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Learn about Pima County's journey to advance data modernization efforts through an elevated partnership with County IT.

Learn about legislation in island areas from the past year to strengthen infrastructure, prevention strategies, health care oversight, and more.

Learn how states can leverage policy to reduce ACEs and improve children's well-being in this Health Policy Update.

Strengthening Public Health Workforce Capacity in Island Jurisdictions Strengthening Public Health Workforce Capacity in Island Jurisdictions A.C. Rothenbuecher, Allison Budzinski, Marta McMillion, Melissa Sever Guam and CNMI leveraged support from ASTHO to improve their public health workforce planning — learn more in this blog post. Strategic workforce planning helps public health agencies stay prepared, attract and retain the right talent, and build flexible systems that can handle change. When done well, it leads to better services, stronger performance, and a healthier work environment. It also saves money by reducing turnover and helps agencies respond to health emergencies or challenges as they arise. A Learning Collaborative Approach For U.S territories and freely associated states, where geography, connectivity, and resources pose unique challenges, strategic planning is especially important. With support from the Public Health Infrastructure Grant (PHIG), the Association of State and Territorial Health Officials (ASTHO) and the Public Health Accreditation Board (PHAB) launched a nine-month Island-Centric Workforce Planning Learning Collaborative to offer support as island health departments strengthen their workforce planning efforts. This pilot included workforce teams from Guam’s Department of Public Health and Social Services and the Commonwealth of the Northern Mariana Island’s (CNMI) Commonwealth Healthcare Corporation, Division of Public Health Services. The learning collaborative gave participating island health departments a chance to build on their strengths while getting tailored support for workforce planning. Through expert guidance, peer sharing, and coaching — both online and in person — participants worked through each step of ASTHO’s Workforce Planning Guide and explored essential workforce components aligned with PHAB’s Standards and Measures for Accreditation. The collaborative took a “start with what you have” approach, building on previous workforce planning efforts, existing data, and plans in both Guam and CNMI while leveraging resources from several national partners in the process. From Resources to Results: Putting Workforce Tools to Work Before the learning collaborative began, ASTHO, PHAB, and the University of Nebraska Medical Center (UNMC) teamed up to streamline and align their workforce planning resources. Early coordination ensured the tools complemented each other and avoided duplication. The ASTHO Workforce Planning Guide served as the foundation, while PHAB’s Workforce Plan Template gave health departments a clear structure to build upon. UNMC’s Public Health Workforce Planning: A Practical Guide and workforce data from the de Beaumont Foundation’s Public Health Workforce Interests and Needs Survey (PH WINS) helped ground planning efforts with practical guidance for facilitators and up-to-date data reflecting current needs and priorities. Callout 1 - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions Collaboration Across Islands: Sharing Challenges and Solutions Over the course of the learning collaborative, Guam and CNMI’s public health teams built strong relationships by sharing challenges, exchanging ideas, and celebrating progress. Common issues like limited workforce capacity helped them relate to one another, while differences in structure and resources sparked creative solutions. The peer relationships and connections that were built and strengthened during the collaborative continue. On-Site Support ASTHO visited both jurisdictions to meet with leaders, review progress, and plan next steps — reinforcing the value of ongoing partnerships in workforce development. During the visits, participants revisited the Workforce Planning Cycle, layered in the latest PH WINS data, refined draft plan sections, clarified alignment with PHAB workforce standards, and considered the sustainability of their work beyond the collaborative. The hands-on sessions blended facilitation, coaching, and dedicated writing time, allowing participants to make measurable progress on their plans. What Guam and CNMI Achieved Through the learning collaborative, Guam and CNMI made meaningful progress in their strategic workforce planning efforts. Some near-term successes include: Active Workforce Committees: Both jurisdictions formed or maintained dedicated teams to lead workforce planning efforts. Steps Toward Accreditation: Each agency advanced efforts towards PHAB recognition related to a core domain, “Maintain a Competent Public Health Workforce.” Smart Use of Data: Each agency used human resource, workforce, and PH WINS data to guide decisions and improve planning. Stronger Capacity: Teams gained valuable skills and knowledge to support long-term workforce efforts. Customized Action Plans: Each agency created tailored plans aligned with their unique goals and needs. While Guam and CNMI achieved many similar milestones, each jurisdiction brought its own strengths and strategies to the table. Their different approaches offer valuable lessons for tailoring workforce planning and technical assistance to local needs. Guam emphasized structural development and broad departmental engagement, while CNMI leaned into data-driven decision-making and sustained leadership support. Callout 2 - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions What Other Jurisdictions Can Learn The Island-Centric Workforce Learning Collaborative offers practical lessons for other jurisdictions focusing on workforce planning: Start with leadership support and clear roles across teams. Utilize and adapt existing tools and frameworks, like the PHAB Workforce Planning Template, the ASTHO Workforce Planning Guide, and UNMC’s Public Health Workforce Planning: A Practical Guide to jumpstart planning. Request tailored coaching and technical assistance through national organizations such as ASTHO and PHAB. Leverage workforce data, such as PH WINS, to inform decisions and progress. Collaborate across partners to benefit from diverse expertise. Celebrate your wins to build momentum and morale. What’s Next for Workforce Development in CNMI and Guam The success of the Island-Centric Workforce Learning Collaborative highlights what’s possible when public health agencies are supported with the right tools, partnerships, and local context. Guam and CNMI’s progress show that even in resource-limited settings, meaningful change is achievable. Special Thanks - Blog - Strengthening Public Health Workforce Capacity in Island Jurisdictions OE22-2203 PHIG article yes

