Arapahoe County Board of Health - Regular Meeting

This is where you wake up and you're like, somebody woke me up.

And then she was back in two weeks. I donated a kidney.

To be sure you can do anything.

Because you're a woman. Like everything was great. Yeah. Well, you were resilient. She loves working with you. So thank you for that partnership. I keep telling her, invite other school friends.

We need other school friends.

Check with you, make sure. Afternoon, I'd like to call the Arapahoe County Board of Health Business meeting to order. Ms. Banks, would you please call the roll?

Director B.B. Kleinman, here. Director Sean Bates, here. Director Christine Bates, here. Director Mark McNeil, here. We are both here.

Okay, director, he's excused food and director Michelle. Thanks. I would now like to ask the directors in the room to introduce the staff that are present today. Sure.

All right. I'll just go around the room here. We've got Steve environmental health manager. Sarah Garrington, Emergency Preparedness and Response Manager. Melissa Orozco, Communicable Disease Epidemiology Manager. Connor Thurkin, Environmental Health Supervisor. Lindsay Brown, Emergency Preparedness and Response Specialist.

Okay.

Before we move, I'm just going to further embarrass Steve. But in our all-staff meeting, we do our Golden Duck Awards. Steve was our quack-tastic leader of the year.

Not only is he a favorite of the staff, he's a favorite of the board, too. So you get the double boot. I do tell them.

Oh, you do? You're my favorite?

We've got to rank y'all. Oh, school parenting.

That is expensive parenting, because then that's therapy.

We were going to put together a slideshow of the staff, but we have this lovely duck jacket that was made for last year that I handed on to last year's winner, So she gets it for a year and it will get passed on to the quacktastic leader year over year. But it is a giant, it's a jacket with rubber duckies. It's over 200 rubber duckies. It is being passed on. Went through a lot of work.

Okay, sorry.

No, that's fine. No other staff?

We have staff. Community Nursing has Laura Breyer-Dawn, Health Connector, and Caitlin Wolfe, Nurse Manager of Immunizations.

And PPCSP has Grace Solon, Health Equity and Community Engagement Coordinator, Alexa Escobar-Payas, Senior Population Health Epidemiologist, and Brooke Wagon-Seller, our Health Planner.

Okay, that's beautiful.

Thank you.

And we would like to introduce our Chief Medical Officer, Dr. Paul Meyer. Thank you. Absolutely. The next item is to approve the August meeting minutes. I hear a motion to move for the Board of Health to approve the August 2026 meeting minutes as presented. Is there a second? Second. Seconded by myself, seconded by Christine. All in favor say aye.

Aye.

Any opposed? Hearing none, motion passes. Next is our public comment. Do we have anybody from the public comment?

No. OK.

So we're now going to move to our director's comment. Next is the director's comment. At this time, board directors are invited to share insights from community leaders and partners to gauge the current state of the community. And I'll go from left to right, starting with Mark.

I gave a little bit of a speech earlier at our thing. And just for people who weren't there, the lack of prenatal care is an issue for the state. There was a meeting I attended this morning from Medicaid that pointed out how good prenatal care can save so much money in terms of neonatal catastrophes. that it's well worth doing, but yet it's been a difficult thing to do. And they showed a map which showed how little availability of prenatal care appears to be in the eastern part of our county. So we talked a little bit about that and how we might be able to learn more about it and potentially advocate for change as we go. So that was that. The rest of the meeting is, of course, all meetings with Medicaid these days are very challenging and sad to see how challenging it is to provide the care that people need and the increase in overhead that's being required from national policy and things like that. So that's all the good news I have.

Two items are jumping out at me. I'm really proud of our agency to continue to build out this relationship with the CSU Spur campus. They are really building out their environmental public health programs. So last year, I think they had eight students, this year they have 50. And my team is very dedicated there. We are providing lectures and field trips and so forth. We're really trying to provide some practical training to students. These are undergrad students, mostly interdisciplinary. We had Dr. Elizabeth Ryan come do a Lunch and Learn Monday. yesterday, recently, fascinating the research that she's doing in that space. So it's just a neat partnership. This doesn't quite fit Sean and others, but I really wanted to give incredible thanks and kudos to this team and the presentation at the Executive Budget Committee. Last week, I think it was, I think last Thursday, the County Commissioners and the County Budget Team had a lot of questions. And Jennifer, Brianna did an outstanding job, but also then turned to managers and people knew the answers right away. Michelle kind of posed a question about partnerships with other agencies and just really showed one, no surprise, how on top of things this team is, but also the connectedness and sort of a holistic view of the work that we have. local public health so just kudos uh for sure it was a pretty outstanding uh moment and michelle was one of many who's given a question and it's immediately there so thank you heather as well jill would just bombarded with questions like yep 613. i can't remember what the question was i might have come to you like yeah i had to look that up uh kind of thing but uh it was a very impressive and it was it was quite easy to uh to be there with you of course

My update is that we, the state of Colorado is launching a recognition for businesses who are honoring that's changing demographic shift that we're seeing. So, businesses that are aligning that are planning for older adulthood, longer life. And doing that from a business model standpoint. I'm thinking a lot about banking institutions, hospitality, retail. Where do we have touch points? The government is not necessarily where we have a lot of touch points, but the grocery store sure is, and the bank, and where we get our haircut, and all of these things. That's where I'm thinking about how we can better engage the business community to be more aligned with aging and older adulthood. The Board of Health and Jennifer will have a scheduled send email that will come to you at 5 p.m. tonight with the nomination form. If you wouldn't mind sending that out, that would be great. We're really thinking about the unconventional partners, the AAA networks, the nonprofit space is doing great work, and the aging community is so teeny tiny. We got to expand it. I think, Mark, you were talking about building the business case for our budget this year. We're building the business case for all of these businesses around Colorado to think about what it means to get older. So the governor is going to present these awards on November 16th. We have to nominate people? Yes. I'm asking for nominations and then suggestions. This is the first time we've done this, so I'm hesitant to give a lot of suggestions because I don't want to change the pool. But Ent Credit Union has these cool ATMs where this feels so silly in the grand scheme of things, but they have a button. If you need help because you have a visual impairment or cognitive impairment or just don't know how to work an ATM, They can zoom a teller into the ATM, which is cool for rural Colorado. If you don't have a bank close by, if you're just going to the ATM at your grocery store, which is pretty cool. The other one that comes to mind is JP Morgan has developed an age-centered investment approach. And this one gets a little bit tricky from a conflict standpoint, so they can't win because Next50 is working on it. So they're out, just to be very clear. But thinking about age responsive investment versus like age centered, age friendly and age centered investments. So like we, for instance, found out that one of the companies that we were invested in was using actual area tables for their retirement planning from 1999. So they aren't fully funding their retirement accounts and they're like, we're not invested in them anymore. So like those are kind of innovative strategies that I'm thinking about in terms of how other companies how companies that are sort of aging adjacent could become more age responsive. It's cool. Yeah. So we're very excited. This has been a long time coming. So very excited.

Yeah.

It's coming to your inbox at 5 PM. Okay.

I think the only two updates, one update. So the Medicaid commission is currently meeting and Summer is like, she's a facilitator who serves as the liaison between the Medicaid Commission and the public. So I had the opportunity to speak one-on-one with her. And for me, what's most significant about that is in that role, I mainly serve in addition to working in Medicaid as a caregiver. And so I tell people I get to speak as a parent and also describe what mainly happens to ins and outs of autism and what caregiving is like and how Medicaid policies, mainly through the home and community-based services waiver program, is changing that. And so one of the questions she did ask me, because a lot of people know I serve in a bunch of roles, is about leadership and my philosophy. And so I said, you know, so many times we get caught up. on the different philosophies. For me, leadership, like in this capacity, means accountability. So I said, I think when things go right, I said, like with Arapahoe County, we're doing great work. I think the staff who are on the ground every day deserve all the credit. I said, when things start to go south, And there's a lot of problems that starts at the top. So that I put on the board. And so I said, in that context, for me, leadership is accountability. When things go wrong, you talk to the board. When things go right, you talk to the staff. If you want to know how to improve something, start at the bottom and work your way up. When things don't go right, it always starts, in my opinion, at the top and the top, not listening. So hopefully that'll just give you all a little insight into how I make decisions. But it's based on history. And like I said, I love being a caregiver because it's so different. And so it forces me to really be kind and take the considerations of every single person. Because part of it is I have to depend on other people to be kind to my son. So I believe if I am, I believe in karma. So I believe it comes back. And it doesn't come back to me. It comes back to my closest loved one, who happens to be one of my sons. So we do have favorites because he has autism. So our whole family is dedicated to taking care of him.

He deserves where I work.

I was going to just skip, but then after listening to you, I want to say a high point for me right now is that some odd bedfellows have come together over the last year because of all the trauma that is impacting healthcare. And so it's interesting that insurers, the hospitals, the docs, the safety net advocacy groups, probably missing a few of the people, have been meeting for a whole year on how we can not get in each other's way. And it's something that Michelle said earlier, we were meeting was that how do we not get into a position where we're competing between healthcare and education or healthcare and something else. And so the same thing with this group, it's an odd group of bedfellows that have been coming together to talk to each other. So when there's legislative opportunities, we're not standing in each other's way, which has been the case For many, many years, when the insurers, which we can say what we want about the insurers, at least they're sitting at the table and they're looking for less pushback. They're losing customers. And so I think that at difficult times, interesting people get together and talk to each other. You can read my notes before. No, it's personal. So anyway, so I wanted to say that. I also wanted to reinforce just how proud I am to be a member of the web.

