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States Partner Across Sectors to Address Lead Poisoning Kayley Humm, Kerry Wyss, Ali Aslam Learn in this brief how three states are using partnerships to improve lead testing and reduce cases of lead poisoning. ASTHO partnered with the National Center for Healthy Housing (NCHH) to provide technical assistance and capacity-building support for lead poisoning prevention efforts in three state health agencies: Maryland Department of Health, North Dakota Department of Health and Human Services, and Arkansas Department of Health. This brief highlights each agency’s strategies for collaborating across sectors along with accomplishments for strengthening lead poisoning prevention capacity in each jurisdiction. Many of these strategies align with those used in a health in all polices (HiAP) approach to lead poisoning prevention. State Examples Maryland Department of Health Maryland adopted a collaborative approach to prevent lead poisoning. The Maryland Department of Health (MDH) has an established lead poisoning prevention program that partners with the Maryland Department of the Environment. The Department of the Environment oversees the childhood lead registry and case management, while MDH focuses on lead testing regulations and Medicaid services. This partnership has been implemented across the 24 local health departments in the state. Maryland enhanced lead case management by providing staff support and tackling complex cases that require additional assistance. In addition to supporting an increase in lead case management activities and lead awareness, ASTHO funding also helped strengthen collaboration and coordination among local health departments, state agencies, and local health care providers. The MDH Environmental Health Bureau also improved efficiency by moving data from the lead registry to MDH for lead surveillance and case management. They also developed and launched sub-county lead testing data as part of their Environmental Public Health Tracking public portal. These activities align with HiAP strategies of developing and structuring cross-sector relationships, coordinating funding and investments, and synchronizing communications. North Dakota Department of Health and Human Services The North Dakota Department of Health and Human Services (NDHHS) made significant strides in building up the state lead program, which recently transitioned from the department of environmental quality to NDHHS. With support from ASTHO and NCHH, NDHHS developed a lead prevention website with a data dashboard, developed a lead screening questionnaire, and built collaborative partnerships. The activities in North Dakota align with the HiAP strategies of developing and structuring cross-sector relationships, synchronizing communications, and integrating research, evaluation, and data systems. Building collaborative partnerships is a key initiative for the NDHHS lead program. Already developed partnerships include stakeholders such as Health Tracks and WIC. Health Tracks developed a newsletter article for their provider network so physicians can stay up to date and aware of the lead program transition and lead testing changes, and WIC will host informational lunch and learns to raise awareness about lead testing within their network. North Dakota is also prioritizing building partnerships with tribal communities. A tribal communications plan was developed with the goal of establishing an effective communication plan between the state of North Dakota and each tribal government for lead-related events. Anticipated outcomes from the communication plan include testing for blood lead levels, conducting environmental assessments on tribal lands, and seeing if a tribal member or government is interested in hosting a lead screening event. Progress has been made with the Standing Rock Sioux Tribe, Turtle Mountain band of Chippewa, and NDHHS is hopeful to establish intertribal meetings with all four governmental tribal representatives. Arkansas Department of Health The Arkansas Department of Health established its lead program in 2011 to support abatement of lead-based paint in residential and commercial properties. With support from ASTHO and NCHH, Arkansas has been using a data-driven approach to gain a more comprehensive understanding of lead exposure burden in the state. These activities align with the HiAP strategy of incorporating health data into decision-making and integrating research, evaluation, and data systems. The Arkansas Department of Health conducts periodic audits on its data system to support access to timely and accurate data. To improve data quality and frequency of blood lead testing reports, the health department is establishing incentive programs to encourage facilities to report cases of elevated blood lead. In addition to conducting outreach to its partners, the Arkansas Department of Health has been working to improve lead case data access and data quality through data mining efforts, case report matching, and migration to a new lead surveillance system. Arkansas has been working to modernize the current reporting system to facilitate automation and promote overall efficiency of data analysis and case identification. Conclusion The collaborative efforts of Maryland, North Dakota, and Arkansas highlight the importance of multi-sector partnerships and data sharing in addressing lead poisoning prevention and align with many of the strategies used in a HiAP approach. Each state implemented tailored strategies that sought to grow collaboration in its unique context. These initiatives highlight the importance of cross-sector collaboration in public health initiatives and may serve as valuable models for other jurisdictions. article yes

