Arapahoe County Board of Health - Regular Meeting

And we have Right. Okay, please.

I'm a call the meeting to order. Good afternoon. I'd like to call the Arapahoe County Board of Health business meeting to order. Miss Banks, will you please call the roll?

Here. Director Sean Hakim?

Here.

Director Christine Berhoe? Here. Director Mark Levy?

Present on the phone.

Director Mark McMillan?

Here. Director Harris Walker? Excused. Absent and excused.

Director Michelle White?

Absent and excused. Yeah. This is not the main Thank you. I found it for you, Mark. Yeah. I would now like to ask the division directors in the room to introduce the staff that are present today. I'm actually Michelle. Okay.

I just want to acknowledge that Talitha Apple is here representing. She's associate director of nursing. She's here for the community health nursing division. Okay. Not

new, but our monthly our monthly crew, we've

got Sarah Garrington, our emergency preparedness and response program manager, Steve Schivalier, who you were

really loyal.

Melissa Aronsico, communicable disease epidemiology band.

She's a frequent guest also. Can get frequent flyer.

It's not here.

Have some new and returning folks. So so Taylor Roberts is our manager of community health promotion. And Grace Sullivan, who you know, our coordinator of health equity and community engagement. And then Melissa Smith, senior community health promotion specialist, particular with a particular focus on healthy aging social, current presenting to you today. And Alexis Barbraez, our senior population health epidemiologist, and Brookwegensteiner.

Welcome.

Next item is to approve the August meeting minutes. There have been one change made to the August meeting recording and presentation materials, which is to remove an employee's identifying information for safety purposes. Okay. So I move for the board of health to approve the August 2025 meeting minutes as amended. Is there a second?

Second.

Motion made by myself, Sean Davis, and seconded by, co chair, B. B. Kleinman. All in favor, say aye. Aye. Any opposed? Thank you, Mark. Any opposed? Hearing none, motion passed. Do we have anybody for public comment? Is there anybody in the queue? No. Nobody in the queue.

Next

is the board of health, director's comment. Mark, would you like to start it off? Do you have anything?

It feels like you're here. Not really. No. I don't. Just welcome to everybody from the Hudson Valley in New York.

Oh, welcome.

We're to

join you, but thanks for offering. I'll start with you, Mark. You got any updates you'd like to offer?

I'm kind of excited. Our our office in Katy Denver, public health is working on a new strategic plan. They won't get too far out in in front of the work that we're doing. They're all the same. Glad to see that our executive director, Karen McGowan, puts a lot of value in community engagement, community participation, and definitely areas of environmental justice and health security.

You know, seeing that reflect being reflected in our in our work and really pulling it out in strategic plans. Good good things. Well, if you have it finalized here next month, then I can talk a bit more about it and if there's interest in it's it's good to see the things that are that are personally important to me or also being reflected in our plan.

We're we're entering the fall season when we'll ramp up in insurance coverage and eligibility and helping make sure that people have coverage when possible. We're gonna lose some of the subsidies, and we're already talking and working with people who are very nervous and upset about those changes, but increased costs are really weighing heavy on the population that we serve. And so it's just kind of where our heads are at is helping as many people being as kind and looking at what alternatives as possible. And so that's just kind of where our heads are at. There's if you know of people who need support or help to just sit down with someone and talk them through, We have very strong Spanish speaking staff in this area, so to help people in that in that way.

We are expanding our volunteer coverage program. We have currently promotoras who we train in coverage work, they go deeper into community where someone like me doesn't exactly fit. And and we're doing some work with Felisa So to on expanding those the training and the volunteers that come out of those communities so we can have a even stronger presence at a lot of these outreach events that occur. If there's not options, there's not options, and we'll cross that bridge when we get there. But I did wanna speak to there is still some opportunity for.

I'll give you well, there's a lot of people.

A lot of people. And I would, just for my update, I won't give a update, but say, as a board of health, within the past month, there's been a lot of violence, a few, killings. And so I tell people, irregardless of where you stand politically or on any of the issues, I'm gonna take a moment of silence and ask that my colleagues take a moment of silence for those, particularly Charlie Kirk, the the young lady also on the bus, and then I believe the representatives from Minnesota who were murdered take a moment of silence for them. And the same, we don't support any form of violence. So just ask for you all to take thirty seconds of a moment of silence.

So I say thank you, you know, for that. A lot of times, I tell people I try to use my position to bring groups together and not divide people, and so not always successful. And I think the world is becoming more divided. And so Jennifer, through her leadership here at Arapahoe County and also Bebe being the co chair, our goal is to bring people together. So anytime we have that opportunity, that's first and foremost, and to really represent all of the Arapahoe County. We have a diverse county, so we also try to do that through our leadership. So thank you all for that. Sean?

There is a lot of heaviness this month, but I'm gonna keep it pretty light on my updates, taking the taking the lead from b b. This week is longevity talent week, as proclaimed by the governor. So September 14 through the twenty first, recognizing and highlighting the value and expertise of older workers in Colorado and why older workers bring to Colorado's economy, businesses, and communities. So it's a really good opportunity to hire older people and think about and celebrate older workers in your communities. The other thing that I wanna

For clarification, what age constitutes? What when we celebrate older, what age are we talking about?

Not that I do not. I do not, categorize older, because it is it means different things for different people.

So the purposes of this, just in case if we had, like, a chair who happened to don't think he's older, but he might be over a certain age

when he

He could be plus. He could be plus.

Thank you. Okay. So me and you were in the pool.

I agree. I agree.

They got a higher up. Yeah. They got a higher up.

That's right.

Thank you. Great. That makes it work challenging, though. So it's a long time for the record.

Me too.

I see.

The other thing that I wanted to mention, in the spirit of bringing folks together, myself and the American Society on Aging and a couple other folks from the Colorado Commission on Aging are hosting a summit, an aging summit, on October 28 on the Anschutz campus. This is really intended to be, a space to talk about cross collaboration. We're inviting a lot of folks from, like, aging adjacent fields, if you will. This is not a knock on the aging space, but we tend to go to the same conferences with the same people over and over again. We know we all serve on each other's board.

We all give to each other's nonprofits. Like, it's very, very it's a very small community. And so we're really trying to break out of that mold a little bit, invite sort of the nontraditional partners. Although, there are no nontraditional partners because I will take this opportunity again to say we are all aging and so it matters to everybody. And so recognizing I I talked to so many people who are like, oh, well, Christine, your work doesn't make like, I don't care about your work really because I don't do aging.

I'm like, yes, you do. Like, you're aging, your employees are aging, your consumers are aging, everybody is aging. And so, this is a cool opportunity to all come together and think about how we can be better partners to each other and have some cross sector collaboration and kinda paint this picture on the return on investment for the private sector and business community because this is a pretty significant market for folks. So please join us. I will send Jennifer the information. And if you wouldn't mind sharing it out, I will great.

Thank you.

We have no general fishiness at this time. We're gonna move into our study session time. The first study session item is the fiscal year twenty six budge budget presentation by Brianna.

Hey, Dan.

Yeah. Well, it's back.

I'm trying to bring balance to my life. So the first thing I'm doing because the budget is is heavy, I wanna acknowledge my shoes.

I have done shoes today.

Joy. Joy today. Joy today. Yeah.

They have little dots on them.

Yes. Okay. Very few. Yeah.

It's my balance for today. Alright.

Next slide, please.

Oh, and I'm sorry. This is the EDC presentation. So this was included in the packet for reference. This presentation was given, to the executive budget committee at the county level on, September 3. So this is the budget that you all approved at the August. So in interest of time, we're just gonna

go to the end of the SEC budget and go straight to the finance.

And they were so excited about it too, weren't they? Like, they were like, whatever you want.

That's very well received as it was.

That's not what I actually want. You know? Oh, you can Didn't write us a check at the moment.

No. That's what I Yeah. We will be.

They will be. Sure.

Let's try the To

the financial. Yes. This is where right there. Sorry, Jenny.

Thank you. Sorry, Hannah.

One one quick comment if I may. I was just so impressed, you know, Brianna, with the the depth of your knowledge. You know, there I think there are 16 requests in there, plus or minus.

Yes.

A lot of detail, and you were just so on top of it. And I know that comes from support around you Mhmm. As well, but and I think you really represented public health very well in that form. I know all the agencies are making requests of that it was very well received, and I can take things up as well. So thank you. Thank you very much.

