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North Dakota Lead Exposure Outreach Program North Dakota Develops Tribal Communication Plan to Support Lead Poisoning Prevention Learn how North Dakota's lead prevention team built strong partnerships with tribal communities in this blog post. Madison Novosel, Paula Comeau Tribal Communication Plan Partnerships with local jurisdictions are crucial to the effectiveness of the North Dakota Lead Prevention Program. This collaboration enhances the depth and sustainability of the community outreach. One priority after transitioning the program from the Department of Environmental Quality to North Dakota Health and Human Services was to connect with local public health units and ensure they were informed about the change. When reaching out to local partners, the lead prevention team realized that there was not a document that clearly outlined who the correct contacts were between tribal communities and state agencies for lead-related events. Recognizing this gap led the team to develop a communication plan to strengthen coordination between the tribal and state lead prevention programs with the Standing Rock Sioux Tribe’s environmental health official. This communication plan established points of contact between the state program and tribal government officials if a lead-related event were to occur involving tribal members or on tribal land. It clearly charted out the corresponding contacts for specific scenarios, which included: A tribal community member who lives on or off the reservation receives an elevated blood lead result. A tribal community member in the Head Start Program receives an elevated blood lead result. An environmental assessment or remediation is requested/needed on tribal lands. Tribal government officials are interested in hosting a screening event or identifying a screening clinic. Community Engagement The outreach to Standing Rock resulted in more opportunities for collaboration. NDHHS staff were invited to attend a community health event at the local high school. This opportunity revealed a gap in the state lead program; no formal outreach guidelines had been developed yet, as the program was (and still is) in its infancy. The team began to create a lead prevention curriculum guide to be used for low-cost outreach activities at the state and local level. The activities range from interactive lead-safe nutrition games to identifying potential lead hazards in a model home. The team was able to pilot one of the activities in the curriculum guide at the Standing Rock Community High School’s “Walk for Wellness.” Students and community members were asked to play a game that teaches dietary tips for preventing lead poisoning for a prize. Over 30 students and 10 community members came to the table to learn about lead prevention and have open discussions around environmental health. This engagement not only strengthened connections between NDHHS and the Standing Rock community, but also expanded education on lead poisoning prevention to a new population. Future Impact Attending the Walk for Wellness event enhanced collaboration with local public health staff also participating in the event. These in-person conversations offered firsthand insight into the challenges rural communities are facing in accessing care and lead testing. The team walked away with a better understanding of what needs to be addressed to support an increase in statewide lead screening, as well as deeper connections with new and existing partners. The lead outreach team at NDHHS will continue to seek more opportunities to conduct outreach efforts throughout the state, including other tribal communities. While spreading lead prevention education through outreach is important, having the opportunity to connect with those in communities face-to-face around the state is invaluable. These connections are essential to decreasing the burden of lead exposure across North Dakota. article yes

Learn about the art of storytelling in public health and how to tell stories to secure support/funding for critical public health initiatives.

