Demonstration Sites

In an effort to identify, support, and chronicle innovative local public health practices, NACCHO funds and supports a number of demonstration site initiatives. Although the demonstration site projects vary widely, all are united by NACCHO's common interest in establishing:

  • Opportunities to test and evaluate new and promising local public health methodologies;
  • Peer-based networks to serve the field as technical advisors;
  • Improvements in local public health practice and outcomes; and
  • An improved local public health workforce.

NACCHO is actively supporting activities at demonstration sites representing projects in the following areas:

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Public Health Infrastructure

Accreditation Preparation and Quality Improvement

A full listing of demonstration sites for NACCHO's Accreditation Preparation and QI initiatives.

Public Health Infrastructure

Accreditation Preparation and Quality Improvement

Environmental Health

Community-Based Environmental Health Assessment (CEHA)

A comprehensive overview of NACCHO Demo Sites for Community-Based Environmental Health Assessment.

Environmental Health

Community-Based Environmental Health Assessment (CEHA)

Community Health

Food Safety

NACCHO selected twelve local health departments to implement innovative programs in food safety.

Community Health

Food Safety

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Public Health Preparedness

Project Public Health Ready

This NACCHO Program helps you prepare for any potential public health emergencies or disasters.

Public Health Preparedness

Project Public Health Ready

[States included: California, Connecticut, Iowa, Maryland, Massachusetts, Michigan, Ohio, Washington, Oregon]

Alameda County Public Health Department, CA

Adaptive Diabetes Management and Education Program for People with Developmental Disabilities (ADMEPPDD)

Approximately 1,400,000 of adult Californians have been diagnosed with diabetes at a cost of more than $12 billion a year. Alameda County, located east of San Francisco, has a diverse population of almost 1.5 million, 60,000 of whom have Type 2 diabetes. However, Alameda County's diabetes program was aimed at the general population and did not address the learning and case management needs of people with developmental disabilities.

California's service system for people with developmental disabilities is delivered through regional centers, local nonprofit organizations under contract with the Department of Developmental Services. The Regional Center of East Bay serves around 4,100 adults in Alameda County; approximately 111 have been diagnosed with diabetes. Many of these individuals depend on direct care staff to assist them in controlling their diabetes and recognizing health problems as they arise. Many direct care staff have limited education and may not be knowledgeable about diabetes, meal planning, and recognizing potential problems associated with diabetes.

The ADMEPPDD serves individuals with developmental disabilities who reside in Alameda County and direct care staff who work with them. The program's curriculum covers the following topics:

  • Diabetes;
  • Nutrition;
  • Meal planning;
  • Medications;
  • Monitoring sugar;
  • Physical activity;
  • Coping with diabetes; and
  • Identifying potential complications.


Central Connecticut Health District, CT

Central Connecticut Health District (CCHD) serves a community of more than 90,000 in four contiguous towns: Berlin, Newington, Rocky Hill, and Wethersfield. It is best characterized as a rural/suburban health district with a growing population of residents over the age of 60.

CCHD implemented a unique, replicable, district-wide health promotion initiative, Able to be Healthy, targeting adults age 21 or older. The program rests on three strategic pillars: 

  1. Local community health workers; 
  2. Implementation of an established personal data assessment tool; and
  3. Implementation and evaluation of a local capacity assessment and implementation of a recognized resource directory modified to meet local needs.


Lee County Health Department, IA

NACCHO is currently offering technical assistance support to local health departments to improve their capacity to develop or enhance health promotion programs for people living with disabilities through coordination of existing health department and community services.

Lee County Health Department is receiving technical assistance from Franklin Regional Council of Governments and is making progress in addressing disability emergency preparedness needs by conducting “Community Conversation” meetings, developing emergency registries with first responders, and shifting their focus from a systems level approach to disability and emergency preparedness to building individual and group capacity. Lee County Health Department also completed an internal assessment of its public health emergency educational messages and materials to assure that they are in a format that is understandable.