Olmsted County Pilots a Regional Population Health Data Hub to Improve Data Accessibility Gelila Tamrat, Sara Black, Reema Mistry, Christina Severin Olmsted County, Minnesota, pilots a regional population health data hub to improve data accessibility, which supports improved decision-making and interventions. Historically, Olmsted County and other local counties in southeast Minnesota have faced barriers to accessing timely and actionable public health data, including limited data analytics workforce capacity, lack of data-sharing agreements (DSAs), and misaligned data suppression standards. To address these challenges, Olmsted County Public Health Services (OCPHS) piloted a regional population data hub, in partnership with the Minnesota Department of Health (MDH) and 10 local health departments (LHDs). OCPHS procured resources to develop a regional data-sharing platform, expanded their epidemiology team, and pursued DSAs. As a result, they gained access to critical data that supports informed decision-making and tailored interventions at the local level. Tina Jordahl - Brief - Olmsted County MN DMI Hub Developing a Regional Population Health Data Hub With financial support from the Minnesota legislature in 2021, OCPHS collaborated with MDH and its regional counterparts to develop a regional population health data hub for smaller LHDs to access community-level public health data. OCPHS maintains the hub by managing data from the state, regional partners, and 10 LHDs, and creating data dashboards to support southeast Minnesota counties’ population health data needs. This effort involved building and expanding relationships with MDH unit-specific epidemiologists, working closely with public health system consultants at MDH, and raising awareness of the need for sustained data analytics workforce support. Following the initiative’s success, OCPHS plans to engage with state and local leaders to identify funding sources that can sustain the hub beyond the pilot funding cycle. Promoting Data Accessibility through Strategic Partnerships and Agreements MDH’s Center for Public Health Practice supports public health system consultants, who offer technical assistance and consultation services to strengthen public health infrastructure across Minnesota. The consultant for the southeast region of the state was crucial in linking state and local staff to advance the development of the regional population health data hub. They helped triage and expedite requests from OCPHS by identifying the right points of contact for datasets and legal counsel within MDH. The collaboration of MDH, OCPHS, and participating LHDs facilitated the development of DSAs, which allowed for proper data flow and enabled OCPHS to request data from MDH on behalf of participating counties, reducing the need for each county to request data. It also helped OCPHS to become the first county in the state to adopt CDC’s ESSENCE tool to monitor hospital visits for syndromic surveillance across Minnesota and neighboring states, better enabling LHDs to address the needs of communities residing along state borders. Hiring Strategies for the Data Analytics Workforce OCPHS focused on hiring staff to support the regional population health data hub with data expertise, strong communication skills, and a particular interest in population health and social determinants of health. OCPHS created two permanent epidemiologist positions to promote sustainability for that position in the future. To expand their hiring pool, OCPHS relied on Olmsted County’s updated remote work policies following the COVID-19 pandemic when many shifted to remote or hybrid work. They also invited leaders from partner counties to help vet candidates who could support other LHDs’ needs. Meaghan Sherden - Brief - Olmsted County MN DMI Hub Advancing Equity Through Data Accessibility Due to data suppression rules, counties in southeast Minnesota had limited access to county-level data for certain statewide datasets. OCPHS worked with MDH to identify appropriate data suppression standards that supported access to community-level public health data and preserved privacy and security, and collaborated with the county IT department to develop the regional data hub with public-facing and internal dashboards, aligned with the required privacy and security standards. The public-facing dashboards show aggregate data with appropriate suppression standards at county, regional, and state levels. The internal dashboards provide complete data summaries and are protected with appropriate permissions and multi-factor authentication for LHD staff to perform population-level analysis. Providing timely, granular data to participating counties allows LHD staff to develop tailored strategies to address emerging health issues promptly, bridging health equity gaps. OCPHS also integrates standard demographic data on race, sex, gender, and age into its dashboards, enabling regional LHDs to gain deeper insights into their communities and fine-tune equity-centered public health initiatives and interventions. Jenny Passer - Brief - Olmsted County MN DMI Hub Implementation Considerations Foster collaborative relationships across state and local health departments to identify opportunities to share resources when advancing data-sharing efforts. Models in which larger LHDs support key data infrastructure needs on behalf of smaller LHDs may bolster data analytics/epidemiology capacity across multiple LHDs and streamline coordination with key partners at the state health department. Consider how state health department consultant or liaison roles charged with providing technical assistance to state or local partners may help facilitate key connections between state and local health department staff pursuing cross-jurisdictional data-sharing efforts. Invest in data analytics/epidemiology workforce strategies that help address specific needs related to population health and relationship building, along with technical skills. Cross-jurisdictional data-sharing efforts require staff with strong data analytics and communication skills, as they work with multidisciplinary leaders and across jurisdictions to inform community-based interventions. Collaborate proactively with legal and IT departments to identify data governance solutions and technical approaches to adhere to required privacy and security standards. Establishing DSAs is important, as it allows sharing of data within required legal guardrails. Similarly, IT leaders can identify technological solutions that support effective access to data. OT18-1802 website yes