Communication, Community, and Power-Sharing: A Conversation with DELPH Scholars Communication, Community, and Power-Sharing Learn how public health leaders are moving from a top-down approach to a collaborative model that builds and sustains trust with community partners. The current public health landscape can feel daunting, uncertain, and increasingly stressful for leaders to navigate. While public health professionals have a wealth of expertise, reliance on expertise isn’t enough; collaborative leadership points the path forward. Moving away from traditional top-down approaches, effective and innovative leaders are learning to share power, practice meaningful community engagement, and create environments where partners, community, and staff feel valued and heard. Three scholars from ASTHO’s Developing Executive Leaders in Public Health (DELPH) program discuss how they apply these principles to strengthen collaboration within public health and build more resilient communities. Meet the Scholars Working in public health is not individualistic; it requires working collectively to achieve a common goal: healthier communities. These three scholars are championing collaboration. Brandon Horvath, Assistant Program Manager of Preparedness at the Philadelphia Department of Health, believes in the power of collaboration to navigate periods of uncertainty and that moving away from top-down leadership allows space for new ideas to flourish. Ethan Greenblatt, Health Education Supervisor at the Saint Louis County Department of Public Health, focuses on building partnerships to combat misinformation, amplify accurate messaging, and support overlooked populations. Halana Kaleel, Public Health Community Engagement Specialist at Austin Public Health, centers her work on developing genuine engagement between partners before making decisions that impact the collective, emphasizing that participation and power-sharing build trust. “When city council, city management, and other departmental leadership attempt to implement programs, policies, and budgetary changes without doing engagement and collaboration with the impacted community first, they lose trust with the communities we are trying to serve.” — Halana Kaleel Brandon, you oversee emergency communications as part of your role with the Philadelphia Department of Public Health. Can you talk more about the strategies and frameworks you have applied and how they help your team manage complex projects during both emergencies and blue-sky days? BRANDON HORVATH: When deciding how best to infuse collaborative leadership principles into our current reporting structure, I wanted to ground my approach in something relatable that staff would typically associate with comfort and relaxation. That’s when I thought back to the activities that worked best for relieving stress during the COVID-19 pandemic response. In my case, those were running, binge-watching a new TV show, or endlessly scrolling through TikTok. Each of these activities has a few key ingredients in common: time and energy set aside to make the activity happen, and controls to customize the experience. I factored these in when developing two activities that encourage staff participation, collaborative leadership, and feedback. The energy check is a self-reflection activity I like to start off our weekly touch-base meetings with, intentionally setting aside time to highlight accomplishments, discuss challenges staff were experiencing, and set attainable goals and priorities for the next week. Let’s talk it out is a collaborative leadership exercise where staff are encouraged to lead the conversation, using a set of functions you’d find on a remote control: Settings, Pause, Rewind, Fast-Forward, Record, and Power On/Off. The conversation begins with Settings, where we establish ground rules and outline expectations, acceptable behaviors, and how decisions will be made. Regardless of how the activity unfolds, it is important to document what’s discussed, identify any successes or pain points, and work together to draft next steps and potential solutions. Some optional functions can be folded in, depending on time and complexity. Pause (Reflect) involves making space for reflection, which can help ensure continuous improvement and make adjustments easier, regardless of where you’re at in a project. Rewind (What Worked) involves looking back at past decisions or progress since the last check-in, which can help ensure successful strategies are repeated and mistakes are avoided. Fast-Forward (What Do We Want to See) encourages discussion of what you would consider a successful partnership or collaboration. This is especially helpful when a project is complex and involves many stakeholders. Power On/Off (Let’s Revisit This) should be considered when a project is not progressing or we’ve identified pain points that require follow-up. This can bring the conversation to an intentional end, and another time can be set when all involved will regroup and resume planning. The strategies and frameworks you choose to apply will likely vary based on the role you play, the collaborations already underway, and the level of buy-in within your organization or team to shift away from the current project management approach. Ethan, in Saint Louis County your department has utilized community-based partnerships for vaccination efforts and to address the opioid epidemic. How does focusing on building community partnerships help address misinformation, reduce stigma, and increase trust? ETHAN GREENBLAT: Community partnerships allow public health agencies to meet people where they are, both physically and culturally. By working with trusted local institutions and leaders, our partners can deliver public health messages with voices that communities already know and respect. These collaborations also provide valuable feedback that helps programs remain responsive, relevant, and grounded in community needs. Halana, you emphasized that collaborative leadership requires a paradigm shift away from performative community engagement. How can governmental public health agencies transition to power-sharing to rebuild trust with community members who have been historically disenfranchised and excluded? HALANA KALEEL: In discussions with community members and stakeholders, time and time again they saw that they were only being consulted after decisions had already been made. Saying things like, “we want to hear from you” is performative engagement when you already know how you are going to approach an issue. At the end of the day, many communities would rather have honesty about a bad system than feel tricked by tokenistic engagement. To share power with community and stakeholders, governmental public health agencies need to provide opportunities for the communities they serve to participate in decision making at the beginning of the process, and we should empower and hire staff or liaisons who reflect the communities we are trying to reach. We also need to meet people where they are through more informal engagement instead of continuing to force community members who have been disenfranchised to come into governmental spaces that may be hard to reach and perceived as too formal. Lessons Learned and Actionable Advice Reflecting on your experiences, how do you actively build and maintain trust with community partners, staff, and stakeholders? HORVATH: Building and maintaining trust with staff requires leaders to be consistent, reliable, and authentic in their approach. For me, it’s always been about showing up and following through. Creating safe spaces, both formal and informal, where staff can share feedback and ideas, is the first step to making two-way communication happen. Recognizing staff for their accomplishments and highlighting team wins reinforces both trust and integrity. These same approaches can be applied when working in the field or communicating with a variety of stakeholders. GREENBLATT: Building trust requires consistent communication, transparency, and a shared sense of purpose. I focus on developing relationships over time and ensuring our partners feel heard and included in decision-making processes. It is also important that teams and stakeholders align around the organization’s mission, vision, and goals. When partners have a role in shaping the direction of an initiative, they are far more invested in its success. KALEEL: One of my best practices is focusing on closing the feedback loop by showing community members exactly how their input and feedback directly inform final plans and policies. What practical strategies can public health leaders use to strengthen partnerships and build more resilient public health systems? KALEEL: Something that can be daunting, especially during times of uncertain funding, is compensating community for their time and expertise, but this can be something as simple as small stipends, gift cards to local grocery stores, or feeding people at events. HORVATH: Start with a clear purpose. Set aside time to meet with your team to talk not only about what each person will be doing but why it matters. Find ways to infuse collaborative leadership into the culture, such as trying out a new approach to staff check-ins or promoting shared ownership of projects. Most of all, it is important to meet your staff and community members where they are and to be flexible with your approach. Mistakes will happen, but how we learn from them and adapt can help us be more prepared and resilient the next time. GREENBLATT: Public health leaders can strengthen partnerships by being intentional about how they engage with communities and partners. An important starting point is understanding the local landscape — specifically the initiatives, organizations, and trusted leaders in your community — so you can build on what’s already working rather than duplicating efforts. It’s also important to identify shared goals, making