For more information of Lee County's project, visit their website.

Charles County Department of Health, MD

NACCHO is currently offering technical assistance support to local health departments to improve their capacity to develop or enhance health promotion programs for people living with disabilities through coordination of existing health department and community services.

Charles County Department of Health is receiving technical assistance from Central Connecticut Health District, and they are bringing the Healthy Lifestyles curriculum to their community, by first going to a train the trainer program. Charles County conducted a Web-based Disability and Health Perceived Barriers survey to assess barriers experienced by individuals with disabilities in regards to health promotion and disease prevention.

As a result of the training received, support meetings will be offered which will incorporate Healthy Lifestyles to people living with disabilities in the community and especially to the 18–30 age group with special needs.  

For more information on Charles County Health Department, visit their website

Franklin Regional Council of Governments, MA

Disability is widespread in Franklin County with 17% of residents reporting one or more disability. Also there are limited public transportation options in the Franklin County region.  Most of the communities in the county have no fixed-route transit services, and only limited paratransit (van) services for elderly and disabled riders. As one indicator of need, the Franklin County Sheriff’s Office TRIAD program visits over 2,000 seniors with patrol stops.

The overall purpose of the program is to improve the health and security of persons with disability in Franklin County, Massachusetts by increasing the responsiveness of municipal and community agencies to the needs of the disabled population by addressing the following issues:

  • Boards of health in the Mohawk Area Public Health Coalition lack the capacity to deliver important services to a high-risk population;
  • Boards of health do not understand the extent of disability in their communities nor do they understand the need for health promotion for this population;
  • The disability community and the agencies that serve them are not integrated into the public health emergency planning process and do not understand the function and capacity of Boards of health; and
  • Years of research have demonstrated that social isolation and barriers in the built environment limit access to health services for persons with disability.


Allegan County Health Department, MI

People with disabilities and disabled elder citizens of Allegan County face many obstacles in obtaining appropriate wellness education with an integrated approach to health. These obstacles include inadequate education of trainers, negative attitudes toward the disabled, self-limiting behaviors influenced by the environment, lack of knowledge and availability of effective health promotion activities, and inadequate avenues for personal empowerment. The Allegan County Health Department (ACHD) lacks funding to create the essential elements for healthy lifestyles for this population.

The Allegan County Health Department trained 18 trainers in the Healthy Lifestyles curriculum. These trainers are conducting Healthy Lifestyles workshops and ongoing support meetings for older adults and people with disabilities in Allegan County. The Partnership for a Healthy Allegan County developed a task force to guide curriculum implementation, revision, and adaptation, while exploring additional funding and collaboration opportunities for 2008.

Akron Health Department, OH

NACCHO is currently offering technical assistance support to local health departments to improve their capacity to develop or enhance health promotion programs for people living with disabilities through coordination of existing health department and community services.

Akron Health Department is receiving technical assistance from Multnomah County Health department and is planning a health promotion summit while working to gain new perspective on how to assure that their summit will have a comprehensive agenda, managed, expected outcomes, and planned action steps to achieve an ongoing network of community resources.

Akron Health Department is surveying clients/patients with disabilities to identify health promotion needs and interests. In addition, they are working in partnership with leaders and members in the disability community to address the social determinants of health for people with disabilities.

Akron Health Department plans to hold their health promotion summit to create an Agenda for Action for health promotion with and for people with disabilities in Spring 2009.

For more information on Akron Health Department's project, visit their website.

Madison County - London Health District, OH

NACCHO is currently offering technical assistance support to local health departments to improve their capacity to develop or enhance health promotion programs for people living with disabilities through coordination of existing health department and community services.

Madison County - London Health District is receiving technical assistance from Allegan County Health Department and is working with the Healthy Lifestyles curriculum.  After learning the curriculum, members of the Madison County will train other trainers and then implement Healthy Lifestyles workshops and ongoing support meetings for older adults and people with disabilities.

