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Interpretive phenomenologist Jennifer Thomas talks about the importance of words and their impact on the public health workforce.

As the overdose epidemic continues, it is imperative for the medicolegal death investigative community to understand the importance of continuous training and the role that accurate death certification plays in protecting the nation’s health.

Sandra Powell, deputy director of Rhode Island Department of Health, how her department was able to increase the number of permanent positions to meet critical public health needs.

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

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.

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.

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

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

As part of ASTHO’s Public Health - Hope, Equity, Resilience, and Opportunity initiative, we are using this post to highlight some acts of thanks for organization leaders and supervisors to consider.

Building a Culture of Care: Leadership in Public Health Agencies astho, association of state and territorial health officials, association of state and territorial health officials astho, state health official, public health official, territorial health official, island jurisdictions, state health, health department, public health, centers for disease control, creating a culture of care, public health workers, health equity, physical health, building a culture of care, health departments, public health professionals, training program, school of public health, mental health problems, public health leaders, public health workforce, mental well-being, culture of care, mental health, workforce development Chris Taylor ASHTO | A blog post highlighting three simple actions agencies can take to strengthen a culture of care. Throughout the COVID-19 pandemic response, many of us have witnessed or experienced increased feelings of exhaustion, mental distance from our work, negativism or cynicism related to our jobs, and reduced professional efficacy. The World Health Organization classifies these symptoms of burnout as an occupational phenomenon, rather than as a medical condition. For governmental public health agencies to successfully promote and protect the health of their communities, it is imperative that they support their staff to remain healthy and resilient. This blog provides information and considerations for state, territorial, tribal, and local health departments to identify and address work related causes of burnout, as well as build and maintain the health and mental wellbeing of their staff. Governmental public health continues to play a central role in the COVID-19 response, which for more than two years has created unprecedented and prolonged demands on staff. Beyond the COVID-19 response, there continue to be massive changes in how and where we do business, as well as how we interact with one another, contributing to additional organizational stress. In 2021, CDC surveyed state, territorial, tribal, and local public health staff to assess symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal ideation. Among 26,174 public health staff who participated: 53.0% reported symptoms of at least one mental health condition in the preceding two weeks, including anxiety (30.3%), depression (32.0%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms was among respondents 29 years or younger, as well as transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages. Public health staff who reported being unable to take time off work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. In a 2022 follow up survey, 75.5% of respondents did not think their employer had increased mental health support. Additionally, other recent surveys have indicated a trend of rising stress and burnout in the public health workforce, leading many to resign and more to consider leaving their agencies. While some support to the workforce may be available in government agencies, staff may feel they don’t have time, or feel supported to utilize these programs. This blog series will explore strategies that health department leadership may consider to strengthen a culture of care in their organization. Three Simple Actions You Can Take Today to Strengthen a Culture of Care Health department leaders can have a major impact on the behaviors and health of their workforce. Consider taking these actions: Practice and offer a model of your own commitment to self-care Self-care, which includes a healthy diet, adequate sleep, and regular exercise, are critically important for leaders in maintaining productivity and effectiveness, particularly during stressful periods. Other ways to practice self-care can include meditation or mindfulness practices, journaling, expressing gratitude or acts of kindness, or connecting with friends and loved ones. Send a message to your entire department discussing the importance of self-care and sharing examples of how you practice self-care. This not only demonstrates that your organization values and supports self-care, but also gives practical examples for staff to consider implementing. This would also be an excellent opportunity to highlight the availability of an employee assistance program (EAP) or employee wellness programs and benefits. Acknowledge the mental health effects of the COVID-19 response Share an example of how you (or someone you care about) has been impacted emotionally or psychologically by the COVID-19 pandemic. Your example can normalize the burnout and moral injury that some of your staff may be experiencing, as well as build trust and connectedness. Talking about mental health at work is important to reduce the stigma and create an environment that is more open and understanding about anxiety, depression, and other mental health issues that might show up in the workplace. This is also an opportunity to discuss mental health coverage in your health insurance plan(s), as well as resources available in the community, some which may be funded by your department. Exercise at the office or on the office grounds One well-proven approach to addressing stress and improving mental health is exercise. As a leader, you can model the importance of exercise to your agency. This can be as simple as taking the stairs rather than the elevator, incorporating stretching throughout the day, or walking during phone calls. Invite staff of all abilities to join you in a stretch, movement, or walk break. Consider a standing desk, replacing your chair with a stability ball, or keeping exercise equipment in the office for use during breaks. By prioritizing and modeling physical activity, you are sending a message that self-care is important. What Does a Culture of Care Mean for You? Has your organization prioritized a culture of health and well-being? Are there lessons learned for your organization’s support of staff during the COVID-19 response? How is your organization ensuring a manageable workload, particularly during times of emergency response? Speak with your employee wellness, workforce development, human resources, and/or professional development teams to ensure the organization is best meeting the health and wellness needs of employees. Based on the alarming findings of the CDC surveys, special emphasis should be placed on ensuring employees have additional information about, and are aware of, services/referrals to treat anxiety, depression, PTSD, and suicidal ideation. What’s to Come? Many employers and leaders have been creative in strengthening a culture of care in their organization. Over the coming months, ASTHO will highlight specific strategies to increase a culture of care in your organization. We’ll also share examples employed by health officials and other senior leaders within health organizations. Finally, we plan to curate a list of resources for executives, supervisors, and employees for creating a culture of care, stress reduction, self-care, and burnout prevention. Conclusion For public health systems to serve their communities most effectively, it is imperative that their staff are healthy, both physically and mentally. State, territorial, tribal, and local health departments should consider policies and programs that support the health and mental well-being of their staff – particularly in high stress emergency responses. We look forward to additional opportunities to discuss these important issues, hear how health department leaders are strengthening a culture of care, and learning how ASTHO can support your efforts. website yes