ASTHO's Public Health & Crisis Communications Resource Hub offers trainings, toolkits, and strategies to enhance crisis communication skills.

Explore why cancer prevention messaging is often ineffective and learn how public health communications professionals can message effectively instead.

State Strategies for Advancing Viral Hepatitis Elimination astho, association of state and territorial health officials, public health officials, state health officials, territorial health officials, state health department, population health, health care systems, distribution of such outcomes, triple aim, defined group, individuals including the distribution, health system, outcomes within the group, save lives, group of individuals including, health outcomes, health improvement, community health, health and health, institute of medicine Cases of viral hepatitis are on the rise across the United States. There are many barriers on the road to progress. See what's being done about it. Cases of viral hepatitis are on the rise across the United States. Current barriers to progress include recent increases in rates of injection drug use, lack of awareness, limitations on testing and diagnostic capacity, access to treatment, and availability of data. ASTHO strives to support states and territories as they work to solidify comprehensive approaches to viral hepatitis elimination. This report synthesizes key actions and proven strategies for public health leaders to consider as they approach elimination planning within their own jurisdictions. Get the Report (PDF) website

This report shares results and key takeaways from interviews on topics including the overall structure of Legionnaires’ disease programs, diagnosis and clinical testing protocols, and risk communication.

Given the emergence of mosquito-borne viruses such as dengue, chikungunya, and Zika in the United States and U.S. territories, this, the second edition of this report, provides guidance to assist local, state, and territorial mosquito control programs in developing and maintaining an effective mosquito control infrastructure to meet the ongoing challenges surrounding vector-borne diseases.

Web Accessibility Content Review Guides Guides to Review for Digital Accessibility Emily Lapayowker These actionable guides help you prepare accessible web and digital content. Digital accessibility is an important process that makes websites, files like Word documents or PDFs, and other digital products accessible to people with disabilities, as well as making these products more user-friendly overall. There are many criteria to meet when making your digital content accessible. The guides on this page serve as checklists for ensuring that web content and digital products are accessible, as laid out in the 2024 ADA Title II Web Rule, and meet the current standard of WCAG 2.1. Neither will address the web development needs laid out in WCAG, but they are useful for most digital content creation. The two checklists represent two different approaches to meeting accessibility standards: standards-driven and content-driven. It is important to remember that many of the techniques contained in each are not exclusive to websites, emails, or Microsoft Office products; they can be used for all forms of digital content. Guide for Meeting WCAG Web Accessibility Standards The structure of this checklist template roughly corresponds with the Preliminary Easy Checks Checklist by W3C. Each section contains a list of relevant WCAG links that detail the criteria and conformance levels covered in that section. It also indicates which checks are manual and which can be done by an automated checker, like the applet ANDI. Get the Checklist for Meeting WCAG Accessibility Standards (automatic Word download) Special Thanks - Resource - Guide for Meeting WCAG Web Accessibility Standards Padding Block - Large Padding Block - Small Guide to Reviewing Digital Content for Accessibility This checklist has a content-first focus and is less technical than the Guide for Meeting WCAG Web Accessibility Standards. Sections are organized to keep like-topics together. Overarching sections include document content, document structure, and multimedia. Get the Guide to Reviewing Digital Content for Accessibility (automatic Word download) Padding Block - Medium OE22-2203 PHIG article yes