For more information on Madison County - London Health District's project, visit their website.

Jefferson County Public Health Department, WA

NACCHO is currently offering technical assistance support to local health departments to improve their capacity to develop or enhance health promotion programs for people living with disabilities through coordination of existing health department and community services.

Jefferson county Public Health Department is receiving technical assistance from Alameda County Public Health Department and created a type 2 diabetes program entitled It Ain’t So Sweet, which has the capacity to build an even greater awareness of diabetes for developmental disabled people and their caregivers.

For more information on Jefferson County's project, visit their website.

Multnomah County (OR) Health Department

Approximately 115,000 residents in Multnomah County have a disability. The Multnomah County Health Department (MCHD) and its community partners conducted a pilot project to promote the health and well-being of people with disabilities funded by the National Association of City and County Health Officials (NACCHO). Project activities include:

  • Identify and survey health department clients with disabilities to support the planning and implementation of health promotion programming for this community;
  • Develop a voluntary registry of people with disabilities to facilitate an effective response in the event of an individual or mass emergency; and
  • Convene a summit for people with disabilities and providers of services for people with disabilities to establish a long-term agenda for health promotion programming.


[States involved: New York, Massachusetts, Maryland, Washington DC, Minnesota, Texas, California, Washington]

Mesa County Advanced Practice Center

Located in western Colorado, the Mesa County APC recognized that hospitals have a difficult time retaining staff and that many hospitals have not used volunteer nurses or other medical professionals during an emergency response. The Mesa County APC will develop and test a toolkit that includes information on the following:

  • Identifying roles in hospitals appropriate for using medical volunteers in an emergency;
  • Identifying action steps to implement a medical volunteer program in a hospital;
  • Developing policies and procedures for the use of Medical Reserve Corps (MRC) volunteers in a hospital;
  • Developing Just-in-Time training curriculum; and
  • Conducting a functional exercise using MRC volunteers in a rural hospital.

Montgomery County Advanced Practice Center

Located outside Washington, DC, the Montgomery County APC will focus on a range of preparedness issues and will develop the following resources:

  • Just-in-Time training to orient non-medical volunteers to their role of assisting people with non-urgent medical needs;
  • An electronic Alternative Care Site (ACS) Medical Surge Model to help users set-up an ACS;
  • Engaging community pharmacists to help communities prepare; and
  • Online training on computer modeling in preparedness.

Multnomah County Advanced Practice Center

Located in northwest Oregon, the Multnomah County APC will focus on Just-in-Time training to help local health departments (LHDs) prepare for and respond to public health emergencies. Resources will include the following:

  • Training materials designed for incident response managers including information on the behavioral and emotional needs of first responders;
  • Risk assessment practices to help managers split resources; and
  • Just-in-Time training products for staff working on epidemiological investigation activities or Point of Dispensing operations.

For more information, email Beth McGinnis at

San Francisco Advanced Practice Center

Located in a state home to many public health emergencies including fires, floods, and earthquakes, the San Francisco Bay Area AC will develop comprehensive toolkits on the topics of infectious disease emergencies and vaccination assessment.

The Infectious Disease Emergency Response (SIDE) Toolkit will contain:

  • A core plan that address the functions that may be activated to address an infectious disease emergency event;
  • Situation-specific annexes;
  • Modifiable templates and forms, including public health-specific ICS forms, job action sheets, and organizational charts; and
  • Modifiable training materials for local health departments to use in training staff on their own SIDE Plan.

The Seasonal Pandemic Influenza Vaccination Implementation (SIVA) Toolkit will provide guidance on the following:

  • Community assessment for preparedness;
  • Survey management and implementation; and
  • Online and electronic tools for community assessment.

