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As schools work to stay open for in-person learning, it is essential to understand key recommendations related to COVID-19 prevention in K-12 schools. CDC recommends that health department staff work closely with K-12 schools to effectively prevent and respond to COVID-19 infections. Health department staff may look to school officials to understand the unique context of each school setting, while school officials may look to health department staff to better understand federal, state, and local guidance. This document compiles CDC guidance for COVID-19 prevention strategies in K-12 schools and should supplement state or territorial and local policies. Schools and health departments should layer the COVID-19 prevention strategies listed in this ASTHOBrief.

Board-certified forensic pathologists play a critical role in public health by investigating death so as to better serve the living. Despite forensic pathology’s contribution to public health surveillance, prevention, and response, the discipline remains largely under-resourced and over strained. These briefs spotlight the critical role that international medical graduates play in minimizing forensic pathology workforce shortages and spotlights a local effort to address financial disincentives for medical graduates entering the field and highlights federal funding opportunities and resources for state partners looking to minimize forensic pathology workforce shortages.

Building Core Policy Skills: A Discussion Guide for STI Prevention Efforts Building Core Policy Skills for STI Prevention Efforts JoAnne Deehr, Lana McKinney Get insight into the ASTHO Policy Academy On Demand training, with practical examples and reflection questions focused on real-world STI prevention challenges. This discussion guide provides insight into and builds on the ASTHO Policy Academy On Demand training — deepening participant engagement through practical examples and reflection questions focused on real-world STI prevention challenges. While the training provides foundational understanding of the policy development process and how it supports programmatic work across health departments, this guide helps translate those concepts into practice by: (1) prompting discussion, (2) exploring implementation scenarios, and (3) connecting policy tools to day-to-day decision-making in STI prevention efforts. Module 1 – What Is Policy? This module provides a foundation for understanding how policy serves as a tool for public health intervention and establishes a foundational understanding of the policy development process. It covers the spectrum of policy actions, from formal state laws to agency-level protocols. Question 1: How can internal policy tools (e.g., updated clinical protocols or statewide guidance for universal prenatal syphilis screening) help to create near-term protection while considering broader legislative or payer policy changes, and how do these different policy levers compare in speed and impact? Question 2: When you think about a change, like expanding prenatal syphilis screening or covering at-home STI test kits, what parts do legislation drive versus internal agency policy or payer rules? Which decisions occur at the federal, state, and local levels, and how do those layers of authority influence what can be changed through legislation versus agency or payer policy? Module 2 – Problem Identification Effective policy begins with using data to understand and define a public health problem and its impact on specific communities. This module focuses on using surveillance to explore the problem that you can use policy to address and tools you can use to analyze the root causes of the problem. Question 1: When confronted with rising STI rates or screening gaps, how do you integrate quantitative data (surveillance, claims, lab metrics) with qualitative input (provider or community feedback) to define the problem? And what additional information would strengthen your analysis? Question 2: If you apply a root-cause method like the "5 Whys" to rising STI rates or missed prenatal screening, what are underlying drivers that might emerge? How would you determine whether the root cause is workflow, funding, access, or policy structure? Module 3 – Interested Parties Engagement and Education Policy development is a team sport. This module focuses on identifying internal and external partners, from community-based organizations to legislative leaders needed to move a policy forward. Question 1: When advancing policies related to STI testing access, congenital syphilis prevention, confidentiality protections, or Medicaid