Arizona Department of Health Services Pursues Policies to Advance Data Sharing with Tribal Nations Erik Skinner, Christina Severin, Reema Mistry The Arizona Department of Health Services is pursuing policies to advance data sharing with tribal nations, centered around partnerships, education, and more. With leadership support and funding to modernize its public health infrastructure, the Arizona Department of Health Services (ADHS) is pursuing policies to advance data sharing with tribal nations. This includes investing in partnerships with tribal leaders, educating the public health workforce about tribal governments and tribal health care, and working to improve data identification processes to support effective data sharing between the state and tribal nations. Data sovereignty is an important consideration for ADHS, as there are 22 federally recognized tribal nations in Arizona. ADHS recognizes the inherent right of tribal nations to access their citizens’ public health data and is developing a tribal data sovereignty policy that both acknowledges their unique data needs and aligns with state requirements around tribal engagement. Leadership Support and Effective Tribal Engagement ADHS leadership understands the importance of making strong connections with tribal nations and recognizing each nation’s public health priorities while meeting its statutory requirement to develop tribal consultation policies. To that end, ADHS developed the tribal liaison position to serve as a resource, advocate, and communication link between ADHS and Arizona’s Native American health care community partners, including tribal community leaders, health and epidemiology directors, Indian Health Service (IHS), and Tribal Epidemiology Centers (TECs). Understanding cultural norms is essential to building trust with tribal partners; the tribal liaison role has been vital to ADHS engagement with tribal nations on data sovereignty topics. People and processes are important to establishing data sharing policies, and a well-informed workforce is essential for effective collaboration with sovereign tribal nations. ADHS is working with the Native Nation Institute to provide training on tribal sovereignty and cultural humility for staff. It has also developed a tribal handbook for public health staff on sovereignty, cultural trauma, and the roles of IHS and TECs. Identifying Tribal Affiliation within Datasets and Tribal Public Health Priorities ADHS conducted a data assessment to identify instances in which data sharing was active and ongoing between ADHS and tribal nations, and instances in which it had expired. A notable technical challenge was identifying tribal members within existing datasets, as many public health datasets are incomplete (e.g., do not include tribal affiliation) or rely on IT systems that are unable to aggregate data appropriately—making it difficult to ensure tribal authorities receive relevant, comprehensive public health data for their communities. In addition, because each tribal nation’s public health priority areas and data needs could differ from the data that state health information systems collect, sharing relevant data with tribal nations can be challenging. ADHS is working with each nation to identify tribal public health priority areas, find solutions to identify tribal data within state collected datasets, and share it with the respective nations. Ken Komatsu - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations Honoring Sovereignty in Data Sharing Relationships Data sharing agreements with public health agencies often establish that the state agency controls the disposition and use of the data, and that each party benefits. Acknowledging that tribal partners are entitled to their citizens’ data without conditions differs from how ADHS has historically approached data-sharing relationships with others. ADHS plans to formally establish a non-transactional data sharing policy with tribal public health partners, and establish data sharing agreements that align with this approach going forward. Implementation Considerations Considerations for state health agencies in fostering strong relationships and effective engagement with tribal partners around data-sharing efforts include: Center tribal sovereignty when framing data sharing agreements with tribal nations. Engage tribal liaisons in data-sharing efforts with tribal nations. They maintain close relationships with tribes and can help develop mutual cultural understanding, which is essential to engaging tribal partners. Assess datasets to determine data completeness with regards to tribal affiliation and identify opportunities to improve comprehensive data sharing with tribal authorities. Invest in state health agency staff training on tribal sovereignty and cultural humility, so staff can be well-prepared when engaging in data sharing conversations with tribal partners. Gerilene Haskon - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations OT18-1802 website yes

Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes

For Emman Parian, Strong Partnerships Are at the Heart of Public Health Strong Partnerships Are at the Heart of Public Health Anya Groner Learn about Immunization Program Manager Emman Parian's approach to public health success: strong partnerships and collaboration. As immunization program manager for the Commonwealth Healthcare Corporation (CHCC) in the Commonwealth of the Northern Mariana Islands (CNMI), Emman Parian and his team work closely with a range of organizations: school systems, government agencies, private businesses, other Pacific Island jurisdictions, and national partners including ASTHO and the Association of Immunization Managers. Maintaining relationships through effective and regular communication sustains those networks and the communities they serve. Thus, the immunization program meets with partners regularly, basing the meeting frequency on partner’s roles and preferences. They also encourage off-island partners to visit in person so they can better understand the CNMI context. According to Parian, they rely on each other for their successes — a lesson he has learned throughout his public health career. Developing a Knack for Community Engagement In less than a decade, Parian has built an impressive career in public health. His journey began in 2018 as a student intern in public health at CHCC. Though he initially planned to become a nurse, his role offering support to community members with hypertension identification and control changed his trajectory. He was able to support people trying to navigate which services they could utilize to improve their health. When his internship ended, participants reported that his calls helped them manage their blood pressure and inspired them to make changes in their nutrition, medication compliance, and regular clinical visits — demonstrating Parian’s impact and providing him with fulfillment.   The Commonwealth Healthcare Corporation Immunization team attend a professional development workshop.   Discovering the Power of Collaboration The power of personal interactions inspired Parian to pursue a bachelor’s degree in health care management and a master’s degree in public health. When the COVID-19 pandemic began, he was shadowing CHCC’s CEO, Esther Muña, and corporate quality and performance manager, Halina Palacios, getting a front row seat as the organization’s leadership team developed their initial response to the pandemic. From this position, he learned effective strategies for addressing public health crises, like leveraging partnerships and building community trust, as well as approaches for successful workforce development. Eventually, he landed a permanent position as a vaccine specialist, managing storage, handling, and distribution of vaccines for the jurisdiction, then becoming the vaccine program coordinator overseeing the COVID-19 vaccination program for several years. Parian attributes his success to the supportive culture at CHCC where program managers and leadership regularly collaborate to align their missions for the benefit of the community. Making Advancements Through Outreach These days, Parian is a leader at CHCC, working as the immunization program manager for CNMI. Post-pandemic, vaccine hesitancy is on the rise. Parian’s team is responding by building trust through relationship-building activities and education. Emman Parian 1 - Strong Partnerships Are at the Heart of Public Health The team regularly visits villages, schools, health programs, and community centers, and even runs Saturday clinics/outreach events to ensure that all community members have the opportunity to get vaccinated. Efforts like these are particularly important given CNMI’s geography, which includes 14 islands, with three populated islands (Saipan, Tinian, and Rota). Even so, CNMI is in a better position to respond to future public health emergencies post-pandemic due to their expanded and improved partnerships and collaboration.   Parian attends a regional meeting with other Pacific Island managers and staff in Saipan.   Leading with Open Communication As a manager, Parian emulates the leadership models that he encountered early in his career. Open communication enabled Parian’s rise in the field, and he encourages discussion among his team. Whether feedback is positive or negative, Parian takes it into consideration. For him, leadership doesn’t mean dictating what your team does but instead working alongside them and being open-minded. That approach resonates. Emman Parian 2 - Strong Partnerships Are at the Heart of Public Health Building a leadership approach that works is important, as turnover can hinder programs due to lost institutional knowledge and a constant need to retrain employees. But lately, there’s less turnover. Parian notes that young people are increasingly invested in health care careers, a shift he attributes to recent health crises. Like him, they have a drive for outreach work and find fulfillment in it. Positioned for Future Public Health Success Strong collaboration builds the sustainability and infrastructure necessary for CHCC to succeed in their public health efforts. Should a new health crisis emerge, CHCC will be able to coordinate with partners to quickly identify resources, technical assistance, and subject matter experts. With strong teams and partnerships in place, Parian believes CHCC is ready for the future. article yes

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 public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