How to Craft Evidence-Based Messaging for the Prevention of Adverse Childhood Experiences How to Craft Messaging for ACEs Prevention Learn how to craft effective, evidence-based messaging to prevent ACEs — with steps and examples to guide your work. Getting Started When it comes to developing strategic messages, public health professionals must first identify the problem they are working to solve. Often, we think about problems in big, broad terms — this can make it hard to know what specific action(s) to take to solve them, especially when working to address complex problems like adverse childhood experiences (ACEs). Consider a common public health challenge: lack of coordinated and aligned prevention efforts among like-minded organizations in a community. While everyone is working toward similar goals, limited time and resources mean this lack of coordination can reduce overall impact. Simply naming “lack of coordination of prevention” as the problem, however, isn’t very helpful — your colleagues may not know what you’re asking them to do differently. To move from a vague concern to an actionable solution, you must narrow the problem. To do this, you might explain that organizations aren’t consistently communicating about what prevention programs they offer or approaches they implement. Digging further, the issue becomes not just misalignment but the lack of a regular, structured process for sharing updates. That clarity leads to a concrete ask: “We’d like to set up a monthly call where we each share program updates so we can coordinate efforts and maximize impact.” This final framing is strong because it identifies a specific, practical solution and serves as a clear foundation for effective messaging, plus next steps. Once you identify the actions to solve the problem at hand, you’re ready to think about the overall strategy. This resource walks you through several easy steps to outline your approach. Your Turn 1 - Resource - How to Craft Messaging for ACEs Prevention Using a Simple, Successful Formula The formula for a successful message is simple and helps you get to the core of your message: Name the problem or issue to be addressed. Talk about why it matters. Tell people what should be done and who should do it. Bonus: Use data to drive your message home. Put it all together. Step 1: Name the Problem You need to clearly state your concern: what the problem is and how you see it affecting people — but keep it short. Resist the urge to say everything. Instead, focus on the aspect of the problem that your proposed solution will address. Establish a general understanding of the issue and its impacts as they relate to ACEs. Example Consider, under the umbrella of ACEs prevention, the topic of reducing the cost of child care. Let’s name the problem: The high costs of child care contribute to economic pressures and stress for caregivers, leaving children at risk of experiencing maltreatment. Your Turn 2 - Resource - How to Craft Messaging for ACEs Prevention Step 2: Explain Why It Matters Using shared values in your messaging to describe why you care can help you make the case for your solution and connect with your target audience. Remember, values statements should indicate why you — and, ideally, your target — should address the problem at hand. What happens if nothing is done? And why does that matter? Example With our example, in working to reduce the cost of child care, this explanation might be: We must take action to support families because their well-being (mental, financial, etc.) as well as their children’s well-being are at stake. Your Turn 3 - Resource - How to Craft Messaging for ACEs Prevention Step 3: Emphasize the Solution Drawing from your overall strategy, keep your focus on the solution or the change you want to see, and name the person, group, or entity that needs to implement this change. It’s best to answer with a specific, feasible solution that is usually an incremental step toward the larger goal or vision. And it’s especially important to name who needs to take action, so that they are aware of what is expected of them. Name the solution you want to see. Example Continuing with our example, a solution to reducing the cost of child care might be: Our state legislature is currently considering a bill to subsidize child care cost in our area. Subsidized child care for families can reduce caregiver stress and increase their ability to provide financially for their families and spend time with their developing children. Your Turn 4 - Resource - How to Craft Messaging for ACEs Prevention Step 4: Drive Your Message Home with Data “Social math” is the practice of translating statistics and other data so that they become interesting, meaningful, and understandable by most people— unlike infographics, which use visuals (e.g., charts and graphics) to present data. Consider social math that can help you make your case. Example In our ongoing example, the following data and social math can help relay importance and meaning: Estimates show the annual national average price of care for one child in 2019 being between $9,200 and $9,600. In other words, families spend on average about $800 every month for child care — similar to a second rent payment. Your Turn 5 - Resource - How to Craft Messaging for ACEs Prevention Step 5: Bring It All Together as One Cohesive Message You can think of the final message as an answer to the question, “How does reducing ACEs lead to healthier outcomes and thriving communities?” Example The final message for our example could be: One of the greatest costs to young families is child care, with the estimated annual national average price of care for one child in 2019 between $9,200 and $9,600. In other words, one family will spend on average about $800 every month for child care — similar to a second rent payment. And these costs increase for every additional child in the household. Child care subsidies can reduce caregiver stress and lower the risk of child maltreatment by minimizing persistent concerns about child care, providing a source of emergency child care when needed, and improving the economic lives of families. We can support children and families by reducing the financial burden of child care, opening up opportunities to remain employed and receive other community or medical support they need. Your Turn 6 - Resource - How to Craft Messaging for ACEs Prevention Additional Resources ASTHO Strategic Public Health Messaging Drives Change Public Health & Crisis Communications Resource Hub State/Territorial Policy Considerations for Preventing Adverse Childhood Experiences CDC Beyond the Headlines: Media Communications Training Berkeley Media Studies Group Worksheet: Message Development (PDF) Media Advocacy Worksheet: Overall Strategy Layers of Strategy (PDF) Using Social Math to Support your Policy Issue ACEs in the News: How Can Advocates Communicate More Effectively About Childhood Trauma? 5 Ways to Create Compelling Messages About Childhood Trauma Using Data Issue 24: Adverse Childhood Experiences in the News: Successes and Opportunities in Coverage of Childhood Trauma Frameworks Institute Impact Spotlight: Framing Child Wellbeing CA Surgeon General's Campaign Brings Attention to Toxic Stress and Adverse Childhood Experiences (ACEs) Changing the Narrative Together: Three Effective Strategies for Talking about Youth Mental Health Moving from Crisis Toward Opportunity: Framing Social Media and Youth Mental Health Toolkit The Impact of Strategic Framing on Early Childhood Advocacy Efforts in Colorado Framing Fundamentals: What is Framing? #FastFrames Series Reviewed by - Maffey article yes