Learn how Michigan has applied lessons learned a year later from a radiological exercise in this blog post.

Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots JoAnne Deehr Suicides continue to be a critical public health issue — learn how states are leveraging policy to improve suicide prevention. Suicide remains a persistent public health challenge, affecting people of all ages, racial and ethnic groups, geographic regions, and income levels in the United States. Despite ongoing prevention efforts, more than 49,300 Americans died by suicide in 2023. National suicide rates steadily rose from 2003 until 2018 and have remained high since then, reflecting an enduring and widespread impact. While all communities are affected by suicide, certain demographics face higher risks. Disproportionately higher rates of suicide are seen among elderly Americans, Veterans, individuals with lower income, less education, and those living in rural areas. People in certain industries, such as mining, construction, and public safety, are also at elevated risk. At the same time, emerging technologies like chatbots powered by artificial intelligence (AI) have raised new considerations related to safety, oversight, and appropriate use in mental health settings, underscoring the need for thoughtful state approaches to suicide prevention. Policymakers are responding to these challenges in multiple ways, including establishing state suicide prevention infrastructure and regulating AI chatbot use in mental health. Suicide Prevention Infrastructure Legislation Suicide prevention efforts are most effective when states and territories have dedicated infrastructure — such as suicide prevention offices, coordinators, commissions, and fatality review processes — to support coordination, surveillance, and implementation of evidence-based strategies. These structures enable state and territorial health agencies to identify populations and communities at increased risk, align partners across public health, health care, and public safety, and pursue sustainable funding for suicide prevention and crisis system improvements. ASTHO’s Suicide Prevention Offices and Committees Legal Map highlights the varied policy approaches states have taken to establish this infrastructure and identifies which states had statutory suicide prevention structures in place as of January 1, 2025. During the 2025 legislative session, states considered at least 30 bills related to establishing suicide prevention offices, coordinators, advisory bodies, and suicide fatality reviews. Five of these bills were enacted, including Delaware’s HB 54 which establishes the state’s Office of Suicide Prevention. Delaware also enacted HB 87, expanding membership in the state’s Suicide Prevention Coalition to include someone who has experienced suicidal ideation or survived a suicide attempt and someone who has lost a loved one to suicide. Conversely, Oklahoma enacted SB 676, repealing the section of the state’s Suicide Prevention Act that established the Oklahoma Suicide Prevention Council, which was slated to sunset in 2020. The council was originally tasked with identifying issues and promoting strategies to prevent suicide, and providing technical assistance on best practices for identifying people at risk of suicide. The Department of Mental Health and Substance Abuse Services still serves as the leading agency for implementing the remainder of tasks outlined in the Act. Illinois and Texas enacted legislation establishing advisory bodies focused on suicide prevention among first responders. In Texas, HB 1593 creates a committee to study suicide prevention and peer support programs within fire departments and requires a report with recommendations by September 2026. In Illinois, HB 2551 reconstitutes the First Responders Suicide Prevention Task Force, and increases membership in the task force to include a member from an organization that provides mental health training and support to first responders and two members who represent organizations that advocate on behalf of public safety telecommunicators, such as 911 operators and dispatchers. The bill also charges the task force with developing a final report by December 2026. Both bodies are scheduled to sunset in January 2027. Currently, Wisconsin has several types of fatality review teams operating through voluntary efforts