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Public health is an ever-evolving field, and state and territorial agencies can evolve with it to meet emerging needs through conscientious performance management.

The ASTHO Profile is the only comprehensive source of information on state and territorial public health agency activities, structures, and financial and workforce resources.

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Technical Assistance Offerings ASTHO STAR Center services and technical assistance to members uses a five phase process to strengthen agency culture, systems, and operations. ASTHO STAR Center services and technical assistance (TA) to members uses a five-phase process to strengthen agency culture, systems, and operations—including vision setting, engagement, assessment, planning, and evaluation in line with principles of change management and leadership engagement. Assistance is provided in the following areas and tailored to address specific needs or preferences of the requesting agency: Administrative and organizational capacity assessment and development Administrative policy assessments and development Federal grants management and spend down Financial systems and funding mechanisms Performance Management and Quality Improvement Services may also include, but are not limited to, connecting to subject matter experts and knowledgeable consultants, facilitating peer-to-peer connections to see how public health agencies are addressing administrative readiness and building organizational capacity in the above areas, and identifying existing resources, tools, and best practices. How to Request Services Public Health Infrastructure Grant (PHIG) awardees and members interested in TA services should work with their agency’s PHIG Director to determine if this opportunity aligns with and supports the agency’s PHIG workplan. If the request aligns with the agency’s workplan, PHIG recipients can submit their TA requests via the PHIVE system. If the request is outside of their agency’s PHIG workplan, recipients can submit their TA requests and any questions to performanceimprovement@astho.org. If you are unsure or have general questions about TA, contact performanceimprovement@astho.org. ASTHO will work with the requesting agency to identify needs, triage the request, define the scope, and develop a plan for the service. website no

The Peer Assessment Program provides an opportunity for health agencies to identify opportunities for modernizing their agency’s infrastructure and operations to meet the needs and challenges of public health.

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State Health Agencies’ Role in Implementing Pharmacist-Prescribed Contraception Health Agencies’ Role in Pharmacist-Prescribed Contraception Sophia Durant, Brittany Lee Learn about three primary barriers to successful implementation of pharmacist-prescribed contraception and actionable solutions. State health agencies lay the groundwork for sustainable and equitable contraceptive access. They play a pivotal role in expanding access to contraception by supporting the implementation of pharmacist-prescribed contraception (PPC). This report walks readers through three major areas for doing so: Mechanisms That Expand Pharmacist Roles in Contraceptive Access: Learn about policy levers jurisdictions can utilize to support pharmacists playing a more active role in contraceptive care, including collaborative practice agreements and standing orders. Payment for Services: Explore legislative, Medicaid, and commercial insurance strategies to address payment for services as a key barrier to PPC programs. Workforce, Education, and Consumer Awareness: Delve into final considerations that can impact the implementation of PPC from workforce development to pharmacy/regional champions and education. Get the Report (PDF) Padding Block - Large Related Content - Report - State Health Agencies’ Role in Implementing Pharmacist-Prescribed Contraception article yes

Communicating the Health Risks of Wildland Fire Smoke Communicating the Health Risks of Wildland Fire Smoke Kerry Wyss, Ali Aslam Learn how state agencies effectively communicate the dangers of wildfire smoke to local communities in this report. Wildfires continue to be a growing risk across large swathes of North America, one of the largest effects of these fires being severe smoke. Smoke from wildland fires — wildfire and prescribed burns — can pose serious health risks to communities, particularly for sensitive or vulnerable populations such as children, older adults, and those with respiratory or cardiovascular conditions. Wildfire smoke can spread rapidly over long distances, so timely and accurate risk communication is essential during wildfire events to help communities understand the dangers of smoke exposure and take protective actions. ASTHO hosted a wildland fire focus group in January 2025 to talk through lessons learned by state and territorial health and environmental agencies in managing wildland fire response. The group identified needs to improve community health in wildland fire response through health risk communication, disseminating information, and developing programs to support public health action (i.e., exposure reduction). Learn more about these takeaways and actionable strategies for wildland fire response in the full report. Get the Report (PDF) article yes