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

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

Case investigators and contact tracers must understand and adapt to the culture of people with COVID-19 to conduct effective interviews and follow up. It is important that case investigators acknowledge existing fears and concerns, and work with residents to build trust. This brief explores four elements of cross-cultural communication.

The COVID-19 pandemic has impacted both the physical and mental health well-being of youth. Disruptions in both their home and school life have put youth at risk for poor mental health outcomes that include increased anxiety, depression, and risk of suicide. This Mental Health Month we examine state and territorial legislation that addresses youth mental health.

In recognition of National Infant Immunization Week, ASTHO and AMCHP interviewed Michael Warren, MD, MPH, FAAP, and Associate Administrator of the Maternal and Child Health Bureau (MCHB) at the Health Resources and Services Administration (HRSA), for his thoughts on how we can protect our infants and children from vaccine-preventable diseases during this extraordinary time. Especially now, as COVID-19 vaccination expands across the country—including the hope for a vaccine for children (five years and older), and with the promise of a return to in-person education, families and communities must quickly catch up on missed vaccinations.

ASTHO compiled a list of informative and inspirational public health podcasts to listen to in 2024.

Strengthening Leadership, Risk Communications, and Preparedness in the Islands Strengthening Public Health Preparedness in the Islands Sidnie Christian, Alyssa Boyea Key strategies in on leadership, risk communications, and preparedness, can help island jurisdictions prepare for and respond to emerging public health threats. ASTHO convened a two-day, in-person workshop in Honolulu from June 25 – 26, bringing together public health preparedness staff from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaiʻi, the Republic of the Marshall Islands (RMI), and Palau, as well as federal partners from CDC, the Department of Homeland Security, and the Administration for Strategic Preparedness and Response. The workshop focused on leadership and workforce development, risk communications, administrative preparedness, and more to support island areas as they prepare for and respond to natural disasters and other emerging public health threats, of which emerged key learnings that can benefit all island jurisdictions. Leadership and Workforce Development Leading through change requires transparency, trust, and collaboration. Planned change involves assessing readiness for change, identifying resources needed, securing buy-in, and determining a path forward. However, sometimes change can leave little to no time for preparation. Island jurisdictions have encountered challenges in the face of change, with many workshop participants sharing firsthand challenges around retaining institutional knowledge, infrastructure, and receiving assistance from the mainland United States in a timely fashion. As such, change readiness, succession planning, and effective change management practices are of utmost importance in the islands. Key recommendations and takeaways include: Utilizing a reputable framework, such as Kotter 8-Step Change Model, is pivotal for improving change readiness and change management. Change management frameworks and methods can assist with different types of change including structural change, strategic operational change, people-centric change, etc. Trust is hard to build, but easy to lose. Participants spoke about characteristics of high trust relationships including open communication, consistency, good judgement or expertise, and cultural sensitivity, while low trust relationships characteristics include lack of communication, inconsistency, and lack of teamwork. Succession planning is important to ensure institutional knowledge and capabilities remain in the wake of staff turnover or retirement. Identifying the necessary expertise, skills, and capabilities for each role is vital in the case of unplanned changes in staffing. Promising practices include annual review of critical positions, conducting talent calibration sessions, defining action plans, and obtaining buy-in from leadership and relevant partners. Risk Communications The island jurisdictions face emergencies that require creative response efforts. Both Hawaiʻi and RMI demonstrated innovative approaches in risk communications during COVID-19, finding success in forming critical partnerships, utilizing trusted voices within the community, and bridging communication gaps: Hawaiʻi utilized social media to showcase individuals such as doctors, pastors, social media influencers, and even local sports teams getting vaccinated, and utilized trusted voices to deliver messages. Additionally, they translated their materials into three languages (Marshallese, Samoan, and Hawaiʻian), modeling that no one gets forgotten, the true meaning of “ohana.” RMI created a working group with a mix of partners that curated press releases, educational