National Association Of County And City Health Officials Research Articles

Best Practices and Lessons Learned From the Public Health Disability Specialists Program: Addressing the Needs of People With Disabilities During COVID-19.

The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) applied funding issued by the US Centers for Disease Control and Prevention (CDC) to implement the Public Health Disability Specialists Program, part of a project to address the needs of people with disabilities during the COVID-19 pandemic. Disability specialists (subject matter experts) were embedded within state, territorial, and city/county health departments to help ensure disability inclusion in emergency planning, mitigation, and recovery efforts. To evaluate the success of the Disability Specialists Program in improving emergency response planning, mitigation, and recovery efforts for people with disabilities within participating jurisdictions. Disability specialists worked with their assigned jurisdictions to conduct standardized baseline health department needs assessments to identify existing gaps and inform development and implementation of improvement plans. CDC, ASTHO, and NACCHO implemented a mixed methods framework to evaluate specialists' success. State, territorial, and local health departments across 28 jurisdictions between January 2021 and July 2022. Average number of categories of gaps addressed and qualitative documentation of strategies, barriers, and promising practices. Specialists identified 1010 gaps (approximately 36 per jurisdiction) across eight needs assessment categories, most related to mitigation, recovery, resilience, and sustainability efforts (n=213) and communication (n=193). Specialists addressed an average of three categories of gaps identified; common focus areas included equitable COVID-19 vaccine distribution and accessible communications. Specialists commonly mentioned barriers related to limited health agency capacity (eg, resources) and community mistrust. Promising practices to address barriers included sharing best practices through peer-to-peer networks and building and strengthening partnerships between health departments and the disability community. Embedding disability specialists within state, territorial, and local health departments improved jurisdictional ability to meet evolving public health needs for the entire community, including people with disabilities.

Public health workforce survey data (2016-2021) related to employee turnover: proposed methods for harmonization and triangulation.

Public health workforce numbers are unsustainable at best and dire at worst: based on 2017 and 2019 data, 80,000 FTEs needed to be hired by health departments to provide basic public health foundational services before COVID-19 hit, suggesting that the situation is worse after the mass exodus of public health officials due to the pandemic. As such, a better understanding of public health workforce turnover is critical to improving recruitment and retention in the discipline. This methods report details how the authors harmonized four public health workforce surveys-the Public Health Workforce Interests and Needs Survey (PH WINS), the National Association of County and City Health Officials (NACCHO) Profile, the NACCHO Forces of Change survey, and the Association of State and Territorial Health Officials (ASTHO) Profile-in order to examine employee turnover. We found that 31% of the public health workforce reported considering leaving their positions at some time in the future. Furthermore, the majority of agencies reported that zero vacancies had been filled in both 2018 and 2019. These findings suggest that retention, recruitment, and onboarding may be areas upon which to focus evaluation and quality improvement endeavors, allowing public health organizations to better attract and retain the most qualified candidates.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

THE ROAD MAP STRATEGIST INITIATIVE: A NATIONWIDE EFFORT TO BUILD LOCAL PUBLIC HEALTH CAPACITY ON DEMENTIA

Abstract The Road Map Strategist Initiative is a nationwide effort to build local health department (LHD) capacity to address cognitive health and dementia. Through a collaboration between the Alzheimer’s Association and the National Association of County and City Health Officials (NACCHO), the initiative aims to make policy, systems, and environmental change, with a focus on health equity. Participating health departments receive funding, training, and technical assistance to establish a part-time Healthy Brain Initiative (HBI) Road Map Strategist, a public health professional serving as a system change agent. With support and education from the program sponsors, Road Map Strategists conduct a community health needs assessment, train LHD staff and leadership, and collaborate with community partners to implement and accelerate public health actions on dementia. Actions taken by the Road Map Strategists are informed by the Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia, The 2018-2023 Road Map. Presenters will share lessons learned from the first cohort of eight (8) LHDs during each stage of the initiative, with a focus on approaches used for Road Map implementation efforts in their communities. This session will share evaluation findings on successes and barriers for changing health department capacity to support local dementia efforts. Data from key indicators related to knowledge gain and capacity change will be shared, including the way LHD characteristics influenced success. The session will also cover effective approaches toward advancing health equity in dementia in local communities and plans for future iterations of the initiative.

Rising to the Challenge: How Medical Reserve Corps Volunteers Serve as a Scalable Workforce for Local Health Departments in Response to COVID-19 and Beyond.

Rising to the Challenge: How Medical Reserve Corps Volunteers Serve as a Scalable Workforce for Local Health Departments in Response to COVID-19 and Beyond.