Building a Resilience Framework in Colorado Creating Resilient Communities in Colorado Heather Tomlinson, Kerry Wyss Learn how Colorado public health is building community and cross-sector partnerships to build community resilience. Following the 2012 wildfire season and the 2013 Colorado Floods, Colorado recognized the opportunity to better prepare for natural disasters and coordinate efforts across state agencies to build resilience into their regular operations. In 2015, Colorado became the first state to develop a resilience framework and created the Colorado Resiliency Office (CRO) with the goal of building more resilient systems in the face of shocks and stressors. The Colorado Resiliency Working Group (CRWG) is an interagency group that meets on a quarterly basis to collaboratively implement and advance resilience actions and goals. The Colorado Resilience Framework serves as interagency guidance on strengthening resilience and emphasizes finding co-benefits across community sectors, reducing community risk and vulnerability to disruptions, and supporting the state in anticipating and preparing for current and future conditions. The framework is updated every five years to adapt priorities and to keep up with current conditions. Changes from 2015 to 2020 included a shift from focusing heavily on long-term recovery to taking a more holistic approach to resilience. The CRWG is currently working on the 2025 update with a focus on statewide vulnerability where they can have the most impact and prepare for future conditions with available resources. They are also focusing on clear metrics and being able to communicate progress effectively. The state also created a statutory definition of resilience, which has helped with coordination across long- term projects and agencies. Coordination with Partners Resiliency work in Colorado is greatly enhanced by working with a wide range of partners that bring their subject matter expertise to the table. As a state with strong local control, Colorado has prioritized working collaboratively with local partners, providing technical assistance and subject matter expertise to support their work on the ground, from planning support to targeted grant programs. This collaboration helps ensure continuity from the state to the local communities. Colorado’s approach to resilience ensures resilience is integrated within its many agencies. For example, the Colorado Department of Public Health and Environment (CDPHE) has continued to evolve and advance their agency’s resiliency work. Beginning March 2025, CDPHE developed a monthly internal working group to funnel knowledge into resilience leadership across CDPHE — including environmental health, chronic disease, environmental justice, disease and public health, and air pollution. Their goal is to build partnerships across internal programs and state agencies. The CRO was first established in the Governor's Office and moved to the Department of Local Affairs (DOLA) in 2018. This move strengthened continuity of its long-term work and, given Colorado’s strong local control governance structure, enabled the CRO to further the goals of building a more resilient Colorado by partnering with and supporting local governments with planning and technical assistance to build greater resilience. The CRO offers flexible Future-Ready Technical Assistance Opportunities for state agencies, which helps them apply adaptability and future-visioning lenses to their resiliency principles in programs and operations. To involve the wider network of resilience practitioners within communities across the state, the CRO launched a community of practice on LinkedIn to foster peer-to-peer learning and dialogue and ensure all voices are heard in a collaborative environment. The Governor’s Office of Climate Preparedness and Disaster Recovery (CPO), facilitates cross agency coordination and collaboration while driving proactive state-wide climate preparedness priorities and supports development of the state’s disaster recovery capacity and capabilities. The CPO also coordinates efforts to ensure that the state budget and legislative processes reflect statewide climate preparedness, disaster recovery, and resilience priorities and leads the development of Colorado’s Climate Preparedness Roadmap — a strategic guiding document updated every three years that uses the best available science and data to prioritize near-term climate adaptation actions across Colorado state government. In collaboration with the implementing state agencies, the first Roadmap, released in 2023, set achievable near-term action items ensuring clear steps to strengthen climate resilience and adaptation. Among the actions, the Roadmap outlined the need to tackle extreme heat through a collaborative interagency approach, while better understanding the unique ways that heat affects Colorado. Social and community capacity were also outlined in the framework as a priority. CDPHE has worked with the Governor's Office to evaluate best practices and strategies tailored for each unique region and implemented their first heat plan in 2024. Extreme heat can be deadly and is projected to continue to intensify. CPO takes the lead in coordinating extreme heat work across agencies. They are partnering with the Colorado State Forest Service to pilot solutions such as climate-smart tree planting to help keep people safe during high-heat events by reducing ambient neighborhood temperatures and shading individual homes to lower indoor temperatures and reduce cooling costs for residents. Building Disaster Recovery Capacity Colorado is investing in disaster preparedness and recovery capacity to reduce the impacts of disasters, help communities recover more effectively, and build resilience into recovery efforts. Ensuring strong recoveries allows for the integration of strategic investments in resilience and hazard mitigation, which the state did in partnership with Xcel Energy — in the wake of the Marshall Fire, the state provided financial assistance to rebuild home to high performance standards and integrated wildfire mitigation actions during the rebuild process. In recent years, Colorado has expanded their recovery investments, including the addition of key positions in targeted recovery areas including within CPO, at DOLA within the Division of Housing and within the Division of Local Government, at the Colorado Department of Agriculture, and at the Department of Public Health and Environment. Technical expertise and capacity at the agency level is leveraged to strengthen preparedness and to support recovery from state declared disasters through the Colorado Department of Public Safety's State Recovery Task Force, providing recovery expertise when activated according to their assigned Recovery Support Function (RSF). Colorado partnered with FEMA’s State Technical Assistance for Recovery Strategies Program to develop processes and strategies that can be integrated into the RSF plan updates within the State Emergency Operations Plan, and to refine RSF functions, capabilities, and partnerships. Over the last year, the state has additionally conducted numerous discussion-based exercises to strengthen RSF relationships and operational capability. The state continues to identify and enhance new opportunities in supporting local communities with pre- disaster recovery technical assistance. Examples include: Hosting Department of Public Safety-led regional recovery symposiums. Piloting additional focused recovery workshops that prioritize rural and less resourced communities. Developing and refining disaster recovery planning tools. Offering recovery and resilience toolkits and expertise to local governments led by DOLA. Strengthening integration of disaster considerations into local planning processes. Colorado implemented this work in summer 2025 when the state experienced numerous wildfires in short succession that received state disaster declarations, activation of the State Recovery Task Force, and required close state-local disaster recovery coordination. Ensuring strong recovery capacity and capabilities is critical to long-term resilience, enabling communities to recover more quickly, more completely, and in ways that integrate proactive resilience strategies. A Path Towards Long-Term Sustainability A key element in Colorado’s long-term approach to building resiliency is closely involving the local community. Building robust community planning and response capabilities at the local level allows for agencies to tailor plans to community needs and ensures everyone is engaged in the process. The CRO, in collaboration with state agency partners in the CRWG, developed the Guidance for Local Government Climate Adaptation, which provides comprehensive guidance, funding resources, case studies, and connections to state and federal programs that can provide support in over 25 implementable actions. The CRO has also focused their resiliency work on anticipating what is to come down the road by assessing current and future community needs. An example is the Rural Resiliency and Recovery Roadmap Program, which brought together 16 different regional community teams with over 150 rural jurisdictions and non-governmental partners to support diversifying and strengthening their economies while building regional resiliency following the COVID-19 pandemic. Each regional team developed a roadmap that evaluates local stressors and how conditions may change in the future. This program also looks at what may impact the community from perspectives of housing availability, workforce, and potential resiliency stressors. Another example is the Camp Resilience: A Rural Prosperity Leadership Academy program, which offers a summer camp themed workshop to build rural community capacity to long-term stressors such as droughts, population loss, climate change, and lack of affordable housing. While funding cycle ebbs and flows