No, seriously, it's perfect. And I am going to say one thing that may be not in Congress, but just a little bit different. I hate the term safety net. I've always hated it because it implies somebody needs to be caught. And we all need to be caught. So then we all should be in a safety net or not. And so I was driving here today from Overland High School, and I drove past the gas station in front of Overland High School, and the diesel was $6.05 a gallon. Mm-hmm. in the heart of Aurora. And it gave me pause, even though we've all watched it creep up, and that's just one of the many factors, right? We know how much our grocery bills look like, and those are for those of us who can go to the grocery store. Because this exists, because you exist, because of the partnerships that you have with public schools, with federally qualified health centers, with myriad other groups, I just think about the scope. The scope hasn't changed. Our urgency doesn't really change. I always have this sense of urgency from you all, and I feel it, and I think we all do in our own personal work. But the urgency for our families is at a level we have never seen, never. I watched it during COVID, too. I was right there, and it's worse. And so it it is incumbent, literally, this is what I was gonna say, it is incumbent upon us to continue to reach out to, your relationship with the Board of County Commissioners is wonderful, it's healthy, they hear you, they see you, and we have to still continue to remind everyone, starting with them and then everybody in our aura, that our families are in a level of crisis at every level, food access, healthcare access, immunizations, you know, as we, I'm watching the COVID and influenza A creep up on the pediatric bug watch at this time. The mental health needs of our families and our family, our immigrant families in this terrible time of crisis for them. And so I just, I always want to just remind us the work we're doing is so right, but, but it, If it's possible to build that one new relationship, make that one more phone call, stop at one more place and have that touch point so that when you meet them next time or they need you, that we have it. Because we cannot do this in a vacuum. And we're not. But I think that expansion has to be created more and more. And I do think they're coming to the table. And I don't really care what their motives are. That's fine. Because they are. Because they are losing customers. But I just, yeah, I'm so grateful. And where did Brianna go? She had to leave. Well, that's too bad because I was just going to say just how she and Mark and your team and, you know, with Sean's leadership, like being able to be where you are in the budget process is just off the chart. Wonderful.

You should be very proud.

Yes, and before we move, we would, as a board, like to say thank you to Mark McMillan, our budget representative for the design record team. And the staff gets all the credit, but the steps may not understand we own our board doesn't have any actual committees outside of a committee of 1. and so when we decided to have that committee of 1, we all said. I'm not doing that. And then we all looked at Mark and said, would you do that for us? And not only did he step up to the table, he's done a fabulous job and reinvented the space. And so it is huge. Thank you for all the work you put into it. Thank you for that.

Agreed.

We're now going to move into our, oh, we have to adopt our bylaws. So do you want me to go through it, or how do you want Monica to go through it?

I'm going to pitch in for Monica. So we've had, we presented, I don't remember which month we presented the bylaws. It was a while ago. And then sent them out. You gave feedback. Monica presented the red line version. Now we're We are ready to adopt them as presented in your packet. So I think some of the major changes, there's an introduction language about carrying out your responsibility in a manner that promotes health equity, community trust transparency. So kind of a purpose statement for the bill. We added some language about governmental immunity act. special meetings of the board during declared emergency, disaster, disease, outbreak, or urgent public health matter of how we can call emergent meetings of the board. Forum, but we can do this via video conference or teleconference. Love that we have. So that it can be hybrid. So if you're virtual, it still counts for forums. And meetings and actions of the committee that had to do open meetings, board committee meetings, you may participate in, that you review annually.

There's also duties. The court terms was holding a two-year term. Two years versus three as an officer.

Just jump in also. Sorry, I can't be with you guys today. Hope you feel better.

Thank you. Yeah, so these are all the changes that we had all gone through already and were proposed by you all. And so I had presented it to the County Commissioners since the bylaws do require that they technically be approved by the County Commissioners and none of them had any issues with your requested changes and And so the County commissioners were in support of all of these changes. Um, but yes, it was all items that we had previously discussed and the major changes Jennifer just went through. So it's just ready for you or, um, approval now.

Okay. Yeah.

Yeah. Go ahead. Comment. Yeah. Okay. Um, a couple of things, uh, number one, the comment regarding The open meetings nature of the board has an undefined acronym, BOH, which is not defined. We need to spell that out, Board of Health. Okay. That's one. The other, that's on the section 3, meetings and actions of committees. And then the last thing on procedure for amendment, Article 6, Section 2, includes the statement, the board intends to review these five laws annually as part of the first meeting of each year. That really belongs in a policy document rather than the bylaws. It's the policy of the, if we were to have a policy document, that's where that should be in the policy of the board rather than the bylaws, et cetera. If it's to be stated as an intention, if it's to be stated as a requirement, then it could be stated in the bylaws.

Okay. So I think, do you want it to be?

Go ahead. Yes.

I just wanted to respond to that. yeah so so the review um on an annual basis so um at the first meeting of each year you all do meet and one of the items on the agenda is to select the chair and vice chair for that year and so as part of that discussion we um we do ask if there's any other things that you all want to make changes to or address as part of the bylaws so it is something that is done on an annual basis so i i would request that that stay in do you does the word intends the board intends to review the bylaws rather than we could state it as a requirement

But I think when you say intends that's not strong enough language will be in the bylaws review the bylaws.

OK. Are you fine with that change? Monica, just send the board will review the bylaws as opposed to intend.

Sure. OK, I need to go back to it.

No, no, we won't need to send it back to the BCC. I think these are it's a minor change that we can just make.

Before we vote on it, has the staff seen the bylaws? It's not important, but I think the most important thing for you all to understand as we talk about it, the purpose, as we see it, the purpose of the board. And so usually it was like the general purpose of the board is to oversee the operations and activities of the department and to exercise the powers and duties. imposed upon the board as set forth in statute. So we added, the board shall carry out its responsibilities in a manner that promotes health equity, community trust, transparency, prevention, evidence informed decision making and accountability to all residents of Arapahoe County. with particular attention to communities experiencing disproportionate health burdens. And so just also for staff to understand what bar we set to holding ourselves accountable to and how we would like to be held accountable. So the staff is aware. So I'm going to move. Does any more comments on board? Any more questions, comments? No. I'm going to move for the Board of Health to approve and adopt the revised bylaws as presented and with the recommended change from Mark Levine. The recommended. Two recommended changes from Mark Levine. Is there a second? Second. Second. Motion made by myself. Seconded by B.B. Kleinman. All in favor, say aye.

Aye.

Any opposed? Hearing none motion passes, we're now going to move into our study session. The 1st, study session item is the update from our August here and that would be from our 8th board members on this side of it.

Yeah, so wanted to provide you with some more positive news that I had in the past.

It seems like our enforcement process is making some good progress with the property owner, especially the cease and desist and providing some momentum there. They have applied for a repair permit and have also paid for it. While there's still some additional things that we need to get from them, we are hopeful that this will continue. And we'll keep trying to work with them to complete all the items.

They're still living, though.

They are still living. Thank you for all your hard work in that space. Are there any lessons learned either at the staff level or for the board? This case seems like such a one-off, and it's so rare that my experience with the board gets these cases this far. But are there some lessons learned there that we should be thinking about?

There might be some fine-tuning that we can do during the title of transfer, or I'm sorry, transfer title process where it's such an interesting timeline when it switches from a seller to the new owner where there are still repairs that are needed. And I think our diligence there in continuing to follow up with both the seller and trying to get Owner information as soon as we can, so we can start that process as soon as we can. Would would be helpful now would it would have helped in this situation? It's hard to know, but I also don't want to discount all the work that the staff put into working with the seller. We were right up to the point of the deadline. It was just trying to get that owner information afterwards. That was difficult. And so it's delayed that everything passed there. So I think if there's one thing that we pull from it is just to try to get as much information about the new ones we can.

Yeah, thank you. Yeah, my two things, or if I may, one is I got the very, very strong impression, I mean, That turned themselves inside out to work with a new property owner. My recollection with this case, I don't know if it was awkward or otherwise, just the way that the handoff from the seller was like, what did that disclosure look like at the end of the day? I mean, I don't know if I ever felt comfortable at the end of the day in terms of like, did the new owner understand kind of what he was walking into? You don't have to respond there as much as there's something to improve that process. To start with us, if it's somewhere else for the Rappaport County, that is. I really appreciate all your hard work on this one. And to your point, it is a positive update. Thank you. Thank you.

I would just say, Mark, in response to yours, I've seen three instances personally that you're describing where the person bought the property. One of them was a family member who lived next door to us and didn't know the condition of the tank. And also it was misrepresented because there's like legal qualifications for the size of the tank. the one that they had fit the legal definition, but it technically wasn't put together, but it met the definition. And so that was a $22,000 job. And so if you think about, you know, what Steve is describing, when you're buying a house, you're like, hurry up, hurry up, let's get this done. And there's There's like 200 pages of documents you're signing. So when you see that one on this will, you're like, OK. And so you really aren't. But to understand what you're walking into, I would say you're absolutely right. Nine times out of 10, if you haven't lived and ruled and truly understand septic tanks, you're not likely to understand what that means, even from a process perspective. And so I commend you, Steve, for saying, hey, at least let's look through how we can be Better educate or better prepare the buyers to what they're walking into because they don't have any idea.