Next slide, please. I'm sorry.

We're gonna skip a couple. I should

have condensed now. Okay. So we're gonna start with the funding update. I've included this as, reference from our EDC presentation, and I'll build to the entire point of the slide. So we are experiencing a year over year indirect compression due to flat funding. So we have managed approximately 45 active grants. 27 of those are renewals. So it's things like WIC and our FEP contracts that we expect to get. There's no reason not to get it. 27 of we received 27 of those, 23 of those this year going into 25, 26 budget were flat funded or slightly reduced or significantly reduced.

Last year, 16 of those were either flat funded or or slightly reduced. So we have this ongoing trend that is creating compression on our indirect rate

because our expenses continue to

go up. 80 as I have drilled into everyone's head, every 85% of our expenses are within our salary benefits. When we have I believe last year, had 2.7% merit increase. Our medical benefits are projected to go up this year. We don't know what our market, increase will be for our staff.

So we're creating a compression. In total, this year alone, you are all very well aware of our nurse liaison reduction, which was 8.5 FTE and 2 $1,200,000 on top of, including, we've gone to 1,800,000.0. So that's just funding reductions that we are working through, and some of working on that has been with our, indirect rate. What that does not include is the governor's line item reduction to local public health. That's a projected 15%.

It's a direct 15% to that line item within OPHP. We're anticipating that to be a direct pass through. That's gonna be approximately $250,000 additional cut that's not included in that number.

Oh, closer to 2,000,000? Correct.

So that announcement came through the Thursday before our EDC presentation. So I jumped on the phone with our county budget analyst and started to I laid out this problem to her and that this additional cut knowing that there's some market merit increase coming, a medical premium increase coming.

What can we do?

Can we can we come up with a creative solution? And her and I, came to the recommendation, and we made a verbal request during EDC that had not been brought to the board, to ask for one time the county to fully fund our total comp increase. So just the increased portion, but right now, I'm projecting that to be right around a million dollars next year. And so if they can one time fully fund that for us, so just next year, gives us more time to see if the if the funding landscape stabilizes, ideally, or continues to deteriorate, in which case we have more time to plan and make appropriate adjustments. So that was a, it was made verbally to EBC.

They understood where that was coming from, but that was the one thing that had changed from our EBC presentation that was not presented to the board. Okay. And it was spurred because of the, governor's line item. So so that this slide was is actually included in the EDC presentation, and I included it here so that I could explain that. Alright.

Onto our so these are the quarter two financials. We have currently collected, just over 71% of our budget in revenue. I'll explain on the next slide why this is is exactly what we expected. And then we're spot on in our expenses at 49.3% or 15% through the year, so this is perfect. Next slide, please.

Oh, goodness gracious. I looked

at this three times, and it looked right, and it came out wrong here. I apologize. It's online. It looks perfectly fine.

So Oh, that's perfect to me.

Yeah. We have prevalence.

Mhmm.

We

do have prevalence. Alright. So the reason that our revenue at 71 71% collected even though we're only 50% for the year is two things. One, our fee for service. We've collected $1,500,000 so far. Of that, $1,100,000 is in our, retail food license fees. Those are heavy loaded to the front end of the year. So we kind of have this great bell curve, and then we know it's gonna level off through the rest of the year. And then if you look at our county general fund contribution, so this is the county contribution that they provide to us. They don't spread that over the year.

We get it all sometime between the beginning of the year and April. So this is exactly what we would have expected. What you can't see is that our expenditures are perfectly aligned. And the one thing I was gonna call out

is at the very bottom, the service and others at 70%. That is where

we were coding our Willow lease.

And so since that ended in August, again, it was

heavy loaded to the front end. We tapered off. Salary and employee benefits are perfect at just under 50%, 50% of the way through the year. So we're in really good shape. I continue sorry. Next slide, please.

So just on that one. Is the difference in the Medicaid insurance reimbursement is are we on track? Because that's the only number. Are we projecting that to be lower? Or

So when we built that projection last year, we looked at and we knew we might be over projecting ourselves. So we were looking we launched Medicaid billing last year Okay. And we went back. So we knew there was basically eighteen months of billing done in 2024. And so we were trying to say, okay. Is that will we see a good level off or will we continue to see growth? So I I think we're gonna come in under budget on that line, and that's what's expected. Okay.

And just the numbers of people who have fallen on our

account. Right. Right.

It's it's a

We are

target to hit.

Yeah.

So continue to include the visual of our revenue and our expenses. There's nothing unusual or new here. And I'm gonna keep it real nice and short so you can say because you guys are really tired

of hearing that.

That's true.

That sounds good. I'm

not hearing that. Even when you're If you

had to give it a percentage, what percentage do you think the ECB is likely to give us the one time funding?

For the county contribution? Yes.

Because it's one time funding,

I think that's a more, palatable request. Okay. I don't know I don't know the magnitude of every other department's request. So that's part of why we made it a one time request was that that's generally always an easier ask. Okay. So I think there's a better than not chance that

it will be.

Okay. Granted, that I I don't

That that million dollars covers the increased cost of insurance, the salary increases. Correct. And that's just

my projection. We don't have so the county has not yet done the market or merit recommendations, so we don't know what that is. If it's the 4.9 that I anticipate, that's where the million dollars comes in. That's a good increase. It would be spread across merit and market. So a portion would be market, and this portion would be merit adjustment. Or I'm sorry, a market as well.

So

And outside of the 8.5 FTE, are we anticipating any more major, like, FTE loss?

Not that we have seen.

Probably not. Yeah. Think not in this year. Okay. Think, you know, we feel pretty good about moving it into the 2026 because, you know, we're on most of our contracts are on the state fiscal year. Yeah. So depending on decisions by the EBC and the adoption of

the budget by the board

of county commissioners and our other contracts start to come in next year, we are hoping and doing everything that we can to avoid any more layoffs in the in next year or the year after, but there's so many things that play with the state budget shortfall. Any additional cuts, you know, there there will be a lot of work to not get cut anymore next year. You know, we don't expect that 3,000,000 to come back right away, but to not have any more cut from public health. So there's a there's just so many factors that play into it, but we we feel we feel good about moving into next year. And then we will keep I mean, next year, I think, is gonna look a lot like this year and just the roller coaster.

Orafow County's fiscal year is January 1, but the state fiscal year is July July 2. Okay. July. Yeah.

And then we have federal

The best.

The best. Then September.

Yeah. We actually have a grant that starts and ends every single month, at least one.

Yes. So we've met a lot

of risk leaders. It's nothing. Any

other questions?

So a quick quick question. I'd probably show on the spot. I don't have the agenda for today in front of me. Are we discussing or not necessarily discussing EHPs just to socialize with the board?

Not these. That's next next

I know. I I just didn't know. So if I may, then I'll take a moment since we're talking money just to let the board know that Michelle and her team and I have started a conversation about fees for next year, and you'll see that in October. But I just want the folks to know that the conversation starts. Thanks to Steve and others. Justin, Shell. Dylan. Dylan, thank you. So I just wanted to Sure. Folks, you know what's going down. Absolutely. Thank you.

Any other questions, comments, none? Thank you for that, Priyanna. Thank you for your presentation. And so that was also the second study session. Right? Yes. Okay. And then

on the third.

Yeah. The third study session is the Steve. Follow-up in August hearing. Steve. Steve. You tell me just might add you to the normal one

then. Well,

I've got

some good news regarding Maplewood. Our property already discussed at our last board meeting for 5705 East Maplewood Place. After following our board meeting, we posted the property with the the public health order and and the notice. And that following week, we're able to make contact with property owner. He reached out to us. He proactively or so. Removed the the there was a metal reinforced plastic sub septic tank that he had installed himself. He had that pumped and provided us with photo documentation that he pulled it out of the the ground and and crushed it.

Is it

leaking? Is that wood cut?

It wasn't leaking. It was just overflowing.

Oh, I see. So that's

what

helped.

That's that's what we were we were noticing. So the program supervisor and I went out to the property. The property owner was off-site at that time. It did allow us access under the property just to visually confirm to, and we were able to to confirm at that time. Between then and now, we were able to, again, make contact with the property owner through guidance for Monica to enter into a stipulation agreement with the property owner for him to continue to abate the nuisance on the property and to transport the the any sewage that he's creating to a nearby campground and then provide us receipts if we need those.