coverage, which interested parties must be engaged for approval, implementation, and community uptake? How do responsibilities differ between those who make policy decisions (e.g., legislators, Medicaid leadership) and those who operationalize them (e.g., clinics, maternal and child health programs, community partners)? Where might you find champions on the issue, coordination challenges, competing priorities, or confidentiality concerns that create friction? Question 2: In a medication shortage where prioritization decisions are required, how would you include perspectives of highest-risk patients and frontline providers? How might priorities differ among payers, clinicians, and community organizations? Module 4 – Policy Analysis This module examines the legal frameworks that empower health departments to act. It introduces methods for evaluating which policy options are legally sound within a specific jurisdiction. Question 1: When using an impact matrix to compare policy options — such as screening requirements, coverage mandates, or partner services expansion — why is it important to include the “status quo” as a baseline? How does that help you weigh feasibility, cost, impact, and potential unintended consequences? Question 2: When weighing the status quo against a proposal, such as at-home STI testing coverage, how would you assess long-term health impact, tradeoffs, operational feasibility (e.g., provider capacity, lab processing, reimbursement workflows) and possible unintended consequences? What sources of evidence would guide your decision-making? Module 5 – Policy Strategy and Design Translating data into a compelling narrative is key to building support for a policy. This module covers how to tailor messages for different audiences, including the media and policymakers. Question 1: When developing and thinking of pitching a policy like at-home STI testing coverage, which partners could help sell the proposal, and how would you address real world implementation constraints? Question 2: When communicating urgency around medication prioritization during a national shortage, which messaging strategies are most effective? What supporting policy elements (e.g., provider guidance, prioritization protocols, or reporting expectations) should be built in from the start to make the strategy workable? Module 6 – Policy Authorization and Enactment This module focuses on the formal process of moving a policy from a proposal to an official law or regulation. It includes navigating the legislative calendar and understanding the rulemaking process. Question 1: What concerns might arise when proposing coverage mandates or new screening requirements, and how would you address them proactively? Question 2: If you were advancing a policy such as expanded prenatal screening requirements or broader congenital syphilis prevention efforts (i.e., closing gaps between screening, treatment, and postpartum follow-up), which key decision-makers would need to be engaged? At what level of government (federal, state, or local) do they operate, and how would that distribution of authority shape your strategy and cross-program collaboration (e.g. maternal and child health, Medicaid, community organizations)? Module 7 – Policy Implementation Enactment is only the first step; implementation involves turning policies and/or laws into functional programs. This module covers the creation of guidance documents and the training of staff to ensure a policy’s success. Question 1: After a policy like expedited partner therapy is approved, what operational steps (i.e., training, workflow updates, and coordination) are required for successful rollout? Question 2: What behind-the-scenes barriers — such as low provider awareness of new requirements (e.g., expedited partner therapy authorization or prenatal screening mandates) or limited public awareness of benefits like at-home STI test coverage — most often undermine implementation and how can early coordination, promotion, and targeted communication address them? Module 8 – Developing the Evaluation Process Plan The final module focuses on measuring whether a policy achieved its intended health goals. It emphasizes using data to refine and improve policies over time. Question 1: Following implementation of policies related to screening access, congenital syphilis prevention, confidentiality, or Medicaid continuity, what indicators would signal success? What frontline feedback would inform policy refinement? Question 2: What indicators would show at-home testing policies are reaching the high-need groups, and how would you respond if the impact differs from what is expected? article yes

