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Learn about Washington Department of Health’s experience with ASTHO’s PH-HERO program, addressing wellbeing & mental health in the workforce.

The National Framework for Addressing Burnout and Moral Injury in the Health and Public Safety Workforce from the HRSA.

Learn about Idaho Department of Health’s experience with ASTHO’s PH-HERO program, addressing wellbeing & mental health in the workforce.

The Total Worker Health approach seeks to improve the well-being of the U.S. workforce by protecting safety, health, and productivity.

The Total Worker Health® model aims to improve the well-being of the workforce by protecting & enhancing their health & productivity.

4 state participants of the Public Health HERO program share how they address wellbeing and mental health in the workforce.

Extensive list of resources for potential adaptation and use by public health entities to advance employee mental health and well-being.

This review discusses the workforce-related challenges persisting in the public health field today and steps for moving forward to rebuild.

This PH WINS data from 2021 documents the effects of two years of COVID-19 response on the public health workforce.

A list from the CDC of promising approaches organizations can use to reduce loneliness & promote more frequent, high-quality relationships.

This article outlines various techniques and technologies that can aid in equitable pay practices across an organization.

This assesses worker well-being across multiple spheres, such as quality of working life, personal life, and physical and mental health status.

An article from Harvard Business Review on the importance of trauma-informed workplaces & the concepts of acknowledgement, support, and trust.

Using PH-WINS data, this study assessed the composition of the workforce that contributed to the COVID-19 pandemic response during 2020-2022.

Learn about public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

Public Health Approaches to Preventing Suicide and Promoting Mental Well-Being Public Health Approaches to Preventing Suicide Caitlin Langhorne Griffith, Arnelle Toffey Learn how to execute public health approaches to preventing suicide, which requires understanding the dynamics of policymaking and implementation. Despite ongoing prevention efforts, suicide remains a leading cause of death and disability among Americans of all ages, racial and ethnic groups, geographic regions, and socioeconomic statuses. While suicide affects populations at all levels, it continues to be the second leading cause of death in individuals under 44 and disproportionately impacts veterans, individuals with lower income and educational attainment, and residents in rural areas, among other groups. Approximately 6% of the U.S. population has a Serious Mental Illness (SMI) (e.g., bipolar disorder, major depressive disorder, and schizophrenia), and a 2022 study found that almost 10% of people who die by suicide had a known SMI. In addition, individuals with or without SMI can experience suicidal ideation or attempts. Factors such as adverse childhood experiences, limited access to health care, and economic instability can contribute to suicide risk. Public health approaches that expand treatment access and address the drivers of suicide risk can help foster mental well-being in communities and reduce the risk of individuals dying by suicide, including those with SMI. However, executing these approaches requires understanding the dynamics of evidence-based strategies in policymaking and implementation. Population-Based Approaches Expanding access to mental health care is critical for reducing risk and managing symptoms of mental illness, as only 50% of young adults (18 to 25 years old) and 53% of adults (26 to 49 years old) with any mental illness received treatment in 2024. However, barriers to mental health care — such as availability of providers, access to telehealth, cost, and other systemic factors — can prevent individuals from receiving treatment, especially during serious declines in mental health. Population-based approaches can fill this gap by focusing on non-clinical interventions and activities that address chronic stressors and other factors contributing to mental health declines, improving mental health outcomes. Examples of these policies include: Addressing structural determinants of suicide risk (e.g., economic security). Promoting access to clinical services (e.g., Medicaid expansion and state mental health parity laws). Limiting access to lethal means for suicide (e.g., child access prevention laws and access to high-risk medications). 