So he did sign that stipulation agreement stipulation agreement and the affidavit that goes along with it. And Monica is in process of filing that with district court here shortly. So that is

Did he remove the trailer? The people?

Oh, so it's actually him that's living

on the property. He's been in the cold. He's still you know?

Yeah. And he is working with zoning on their separate stipulation agreement, which he still has to sign it. I believe he has until the nineteenth to sign up with zoning. And I think they're giving him until October 25 to remove the RV from the property. And so as of this morning when I checked in with the zoning manager, he hadn't signed it yet. But I think that's that's in progress. So quite a bit of resolution in the last few weeks, and I thank the board for for listening to to the presentation and also offering the guidance that that helped us get to this point.

I just have to ask. Yeah. He doesn't have a tank. He doesn't have a solution, and and he's still living there. So he's still creating waste.

He is. So it's going it'll be it'll have to be transferred via tote to to, like, the KOA campground that's nearby, which isn't a great a great situation, but it's better than not just disposing it right on the ground.

And I would just say thank you to you, Steve. I think you went above and beyond in communicating with us and then also serving. Part of our priority as board is also to make sure that Eastern Plains' voice is heard. We don't have a representative from the Eastern Plains. And a lot of times when they come in front of the board, it's usually an issue. And so a lot of times, they feel like public health or government doesn't really listen to them. And so we really do try to work with rule and make sure that they do have a voice here. And so thank you for going above and beyond. I mean, trying to communicate and us working through that. So I really do appreciate that and so does the coworkers.

Yeah. Mark? Yeah. My son, I mean, is exactly Steve. You and your your team, you know, having had some similar challenges both city of Canada, Denver, and also at the state. I mean, it is heavy my experience has been very heavy administrative process. I mean, recall from your presentation all the runs that you took at the the property owner, and then it seems like that it was the order that may have finally got caught his attention.

Are are

there lessons learned in there in terms of something about how, you know, the county communicates in that space? I mean, there's a is the the the public health order itself a big enough hammer that that's one just the tipping point to get to these changes?

Yeah. I I appreciate that question, and I've I've been circling it around my head as well. I think we attacked it at every angle that we possibly could. Bless you. And and did go go out of our way to try to get compliance because that's we we don't wanna go through this process. We don't wanna have to issue a public health order. We just want compliance

Mhmm.

For for the community as well. And and I think finally what it came down to was that that public health order and posting it on the property because I did I did find out afterwards that his mailing address, we were getting mailed there in Oklahoma. I just don't know if he was receiving it there. So we we reached out to multiple departments within the county to to to try to get all these different contact methods. And, you know, that that's something that I I will encourage my staff to do again upfront and and try to make contact as as soon as possible. But I'm I'm still proud of the actions that we took and the steps that we took. So it comes comes down to that again when that's that's the path that we'll take.

Great. Thank you, sir.

And then the spirit of safety, they they did go out together, both Steve and Connor, just to make sure we were attentive to staff safety. Yeah. Yeah. Communicating before and after. Yeah.

Thank you for that.

Thanks a lot. Thank you. Nice. See

See you next month. Alright. So

our fourth study session is emergency preparedness and response, the, their core presentation. Sarah?

Hard to follow, Steve.

Yeah.

That's It's hard to follow,

But

it is National Preparedness Month. Yes. So we should all be very excited for this. Now this is a picture you've seen before. It was in our budget presentation.

It was our favorite team picture from last year at the South Metro Warehouse where we were partnering with them around logistics and strategic national stockpile efforts. So the story for our core metric presentation is a little different from what you heard last week with Vital Record or last week. Last month with Vital Records where they had really specific interaction, a truly a a narrative to tell. Our story is more about the challenge in coming up with the metric for an EPR program. We don't have the same kind of interactions with clients or numbers to track.

We don't want to track the number of times we're activated as a metric because we don't want to be metric, you know, activated similar to Melissa in communicable disease where they're saying, you know, we don't want outbreaks, but that's an important number. So it's a challenge, and we talked a lot about that both within our program, with external partners, with, you know, our folks on the RAFT team, and kind of came up with something different. We wanted to go back to the purpose of our program, which is really to ensure that our staff at ACPH are prepared to respond to incidents that are above routine operations within the county. So how do we measure that, right?

A part of

our routine work in EPR are after action meetings, following exercises, activations to incidents. We always talk about what went really well, what maybe needs some improvement. And the biggest thing we've heard from our partners throughout ACPH is we want to feel more confident in our ability to respond to an incident. We want someone to formalize what response looks like, we want to know what's really expected of us as individuals, and we want to be able to practice that so that we feel confident. So we have some of the best staff, right, at ACPH.

It's a new health department, but we have some of the best trained staff and some of the best experience across the state. So it's less about teaching the skills and more about honing the skills they already have and increasing confidence. So if you want to flip to the next. So our metric is truly measuring feelings, which is normally not what you want to measure when you're measuring, you know, the way a program is going, but we want to measure how staff report feeling in terms of preparedness in their role in a response. So incidents continue to increase in frequency and complexity.

We are required to maintain a state of readiness at all times, and we want to make sure that our staff are trained not just to respond to an incident, but to transition between routine incidents to responses and back to routine incidents. So we're ensuring that efficiency, effectiveness, and resilience of our staff in both routine work and response work. So we're measuring that through our pulse survey that we do quarterly. We've included several questions then in that document about understanding your role during a response and your confidence in being able to fill that role. And so kind of keeping an eye on that.

Our goal is to have 80% of staff feel prepared to respond to an incident. And the reason that goal exists is sometimes, you know, we have new staff who are just new to the department and have tons of experience or staff who are new to the profession and aren't quite sure what to expect yet. So that's kind of our goal most of the time. We might have to increase that because we've measured two quarters and we're almost at 80% already. Again, that comes back to the fact that our staff are hugely experienced, have done so much work in the past and we've all worked together, know, many of us for many, many years and we understand kind of what that looks like and we've been through a heck of a lot.

We've got

Wait. I have more slides. No.

I was gonna say, is

this for all ATPH staff or just emergency group?

ATPH staff. All staff.

Okay. Mhmm.

That was my first question. Second question, how many people fall in staff? So 75% of how many?

Twenty ninety five.

One eighty five. So 1,195.

Responds to the pulse survey. So when they just give you pulse numbers, it's the same numbers. So it's out of the 195 people, the survey goes out to that number. It's probably we

get about a 75% response from 85. So 75% of 75%.

But you don't know who didn't. She's gone. Correct. Can't change Yes. With that. Yes. And do you ever get the, like, the response is the reason why I don't feel confident is because

We not in that survey, but we have lots of opportunities for those conversations.

Because that

would be interesting. Yes. So

we we can touch on that a little bit in the in the next slides. Yeah. So if you wanna switch. So learning opportunities for us to continue to grow. So some of the challenges as we approach this, right, is is, of course, we we can't talk to everybody every day about what their confidence level is. And sometimes, you feel super confident, and then your confidence takes a hit because of an experience. Right? Some of that, again, is factored into that 20% maybe not feeling great at the time. But some of the challenges for trainings to kind of improve that culture of preparedness are around tailoring those trainings to public health staff. There are a lot of existing trainings out there for first responders, So for fire, for law enforcement, for emergency managers, but we have a lot of nuance in public health.

We kind of are emergency management and responders and support to other disciplines. So it's tailoring existing trainings is something we're working on. Everyone on our team, which is four folks, myself and the three specialists, do a lot of training and exercise development, but we have one person whose focus is around that training and exercise component. So she does a lot of work tailoring, like those ICF classes everyone's required to take, Taking some of those longer, more complicated ones and putting a little public health flare and providing them that way. So we wanna be creative with what's out there, what's out there, turn it more into something palatable for our teams so they make sense.

Because again, our responses look different than a fire. A fire, the response is unless you're talking about wildland fire, our response is a few hours. In public health, we've seen it can be years, right? So it has to look a little bit different. Another is integrating preparedness into routine work.

So much of our staff are paid out of grants that don't leave wiggle room to say, Yes, your EPR training counts towards this group. Have to be able to tailor those efforts into routine opportunities. So being creative about that and starting to figure out how do we work with teams, for instance, working with environmental health on boil water responses, how do we build an SOP that's really EPR focused because a boil water is, at this point, not really above routine operations for the most part, but we integrate closely and we follow the same procedures when they respond to a boil water. They don't necessarily need EPR to set up a response structure, but it's following the same steps, so if it does grow, we're there to support, but also they're all trained in what those steps look like no matter what the type of incident is. So figuring out how we integrate that in.