Island Areas Workgroup: Methodology for Annual Reports Island Areas Workgroup Overview The Island Areas Workgroup (IAW) seeks to improve health outcomes for U.S. territories and freely associated states (T/FAS) through local and federal departmental coordination and administrative change. It brings together leaders from island jurisdictions, federal agencies, and partners to find solutions that can optimize the procedures, organizational policies, and programmatic structures surrounding island health programming. It is hosted by the Island Support Team at the Association of State and Territorial Health Officials, a nonprofit membership organization whose members include the chief health officials of the U.S. states, Washington, D.C., territories, and freely associated states. IAW maintains three subgroups focused on health financing, data capacity, and workforce. These subgroups are responsible for creating deliverables each IAW year, which runs from November to October. Subgroups typically contain island health agency staff, U.S. federal agency staff, non-profit partners, and academic partners. Process: Creating IAW Reports Priority Selection: In the first few months of each IAW year, IAW subgroups discuss and vote on where to devote their energy over the coming nine months. Each subgroup is responsible for creating a deliverable — such as a report — by October of the following year. Research, Drafting, and Review: When a subgroup chooses to produce a report… ASTHO staff lead the research process, which has included surveys and informational interviews, as well as analyses of publicly available data. Subgroup members guide data collection and participate in surveys/interviews as appropriate. ASTHO presents draft reports back to the subgroup approximately three months before the end of the IAW year. The goal of subgroup review is to ensure accuracy and representativeness, and to generate recommendations based on research findings. Subgroup members review and share feedback on the reports during subgroup meetings. Subgroup meetings typically include 15-25 people representing island health agency staff, federal agency staff, and nonprofit/academic organizations. Subgroup members self-select into their subgroup and are united by a shared vision of improving administrative and operational policies at the local and federal levels to improve island health outcomes. Reports also circulate via email to all subgroup members, allowing participants to provide private feedback to the ASTHO team or reply all with more public commentary. This subgroup repeats this process for subsequent report drafts, as relevant. Subgroup participants review and clear the final report, with final approval from subgroup leaders (who are not ASTHO staff). After the subgroup approves the report, ASTHO’s Content Development team copy edits and provides editorial feedback as appropriate. Sample: Review Process for the October 2024 Report, “Addressing Island Participation in Six Priority Federal Public Health Datasets: Report Addendum” As of December 2024, there were 56 participants in the IAW Data Capacity Subgroup. These participants self-selected into the group with a common interest in strengthening island-relevant data structures. The group consists of: 19 island representatives, with at least one representative from each of the eight T/FAS. These representatives work in the public health agency or partner agency (e.g., Ministry of Finance) in these jurisdictions and are involved in collecting and reporting data. 28 federal representatives, with participants from various departments and agencies involved in maintaining or reviewing federal public health datasets, including HHS, DOI, EPA, GAO, and Census. Nine academic or nonprofit representatives who collectively represent three academic institutions and four nonprofits. These partners use island data and/or offer technical assistance to support island data capacity. From December 2023 through March 2024, the subgroup brainstormed, discussed, and ultimately voted on where to devote its energy during the third year of IAW (November 2023 through October 2024 ). The group elected to research barriers affecting island participation in six federal public health datasets: the National Vital Statistics System, the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System, the National Notifiable Disease Surveillance System, the Pregnancy Mortality Surveillance System, and the National Youth Tobacco Survey. From March – August 2024, research proceeded through several avenues: Subgroup participants provided feedback on island participation in each dataset in monthly subgroup meetings and email. Additional 1:1 informal interviews with CDC and partner staff addressed knowledge gaps identified among subgroup members. Outside monthly meetings, ASTHO staff led the research into administrative requirements associated with each dataset, including an analysis of public information on the CDC website, publications featuring that dataset, and outreach to administrative staff associated with each dataset. Drafting and review of the final report: The IAW data capacity subgroup received a first draft of the report in August. They provided feedback during the monthly meeting and via email, with prioritized T/FAS representative feedback to ensure report accuracy. Members could share feedback anonymously (to the group, not to ASTHO) via email, while discussions during meetings provided opportunities for public feedback. The IAW data capacity subgroup received the second draft of the report in September, and gathered feedback via email and over the course of two additional meetings. Subgroup leadership approved the final report (i.e., Janis Valmond, MS, MPH, DrPH, CHES®, Deputy Commissioner of the USVI Department of Health, and Ted Trimble, MD, MPH, Senior Advisor for Global HPV and Cervical Cancer Control, Center for Global Health, National Cancer Institute, NIH) in October 2024, and presented to the full IAW at the Year 3 Closeout Call on Oct. 7, 2024. ASTHO published the report on its website later that month. article yes