with no law formally establishing or governing these teams. Wisconsin is considering SB 192, which would formally establish processes for reviewing fatalities, including deaths by suicide. It would also direct the Department of Health Services to establish a fatality review program comprised of established local teams and authorize the department to establish state fatality review teams. AI Chatbots While states continue to strengthen suicide prevention infrastructure, policymakers are beginning to turn their attention to emerging mental health considerations related to AI. Since emerging in the 1950s, AI has evolved from rule-based systems to today's machine learning and natural language processing applications, powering everything from data analysis to interactive chatbots. Recent AI advances enable chatbots to simulate human conversation so convincingly that users may forget they are interacting with a machine. However, these systems lack genuine empathy and cannot substitute for professional mental health treatment. Their tendency to be excessively agreeable creates particular dangers for people experiencing suicidal ideation, leading some states to explore regulations governing AI chatbot use in mental health and suicide prevention contexts. At least 19 states considered legislation regulating the use of AI for mental health related reasons to promote user safety. At least five bills were enacted, including California SB 243, which requires chatbot platform operators to disclose that users are interacting with AI if confusion could occur, develop protocols to prevent and respond to suicidal ideation or self-harm, and report annually on safety measures to the state Office of Suicide Prevention. The California legislature also passed AB 1064, which the Governor subsequently vetoed due to concerns that its broad restrictions on AI companion chatbots for minors could limit access to potentially beneficial tools. Illinois and Nevada passed legislation that largely prohibits AI from providing behavioral health services. Illinois HB 1806 restricts the use of AI for therapy or psychotherapy unless delivered by a licensed professional who is required to inform the patient, or their legal representative, in writing and receive consent. The law also prohibits licensed professionals from allowing AI to make independent therapeutic decisions or interact directly with clients and allows the use of AI only for administrative or supplemental tasks under professional oversight. Nevada AB 406 similarly prohibits AI systems from providing or representing themselves as offering professional mental or behavioral health care, prohibits AI from performing the functions of a school counselor, psychologist, or social worker in public schools, and allows licensed professionals to use AI only for administrative or supportive purposes, with oversight to ensure accuracy and safety. New York and Utah passed laws requiring mental health chatbots to clearly disclose that they are not human. As part of their annual budget, New York S 3008 mandates that AI companion systems capable of simulating human-like interactions detect suicidal ideation or self-harm, provide crisis referrals, and regularly disclose that users are interacting with AI rather than a person. Utah HB 452 requires AI-driven mental health chatbots to provide clear disclosures and limits advertising and data practices. At the federal level, on December 11, 2025, the White House issued an executive order seeking to establish a national policy framework for artificial intelligence and create a “minimally burdensome” federal approach. The order also directs the Department of Justice to form an AI Litigation Task Force to identify and challenge state AI laws deemed in conflict with this federal policy, and the Department of Commerce to limit eligibility for certain federal funds for states that take a non-preferred approach. The scope and criteria of these federal actions, including their impact on state laws aimed at suicide prevention, have not been clearly defined. Advancing suicide prevention will require states and territories to take comprehensive approaches that address both systemic gaps within state infrastructure and emerging technologies. ASTHO will continue to monitor these policy developments and provide relevant updates. Reviewed by - Baker-White, Maffey article yes