And I'm sorry, we are working really hard to connect with realtors. Yes, we provide. webinars every year to connect with realtors to let them know, like, this is what it means when you're selling a property with a septic. And these are all the steps that you have to go through before that sale should go through. So that's another avenue that we've been trying to more proactively. That's great. Christine?

I still have a lot of consternation about the title company just ignoring the hold that, you know, put on the title in the first place. Like, I mean, this seems like it's resolving, but, like, that would have solved the problem in the first place. and generally that's that's uh like what are repercussions there they're repercussions we can't like instagram no no it's gotta be able to like sue the title company have them pay for a septic tank i mean they're kind of liable right yeah and i'm not gonna i'm not providing legal advice monica

I will just say that that that is beyond the scope of of this board.

Yeah.

I don't think that there's any any remedy that that that the public health would have in that respect.

Yeah, yeah. Thank you. Any other questions? No, no. Okay, so thank you, Steve. We're now going to move into our third study session. It's a facilitated POD discussion by Sarah.

Are we skipping the community health improvement presentation?

Oh, I'm looking at the packet. Yeah, it is. It is our second half of the community. Sorry. I mean, I'm not going to go first if you want me to. Okay.

Oh, okay.

You're exactly right. So the second study session is the second half of our community health improvement plan presentation by Heather. Sorry, Heather. I apologize.

No worries at all. I know we spent time together on this last month, but thank you so much for this time. This is the second half of that presentation. It will be more But we appreciate the chance to walk you through new objectives, sunsetting objectives, and next steps.

Thanks, Heather. And we'll just kick off today with our new objectives. So, very happy to share that we have two, or more than two, but two on this slide, safety objectives. The first one speaks a little bit to the budget request that Brianna mentioned in one strategy that falls under this effective last Board of Health meeting. But we are, so there was a request to build in more FTE. And in addition, we received some funding from CDC to add it to our current Family Connects FTE. And so previously we're at one FT from that program for nursing, and now we are at 1.5. So we have a new nurse who started part-time last week. So super excited to see that program continue to expand and for that to be one of our objectives. The second strategy on the screen is in response to school administrators and educators. voicing concerns about disposing of confiscated vapes in ways that minimize safety risks and environmental impacts. As a first step, we at ACPH, our tobacco control team is partnering with South Metro, our environmental health colleagues and other counties to assess associated risks like lithium battery hazards and hazardous vapes. juice waste. So super excited to be sort of embarking on that work. Continuing on in our safety objectives, we have outlined an increased capacity to support initiatives that prevent firearm injury-related injury. We've been doing this work for some time. And as you heard last month, we went through a injury and violence prevention, that assessment and came out with some really good recommendations. And one of the areas where, you know, we can continue to kind of grow our work is in that firearm and injury prevention work. And then our last safety objective is to implement at least three initiatives to enhance safety for youth and families by leading causes of child fatalities. So our child fatality review team is very much helping to kind of inform what that may look like. Under our economic well-being priority, we have a few new objectives. The Arapahoe County Food Coalition will expand overall membership, member engagement, and diversity of member experience background. For example, the Food Coalition is working to recruit active members with targeted expertise in areas like fundraising, food distribution, commercial real estate, marketing, and social enterprise startups. We also have a new objective to increase our community presence related to economic mobility to identify collaborative opportunities. In partnership with the PHE, We'll continue to lead a LPCA learning circle for that economic mobility priority area. We'll convene an internal Arapahoe County public health work group focused on healthcare coverage and access. And so those are a few additional things we will be working on that are outlined in the purchase.

Oh, I have one more.

We have a few more new economic wellbeing objectives. So the trend here is that a lot of objectives tend to fall under this priority area. We aim to increase access to economic supports for families in Arapahoe County by securing funding or improving workflows. We will develop a plan to share ongoing access to the ACPH Resource Center with at least two community-facing organizations. We'd love to thank you for helping Doctors Care get on board. We met with them a couple weeks ago, and that partnership is underway so that we can expand. And we hope to be able to continue to expand the reach of that resource center or get it. It's called the DOC now. Directory of Useful Community Knowledge. So it's an acronym. And lastly, but just as important, we will increase assisted postpartum support and empower families to achieve their breastfeeding goals by offering more or an additional baby cafe location. So Lots going on in this area.

Oh, duck.

Yeah.

I didn't see this going. I don't think I get this going. Knowledge. You said duck, and I just couldn't get the letters to work for me. Yes. No, it makes total sense. Yeah.

really was caught up on this screen you may be familiar with these objectives because they are continuing economic well-being objectives um so we are continuing to work to develop a food hub model to promote the family affordability tax credit and increase mmr vaccination rates for kindergarteners and k-12 students and work on policy and advocacy to inform and influence health. And these are our cross-cutting objectives. So they span both of our priorities, economic well-being and safety. And the last one on the slide is the only one that's new. And we will be assessing each and every CHIP objective to identify age-friendly practice opportunities. Yay!

I did mine already. Melissa Smith is leading that effort.

If you can't tell, we're very excited to talk about the work that's in front of us and that is ongoing. Happy to talk about that anytime, anyplace. But another reason that we wanted to come before you refers back to Sean's comments earlier about accountability and transparency. So the next two slides walk us through six objectives that made sense at this time to either pause, sunset, or update significantly enough that we wanted to call it out. In every case, the work in these arenas is absolutely continuing, but we want to always be intentional and precise about how it's documented and communicated. So on this slide, two of our original objectives are currently paused. because we anticipate that these will be able to continue as written in the next year or two as our capacity evolves. The first relates to playing a more active role in increasing access to healthy housing, and the second relates to piloting a process for engaging directly with students and school faculty to dive more deeply into Healthy Kids Colorado survey data and use that as a collective springboard for advancing social connections and wellness. This next slide, includes objectives that are transitioning or sunsetting. So the first two here relate to seeking resources that support social connections and emotional well-being. This work is definitely continuing, but we didn't feel like the way that we had written up these objectives made sense any longer. So those will be sunsetting as written. The third relates to supporting healthy housing, and it is sunsetting as written, but again, we continue to make exciting progress and just wanted to say, congratulations again to Michelle and the HPR division on their recent creation and hiring of the healthy building specialist. So over time, we definitely anticipate ability there will grow. And then the fourth has transitioned away from the promotion of specific predefined strategies to a more customized approach. So the new version is assessing all CHIP objectives to identify age-friendly practice opportunities.

Okay, I'm going to go over the completed objectives under economic well-being and safety. So these on the slide are all completed they were met within their given time frame and they relate to work with our regional regional accountable entity to increase access to resources our community-centered collaboration on financial health strategies action teams for the screening resources and referrals group and finally the last one is home business through family connects and we have a couple, okay, three completed safety objectives. We hosted a series of rapid response multi-service events for high need apartment complexes by offering vaccines, STI testing, arm reduction, rent assistance, WIC and other supports to residents all at one time. We collaborated with Stride Human Services and Community Resources to respond to this urgent and complex situation, and now we have a strong blueprint if something similar comes up. We also engaged in community events and a staff training as part of the Aurora Place-Based Crime Prevention Collaborative. That partnership included an intensive effort with the City of Aurora and Aurora Public Schools that resulted in the passage of 2026 local ordinance creating a licensing program for selling tobacco, kratom, and age-restricted hemp products. And finally, while grant applications that we submitted to fund social connections work were not funded, we were pleased to partner with agencies like CSU Extension to successfully pilot a 10-session social connectedness program in the Town of Byers.

All right, so we are to our last slide. So this is the most exciting, but maybe it's because I'm presenting it. So one of the things, I mean, we're really excited for the CHIP and where the work was and where it is now and where it's going. So this has been a really good project for us. But anyways, one of the things that is really important is just to ensure the CHIP is relevant and impactful. rather than, you know, like Heather went over some of the sunsetting, making sure that we're, you know, we're doing work that is actually impactful and relevant to our communities. We're growing our efforts. Laura talked about the injury and violence prevention. We have more in the pipeline there, so that's really exciting. We will support and increase CHIP-engaged FTE, like they already said, the healthy building specialists, and we hope to see even more Down the line, obviously extend the age-friendly initiatives. That's exciting. We talked about social connectedness. So we're going to keep doing that and we're going to keep building on that, especially with a public health collaboration that we have with the public health hospitals and it's public health and hospitals. So that's really fun. Also increase CHIP visibility among public and partners. So we really do want people to see the work that we do. So that will be coming along here soon. We hope 2027. We're going to keep getting community input to inform adaptations. So instead of getting just at the very beginning of our CHIP, instead of getting feedback there, we really want to continue to ask people what's going on that's relevant to their communities within the CHIP. One of the ways that we're doing that is like the community polls. Some of you are on that, but it's just a good way for us to just keep understanding what people need, what they're saying, what they're seeing. We're also welcoming new internal and external CHIP partners. We will continue to foster intentional learning and innovation. I think that that's one of the biggest parts of the CHIP is learning and innovating. And then again, transparency, we talked about that a little bit, but really sharing our opportunities and achievements, but also sharing some of those things that we've decided that might not be doing what we wanted to do, or we just don't have the capacity or the resources to do it. So that's where we're at. And I will just close with saying thanks to this group for this presentation, but I'll pass it on over to Heather. or any last comments before maybe we open it up for questions.