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

Public Health and Academic Leaders Unite Through Texas Consortium Mayela Arana Learn how a consortium in Texas strengthens and supports activities between public health practice and academic institutions. In a state as vast as Texas — spanning 254 counties and operating under a decentralized public health system — collaboration is key to strengthening public health efforts. With local and county health departments working independently and the state stepping in where no local health department exists, fostering partnerships across institutions is both a challenge and an opportunity. Recognizing this, the Texas Department of State Health Services (DSHS) brought multiple schools of public health together under a unified program: the Academic Health Partnership Initiative. Led by the DSHS Office of Practice and Learning within the Center for Public Health Policy and Practice, this initiative is designed to strengthen, support, and enhance activities between public health practice and academic institutions, in which the Academic Public Health Consortium plays a key strategic, collaborative role. Partnership Purpose and Benefits DSHS believes that forming Academic Health Department (AHD) partnerships creates accountability, clearer collective value, and greater access to funding opportunities. AHD partnerships, which can range from student internships to fully integrated collaborations and shared resources, provide a framework for public health departments and universities to work in lockstep. By taking a statewide approach, DSHS not only enhances public health workforce development but shapes a more resilient and connected public health infrastructure in Texas. In addition, DSHS asserts that strengthening academic public health partnerships… Improves the relevance of education to public health practice. Creates innovative public health practices and research. Strengthens connections, communication, and trust. Shares and replicates evidence-based projects, initiatives, and interventions. Maximizes resources, expertise, and funding. Provides opportunities to meet strategic goals. Helps build and train the public health workforce. Evolution of DSHS Partnerships with Academic Institutions DSHS has always valued its relationships with academia and collaborations have been a long-standing piece of their work. State legislators also acknowledge this powerful connection between public health agencies and universities. In fact, through 1999 legislation, Chapter 121, Subchapter F, Health and Safety Code directed DSHS to establish a “public health consortium” composed of academic partners to conduct activities like developing curricula and trainings, conducting research on improving health status outcomes, and developing competency certification standards for public health workers. DSHS’s partnerships with universities have since grown and evolved — while the agency has historically gravitated toward schools of public health as natural partners, DSHS recognizes that public health is a broad field and it can benefit from having expertise in other disciplines. As such, the Academic Public Health Consortium consists of schools of public health within eight Texas university systems but is open to any school or local health department to contribute and participate. Building a Shared Vision Through Statewide Collaboration The Academic Public Health Consortium held roundtable discussions across the state to collect initial input for its Statewide Strategy. Members undertook the following collaborative steps to co-create their shared strategies and goals. Set up introductory meetings with each school to introduce the concept and get buy-in. Discuss the specifics all parties would like to gain from the partnership (e.g., collaboration on research projects or grants, training for staff, internship placements, consultation on curriculum, support for accreditation, guest lectures, hosting career panels, etc.). Identify work groups or committees with each school and agree on meeting frequency. Draft a sample memorandum of understanding or agreement to answer the following: what is our purpose, what are we going to do, how are we going to do it, why is it important, and how will we both benefit. Conduct inventory of current activities. Review each organization’s strategic priorities, goals, and needs. Conduct a SWOT (strengths, weaknesses, opportunities, threats) or SOAR (strengths, opportunities, aspirations, and results) analysis. Develop goals and priorities focusing on the mutual needs of each organization and action plans to achieve them, such as: Increasing student placement in applied practice experience opportunities. Increasing the number of real-world scenarios in the classroom. Providing workforce trainings to health department staff. Increasing student exposure to public health careers through panel discussions. Conducting a rural workforce training needs assessment. The resulting roadmap helps monitor and evaluate progress on agreed-upon action areas and show the impact of the partners on achieving the organization’s mission and goals, including: Prepare, educate, and train the public health workforce. Support public health careers. Speed the translation of research to practice, share best practices, and pilot projects in communities. The Consortium plans to develop subcommittees, get more public health practitioners involved across the state, and secure funding to support the Academic Health Partnership Initiative’s activities. Advice for Others Seeking to Establish AHD Partnerships Organizations can structure AHD partnerships in a way that best suits the nature of the relationship and those involved. There is no right or wrong way to operate this type of partnership, and it may evolve over time. One of the broader and bigger goals is to lay a solid foundation of trust, communication, and structure. Create a space where you can get to know each other better; discover each other’s strengths and needs and communicate opportunities and challenges. Like any good and solid relationship, strong partnerships are not created overnight — they require consistency, intentionality, hard work, and grace. Learn more about Academic Health Department 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 performanceimprovement@astho.org. Special Thanks - Blog - PH Academic Leaders Unite Texas Consortium article yes

