Territorial 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.

Implementing a Needs Assessment to Advance Health Equity in Overdose Prevention and Surveillance Initiatives.

State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.

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.

Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies.

Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Understanding Factors Influencing Decision Making by State Health Officials in a Public Health Emergency.

State and territorial health officials (STHOs) play a critical role in leading public health emergency response in their respective states. Through an exploratory qualitative study with 21 current or former STHOs, we sought to understand the issues that impact STHO decision making in public health responses. Initial findings suggest the need for structured decision making tools for use by leaders responding to public health emergencies, including COVID-19. Such tools could lead to more systematic responses by STHOs during public health crises.

Geographic information system protocol for mapping areas targeted for mosquito control in North Carolina.

Geographic information systems (GIS) can be used to map mosquito larval and adult habitats and human populations at risk for mosquito exposure and possible arbovirus transmission. Along with traditional methods of surveillance-based targeted mosquito control, GIS can help simplify and target efforts during routine surveillance and post-disaster (e.g., hurricane-related flooding) to protect emergency workers and public health. A practical method for prioritizing areas for emergency mosquito control has been developed and is described here. North Carolina (NC) One Map was used to identify state-level data layers of interest based on human population distribution and mosquito habitat in Brunswick, Columbus, Onslow, and Robeson Counties in eastern NC. Relevant data layers were included to create mosquito control treatment areas for targeted control and an 18-step protocol for map development is discussed. This protocol is expected to help state, territorial, tribal, and/or local public health officials and associated mosquito control programs efficiently create treatment area maps to improve strategic planning in advance of a disaster. This protocol may be applied to any NC county and beyond, thereby increasing local disaster preparedness.

Preparing for the Next Pandemic or Public Health Crisis.

Association of State and Territorial Health Officials, Arlington, Virginia. Correspondence: Thomas Dobbs, MD, MPH, Association of State and Territorial Health Officials, 2231 Crystal Dr #450, Arlington, VA 22202 ([email protected]). The authors declare no conflicts of interest.

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

Maternal and neonatal risk-appropriate care: gaps, strategies, and areas for further research.

Risk-appropriate care is a strategy to improve perinatal health outcomes by providing care to pregnant persons and infants in facilities with the personnel and services capable of meeting their health needs. The Association of State and Territorial Health Officials hosted discussions among state health officials, health agency staff, and clinicians to advance risk-appropriate care. The discussions focused on neonatal levels of care, levels of maternal care, ancillary services utilized for care of both populations including transport and telemedicine, and issues affecting provision of care such as standardization of state policies or approaches, reimbursement for services, gaps in risk-appropriate care, and equity. State-identified implementation strategies for improvement were presented. In this Perspective, we summarize current studies describing provision of risk-appropriate care in the United States, identify gaps in research, and highlight ongoing and proposed activities to address research gaps and support state health officials and clinicians.

TOOLS TO SUPPORT NEEDS ASSESSMENTS ON DEMENTIA, COGNITIVE HEALTH, AND CAREGIVING

Abstract Dementia, cognitive health, and caregiving are not always included in community health needs assessments, leading to their absence in public health improvement and strategic plans, and subsequent lack of action and funding to address these needs. In response, the Alzheimer’s Association and the Association of State and Territorial Health Officials published the Needs Assessment Toolkit for Dementia, Cognitive Health, and Caregiving. Designed for state, local, and territorial public health and aging officials, this toolkit helps communities identify unmet needs of older adults, scale up existing community strengths, and promote healthy aging. The toolkit embeds health equity as a cornerstone to assessing community health. It offers approaches to operationalize equity in the assessment process by including wide representation of people from different racial and ethnic backgrounds, geographic locations, and levels of socioeconomic status and educational attainment. The toolkit’s five steps are modular in design and allow jurisdictions to enter the process at any stage. It considers alignment with jurisdiction-wide plans including Alzheimer’s plans, health improvement plans, aging plans, and the Healthy Brain Initiative Road Map, helping public health agencies advance attention to Alzheimer’s through their networks. Developed through an iterative process, expert input from public health and aging practitioners guided the development and organization. Over 1,600 comments were reconciled to ensure usability among stakeholders, elevate equity to an essential component throughout the assessment process, and add value to allied strategic plans. This presentation complements Learn, Plan, Do: Public Health Planning to Address Dementia and Caregiving, abstract ID 1229181.

LEARN, PLAN, DO: PUBLIC HEALTH PLANNING TO ADDRESS DEMENTIA AND CAREGIVING

Abstract To respond to growing rates of dementia, as well as emerging scientific evidence, there is an urgent need for states to leverage public health strategies to reduce the risk of dementia, promote early detection, and prevent avoidable health issues related to dementia as well as systematically support dementia caregiving. The BOLD Infrastructure for Alzheimer’s Act passed into law on December 31, 2018. The law is designed to promote implementation of CDC’s Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map Series and the Healthy Brain Initiative Road Map for Indian Country. Its goal is to create jurisdiction infrastructure and promote planning and action to address dementia across the life-course. With support from CDC, the Association of State and Territorial Health Officials developed an e-learning module to guide public health departments on engaging partners in jurisdiction planning on dementia. The module aligns with the Healthy Brain Initiative Road Map and offers approaches to operationalize health equity throughout its resources. During this session, presenters will overview the module contents and detail the process developed to help jurisdictions assess their dementia and caregiving needs, prioritize actions from the Road Map, and create an action plan. They will also share examples of state planning efforts. Participants will learn how to get started with their own planning process using the tools offered in the module and examples from other states. This presentation complements Tools to Support Needs Assessments on Dementia, Cognitive Health, and Caregiving, abstract ID 1226183.