materials, and sitreps, and served as a liaison between RMI Ministry of Health and Human Services and the community. It also partnered with several media outlets (e.g., radio stations, local papers, and other private sectors) and utilized mass text messaging to spread information quickly. The latter proved to resonate with most island jurisdictions who struggle with staying connected to hard-to-reach populations, namely those in more rural and disconnected communities. RMI was able to connect with these populations through WhatsApp to keep them updated throughout the COVID-19 response. Administrative Preparedness Improving administrative preparedness plans and processes ensure timely and efficient access to needed resources for a public health response. Most workshop participants are currently in the process of updating existing administrative preparedness plans, while some are working with other departments to create and implement new plans. Attendees discussed key partnerships for collaboration including other departments, Medical Reserve Corps, and other volunteer organizations. One common key challenge that emerged was around staffing (e.g., finding qualified people to fill vacancies, hiring process issues, making sure positions are competitive, etc.). To address this issue, island jurisdictions can work closely with other departments or jurisdictional agencies to streamline current processes, establish memorandums of understanding with different partners/facilities to assist with emergency procurement, and ensuring staffing vacancies are competitive and match public health classifications. Disease Forecasting A survey on state and territorial expertise and needs for infectious disease forecasts, models, and other outbreak analytic techniques—implemented by ASTHO with support from CDC’s Center for Forecasting and Outbreak Analytics—revealed that respondents from island jurisdictions experienced several barriers that led to limited use of infectious disease forecasts to inform communication and decision making. Challenges noted include limited software access, limited disease modeling capacity or skills, and lack of uniform reporting systems. Through a discussion-based exercise, workshop participants shared their challenges and considerations for ASTHO and CDC to assist with disease forecasting in the island jurisdictions moving forward. Challenges include but are not limited to: Delays with sending samples to labs and receiving results in a timely manner. Without timely results, it is challenging to take swift action. Lack of staff / staff wearing many hats with limited capacity. In most cases, there is no specific communication plan for disease forecasting within the departments. Communication can be challenging without clear processes and channels. Participants noted the desire for additional disease forecasting training and opportunities for collaboration. They suggested an integrated training session with island epidemiologists and other relevant staff to enhance disease forecasting knowledge and communication, as well as strengthen collaboration. Preparing for and Responding to Climate Events From hurricanes to typhoons to volcanic eruptions, the island jurisdictions are no strangers to the effects of changing climate. Willliam “Brandon” Aydlett, science and operations officer at the National Weather Service, and Shelbi Davis, Senior Analyst on the Environmental Health team at ASTHO, offer the following recommendations to island jurisdictions for preparing and responding to unprecedented climate events, as discussed with workshop participants: Create or update standard operating procedures for various climate related responses unique to the island. Always prepare for a category higher storm than is expected. Consider conducting regular vulnerability assessments to better understand areas where the island or its people may be most susceptible to adverse health impacts from climate events. Jurisdictions can learn from one another and find a sense of camaraderie in their preparedness efforts, much like the workshop participants. For example, one island jurisdiction noted that they currently do not have a warehouse to store equipment but are working on a plan to secure one; another jurisdiction, having recently revamped their warehouse, noted that they could assist their island neighbor in this endeavor and provide lessons learned as well as strategies to help secure a warehouse that will fit their needs. Looking Toward the Future Sharing lessons learned with one another and reflecting on how to apply those learnings in respective communities is crucial. Workshop participants shared their intent to share and utilize resources and information shared throughout the workshop with their leadership and team to begin implementing in their jurisdictions, as well as using strategies and skills learned to enhance partnerships. To all the participants and our Hawaiʻian hosts, we say mahalo. Related Resources Modernizing Infrastructure and Facilities for Readiness and Response | ASTHO PH-HERO Workforce Resource Center | ASTHO ASTHO STAR Center | ASTHO Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response | JPHMP article yes

