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This brief examines the ways states can support certification for community health workers.

Learn how boundary spanning leadership can help develop more robust and productive public health workplaces.

Explore key actions, indicators, and supports to enhance workforce recruitment and hiring in governmental public health.

In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.

Insight and Inspiration: Conversations for Public Health Leaders ASTHO is honored to present Insight and Inspiration, the premier webinar series designed to motivate public health leaders as they respond to new and ongoing public health challenges. The nation’s preeminent thought leaders, authors, and strategic thinkers offer attendees strategies to further develop their leadership skills as well as ground themselves and their teams even amid crisis. This series is open to governmental public health professionals at all stages of their careers. Check out upcoming opportunities and previous session recordings below to take your leadership to the next level. website

Reprioritizing Black Maternal Health How We Can Prioritize Black Maternal Health Lawrence Young Black women face significant rates of maternal morbidity and mortality — learn how public health can better support them in this blog post. I do not have to look far to understand the urgency of the Black maternal health crisis. I have watched friends, colleagues, and loved ones from every walk of life struggle through pregnancies that should have been safe and celebrated. Some are highly educated professionals. Others are young mothers still finding their way. Many had access to quality insurance and still faced complications, long hospital stays, and minimal follow-up care. Many have shared unfortunate experiences that run the gamut from feeling unheard or perhaps unnecessarily undergoing a procedure — the care in health care was not there for them. These are not isolated incidents. They are part of a larger, structural failure that demands our attention and our action. As public health professionals, we must ask ourselves: How can we better care for and about Black mothers? And what would it look like to center them in the systems that were created to protect women in one of the most vulnerable times of their lives? Understanding the Root of the Crisis Black women in the United States are three to four times more likely to die from pregnancy-related causes than their White counterparts. In many states, including Connecticut, this difference persists even when controlling for education and income. These outcomes are not the result of individual choices or biological differences — they are the result of systems designed with historical blind spots. Education and income, often seen as protective factors, do not shield Black women from these outcomes. Research shows that pregnancy-related mortality rates are higher among Black women with a college degree than among White women with the same level of education or with less than a high school diploma. The same is true for women with respect to the risk of dying within the first year postpartum. These disparities grow with age and extend beyond mortality to include severe maternal morbidity, such as preeclampsia — a pregnancy complication related to high blood pressure — which can have lasting health impacts if untreated including death. Additionally, American Indian, Alaska Native, Black, Native Hawaiian, Pacific Islander, Asian, and Hispanic women all experience higher rates of ICU admission during delivery compared to White women. ICU admission is considered a key marker for maternal complications and system-level failure. Public Health as Partner in Progress Public health has a responsibility to do more than document issues and concerns. We must be in the business of addressing them. In Connecticut, we are working across agencies and community organizations to move from acknowledgment to action. One of the most important leaders in this work is #Day43, an initiative launched by Waterbury Bridge to Success Community Partnership. The name refers to the period between 43 days and one year postpartum, during which approximately 20% of pregnancy-related deaths occur. #Day43 exists to raise awareness of Black maternal health and transform systems to support mothers. Their work spans research, advocacy, policy, technical assistance, and storytelling grounded in lived experience. Waterbury’s maternal health data reflects this crisis. According to the #Day43 Black Maternal Health Report, 18.6% of pregnant women in Waterbury received late or no prenatal care. Those in the city face higher rates of C-sections, limited access to postpartum care, and insufficient support for mental health and breastfeeding. The community described a significant lack of maternity care resources, particularly in the North End, where many Black and Hispanic families reside. Through initiatives like this, residents are not just seen as stakeholders. They are recognized as storytellers, system builders, and agents of change. Their leadership is shaping how we define, measure, and deliver maternal care in Connecticut. This vision aligns with broader maternal health equity efforts across the state. For example, The Connecticut Health Foundation is developing a Maternal Health Equity Blueprint in partnership with community leaders, researchers, and families. Waterbury voices are essential contributors to this process. Listening as a Path of Healing The experiences of Black mothers reflect a broader truth. Too often, our systems are not built to hear them. That lack of trust is both historical and current. It shows up in rushed appointments, dismissed symptoms, and inaccessible services. Community-based providers, such as doulas and midwives of color, are critical to bridging this gap. They do more than provide care — they restore dignity. Yet these providers are often underfunded and undervalued in mainstream health care systems. Public health must champion integrating these providers into existing systems and promoting long-term sustainability. To maximize maternal health outcomes, the next phase of this work must intentionally include structured cross-sector collaboration. It must focus on building systems that educate both providers and families on urgent maternal warning signs, provide consistent discharge education, and strengthen local surveillance and outreach infrastructure. These strategies are essential, scalable, and lifesaving. We cannot improve outcomes without acknowledging the deep cultural, emotional, and psychological work required to rebuild trust. We cannot heal what we do not hear. Re-Examining the “Public” in Public Health Re-examining the public in public health means placing the needs of our most vulnerable communities at the center. It means investing in care that is integrative and supportive with community co-designed solutions. It also means wholistically addressing other intersecting systems that influence maternal outcomes. We can start by: Expanding funding for community-based perinatal health workers, including doulas and midwives. Embedding relevant metrics into maternal health program design and evaluation. Creating statewide listening sessions and family advisory councils to ensure policies reflect lived realities. Partnering across sectors to improve access to safe housing, transportation, and mental health supports for new mothers. Supporting local initiatives like #Day43 that lead from within communities and reflect community-defined solutions. Educating families on health information and individual health rights through accessible, trusted channels. To truly care for and about Black mothers, we must act beyond awareness months and social media campaigns. We must improve current processes and design opportunities that will support them and keep them alive. Public health was created to serve the public. The most powerful way to honor that mission is to focus on the public, ensuring they are a priority and not an afterthought. article yes

