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An interview with DELPH scholars Halina Palacios and Nathifa Miller about the importance of developing a strong leadership style, advice for future public health leaders, and using the DiSC Personality Assessment.

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

Support for programs and policies that encourage positive mental health in early childhood and provides support for parents and caregivers to have the best chance to improve mental health across the life course.

During the early spread of COVID-19, the National Rural Health Association senior vice president Brock Slabach stated: “Before the pandemic, rural hospitals were struggling for survival. COVID-19 has put a spotlight on the fractures that already existed within rural communities in terms of their healthcare delivery.” These fractures also exposed the desperate need for ethical transformational leadership within rural healthcare delivery systems. The time to build these capacities is now.

Data-Sharing Strategies to Support Access to Care Interventions Anna Bartels, Chikamso Chukwu Learn how primary care offices improve community access to health care in this Health Policy Update. Every state public health agency houses a Primary Care Office (PCO), which monitors the effectiveness of that jurisdiction’s health system. HRSA funds PCOs to identify communities with health professional shortages, and PCOs may also administer workforce programs to place providers in those communities. To identify which communities are experiencing shortages, PCOs collect state-level data on where health care providers work, what services they offer, and how many hours they spend on patient care. PCOs also track data on community needs, such as household income levels and community transportation options, to create a holistic picture of whether health care is truly accessible. PCOs across the country have explored different policy pathways to access reliable, accurate data, including laws that support PCO access to certain data sets, cross-sectoral relationships, and data-sharing agreements. According to ASTHO’s national PCO workforce assessment, over 85% of PCOs are part of a formal data-sharing arrangement, with licensing boards and Medicaid agencies serving as two of the most common data sources. This health policy update describes several types of actions jurisdictions have taken to support PCO data access. New Hampshire Law Allows the PCO to Survey Providers During License Renewals The New Hampshire PCO’s Health Professions Data Center administers a survey tied to health care providers’ medical license renewals that gathers self-reported provider and practice data, such as where providers work, how many hours per week are spent delivering direct patient care, and anticipated changes in capacity over the next five years. New Hampshire law outlines the scope of the survey and authorizes the PCO to collect, store, analyze, and report on health care workforce supply and capacity through surveying during license renewal. Although survey responses are the primary source of data on the health care workforce, data from the state’s all payer claims database housed within the Medicaid division provides supplemental information. Given the type of data involved, legal agreements are required between the PCO, licensing agencies, and relevant parties to maintain privacy for providers. These data are critical for the PCO to evaluate current and future capacity — especially in regions with limited providers — and proactively focus recruitment efforts on those communities. Colorado Braids Data Collection Strategies Across Multiple Sources While the Colorado PCO has relied on a similar law that authorizes collecting licensure data for more than 10 years, its data collection efforts have since expanded. The state now collects and integrates data across 16 different sources, each requiring a different procurement strategy. While some data sources are simple to access because they are public use files (e.g., Medicare provider data), other sources — namely state agencies — require the PCO to submit an application or enter into a memorandum of understanding or contract for access. Pursuing multiple data sources in this way takes significant effort and staff time, necessitating the health department to supplement HRSA’s PCO cooperative agreement funding with other sources, including state appropriations and private funding. A commitment to collaboration and investment and a willingness to build new relationships and processes from scratch support the Colorado PCO’s wide-ranging data collection strategy. Iowa Builds on Existing Relationships to Access Provider Data Iowa’s PCO has a long-standing relationship with the University of Iowa and a joint interest in health care workforce data. Currently, the PCO purchases provider phone survey information from the University of Iowa’s existing program and receives data on a biannual basis. The university’s data collection is part of its own research efforts and not collected on behalf of the PCO, so while the data are broader than what the PCO needs, it is still a valuable source of provider information. Because of this existing arrangement, the PCO could pursue a more expansive agreement (that would likely require additional funding) and expand the scope of the data, such as by adding data collection on provider residence or sliding fee scales. Other PCOs may consider approaching partners that have pieces of the data they need so there is an established relationship in place that may be expanded as new resources become available. PCOs Secure Access to Medicaid Claims Data State Medicaid agencies are another frequent data partner for PCOs, with at least 16 receiving provider data from their state Medicaid agency in various formats. In some states the Medicaid agency shares a point-in-time file with the PCO, who may manually recode the data before submission to HRSA. In other states, the PCO has direct access to the Medicaid claims processing system to independently extract the necessary data points. The nature of the partnership between the PCO and Medicaid agency may vary based on the state’s organizational structure (e.g., whether the PCO and Medicaid agency sit within the same department). However, a PCO seeking access to Medicaid claims data should be prepared to justify the need for the data, articulate how it can support the Medicaid agency, and develop the necessary relationships to support a workable solution for both parties. Conclusion Each PCO and state health agency has its own unique structure, and there is no “right” way to collect health care provider practice or access data. However, exploring how different jurisdictions approach these processes can help PCOs think strategically about new initiatives and relationships. ASTHO will continue tracking PCO success stories and remains available to facilitate connections among health agency staff. 2 UD3OA22890-13-00 article yes

Learn how state public health programs like Title V can help sustain community engagement infrastructure.

This video post highlights the Colorado National Collaborative, an innovative collaborative framework that is improving suicide and overdose prevention efforts in Colorado, and how a similar approach might benefit other jurisdictions.