Strengthening Public Health Communication: Oklahoma’s Strategy and Lessons Learned ASTHO Staff Communications is a foundational capability for all health departments, essential for supporting public health protections, programs, and activities that ensure community well-being and promote equitable outcomes. To educate their communities and encourage healthy behaviors, health departments must communicate clearly and effectively. After COVID-19, the Oklahoma State Department of Health revisited and modernized its communication strategies. This video shares their journey, including the process they followed, best practices they adopted, outcomes achieved, and lessons learned—offering valuable insights for other Public Health Infrastructure Grant (PHIG) recipients aiming to enhance their communications capabilities. OE22-2203 PHIG article yes

ASTHO Statement on Public Notification of Legionella Outbreaks ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) issued the following statement today regarding the role of public health officials in notifying the public about complex infectious disease outbreaks, particularly as states continue to deal with Legionella outbreaks. “As leaders of state and territorial public health agencies charged with promoting and protecting the health of our jurisdictions, we are keenly aware that decisions on whether and when to notify the public of infectious disease outbreaks are complex. There is no national standard concerning the timing of public notification to prevent the spread of Legionella. Health officials must instead rely on the facts of the specific outbreak situation, assess the risks and benefits of notification, and consider other factors to determine the appropriate course of action to reduce harm, protect health, and save lives. The most urgent priorities in managing Legionella outbreaks are identifying those who have been potentially exposed and mitigating the environmental sources of infection. Both priorities require health authorities to provide immediate guidance to the facility where the outbreak is occurring. Public notification is, therefore, often not an urgent priority, particularly when there is no ongoing risk to the public and health agencies are actively working with facilities on how to (1) identify and notify anyone potentially exposed and at risk for illness and (2) implement potential remedial measures. The decision to issue public notification also involves carefully considering the potential ramifications of acting on preliminary or incomplete information, which could lead to unnecessary and burdensome protective actions being taken and result in erosion of trust in the public health authority. Decisions regarding public notification of Legionella outbreaks should be thoughtfully made by qualified, experienced public health professionals and should be informed by a solid understanding of the epidemiology of the disease and the particular characteristics of each individual outbreak setting. We strongly assert that public health officials should not be subjected to civil penalties or criminal charges for decisions made in good faith using available information and informed by sound public health science and practice.” ASTHO Press Release Boilerplate website yes