Climate Change Adaptation Activities and Needs in US State and Territorial Health Agencies.

To characterize US State and Territorial Health Agencies' (S/THA) climate change adaptation activities and priorities to facilitate appropriate investments, skills development, and support that will strengthen health sector capacity in response to a changing climate. In 2021, we conducted an online survey of S/THA staff requesting information on current activities related to climate change and health, the state of climate and health programming, and anticipated needs and priorities for assistance. We analyzed survey results using descriptive statistics. US State and Territorial Health Agencies. We received responses from 41 of 59 S/THAs (69.5%). Implementation of S/THA climate and health programs (CHPs); engagement in climate and health activities; maintenance of hazard early warning systems and action plans; employment of climate and health communications strategies; capability to assess risks and adaptation needs related to various climate-sensitive conditions; priorities and plans for climate change adaptation in relation to climate-sensitive health risks; climate change adaptation-related partnerships and collaborations; requests of the Association of State and Territorial Health Officials (ASTHO) for advancing climate change adaptation activities; and the impacts of the COVID-19 pandemic on climate change work. Nineteen S/THAs reported having CHPs, the majority of which are federally funded. On average, S/THAs without CHPs reported engagement in fewer climate and health activities and more early warning activities. The S/THAs reported the highest levels of concerns regarding non-vector-borne infectious disease (66%), vector-borne infectious diseases (61%), and extreme heat (61%) hazards. As S/THAs with CHPs report substantially greater climate and health capacity than those without, additional federal and state investments (eg, Building Resilience Against Climate Effects [BRACE]) are urgently needed to catalyze climate and health capacity.

Improving Older Adult Health by Operationalizing State Plans on Aging and Health Improvement.

The COVID-19 pandemic, a growing aging population, and inconsistent equity in aging have prompted more public health departments and agencies that focus on older adult services to establish partnerships to improve older adult health. To develop a model for strengthening and better aligning public health-aging partnerships, the Association of State and Territorial Health Officials (ASTHO) and Trust for America's Health engaged the Georgia Division of Aging Services (DAS) and Georgia Department of Public Health (DPH) to participate in a pilot project. ASTHO conducted an intensive qualitative analysis of Georgia's State Health Improvement Plan and State Plan on Aging to systematically assess shared priorities and differences. Through facilitated discussions about the results, prioritization, and planning, DAS and DPH developed an action plan with 2 priority areas to collaborate on and further their partnership. This process can be replicated by other jurisdictions seeking to enhance public health-aging collaboration.

Staffing Up and Sustaining the Public Health Workforce.

Estimate the number of full-time equivalents (FTEs) needed to fully implement Foundational Public Health Services (FPHS) at the state and local levels in the United States. Current and full implementation cost estimation data from 168 local health departments (LHDs), as well as data from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, were utilized to estimate current and "full implementation" staffing modes to estimate the workforce gap. The US state and local governmental public health workforce needs at least 80 000 additional FTEs to deliver core FPHS in a post-COVID-19 landscape. LHDs require approximately 54 000 more FTEs, and states health agency central offices require approximately 26 000 more. Governmental public health needs tens of thousands of more FTEs, on top of replacements for those leaving or retiring, to fully implement core FPHS. Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.

2021 AMCA Presidential Address.

2021 AMCA Presidential Address.

Digital Tools Adopted by Public Health Agencies to Support COVID-19 Case Investigation and Contact Tracing, United States, 2020-2021.

During the COVID-19 pandemic, public health agencies implemented an array of technologies and digital tools to support case investigation and contact tracing. Beginning in May 2020, the Association of State and Territorial Health Officials compiled information on digital tools used by its membership, which comprises 59 chief health officials from each of the 50 states, 5 US territories, 3 freely associated states, and the District of Columbia. This information was presented online through a publicly available technology and digital tools inventory. We describe the national landscape of digital tools implemented by public health agencies to support functions of the COVID-19 response from May 2020 through May 2021. We also discuss how public health officials and their informatics leadership referenced the information about the digital tools implemented by their peers to guide and refine their own implementation plans. We used a consensus-based approach through monthly discussions with partners to group digital tools into 5 categories: surveillance systems, case investigation, proximity technology/exposure notification, contact tracing, and symptom tracking/monitoring. The most commonly used tools included the National Electronic Disease Surveillance System Base System (NBS), Sara Alert, REDCap, and Maven. Some tools such as NBS, Sara Alert, REDCap, Salesforce, and Microsoft Dynamics were repurposed or adapted for >1 category. Having access to the publicly available technology and digital tools inventory provided public health officials and their informatics leadership with information on what tools other public health agencies were using and aided in decision making as they considered repurposing existing tools or adopting new ones.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Sustained Management of COVID-19: Doing More of What Works to Control Future Surges.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

A Rapid Survey of State and Territorial Public Health Partnerships With Faith-Based Organizations to Promote COVID-19 Vaccination.

During the COVID-19 pandemic, media accounts emerged describing faith-based organizations (FBOs) working alongside health departments to support the COVID-19 response. In May 2021, the Department of Health and Human Services, Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) sent an electronic survey to the 59 ASTHO member jurisdictions and four major US cities to assess state and territorial engagement with FBOs. Findings suggest that public health officials in many jurisdictions were able to work effectively with FBOs during the COVID-19 pandemic to provide essential education and mitigation tools to diverse communities. (Am J Public Health. 2022;112(3):397-400. https://doi.org/10.2105/AJPH.2021.306620).