Yeah, huge thanks to the team. As you can tell, this is a coordinated effort across the entire agency, and agility has been kind of the name of the game, especially for the past year and a half, and the chip has been no different. So we've really appreciated you coming along on a journey with us as we've needed to pivot. Many of the successes that we talked about last month were the result of plans made initially, but in many, many cases, we ended up getting there through different routes as well. So thanks for engaging with us on the creativity. Any questions come to mind initially? Yeah.

Kind of a recommendation and then a question. I recall maybe about this time last year as we're just coming into the chip removal year before, it was a check of time, that some of the presentations that were delivered by staff also showed that direct line back to the chip and kind of the priorities. And so I'd be interested to see those in future presentations, kind of remind the board, like, you know, how this works. program or initiative really does tie back to the CHIP since there was so much energy in this space, but also really, in my recollection, community driven. And then my question is, will you remind me, like, the cadence to revisit the CHIP and when we can expect that next round of, like, community engagement and refresh? And obviously, we've got new challenges with the budget that probably informs that as well. When do we get back into that refresh process?

Right. Well, as you know, we are, according to Colorado statute, on a five-year cycle still. I think, you know, when the Public Health Act was passed in 2008, I think it probably felt like things moved fast at that point, but they sure move a lot faster now. And so that five-year cadence feels like far too long now. And that's partly why, you know, you can see us saying, okay, let's revisit it a year in to see what changes need to be made, and let's keep collecting data. Constantly to help inform that in terms of a large scale. Assessment, I think it would be another 2 years from now when we would kick in. But at the same time. I won't be waiting.

Is that similar sort of like the cha and that piece and then we'll get to the, the champion, the former plan.

Exactly.

Thank you.

And as you know, the hospitals are on a three-year cycle. We just heard from our partners at AdventHealth, and they're ready to jump into their next assessment. Great use of ours as part of their last cycle. So lots of opportunities to work with others.

Have there been any conversation emerged or two?

In a way, we did the last round. had their own internal data they were looking at, and they also built heavily on our CHHA data and participated in the planning process that we had to outline how we were going to use that information to prioritize health issues with partners and the public. So they were very much alongside us and kicked in funding to fund the external facilitators, Advancing Dynamic Solution, if you remember those. So that's kind of what our partnership looked like last time. Actually, this week we're talking about some opportunities as well.

Because Mesa County, they only produce one. So the hospitals and public health, yeah. And that was part of the reason they combined them because they were like, that way it forces us to be on the same.

There has always been talked about. And the Metro Denver Partnership for Health talked about, do we do that as a partnership with the hospital systems that serve those counties? think it's just, it's a challenge when you have a hospital system that serves multiple counties in the jurisdiction as well. And then it just, it's always been a challenge. So we have never been able to successfully do it. And I think when at Tri-County, we had tried to do a three-year cycle to align with, and it actually didn't go well. So I think it's It is hard when in a metro area where there's so many counties and so many systems. With counties, if you have like one system, it's so much easier to work with the one. But we're developing really good partnerships. It doesn't help when they merge, they have a new change, they have CEO change. But I think the team has developed some really strong relationships with some of our systems and aligning with them as best we can. It absolutely, ever since the Public Health Act. We've been talking about that, like, why did Sheena's go three and we went five?

And is it the same three and the same five? Is every public health on the same five? No, every hospital's not on the same three.

Definitely, I think things have advanced in terms of doing some financial support here and there and definitely sharing information and processing these. It still feels a little popcorn sometimes. Jennifer and I just met with Kaiser yesterday, and Alexa currently is gathering input across the agency to inform Children's Hospital's next plan as part of their assessment. I think it could be a little bit more seamless.

Other questions or comments? Thank you. Thank you. Now, Sarah, you get to go.

Tell me about how much time you want me to make sure I'm facilitating correctly. Oh, God.

40 minutes, but I'm giving her.

Okay.

I'm going to aim. So you guys can have lots of questions.

National preparedness. Observe. Very good.

I have for you guys, we've partnered with Vital Records to see in the director's report a little more information about what we did as the EPR program. But I brought you the preparedness item, which is a fireproof, waterproof document bag for your vital records and your vital documents. Some facts about that. And then also on here is meningitis sheet for our facilitated conversation. So I'm going to hand this to you, Michelle, if you wouldn't be taking one down and pass it around.

And so I'm going, I've never used literally course. I don't know what I'm doing. What's up? Apparently you do fast learning. There's four buttons. Oh, sorry. Yeah. Two sheets of paper. Okay. So what we're doing is, um,

Some of you may remember a couple of years ago, we did a facilitated conversation. Michelle facilitated it around the Board of Health role in a large measles response. So we're doing something similar to that with a different scenario, some different functions to kind of reinforce some of that emergency preparedness and response training. And kind of walk through that, and if you guys have questions, certainly, it gives us an opportunity to update some of our planning assumptions and processes. The 1st thing, when we have a facilitated conversation, or an exercise like this, we set some ground rules, the biggest things that I want to point out open and stress free conversation. This is a dialogue. This is not a presentation that I am making for you. So other folks have kind of given us a lot of subject matter expertise, Paul, Melissa, Spencer, Caitlin, Wolf, Melissa, Roscoe. Everyone had a lot of information they added into this. So they will have pieces to say, Melissa is going to pronounce the antibiotic name.

And we're going to pay attention to time.

So if you have thoughts and questions that aren't going to necessarily move our conversation forward, I'm going to write that down and it can form a future conversation. It is not to be rude to you. It is so that we keep that conversation moving forward within our allotted amount of time. We want to be respectful. We want to be curious. You guys have different subject matter expertise than I have. They have different subject matter expertise from each other. So we all need to kind of provide that to this conversation. So nothing in here is precedent setting. So if we make something up and it doesn't work, we can always change it. That's important. Okay, here's our scenario. There is a surge in confirmed and suspect meningococcal disease cases within Arapahoe County. All the individuals attended a multi-d wrestling tournament. You're welcome, school. I know.

3,000 attendees at the fairgrounds.

Teams came from across the Metro Denver area, and many impacted individuals attend the same high school in Arapahoe County. I'm not naming a school.

We can't talk about how we wouldn't say yes to a big MET event.

No, thank you. I'm going to go back to the rules. Do not pick a party. I'm sure that Sheridan...

Okay, so notifications. So internally, how would we find out about this and how would we let folks know? So this is a little bit more of a seminar part where I'm just going to tell you. I'm not going to make you guess. So most likely, hospitals or other providers are going to be contacting our communicable disease team. Or they're going to hear from CDPHE or something along those lines. That information is going to go to Melissa through their process that's already outlined with CDPHE and providers. That information comes in. B is going to recognize that it's this surge, and she's going to tell Michelle. She's going to tell me. She's going to tell Jennifer. She's going to tell communications, Paul, and probably Caitlin Wolf over here from immunizations. And she's going to say, we're seeing this, we need to do something about it. And we, in this group will make the decision as to whether or not we want to activate, which I'll get to in a 2nd. If additional notifications need to occur typically to you guys, Jennifer is going to provide that information. She serves as our point of contact to you guys representing all of public health. So she'll be informed. She'll have all that information. She'll be sharing that with you. If the board of county conditioners needs to be notified, same that comes from Jennifer. We update our office of emergency management for the county, which is out of the sheriff's department. Every time we activate in response to an incident, or if there's something that's maybe looks like it's going to turn into an incident, our emergency preparedness and response program, myself, Lindsay, who is over here now and Lauren is online and Serena. 1 of us would be notifying and working with and they would be the ones to make the decision whether or not to activate. Kind of as a county in that response. A lot of information goes to that. This is all separate from a declaration. We do not have the power in Colorado to declare a public health disaster. That doesn't exist legally in Colorado. There are only disaster declarations, and that process runs through the Office of Emergency Management. And Jennifer would be the one to work with Nate Fogg as our county emergency manager to take that choice to the Board of Community Commissioners. So for activation, when we activate, we have what's called the Public Health Incident Response and Support Team. You've heard that before. The first, we're number one. That is a group made up of around 30, 35-ish folks from across the department trained in the incident command system and all these different command and general staff positions. So we have primary folks who fill those roles routinely, and then we have additional folks to build depth within that response team. But we would activate the... Positions required to respond to this incident. Michelle's typically the incident commander. I am typically the deputy incident commander. We've got plans, operations, logistics and finance safety and so on. So we would public information equity all of that as part of the response. So we would activate those folks. We always have safety and equity to protect our staff and to make sure we are delivering our services in the best and most appropriate way possible for our communities. So. So just be aware of that as you're thinking through this response. So we would activate those folks, have a briefing, and move forward. So in order to activate you guys for a response, again, it goes through Jennifer. And first it's initially that notification. Okay, let's say now for the scenario we've activated the first, this is huge. Jennifer would confer with probably Michelle as the incident commander and decide, well, do we think we're going to need anything from the board of health? And if the decision is yes, she would be communicating with you to say, we're going to schedule an emergency meeting, which now exists in your, your board of health bylaws. We do that. So you guys are intimately aware of how that operates. So later, if anyone wants to tell me how that looks, I would love to hear it. Yes. Do you guys know?