Recent HHS Leadership Changes That Impact Public Health Recent HHS Leadership Changes Impacting Public Health Catherine Murphy Get a rundown of recent HHS leadership changes that impact public health, including to CDC director, ACIP, and the U.S. Surgeon General. Over the last 16 months, the Trump Administration has championed the Make America Healthy Again (MAHA) agenda within HHS — with Secretary Robert F. Kennedy, Jr., leading the department. He was confirmed by the Senate and sworn in on Feb. 13, 2025, and has since worked to implement sweeping changes in the department and MAHA priorities (e.g., addressing chronic disease and childhood allergies, removing specific food dyes, and increasing transparency within the agency). Significant changes within HHS over this period include the termination of 10,000+ employees via Reductions in Force and more departures via voluntary separation incentives. This has left many agencies and offices to adjust and impacted how state and territorial health departments collaborate with partners at HHS agencies like CDC. Alongside these major ongoing changes (and more proposed) to the department are the appointments and alterations to HHS leadership by President Trump. CDC Director CDC has seen a handful of changes during the first year of the Trump Administration. Its director leads the agency and directs public health priorities like disease prevention, outbreak control, and health threat defense. In July 2025, Susan Monarez was confirmed as CDC director but removed a month later due to disagreements with the Administration over vaccine policy. Soon after, she appeared before the Senate Health, Education, Labor & Pensions (HELP) Committee to testify about events around her termination. The lack of CDC leadership was a source of concern for the public health community, as leaders cited the importance of evidence-based decision-making from the agency and sound leadership to respond to ongoing health threats and emergencies. Following the departure of Monarez, Jim O’Neill, deputy secretary of HHS, was appointed acting director of CDC. In February 2026, however, he was removed from the role amid his departure from HHS to be nominated as the director of the National Science Foundation. Meanwhile, department restructuring elevated Chris Klomp to chief counselor, in charge of all HHS operations. While HHS searches for a new CDC director, Jay Bhattacharya, director of NIH, is performing delegable duties. Federal law dictates that Senate-confirmed positions, including CDC director, have acting replacements for a maximum of 210 days — a deadline that passed on March 25. The agency says that they are actively looking for a replacement. Advisory Committee on Immunization Practices CDC’s Advisory Committee on Immunization Practices (ACIP) is a group of up to 19 voting members — independent medical and public health experts — who make recommendations on vaccines, which become CDC policy once adopted by its director. Recommendations bear on immunization schedules, the Vaccines for Children program, and clinical decision-making, and have downstream effects on whether insurance providers cover vaccines and the context in which they can be administered (i.e., pharmacy vs. office visit). ACIP has also seen considerable change under this Administration: In June 2025, HHS removed all 17, Biden-appointed members of ACIP. In a press release, the department noted the goal to “reestablish public confidence in vaccine science.” This move garnered bipartisan response from Congressional leaders, especially those on the Senate HELP Committee, who specifically questioned Secretary Kennedy on his potential revisions to CDC’s vaccine recommendations during his confirmation hearing. In January 2026, HHS announced an overhaul of the childhood vaccine schedule outside of the ACIP recommendation process. The announcement included changes to recommendations for hepatitis A, rotavirus, influenza vaccines, and more. In March 2026, a federal judge placed a stay on all of Secretary Kennedy’s appointments to ACIP, the panel's recommendations, and the 2026 schedule change. Surgeon General Finally, the U.S. Surgeon General role, which advises the public on health and leads the Commissioned Corps of the U.S. Public Health Service, has been marked by ongoing shifts. In May 2025, after withdrawing his nomination for Janet Nesheiwat, President Trump announced Casey Means, MD, as his new nominee for the position. Means is a doctor and wellness influencer who advocates for MAHA priorities, including finding ways to reduce rates of chronic disease. Several members of the Senate HELP Committee have stalled her confirmation, citing concerns around Means’ statements on vaccine safety. Means appeared before the committee in February 2026. Public Health Impacts The flux within HHS — a side effect of the administration’s desired changes within the department — has had ongoing impacts on the process for issuing public health guidance, approving and altering vaccine recommendations, and more. Congress remains interested in understanding the impact of reforms occurring within HHS, including in hearings centered around agencies and nominees. ASTHO will continue to track changes within HHS as well as responses from legislators, and work to be a resource to Congress on best practices for public health. article yes