So we're doing a lot of those conversations, with folks all the time, supporting efforts to develop SOPs or to talk through ideas. So I think that's one of those places we're addressing the, what do

you feel confident about, what do you

not feel confident about piece. We can do more of that and we'll continue to do more of that kind of with some of those more public health programs that we don't interface with as frequently. Environmental health, nursing, communicable disease, work with every day. But some of the other, like, harm reduction, WIC, there are lots of opportunities for us to interface. It's just finding the right time to do that. So yes.

I'm so kinda hung up on on the the the measurement of of success there in terms of how people feel about things and understand the the rationale. But it just as you're going through that slide and talking about learning opportunities, it seems as if there's some additional ways to measure that success of the program.

Love opportunities to talk to about that. Really? This is very we've talked with folks from across the country, and nobody has cited Right. Figured out the right way to measure the success of EPR. But I would love to take your break.

And every county in the country has group like this, maybe smaller, bigger.

But For EPR, you're saying? So yeah. So I will say every health department is required to have EPR work done, but it looks we have a team. We have a luxury of the county prioritizing EPR work, so we have a team. But, like, Albert County, it's one of many hats an individual will wear.

So in some jurisdictions, it's it's the public health director who's writing the public health emergency operations plan. And so you what you're saying is the county is paying for this. This isn't a grant. This is a grant. So we get public health emergency preparedness funding, so PEP funding, and Cities Readiness Initiative funding, which is kind of as a separate grant but under the same PEP umbrella that specifically targets working on medical countermeasures work. So we are funded through the grant programs.

And is that grant federal?

I guess it's federal. Yes. It's a federal pass through grant.

So we nervous about that? Yes.

I guess so.

Yeah.

So we are nervous about that. So that we are one of the ones that were impacted with we were under the continuing resolution. We're supposed to be flat funded. We received 75% of our funding.

Right.

We are supposed to receive the additional 25% any second now. By the thirtieth is the deadline for the feds to push that down, and we're very closely following the appropriations process at the federal level to see where we land. But it's one of those that that gets called out. You'll see that FEP language in some of those where they'll say if it's how they're funding it. I

would just add, was it last year, Jennifer, when you did the when you did the simulation?

The missiles

take a moment.

Two years ago. One of the things we learned as a board, I would say me particularly learned is part of when you deal with emergency preparedness, if you're not practicing it, no matter how much just say, we seek to measure it, when you're put into an emergency situation or a situation like that and the thought process has to come within minutes, seconds, or even hours, you respond very differently than we did. And and I would say, and so it is also good to talk about what process you would use. And so I communicated. I rely on the experts on the board who have expertise in that area.

So those are different environments. The military calls it VUCA environments, you know, where they're volatile, uncertain. And so you don't make the same decisions that you would. And so just be cautious when you recreate it. What you would do when we're sitting here talking about it is very different than, like, if somebody come in there and there's an emergency, you have to train for that. And so that was one of the things that they pointed

there are lots of different types of exercises

that you

can do.

The first kind of chunk of those are different types of discussion based exercises, which is what you're talking about. You have more time to think about it. They're not considered precedent setting. It's just kind of practice and getting to it's more about the relationship building than the actual decisions. The second half of those, the functional to full scale exercises we're doing, which feel a lot more real than those discussion based.

Since we're such a new health department, we've been building the documents, building the plans, and doing the discussion based. We're in the process of transitioning now to being able to do those more functional and full scale exercises. Yep. And bringing in a lot of external partners to be a part of those, it's not us making decisions in a vacuum, it's really working with those partners. So we have an exercise in October, our one piece of a regional full scale exercise.

So the 10 counties, it's a bioterrorism exercise, and it's us, it's the sheriff's department, it's our hazmat team, it's South Metro Fire, all working together, our entire public health incident response and support team. So that's from across the whole department working with all of those folks to talk through how do we talk, how does that look, who makes decisions, whose responsibilities are what. So so, yes, exactly to your point, it's the doing that makes you good.

So, in the Pennsylvania when that train got off and there

was Oh, Ohio. Oh, Ohio. Yeah. And On the border. My cousin was the incident commander, so very familiar. That's

so then public health would know its piece of that. Correct.

Okay. Yep. Yep. It's making sure and that hazmat and South Metro Right. They know public health piece.

Okay.

So they are putting different expectations on us so we can feel confident in what we know what we're doing, and they can feel confident that we as public health know what we're doing.

They know your rules. Correct. Find your rules. Probably playbooks that support all that.

Exactly. Next slide. So this is kind of some stuff we're working on. So we're rolling out, every staff person is required to take an EPR one zero one when they first start. One of our biggest lessons learned is, of course, you can be trained once. Fantastic. You're gonna have to use it in ten years and you're not gonna remember. So we're building an EPR two zero one in the learning management system that folks will be able to retake on a routine basis as a reminder. Also, that ICS 800, making it much more public health palatable in the learning management system so folks can take it on their own time. We have ongoing other opportunities in person and kind of on the learning management system.

We have about seven exercise planned in the next five months for folks to work on. Some of them very internal to ACPH, some of them regional, some of them the whole front range that we are facilitating on behalf of all of these counties so that we're all working together. We are finding more and more as those incidents increase in frequency and complexity, they're also increasing in size. So it's very cross jurisdictional. So it's partnering with all of our partners, you know, our counterparts and all of these other health departments.

And then some of them are very program specific, some of them are cross programmatic, so making sure we're hitting all of those different levels. And we're as part of preparedness month, we are in the process of doing a training needs assessment. So it's asking staff across the whole department, what do you feel good about, what do you not feel good about in a much more in-depth way than those pulse surveys, and that will inform our multi year training and exercise plan so that we can look out five years and say, these are things we really wanna prioritize over the next five years so staff are feeling better about those pieces.

Can I recommend something?

Yes, please.

I would say, how about next time? I like the presentation, but I would say doing one where you take the board through an exercise and engage up Happy to do that. One of that because I think we thank you for doing that. We're not we're not used to emergency. But but I think it's good because

I love it.

You can talk about it, but when we're forced to make a decision within seconds or minutes, it, you know, focuses us to see how quick we are on our feet. So I would enjoy that.

Yeah. We we can definitely schedule that in as we plan for next year. Yeah. I don't think they'll have time this year. No. We can't. We'll schedule it in for next year Yeah. To do another table talk because I do think there's a lot of value.

And Steve takes up all your time. I know. He would not even talk to you for very long.

Any of those comments?

I do.

And and I think that doing something Yeah. Would help me understand what that is because all I have is other examples and examples that happened in other places. Right. It probably won't happen here, but with that flood in Texas Yes. Where what was public health part? What where was public health in that piece? I mean, all you hear about is FEMA. Right. Right.

And they're not responders. Yeah. Not responders. Right. So all public health staff are considered public health responders. So our job in so we could serve one of three roles. So the first is, if it is a public health incident like an outbreak, you know, which we do all the time here, is we're the lead. We're incident command, similar to a fire department, similar to a enforcement. We are the ones saying these are the tactics that have to happen. These are the partners we need to work with.

These are the consequences that someone needs to manage, be it us, be it law enforcement, whomever, right? As you're having the conversation with Steve about, you know, kind of the septic pieces when we say, do we need to bring in law enforcement? That's that consequence management piece. So again, it translates from routine work to it's the same for incident response, it's just bigger or faster. So second role we might fill is if it's an all hazards incident that has public health pieces to it, like flooding, we would serve in the role as the public health lead, doing that consequence management piece for the public health part.

If it's a flood, our job is to do that disease surveillance for, you know, all of that stuff that might happen, to be worried about that septic piece if there are, know,

inactive facilities. So Mhmm.

Testing. Correct. So doing surveillance, doing monitoring, doing testing, informing things like debris management. Mhmm. Right? So where should it go? What facilities can take what? What does that look? What's considered hazardous? What's not? Following, like, the Black Forest fire Yeah. We did a lot of work with, all of those houses that burned, Marshall Fire. They're they're all hazardous material sites now because of everything that was under your sink is now hazardous material. It was exposed to extreme temperatures. Right.

