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CDC's 2011-2021 Youth Risk Behavior Survey results, summarizing data from the past decade, show some alarming trends in mental health conditions, especially for teen girls, LGBQ-identified youth, and youth of color.

This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.

Five great reasons to attend ASTHO's 2023 Health Equity Summit.

Why Kentucky Chose to Pursue Community Health Worker Certification astho, association of state and territorial health officials, certification program, kentucky department for public health, community health worker, public health workforce, kentucky association of community health workers, national association of community health workers, health affairs, cultural competence of service, professional certificate, community health workers chws, department for public health, range of activities, kentucky department for public, chronic disease, centers for disease control and prevention, public health worker, builds individual and community, covid-19 pandemic, health care, public health Shelby Rowell ASTHO | Kentucky shares how they collaborated with the CHW workforce to develop a CHW certification process. Community health workers (CHWs) play a critical role in improving public health outcomes by serving as a bridge between systems of care and the communities they serve. They are often trusted members of the communities they work in and can provide culturally appropriate and linguistically accessible health services and information to individuals who may have limited access to traditional health care settings. Many states are considering certifying CHWs to ensure they have the necessary training and skills to provide high-quality care. Given every jurisdiction’s varied needs and policies, determining whether to pursue CHW certification should be discussed state-by-state. Kentucky and Louisiana are examples of states that have taken two different approaches to supporting the CHW workforce. While Louisiana chose not to pursue CHW certification, Kentucky has opted to develop a CHW certification program. ASTHO spoke with Laura Eirich, Kentucky Office of Community Health Workers administrator, to discuss the state’s decision-making process behind implementing CHW certification and how the Kentucky Office of CHWs has maintained shared decision-making with their state’s CHW workforce. When did Kentucky develop a CHW program within its state health department? Kentucky has funded several programs to deploy CHWs across the state, including the first Kentucky CHW program in 1994 called Kentucky Homeplace and a CHW program that served migrant farm workers with outreach and case management services. In 2014, the Kentucky Department for Public Health (KDPH) dedicated part-time staff to form a CHW Advisory Workgroup, which established three sub-committees (Certification, Curriculum, and Evaluation) that met monthly to draft a state CHW certification manual, core competencies, and a code of ethics. The work group brings together CHWs, representatives from state and local public health departments, federally qualified health centers, community-based organizations, universities, and other organizations who want to employ or otherwise advance the CHW workforce. By 2017, KDPH formed the Kentucky Office of Community Health Workers (KOCHW) and hired an administrator. What was the process for determining if Kentucky would have a certification program? The CHW Advisory Workgroup held formal discussions regarding a potential certification program beginning in 2014. The workgroup reviewed other states’ CHW training curricula and certification processes to develop Kentucky’s draft core competencies. In 2018 and 2019, Kentucky participated in a technical assistance project with ASTHO to renew its focus on CHW efforts. With ASTHO’s assistance, Kentucky conducted a statewide survey of CHWs to gather insight into attitudes towards the CHW profession and certification, which showed widespread interest in pursuing certification. Nearly half of the respondents identified as CHWs. Between 2019 and 2022, KOCHW launched an approval process for CHW training organizations and instructors to be certified, as well as an official Continuing Education Unit approval process. In 2022, Kentucky’s legislature passed legislation that outlined statutory requirements for CHW certification, continuing education, certification renewal, and associated duties of KDPH. Kentucky Administrative