Learn how the Maryland Department of Health leveled up their strategic planning process to improve their critical public health work in this blog post.

States Amending Policies to Slow Congenital Syphilis Increases States Trying Policies that Increase Syphilis Testing Amelia Poulin State are exploring ways to slow the rapid increase of congenital syphilis cases by strengthening policies to require testing at key points during pregnancy. Syphilis among newborns, or congenital syphilis, is preventable. Yet the latest CDC data show that congenital syphilis cases have more than doubled (106%) from 2019-2023. In 2023 alone, there were nearly 4,000 cases of congenital syphilis resulting in 279 stillbirths and infant deaths. Timely testing and adequate treatment during pregnancy might have prevented up to 80% of these cases. Increases in congenital syphilis often mirror increases in syphilis among reproductive-aged women. From 2022 to 2023, the rate of syphilis (all stages) increased 6.8% among women aged 15–44 years; rates also increased in 39 states and Washington, D.C. CDC recommends testing pregnant women for syphilis at the first prenatal visit, as well as at 28 weeks gestation and delivery if they are at increased risk of infection. Syphilis testing recommendations extend to asymptomatic women who are at increased risk for infection as they may face additional barriers to health care. ASTHO’s policy-level interventions for states and territories suggest universal syphilis testing for pregnant women. Additionally, states have been taking action to increase access to syphilis testing for people, including those who are pregnant. The Syndemic Perspective A history of incarceration, sex work, drug use, and geography can all significantly increase risk for sexually transmitted infections (STIs), HIV, tuberculosis (TB), and more. Structural barriers, including housing instability, economic insecurity, stigma, and restricted health care access, create conditions that heighten vulnerability to multiple infections. These conditions do not occur in isolation but rather as part of a syndemic, where overlapping epidemics interact with and exacerbate one another. Health agencies may be positioned to address upstream and root cause issues recognizing and addressing the intersections of these disease areas and related structural and social issues (e.g., drug use and poverty). Health agencies carry a wealth of interdisciplinary expertise, with staff leading efforts around data collection and surveillance, policy, community mitigation, and more, all of which support capacity to identify root causes and design an evidence-based, multifaceted response. Policies that prioritize housing stability, harm reduction services, and access to comprehensive health care, including STI screening, can help mitigate these risks and improve health outcomes. Geography can also increase the chances of syphilis transmission. Some regions with limited health care infrastructure, provider shortages, and limited STI prevention program funding and capacity may have higher rates of infection. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Social and economic differences across different geographic locations contribute to varying levels of disease burden. By adopting a syndemic framework, states can move beyond disease-specific interventions and implement comprehensive strategies that address upstream factors contributing to disease transmission. State Actions Several states have introduced or passed legislation to expand syphilis testing access, with a focus on increasing screening opportunities, mandating insurance coverage, and ensuring appropriate prenatal testing protocols. Syphilis Testing In 2024, Colorado enacted HB 24-1456, which gave the state’s Board of Health rulemaking authority over syphilis testing. This flexibility allows the state to adapt its public health response based on emerging epidemiological trends as new data on syphilis transmission and congenital infections become available. The 2025 legislative sessions have highlighted additional approaches to expanding access to syphilis testing. The New York legislature introduced S 2704, which would require health insurance coverage for certain approved STI home test kits. This policy would provide individuals who face barriers to in-person care a convenient and private way to get tested and stay healthy. Oregon is also addressing testing accessibility through HB 2943, which would require hospitals to test people for HIV and syphilis when they have blood tests done in the emergency department (ED). Since EDs often serve populations who do not routinely access preventive health care (e.g., people experiencing homelessness or struggling with substance use disorders), this legislation would strengthen the role of emergency settings in STI prevention and intervention. Perinatal Syphilis Testing Recognizing the importance of perinatal screening, several states have introduced legislation to add requirements for syphilis testing at key points in pregnancy. Tennessee recently enacted SB 1283, which requires that health care providers take a blood sample to screen for syphilis, hepatitis B, and hepatitis C at the first prenatal examination, ten days after the examination, and at delivery. This approach aligns with CDC recommendations and ensures infections are identified and treated in time to prevent congenital transmission. Similarly, Nebraska LB 41 would require testing for syphilis at the first examination, in the third trimester, and at birth (with the mother’s consent), reinforcing a multi-point screening strategy to detect and treat infections that may develop later in pregnancy. Missouri’s SB 178 would take a comprehensive approach to syphilis prevention during pregnancy by requiring an additional test at 28 weeks, a critical point for intervention. The legislation would also require treatment for mothers who test positive for an STI, reducing the risk of congenital infections. Additionally, it would expand Expedited Partner Therapy by allowing any health care professional authorized to prescribe medications to administer Expedited Partner Therapy as well as include other STIs in the treatment, enabling faster treatment for sexual partners who might otherwise go untreated and continue the cycle of transmission. Policy Considerations Expanding both syphilis and perinatal syphilis testing policies demonstrate a growing recognition of the need for proactive, evidence-based strategies to address the increasing rates of syphilis and congenital syphilis. However, the ability of policies to affect public health outcomes may depend on continued resource allocation, workforce training, and public awareness campaigns. State and territorial health agencies can consider additional measures, such as integrating syphilis screening into routine primary care visits and providing funding for community-based outreach. Conclusion These legislative actions represent various approaches states are taking to addressing syphilis. Implementing screening protocols aligned with current evidence may contribute to efforts to address syphilis and congenital syphilis. By leveraging legislative action and evidence-based interventions, states can improve health outcomes and reduce disparities in syphilis and other STIs. A comprehensive approach that includes additional testing, expanded health care access, and targeted interventions for populations at higher risk for infection or severe disease may ensure better health outcomes for parents and infants alike. ASTHO will continue to monitor and report on this important public health issue. article yes

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Learn how peer-to-peer collaboration has helped health agencies develop their performance management and quality improvement efforts.

