NACCHO Annual 2018: Preview the Power of Collaboration—The Arizona Athlete Opioid Initiative

Interview by Taylarr Lopez, Communications Specialist, NACCHO

This entry is the first in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2018. Tracy Cruickshank, MBA, MSW, Manager for the Office of Healthcare Innovation at the Maricopa County Department of Public Health (MCDPH), will discuss her department’s Arizona Athlete Opioid Initiative, which was developed to prevent prescription opioid misuse among high school athletes, in her upcoming presentation, “The Power of Collaboration: The Arizona Athlete Opioid Initiative.” Below, she shares how and why this initiative was, how it expanded to include partners with much greater reach and influence over high school athletes, and the benefits of this collaborative effort.

Tell us about the burden of opioid misuse among high school athletes in your jurisdiction. What was the impetus for this program?

Among the many initiatives aimed at addressing the opioid epidemic in Maricopa County, none were focusing on preventing prescription opioid misuse among high school athletes, which is steadily rising. When the Arizona Interscholastic Association indicated to MCDPH that they thought this was an important issue to address, we began our work in this area by conducting qualitative research among former high school athletes, parents, athletic coaches, and medical providers to get a better understanding of how prescription opioids can affect this group. Findings included that high school athletes often have access to prescription opioids because of injuries and can feel pressure to get back into the game, which can lead to prescription opioid misuse. According the Journal of Child & Adolescent Substance Abuse, one study found that 8% of female athletes and 12% of male athletes reported abusing prescription painkillers in the past year. The study also mentioned that among high school athletes, football players have the highest rates of opioid misuse.1

How does the Arizona Athlete Opioid Initiative work with its partners to address opioid misuse?

The Arizona Athlete Opioid Initiative (AAOI) meets monthly to collaborate on developing curriculum and other content for student athletes, parents, and coaches that teaches opioid misuse prevention among high school athletes. These monthly meetings have been very helpful because as a new initiative, we do not have a roadmap for this work. We work with community partners including the Arizona Interscholastic Association, the Tempe Union High School District, and the Governor’s Office of Youth, Faith and Family to collaboratively leverage resources, areas of expertise, and access to the target audience.

One of the strategies of the AAOI has been to invite new partners to the table who have been interested in starting similar initiatives in our community. On multiple occasions, we have learned about groups interested in starting their own program focusing on prescription opioids and high school athletes, and we have worked to bring those groups to the table to collaborate to maximize our limited resources and reach.

What has been the most valuable resource developed or lesson learned through this initiative?

I think that the most valuable lesson learned through this initiative is how important it is to take the time to get the buy-in of organizations that can effectively and efficiently take an initiative to a target audience. Maricopa County is one of the largest public health jurisdictions in the United States, and MCDPH has only one person who is dedicated to addressing opioids in our community. If MCDPH were doing this alone and did not have an organization such as the Arizona Interscholastic Association’s support in this effort, we would not be able to reach nearly the number of high school athletes that we will be able to through this partnership. Access to our partners’ expertise and distribution system has been invaluable and has taken this initiative to another level.

What has been the reaction of the participants since the start of the program?

We have found that many people do not know what to do if a high school athlete has been injured and is prescribed opioids. We are still developing content for this initiative and continuing to test it with the intended audience and collect feedback. Once more data has been collected and evaluated, we will have a better understanding of how the community is responding to the initiative.

What advice can you offer to other local health departments who want to replicate the success of the program?

I would recommend that local health departments consider working with organizations that can reach high school athletes easily. Cooperation and support from our partners has been monumental to the implementation of this initiative. Partnering with other organizations that have the resources and the means to communicate to your target audience is key. Local health departments that would like additional information are more than welcome to reach out to us.

Have you ever attended NACCHO Annual? What are you most looking forward to at NACCHO Annual 2018?

I have attended NACCHO Annual twice before; in 2013 and 2017. I think that I am most looking forward to hearing about the real-life experiences of other health departments—their successes, challenges, and the lessons they have learned. All these things help us gain a better understanding of whether something might work in our community.

Interested in learning more about innovative initiatives like this one? View the full schedule, conference tracks, and objectives, and start making your plans to join hundreds of local public health professionals from across the nation for NACCHO Annual 2018. We look forward to seeing you and your team July 10–12 in New Orleans!