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. Special Thanks - Blog - AHP Prioritizes Workforce Development in FL article yes

Partner Spotlight: Q&A with Kate Menard on Levels of Maternal Care State Implementation Advancing Levels of Maternal Care: Q&A with Kate Menard Lexa Giragosian Learn how health agencies should approach levels of maternal care implementation, with key insights from Kate Menard, a key leader and expert on the topic. As the maternal health crisis continues nationwide and states face hospital closures and workforce challenges, health agencies are increasingly implementing levels of maternal care (LoMC) to improve access to maternal health services. LoMC provides a standardized way to classify health care facilities based on their ability to manage maternal risk conditions and complications during birth. LoMC implementation helps to ensure that perinatal patients receive the appropriate care for their specific health needs, supporting optimal health outcomes. When states or territories adopt LoMC, it can strengthen access to risk-appropriate care and build more coordinated systems of perinatal regionalization. LoMC implementation is a critical lever in systems level improvement and supports efforts to reduce severe maternal morbidity and mortality. ASTHO spoke with Kate Menard, a key leader in advancing LoMC implementation nationally, to learn more about how health agencies should approach LoMC implementation in their jurisdictions. She co-led the development of the original LoMC guidelines by the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine, collaborated with CDC on its Levels of Care Assessment Tool (LOCATeSM), and partnered with the American College of Obstetrics and Gynecology on pilot testing onsite LoMC verification. For jurisdictions beginning implementation of LoMC, what are the critical first actions to take? Establishing a shared understanding of why LoMC matters, and how it supports access to RAC, is vital for sustained commitment. Begin by engaging diverse stakeholders, such as public health leadership (including rural health, maternal child health, minority health, and regulatory agencies), clinical leadership, payers, health administrators, patient advisors, and emergency medical services. I would also recommend conducting a thorough assessment of the existing regionalization system in your jurisdiction, identifying strengths and opportunities. This assessment can help tailor the LoMC implementation process to specific regional needs and contexts. Using CDC LOCATeSM can enable some aspects of this preliminary assessment. Which stakeholders should be involved from the beginning, and how can health agencies effectively engage them? Relevant partners may include clinicians (obstetricians, pediatricians, anesthesiologists, etc.), hospital associations, health system administrators, payers, community representatives, emergency medical services, and legislative authorities. Health agencies are in a unique position to convene stakeholders and bolster early and effective engagement. They can organize stakeholder convenings that bring all parties together and facilitate collaborative discussions, foster relationships, and ensure that diverse perspectives are considered in the planning process. Are there any lessons learned from your experiences that would be beneficial to those in the process of LoMC implementation? I would recommend leading with the ‘why’ as you begin this process. Clearly articulating your jurisdiction’s most urgent maternal health challenges and how LoMC can help address them will create alignment from the beginning. For example, if closure of obstetric services in rural hospitals is a major concern, focus on the design of a regionalized system that supports rural hospitals through education, training, and seamless systems for escalation of care when needed (antenatal consultation/referral or maternal transport). Jurisdictions can use Maternal Mortality Review Committee findings and hospital-based severe maternal morbidities reviews to identify key needs. Building trust is equally critical and strong relationships among stakeholders helps overcome resistance to change. Using data and evidence-based practices will enhance credibility and encourage partner buy-in. What are the key considerations and best practices needed to effectively implement LoMC? Firstly, define specific objectives for the implementation process through collaboration with stakeholders, ensuring they are measurable and achievable within the timelines set. Leverage stakeholder engagement to collaboratively determine how your jurisdiction will implement LoMC (e.g., legislation, regulation, governing body, adoption of the American College of Obstetrics and Gynecology/Society for Maternal Fetal Medicine guidelines as is or with state specific adaptations, designation method, onsite verification). Through this process, maintain open lines of communication among all stakeholders to foster transparency and collaboration. Once your jurisdiction is prepared for implementation, agency leaders should ensure adequate training for health care providers and administrators to understand the LoMC system and their role within it. Don’t forget to embrace quality improvement and utilize data and feedback from the implementation process to make informed adjustments and improvements, confirming that care delivery continuously aligns with best practices. How can jurisdictions use their LoMC data to demonstrate its value and return on investment to hospital leaders and decision-makers? Defining LoMC is the first step. Building shared language to advance collaboration, risk appropriate care, and improved maternal outcomes is how the investment is realized. Jurisdictions should track and report on key performance indicators, such as reductions in maternal morbidity and mortality rates, improved access to care, and increased adherence to best practices in maternal health. To make the business case, highlight cost benefits that effective LoMC implementation creates, such as fewer unplanned ICU admission, shorter hospital stays or readmissions, and avoidance of medical legal claims. Emphasize that effectively utilizing a LoMC system may actually improve retention of providers and staff in rural hospitals. Patient feedback may additionally demonstrate improved experiences for mothers and newborns, reinforcing the need for continuous investment in LoMC. article yes