Puerto Rico Program Supports Vulnerable Populations ASTHO Island Support Learn how Puerto Rico addresses social determinants of health and promotes equity among vulnerable populations. The Puerto Rico Department of Health’s Health Equity Program implemented an innovative initiative to support diverse institutions, with the goal of addressing social determinants of health and promoting health equity among vulnerable populations. This provided opportunities for a wide range of sectors including private non-profit organizations, universities, and hospitals. The project evolved throughout its duration, demonstrating the power of local funding and the importance of flexibility in program administration. Project Kickoff Grant Awarding and Training Process During the second request for proposal, 30 organizations expressed interest in submitting applications. However, given the detailed and rigorous rubric, six applied, of which four grants were awarded. The team scored the proposals based on the rubric, and allocated funds to support vulnerable populations such as individuals living in rural areas, people with disabilities, pregnant women, and older adults. Implementation and Best Practices Once the Health Equity Program awarded grants, they designed a detailed work plan, including key indicators for monitoring and tracking the progress of beneficiary organizations. They implemented a SharePoint-based system for the submission of reports and documentation. In addition, they held monthly meetings to ensure cohesion and effective communication among all stakeholders. This collaborative approach enabled efficient and transparent monitoring processes. “It was a collaborative process since the institutions know their populations best. We just wanted to ensure a systematic and consistent plan because these matters are crucial for project progress and monitoring.” — Miguel Cruz, PhD, Co-Principal Investigator Project Evolution The program initially funded one institution and due to its positive impact, additional opportunities emerged to provide funding for up to four additional institutions. The main topic revolved around health literacy as a strategy to reach health equity among people living in rural areas, older adults, people experiencing homelessness, individuals with functional diversity, and those experiencing a mental health challenge. These four new institutions covered the west, central, and other rural areas broadening coverage within traditionally underserved communities. Administrative Flexibility and Communication Strategies Administratively, the program had to be flexible during pre-award and award processes, ensuring compliance with state and federal regulations. This included revising announcements and creating plans. Additionally, the program created documentation, like templates, and provided technical assistance to clarify compliance guidelines to ensure transparency and proper use of funds. The program implemented effective communication strategies to inform institutions about funding opportunities, including announcements via mass media and the Department of Health’s official social media platforms. They also created an external technical committee as an official communication channel to evaluate proposals. For this purpose, the creation of a detailed rubric facilitated its proper, unbiased, and timely assessment. Technological Challenges and Solutions One key challenge throughout the project was the use of technology to receive, process, and manage documentation. To mitigate obstacles, a SharePoint webpage facilitated electronic documentation acquisition between each subgrantee and the program. Additionally, the program provided clear instructions and developed a Q&A guide based on the needs that various institutions identified. In case of new inquiries, the Health Equity Program also shared responses collectively to ensure all organizations received consistent information, enabling them to complete the process smoothly and with equal opportunity. Lessons Learned A final evaluation of the process revealed that anticipating challenges was key to the project’s success. However, there are still areas for improvement: One of these is the optimization of financial processes by the organizations. It is critical to submit evidence of fund use in a timely manner and ensure accuracy in reconciling invoices within the allocated period. Organizations should also align internal processes with the parameters set when they receive funds. Adhering to these parameters can streamline the process on the Department of Health's side. Although beneficiaries get an assigned accounting professional, the documentation must still go through the Fiscal Office for review. Another challenge faced by institutions was retaining participants in the training sessions provided as part of the grant. Therefore, mechanisms need to be in place to ensure active and continuous participation in future interventions. The Health Equity Program also identified the opportunity to standardize the evaluation processes for organizations. While each institution worked on diverse projects, evaluations were based on their respective work plans and progress reports. However, a standardized evaluation process could improve efficiency in future interventions. Sustainability and Recommendations Many institutions that received funds have used them as a starting point to develop larger initiatives while others have used them to develop internal resources (i.e., digital libraries, trainings). “Organizations used this funding as seed money for projects that are now receiving greater financial support. Others have developed internal resources that allow them to continue addressing key health issues. For instance, they have optimized the use of digital libraries, expanded training reach, and replicated projects funded by this grant in other municipalities.” — Miguel Cruz, PhD, Co-Principal Investigator For other agencies looking to implement similar programs, the recommendation is clear: Streamline efforts to maintain consistency and coherence. Additionally, explore other agency or office supports for fostering an organizational culture that prioritizes continuous monitoring and process improvement, emphasized Cruz, PhD. Conclusion Clear, transparent communication and flexible administration with a focus on health equity generate a positive impact on vulnerable populations — as evidenced by increased knowledge, improved participant skills, attitude changes, inclusion in services, greater technology use among older adults, and enhanced equity skills among workers. This project demonstrates how health departments can collaborate with other sectors to address social determinants and ensure equitable access to resources. article yes

Learn about four Congressional hearings focused on challenges affecting older adults, including inflation and opioids.

State and territorial health officials gathered on Capitol Hill to meet with lawmakers and discuss public health priorities—learn more about Hill Day in this blog post.