Navigating Public Health Planning with Precision and Purpose Discover examples and best practices for developing strategic plans that enhance community health outcomes. Embarking on the journey of public health planning demands more than good intentions. It requires a meticulous blueprint that encompasses budgetary considerations and strategic timelines, and effectively leverages external support. Across a landscape in which every decision has the potential to uplift entire communities, there are a world of opportunities and details to explore. Included among them are the critical components of crafting a robust plan, the value of engaging contractors, and strategies for optimizing resources. Mining Existing Plans for Insight and Inspiration Organizational strategic plans, Community Health Assessments (CHAs), and Community Health Improvement Plans (CHIPs) can supply guidance and inspiration for comprehensive public health planning. These documents offer both valuable insights into public health initiatives and tangible examples of effective planning frameworks. There are multiple examples of existing plans within health agencies across jurisdictions; when seeking them out, consider various criteria (e.g., population characteristics, geographic location, and specific health priorities). By examining plans tailored to communities with similar demographics or facing comparable health challenges, planners can apply approaches that resonate in their own context. Additionally, understanding the distinctions between strategic plans, CHAs, and CHIPs is essential, particularly for agencies aspiring towards PHAB Pathways Recognition Program or PHAB Accreditation. These plans are separate entities within the PHAB framework, each playing a vital role in shaping public health strategies and fostering community well-being. Strategic Plans Strategic plans outline organizational goals, plans to achieve them, and how to measure success. They drive resource allocation, decision-making, and other priorities organization wide. Examples U.S. Virgin Islands Hawaii Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Community Health Assessments Community health assessments offer a complete view of risks, resources, and factors influencing outcomes. Supported by diverse environmental and socio-economic data, CHAs inform health policy, staff protocols, partnerships, program development, funding, resource allocation, and health improvement planning. Examples U.S. Virgin Islands Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* Community Health Improvement Plans Community Health Improvement Plans are strategic, collaborative roadmaps derived from CHAs. They outline how health agencies, partners, and communities will unite to enhance overall health. They guide priorities, resource allocation, and steer project, program, and policy implementation. Examples U.S. Virgin Islands Hawaii Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* *PHAB Accredited Health Department Plan Components, Timeline, and Budget Agencies considering planning processes and examples from other jurisdictions should recognize the diversity in approaches across different agencies and jurisdictions. There truly isn’t a singular “right” way to undertake public health planning. Instead, it’s about tailoring the process to suit the jurisdiction’s unique needs and circumstances. Examples to Guide Plan Development The Kansas Institute of Health’s Strategic Planning in the Public Health Sector Handbook offers a comprehensive breakdown of planning elements and timeframes based on a six-month plan development calendar. Explore Minnesota Department of Health’s Community Health Assessment and Planning Toolkit, a rich resource for navigating the CHA-CHIP process and timeline. Their template includes a detailed approach that considers capacity to accomplish each step within a desired timeline. Given the variation in the depth and breadth of jurisdiction planning processes, it is challenging to pinpoint a specific dollar amount to cover a planning endeavor. NACCHO’s MAPP Budget Template (part of their downloadable MAPP 2.0 process) can help systematically think through the resources necessary for planning processes. Outsourcing Key Support External support—in the form of facilitators, contractors, or other specialized professionals—can play a pivotal role in enhancing public health planning by offering fresh insights, innovative strategies, and diverse perspectives. Such support also allows for full, active organizational participation in the planning process. Moreover, they can provide valuable technical assistance, helping to navigate complex challenges and identify best practices from other contexts. By harnessing external support, organizations can optimize their decision-making processes, foster collaboration, and enhance the delivery of services to communities, thereby promoting better health outcomes for all. Conducting a SWOT Analysis: Contractors can assist in facilitating a thorough analysis of the organization's strengths, weaknesses, opportunities, and threats (SWOT). This structured assessment helps identify internal factors that impact the organization's ability to achieve its objectives and external factors that may affect its operations. Proposing Strategic Priorities: Based on the SWOT analysis and input from stakeholders, contractors can help planning teams crystallize priorities aligned with the organization's mission and vision. These priorities serve as the foundation for developing the plan. Facilitating Steering Committee Meetings: Steering committee meetings are crucial for decision-making and guiding the strategic planning process. External facilitators can lead these meetings, ensuring productive discussions, consensus-building, and alignment with organizational goals. Developing Components of the Strategic Plan: Contractors can support in drafting or reviewing various components of the plan, including vision and mission statements, goals, objectives, and action plans. They may ensure these components are clear, concise, and aligned with the overarching strategic direction. Developing a Draft Implementation Plan: An implementation plan outlines how to achieve strategic goals, including timelines, responsible parties, and resource allocation. Contractors can support an organization to develop a draft implementation plan that outlines actionable steps to translate the strategic plan into reality. Developing Quality Improvement Metrics: Contractors can assist in guiding the development of metrics to measure the effectiveness of the strategic plan. These metrics should be specific, measurable, achievable, relevant, and time-bound (SMART), providing a framework for monitoring progress and making data-driven decisions. Conducting Training Among Organization Staff: To ensure buy-in and understanding of the strategic plan and process itself, contractors can help develop and co-facilitate training sessions for staff members. These sessions may cover strategic objectives, action plans, and their roles in achieving organizational goals. Developing a Communication Plan: Effective communication is an essential key for keeping any strategic plan off the shelf. Contractors can support an organization in developing a comprehensive communication plan that outlines key messages, target audiences, communication channels, and timelines to ensure consistent and transparent communication throughout the organization and with partners. Developing Process Logs, Templates, and Meeting Notes: Contractors can create documentation tools such as process logs, templates for strategic planning documents, and detailed meeting notes. These resources streamline the planning process, capture important discussions and decisions, and serve as valuable references when considering sustainability. In summary, external support brings valuable expertise and resources to public health planning processes, enabling organizations to navigate complexities, engage partners effectively, and develop actionable strategic plans that drive positive health outcomes for communities. OE22-2203 PHIG website yes

This brief analyzes the Colorado Department of Public Health and Environment and the Maine Center for Disease Control and Prevention to participation in the Suicide and Opioid Overdose Prevention Public Health Initiative.