988 Suicide & Crisis Lifeline State health agencies can also consider approaches that provide and enhance direct crisis support. The 988 Suicide & Crisis Lifeline is a nationwide hotline that provides emotional support to individuals experiencing suicide, mental health, or substance use crises. Since its launch in July 2022, call volumes have steadily risen in all states, and the Lifeline has been shown to improve callers' mental well-being as well as reduce suicide risk. Implementation of the 988 Lifeline occurs at both the state and local levels, resulting in variations in funding and infrastructure across communities. In the most recent legislative session, jurisdictions enacted legislation to fund and sustain 988, ensuring consistency in quality and access across all communities. For example, North Dakota SB 2200 allocates funding for 988 operations from a community health trust fund, while Texas HB 5342 established a trust fund outside of the state treasury to support the 988 Lifeline. States also enacted legislation either consolidating (Colorado SB 236) or ensuring interoperability with 988 and 911 emergency lines (Nebraska LB 362), streamlining services and accessibility for those in need of mental health support. In addition, 12 states have adopted a 988 telecom fee — similar to fees that support 911 infrastructure in every state — to create a sustainable financing source for 988. Adolescent Mental Health Support at School Schools are a critical setting to support adolescent mental health, particularly for children with serious emotional disturbances who are at elevated risk of suicide. Several states have mandated suicide prevention training requirements for school personnel as part of ongoing professional certification requirements. Federal funding — such as the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act, which focuses on evidence-based programs for students — can help states and tribes establish/expand training for school staff and equip them with the education to recognize warning signs and connect students to resources, alongside student-directed programs that increase mental health literacy and foster peer support. In the 2025 legislative session, at least three states enacted legislation focused on preventing youth student suicide. Kentucky (HB 48) and Montana (SB 369) mandate training for school staff on suicide awareness and prevention, while Virginia HB 2055 requires school staff to provide materials to parents on suicide prevention (including the safe storage of firearms) if they believe a student is at imminent risk. At least three additional states enacted legislation that requires student identification cards to include mental health information and suicide crisis resources, including the 988 Lifeline (Colorado SB 326, Illinois HB 3000, New Jersey A 4897). Georgia HB 268 requires public schools to provide at least one hour of suicide awareness prevention and training to students in grades 6-12. Conversely, an Idaho bill (SB 1199) that would amend a 2024 law to allow minors to access medical treatment when calling the 988 Lifeline without parental consent passed the Senate but did not advance in the House. Jurisdictions have also incorporated policies that provide additional safeguards for adolescents and their use of the internet: Utah recently enacted SB 98, which requires the state Board of Education to create a video presentation for parents outlining the safety and legal issues students may encounter while using technology. Maryland's SB 310 expands the state's Youth Suicide Prevention School Program to include instruction to students on the relationship between gambling and youth suicide. At the federal level, Congress is considering the Kids Online Safety Act, which requires platforms, applications, and streaming services that connect to the internet to exercise care in creating and implementing design features to prevent and mitigate harm to minors. Looking Forward It is important to understand suicide prevention approaches nationwide, including how jurisdictions formalize and strengthen suicide prevention infrastructure as well as promote healthier environments. Strategies for policymakers include the following: Analyzing and comparing suicide prevention infrastructure laws nationwide to identify gaps and guide jurisdictional changes. Building protective environments that address upstream social and structural risk factors (e.g., access to clinical services and food insecurity), while advancing policies that reduce access to lethal means. Strengthening school-based prevention efforts by leveraging available funding to expand evidence-based programs, train school staff, establish student-directed programs, and connect students to needed resources. Promoting safer online spaces for youth with policies that limit harmful design features, strengthen parent engagement, and increase online platform transparency. Continuing investments in crisis services to expand and sustain programs like the 988 Lifeline. Prioritizing economic support policies to strengthen families and reduce ACEs, supporting healthier development and well-being. Leveraging these legal and policy frameworks can reduce suicide risk, support mental well-being, and build a stronger public health system for all. article yes

