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Partnership as the Foundation for Advancing Adolescent Health in American Samoa Partnership Advances Adolescent Health in American Samoa Gabby Ruiz Learn how American Samoa advances adolescent health in American Samoa through collaboration among state and local health and education agencies. Cross-sector partnerships are essential to advancing adolescent health, particularly in school-based settings. The intersection between public health, education, and clinical health is vital to the delivery of integrated services. In the United States, it is estimated that children in grades K-12 spend at least 1,231 hours each year in school, not including time dedicated to clubs or extracurricular activities. When schools function as trusted environments where health and learning meet, they become powerful access points for early identification of needs, preventive services, and supportive relationships. The public health sector brings expertise in prevention, population-level data, and community engagement. Meanwhile, the education sector provides youth engagement and the ability to creatively embed health into learning environments by leveraging diverse resources. When sectors work in isolation, resources are used inefficiently and adolescents may experience gaps in care, fragmented supports, and inconsistent access to essential services. With support from CDC’s Division of Adolescent and School Health, ASTHO leads the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice, an initiative that promotes collaboration among state and local health and education agencies to strengthen health education, connect schools to services, and foster safe, supportive learning environments. This initiative provides a space for teams to share ideas, troubleshoot challenges, and build sustainable partnerships. Through this effort, the American Samoa team built a strong partnership between the Department of Health and the Department of Education to expand and enhance effective communication about sexual and reproductive health to reduce risk taking behaviors and promote protective factors. Peer-to-Peer Learning as a Catalyst for Youth Engagement Grounded in the belief that young people are often the most trusted messengers for their peers, the American Samoa team launched the Students Promoting Education, Awareness, and Knowledge (SPEAK) project: a student-led, peer mentor collaborative effort between the American Samoa Department of Education (ASDOE), the American Samoa Department of Health (ASDOH), and youth peer leaders. The project builds a network of trained peer educators who engage students on topics such as healthy relationships, personal responsibility, privacy, consent, HIV, STI, and pregnancy prevention. SPEAK peer leaders are students in grades 10 through 12, with two or more representatives from each grade level. High school counselors help identify students suited for this role, which includes: Co-creating educational materials that reflect their identities (i.e., their values, abilities, and lived experiences). Fostering safe spaces for support and dialogue. Managing online platforms that allow youth to ask questions anonymously. Collaborating with schools, communities, and health care providers to develop and promote educational campaigns through social media channels. SPEAK promotes student leadership, shared accountability, and open, stigma-free dialogue. Forging Strong Relationships Alignment and Sustainability From the beginning, ASDOH and ASDOE committed to building a unified team to support adolescent sexual and reproductive health. This collaboration became one of their greatest strengths. The team noted that establishing a shared vision early on helped them maintain momentum through challenges. Donation Ape, ASDOE Program Director, played a pivotal role in bridging agencies and strengthening the network that supported the project’s success. While Ape’s dedication and tenacity have been key to nurturing this partnership, both sides of the team are working to ensure that this partnership is sustainable. “With the right network, we were able to do it.” — Donation Ape, ASDOE Program Director Thoughtful Health Education In addition to coordinating across school systems and community partners, long-standing cultural values that emphasize privacy around family and personal matters made open discussion of adolescent health topics more challenging. Prior to SPEAK, students were not receiving structured health education in this area. ASDOE staff and leadership initially expressed understandable concerns about ensuring any peer-led approach would be age-appropriate, culturally respectful, and aligned with community standards. A key strategy for addressing these concerns was thoughtfully engaging youth alongside educators, families, and community stakeholders to help demonstrate the need and shape a solution to delivering health education. “When you see young people not just as children but as contributors to society, you start to see what’s possible.” — Fatih Seiuli, Health Educator, ASDOH Key Considerations for State and Territorial Health Agencies American Samoa’s experience offers key insights for other jurisdictions seeking to strengthen adolescent health through school-based partnerships: Integrate public health into education, clinical health, and mental and behavioral health to ensure a more holistic and sustainable cross-sector approach. Together, these sectors form a coordinated system that has the capacity to address pertinent adolescent health concerns. In addition, youth hold a critical role in their own care, and engaging them as part of these cross-sector partnerships is essential to adolescent health program uptake and understanding. Involve essential community voices by engaging key stakeholders and end users early on. Creating a peer educator network and creating space for youth-led engagement ensures programs reflect young people’s lived realities — increasing relevance and reach, and fostering trust and ownership among students who may otherwise feel disconnected from traditional health messages. Adapt curricula with cultural responsiveness. Integrate bilingual materials and tailor them to the unique needs of communities — expanding reach across cultural contexts and addressing stigma or other social and structural barriers. Additionally, ensure the framing of the program is appropriate for audiences and helps to overcome cultural barriers. Looking Ahead American Samoa’s journey demonstrates how intentional partnerships, youth leadership, and culturally grounded approaches can advance adolescent health in meaningful and sustainable ways. Their work reinforces that collaboration is a critical strategy that serves as the foundation for lasting impact. ASTHO will continue supporting jurisdictions through the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice by fostering connections, strengthening multi-sector partnerships, and creating spaces where teams can learn from one another. As American Samoa’s experience shows, meaningful progress in adolescent health is possible when sectors and systems align around a shared purpose. Reviewed by - Akbarali, Mackie, Vance article yes