We call it an emergency meeting.

That's right. Yep. And you have to have 24 hours of notice, correct? Before that happens.

Well, we said we're going to suspend the public information ruling. Perfect. We're going to secretly.

So, the scenario continues, so. So, let's say we are, we know the spread as person to person through respiratory droplets. This goes through some of the symptoms, which you also have in front of you. This fact sheet that's in front of you is available on our web page and is also available in Spanish and communicable diseases in the process of identifying. what fact sheets need to be translated to what languages so we can kind of build depth again in that access to information. But it's important to know that the incubation period is one to 10 days. There's a whole host of symptoms. Someone can die from it. And it is a rapid progression of symptoms. So this is all very timely as we're thinking through this. And the number of individuals exposed is significant. ACPH made the decision to initiate post exposure prophylaxis. What I want to make sure we point out here is that we would not be focusing on any vaccinations. Like we are not providing PEP, pre-exposure prophylaxis, only for the, we are only providing post-exposure prophylaxis because this is a lot of people. It's very resource intensive. If someone comes to us and says, I want the vaccine now, great, go to your PCP or give us a call later. Is this a

vaccine that most PCPs keep in stock?

Is this a vaccine?

Yes. This is vacuo meningitis. And I assume there will also be some rapid typing at the state lab to make sure it's one of the five or five strains covered. The main four ones, kids get standardly at 11 and 16. Men B, which we've seen a lot of college outbreaks, kids get standardly at 16, 18.

So everyone has it.

Yes. It's not school required, but it is VFC supplied, and most kids should get it at 11 when they get their Tdap.

Okay.

But the typing would matter because that would depend whether we would have... a decent chunk of kids who are protected versus not, since there's a lot more types of meningitis than just the vaccine.

But my concern isn't, I mean, those of us that work with vaccines for children, so we have, but most, do most primary care offices, many of them don't stock a lot of vaccines.

In our experience, and I can actually pull up the number of our county, but it's something like 80% of our like teenagers.

Would it be useful for us to know whether the people who attended this event were participant in the wrestling or were they in the audience?

It's a mix. Okay. A mix of individuals, spectators, family, supporters, coaches, and participants. Yep. Thanks. Maybe some cheerleaders.

Definitely the cheerleaders.

Girlfriends and boyfriends are also there.

So who's involved in making decisions regarding ACPH? So when we talk about a response to something like this, it's complex. There are different parts. So we have our incident response organizational structure using ICS. So Michelle's at the top. She's got the liability and accountability. You're welcome. In ICS, just as practice, how many guys have you guys taken ICS? Yeah, we love it. We remember the operations section. Sorry, excellent question. The incident command system, it is... Common language and organizational structure used across disciplines and across the country to help align disaster responders. It was an aftermath of September 11th when nobody could talk to each other. No, 1 understood anything. They would use the same words and it meant different things and it has aligned us. So I can talk to law enforcement hospitals and so on and we all are using the same language. Okay. So within this structure, the operations section are the doers of the incident. So those are our subject matter experts who are coming up with and kind of figuring out the tactics for how we respond. So they're a key player, but only one of the players in the decision making for a response. So within our operations branch, we would have, or sorry, our operations section, We would have our immunizations branch, our medical countermeasures branch. We would have our disease control branch with communicable disease and kind of any other branch that we might need to support the response. So they're coming up with kind of all the smart, these are what we would, this is what we would do. This is what we want to do. But we also have our safety officer making sure our staff is safe. So they're making decisions or influencing decisions. Incident commander, of course, is influencing decisions. Jennifer, as our public health director, is influencing those decisions and other subject matter experts we need to bring in. Paul would be influencing those decisions and kind of weighing in on all of that. So we make our decisions using that incident command system or ICS structure so that all the right players are at the table. And then everyone who needs to know the outcome of those decisions are made aware of it during scheduled briefings. It's all very structured and it's intentional. We provide a lot of structure to the chaos of an incident in those first few hours.

Who has the final call?

Who has the final call? That's a good question. Safety can always say no because we need to protect our staff. So they are a final call. An incident commander really has the final call. Okay. That sounds good. Get going. She carries the liability. Liability. Yeah.

Verification what you're saying is the CMO isn't a key part of the team?

They are. So he is a key part. He is within that operations section. Okay. As another subject matter expert giving a lot of important information. But he is one of those kind of subject matter experts supplying information.

One of the challenges during COVID is that People were carriers, but weren't necessarily sick and I see that this is the same issue here. So, how are you, how are you educate? I mean, that's 1 of the concerns is education.

That's a great question. And in fact, it's the last bullet on this very slide. That's how amazing you are. So, if you can just 1 minute, we'll get there. So. We talked about that decision making, so the public health director's role during an incident is.

What's your old Jennifer?

Well, it really is the communication with you all and Board of County Commissioners, depending on where we are. So it's making sure that you're aware, could be serving as a spokesperson for the incident, most likely and probably going to be turning it to Paul, because the questions are going to be very medical. So it would be Paul or Caitlin or Melissa to talk, because they're going to want to know all the medical, and I wouldn't be able to speak confidently to that. I could speak to the rule of public health, the clinics that we're going to be running. But in ICS, so when you're in an incident, even though I'm the public health director, I mean, Michelle and I are working together, but as incident commander, she has control over the incident. But my role would be Liaising between board of health, if we need to call an emergency meeting, working with Hannah and Monica to get that done communicating with the board of county commissioners. Oh, and if we needed. If this was evolving to anything.

I'd say the only other thing I would say is with an incident this large, we're going to be looking to a lot of staff to provide that response. So part of Jennifer's role is separate from that is maintaining continuity of operations for the entire process. So we have a whole continuity of operations plan that kind of walks through how we as an organization continue to provide our mission essential functions, which we've identified five very specific mission essential functions. They have to happen or we create a secondary incident. So Jennifer's making sure that's happening while we are focusing on the response.

So for clarification, I know you said, Jennifer, you don't have a medical background. I guess when you mentioned COVID, one of the things that happened is when quote unquote experts or just say medical got to talk and they did more damage because they're not used, they're used to talking to other medical as opposed to like the public and the lay person. So I would just say, would that apply to this? Because just say, explain it is, you know, like when y'all get to talk and I'm like, Ooh, that's different.

I think that is that I know we're going to be leaning into as the scenario. Okay. Great. don't lose that because that is really important when we start getting into what could be really controversial and bring back some of the remnants. That's my question. Depending on the spokesperson, you may recall when we first opened, we had, wasn't it meningitis? Yes. I think Melissa did. an interview and Chris and I had done like a, I think it wasn't a press conference that we did, virtual press conference. And so we, you know, bounced depending on what the question was. So we both were speaking different, different things, but yeah.

Okay.

So I think that's a good point that we, that's a really good point too.

Yeah. The next question here is how is ACPH coordinating with school districts and other key partners? Because this is clearly students, right? That we're really experiencing. So we actually coordinate in several different ways with our school districts in a response like this. The first is our communicable disease team is always working with schools, right? So they have their points of contact to get information, to get the right names, numbers, families, to push information out to people for education. They're utilizing their avenues. We, and also have facilities use agreements with our school districts. So, if we're looking at this and we're like, oh, we open, we need to open a point of dispensing and a school would be the right place to do it. Our logistics team. So, led by Lauren and has points of contact that they work with closely at the school districts that are completely different from the folks. Melissa's we're talking facilities security. Those types of folks, so that we're kind of working in that way. We also have our liaison officer that could be pushing information out to maybe schools that are not directly impacted, but need all of the same information. So their job is working with those external partners that are not necessarily responding, but need the information need to be linked in need to be continuing that same message. We're trying to share. So those are a couple of different ways we're coordinating with school districts. And we work with them again, very routinely. That's what Michelle and I were just talking about at the beginning of the meeting. She and one of her colleagues and I were working together on something. It's just routine for us to work with schools. And then I don't know if you have anything you want to add with schools. Immunizations, of course, works with schools.

Yeah. Other Michelle we meet with.

Yeah.

Other Michelle we know best. Yeah. It's better than both of us.

Sorry.

No offense.

No, I know you didn't because, you know, a lot of ways that we're working with the schools and then public information goes back to what you were talking about. So we learned a lot during COVID around crisis and emergency risk communications. We have a crisis and emergency risk communications or a CERC plan. With ACPH, we work very closely with our communications team under the Board of County Commissioners. They serve as our PIO. We also work with the PIOs in the Sheriff's Department to partner in messaging. So we're getting information out through lots of different channels and really coordinated messaging. So we learned a lot about misinformation and disinformation and strategies and tactics for dealing with those. And sometimes it's ignoring it. Sometimes it's addressing it very specifically. Sometimes it's allowing other folks within the community to manage that on your behalf. Because there are a lot of very smart, very educated people who are willing to go to bat for you. And then we as ACPH don't have to step into that line of fire. We can focus on the tactics of the response. But this is also the language that you're referring to, not necessarily having a medical professional as the spokesperson, but rather a spokesperson as the spokesperson, be it Jennifer or, you know, someone else within the health department or Jill, who is the spokesperson, not this Jill, other Jill, who's the spokesperson, unless you want to. I'm happy to include you, always. So some of the identified cases are unwilling to receive treatment and are unwilling to isolate for the duration of their infectious period. And then there are questions on media and across social media around school closures. A lot of folks were exposed. We know rumors are going to start and people are going to say, well, they're going to close the schools.