Regulation authorized KDPH to promulgate administrative regulations for CHW certification. How did Kentucky work with CHW groups to develop a CHW certification process? Kentucky CHWs were initial advocates for pursuing certification. They were instrumental in helping with outreach, conducting research, and drafting a certification manual, policies, code of ethics, and core competencies. One of the top priorities of KOCHW was to ensure that the certification process was developed in partnership with Kentucky CHWs so that any resulting certification program would effectively meet their needs. The launch of the Kentucky Association of Community Health Workers (KYACHW) provided an opportunity to connect and collaborate with more CHWs in the state. Staff from KOCHW have attended association meetings across the state to share updates and request KYACHW members to approve, deny, or suggest alternative wording or changes. For instance, we shared each iteration of the draft certification manual in-person at these KYACHW meetings and virtually to increase opportunities for feedback. What were the benefits of certification that you identified in your discussions? The most significant benefits and drivers of certification include the following: Increased recognition and respect for the profession. Increased confidence for individual CHWs. Opportunities for professional growth. Potential for future Medicaid reimbursement and financial sustainability of the profession. However, it is important to note that the Centers for Medicare & Medicaid Services does not require certification as a requirement for Medicaid reimbursement; this decision is made on a state-by-state basis. What measures do you take to ensure all interested CHWs can participate in your certification program? Each year, KOCHW sends a survey to all known CHWs, providing an anonymous space for feedback. All formal and informal CHW feedback is cataloged, and KOCHW periodically holds discussions to dive deeper into concerns or issues. When we make changes to the CHW certification manual and process, KOCHW is transparent about the reasoning behind the changes. It is worth noting that CHWs had (and currently have) the power to approve or reject any proposed changes. Soliciting and incorporating changes based on CHW feedback helps demonstrate that certification is for all CHWs. It’s important for CHWs to know that this is their certification and their voice matters. For example, KDPH and the CHW Advisory Workgroup suggested charging a fee for certification and renewal. KYACHW members felt it was important to assess a fee, but they decided on the price. To avoid creating a financial barrier, a fee of $50 for initial certification and $25 for renewal was decided upon by CHWs. These fees are now in the Kentucky statute. One way to make certification more accessible was to change the GED/High School Diploma requirement to a “strong recommendation,” which allows those without formal degrees to become certified. Additionally, KOCHW does not perform background checks on applicants pursuing CHW certification, which allows those who have experience with the justice system to use that lived experience to assist others. Did you communicate with states with existing CHW certification programs to inform your decision? Yes! We met with representatives of several states, including Massachusetts, Texas, and Connecticut. We also learned from state and national experts, such as Carl Rush, MRP, and were fortunate to participate in two ASTHO learning communities supported by HRSA. These projects were integral to understanding the national CHW landscape, identifying best practices, and formalizing the process in Kentucky. What advice would you give to states and territories currently assessing if a certification program is right for them? Talk to your CHWs! Initiating and building relationships with existing programs and associations is essential to ensuring CHW voices are heard. Take advantage of the existing plethora of resources! Talk to states and territories that have opted in and out of pursuing certification. The beauty of CHW work is that each state and territory is different, and there is no wrong path. Consult subject matter experts, such as ASTHO and the National Association of Community Health Workers (NACHW) who have a wealth of knowledge and can help convene groups, identify goals, and formalize your process. State comments have been edited for length and clarity. 2 UD3OA22890-10-00 website yes