Partner Spotlight: Q&A with Kate Menard on Levels of Maternal Care State Implementation Advancing Levels of Maternal Care: Q&A with Kate Menard Lexa Giragosian Learn how health agencies should approach levels of maternal care implementation, with key insights from Kate Menard, a key leader and expert on the topic. As the maternal health crisis continues nationwide and states face hospital closures and workforce challenges, health agencies are increasingly implementing levels of maternal care (LoMC) to improve access to maternal health services. LoMC provides a standardized way to classify health care facilities based on their ability to manage maternal risk conditions and complications during birth. LoMC implementation helps to ensure that perinatal patients receive the appropriate care for their specific health needs, supporting optimal health outcomes. When states or territories adopt LoMC, it can strengthen access to risk-appropriate care and build more coordinated systems of perinatal regionalization. LoMC implementation is a critical lever in systems level improvement and supports efforts to reduce severe maternal morbidity and mortality. ASTHO spoke with Kate Menard, a key leader in advancing LoMC implementation nationally, to learn more about how health agencies should approach LoMC implementation in their jurisdictions. She co-led the development of the original LoMC guidelines by the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine, collaborated with CDC on its Levels of Care Assessment Tool (LOCATeSM), and partnered with the American College of Obstetrics and Gynecology on pilot testing onsite LoMC verification. For jurisdictions beginning implementation of LoMC, what are the critical first actions to take? Establishing a shared understanding of why LoMC matters, and how it supports access to RAC, is vital for sustained commitment. Begin by engaging diverse stakeholders, such as public health leadership (including rural health, maternal child health, minority health, and regulatory agencies), clinical leadership, payers, health administrators, patient advisors, and emergency medical services. I would also recommend conducting a thorough assessment of the existing regionalization system in your jurisdiction, identifying strengths and opportunities. This assessment can help tailor the LoMC implementation process to specific regional needs and contexts. Using CDC LOCATeSM can enable some aspects of this preliminary assessment. Which stakeholders should be involved from the beginning, and how can health agencies effectively engage them? Relevant partners may include clinicians (obstetricians, pediatricians, anesthesiologists, etc.), hospital associations, health system administrators, payers, community representatives, emergency medical services, and legislative authorities. Health agencies are in a unique position to convene stakeholders and bolster early and effective engagement. They can organize stakeholder convenings that bring all parties together and facilitate collaborative discussions, foster relationships, and ensure that diverse perspectives are considered in the planning process. Are there any lessons learned from your experiences that would be beneficial to those in the process of LoMC implementation? I would recommend leading with the ‘why’ as you begin this process. Clearly articulating your jurisdiction’s most urgent maternal health challenges and how LoMC can help address them will create alignment from the beginning. For example, if closure of obstetric services in rural hospitals is a major concern, focus on the design of a regionalized system that supports rural hospitals through education, training, and seamless systems for escalation of care when needed (antenatal consultation/referral or maternal transport). Jurisdictions can use Maternal Mortality Review Committee findings and hospital-based severe maternal morbidities reviews to identify key needs. Building trust is equally critical and strong relationships among stakeholders helps overcome resistance to change. Using data and evidence-based practices will enhance credibility and encourage partner buy-in. What are the key considerations and best practices needed to effectively implement LoMC? Firstly, define specific objectives for the implementation process through collaboration with stakeholders, ensuring they are measurable and achievable within the timelines set. Leverage stakeholder engagement to collaboratively determine how your jurisdiction will implement LoMC (e.g., legislation, regulation, governing body, adoption of the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine guidelines as is or with state specific adaptations, designation method, onsite verification). Through this process, maintain open lines of communication among all stakeholders to foster transparency and collaboration. Once your jurisdiction is prepared for implementation, agency leaders should ensure adequate training for health care providers and administrators to understand the LoMC system and their role within it. Don’t forget to embrace quality improvement and utilize data and feedback from the implementation process to make informed adjustments and improvements, confirming that care delivery continuously aligns with best practices. How can jurisdictions use their LoMC data to demonstrate its value and return on investment to hospital leaders and decision-makers? Defining LoMC is the first step. Building shared language to advance collaboration, risk appropriate care, and improved maternal outcomes is how the investment is realized. Jurisdictions should track and report on key performance indicators, such as reductions in maternal morbidity and mortality rates, improved access to care, and increased adherence to best practices in maternal health. To make the business case, highlight cost benefits that effective LoMC implementation creates, such as fewer unplanned ICU admission, shorter hospital stays or readmissions, and avoidance of medical legal claims. Emphasize that effectively utilizing a LoMC system may actually improve retention of providers and staff in rural hospitals. Patient feedback may additionally demonstrate improved experiences for mothers and newborns, reinforcing the need for continuous investment in LoMC. article yes

Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes

ASTHO and Safe States Alliance Commit to Supporting State Injury and Violence Prevention Programs ARLINGTON, VA—The Association of State and Territorial Health Officials supports the just-released Safe States Alliance’s 2015 State of the States report, which highlights the important role that state health department injury and violence prevention (IVP) programs play in addressing injuries and violence across the nation, including falls, prescription drug overdoses, sexual violence, child passenger safety, and suicide. ASTHO and the Safe States Alliance are committed to advancing the significant efforts of state injury and violence prevention programs. According to the report, nearly one person dies every three minutes due to injuries and violence, and the total lifetime costs of injuries and violence sustained in a single year amount to $671 billion in medical and work loss expenses. The costs are disproportionate to the investments, with only $90 million dollars being invested into prevention across states surveyed for this report. “State IVP programs are working to lift the immense health and societal burden of injuries and violence to create a society where people can live to their full potential,” says Dr. Michael Fraser, ASTHO Executive Director. The State of the States report is the only national assessment of capacity among state public health IVP programs. “The State of the States report is critical for sharing the vital work of our state health departments and informing our federal, state, and local prevention partners of the need for continued and expanded support of comprehensive injury and violence prevention programs across the country,” says Amber Williams, executive director of the Safe States Alliance. ASTHO affirms that injury and violence prevention activities are an integral component of public health practice to improve health outcomes. Efforts should use a multidisciplinary approach, address prevention of injury and violence across the lifespan, and focus on a broad range of injury prevention issues. For more information, view ASTHO’s Preventing Injuries and Violence Position Statement. ASTHO Press Release Boilerplate Safe States Alliance Boilerplate website yes

ASTHO and de Beaumont Foundation Commit to Improve the Public Health Workforce ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) and the de Beaumont Foundation announce a new project building upon their successful Public Health Workforce Interests and Needs Survey (PH WINS). The new project will enhance public health workforce policies and practice and is called “PH WINS: Research to Action.” Earlier this year, ASTHO and de Beaumont released PH WINS, the first nationally representative survey of the governmental public health work force. PH WINS surveyed more than 10,000 public health workers, exploring their attitudes, morale, and climate, and developing a baseline of key workforce development metrics. Analyses of the PH WINS data set were published in a special supplemental version of the Journal of Public Health Management and Practice in November 2015. “PH WINS: Research to Action” builds on these findings to meet the training and development needs of the public health workforce. Together, the de Beaumont Foundation and ASTHO will: Create and maintain a community of practice focused on the development of the public health workforce. Craft and implement a standardized training needs assessment that goes beyond PH WINS. Develop and test a web-based tool for high-quality online training for the public health workforce. To achieve these objectives, ASTHO will utilize focus groups and a newly developed community of practice to develop innovative ideas to encourage the uptake of recommended policies and practices. The outcomes of “PH WINS: Research to Action” will be made available to all state and local health departments. ASTHO Press Release Boilerplate de Beaumont Boilerplate website yes

Journal of Public Health Management and Practice Releases Studies Analyzing Largest Ever Public Health Workforce Survey