Discover how leadership coaching sessions reinforced partnerships between public health and community-based organizations.

Learn about the art of storytelling in public health and how to tell stories to secure support/funding for critical public health initiatives.

Reprioritizing Black Maternal Health How We Can Prioritize Black Maternal Health Lawrence Young Black women face significant rates of maternal morbidity and mortality — learn how public health can better support them in this blog post. I do not have to look far to understand the urgency of the Black maternal health crisis. I have watched friends, colleagues, and loved ones from every walk of life struggle through pregnancies that should have been safe and celebrated. Some are highly educated professionals. Others are young mothers still finding their way. Many had access to quality insurance and still faced complications, long hospital stays, and minimal follow-up care. Many have shared unfortunate experiences that run the gamut from feeling unheard or perhaps unnecessarily undergoing a procedure — the care in health care was not there for them. These are not isolated incidents. They are part of a larger, structural failure that demands our attention and our action. As public health professionals, we must ask ourselves: How can we better care for and about Black mothers? And what would it look like to center them in the systems that were created to protect women in one of the most vulnerable times of their lives? Understanding the Root of the Crisis Black women in the United States are three to four times more likely to die from pregnancy-related causes than their White counterparts. In many states, including Connecticut, this difference persists even when controlling for education and income. These outcomes are not the result of individual choices or biological differences — they are the result of systems designed with historical blind spots. Education and income, often seen as protective factors, do not shield Black women from these outcomes. Research shows that pregnancy-related mortality rates are higher among Black women with a college degree than among White women with the same level of education or with less than a high school diploma. The same is true for women with respect to the risk of dying within the first year postpartum. These disparities grow with age and extend beyond mortality to include severe maternal morbidity, such as preeclampsia — a pregnancy complication related to high blood pressure — which can have lasting health impacts if untreated including death. Additionally, American Indian, Alaska Native, Black, Native Hawaiian, Pacific Islander, Asian, and Hispanic women all experience higher rates of ICU admission during delivery compared to White women. ICU admission is considered a key marker for maternal complications and system-level failure. Public Health as Partner in Progress Public health has a responsibility to do more than document issues and concerns. We must be in the business of addressing them. In Connecticut, we are working across agencies and community organizations to move from acknowledgment to action. One of the most important leaders in this work is #Day43, an initiative launched by Waterbury Bridge to Success Community Partnership. The name refers to the period between 43 days and one year postpartum, during which approximately 20% of pregnancy-related deaths occur. #Day43 exists to raise awareness of Black maternal health and transform systems to support mothers. Their work spans research, advocacy, policy, technical assistance, and storytelling grounded in lived experience. Waterbury’s maternal health data reflects this crisis. According to the #Day43 Black Maternal Health Report, 18.6% of pregnant women in Waterbury received late or no prenatal care. Those in the city face higher rates of C-sections, limited access to postpartum care, and insufficient support for mental health and breastfeeding. The community described a significant lack of maternity care resources, particularly in the North End, where many Black and Hispanic families reside. Through initiatives like this, residents are not just seen as stakeholders. They are recognized as storytellers, system builders, and agents of change. Their leadership is shaping how we define, measure, and deliver maternal care in Connecticut. This vision aligns with broader maternal health equity efforts across the state. For example, The Connecticut Health Foundation is developing a Maternal Health Equity Blueprint in partnership with community leaders, researchers, and families. Waterbury voices are essential contributors to this process. Listening as a Path of Healing The experiences of Black mothers reflect a broader truth. Too often, our systems are not built to hear them. That lack of trust is both historical and current. It shows up in rushed appointments, dismissed symptoms, and inaccessible services. Community-based providers, such as doulas and midwives of color, are critical to bridging this gap. They do more than provide care — they restore dignity. Yet these providers are often underfunded and undervalued in mainstream health care systems. Public health must champion integrating these providers into existing systems and promoting long-term sustainability. To maximize maternal health outcomes, the next phase of this work must intentionally include structured cross-sector collaboration. It must focus on building systems that educate both providers and families on urgent maternal warning signs, provide consistent discharge education, and strengthen local surveillance and outreach infrastructure. These strategies are essential, scalable, and lifesaving. We cannot improve outcomes without acknowledging the deep cultural, emotional, and psychological work required to rebuild trust. We cannot heal what we do not hear. Re-Examining the “Public” in Public Health Re-examining the public in public health means placing the needs of our most vulnerable communities at the center. It means investing in care that is integrative and supportive with community co-designed solutions. It also means wholistically addressing other intersecting systems that influence maternal outcomes. We can start by: Expanding funding for community-based perinatal health workers, including doulas and midwives. Embedding relevant metrics into maternal health program design and evaluation. Creating statewide listening sessions and family advisory councils to ensure policies reflect lived realities. Partnering across sectors to improve access to safe housing, transportation, and mental health supports for new mothers. Supporting local initiatives like #Day43 that lead from within communities and reflect community-defined solutions. Educating families on health information and individual health rights through accessible, trusted channels. To truly care for and about Black mothers, we must act beyond awareness months and social media campaigns. We must improve current processes and design opportunities that will support them and keep them alive. Public health was created to serve the public. The most powerful way to honor that mission is to focus on the public, ensuring they are a priority and not an afterthought. article yes