Seattle & King County Advanced Practice Center

The Seattle & King County APC, located within the largest metropolitan health department in the United States, will create multiple resources that include the following:

  • A comic book to communicate personal preparedness messages to limited English proficient populations;
  • A toolkit to assist LHDs enhance the capacity of their call center;
  • A toolkit to help LHDs create effective and sustainable dispensing strategies;
  • Resources to address the informational and behavioral needs of disaster victims' families and;
  • A toolkit focusing on business continuity in an emergency.

South Carolina Advanced Practice Center

The South Carolina APC, housed in the South Carolina Department of Health and Environmental Control, Region 7, serves a population of more than 600,000 across three counties. The South Carolina APC will focus on security issues during various public health emergency response activities. Resources will include the following:

  • A healthcare and law enforcement workshop template to engage law enforcement agencies in public health preparedness planning;
  • A Point of Dispensing security and traffic management template; and  
  • A hospital security plan template for medical surge.

Tarrant County Advanced Practice Center

The Tarrant County APC, located in Fort Worth, TX, will develop a number of projects including the following:

  • A toolkit to assist LHDs in establishing health data surveillance programs in school settings;
  • A disaster mental health and psychological first aid module for radiological and nuclear events;
  • Business preparedness resources for Hispanic businesses; and
  • An evaluation framework and guidance document to help LHDs assess the quality of emergency communications (fact sheets, virtual Joint Information Centers, and Point of Dispensing signage).

Toledo-Lucas County Advanced Practice Center

Located in northwest Ohio, the Toledo-Lucas County APC will develop a toolkit to enhance LHDs capability of responding during a pandemic. The Transitional Framework for Pandemic Readiness and Response toolkit will provide resources to help communities identify when and how to move from traditional to transitional medicine and will focus on various frameworks including urban, suburban, and rural. The toolkit will include the following:

  • A guide to the Transitional Framework for Pandemic Readiness;
  • Train-the-Trainer manual for a transitional medicine tabletop exercise; and
  • Train-the-Trainer manual for a traditional medicine tabletop exercise.

APC Alumni Network

Since the APC Program's inception in 2004, a number of LHDs have served as an APC. While a part of the APC network, these LHDs developed outstanding tools and resources for other LHDs nationwide. Alumni APCs include the following:

  • Cambridge Public Health Department (MA);
  • DeKalb County Board of Health (GA);
  • Santa Clara County Public Health Department (CA);
  • St. Paul-Ramsey County, Hennepin County, and the City of Minneapolis (MN); and
  • Western New York Public Health Alliance.

APC Alumni Network

The Advanced Practice Centers (APC) Connector Sites Initiative is designed to expand the APC network, and to support field testing and quality improvement of selected APC products. Each Connector site is paired with an APC Site, and the APC Site’s product.  

Developed by local health departments and funded as Advanced Practice Center Sites, the products are designed to strengthen the capacity and capabilities of local health departments to prepare for, respond to and recover from disasters and other public health emergencies.  The 2010–2011 Connector Sites, and the new APC products that they are testing, are listed below.    

  • Champaign-Urbana Public Health District (IL) – Reviewing  Transitional Framework for Pandemic Readiness and Response (developed by Toledo-Lucas County Advanced Practice Center).
  • Gunnison County Department of Health & Human Services (CO) - Reviewing Blueprint for the Use of Volunteers in Hospitals (developed by Mesa County Advanced Practice Center). 
  • Palm Beach County Health Department (FL) - Reviewing A Prescription for Preparedness: An Online Community for Local Health Departments and Pharmacist to help Ready America for Emergencies (developed by Montgomery County Advanced Practice Center)
  • Coastal Health District (GA) - Reviewing  On the Safe Side: A Security Toolkit for Public Health Emergencies (developed by South Carolina Advanced Practice Center).
  • Southern Nevada Health District (NV) -Reviewing  Infectious Disease Emergency Response (IDER) Toolkit (developed by San Francisco Advanced Practice Center).
  • Cerro-Gordo County Department of Public Health (IA) - Reviewing  Sustaining Critical Services: Continuity of Operations Toolkit for Public Health  (developed by Seattle & King County Advanced Practice Center).
  • Thurston County Public Health and Social Services Department (WA) - Reviewing  Inclusive Just-In-Time Training for Public Health Investigations (developed by Multnomah County Advanced Practice Center).
  • Oklahoma City-County Health Department (OK) - Reviewing Biosurveillance Solutions Toolkit (developed by Tarrant County Advanced Practice Center).