Partnership as the Foundation for Advancing Adolescent Health in American Samoa Partnership Advances Adolescent Health in American Samoa Gabby Ruiz Learn how American Samoa advances adolescent health in American Samoa through collaboration among state and local health and education agencies. Cross-sector partnerships are essential to advancing adolescent health, particularly in school-based settings. The intersection between public health, education, and clinical health is vital to the delivery of integrated services. In the United States, it is estimated that children in grades K-12 spend at least 1,231 hours each year in school, not including time dedicated to clubs or extracurricular activities. When schools function as trusted environments where health and learning meet, they become powerful access points for early identification of needs, preventive services, and supportive relationships. The public health sector brings expertise in prevention, population-level data, and community engagement. Meanwhile, the education sector provides youth engagement and the ability to creatively embed health into learning environments by leveraging diverse resources. When sectors work in isolation, resources are used inefficiently and adolescents may experience gaps in care, fragmented supports, and inconsistent access to essential services. With support from CDC’s Division of Adolescent and School Health, ASTHO leads the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice, an initiative that promotes collaboration among state and local health and education agencies to strengthen health education, connect schools to services, and foster safe, supportive learning environments. This initiative provides a space for teams to share ideas, troubleshoot challenges, and build sustainable partnerships. Through this effort, the American Samoa team built a strong partnership between the Department of Health and the Department of Education to expand and enhance effective communication about sexual and reproductive health to reduce risk taking behaviors and promote protective factors. Peer-to-Peer Learning as a Catalyst for Youth Engagement Grounded in the belief that young people are often the most trusted messengers for their peers, the American Samoa team launched the Students Promoting Education, Awareness, and Knowledge (SPEAK) project: a student-led, peer mentor collaborative effort between the American Samoa Department of Education (ASDOE), the American Samoa Department of Health (ASDOH), and youth peer leaders. The project builds a network of trained peer educators who engage students on topics such as healthy relationships, personal responsibility, privacy, consent, HIV, STI, and pregnancy prevention. SPEAK peer leaders are students in grades 10 through 12, with two or more representatives from each grade level. High school counselors help identify students suited for this role, which includes: Co-creating educational materials that reflect their identities (i.e., their values, abilities, and lived experiences). Fostering safe spaces for support and dialogue. Managing online platforms that allow youth to ask questions anonymously. Collaborating with schools, communities, and health care providers to develop and promote educational campaigns through social media channels. SPEAK promotes student leadership, shared accountability, and open, stigma-free dialogue. Forging Strong Relationships Alignment and Sustainability From the beginning, ASDOH and ASDOE committed to building a unified team to support adolescent sexual and reproductive health. This collaboration became one of their greatest strengths. The team noted that establishing a shared vision early on helped them maintain momentum through challenges. Donation Ape, ASDOE Program Director, played a pivotal role in bridging agencies and strengthening the network that supported the project’s success. While Ape’s dedication and tenacity have been key to nurturing this partnership, both sides of the team are working to ensure that this partnership is sustainable. “With the right network, we were able to do it.” — Donation Ape, ASDOE Program Director Thoughtful Health Education In addition to coordinating across school systems and community partners, long-standing cultural values that emphasize privacy around family and personal matters made open discussion of adolescent health topics more challenging. Prior to SPEAK, students were not receiving structured health education in this area. ASDOE staff and leadership initially expressed understandable concerns about ensuring any peer-led approach would be age-appropriate, culturally respectful, and aligned with community standards. A key strategy for addressing these concerns was thoughtfully engaging youth alongside educators, families, and community stakeholders to help demonstrate the need and shape a solution to delivering health education. “When you see young people not just as children but as contributors to society, you start to see what’s possible.” — Fatih Seiuli, Health Educator, ASDOH Key Considerations for State and Territorial Health Agencies American Samoa’s experience offers key insights for other jurisdictions seeking to strengthen adolescent health through school-based partnerships: Integrate public health into education, clinical health, and mental and behavioral health to ensure a more holistic and sustainable cross-sector approach. Together, these sectors form a coordinated system that has the capacity to address pertinent adolescent health concerns. In addition, youth hold a critical role in their own care, and engaging them as part of these cross-sector partnerships is essential to adolescent health program uptake and understanding. Involve essential community voices by engaging key stakeholders and end users early on. Creating a peer educator network and creating space for youth-led engagement ensures programs reflect young people’s lived realities — increasing relevance and reach, and fostering trust and ownership among students who may otherwise feel disconnected from traditional health messages. Adapt curricula with cultural responsiveness. Integrate bilingual materials and tailor them to the unique needs of communities — expanding reach across cultural contexts and addressing stigma or other social and structural barriers. Additionally, ensure the framing of the program is appropriate for audiences and helps to overcome cultural barriers. Looking Ahead American Samoa’s journey demonstrates how intentional partnerships, youth leadership, and culturally grounded approaches can advance adolescent health in meaningful and sustainable ways. Their work reinforces that collaboration is a critical strategy that serves as the foundation for lasting impact. ASTHO will continue supporting jurisdictions through the Leadership Exchange for Adolescent Health Promotion Plus Community of Practice by fostering connections, strengthening multi-sector partnerships, and creating spaces where teams can learn from one another. As American Samoa’s experience shows, meaningful progress in adolescent health is possible when sectors and systems align around a shared purpose. Reviewed by - Akbarali, Mackie, Vance article yes