Do you want to talk a little bit about public health authority? Sure. So I think this is where we get into and we're talking about... refusals to isolate. We do issue public health orders, isolation orders. We have done that as a new health department. We do that. It might be for TB or other outbreaks. We've had to do that to gain compliance, but it is within the state statutes. It is a requirement that we must contain. And so it's within our purview and our public health authority to issue public health orders. If it is one incident or instance, we may issue a public health order without coming to the board. With a large scale incident like this and managing rumors or miscommunication, we absolutely would be coming to the Board of Health on issuing public health orders, especially if it was more than just one because of the ramifications, the optics of that. But the why. We have to, as a responsibility of public health, contain outbreaks and the spread of disease. And public health organs are one way of doing that. They're isolation for quarantine. So if it were large scale, if we were doing more than one order, we would probably be coming to the board for, one, awareness, support, and just, you know, we may need to talk through, like, is this, it's probably individual orders, but. to what degree and scale.

And one of my ESD things is that it was all or nothing. And that created so much conflict where, okay, let's say these three or 4,000 kids were at Cherry Creek High School, the only school that could house 4,000 schools at any one time. Then you have the Douglas County Schools or the Sheridan Public Schools or the Littlesburg who were saying, that's not my problem. And then that's where the conflict came, COVID, I think. And so I don't know when you say we have a plan, we're going to do it better the next time. What does that mean? Yeah.

So that's a really good question. So I think. It's easier this time, because it's a county and we have a smaller county so we can come to agreement and do that. And I think that's part of the role of the board of health and why we would come to you with these questions is to really get a pulse on what your feel is in the community. Right? we know what we want to do, but if there's a question of whether or not it's the right thing to do, we want to make sure we're going into it with consulting you as community subject matter experts, as members of the community and getting your buy-in when we make that decision. For this specific scenario, I don't know if you want to talk to whether or not we would do like close the school.

Yeah, I think for the real, like the realistic piece of like a meningococcal disease exposure in a school, I think recommending closure is unlikely because it does require very close contact. It's not the same as like measles or COVID. You do have to share nasal secretions with someone. Sharing drink gets a household contact.

Some cheerleaders.

It may be a discussion or rumors may come up or parents may be asking. Our team gets questions about this a lot, almost every respiratory season, if schools are going to be closing when there's outbreaks. So I think the rumors will be there and questions about it that will need to be addressed. But really targeted contact tracing is really the most interactive method for.

And I just learned from Melissa that it probably won't be typed in time to decide to have kids. But of interest, the vaccine that we give to kids protects against the things that most commonly come up in outbreaks. And 86% of our teenagers in the county had at least one dose. So just FYI, I think that would be a helpful communication, very helpful.

So hopefully that helps a little bit, kind of think through that.

Yes. Are public health orders able to be negated by somebody else in state government or the health department or the governor?

No, I think, I think, You really have the authority to do the public health. Jennifer has the authority, but the state can't overturn our public health order.

County commissioners can't do that.

That's good. That's why it's under state statute for the health department. So you are not eligible.

I'm sorry to repeat that question.

Oh, that we're advisory, but we don't have to confirm the public health order. That's Jennifer's call.

Yeah, Jennifer signs the public health order, but we would want your full support to do something of that size. So that's really the role of the Board of Health, right? We've kind of hit on that. It's really a lot of that informational piece. It's also if we need to access public health funding, like the funds in order to pay for things. It's you know, a lot of those pieces. That's what we would be coming to with that for the, at the emergency meeting. This is a question for you guys. What information is expected or do you expect us to bring to you as part of that briefing? What would you want to know? What would you want to see? What would be helpful so that we can prepare in advance to know Jennifer's prepared to talk to you?

how the different communities are going to be impacted, what message do you think the communities are going to be asking? Like I envision the Eastern Plains asking very different questions than the urban areas. Are there any groups likely to be opposed to it who we would have to know about? And then what's your recommendation? I usually want to know what staff's recommendation is and what are you recommending that we do?

I like that we would know 86% of kids, the rates. But we don't know that the 3,000 that were there were necessarily out in the county where they're from.

And if I can just add, just so we're not getting confused with the vaccine and PEP. PEP is recommended regardless of someone's vaccine status. So that would be something we would be recommending and really pushing for regardless of someone's vaccine status.

I would like to know the timeline of that. Oh, okay.

I'd like to know that at least there's, you know, a plan in place in terms of language access. You know, recognize and also kind of maybe build a little bit on what Sean was saying in terms of health disparities and especially vulnerable communities. You know, if there's a targeted strategy for that as well.

Level of risk. I mean, if 86% are vaccinated, like, what is the level of risk for, like, how impactful this could be?

One of the concerns in COVID is that it was mostly old people and very vulnerable people. So I think that created a lot of tension in communities who said, that's not us. Why do we have to? It doesn't seem like the same problem. It's pretty even, or is it?

Well, one of the questions I'd want to know is how many of the folks of the 3,000 to 4,000 were student athletes, and how many are Spectators who are not so kind of an overview of the demographic, because they're not going to have the same level of compliance humanization.

Michelle, I don't disagree. I'm just thinking through that comment. What would we as a board of health do with that information?

Well, I mean, for me, it would help me understand why they're going to make the recommendations they're going to make as it relates to the public health order and the details of the order, because some of the work is going to be very specific to the student population. And some of it's going to be specific to the spectators and the coaches and the security and all the adults.

Like the targeted messaging, for example.

Well, yes, because an adult is going to wonder if their exposure level or risk is as high as the kid on the mat.

When you provide us with notice of an emergency meeting, we've got 24 hours. At that point, when you notify us, I would hope that you would tell us what decisions need to be made, what are the pros and cons of each decision, et cetera, what additional information we might need to have, et cetera. So just getting all of that upfront to give us time to think about it, I think would be very useful.

One of the challenges, yes, we get to have a meeting, You have to have notice whenever all of us are in this room together. One of the concerns is, and what happened during COVID, was there was a lot of back-end meetings between some commissioners. Like three people were talking together and you're not allowed to do that. And I think that that's one of the things that we would have to be reminded of. Again, this is how it has to happen. Three of us can't get on a Zoom call together because we just want to chat it through. We're not really allowed to do that. We have to be together.

We probably will have to remind me because I'm used to bringing that up. I need to talk things out.

Like, is he like, who can we get on the phone right now? It's like four of us are talking.

So the next, yeah, the next piece here. So interviews have indicated, you know, Melissa's team has done a lot of interviews. They indicate that there's one symptomatic person now hospitalized. Okay, it was in a lot of common areas and so on 1 of the impacted school districts is not providing requested information for ongoing investigation and has not yet ruled out ongoing transmission. So, 1 thing we're looking for is, as Melissa said, we would not. In this scenario, likely asked to close the school, but we may ask to. suspend wrestling practices and wrestling tournaments or matches. So that is something we would likely come to the Board of Health for is to talk through that piece of it. There are equity considerations around even canceling those things, that senior who needs that tournament to get the scholarship. There are pieces that we need to really think through when we make these decisions. We would, for the non-compliant individuals, we need to act fast, right, for those types of things. So as Jennifer said, Melissa would be working with Monica, with Jennifer on issuing those individual public health orders without coming to the Board of Health for that. We do that all the time. It's really timely. We have to do it. We would come and talk about information sharing and event cancellation. So should we issue this public health order to the school district that's not sharing information? Should we issue kind of the stop these special activities and have those conversations? So those are some things to kind of think through. So equity considerations around those public health orders that we're always thinking through for those families that are isolating or they have an individual or maybe it's the person who provides the income from the family and they're the ones who has to isolate. We try to make sure that we are meeting the needs so that they can safely isolate. Are they in a location that they can safely isolate? Do they have access to their mental health care? Do they have access to food? Do they have access to enough to pay their utilities and so on? So thinking through some of those, and that's what Grace and the equity team is really kind of thinking through and bringing us those considerations. And Grace has been very diligent in finding resources across our communities really across the entire metro area that we can access to provide those supports to make it a possibility. We're also thinking through that language access to your point who's really impacted by this and do we have the right languages to provide them information in their own languages and that's culturally aware. So we have resources at CDPHE we can utilize for some of that. I have also now started putting a chunk of our Grant funding for EPR is for translation purposes. So we have access to those funds to make sure we can translate things just in time. It's incorporated into our translation process as well. If it's an emergency, we can skip over some of the steps, get it translated right away. Household impacts, transportation to points of dispensing are a big one, which we'll get to in a second. And then those community impacts, what's the revenue from canceling a, you know, in a big event or things like that. So those are things we would want to talk through and consider when we're making those decisions. And if you have others, always bring them to the table. It's really important.

So the last one is an interesting example. They're like the financial impact in the communities or some sort of blueprint that would be used in that. I mean, it's an important question, but it was, yeah. So how do you, you know, I know there's some magic algorithm, but maybe there is, I don't know.