States involved: North Carolina, California, Texas, Minnesota, Indiana]

NACCHO initiated this Preparedness Integration Demonstration Project to build local health department (LHD) capacity. NACCHO funded six LHDs to improve their integration efforts around traditional public health activities. The LHDs will disseminate information about their methodologies, performance measures, collaborative strategies, and lessons learned to other LHDs. The goal of the project is to enhance collaboration with internal and external partners to develop and implement a plan for integrating preparedness efforts within public health departments.

Alamance County Health Department, NC

  • Assess the health status and health priorities of residents using neighborhood-level data;
  • Improve the health department’s capacity to plan for and respond to natural or man-made disasters;
  • Decrease the incidence of infant mortality and the racial health disparity in rates of infant mortality; and
  • Decrease the incidence of disease with environmental health factors as contributing risk factors.

Alameda County Department of Public Health, CA

  • Educate 12, 000 school children (K-12) improved hand hygiene habits
  • Increase Fremont Flu vaccinations
  • Evaluate absenteeism rates
  • Complete After-Action report evaluating the project

City of Fort Worth Public Health Department, TX

  • Conduct focus groups with community members and stakeholders
  • Organize and hold a community luncheon
  • Evaluate community participation and benefits in the community event

Fillmore County Public Health, MN

Improve all-hazards public health preparedness among the Amish residents of Fillmore County

Marion County Health Department, IN

Improve disease reporting of surveillance system

Montgomery County Health Department, IN

  • To build and maintain the health department’s epidemiological capacity
  • Conduct a table top exercise

Overview of Demonstration Sites

Local public health officials and representatives from mental health organizations concluded that partnership and communication among federal, national, state, local and community partners is the first step to improve collaboration on public health, mental health and primary care. In 2005, NACCHO awarded $27,000 to three local health departments (LHDs) to:

  • Establish a strategic planning coalition to address mental health from a clinical and public health approach; and
  • Share lessons learned about coalition building and strategic planning with NACCHO and other LHDs.                   
  • It is anticipated that funded programs will become self-sustaining by leveraging additional funds once the project period ends.

Criteria for Demonstration Sites

The sites selected demonstrated a history of collaboration with various partners in their communities to integrate mental health and public health. Specifically, sites were asked to demonstrate involvement in broad-based planning coalitions. Special consideration was given to applicants able to demonstrate involvement in a coalition that could be modified to accept the charge of addressing mental health through a clinical and public health approach and/or demonstrate an established collaborative relationship with the mental health community.

Selected Sites

Buncombe County (NC) Health Center

Lyon County (KS) Health Department and Flint Hills Community Health Center

Washington County (NY) Public Health Nursing Service/Warren County Public Health Service

The Work of the Demonstration Sites

Each selected grantee:

  1. Established a local coalition(s) to develop a strategic plan addressing mental health from a clinical and public health approach.
  2. Developed a work/action plan for the project, including responsibilities for each partner organization
  3. Demonstrated how funds will be leveraged to sustain the program beyond the funding period.
  4. Shared lessons learned with NACCHO and described how they will be shared with other LHDs.

[States Included: California, Washington, Minnesota, Florida, Texas, Illinois]

Local health departments (LHDs) were invited to submit applications in response to a request to conduct a one-year demonstration project to provide support to LHDs towards increasing the level of coordination and communication between disparate programs involved in addressing the public health consequences of climate change.