  1. HealthDay News. (2014). Abuse of Prescription Painkillers on the Rise Among High School Athletes: Survey.

NACCHO Annual 2018: Take a Glimpse into New Orleans Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

Torrie Harris, Dr.P.H., MPH is a Health & Equity Strategist at the New Orleans Health Department (NOHD). In the following post, she discusses her role within the department, shares how NOHD is addressing the public health burdens of maternal and infant issues and mental health, and highlights the fun things NACCHO Annual 2018 conference attendees can do during their visit to New Orleans.

What is your role within the New Orleans Health Department? What does a typical day look like for you?

I am the health and equity strategist and my role is to train and educate our workforce on equity and to develop an implementation strategy through the programs delivered through the department. I am currently working with our Information Technology and Service Innovation departments to develop a method for tracking and mapping social determinants of health. A lot of my time is spent doing community health outreach and also by working across departments throughout the city on health equity and health strategies. For example, I recently did a presentation to our Department of Public Works about health equity and the health in all policies approach. I’m also responsible for our violence prevention portfolio, which includes trauma-informed schools and our domestic violence initiative.

Please tell us about the community your department serves.

The department serves the entire population of Orleans Parish, while also collaborating with surrounding parishes. Like many local health departments across the country, NOHD transitioned from being mainly a health service delivery provider to a department with a stronger focus on health system improvement, health policy, and health promotion and programming. However, NOHD does operate one Federally Qualified Health Center, Healthcare for the Homeless Clinic (HCH), which offers primary care services to adults in the city of New Orleans and surrounding parishes regardless of ability to pay.

HCH also offers dental services to adults and children. The HCH site offers the Women, Infant, and Children (WIC) program and other wrap-around services such as laboratory services, behavioral health, and a pharmacy. Additionally, NOHD provides support to low-income families through Healthy Start, a prenatal/postnatal health education program that offers free baby supplies, links to employment resources, individual and family counseling, and legal assistance.

Moreover, NOHD contributes to the monitoring and surveying of health ordinances that were established by our city council, such as our recent smoke-free and noise pollution ordinances.

What are some of the most pressing public health burdens your community is facing? How is your health department addressing those challenges?

The most pressing health priority is access to mental and behavioral health services, as there is limited access and a need for integration into the primary care health system. The city’s other most pressing public health burden is infant mortality. According to the March of Dimes, as of 2014, the infant mortality rate among African Americans is 9.8 per 1000. The department is also working to address opioid use through a prevention strategy program that is making strides in reducing the burden of misuse.

NOHD coordinates the Behavioral Health Council, which convenes behavioral and mental health agencies and professionals to achieve a high-functioning health system that works collaboratively to meet the needs of vulnerable populations across the life span. To address infant mortality, NOHD works with Healthy Start, WIC, and leverages partnerships with the National Birth Equity Collaborative and the New Orleans Breastfeeding Center.

The department uses a Health in All Policies approach to ensure residents have access to clean, safe, and affordable housing in the city. We work with different departments in the city to discuss equitable strategies and how housing relates to health. We use an equity lens to educate faculty, leadership, and area schools about managing trauma to reduce infections and improve the quality of life of the area’s students.

The department is working with police officers and other emergency personnel to better identity risk factors when responding to domestic violence and sexual assault calls. NOHD also has behavioral health programs that convene public health professionals across the city to develop a strategy for providing better mental health services.

We are working to mitigate the burden of obesity and chronic disease in our community by partnering with the city’s recreation department. Through this partnership, Fit NOLA was established; a residual of former United States First Lady Michelle Obama’s “Let’s Move” campaign. The program focuses on physical activity and nutrition, and offers classes to those interested in adopting or maintaining a healthy lifestyle.

What can other health departments learn from the work you are doing?

Events such as Hurricane Katrina, the passage of the Affordable Care Act, and subsequent Louisiana Medicaid Expansion, reshaped the structure and function our health department. NOHD now has a comprehensive and coordinated team that works alongside EMS, state emergency preparedness agencies, and all other health and safety response teams to assure preparation for potential disaster and respond swiftly. The devastation of Hurricane Katrina also precipitated the importance of community resilience and involvement.

New Orleans has nearly 72 neighborhoods with their own character, which community residents self-identified. Thus, understanding the culture and needs of each community has been the driving force in how NOHD plans and develops programs. Community resilience has been important to the sustainability of our city, as was seen in the recent election of our first female and African American mayor, LaToya Cantrell. Her passionate and genuine grassroots work as a city council member, where she developed a connection to the community by listening to their voices and concerns, led to her historic triumph. Mayor Cantrell also led the city to a smoke-free ordinance which includes bars and casinos.