Leveraging the NIH Bookshelf to Showcase Health Agency Research Island Areas Workgroup, Data Capacity Subgroup Learn how to submit your health agency research to the NIH Bookshelf to increase visibility and expand reach. If you’re looking to strengthen ties with the academic community and increase the visibility of your public health agency’s published population health reports, consider submitting them to the National Institute of Health’s Bookshelf platform. This free, searchable collection feeds into the PubMed database and accepts “gray literature,” or research produced outside of traditional commercial or academic publications. It is a great opportunity for public health agencies to expand their reach. Application and Review Process Submit content Initial screening Scientific review Technical review Publication Before submitting your content, make sure it meets Bookshelf requirements: Is your content: Full text (a full report, not just an abstract or data) with an executive summary or abstract? Aligned with at least one of the subjects priotitized by Bookshelf? Written in English? Accessible via a PDF/Word Document or online via a web link? While drafting the document, did you undergo some sort of peer review process? (E.g., an advisory council reviewed, offered feedback, and approved the final draft.) The peer review process must be publicly documented within the content, in a separate document, or via a description on the website. If you answered yes to the previous questions, follow these steps to apply: Download and complete the application for a single title or application spreadsheet for multiple titles. Complete publisher information sheet (if you are new to submitting to Bookshelf). Email your application to bookshelf@ncbi.nlm.nih.gov. Other information you will include in your application: Title of content. PDF/Word Document or URL where content can be accessed. Publishing information (name, management, qualifications, policies). Short author/editor biographies or CVs (1-2 pages). Resources for writing a professional CV (PH resume and examples). Copyright information. Abstract or summary. If you have questions about the application process or the suitability of your content, please contact bookshelf@ncbi.nlm.nih.gov. Note: If you have been publishing related content for at least two years, Bookshelf may review your content as a collection. This means any future materials may be added to the collection without an additional application. Once you have submitted your content: Initial Screening: Bookshelf staff checks that your application is complete and meets the minimum submission requirements. If Bookshelf staff have questions, they will contact you. Be ensure the project point of contact is responsive to inquiries, as timely responses are critical to moving your application forward without delays. If all submission requirements have been met, your content will move into the Scientific Quality Review. Scientific Quality Review: Bookshelf staff will assess whether your content meets the platform’s scientific standards (e.g., whether its content is substantive and valuable). Your content will either pass or fail this review; there is no opportunity to revise in response to feedback. If rejected, you may resubmit the content after two years. If your content passes this review, it will move to the technical review. Technical Review: Bookshelf staff will assess whether your content meets the platform’s technical requirements (e.g., an XML document with proper formatting and accessibility). This is typically the longest stage of the process, as there can be some back and forth between Bookshelf staff and applicants, as applicants strive to address any technical issues with the content. An applicant can contract with a commercial vendor to produce the necessary XML document, if needed. If your content is accepted: Bookshelf will give you an opportunity to preview the content. Make sure you’re comfortable with how the content looks, as this preview represents how the content will look on the platform. Ensure there are no typos or formatting issues! Sign the participation agreement, discussing questions with NIH Bookshelf staff as relevant. Celebrate your success, and share the link with peers and partners! Additional Resources from NIH How to Include Content in Bookshelf: Summarizes the Bookshelf application process. Bookshelf Copyright Notice: Summarizes relevant copyright restrictions that apply to Bookshelf. NLM Retention Policy: Summarizes the National Library of Medicine’s retention policies, which apply to Bookshelf. Background This product was created by the Island Areas Workgroup (IAW) — Data Capacity Subgroup. Established in October 2021, IAW brings together representatives from island jurisdictions, federal agencies, and trusted partners to address key administrative challenges impacting health outcomes in island jurisdictions, including efforts to strengthen procedures and organizational policies affecting health financing, data capacity, and workforce development. The Data Capacity Subgroup drafted this resource to support territorial and freely associated state public health leadership and researchers in their efforts to expand the reach of local population health data and research. OE22-2203 and PW-24-0080 article yes