There, you know, there was a lot of work. I know I spent a lot of time on the phone with different chambers of commerce during cobit having those very conversations. I don't know that there's an actual rubric that I could pull up and say, this would be the economic impact. But I think those are conversations. A lot of people are familiar with having so again. Um, as response partners, like, when we're talking to the schools, how is this impacting you? If we do this when we're talking to, you know, and figuring out those answers was like, a list of questions that you would take in those calls and then a quick question.

How many school districts are in the county?

7. Thank you. Hey, is holding a pod or a point of dispensing for individuals exposed at the tournament. So that is potentially 3 and a half to 4000 people. The pod will include separate and subtract. An injectable antibiotic for those under 18 years of age. So this is a different type of structure for a pod. We're used to COVID. We're used to measles where someone shows up, they do their triage, they fill out their forms, they go through the line, they get their medications, they leave. This one, there's a decision point. If someone is over the age of 18, they get Cipro, which is pills. If they are under the age of 18 or... allergic to Cipro, then they're going to get this injectable. So it's a different pod set up. So we have a medical countermeasures plan at ACPH. And in the past, it would be like, this is what it looks like if it's pills. This is what it looks like if it's injectables or vaccines. We now have kind of a lot more flexibility built out. So we have a layout for this is what it looks like if we have to do both. So we've kind of taken that into account. And you have pills for 3,000 people right now? Good question. Who will cover the cost of antibiotics for this pod? No, we do not have pills for this many people.

Who would cover the cost of this, Jennifer? The public health emergency.

So in the public health fund, everything's great on this quiz. It's like prepared in advance. It's weird. We, you know, that is why in the, in the policy, the public health fund policy, There is a set-aside. Granted, we have not even met our minimum, but we would, that is something we would be coming to you. First, we would be checking with CBPHE. We would be checking with other metro, like who has this, who can we bring, like, because we can, we, What's the word? Vaccine.

And we share a lot. There's a lot of shuffle of drugs.

Because, you know, one county may have it. We hold just a lot of medications for CDPHE. And so we shift. So we would first be looking at what is out there, how much can we get our hands on, and then to make up the difference, we would be coming to you. We would likely, depending on how much it's going to cost, We might be able to cover it within the current budget, or we may have to go into use of emergency funds. Leading up to that, we probably have already had meetings, and I've been prefacing that we may, like we're forecasting that there's going to be money spent on this, and it may go over what would be in our allocated budget. And so we may have already preemptively received approval from you to use emergency funds up to a certain dollar amount in the event that we have to do this without having to call another emergency meeting so that we can be purchasing on the fly. We are going to be recording all of this from the minute the first is activated. We start documenting our time. and other expenses in the event of how large it gets. If there were an opportunity to get reimbursed, there rarely has been, but we start documenting immediately on the cost of response. So we would be, we, that, that is how we would, we would have to, we would have to, but we would look for, we would, find first who has it to see how much supply.

People that are insured or have Medicaid, can't they just go to their regular doctor?

They can if they want to, but typically we want to address it right away. So we're not.

Who's responsible for assuring the availability of the medication, which is not expired and is available to be distributed right away to a large population?

Yeah, so, because there are right there is. Things we have on hand and the state has in larger supply, usually the board of vaccines and actual antibiotics. But there are caches right of various antibiotics in various places and whoever's maintaining the cash is responsible for making sure it's stored appropriately and isn't expired. There's also diseases that come up where like we have a medication shortage or we that medication like it only exists in the strategic national stockpile. That's where our first doses for those pods came from was actually just from the feds. So it's going to be frankly very disease specific. And then also then you're going to be using your contracts with private manufacturers like we have here to buy antibiotics. We buy both of these things. and seeing how much is available and hoping there's no national shortage like there is for by selling right now. But it's complicated every time and it never works the exact same way.

Just two quick comments on the budget piece. So it was interesting. So the board may recall, we did give approval to Red Bull County. So the bag goes down, we can spend the money to that four by six months ago, kind of lost track of time. It was interesting too to hear, The emergency funds in such a huge situation, because when they thought about, we lost the grant and so now we've got maybe the slow burn on the emergency reserves. Like, no, actually, we have to write a half a million dollar check. Um, and so it's reframes a little bit for me about how we think about the reserve. We need to pump that bad boy up a little bit.

So not only are we looking at funding, but in a pod of that size, it takes a lot of staff, right? And for a certain period of time, whether we run it for a couple of days or if it's one day or whatever, we have plans with departments, everyone in their job description that says you're a public health responder. So different folks may reassign, be reassigned to work in that pod for a couple of days, an environmental health specialist, working logistics in a point of dispensing or something like that. So we also have two different avenues through the Board of County Commissioner's Office and Arapahoe County Volunteers. So we have folks who have selected to be public health volunteers for disasters. And then we also have the Colorado Volunteer Mobilizer, which are volunteers kind of within the community that go through like Medical Reserve Corps or kind of clinical volunteers that we can access as well. And we can partner with our other health departments. So this leads into that last question on the slide. What will coordination with other and look like with an incident of this size? It is absolutely regional. Not all of these people are in the county. I would be holding daily, if not more frequently meetings, and we would do a lot of coordination on those calls and we would have the opportunity to look to other if we are the only ones opening the pod because it happened in Arapahoe County, we could ask them to help provide support for that staffing and so on. And many of us have worked in pods and other jurisdictions for those reasons. I. myself, you know, was a line monitor at a pod at CSU for meningitis. So, it happens quite frequently, or when it happens, you know, many of us have that experience.

Let me talk a little bit about continuity of operations. Yes. Oh, sorry. Watch your time. That's outside. I know. We're good. We're good.

We, Sarah mentioned early on in the response, you know, we would

We would still be managing all of our other continuity of operations and things that we must do. Yes. The essential functions. That would still, even though it's all hands on deck and we would be pulling in a lot of staff, we would not be closing down essential services. So we would still be seeing WIC clients. We would still be issuing birth and death certificates. There are essential services that have been identified in our continuity of operations plan. So we wouldn't be pulling in 100% of staff because we still have to get baby's food and still have to issue the vital records. And there are a few others that wouldn't be pulled in. Because it's immunization is communicable.

They're already working.

But having access to other volunteers and other local public health agencies, and we do help each other out a lot. So that is going to be needed. And that might be also something that we're asking board of health, like, give us some help.

We are a couple of years in now to where Arapahoe County Public Health has been hosting twice a year cross-jurisdictional exercises with LPHAs from Pueblo to Larimer. So kind of 14 counties come together twice a year to have these conversations and figure out how we would be supporting each other.

So, I know we're chatting time, but example, you just mentioned there, like, the regional. So, does the step in? So, as much as I want Michelle on point is Michelle on point.

So, every incident is considered local. So we'd be handling the piece within Arapahoe County. CDPHE's job is to make those connections at the regional or state level. So yes, they're facilitating meetings every day where Melissa's providing an update or Caitlin's providing an update, and then their counterparts across those other impacted jurisdictions are providing their updates to create a big picture. So we can start prioritizing resources and moving, hey, we're opening a pod, we need antibiotics, and no one else is. Can you send us your antibiotics? That's where those conversations happen.

I have a question about scope on this. I'm having a hard time, like, we're working with the districts, but it also strikes me that, like, there are, like, 10 schools that are coming here. Like, what is that, how does the school, like, the specific school versus the district, and then, like, We're looking at all those individuals exposed coming to the pod, but, like, they're all high school students. So, like, are we bringing, like, the girlfriend who did not go to the tournament was, but was definitely hanging out with the wrestler, like, afterwards.

Great question. Do you want to talk about that?

Communicable disease team would be working with a variety of people. We would likely start with, like, a wrestling organizer. You know, and then there will be points of contact at each of the school districts to help get who's on your wrestling team who went there. And so there'll be multiple points of contacts that we would be. Working with to get information, help share information out and understand who was there in the scope of the event since we were not on. For other, like, intimate partners, other friends, people that were there, but are on the wrestling team, it would kind of depend on their situation where they just. are they just maybe dating someone on the wrestling team, but this person was not sick, then we wouldn't be worried about them. They weren't at the exposure event, and they're not closely with someone who is actually sick. If they are, you know, like a boyfriend or girlfriend or something of one of the cases, then we would be doing direct outreach to that person because we would consider them a high-risk contact.

Also yesterday, those 10 schools might not all be in Arapahoe County. So part of the role is going to be like, hey, Jeff, you have 2 schools Douglas. We have 2. And there's a great centralized database, EpiTrac, now to assign out contacts, which CDPHE seems to, I don't remember yet, but I'm just, all those meetings to like, it's done with that, which I think is a great organization tool.

Yeah, and I think another part of that's kind of, it's hugely helpful in these responses that's not mentioned is CDPHE's other main role would be also maintaining continuity of operations for all of our other reportable conditions, because all of our epi teams would be working on this, with the exception of rabies. That's the only one that... has to maintain local regardless of what else is going on so they would also be interviewing all of our other cases and outbreaks while we're doing this response thank you okay so there were no additional meningococcal disease cases reported within the county or the region following the pod because we are

Oh, recovering, everybody's recovering. So what are we doing, Michelle? I'm going right.