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

Both the Pacific and Caribbean are on the front lines of the dengue health security threat. As a result, many island areas, especially in the USAPI and Puerto Rico, are doing great work to combat dengue.

Predictions regarding how the health system would be impacted in the event of a U.S. default paint a grim picture for the country and for public health.

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

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

Three key leadership strategies that can help every leader build a high-performing team.

How states are using 1115 waivers to improve health equity for people on Medicaid.

As the United States begins to see more wildfires, it is important for health agencies to be ready to address concerns from the public and collaborate with other state agencies to mitigate the health risks of wildfire smoke.

An interview with ASTHO President Anne Zink (SHO-AK) about strengthening state and federal connections for public health.

Accompanying an infusion of federal funding, states are considering several policy changes to strengthen the public health workforce and address challenges within the health care workforce.

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

An ASTHO blog article about the importance of resiliency in the workplace, pertaining to leadership and organizational work environment.

ASTHO spoke with Palina Louangketh about her history as a refugee to the United States, her extensive work in expanding health equity in Idaho, and how her past has influenced her present.

Public health officials have a significant opportunity to provide leadership on the issue of Long COVID, through their own authorities, and by capitalizing on their influence in the public health and healthcare sectors.

Hearing the Hill astho, association of state and territorial health officials, opioid crisis, covid-19 funds, public health, public health data and workforce, american rescue plan, promoting health, drug overdose death, coronavirus preparedness and response supplemental appropriations act 2020, de beaumont foundation, infectious diseases, substance use disorder, health equity, drug overdoses, january 2022, state local, opioid epidemic, opioid use disorder, workforce development, synthetic opioids, overdose deaths, prescription opioids, cares act, health departments, covid-19 pandemic Devon Page ASTHO | Takeaways from congressional meetings on leading public health topics. CSPAN is no Netflix. But that’s not to say this endless stream of content fails to entertain. In one short month, the new Congress has held several richly informative—and sometimes lively—hearings regarding the nation’s most pressing public health topics. The debates over COVID-19 funding, government oversight, and substance control—to name a few—illuminate the multiplicity of party agendas, how members of Congress are grappling with different issues, and opportunities for bipartisan collaboration. Since assuming the majority, House Republicans have been dutifully fulfilling their promise to scrutinize the origins of, funding for, and agency response to COVID-19. Three hearings were held in the first two weeks of February alone. The House Committee on Oversight and Accountability held a Feb. 2 hearing to discuss what Chair James Comer (R-KY) called “the greatest theft of taxpayer dollars in American history,” namely the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. The hearing spotlighted the tradeoff between urgency and accountability: essentially, getting loans out the door quickly created vulnerabilities for fraud. To make matters worse, agencies were slow to implement modernization policies, such as data sharing between agencies, which only exacerbated the problem. While politicking reared its face in some cross-aisle imputations, committee members on the whole recognized that the issue warranted attention and demonstrated a willingness to work together to produce solutions to avoid similar instances of fraud in the future. Just down the hall, the House Committee on Energy and Commerce was holding a hearing titled, “Challenges and Opportunities to Investigating the Origins of Pandemics and Other Biological Events.” Here again, agreement penetrated party lines. Proactively addressing pandemics seemed a unanimous priority, albeit with some caveats: House Republicans focused chiefly on identifying the origin of the COVID-19 pandemic to help the U.S. better prepare for the next pandemic, where House Democrats tied this into preparedness and infrastructure. The blockbuster event of the COVID-19 hearings occurred a week later, featuring Lawrence Tabak of NIH, FDA Commissioner Robert Califf, and CDC Director Rochelle Walensky. Representatives, with a markedly more partisan fervor, explored a myriad of topics—from the impact of CDC guidance on declining public trust to NIH laggard interventional clinical trials for long COVID research—and expressed a mix of dissatisfaction and approval. Amid criticism from largely the conservative members, Walensky was steadfast in requesting broader public health data and workforce authority, as well as robust funding for public health core capacities. Rep. Diana DeGette (D-CO) echoed the director, calling for updated agency data infrastructure. The strong partisanship and serrated critiques of the agencies made clear the canyon-sized gap separating Democrats and Republicans on the federal COVID-19 response. In each of these hearings, at least one representative made mention of a different priority of this Congress: the fentanyl crisis. On Feb. 1, a House Energy and Commerce Health Subcommittee hearing was devoted entirely to the subject. And while Chair Brett Guthrie (R-KY) and Ranking Member Anna Eshoo (D-CA) appear postured to produce bipartisan legislation, differences in how the parties want to approach the issue are not insignificant. Republicans, on the one hand, favor classifying fentanyl as a Schedule 1 drug and cracking down on smuggling across the United States-Mexico border, while some Democrats strongly resist such measures. These points will likely be hashed out in future debates concerning H.R. 467, the Halt Fentanyl Act, and similar legislation. The committee also touched on the importance of investing in mental health. Rep. Tony Cárdenas (D-CA) emphasized the value of the 988 Hotline, and introduced H.R 498, the 988 Lifeline Cybersecurity Responsibility Act, to protect the hotline from cybersecurity incidents. Additionally, Rep. John Sarbanes (D-MD) requested that SAMHA’s Chief Medical Officer Neerja Gandotra, one of the hearing’s witnesses, explain why continued investment in mental health programs is paramount. Gandotra noted that the investments, specifically in youth, lead to decreased criminal justice involvement, fewer hospitalizations, and improved performance in school. There was also a Feb. 9 Senate hearing examining the state of the U.S. territories, which included testimony from the governors of the U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and Commonwealth of the Northern Mariana Islands. Both parties were resolute in supporting the governments. Several senators, including Ranking Member John Barrasso (R-WY) and Senator Mazie Hirono (D-HI), emphasized the importance of supporting Compacts of Free Association (COFA) citizens’ health and social safety nets. With just about 90% of this Congress’s session ahead of them, these issues, among others, will certainly be probed further as the object of congressional concern. Regarding public health, much remains to be said and—hopefully—done. Bipartisanship, no doubt to the surprise of many commentators, seems to be the reigning attitude: a sign of things to come or merely pretense? Only time will tell. website yes

ASTHO's Kimberlee Wyche Etheridge reflects on the state of public health in Honduras, after a recent trip with her medical students.