You know, what does that look like? So it's in providing guidance, informing all of that thing. The third role we might play is, in Arapahoe County, ACPH has designated as the what's called the ESF eight lead. So, everything to do with disaster response fits into one of eight, one of 15 categories, emergency support functions at the federal level. ESF eight is everything to do with health and medical, so it's public health, hospitals, behavioral health, fatalities management, some pieces of EMS, some pieces of veterinary care.

Our job, we are not the boss of all of those. We're not regulatory. We don't tell them what to do. Our job is to create the framework so we're operating together as a system and partnering on all of our responses. And we service that, one stop, one call for, like, a hospital that needs something.

So during an active threat incidents, you know, if I'm sitting in the ESFA chair and a hospital needs law enforcement to enforce lockdown at the hospital to protect the impacted folks, they'll call me and I'll coordinate with law enforcement on their behalf. If a foreign, a coroner needs more, facilities for cold storage, they'll call me. I'll coordinate with logistics in order to get them what they need. So, we at ECPH and the EPR program fill that role. So we're activated for any type of incident regardless of the public health consequences that need to be managed.

They wouldn't call law enforcement first?

No. They would call because if we're activated, law enforcement is so busy, They're gonna call me, and I'm gonna talk to the police officer next to me to figure it out because they're too busy and they're too busy, but we can talk.

They'd be in trouble. We got a lot of

people. Mark, Christy. From

a feeling standpoint Yes. I'm curious about how you're like, the question around, like, feeling prepared because I assume that depending on the incident, like, people could be deployed in various different capacities that could be potentially outside of their normal realm. Potentially. So, like, are you tracking like, how do you feel about fire response versus, like, an outbreak response versus, like,

is that So we we wouldn't ask it like that because we're what's called capability focused versus, versus scenario focused. So staff who are going to operate outside of their routine work are going to be trained either routinely on what their role will be. So when I talk about that public health incident response and support team, it's called the FIRST, they're trained to serve in the roles command and general staff. So Talitha, for example, she is in our nursing division, but when we might activate in response to an outbreak, she might serve as the Operations Section Chief to oversee communicable disease, immunizations, and testing. Gotcha.

So she's trained to do that. So we work very routinely on training her to do that role. Folks who might be moved, you know, from environmental health to respond to the consequences of a fire, they're doing environmental health work. They're not going to be asked to do firefighting. Right?

They're going to be asked to do that hazmat piece. They're utilizing their routine subject matter expertise to respond to the incident. And then we are not going to shift certain folks around. So, for instance, our vital records folks that you've heard so much from today. If we have identified them as what's called mission essential functions, and we have a handful of mission essential functions, which we will never pull staff from those to do response work, because if they're not doing their job, we're creating secondary disasters.

So those folks, what they need to know about their role during responses, I'm going to be doing my role. And so they need to feel confident in the fact that they know their job and they're doing it at an increased rate maybe, maybe outside of routine hours, but they're doing their job because their job is a mission essential function. So that's like, communicable disease epies, that's immunizations, that's, vital records, that's disaster response, like spill response, and that is what is the other one? Oh, WIC, WIC, educators, because we need to make sure that folks are always in compliance with WIC and we're getting resources into our communities in order to ensure that we don't meet gaps in them.

So just for clarification, if any of these scenarios arise, you do understand me and Vivi did not sign up That's good to be sure. Exactly.

To help with that, you'll be doing exactly what you've been doing. You'll be helping make decisions with Steve around, do we wanna do a public health order or do we not? Because Melissa's making those tactical decisions around outbreaks. You don't have to worry about that. You have to worry about, are we closing that school? Let's talk through the consequences of that and make that decision. That's great.

Yeah. And I pointed out, all jokes aside, public health has been under threat, just say for years. And I think one of the limitations is when people are in power who don't know what in the hell they're doing, they don't like to admit that, hopefully speaking for me and myself, we have no problem saying that is not our area of expertise. We will definitely ask the experts and rely on y'all and not try to make decisions for y'all, but we are under no illusion that that is our area of strength. So we just wanted to throw that out there and take a few.

Clarity. Yes. Our job is then to be sitting down talking to you to do a public health work. That makes sense to me.

Yeah.

Yeah. I was thinking you want me to you need extra help testing,

and I was like, no. So, genuinely,

I mean, that's beauty to fire. But the rest of you your decisions, I

think we'll be good. Yeah.

No. That's that was good.

And and and a serious question here too with the pickle. I'm envisioning, like, a situation where maybe there is, like, a a last minute need for a public health order. And is there a process that's established like that and for

Right.

The our our leadership move for the whole board, like, are we familiar with it? So if we do get the call Right. We do. And, like, what's within our authority? I mean, obviously, it's a Monica question to you, but

So so it's a Monica and and a Jennifer question, but it's it's the process you follow for any sort of emergency public health Board of Health hearing. That's the process we would follow. So that's the one that's already outlined, right? The calling up, you have to have twenty four hours of mass notice, this is what it looks like, that's the process we would follow. So again, it's something you're very familiar with. It's just following those same steps because it's this type of a situation.

You don't feel familiar with it, but that's is it in your bylaws, or where does that live?

It wouldn't be in the bylaws. It would probably be in your training manual around under, like, open records not open records. Excuse me. Open meetings requirements. Mhmm. Like, we have to post this meeting so many days in advance. You can call an emergency meeting and have it posted within twenty four hours. So there are, like, rules around we can pull you together Right. In an emergency and only get twenty four hour notice. We did have to do that in during COVID, but luckily, we haven't had to do that with this board. Now that I say that that

You can Go ahead. You still have to turn my clips on. Yeah.

And and so where where did like, you hear so much about FEMA. Mhmm. Where do they fit in?

So FEMA are technically largely grant administrators, so they're doing a lot of getting money into a jurisdiction that requires support and supporting recovery operations. So one of our staff on the EPR team is also a FEMA contractor, so she can she's on call to be activated to provide support. She was deployed, to go to one of the hurricanes last year and provide recovery support, but they're less boots on the ground than you picture them to be. Right. They do have staff that could come in and provide some direct services, but it's all at the request of the impacted jurisdiction and run through the state, and they don't take over.

Their job is to support the state in the request that they So they are supplemental when things are catastrophic. Just because you you hear there's so much negativity right now about but if

but maybe we all just don't know their jobs, and they're doing exactly what they're supposed to do.

And That's a very early point.

Because Yes. The money's not flowing fast enough.

People think FEMA is supposed to be in and like rescuing people. Yeah. And FEMA's like, I I've got a grant you can apply for. Like, it's it's they just wear flashy jackets, people and people assign names. Right? That's exactly what it is. They wear their names so people think that they should be doing more. Right. And we we have a tendency because they paid for something, we call it a FEMA thing. Right? It's a FEMA shelter. It's a FEMA they're not running it. They they paid for it. Okay. Good information.

Go ahead.

I still wanna have two quick things. The first one is data is not perfect. Yeah. And, you know, feelings, it does sometimes, like, feel like there is something being left at the table that we're not capturing. But

it is

not perfect, and sometimes, like, gathering people's feelings about something is the best thing that we can do, and some of our most, like, renowned data points come from people's feelings. So I don't want, you know it it's very hard to capture data from your job in a quantifiable, like, how many. So sometimes feelings is, like, the best that we have. I wanted to bring that up. And then the other thing is, sorry, I have minted my mouth. When we started this process, we kinda broke down our measures into these three very simple buckets. So trying to

capture what we're doing, how well are

we doing it, and is anybody better off. Those three are distinct from each other by degree of control that you have over them, but also by how simple it is to capture them. Capturing sentiment is actually in the middle bucket, so how well are we doing it. So it is actually considered one of the more elevated types of performance measures that you can have as opposed to, like, how many of these did we do? Like, if you wanted to capture how many trainings did we do?

We did five trainings this year. That is a great measure, but it it loses some of the nuance of, like, how well are we doing it and then obviously not as great of is anybody better off? Right? Like, can we capture if the training and the sentiments are really cutting us with time or money or whatever. So Yeah. Just wanted to put that. It it is feelings, but it it is important and it matters and it does capture something that yeah. Exactly.

And it's challenging to say, like, to measure something like how many trainings or how many whatevers we do intentionally because if something big happens, all of that goes to the side, and so that work doesn't get counted. So it looks like we did nothing.