Discover how leadership coaching sessions reinforced partnerships between public health and community-based organizations.

San Diego Academic Health Partnership Strengthens Service During COVID-19 and Beyond San Diego Academic Health Partnership Strengthens Service Mayela Arana Learn how the Academic Health and Human Services Department in San Diego strengthens service, research, workforce development, and more in the region. In San Diego County, the connection between academia and public service continues to grow stronger, shaping the future of health and human services. With over 8,200 employees serving a diverse population of 3.3 million residents, the County of San Diego Health & Human Services Agency (HHSA) plays a crucial role in advancing health, housing, and social services across the region. Recognizing the immense value of bridging education with real-world public service, HHSA and San Diego State University (SDSU) formed an Academic Health and Human Services Department (AHHSD): the Live Well Center for Innovation & Leadership (LWCIL), a first-of-its-kind initiative in San Diego County. This partnership is more than just a collaboration; it’s a transformative effort to strengthen education, research, workforce development, and service in the region, inspired by collaborative successes during COVID-19. A Vision Years in the Making Even before the COVID-19 pandemic, leaders at HHSA, SDSU, and SDSU’s College of Health and Human Services (CHHS) recognized the opportunity to deepen their relationship through an Academic Health Department (AHD) partnership. Many of those contributing to HHSA’s success began their journey at SDSU, with over half of the agency’s leadership team and a significant portion of its workforce having graduated from SDSU, particularly from CHHS. With a long history of partnering to provide real-world experiences for students, collaborating on research, and developing practice-informed curriculum, formalizing the partnership to integrate academia and health and human services practice was a natural next step. An Academic-Public Health Partnership in Action HHSA and SDSU’s longstanding relationship initially focused on student field experiences, research collaboration, and workforce development across select schools and decentralized departments but went on to have a major impact on the ground — most notably, enhancing HHSA’s COVID-19 response. Mobilizing Promotoras for Outreach and Support SDSU and HHSA worked together on recruitment, training, and community outreach. They successfully recruited 40 community health workers for a Promotoras program, which initially helped with contact tracing within the highest-risk communities. The Promotoras also identified where people needed assistance (e.g., food, services). SDSU provided support by organizing food pantries in high-risk areas, while the Promotoras took food to those in need. As vaccines became available, HHSA trained the Promotoras on messaging and communications to dispel misinformation and to encourage vaccine uptake. The Promotoras also helped those in the highest-risk communities get appointments at the county vaccination sites. Expanding Public Health Capacity with Nursing Students In addition, SDSU and HHSA worked together to train and deploy nursing faculty, students, and recent graduates in county vaccination efforts. From January through March of 2021, the SDSU School of Nursing partnered with Champions for Health, the local nonprofit arm of the San Diego Medical Society, to train 200 vaccinators. Once trained on the proper storage and administration of the COVID-19 vaccine, faculty-led groups of undergraduate nursing students administered vaccines at community sites in primarily underserved areas of the county — many organized by the San Diego Black Nurses Association. In addition to providing surge capacity staffing to support community and public health efforts, the partnership allowed students to complete clinical hours required for graduation during the pandemic when students were restricted from other clinical sites. Many of the students and graduates who served as temporary contact tracers and case investigators transitioned into full-time positions within HHSA as the COVID-19 response scaled back. Formalizing Collaboration for Lasting Impact Given the tangible value of their collaboration demonstrated during the COVID-19 pandemic, HHSA and SDSU chose to use and adapt the national AHD model — gaining access to the growing, nationwide network of AHD partnerships that inform their goal of sustaining a high-impact academic-practice partnership. They formalized the partnership with a public signing of an overarching five-year memorandum of agreement (MOA) in October 2022 that launched the bold vision of creating San Diego County’s first and only AHHSD. They assigned an additional MOA specifically addressing joint research and data sharing in December 2024, and an addendum supporting agency-wide student field experiences