Improving Grants Management in the U.S. Virgin Islands: Q&A with Tatia Monell-Hewitt Improving Grants Management in the U.S. Virgin Islands Anya Groner Learn about how the U.S. Virgin Islands Department of Health streamlined grants management, as explained by its Chief Finance Officer Tatia Monell-Hewitt. Public health agencies have an important role in piecing together federal and local funding to support a comprehensive, cohesive array of programs and services for their communities. Optimal management of these funds ensures communities maintain access to these crucial initiatives. In the U.S. Virgin Islands (USVI), decentralized and inefficient processing coupled with high staff turnover caused delays in grant procurement that, at times, caused funds to go unspent. In the aftermath of Hurricanes Irma and Maria, Category 5 storms that devastated the islands in 2017, USVI Governor Albert Bryan Jr. sought assistance to manage and spend the federal funds available for the massive recovery process. In collaboration with ASTHO and the Department of the Interior, the territorial government began a three-year business process improvement initiative to streamline grants management. Nine agencies, including the governor’s office, came together to establish official grant and financial management systems, ensuring that federal funding could be accessed faster once approved. By maintaining a long-term vision, consistency of effort, and steadfast support from leadership and staff, USVI has been highly successful in streamlining the grants management process. Since the new system launched in 2023, initial sample data showed a range of 25-64% reductions across agencies in the time to set up federal grants, which enables the health agency to begin work sooner – highlighting what is possible with continual improvement. Furthermore, communication channels established through the business process improvement initiative have enabled interagency collaboration. This initiative built the foundations for improving grants management in USVI, and the Department of the Interior awarded additional funds to continue interagency communication, collaboration, and improvement to sustain the gains. In this interview, the USVI Department of Health’s Chief Finance Officer Tatia Monell-Hewitt discusses how changes to USVI’s grants management process and increased interagency collaboration impact public health. What prompted the update to USVI's grants management process? Was there a particular event or series of events? The update was prompted by the USVI’s Department of Health’s successful Business Process Improvement initiative in 2019-2021, along with a broader recognition of inefficiencies and inconsistencies in how federal grants were being managed across government agencies. An analysis of several grants conducted by ASTHO throughout government agencies revealed that, in some cases, the setup process from the receipt of a Notice of Award (NOA) to having the budget available online, could take up to 255 days or the better part of a year. These delays significantly hindered program execution and the timely drawdown of funds. The findings highlighted the urgent need for a streamlined and standardized grants management process. What were some of the biggest changes that you made to the grant process, and why are they so valuable? The most impactful changes include adoption of a standardized federal grant planning and setup process across the nine agencies defined as receiving the NOA to having an approved budget online. We moved from paper to an electronic process to improve transparency, speed, and accountability, and agreed to/established defined time frames for each step. Lastly, the creation of the Federal grant community of practice allowed for ongoing training, problem identification and resolution, and building process consistency across and within agencies. These improvements reduce delays, increase first-time accuracy, and enhance compliance, ultimately allowing agencies to deliver services to the community more quickly and effectively. The grants management process is often invisible to the public. Have USVI residents noticed the quicker turnaround? Yes! A more efficient grants management process has strengthened community trust in the U.S. Virgin Islands public health system. Improved customer satisfaction, faster service delivery, increased outreach participation, and more responsive agency communication have made a real difference. The community sees that the department is being a responsible steward of federal funds, which builds confidence in our ability to serve and protect. How did the improvements to the grants management process impact health agencies in particular? The Department of Health benefits from clearer roles and responsibilities in grant execution. That translates to quicker access to funding. A key example is the Epidemiology and Laboratory Capacity grant. The budget was approved and online within 30 days of the NOA. This enabled a swift response to the dengue outbreak that began in December 2024 on St. Thomas and St. John. Using real-time surveillance from the dengue dashboard, the epidemiology team targeted mosquito control efforts in hotspot communities. Supported by case mapping and proactive prevention strategies, the combined efforts — surveillance, lab testing, provider education and resource deployment — helped contain the outbreak and safeguard public health. How have partnerships strengthened health access and preparedness? Has that culture of collaboration and communication across government agencies continued in other projects? Absolutely. Agencies such as the Department of Health, Department of Human Services, Department of Finance, Department of Justice, and the Office of Management and Budget now coordinate processes, resolve issues collaboratively, and share training initiatives. Strong partnerships ensure that the Department of Health can align financial resources quickly to support health programs and improve access to care and emergency preparedness. Shared accountability has enabled timely and effective service delivery for the community. Have other improvements to grants management and agency coordination resulted from the business process improvement initiative? Definitely. The process has led to a uniform process across departments. Shared expectations include ongoing performance measures, a focus on timelines, a standard operating procedure checklist, and shared tools such as Adobe Acrobat Sign. Regular communication and updates shared in the community of practice meetings have made the grants management process more efficient, trainable, and adaptable to new challenges. What does the Department of Health’s grants management data collection show, and how does it use this data for continued improvement? The Department of Health uses a scorecard to track critical metrics such as milestone completion times, low spending rates, slow drawdowns, and the number of corrections needed. This data driven approach has helped us identify bottlenecks, guide training, and informed standard operating procedures. It has also highlighted programs that consistently manage their grants well. How do you see this work continuing over the long term? This work is built for long term sustainability. We’ve set up continuous education using the-train-the-trainer model, ongoing performance reviews and interagency meetings, and accountability by the community of practice and the cross-agency leadership team. We have a shared vision of efficiency and citizen-focused service delivery. What about this work are you most proud of? I am most proud of how multiple agencies came together to build a unified, efficient system. We've significantly shortened the time between the NOA and getting the budget online. We’ve established timeframes for each step of the grant procurement process — two days to receive the NOA, 10 days to adjust the spending plan, three days to obtain financial codes, seven days to submit the budget, and three days to get the budget online. That’s 25 days total for the entire grant turnaround. That alone has enabled us to serve our community much faster, which is what matters most. CDC-HHS - $1,000,000 article yes