Aligning Strategic Plans Across Health, Aging, and Dementia ASTHO Staff, Alzheimer's Association Learn about the importance of and approaches to aligning strategic plans across health, aging, and dementia. Strategic planning helps state agencies on aging prioritize organizational action and meet community needs. Most state governments now have a health plan and a dementia plan, and all states are required to develop an aging plan as well per the Older Americans Act. As they work to respond to increasing calls for action on brain health, dementia, and caregiving, opportunities for shared priorities and cross-sector collaboration continue to grow. This resource supports the development and implementation of these state-level strategic plans, walking agencies through: State scan and key findings: Learn about ASTHO's scan of health, aging, and dementia plans across states to understand alignment and integration opportunities. How to use this tool: Explore six key steps for optimal use of this tool, from identifying purpose and partners to preparing for alignment, developing your implementation approach, and more. Outcome sharing and next steps: Understand how to best share results from what exactly you should share to who should lead sharing and channels for sharing. By turning complex planning landscapes into practical insights, this tool allows states to use resources more effectively, enhancing health outcomes across the lifespan. Get the Report (PDF) article yes

Learn how Hawaii and Iowa have leveraged policy change to improve overdose prevention.

Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners Responding to Disruptions in Access to Controlled Substance Medications astho, association of state and territorial health officials, public health official, state health, territorial health, island areas, island jurisdictions, opioid prescriptions, access to opioid prescriptions, opioid rapid response program, opioid therapy, withdrawal symptom, rapid response, opioid crisis, opioid overdose, mental health, prescription monitoring, united states, discontinuation of opioid, opioid withdrawal, symptoms of withdrawal, opioid use disorder, type of drug, opioid medications, department of health, stop drinking, drinking alcohol, prescription drugs, opioid prescribing, drug withdrawal, opioid pain, physical dependence ASTHO | A guide on responding to disruptions in access to opioid prescription. Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners (2025) provides important updates to the 2022 edition and ASTHO’s 2020 document Responding to Pain Clinic Closures: A Guide for State Health Departments. This guidebook reflects the current state and federal landscape regarding disruptions, shares updated recommendations on strategies states might use to mitigate risks to patients affected by a disruption, and includes additional state examples. These updates are informed by the CDC’s Opioid Rapid Response Program (ORRP) and states’ coordinated responses to ORRP notifications since the program was formally established in late 2020, as well as tabletop preparedness exercises ASTHO has conducted with states. Get the Report (PDF) Content Updated - Report - Responding to Disruptions in Access to Controlled Substance Medications website yes

Learn how to leverage public health assets in Medicaid managed care, with helpful background, life cycle details, and information on key obligations.

Learn how boundary spanning leadership can improve overdose prevention programs in this brief.

Learn how state health agencies are leveraging flexible funding to advance initiatives addressing non-medical factors that influence health.

Learn how state health agencies can support brain health and caregiving through policy and innovation.

Explore this report to learn about radiation readiness capacity in the public health workforce.

Learn how territorial and freely associated state health agencies can support community health workers and their vital work in this brief.

Supporting Health Department Decision Makers with Disease Forecasting and Outbreak Analytics Disease Forecasting and Outbreak Analytics Amelia Poulin, Chris Taylor ASTHO and CDC surveyed states and territories about disease forecasting and outbreak analytics—learn more about the results. ASTHO, with support from CDC Center for Forecasting and Outbreak Analytics, conducted a survey to assess state and territorial health agencies' expertise and needs in using infectious disease forecasts and analytic techniques. Senior deputies from 28 jurisdictions submitted responses, which will help to inform health agency communications and decision-making efforts. The information in this report, fielded from March – May 2023, provides a comprehensive overview of the needs assessment results as well as key takeaways. Get the Report article yes

Learn in this report how Colorado is using policy to address rising syphilis and congenital syphilis cases.