So what we're always doing throughout the course of an incident and in my role looking through, you know, in that that pieces. what are folks doing and knowing while we don't take folks away from certain roles related to continued operations, there are people supporting the incident that are still not doing their routine work that is still very important and critical. It was something we learned during COVID that certain folks needed to be released sooner to get back to some of those other critical routine roles that we maybe took for granted. We were just focusing only on COVID, which was critical. There was also other critical things happening in tandem. So what we do is we assess the needs on a daily basis, what's happening, where we are in the scope of this response. Can some roles be deactivated? It doesn't have to be a full-fledged, okay, we're done, we're deactivating our entire first, but rather we deactivate certain positions or retaining some key roles that we need to have to assure safety. ongoing work related to the response and that others can get back to their other routine jobs that are also critical and were paused. So we do that until we're ready to then fully deactivate the first time that we decide. We are really ready to incorporate everything into routine operations. And that there's a, you know, it's a nuanced approach where we're continuing to look at the medical countermeasures portion of the work and when is it really back into under the umbrella of routine operations? When have we felt like we've reached a point of our communicable disease efforts and interviews and disease monitoring, looking at communication, making sure we're meeting the needs of our communities and what we're putting out? When has it moved into a routine enough place where we can deactivate? Something else that we've learned over the years is when someone is activated, our staff members are activated, it just adds another level of stress knowing they're activated. So we're very attentive to that nuance sweet spot of when we deactivate staff and when we do the full deactivation. So that is what we look at and consider in each incident to make sure we're attended to that and then can return to our routine operations. And something we also learned over the years is making sure we notify our staff and leadership team and everybody else of, hey, we had deactivated our response at the beginning. We'll always send in all staff so folks are aware. A phone script, here's what things we'll be hearing in case you get any calls, redirect them here so you're not answering questions inadvertently. We'll send the deactivation afterwards as well so folks are aware, which then leads us into Sarah's final question.

The last question is, how do you guys want to be deactivated from a response? Like, How do you want to be notified that it's done? At what point are you like, I don't want your information.

Just send me a text.

One, just for pure communication, you don't have to give a lot of detail. I mean, because to me, throughout the process, there's a lot going on. So you got to say, hey, look, look, you're done. You don't have to have no long drawn out explanation of why. See you next week. I'll be like, okay.

See you next September.

Yes, y'all did a great job.

For me, I agree with what John said there, you know, just sort of like NFA for the board. I would anticipate that there would be a briefing to the board during the next regular schedule meeting and that even if we need to like set up some standard agenda items aside, like important, but we'll get that briefing later. Like let's really post. I don't want to use that word. let's have an after action review and discussion on it.

A little information confirming why you made the decision that we don't need to do anything else. Like you said, it's done. You're released. You're released. Stop thinking about it. But people in the world around us are still, you know, the ongoing or what if. But if you're saying 10 days, no more, no one else has, we kind of need to know. Yeah. Great.

So I will say, as we wrap up this conversation, this is the same scenario we're using for a full-scale exercise in January. So you guys are part of this medical countermeasures exercise series. So you get credit for being a part of this. Thank you. I get credit for you. Thank you.

Here's you. It's not the national preparedness. What have we got? Also, any thoughts? How was this for you guys?

Did it meet your need and kind of help you understand what a scenario like this is?

Very helpful.

We will not be the district that is not cooperative.

No, you're going to be our best friends.

That athletic director is going to be on it. Why would a district not cooperate? Do they not have the resources or do they think it's annoying?

It's hesitation to share names, phone numbers, addresses for their students. And so it just takes a little bit to get that encouragement for talking to them.

Yeah, the only thing I would say is if that exact same scenario happened and it wasn't a wrestling match, what happens if it was like a special needs event and the majority of the parents are against like shops? And so that's where, you know, I've been part of the groups.

Yeah, that's great. Great question. So that's where we would absolutely, we would be working with like the event organizers, right? Whoever put this event on and working with families. But if there was a huge pushback from the community most impacted around some of this you know, prophylaxis piece, you know, post-exposure prophylaxis. I think that's when we also would be looking at the board. Is there a reason to be doing a public health order differently than in a situation where people, maybe we had higher vaccination rates and so on.

I think that would be informing them to expertise and what can we do from having you approach this when, you know, having that conversation and education really leaning in, like what, how else, you know, using public, how else can we communicate this in a way that is resonating with what we're doing?

Right, right.

And what community partners we want to bring in to help be messengers with us in partnership that are trusted partners.

it's not an unusual circumstance working with religious communities, like with different belief systems and so on, right? That these conversations happen on a pretty routine basis. I think Melissa's team, Caitlin's team are really adept at some of those complex, you know, conversations and figuring out a lot of that. Like it's the incentive, right?

With our recent experience, not kids have been put out of school or after school activities was a huge incentive to get a pet. Yeah.

I think for like some of my Ninja Cockle diseases, we just see need to a different response from parents than, say, measles. With measles, PEP is a vaccine, and so there are different hesitations and considerations there, whereas meningococcal disease, like PEP, is an antibiotic. And so I just think there's just a different, you know, in our experience so far, there's just been a different feeling toward receiving PEP.

Two quick thoughts. One is, I love the question. Clearly that works during the community engagement with building those relationships up front. out of the emergency crisis. The second piece that I was saying was, I was at the state health department, I was on the COOP team, and one thing that I took away from all that, aside from the logistics and what have you, is the mental health piece. And I think for many of us, we underappreciated the significance. I mean, this scenario is not Many months long, but recognition of the toll it takes on people, then you don't just get to go home at the end of the day and you want to potentially carries that burden.

It's a big part of our responder health and safety plan is that mental health component how we work with our partners within the community with all health recovery. We have, it's required for all staff at ACPH to take psychological first aid to support each other and support, you know, kind of everybody you're working with or just keeping your eyeballs on your, on your colleagues. Um, and we've worked really hard, like Michelle was talking about. Sometimes you deactivate people, not because the incident is all done, but because it's far enough along that it takes that level of stress off. They can just do the work as part of their routine work. Um, So we've been very attentive to that. Thank you so much.

Absolutely. Would there be a scenario where you would deactivate somebody because it was no longer safe for them to participate?

Yep, a thousand percent. We have a very strong safety officer team of folks with varying levels or different expertise, and they're always keeping an eye on that and they're not afraid to say, Things seem stressful for you right now. Maybe we swap you out with someone else. That's why we build that depth in those positions. People trained for those positions.

Thank you. We still have our final study session. Thank you, sir.

Thank you.

Yeah, there have been so many things that we need to do. It's been a really heavy engagement year for the board, the actions, decisions, hearings. So I recognize that we haven't had a chance to really do the director's report. But I hope that the information included... I think the last month was really long just because it seemed so valuable though.

Yeah. And I'm sorry it takes so much, but it's really valuable.

Good. And I am glad to hear that because staff contribute and we do want you to know what is happening at, you know, within the clinics, in the field, the work that we do, great, amazing work. I can point out one thing because it was, it was really fantastic. And then I have a, new business, so hopefully this is okay. We just recently had some great news coverage on the doula program that we mentioned earlier. So we pitched to the county PIO, the doulas that are trained in the community, and she pitched it to Channel 4, picked up on it, and ran a great series. There is a link to the website where the video one of the news clips is I couldn't, I couldn't figure out how to get both news clips in here. So, but really fantastic. Michaela was able to recruit three of the doulas, one was Spanish speaking and had interpretation. So it's a really, it was a great story of doulas in the community and the relationship and partnership that public health has with community-based organizations. So I just wanted to highlight that as one of our mission moments, because it was, it was a Great story. Michaela did a fantastic job with the interview. And we hope to be able to continue expanding doulas in the community as a great resource and health care provider. So wanted to share that. And then just there have been amazing things that have happened throughout the entire summer. So if you haven't had a chance, it's all in the director's report. It's great. So before we close out today, I do want to mention that in October, the two to three session is a joint Board of County Commissioners, Board of Health meeting. So I will work with Chair and Vice Chair on, I have some ideas of what we may want to share with the BMCC in the conversation. And we'll then share that with the rest of you. I think we're back in here in this room for that meeting. And I think our business meeting is in here, too, probably because of elections.

It's too bad we can't use. Oh, I guess because of the election, we can't use their privacy. So even their space over in.

We could, but I also don't know. It doesn't mean necessarily that they are on site.

Anyway, I just want to see if there's.

And we'll notify you well in advance if we're going to be at the Prince Street location. That room, the table's not, the table is definitely not bigger, but there's more space around the walls. So I'll, we'll work together on...

When that's an, oh no, it's the two or three. So we don't have time. Okay. I'm sorry. Post it. We still have to post it.

Yeah. But we probably still don't have a whole lot of time. Right. But it is only one hour. My thought is to share like all the actions that you've taken this year, the hearings, all the health orders. Yeah. The fees, the budget. Yeah. It's been a really busy year. You can talk about budget moving into the future. what we're looking forward to in the air. So we'll work together on what we want to put the agenda and then we'll send out something to everybody. So we're all on the same page. I think that was it.

Remind me, did we do that last or two? I've just had to see the commissioner attend.

Yes. Yes. One kind of commission.

Yeah, here it shows up. It was both the commission.

Yes.

can't remember now i mean not badly i mean yeah so yeah yeah we'll try to be here um so that was it so hearing that the meeting is adjourned thank you thank you look at that too