New Orleans is a known for being a place to have a good time, but we are also serious about having a healthy quality of life for our families and children. It’s all about balance. Thus, NOHD has done a good job incorporating both in the work we do, which can be seen through our Fit NOLA program where we have public-private partnerships to encourage physical activity and healthy eating. This program offers free fitness programming, nutrition programs, and farmer’s market vouchers. NOHD also worked with the former administration to support Healthy Corner Store Initiatives. People in New Orleans know we are a unique city and with that notion, NOHD recognizes the need to really utilize community voice in everything we do. There is still much work to do, but NOHD is dedicated to making New Orleans a healthy city in addition to being a place where you can have a good time.

What are some fun things you recommend NACCHO Annual 2018 attendees do while in New Orleans?

I suggest going beyond Bourbon Street to see what else the city has to offer. People can take the street car to the Audubon Zoo. It is a very popular attraction. It’s beautiful and in the Uptown area of New Orleans. Visitors should also check out all of our wonderful New Orleans restaurants. I also recommend heading to Frenchman Street. It’s off the beaten path of Bourbon Street and not quite as risque. There you will also find artist markets and jazz clubs there that you can walk into for free.

City Park is where you’ll find the New Orleans Museum of Art, botanical gardens, and Morning Call, where you can eat beignets and drink café au lait. New Orleans is a very walkable city. You can walk almost anywhere from the conference location. For shopping, Magazine Street is a great place for boutiques and dining. You can eat your heart away in New Orleans and then walk it off!

To learn more about the New Orleans Health Department and the services it offers, visit their website.

2018 Preparedness Summit First Plenary Session—“Extraordinary Events of 2017: State, Local and Territorial Perspectives on Hurricane and Wildfire Response”

This story originally ran in Preparedness Brief blog.

At the 2018 Preparedness Summit, speakers representing the state, local and territorial perspectives on last year’s hurricane and wildfire events gave an overview of what happened, what went well, and what could have been done better.

Susan Fanelli, assistant director, California Department of Public Health, provided the state perspective on the California wildfires. California developed the Public Health & Medical Response System several years ago to share resources and situational awareness to increase coordination across counties. Between this resource and the GIS-based (geographic information system) dashboard that allowed the state to capture updates in real-time to disseminate out to stakeholders, local health departments were equipped with the most accurate information available.

Last year’s wildfire season was especially challenging because the affected areas were heavily populated areas. The challenge to evacuate assisted-living facilities was unprecedented. They needed a lot of things that were difficult to acquire, quickly.

Chris Rosa, deputy emergency medical services (EMS) administrator, Ventura County EMS Agency Rosa, from Ventura County, Calif., spoke from the local perspective. His cautionary advice included: Know your roles and responsibilities, develop and maintain relationships, trust the information relayed by partners, capitalize on available resources, and balance logistical “wants” with “needs.”

In addition to the behavioral health challenges, the largest impact (mental health and otherwise) the county sustained was the loss of a psychiatric hospital.

The U.S. Virgin Islands (USVI) experienced two Category 5 hurricanes back-to-back—Hurricane Irma and then Hurricane Maria. Almost 100 percent power was lost, there was significant damage to health department buildings and hospitals, 13 schools closed and about 900 critical-needs patients and caregivers had to be evacuated.

The most successful aspect of the response was the coordination between EMS, nursing, and preparedness staff and the collaboration with federal partners. EMS teams from Arkansas and New Jersey helped respond to the spike in emergency calls made in USVI.

Michelle Davis, health commissioner and chief health officer, U.S. Virgin Islands Department of Health, pointed out the necessity to talk about cultural competence and increasing diversity across race, gender and languages spoken when talking about national preparedness efforts. USVI is a territory consisting of primarily people of color; and the territory experiences many health disparities. Other improvements that could have helped response efforts include increasing procedural flexibilities for government operations (e.g., procurement, hiring/reassignment of staff) when in the midst of crisis and developing a more equal partnership with local government officials and communities.

Robert Eadie, health officer and administrator, Monroe County, Fla., shared his hard-earned wisdom with the crowd. All communication was lost for four days and the debris from Hurricane Irma created significant logistical challenges. Eadie recommended to think beyond what supplies you need, and consider how you’ll get it from where it lands, to where you actually need it. Other suggestions included testing out your resources (e.g., a satellite phone) prior to an event.

Eadie reminded the crowd, “Be with your people, with your staff. Tell them what a great job they’re doing. Remember, they’re affected like everyone else. You’re asking them to put that aside to serve everyone else.” And it takes everyone in the room to respond in a comprehensive way.