A Qualitative Analysis of Local Health Departments' Experiences With Contact-Tracing Tools in Response to COVID-19.

A Qualitative Analysis of Local Health Departments' Experiences With Contact-Tracing Tools in Response to COVID-19.

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes.

The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

NACCHO announces funding and TA for SSPs

Via federal grants, the harm‐reduction workforce may take off for the first time (see story, p. 1), with the help of funding for staffing, technical assistance (TA), and more. Most recently, the Centers for Disease Control and Prevention and the University of Washington have partnered with the National Association of County and City Health Officials (NACCHO) to fund monitoring and evaluation of syringe services programs (SSPs), and to support the use of data for SSP program improvement. The funding will go to local health departments and community‐based SSPs. SSPs, originally created to help prevent HIV transmission via needle sharing, have become part of the harm‐reduction landscape with the opioid overdose epidemic, as a place for drug users to turn instead of the street for help. Monitoring and evaluations will include routine (e.g., intake or encounter‐level) and periodic (e.g., surveys) data collection, as well as management, analysis, evaluation and reporting. Up to $98,750 can be requested per application. Applications are due May 21. For more information, go to the Request for Applications (RFA) at https://www.naccho.org/uploads/body‐images/NACCHO‐Harm‐Reduction‐Monitoring‐and‐Evaluation‐RFA‐FINAL.pdf. The RFA includes an appendix that characterizes common software used by SSPs. NACCHO and UW will hold “office hours” Tuesdays from 1:00 to 2:00 p.m. ET from April 27 to May 18. Applicants are encouraged to sign up for a specific time slot. Go to the Zoom link (https://washington.zoom.us/meeting/register/tJwqceiupzgiHtUY8mVISv2eopBnk9PHwmLD) and also go to the sign‐up link (https://airtable.com/shrDeGHAbUO5K4mq8). If you have questions, submit them in advance via form or by emailing SSP Measurement and Evaluation Technical Assistance Program Manager Kelly Knudtson (kellyknu@uw.edu). Kat Kelley, senior program analyst at NACCHO for HIV, STI, and viral hepatitis, will need all of the documents for the grant, titled “Building Capacity for Harm Reduction Monitoring and Evaluation.” State health departments are eligible to apply for the funding. SSPs that are currently operating are eligible as well. In states that don't allow SSPs, there may be no opportunity for funding. The grant money cannot be used for lobbying. However, if SSPs are legally allowed to operate in a certain jurisdiction but face restrictions such as exchange only with no secondary syringes allowed, the grant could be used for data collection and analysis to demonstrate the benefits of changing policy and practice. Funds cannot be used for syringes, naloxone or fentanyl test strips. Funding can be used for staff time to conduct monitoring and evaluation. Approaches such as vending machines, marketing promotion of SSPs and other issues may be funded as well, providing the applicant describes how these activities would enhance SSP monitoring and evaluation, or the use of SSP monitoring and evaluation data. Funds could not be used to purchase a vending machine. The number of awards depends on the funding amounts requested by the organizations with the highest scores in their applications. The smallest number of programs that would be funded is 16, but the amount could be higher if applicants do not request the maximum funding amount ($98,750). “Equity” is important as well; grantees who find that they primarily serve cisgender men and women, for example, may use the funds to conduct data‐collection activities with trans, nonbinary or gender‐nonconforming people to see how the SSP could better meet their needs.

Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

BackgroundThe Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships.MethodsWe used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships.ResultsStronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03).ConclusionsStronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States.

Moving the Field Forward: A Decade of Progress Implementing Health in All Policies in the United States.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

Go Local: Innovating Local Health Departments' Engagement on Alzheimer’s

The aging Baby Boom generation is a major force behind projected increases in the prevalence of Alzheimer’s, which is expected to grow from 5.8 million (2020) to 13.8 million (2050). Local health departments play a major role connecting people living with dementia (and their caregivers) to services, supports, and education, and to ensure safe, accessible environments where they can flourish. From September 2019-July 2020, two local health departments (from San Diego County and the City of Boston) participated in a yearlong collaborative pilot project with the Alzheimer’s Association to advance cognitive health, dementia, and caregiving issues in their local jurisdictions. The National Association of County and City Health Officials (NACCHO) provided expert guidance and input throughout the collaboration. As part of the project, the local health departments: scanned their current work on healthy aging, identified existing data sources, and examined how existing healthy equity initiatives can apply to cognitive health, dementia, and caregiving issues. Action plans were developed, with a focus on policy mechanisms to initiate and sustain these projects and workforce development initiatives. Plans corresponded to actions of the Healthy Brain Initiative Road Map, helping elevate recommendations to change systems, policies, and environments. In fall 2020, LHDs will be able to use best practices, case studies, and tools developed from San Diego’s and Boston’s pilots to address Alzheimer’s as a chronic condition. The tools will help them engage health officials, develop action plans, and train the public health

Does Collaboration Between Local Health Departments and Nonprofit Hospitals Foster Community Health?