Right.

Right? Or, like, how many responses did we do? For for three years, we did one. Right. We did COVID. We did one response. Right. So our number would be one. Well It's not a good measure.

Good example of preparing. Yes. The We were not prepared clearly. In terms of

equipment Yeah. Not not the decision making part.

The part of we were caught off guard. The the equipment was old and dated and there weren't masks. And I don't know if that can be counted in some way. Like, for most disasters, you you have protection equipment for your staff, and it's well maintained, and it's current. Where that was some of the issue with COVID is that that stuff was dated and not effective.

A lot of the issue too was it was such a big, sexy disaster. People took over to control of that decision making who were not prepared, whereas the folks who were prepared, like local public health who have been working on this forever, our plans were set aside Right. Which made it much more challenging. Yeah.

That's all

I got.

That was my throw

in. Yes.

There's a link. Yeah. Yeah.

Think it's not going bad.

Yeah. Thank you. That's all. Yeah.

I'm serious. Good conversation. If yeah. We'll we 'll plan a point early in the year if there's another table.

And the first study session is the CHIP spotlight on healthy aging What? Which Christine requested.

So It's not. Not. Not. It's

I gotta go. Yeah. I'm leaving. It's

Alright. Well, I'm gonna have my gear here.

So last item before the executive director's report and with this hot off of a presentation to public health care, Rafi, that was very well attended. It's fun. Lots of fun. Yeah. Thank you

for that. And that's why I brought props that I'll pass around.

Oh, I actually love your sticker.

Oh, thank you.

You are cool. Oh, people are cool.

I picked

this up at conference. Metro State had these at their table, and it's a campaign from somewhere, but Oh my gosh. They gotta do it. Oh, I'm taking a rope. Well, you'll get to their website. So it is really fun.

That's hilarious. I know. I'm impressed that you could see that. I just saw the swirls of my eyes. The tide. My eyes. That's good.

Hey. You know, I've been locked

in on, like, the age positivity. You know?

If it

was gonna say something else, I might not have

recognized it.

But isn't that the conundrum in gerontology? It's supposed to be the study of aging, but we associate it with age.

Mhmm. Providence? Okay. I'll touch on that. Mhmm. Alright.

Well, thank you so much for having me. My name is Melissa Smith, and I'm a Community Health Promotion Specialist. I focus on healthy aging. And I'm just really excited to be here today to share how we are prioritizing older adults in our CHIP and just in our work in general, I think it really, we've got some examples to kind of highlight how we're working to embrace not just older adults that aging across the lifespan and older adults is really truly vital to our community's health. So as a short agenda, the flow of this, I'll talk a little bit about how we work, a key framework that is part of what guides our work, strategies, partners, and then looking ahead using this healthy aging as a strategic lens, and then some discussions and questions.

And so in the next slide, we've got three buckets that really represent the three key strategies that I employ in my work in this role. So first is integration, And there's framework that I'll share in a slide in just a minute that we have followed. But it's really healthy aging is not a standalone program. It's really how do we work across all programs in the agency. And there's a lot of things already happening that provide a tremendous foundation.

And so we look at what are ways that we can continue to integrate and build scale. And then strategic partnerships, you know, who are those partners in the community that we have worked with, where do our goals align, where can we partner, and community engagement is really a a core piece of that. So if that sounds okay, with the next slide, I'll jump in. So we were recognized in January as an age friendly public health system, and we were the first in the state of Colorado. So here's the actual Well, I'm You're

welcome to. We'll copy.

But what that means is really that we're work not that we're perfect, but that we're working to integrate age friendly practices into our work. And so I'm going to give a little bit of an overview that starts on the next slide. What is an age friendly public health? So there's an organization you may be familiar with called the Trust for America's Health. Their acronym oh, I see the direct pronounced TIFA, and they are a national nonprofit, nonpartisan organization that focuses on health issues like chronic diseases.

They are really the lead agency for this age friendly public health system path. They partnered with the John A. Hartford Foundation, which their mission is really to improve care for older adults. And they funded this work. They worked with other partners to create a framework.

NACHO, the National Association of City and County Health Officials, ASTHO, State and Territorial Health Officials, Public Health Institutes. So it's a real thing. It's not something somebody just whipped up. And so at the core, it's intended to help health departments embrace aging as a core public health function. And it's got six areas of actions and things that public health departments can do.

And they took a lot of time to ensure that it aligns with the 10 essential public health services. So next slide, this is my heaviest slide. This is here. I was gonna do that. So this is the framework. As you can see, it is center centered on advancing health equity. There are six categories. Each category begins with the letter c. Therefore, it gets called the six c's framework. And when

I learned about it, it was

the five c's framework. But as framework should, it continues to evolve, and this is where we are now. And I'll just highlight each category and share a brief example and then give some more practical examples of work that we're doing and how it aligns. So creating and leading is really about having a champion or somebody to lead the work in your organization. Connecting and convening, think, is something health departments do already and do well.

We are natural connectors. We are neutral conveners. Coordinating programs, I I really think there's an opportunity here for us to acknowledge all the work that happens in the aging sector. That is not traditionally public health in terms of delivery of services for older adults. From an organization called the Arapahoe County Council on Aging that's made up of government entities, nonprofit entities, for profit entities, and they're really focused on that service delivery piece and doing a lot of work.

Then coordinating programs can also look like, you know, co branding messaging with those organizations to help promote flu vaccines. So it can be you know, that's something that's already happening. It can be easy or it can be complex. Collecting data, you know, not just collecting, that's I think just foundational to what health departments do. It's the analyzing.

It's, you know, the Alexis and the James helping people like me say, here's what you can say about this data point and here's what you can't. Communicating is an area that we identified to really try to improve on. And so an example of a project under that right now is working with our epidemiology team and with our communications business partner to get an aging presence on our website, making an aging profile, information like that, and then complementing our work. So thank you. Next slide.

Ask a question. I'll back one side. So on the creating cell on that graph, hey. Environmental changes, can you kind of go through a second flavor on what that means? Yeah. Environmental in the sense, like, environmental health, it's really more like the the environment of of those, like, in the in that aging framework.

Great question. Yes. So creating and leading policy systems and environmental changes. So I really think of that in the context of social determinants of health and the environment and how that affects how our bodies age over time. But certainly could include environmental health when you think of the protective features and things of that nature. So yeah.

Yeah, thank you.

Yeah, thank you. And this next slide is actually an example that meets the criteria under that category to be able to apply. And so it's called an Age Friendly Public Health Champion Program. And the really fun thing about this is that absolutely anybody can become an Age Friendly Public Health Champion. And so all and if you have one person in your organization who has done that, that meets the criteria under that box, you can have other things in that category to take the next steps to start filling out the rest of the application in those other five areas.

So we, in our first year, have five people that I'm aware of that completed that step. So it's really simple. The Trust for America's Health hosts smoothly webinars and trainings. They're sixty minutes a piece. A person has to agree to attend six of those. They can be live. They can be recorded. You just fill out a little survey that says I attended. It's not a test or anything like that. And at the point you reach six, they will send you the seal.

So if you get an email with somebody with the seal and their signature, for example, it means that they have taken that step. So next slide, I believe is a friendly public health champions by state. And so you can see this is a movement that's really gaining traction. So Colorado is kind of in the mid hue blue there in the middle between six and twenty folks have, you know, on our own kind of taken this step. I'm not sure

if I

think I mentioned we had there were five of us who who did that initially. Two of those positions are no longer exist. However, we all take this training with us wherever we go. So I think it's a really great investment of time. So yeah, six to 20. I know that Jefferson County has at least one person, and this was our session at Public Health in The Rockies, was all on this process. 61 people signed up as being interested, and there were well over 50 in the room. I was floored and thrilled. So yeah. A lot of momentum and and just says that people really wanna engage.

No cost to any of this, and that was a real upside. So we felt like we'll apply. Worst case scenario, we get feedback on how to improve. But instead we learned that we were indeed recognized. That yeah.

What what what would that map tell you? What what takeaway would you take would you take from that map? Yeah.

That Tennessee is on fire.

Which I would say, if you know Tennessee, they don't do anything in aging. So it's just kinda interesting.

Now people

will take the test.

Oh, that I think that's

kind of a new thing that's been embraced. And I know that states like Florida and California approached this from a state level. I I think it's an opportunity.