Check out this slideshow from the Summit!

Stay up-to-date on the Preparedness Brief blog in the next few weeks to get a summary of each plenary and late-breaking session.

Access 2018 Preparedness Summit Resources

  • Visit the Preparedness Summit website to stay up to date on when abstracts open for the 2019 Preparedness Summit and when to register.
  • To access photos and presentation slides of the sessions, go to the Preparedness Summit website, click on the “Schedule of Events” tab to go to the full schedule. Log into your account by clicking “My Schedule” on the left column and click the audio icons next to each session.

Save the Date for the 2019 Preparedness Summit

Next year’s Preparedness Summit will take place March 26-29 in St. Louis, Mo.

The Preparedness Summit is the first and longest running national conference on public health preparedness. Since its beginning in 2006, NACCHO has taken a leadership role in convening a wide array of partners to participate in the summit; presenting new research findings, sharing tools and resources, and providing a variety of opportunities for attendees to learn how to implement model practices that enhance the nation’s capabilities to prepare for, respond to, and recover from disasters and other emergencies.



Allegheny County Health Department Assesses Antibiotic Stewardship

By Kristen Mertz, MD, MPH, Allegheny County Health Department, Pennsylvania

This story originally ran in NACCHO’s Stories from the Field.

Overuse and misuse of antibiotics contribute to the growing problem of antibiotic resistant organisms, which are estimated to cause over 20,000 deaths each year in the United States. Bacteria that were once easy to treat are developing resistance to antibiotics, leading to more severe and more costly infections. Continue reading

Foreword: Exploring the Public Health and Healthcare Connection to Advance Population Health

By E. Oscar Alleyne, DrPH, MPH, Senior Advisor for Public Health Programs, NACCHO

The following is an excerpt from the winter issue of NACCHO Exchange.


Historically, America’s public health and healthcare systems have worked in isolation from one another. But as our nation continues to face complex and cross-cutting threats to population health, it is more important than ever to identify and advance the connection between public health and healthcare. Recently, public health has witnessed several benefits from bridging the two sectors. The Patient Protection and Affordable Care Act, enacted by the U.S. Congress in 2010, marked the greatest revolution in U.S. health policy since the 1960s. The law established the first National Prevention Strategy,1 added new funding for prevention and public health programs, promoted the use of clinical preventive services and other measures, and provided the impetus for greater collaboration across the health system. In fact, since the release of the Institute of Medicine’s 2012 report, Primary Care and Public Health: Exploring Integration to Improve Population Health, there has been an uptick in initiatives that support the creation of linkages across public health and healthcare to address national health priorities. Continue reading

SAMHSA’s National Prevention Week: Action Today, Healthier Tomorrow

May 13–19, 2018, is the Substance Abuse and Mental Health Service Administration’s (SAMHSA) National Prevention Week. NACCHO encourages local health departments (LHDs) to engage their communities in promoting mental health and substance abuse prevention efforts throughout this week. The theme this year is “Action Today, Healthier Tomorrow!”

Daily Themes

  • Monday, May 14: Promotion of Mental Health & Wellness
  • Tuesday, May 15: Prevention of Underage Drinking & Alcohol Misuse
  • Wednesday, May 16: Prevention of Prescription & Opioid Drug Misuse
  • Thursday, May 17: Prevention of Illicit Drug Use & Youth Marijuana
  • Friday, May 18: Prevention of Suicide
  • Saturday, May 19: Prevention of Youth Tobacco Use

Continue reading

Three Ways Local Health Departments Can Commemorate Mental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

May is Mental Health Month, a time for local health department (LHD) leaders and staff to bring awareness to mental health issues and help reduce the stigma associated with mental illness. Led by Mental Health America and the National Alliance on Mental Illness (NAMI), this month provides an important opportunity to reflect on the ways in which local public health agencies can support the mental health of our communities.

Mental health issues affect wide ranges of the populations we serve as LHD leaders and staff. According to the Substance Abuse and Mental Health Services Administration’s 2014 National Survey on Drug Use and Health, an estimated 44 million American adults, (nearly one in five adults) experienced some form of mental illness. Mental health disorders can include anxiety; attention deficit hyperactivity; bipolar disorder; depression; disruptive, impulse control, and conduct disorders; obsessive-compulsive disorder; schizophrenia and other psychotic disorders; and trauma- and stressor-related disorders. Continue reading