is underway. With formal agreements across all key areas, the foundation will be in place for increased and accelerated collaboration by summer 2025. Building on the regional collective impact vision called Live Well San Diego, the AHD partnership adopted joint branding as LWCIL. An active Steering Committee, co-chaired by HHSA’s Deputy Chief Administrative Officer and CHHS’s Dean, meets quarterly and represents the highest-level leadership for each organization. Members include key leaders in HHSA operations, human resources, and strategy, and the directors from each of its eight service departments. On the academic side at SDSU, the Steering Committee includes representatives from the six schools and multiple institutes within CHHS. Setting Partnership Priorities LWCIL co-created and recently adopted a joint, multi-year Strategic Roadmap to guide the next three years of the partnership’s development and its contribution to a healthy, equitable, safe, and thriving San Diego region. It is organized around four high-impact priority areas: People Success: Build a diverse, competent, and engaged health and human services workforce​, including students and both partners’ workforces.​​ Research & Data Excellence: Inform and improve academia, policy, and practice with rigorous and relevant research. Service to Community: Integrate academia, practice, and community to advance equity and eliminate health disparities. Leadership & Sustainability: Create a nationally recognized academic-practice model with innovative leadership committed to improving academia, policy, and practice. Subcommittees for each priority area, co-chaired by leaders from both organizations, have launched and created action plans tied to advancing the Strategic Roadmap. In addition, emerging workgroups are aligning ​work plans​. Next steps include: Assessing what is already in place and integrating it into the partnership. Developing a standardized and streamlined process for students to complete internships at HHSA. Leveraging opportunities to bridge research and practice and, where appropriate, in collaboration with the community. Investing in capacity has been essential in moving the partnership forward and providing coordination. The director of LWCIL is a “boundary spanning” position, co-funded by SDSU and HHSA. Additional staff support has assisted the partnership, including two HHSA Management Fellows engaged in a year-long program. Advice for Others Seeking to Establish AHD Partnerships HHSA and SDSU offer the following tips to agencies looking to develop or expand AHD partnerships, based on their experiences: Secure leadership commitment: Ensure the highest-level leaders are committed to the partnership’s success and sustainability. LWCIL started with the support of the dean, deputy chief administrative officer, and directors within both organizations who continue to be actively involved as members of the Steering Committee and subcommittees. By doing so, they have helped set priorities, identified staff to participate, and continuously champion the partnership within their respective organizations. Start small: Build from what already exists between the partners, leverage willing internal resources, and celebrate early successes. LWCIL started with conversations focused on workforce development because of existing relationships and shared interests. Those conversations eventually evolved to include collaborating on rigorous equity-focused research and partnering to address needs identified by the community, such as housing stability for our older adult population and food insecurity. The subcommittee structure was created to support those shared priorities; however, it began with smaller, more narrowly focused conversations. Be strategic: Create a common agenda/plan that aligns with the goals of both organizations, making it easier for already-stretched organizations to commit to and benefit from the partnership. LWCIL's co-creation of a multi-year Strategic Roadmap allowed the partners to discuss the many opportunities for collaboration and integration, and to prioritize. It now guides where the partnership is going and helps keep everyone focused on what they collectively decided is important. Then, grow: By getting systems in place and understanding the benefits and challenges between two organizations (HHSA and SDSU), LWCIL is setting the stage for expansion to include other local universities. Take time to plan and set up structures: Creating the LWCIL ​Strategic ​Roadmap was a six-month process that engaged leadership from both organizations. This was critical for identifying priorities and direction, including what structures and systems needed to be organized so the work could move forward. Learn more about San Diego’s Live Well Center for Innovation & Leadership and AHD partnerships, or explore other workforce development resources from the Public Health Foundation. If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact

Academic Health Partnership Prioritizes Workforce Development in Florida Florida Academic Health Partnership Prioritizes Workforce Development Mayela Arana Learn how an Academic Health Partnership in Florida focuses on workforce development and get inspired. In Hillsborough County, the Florida Department of Health (DOH-Hillsborough) and the University of South Florida (USF) have a long history of working together. Their partnership took on a new level of structure and purpose in 2022 when they formalized an Academic Health Department (AHD) partnership agreement, focused largely on workforce development. This collaboration, supported by the Public Health Infrastructure Grant (PHIG), creates opportunities for DOH-Hillsborough staff to enhance their skills through USF’s public health programs. By providing structured training and education, the partnership is helping to build a stronger, more prepared public health workforce to serve the county’s 1.5 million residents. A Longstanding Partnership Embraces a New Opportunity When CDC released a notice of funding opportunity for PHIG in 2022, the DOH-Hillsborough health officer and the dean of USF’s College of Public Health (COPH) worked together to co-write a successful proposal. One of the resulting contracts formalized their partnership in the name of strengthening the public health workforce through recruitment, training, and retention. Like many public health agencies, many of DOH-Hillsborough’s employees do not have degrees in public health. The health department is focused on upskilling through coursework and certificate/micro-certificate programs directly related to job tasks. These opportunities are available to every staff member including those categorized as “other personnel services,” non-career services, and certain contracted employees — as DOH-Hillsborough recognizes the importance of extending these educational opportunities to all employees. Initial PHIG funding was critical in establishing the necessary dedicated staffing and infrastructure for workforce development program offerings at the health department. Current funding continues to support infrastructure, new custom program development, and the educational offerings. Infrastructure: USF works with DOH-Hillsborough to conduct staff training needs assessments and has provided training at agency-wide “all-staff” meetings. USF also developed and provides a Certified in Public Health (CPH) exam preparatory course that is open to any health department employee who is eligible to sit for the exam, at no cost to them. Custom program development: Additionally, the university, in collaboration with DOH-Hillsborough and two other local county health departments, developed a custom leadership program that groups emerging health department leaders with community partners of their choice (e.g., Healthy Start, Homegrown Hillsborough) and includes two full days of instruction over a six-month period. Educational offerings: The health department is also using PHIG funds to cover tuition for current staff to take graduate and undergraduate courses at USF’s COPH and across the university. Representatives from DOH-Hillsborough and USF hold virtual information sessions for staff about available educational offerings, the university enrollment and registration process, and completing internal agency requirements for pursuing and participating in the PHIG-funded opportunities. Measuring Impact and Continuous Improvement Given that the bulk of activities in this AHD partnership are currently PHIG-funded, PHIG performance measures provide a clear and valuable opportunity for evaluation. DOH-Hillsborough is focused on three of the PHIG measures that address hiring and retention: Number of PHIG-funded positions filled by job classification and program area. Overall agency staff retention rate. Median number of days to fill a position. Tracking performance of these measures both contributes to the agency’s overall PHIG evaluation and provides the AHD partnership with a clear process for quality improvement. Advice for Others Seeking to Establish AHD Partnerships Learning from the success of USF and DOH-Hillsborough’s partnership, considerations in developing or expanding AHD partnerships include: Appreciate the unique nature of each organization. For example, while the health department and university may have a common vision, they may also have different funding category restrictions to consider prior to solidifying the partnership. Be mindful that each organization has its own legal considerations. Allow ample time for the proper review of contracts, agreements, and external communication about the joint endeavor. Know that, at times, the collaborative process can be complex and challenging. Take a few steps back. Work together to find solutions, and don’t give up. Be flexible, humble, and willing to pivot, remaining confident that the partnership will have a bigger impact than your organization would alone. Learn more about AHD partnerships or explore other workforce development resources from the Public Health Foundation (PHF). If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact performanceimprovement@astho.org. 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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

Learn how public health leaders are redefining leadership and building more collaborative, sustainable systems.

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

This guide captures the experiences and best practices of state and local public health agencies and their partners who are currently in the Cardiff Model implementation phase.

Initial estimates from 2020 suggest that annual drug overdose deaths in the United States reached a record high of 93,000. Fortunately EMS strategies are being put in place to combat this nation-wide issue.

Health departments can use this guide to improve their public health accreditation efforts.

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

Learn more about DELPH Cohort 3 participants.

Learn more about DELPH Cohort 5 participants.

Developing Executives Leading in Public Health (DELPH) is a leadership development program that increases and strengthens participants’ visibility and exposure in public health systems, access to key networks, and leadership development opportunities.

Learn more about DELPH Cohort 4 participants.