Academic Health Partnership Prioritizes Workforce Development in Florida Florida Academic Health Partnership Prioritizes Workforce Development Mayela Arana Learn how an Academic Health Partnership in Florida focuses on workforce development and get inspired. In Hillsborough County, the Florida Department of Health (DOH-Hillsborough) and the University of South Florida (USF) have a long history of working together. Their partnership took on a new level of structure and purpose in 2022 when they formalized an Academic Health Department (AHD) partnership agreement, focused largely on workforce development. This collaboration, supported by the Public Health Infrastructure Grant (PHIG), creates opportunities for DOH-Hillsborough staff to enhance their skills through USF’s public health programs. By providing structured training and education, the partnership is helping to build a stronger, more prepared public health workforce to serve the county’s 1.5 million residents. A Longstanding Partnership Embraces a New Opportunity When CDC released a notice of funding opportunity for PHIG in 2022, the DOH-Hillsborough health officer and the dean of USF’s College of Public Health (COPH) worked together to co-write a successful proposal. One of the resulting contracts formalized their partnership in the name of strengthening the public health workforce through recruitment, training, and retention. Like many public health agencies, many of DOH-Hillsborough’s employees do not have degrees in public health. The health department is focused on upskilling through coursework and certificate/micro-certificate programs directly related to job tasks. These opportunities are available to every staff member including those categorized as “other personnel services,” non-career services, and certain contracted employees — as DOH-Hillsborough recognizes the importance of extending these educational opportunities to all employees. Initial PHIG funding was critical in establishing the necessary dedicated staffing and infrastructure for workforce development program offerings at the health department. Current funding continues to support infrastructure, new custom program development, and the educational offerings. Infrastructure: USF works with DOH-Hillsborough to conduct staff training needs assessments and has provided training at agency-wide “all-staff” meetings. USF also developed and provides a Certified in Public Health (CPH) exam preparatory course that is open to any health department employee who is eligible to sit for the exam, at no cost to them. Custom program development: Additionally, the university, in collaboration with DOH-Hillsborough and two other local county health departments, developed a custom leadership program that groups emerging health department leaders with community partners of their choice (e.g., Healthy Start, Homegrown Hillsborough) and includes two full days of instruction over a six-month period. Educational offerings: The health department is also using PHIG funds to cover tuition for current staff to take graduate and undergraduate courses at USF’s COPH and across the university. Representatives from DOH-Hillsborough and USF hold virtual information sessions for staff about available educational offerings, the university enrollment and registration process, and completing internal agency requirements for pursuing and participating in the PHIG-funded opportunities. Measuring Impact and Continuous Improvement Given that the bulk of activities in this AHD partnership are currently PHIG-funded, PHIG performance measures provide a clear and valuable opportunity for evaluation. DOH-Hillsborough is focused on three of the PHIG measures that address hiring and retention: Number of PHIG-funded positions filled by job classification and program area. Overall agency staff retention rate. Median number of days to fill a position. Tracking performance of these measures both contributes to the agency’s overall PHIG evaluation and provides the AHD partnership with a clear process for quality improvement. Advice for Others Seeking to Establish AHD Partnerships Learning from the success of USF and DOH-Hillsborough’s partnership, considerations in developing or expanding AHD partnerships include: Appreciate the unique nature of each organization. For example, while the health department and university may have a common vision, they may also have different funding category restrictions to consider prior to solidifying the partnership. Be mindful that each organization has its own legal considerations. Allow ample time for the proper review of contracts, agreements, and external communication about the joint endeavor. Know that, at times, the collaborative process can be complex and challenging. Take a few steps back. Work together to find solutions, and don’t give up. Be flexible, humble, and willing to pivot, remaining confident that the partnership will have a bigger impact than your organization would alone. Learn more about AHD partnerships or explore other workforce development resources from the Public Health Foundation (PHF). If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact performanceimprovement@astho.org. Special Thanks - Blog - AHP Prioritizes Workforce Development in FL article yes

Learn how Nebraska's Division of Public Health restructured their grants monitoring process in this blog post.