Fact sheets about the selected sites and their projects are available below. The fact sheets include a summary of the project, lessons learned, project outcomes, and information on project sustainability and capacity building. 

Infectious Disease Prevention and Control (IDPC) Project

Through a cooperative agreement with the Centers for Disease Control and Prevention (CDC), NACCHO has undertaken a number of activities to increase the capacity of local health departments to prevent and control infectious diseases in their communities. The IDPC project aims to enhance local health preparedness and response to emerging infections by accomplishing the following:

1) Increase the number of national IDPC and related epidemiology policies, priorities, guidance documents, and decisions informed by local health department input;

2) Improve understanding of ongoing and emergent IDPC and related epidemiology needs, challenges, and successes of local health departments by NACCHO, CDC, and other partners;and

3) Increase the number of IDPC and related epidemiology evidence-based strategies, tools, and resources available for local health departments.

NACCHO identifies and disseminates resources and model practices to local health department IDPC programs through a variety of strategies and communication mechanisms. The project supports NACCHO's IDPC workgroup, which consists of staff from local health departments across the country. The IDPC project also enabled NACCHO to inform more robust and systematic strategies for gathering local H1N1 situational awareness, useful practices, lessons learned, and input on guidance and policies during the 2009 outbreak.

Healthcare-Associated Infection (HAI) Project

The goal of the HAI project is to increase the capacity of local health departments to prevent and reduce HAIs and antimicrobial resistance and improve antimicrobial stewardship in their communities. This includes increasing local health department engagement in state HAI prevention activities, increasing stakeholders' understanding of HAI-related needs, making available resources that help to inform engagement of local health departments in HAI prevention, and supporting collaboration between local health departments and partners such as hospitals and long-term care facilities. The project will investigate the challenges and benefits to establishing collaborative relationships centered on the prevention and control of HAIs and antimicrobial resistance.

In 2011, NACCHO, in collaboration with CDC, conducted a needs assessment of 13 local health departments to better understand the following:

  1. Local health departments' awareness of HAIs;
  2. Extent to which local health departments were engaged in HAI prevention, surveillance, and response;
  3. Barriers to primary HAI prevention; and
  4. Local health departments' needs in order to become more involved in expanding national and state HAI prevention activities.

NACCHO, in collaboration with CDC, initiated a demonstration project for two local health departments to engage in state HAI prevention efforts in 2012. The DuPage County (IL) and Livingston County (MI) health departments were selected to explore the role of local public health and local health department collaboration with long-term care facilities in HAI/MDRO prevention. In 2013, the demonstration project was expanded to the City of Milwaukee Health Department (WI) and the Philadelphia Department of Public Health (PA). In 2014, three demonstration sites –DuPage County (IL), Florida Department of Health in Orange County (FL), Philadelphia Department of Public Health (PA) –informed the development of a guidance document that outlines roles and opportunities for local health departments to prevent and reduce HAIs in collaboration with state health departments. In 2015, the three demonstration sites will continue and/or expand their HAI prevention work by focusing on antimicrobial stewardship, partnering with long-term care facilities, and collaborating with their state health departments.

Flu Near You

NACCHO has partnered with Skoll Global Threats Fund to increase the capacity of local health departments to engage in digital disease detection and inform the potential of using the internet and other mobile technology to plan for and detect pandemics.

To achieve this goal, NACCHO hosted a session at the 2015 Preparedness Summit to feature how local health departments have used Flu Near You data for public health action and facilitate a discussion on how Flu Near You can be useful for local health departments. This project has also involved sharing aggregated Flu Near You data with select local health departments to determine the potential for the data to be used as part of a surveillance strategy. In addition, NACCHO will conduct exercises with local health departments partnering with local pharmacies to determine how the partners can use Flu Near You with the population they serve.

Want to get involved with Flu Near You? Sign up today at and encourage your friends, family, and colleagues to do the same. If your local health department is interested in or already using Flu Near You data for local influenza surveillance efforts, email