Learn how public health and WIC partnerships are critical to addressing syphilis and congenital syphilis rates in this resource.

Engage in meaningful dialogue in island grantor/grantee relationships, with support from these sample questions and comments.

This worksheet provides actionable steps for public health agencies improve their recruiting and hiring practices, and to bolster the public health workforce.

Wildfire and Wildfire Smoke Guidance and Resources ASTHO and various public health agencies list of wildfire resources and guidance. Following the 2023 wildfire smoke events that impacted several states in the Midwest, Northeast, and Mid-Atlantic, as well as the devastating wildfires that impacted Hawaii, ASTHO developed a document that included a list of federal, state, and partner organization resources on wildfire smoke information and how to message that information to the public to support public health officials, clinicians, schools, and communities. These include air quality data, health guidance, masking and ventilation tips, and communication tools to protect specific groups, pets, and outdoor workers. Get the Resource (PDF) article yes

Sustaining DMI: Conditions for Enhanced Funding How state Medicaid agencies can receive enhanced federal funding for certain expenditures. What are the Conditions for Enhanced Funding? Why are they important? The Conditions for Enhanced Funding (CEF) are a series of federal requirements that states must meet to receive federal financial participation. If a state Medicaid agency (SMA) meets the CEF and couples them with measurable outcomes and metrics that improve the Medicaid program, it can receive enhanced funding at the rate of 90% to design, develop, or implement a Medicaid Enterprise Systems (MES) module or at 75% to operate and maintain an MES module. Each state operates an MES to manage its Medicaid data and run its program. Increasingly, SMAs’ MES are composed of independent modules in categories such as eligibility and enrollment and financial management. An SMA that uses these funds can build a strong financial foundation for a data modernization initiative and can secure reliable funding to better sustain the initiative. How can states receive enhancing funding to design, develop, implement, or operate and maintain an MES module? To receive enhanced federal funding, SMAs must collaborate with the federal government from the original implementation of their MES module and throughout its operations and maintenance. Frequently, SMAs begin the MES development journey through a request for planning funds. Planning activities include assessing impact, conducting a Medicaid Information Technology Architecture self-assessment, convening work groups to identify potential system enhancements, and exploring outcomes and metrics. These plans often are converted into requests for design, development, and implementation funding. The 90% funding match for design, development, and implementation could cover the performance of system fixes, establishing connectivity and interfaces, developing business continuity plans, software leasing, configuring off-the-shelf software, and ongoing planning activities. To receive the 75% funding match for operation and maintenance of an MES module, the state must have its module certified by and continuously report operational metrics to the Centers for Medicare & Medicaid Services (CMS). After certification, the SMA can receive enhanced federal funding to support security updates, software leasing or licensing, portal and technology maintenance and operation, and training for personnel engaged in the operation of the MES. Although these eligible activities are diverse, states should ultimately meet seven conditions for enhanced funding (Table 1): Modularity Medicaid Information Technology Architecture (MITA) Industry standards Technology reuse and sharing Business processes Reports Interoperability Table - Resource - Sustaining DMI: Conditions for Enhanced Funding What best practices should states consider when seeking enhanced funding? If an SMA meets the CEF and couples them with measurable outcomes that improve the Medicaid program, it can receive enhanced funding. Public health data modernization initiatives and their ongoing support may be eligible for enhanced federal funding through the Medicaid program. Best practices include: Start the Streamlined Modular Certification early. Certification is a crucial piece of CEF and requires many interrelated activities. States should use the intake form to enter information about MES certification and CMS-required outcomes to develop documentation of their compliance with regulations applicable to their Medicaid-based data modernization initiative, state-specific outcomes, and metrics. The intake form can be used to show that the project is achieving outcomes on a continuous basis. Become familiar with CEF best practices. CMS highlights several best practices for successfully engaging with CEF. States should become familiar with this guidance to help them complete various required forms and documentation, understand connected activities, create realistic timelines, prevent duplication of work, identify efficiencies, and more. Identify outcomes that are feasible to achieve and measure and improve the Medicaid and public health programs. Some outcomes can take years to appear and intensive research and resources to measure. A state should identify outcomes that are feasible to achieve and measure based on its Medicaid-based data modernization initiative, available resources, staff capacity, and other factors. This includes setting measure targets that, when reached in the designated time, collectively provide proof that there is progress toward achieving Medicaid and public health outcomes. website yes

This report shares Puerto Rico’s strategy and recommendations for developing a social determinants of health dashboard.

