response, planners must include input from the pharmacy community when identifying areas for improvement, as well as best vaccination practices in advance of future public health emergencies.