Yeah.

Yeah.

I'm a Tennessee resident, so I just said. That Thank you. Yeah.

How long has the program been around?

So the the framework, that's a great question, I think it's probably been around, I'm gonna guess, less than a decade. Yeah.

How do you get so much interest at public health in The Rockies? It says a lot about, like, the marketing. It says to me a lot about the marketing and the program. I I'm just excited you're looking over my my colleague. You're you're beaming.

Oh my god.

They're, you know, I'm just so proud of basic PH for me and Alyssa for being age friendly.

So I think that Good. Gets marketed to actually take a note here to go back to my own agency and say, ladies and gentlemen, what are we doing over here in in Denver?

We're happy to share any part of the process. And and the organization, they're you know, I sent a few emails. They were very responsive, very accessible, helping to answer questions. And I think beyond I think to me, this provides a path. And quite frankly, healthy aging, you know, how health departments can or should engage is not always clear. And so this provides a path and some really clear examples of these six areas, these kinds of things. These are the national recognitions. And so that's the part I think that interests us also just partly people recognize the opportunity, and and there's just a growing interest in how can we engage even without funding.

Happy to ask about funding. Who's funding this?

My my position is funded by the county through general funds. We do not currently have any additional funding beyond that. At

least it's not federal

funds. Well, I so, you know,

it's that they opened the health department that this was an area that they wanted to do and had I had been wanting to do for a long time. So we committed to it when we opened and and did not rely on grant funds because they are limited and hard to come by and that's sustainability. So

But now that we recognize there may be grant opportunities beyond.

Do that?

I think there are a lot out there. There's not a lot.

We have been pursuing several over the past year and a half. Even ones that seem adjacent where we do Yeah. You know, we just kind of work in, but it but I don't I have not like other like, to these category areas. Right. Right. Yeah. But

there is that foundation, to call, you

know, you're on the board.

The x 50. Is this the kind of thing that, like, they wanna follow out or become the darkest public state like Tennessee? I mean, is that is that the kind of

We focus on more, like,

economic security and, like, make it less expensive to get older in

Colorado. But

Superior. Yeah. Mhmm. But, I mean, Trust for America's Health and John a Hartford are good. We'll fund this work. Right. I mean, they're pretty significant funders just around the nation. So but this is like talk about this all the time in the aging. Like, there's just not a lot of money because it's sexier to fund puppies and like yeah. And not people think about funding eating an older adults as a cost and funding like kids as an investment. Right. And we, in this space, talk about that a lot that like funding older adults is an investment. This is an investment in our communities and so there's a lot of narrative shift to be done around that piece.

And we're Hello.

Yeah. Art.

Art. He's up in the sky.

Yeah. He's proud. He's touching the fence. Oops.

Can I get a word?

It's Yes. Yes.

Age friendly is not a performance. It's an attitude. And changing the way people think about aging and approach it is really, I think, the whole goal of the age friendly movement. It's not achieving certain, you know, clear performance goals, but rather getting people to think about aging in a different way. Does that make sense?

Yeah. Yeah. Thank you for sharing that. And and I do I think that we all want to contribute to making healthy aging and quality of life a reality for more older adults. So

Well, sir, you're gonna be at the October 28 evening summit?

I sure hope so. And I jotted that down, so I'll probably look forward to finding out more of the.

Yeah. Yes. Yeah.

But just two more slides on this, and then I'll show you some other examples of you know, to Christine's point about funding being limited. Our attitude has really been what can we do anyway? And that has proven to be really productive, and I'm excited about that. So the approach, and to Doctor. Levine's point, how to cross the link, the H SPAN, health equity, also to elevate our role as an ally.

So your question about this, I think it absolutely strengthens funding applications to say, this isn't new for us. We believe in this. We've had some training in this, things of that nature and different collaboration opportunities. And then in our next slide, I just wanna highlight the group that really made this possible. We have a healthy aging advisory team. It's made up of staff members from across different divisions. Division directors recruited those folks. We're looking for people who would agree to be a division level liaison. Some of those folks are in the room. And it is an advisory team.

It's not a work group. So they are able to provide really diverse insights and input into things like the multi sector plan on aging. There was an opportunity for health departments to provide input. Will be sounding boards for new opportunities. And that is the group that really assisted with.

We did a scan of touch points where we found out we've got a strong application for this application already, which means that other health departments do as well. So thank you for that. Oh gosh. The next slide is an example of something that actually came through a tip through a member of the Healthy Aging Advisory Team. I learned about interest in healthy aging from the extension office, and that led to a conversation.

They shared it with their representative. We had a phone call, several phone calls over the course of ten months, and we are now partnering with the Arapahoe County Extension, the CSU Extension, and the Arapahoe Library System to offer a 10 session series of classes called the Aging Mastery Program in Byers in Eastern Arapahoe County. Just had our third session yesterday. I believe there were 17 people in attendance. Just super fun, but I I just love this idea of organizations coming together saying, Hey, we would really like to do something.

We couldn't have any of us, I think done it on our own, but by coming together, we're able to pull it off. And one of the other benefits with this is an evidence based program and one of the things that people report is increased social connection. So that is happening twice a week through the October, and there will be a formal graduation. The other thing that's happening right now, we had an invitation, I think that initial came from a contact with our partner at the Alzheimer's Association, the National Alzheimer's Association, was recruiting public health departments to pilot test a toolkit that they have created on community convenings. And so the focus is on dementia risk reduction through modifiable risk factors.

So all the risk factors for chronic disease are also risk factors for dementia. High blood pressure, diabetes, you know, all those kinds of things. And so this did not include a funding award, but we thought, we're public health. We convene. Well, let's do it. Let's see what we can accomplish. We still have a wonderful planning committee. But what we've done, we've just had our first meeting. We agreed to post two convenings. We're doing that at the Venus Public Library in Littleton.

We have probably 15 or so different folks that signed up and attended government, nonprofit, some for profit members of that Confluent Aging organization, sharing the science behind the dementia risk factors that are modifiable, and working with that group to identify what are some really practical things without funding that could happen that we could do. The people in the room, recommendations for other people like us, what might they do? So in October, we'll have part two, and they'll prioritize those activities and come up with kind of better action plans under under making the top two to four. So I I again, I think I'll come back to this at the end because there's kind of a a magical moment in that. But our next slide was just a nice piece of news coverage that we were included in.

So the Maui Reformation Center in Inglewood is hosting a senior symposium day on Friday, and will be one of the organizations that's offering a session. This connection also came through a member of the Healthy Aging Advisory Team. So you can see how I'm like, why they're really important no matter how many meetings they have. They provide these wonderful connections. So I'll offer a session on navigating health information, staying savvy, really recognizing that we have access to health information and we get fed health information from social media and search engines twenty four seven.

It's not all accurate. It's not all safe. So we'll do some scenarios where we look at some advertisements and break it down. And the intent is really to help people feel confident in their ability to evaluate and make good decisions. So looking forward to that.

So looking ahead, you know, I think partnerships continues to just be a primary mechanism for how we approach this work. You know, with regard to funding organizations, like, you know, the town of Bennett has provided letters of support for grant applications. They have recruited others to provide support, letters of support for our grant applications. So just continuing to stay connected and find out, be open to those other ways that we can embed efforts. The commitment, I think, is there whether we're this position or that designation existed or not.

And again, to Doctor. Levine's point, this is really a strategy and a way of thinking. And my role is to try to make it easier for us to make any changes or implement any activities. I don't have any slides specific to the core in this, but some of those objectives are really around some staff training. Christine led a session on reframing aging.

The eighteenth judicial district is going to offer a session for us in December around fraud and scams in older adults. So we're looking at kind of tracking some of these relationships, and at what point do they turn to become more partnerships and then some of those education kinds of things. So my final slide, neuro engagement accelerates progress. So the sharing of expertise, the connections to expand our network, championing of funding opportunities means so much. And I wanted to leave you with an example before we go to questions and discussion.

So I mentioned there was kind of a magical moment at this community convening in September. And that moment was that the library opened at nine and we had to have everything set up by 09:30 to start. And people who had already volunteered to lead things at the event and people who had signed up and showed up early just kind of started working together. They unloaded my car. We got the room set up.