Community Action Plan Templates for Children’s Environmental Health Environmental Health Community Action Plan Templates Health agencies can use these community action plan templates to bolster their children’s environmental health programs. ASTHO, through support from EPA, developed a set of four Community Action Plan Templates for use by state and territorial health agencies. These templates are intended to be adapted and customized by jurisdictions according to their specific needs and goals for children’s environmental health. Jurisdictions can prioritize the most pressing actions based on the areas of highest importance, needs, strategic plans, and timelines. The templates focus on air quality, climate, environmental justice, and lead poisoning. They provide a roadmap for creating community change by specifying what will be done, who will do it, and how it will be done. Health agencies can utilize the templates when helping communities develop new (or refine existing) action plans. Learn more about the templates by exploring the primer, or dive right in with one of the four templates below. website yes

This resource provides strategies to incorporate health equity in overdose prevention programs.

The Keys to Driving Generational Health, Well-Being, and Justice 30:13 Tune in to this podcast episode to hear a discussion about the vital conditions for health and well-being framework to reach full potential. PH Conversations Series - The Keys to Driving Generational Health, Well-Being, and Justice Somava Saha and Andrew Martin from Well-Being and Equity in the World (WE in the World) discuss the vital conditions for health and well-being framework or what we all need to collectively thrive and reach our full health and wellness potential. Through their conversation, they offer reflections and stories around how public health and community collaborations across the country organize around the vital conditions, prioritizing belonging and building civic muscle, to drive health, well-being, and justice across generations. Show Notes Guests Somava Saha, MD, MS, President and CEO, WE in the World Andrew Martin, MS, MHCDS, Director of Networks and Partnerships, WE in the World Resources Organizing Around Vital Conditions Moves The Social Determinants Agenda Into Wider Action | Health Affairs Thriving Together Springboard Vital Conditions | WIN NETWORK Pathways to Population Health Equity PHC Podcast Transcript - The Keys to Driving Generational Health, Well-Being, and Justice website yes

This organizational strategic planning guide, which details seven phases, can help health agencies create or refine strategic plans that are responsive to evolving needs.

Explore the 2025 Telehealth Needs Assessment to understand how public health agencies structure, fund, and utilize telehealth, and identify key goals and support needs for expanding access to care.

Media Relations Toolkit for Health Departments Discover expert media relations insights and actionable guidance tailored for health departments in this ASTHO toolkit. Integrating media relations strategies into operational frameworks is crucial for fostering meaningful community connections. ASTHO’s Media Relations Toolkit helps health departments craft effective communication strategies and navigate the landscape of media engagement to cultivate a resilient public image among the public, media, policymakers, funders, and stakeholders. This toolkit is a foundational resource for establishing robust media relations practices and offers a step-by-step roadmap for successful media engagement and strategic planning. It reflects the latest insights and trends in media relations, ensuring health departments stay ahead in effectively communicating their messages to their audiences. Get the Resource (PDF) website yes

Branding Resource Guide for Health Departments A step-by-step guide for moving through the branding or rebranding process for health departments. ASTHO's Branding Resource Guide helps health departments as they embark on strategic planning, quality improvement, and exploring how best to position their agency. A robust brand enhances visibility in the community and can greatly impact how the public, policymakers, funders, and other key stakeholders view the agency. This guide introduces the basic facets of brand development, outlining the path to fortifying a more resilient health department brand. It breaks down the brand enhancement journey into understandable and manageable steps. This guide will be continuously updated to reflect new information as it becomes available. Get the Resource (PDF) website yes

This brief from ASTHO discusses the results of standing up virtual and hybrid emergency operations centers during the covid-19 pandemic.

This ASTHOBrief highlights healthy aging frameworks by AARP and Trust for America's Health that include health promotion, injury prevention, and chronic disease management along with another domain that emphasizes facilitation of social engagement, as well as a final domain focused on optimizing physical, cognitive, and mental health statuses of an individual.