Learn about Pima County's journey to advance data modernization efforts through an elevated partnership with County IT.

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

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

Environmental health and public health preparedness staff work closely together to respond to natural disasters and climate change—learn how in this report.

How Mississippi Prioritizes Environmental Justice During Disaster Response Association of state and territorial health officials, astho, environmental health, environmental justice, public health, cross sector partnerships, emergency preparedness, natural disaster response, emergency response, health equity, social determinants of health, missisippi state department of health, office of environmental health, office of health equity, covid 19 pandemic, emergency planning and response Ali Aslam, Yaryna Onufrey, Beth Giambrone This case study dives into the Mississippi State Department of Health’s environmental justice initiatives, conducted using cross-sector partnerships. Environmental justice is defined as all people enjoying the same degree of access and protection from environmental and health hazards. This happens by intentionally involving all people—regardless of race, color, national origin, or income—while developing, implementing, and enforcing environmental laws and policies. The Mississippi State Department of Health incorporates environmental justice principles into their disaster response and emergency preparedness efforts. Mississippi's environmental justice work has been community-based and equity-driven. This case study dives into Mississippi’s cross-sector partnerships, community health initiatives, and health equity work as the state has worked to address environmental health concerns. Get the Report (PDF) website yes

Policy Options to Improve Data Sharing Between State and Local Health Departments Organizational policies on data sharing between state and local public health agencies. This report explores organizational policies related to data sharing between state and local public health departments. ASTHO, in collaboration with the National Association of County and City Health Officials and the Network for Public Health Law developed this report, which aims to serve as a guide for state and local public health leaders as they consider organizational policy options to improve state and local data-sharing efforts. Get the Report (PDF) website yes

Moving from Design to Implementation: Lessons on Expanding Contraception Access in New Jersey Liz Gipson, Jahira Sterling, Lauren Moran, Brittany Lee, Sophia Durant Lessons on expanding contraception access in New Jersey. Public sector health leaders play a critical role in influencing reproductive health policy design and program implementation. As the key authorities on state programs, public sector leaders foster necessary collaboration between community partners and other state agencies. In New Jersey, state officials are implementing two contraception access bills, S 413 and S 275, enacted in 2022 and 2023 respectively. This report details lessons learned from New Jersey’s cross-sector and interagency collaboration, which can guide public sector leaders in other states working to expand access to reproductive health services. Get the Report (PDF) website yes

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.