Laura Parajón, MD, MPH, deputy cabinet secretary for the New Mexico Department of Health details the process of building a pilot internship program with the University of New Mexico.

The Louisiana Department of Health launched an employee mentorship program in 2021. Two members of LDH discuss the program, which has been a huge success despite launching during the COVID-19 pandemic.

ASTHO convened a Workforce Think Tank for public health leaders in 2021 during which Trista Harris—a philanthropic futurist—identified the seven trends most likely to impact the future public health workforce: sector shifts, pivot to the future, just-in-time learning, remote work, accelerated data collection and sharing, public health burnout, and reimagining systems.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: public health authority, immunization, data privacy and modernization, public health workforce, and health equity.

What better way to start the new year than with a new strategic plan! ASTHO’s Board of Directors approved the 2022-2024 Strategic Plan and launched it on Jan. 3, 2022, with a new set of priorities that reflect our ever-changing world and factors that influence the future of public health.

ASTHO has identified health equity and rural health as issues that policymakers across the country will consider in 2022.

ASTHO's mission is to support, equip, and advocate for state and territorial health officials in their work of advancing the public's health and well-being. To that end, here are the 12 most popular resources our members, partners, and email subscribers accessed in 2021.

In recognition of Rural Health Day, which falls on Nov. 18, we spoke with Ayne Amjad (SHO-WV) and Maggie Cook-Shimanek (SHO-MT) about the importance of public health in rural areas.

November 18 is National Rural Health Day, a commemoration started by State Offices of Rural Health to recognize the power and resilience of rural communities. Twenty percent of the U.S. population lives in rural communities. Recognizing the needs of rural areas, states are introducing and enacting legislation that leads to focused investment in rural communities and expanded access to care.

The impact of the COVID-19 response on the public health workforce has been profoundly felt by employees and the agencies they serve. Across the country, unplanned leadership transitions, early retirements, and personnel scale-ups have all impacted who the workforce is and what they do day-to-day. Many of those who have remained are feeling depleted and battered. In order to support and build the public health system the country needs, we need data specific to governmental public health.