ASTHO Announces Sixth Developing Executive Leaders in Public Health Cohort ARLINGTON, VA — Today, the Association of State and Territorial Health Officials (ASTHO) announced its sixth cohort of Developing Executive Leaders in Public Health (DELPH). This highly competitive program began in 2021 and continues to strengthen the leadership capacity of mid- to senior-level governmental public health professionals. “I am thrilled to welcome the sixth cohort of the DELPH Program,” says Avia Mason, ASTHO vice president for leadership and learning. “This group of 20 scholars brings exceptional dedication and passion to the work of public health, and we are honored to support their journey as they strengthen their leadership, expand their impact, and improve the health of their communities.” Cohort six scholars include: Faisal Adam, DC Health Department Vina Ayuyu, Commonwealth Healthcare Corporation Misty Carney, Maryland Department of Health Colette Cobb, Office of the California Surgeon General Angela Cochran, St. Mary's County Health Department Jessie Fernandes, Montana Department of Public Health and Human Services Tynisha George, Chicago Department of Public Health Ethan Greenblatt, St. Louis County Department of Public Health Gabby Hadly, Snohomish County Health Department Shebra Hall, Delaware Division of Public Health Brandon Horvath, Philadelphia Department of Public Health Halana Kaleel, Austin Public Health Markeeta Keyes, City of Minneapolis - Health - Green Career Exploration Aracely Macias, New Jersey Department of Health Chelsea Moriarty Coffield, Harris County Public Health Natasha Pickens Shumpert, Jefferson County Department of Health Dipa Shah, Los Angeles County Department of Public Health, Nutrition and Physical Activity Program Jamilia Sherls, Washington State Department of Health Iliana Siarmalis, Maryland Department of Health Tenneh Turner-Warren, Arizona Dept of Health Services ASTHO continues its commitment to developing, elevating, and modeling strong leadership for the next generation of emerging public health leaders. At a time when public health demands courageous vision, strategic action and collaborative strength, programs like DELPH are more essential than ever. Through an innovative, cohort-model, participants will deepen their leadership identity, enhance their communication, and grow their ability to positively influence their organizations. Each participant is matched with an executive coach, accountability partner and DELPH team member for personalized, transformative leadership development. “Morehouse School of Medicine is proud to continue its partnership with ASTHO in facilitating the DELPH program,” says Sandra Harris-Hooker, senior vice president for external affairs and innovation and interim director of the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine (MSM). “This ongoing collaboration between ASTHO and MSM’s SHLI advances our institution vision of ‘Leading the creation and advancement of health equity to achieve health justice.’ Together, we are equipping and empowering individuals to step into national and global arenas where strong, equity-centered public health leadership is needed most.” With support from the CDC, the success of the DELPH program’s more than 100 alumni demonstrates how strengthened leadership translates into stronger public health systems as they take on the pressing challenges facing our communities. Cohort six scholars will kick off their programming on December 8 in Arlington, VA. ASTHO Press Release Boilerplate website yes

Explore how partnerships across state and local agencies expand adolescent access to school health services in Illinois and strengthen student wellness.

In this episode, hear firsthand from an AmeriCorps member and supervisor about mentorship, impact, and workforce development.

In this episode, experts spoke with ASTHO about solutions to recruit new public health professionals and the partnerships forming around that endeavor.

On this episode of Public Health Review, we speak with representatives from public health, public safety, and community harm reduction programs to discuss their perspectives, experiences, and the importance of maintaining strong relationships while also negotiating differing strategies and approaches to overdose prevention.

Experts from the Washington State Department of Health discuss understanding and addressing climate and equity concerns.

In honor of ASTHO’s 80th anniversary, a leadership panel—including CEO Michael Fraser, President Anne Zink, Past President Nirav Shah, and Idaho Commissioner of Health Elke Shaw-Tulloch—discusses the unique role ASTHO plays in the public health landscape.

A public health approach is needed to address youth mental health by supporting frontline staff through a “helping the helpers” model. In this episode, experts discuss strategies and promising state practices for cross-sector collaborations.

ASTHO’s Senior Leadership Reserve Corps is helping state health officials and their agencies achieve their goals, like the revitalization of Wisconsin’s Public Health Council.

Learn about how Louisiana’s perinatal quality collaborative is caring for pregnant and postpartum people with substance use disorder by reducing stigma and radical collaboration.

With the pandemic upending social interaction, youth mental health is an increasingly important issue. This episode explores why understanding the intersection of suicide, overdose, and ACEs is critical to helping individuals live happy and healthy lives. It also focuses on the importance of connecting community needs, implementing awareness campaigns, and addressing stigma to reduce health disparities.

ASTHO and the American Public Human Services Association (APHSA) have partnered to support the transformation of the child welfare system through a prevention-first model. In this episode, ASTHO’s CEO Michael Fraser, along with APHSA’s CEO Tracy Wareing Evans, discuss the intersection of public health and human services and why it’s so important for these two sectors to work together to achieve a shared vision of thriving families.

This episode discusses why there needs to be a comprehensive response in public health surveillance, in particular around the opioid epidemic. After all, without thorough data, it’s tough for lawmakers to drive action that will reduce the prevalence and incidence of drug overdoses.

Each year, nearly 700 women in the United States die from complications related to pregnancy or delivery. Three in five of these deaths can be prevented, but it involves a collaborative approach, including consistent care and cross-sector partnerships.