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

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What Public Health Leaders Need to Know About HTI-2 Proposed Rule How Proposed HTI-2 Rule Will Benefit Public Health Data Exchange Lillian Colasurdo, Lana McKinney, Alexandra Woodward Read how the HTI-2 rule improves upon HTI-1 standards and criteria for data exchange among public health, health care, and data providers to benefit public health. On July 10, 2024 HHS’s Assistant Secretary for Technology Policy/Office of the National Coordinator of Health Information Technology (ASTP) published the proposed rule: Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2). This rule, which advances interoperability and supports access, exchange, and use of electronic health information (EHI), represents a significant step towards strengthening public health data infrastructure and promotes interoperability between health care and public health entities. It proposes significant changes impacting public health agencies (PHAs) and removing barriers to EHI exchange, while attempting to streamline health IT processes. Background Two of the most significant federal laws passed in the past fifteen years for health data exchange are the Health Information Technology for Economic and Clinical Health (HITECH) Act and the 21st Century Cures Act. Together, these laws provided ASTP with authority to set standards for and certify heath information technology. ASTP’s certification program mandates that electronic health records (EHR) comply with the new standards and eligible providers and hospitals must use certified technology to be fully reimbursed by the Centers for Medicare & Medicaid Services. Additionally, these laws grant ASTP rulemaking authority. Earlier this year, ASTP finalized the HTI-1 rule, taking substantial steps toward improving public health and health care data exchange. This rule requires EHR systems to support either HL7 Clinical Document Architecture (CDA) or Fast Healthcare Interoperability Resources (FHIR) standards for electronic case reporting, both of which enhance the data quality and timeliness for public health reporting. HTI-1 also directs EHR developers to track and report on the amount of data electronically submitted to Immunization Information Systems (IISs); that information helps improve vaccine product distribution and availability. While the rule sets the stage for a future transition to a FHIR-based approach for case reporting, there must be an adequate transition period for public health agencies. While HTI-1 took significant steps toward improving the way data is exchanged, primarily in the health care setting, the proposed rule HTI-2 aims to expand these standards to further benefit public health. The HTI-2 expands upon the interoperability standards established in HTI-1 and aims to improve interoperability by revising the ONC Health IT Certification Program. It specifically proposes two new sets of certification criteria for IT developers that will benefit public health entities and payers. Public health agencies face many barriers to efficiently exchanging data with health care providers and other entities including lack of common data standards, inconsistent reporting requirements, limited system interoperability, and inadequate public health data infrastructure. HTI-2 addresses these challenges by establishing certification criteria for public health technologies, creating a common floor to support data exchange. In addition, HTI-2 introduces changes to the Information Blocking Rule and provides transparency to Trusted Exchange Framework and Common Agreement (TEFCA) requirements. Micky Tripathi - What PH Leaders Must About HTI-2 Proposed Rule Key HTI-2 Provisions Certification Criteria, Standardizing Application Programming Interfaces (APIs) HTI-2 proposes four standards and certification criteria that may impact public health systems. Depending on the criteria, ASTP proposes that many of them be implemented by the beginning of 2027 and 2028. Updating naming conventions and standards for existing functional criteria. There are currently nine functional (or “f”) criteria EHRs must meet to exchange data with public health agencies. The updated naming conventions and standards point EHR vendors and public health systems to the latest standards for implementation. Additionally, these updates include two new criteria for birth reporting and bi-directional exchange with a prescription drug monitoring program. Establishing new certification “f” criteria for Health IT so Public Health certified systems can receive, validate, parse, and filter standardized data. These functions will apply to immunization, syndromic, laboratory, cancer pathology, case, birth, and prescription drug monitoring program data. Adopting the United States Core Data for Interoperability (USCDI) version 4, a standardized set of health data classes and elements for interoperable health information exchange. Version 4 includes several new data elements relevant to public health, such as health status assessments (e.g., alcohol and substance use). Standardizing HL7 FHIR-based API for public health data exchange by creating new certification criteria to support ongoing development and transition to FHIR for patient and population-level data exchange. CDC and ASTP have noted potential benefits of increasing public health access to critical data while reducing the reporting burden on both health care organizations and developers. HTI-2 proposes similar certification standards and alignment for reporting to payers that comply with existing CMS API requirements. Information Blocking Updates The Information Blocking Rule requires that patients have timely access to their own electronic health records and prohibits health care providers and networks, HIEs, and developers from interfering with said access. When a public health agency serves as a provider, it is crucial to ensure that patients can access records in compliance with the existing rule. HTI-2 clarifies what constitutes “interfering” with the access and exchange and provides a non-exhaustive list of examples. HTI-2 also proposes a new exception to information blocking—the Protected Care Access Exception—that would “apply to acts or omissions likely to interfere with access, exchange, or use of particular EHI that an actor believes could create a risk of exposing patients, care providers, and other persons who assist in access or delivery of health care to potential administrative, civil, or criminal investigations or other actions on certain bases.” This exception is particularly relevant for jurisdictions with more restrictive laws for sharing reproductive health data. TEFCA Governance Rules As ASTP and its Recognized Coordinating Entity (RCE), the Sequoia Project, seek to establish standards for implementing the Trusted Exchange Framework and Common Agreement (TEFCA), the proposed HTI-2 rule would codify one portion of the framework by establishing the qualifications for Qualified Health Information Networks (QHINs), onboarding and designation processes, the attestation process, termination and appeal rights, and ASTP’s formal authority to delegate responsibility to the RCE. Conclusion The HTI-2 proposed rule represents a significant step towards strengthening public health data infrastructure and promotes interoperability between health care and public health entities. It is specifically designed to “address gaps in public health data and help the nation become response-ready, promote health equity, and improve health outcomes for all.” The Joint Public Health Informatics Taskforce (JPHIT), coordinated by ASTHO and consisting of 14 member organizations including public health associations, gathered comments and input from constituent members and submitted consolidated feedback on the proposed rule in October and awaits responses and the final rule from ASTP. OE22-2203 PHIG article yes