We investigated whether stronger collaboration between local public health departments (LHDs) and nonprofit hospitals within a community is associated with individual-level healthier behavior. In accordance with a conceptual framework we developed that was motivated in part by theoretical perspectives on social exchange and social capital, we assessed the strength of LHD-hospital collaboration within communities using data from the National Association of County and City Health Officials (NACCHO) Forces of Change Survey. Health behavior data came from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. For social capital we used an index developed by the Northeast Regional Center for Rural Development at Penn State. We estimated multilevel models controlling for both individual and community-level factors. Stronger LHD-hospital collaboration was positively and significantly associated with several types of health behaviors including not smoking (odds ratio, OR=1.32, 95% CI=1.11-1.58), eating vegetables daily (OR=1.29; 95% CI=1.06-1.57) and vigorous exercise (OR=1.17; 95% CI=1.05-1.30). There was some evidence of a modifying effect for social capital. Our results should spur policymakers to encourage greater collaboration between these two sectors. Additionally, social capital may play a moderating role in improving community health.

Social Media in Public Health Departments: A Vital Component of Community Engagement.

Social Media in Public Health Departments: A Vital Component of Community Engagement.

Medical Reserve Corps: Increasing Community Resilience in Mass Casualties Through Active Bystander Training.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to jfox46@jhu.edu.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

A Seat at the Table: Public Health Is Working Differently in Snohomish County, and It's Paying Off.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to jfox46@jhu.edu .

Using Health Information Exchange to Improve Family Reunification After a Mass Casualty Incident.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org.

Scripted Surge Pharmacy Pandemic Exercise: Testing Vaccine Administration and Antiviral Dispensing

In 2015, the Centers for Disease Control and Prevention (CDC) collaborated with the National Association of County and City Health Officials (NACCHO) to develop and conduct the Scripted Surge Pharmacy Pandemic Exercise to assess the capacity of pharmacies to administer vaccines and dispense medications during a severe influenza pandemic and to evaluate their various approaches to this activity. A mass merchant pharmacy and a supermarket pharmacy were recruited in 2 different states. At each pharmacy, 2 consecutive 90-minute exercise runs were completed in which actors, simulating patients, presented themselves to the pharmacy counter and requested a vaccine and/or prescription(s). Each run was slightly different in terms of patient flow, staffing, and physical configuration. Individual plays were timed, and a quality assessment was conducted as each patient left the store. Despite the complexities of the pandemic scenario, the number of vaccines administered and prescriptions dispensed surpassed what that pharmacy could typically accomplish during current peak hours of operation. Furthermore, the number of requests successfully processed increased between the first and second runs at each site, suggesting that processing efficiency improved with practice and experience. Few unexpected outcomes were observed, most of which were attributable to exercise artificialities, and they were judged unlikely to occur under real-world scenarios and routine pharmacy practice. The experience gained from this exercise indicates that pharmacies can likely play an important role in improving access to vaccinations and medications during a future pandemic.

Bridging the Expertise Gap: Developing and Utilizing a Radiological Advisory Committee for New York City.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. This month's column features a submission from the New York City health department that describes their experience in setting up a radiological advisory committee. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org . A significant radiological emergency response in New York City would require scientific expertise beyond the routine capability of the New York City Department of Health and Mental Hygiene (DOHMH) and its partner agencies. Health physicists (radiological safety specialists) are chronically in short supply in the United States, which translates into a limited supply available to local health departments facing a radiological crisis. These professionals support medicine, industry, and the military in routine, nonemergency situations. In order to prearrange the availability of this expertise, a radiological advisory committee (RAC) was formed. The committee engages leading experts in the fields of radiation medicine and environmental radiation science in anticipation of the technical questions that arise from the clinical aspects of internalized radioactivity and the mitigation of the urban environment following a terrorist attack using radioactive materials. The creation of the RAC and its application in a nonemergency public policy forum is described, as are the problems foreseen in operationalizing the RAC during an emergency. Some conclusions are drawn about the effort and cost of maintaining the RAC and the benefits obtained by maintaining it. This information may be useful for other jurisdictions seeking to form a similar expert committee.