All these things happened, and it was just kind of this magical moment and a reminder of the importance of community and teamwork. So I'd asked some folks, said, you know, ponder what a good oh, what's the word? Not acronym, but what, you know, what a good analogy could be. And so I got a message last week from one of the people who was one of our early age friendly champions. She's in a role with Community Services Now. And she had come up with some. She said community is like a foundation of a home. It provides stability, secure and security for its members. Yeah. And I thought that's that's our why right there.

So so thank you for investing in the position to help lead the work. I'm excited about the future, and I'd love to have any conversations

about Before we ask conversations, your update is gonna be Tim, how long will we be for executive session? I wanna make sure because we we also have to go into executive session.

Yeah. At least twenty minutes. Okay. And I can I can be really quick here?

Okay. So so now you have to go ahead. Okay. Because we have to go to executive session. Just so I wanna

make Yeah. Yeah. I don't wanna help One

one question is, is the advisory board open to new members? Yeah. You people because people talk all the time. Look. I wanna do something or I wanna be involved in something. And when I talk to them about stuff like that, if their interest is aging or in some other area like that, it could be a good

Great point. And then this is a time, I think, where we wanna look at how can we folks have been engaged for a while, and we want them to stay if they wanna be there. The structure has been that division directors do that recruiting and share amongst their staffs and identify. Sometimes for that reason, somebody's role might be very strictly tied to grant funds and deliverables,

and that might be some of that. So we're not outside of the department. No. I no.

I think we will evolve in whatever way it is for us. There's no hard strength.

You

know, I just yeah, if you would like to come, you know, I Yeah.

Volunteering. I'll be next six months.

But people I talk to people all the time about, you know, they're newly retiring and they want to be involved in something. This could be a win. That's a really great suggestion. Yeah. To have community.

That was nice.

You were glad. It's a good point. Was Marjorie. Marjorie. Marjorie.

Marjorie. Marjorie.

Marjorie.

Just thought I would mention really quickly. Another thing that Melissa has been great about is helping us increase our accessibility of our materials. Yeah. And because of her guidance, we have done made changes, made sure things are in larger font. Yeah. I have a tendency to over engage on people's slides, and she's very good to remind me, no. These have to be as this font. Right. And so I don't know if you noticed that we go over as you went through, but she what

did you keep it to? I tried it not go below 32. Thirty and fifty.

A good idea.

Thank you for bringing that up. So, yeah, it's a it's a really easy change Right. For for folks to try to integrate and and high contrast. So if it's white text that it's on a dark colored background as opposed to, like, a shaded box or black on white text. Okay.

Page friendly. Excellent.

Well done. Thank you. Thank

you. So much.

Okay.

That's about the work.

Yeah. Thanks.

So I do have a few things that I wanna highlight, and I'll do that, and then we can move into the session. But in the director's report, I wanted to point out in our mission moment, we launched Family Connects. So this has been in the works for some time. The team has been phenomenal in setting up the infrastructure, and we had our first home visit on September 4 and the second on the next day. Yeah. So really excited to finally have launched that program.

So

we look forward to and they've had more home visits since then. So I think they're gonna be very busy, and I think pretty soon we're gonna see the best program that we will need to invest more in. And then I wanted to we've we've talked a lot about our harm reduction team that we think of as the outreach team on the, prevention point, but we do have another harm reduction effort. It was an expansion or it's called the expansion grant program. It falls under Heather's division and Taylor, but it is working more on the the policy side and working and creating an ad advisory board or advisory committee.

It's called the PALI, which is participant advisory leadership initiative, and it is people with, lived or living experience who are providing you know, we've engaged them in various ways. But there was an event in August. They brought in, an expert from CDC Drug Checking LA program at UCLA and using some new technology that could identify drugs that are out on the street that could potentially cause mass chaos, like mass overdose, and prevent that from becoming an issue. So it's it's new emerging technology that we're inquire curious about. So they had a a session on that, really great participation in learning.

So we're we're just exploring what that type of technology and what would what might that look like for Arapahoe County, who's the best entity to do that. But it was great to have them bring in that expertise. And the PALI's were, you know, really looking at other ways that we can start engaging them more because I think they bring a a really important perspective to the work. And then I wanted to mention, we had the maternal child health program had the first ever doula training for Rampahoe County. And it was a four day training.

They had 22 participants, and it was bilingual. And they now have 20 more are on the waiting list for another training. So very well received, much need out in the community for people who need to either culturally competent or looking for alternative means of care, but we need more Yeah. And will need more providers. So it's a great partnership, and, hopefully, we can continue to do more with that.

And I wanted to the sexual health program, through title 10, we are required to do to survey our participants. And they completed the survey. They got 98 responses. Our average score was 4.7 out of five. The highlights from the survey were the courtesy of the front desk, feeling listened to by the provider, and then the time spent, with each patient by the provider and really listening and hearing.

So overall, seventy one percent of the patients reported hearing oh, the other thing I wanted to mention. Seventy one percent heard about our services from another. So it really goes to show word-of-mouth how important it is, which goes, like, the customer service and, you know, best people are talking about us because they would recommend their family, their friends, their neighbors to come and see us. So it's important that, you know, word-of-mouth helps because marketing doesn't always work for our programs. But for 71%, it shows that a lot of people feel good enough about the service that they'll recommend.

So pleased and proud of the team. They've done a lot of work over the two and a half years to build up to that. And we're not worried about title 10 funding. Oh, highly worried. Yeah.

If you

think you need to ask, then we're worried about

it. Okay. I'm worried about we've definitely worried about that. Also, in the communicable disease report, I wanted to pull out West Nile virus. We haven't talked much at all, I don't think, West Nile here, but there have been a hundred and thirty three cases in Colorado, four in Arapahoe. But of the one thirty three statewide, sixty three, cause neuroinvasive illness, sixty two hospitalizations, and there weren't eight deaths. So there's still a good reason why we talk and do a lot of education early on. And mosquitoes. Yes. And we do trapping of mosquitoes.

There's four different places throughout Arapahoe County that we trap. And in our lab over here in this building, they mush them together, and then they look at them, and they send them in. And of our 38 mosquito samples that we sent in, two have tested positive for the West Nile. So And today, third one just. Oh, third one's today. All in

the same location all season, so it's in one concentrated area.

Oh, okay.

We just got

So it's still important to to, you know, make sure you do all the great things around mosquitoes.

And and

because they all came from one area.

Do you view education in that community or that neighborhood or with that? So we do we work with the like, this one's in near the Cherry Creek Ecological Park, and they do mitigation and different ways to help do that. And then we yeah. We we do put out messaging through our partners. Like, here's things we can share, extension this, something like that.

Does that messaging reach the practicing clinicians in the area?

Generally in this season, there's messaging that comes out to the health alert network about things to look for with West Nile and and what physicians should be looking for for should you encounter someone who you suspect may have West Nile virus. But because of folks moving in and about the metro area traveling, there's a chance that someone could be bitten by a mosquito and could be, you know, susceptible to a mosquito carrying West Nile virus anywhere. So, really, when we get these alerts of a tracking area that has positive mosquitoes, we do not send something out to physicians in that way.

Well, I recognize that general education is important as you point out, but those physicians who are treating people in the area that we know is of particular danger, one wonders whether or not a targeted educational campaign or just a letter of notice or something like that to alert the physicians and make sure that they are particularly adept at, you know, thinking about it might be worthwhile to consider.

Yeah. It's it's really good feedback and definitely something we have some challenges in much of our messaging going out to providers comes through our state list that we don't have access to unless we make special requests for providers in those specific areas, which is why we try to provide that prevention messaging early in the season to be on the lookout through that specific season through September when we are most likely to see cases of wax nano viruses impacting humans. But it is something important to consider that we'll we'll think about and and talk about internally for next season.

So you Thank you. You've identified this one community this one area. Every year is that one so so do the mosquitoes fly in from someplace else that have West Island then settle there, or they hatch there? So but we don't know that it's not generational. Like, if your parent had you know, the mosquito parent had West Island, mosquito child was gonna

don't think so. It doesn't It doesn't work like that.

It just might That's And why we try to find areas across the county with four different trapping areas to try and get a good idea if there's a presence of mosquitoes carrying West style in that part of our jurisdiction. It's our it's our best effort. And then as soon as we see it somewhere in the metro area, then then we know there's a strong chance it's present, and that's why we'll then put out to the state. We'll send out West Nile messaging as a reminder that we should all be on the lookout, prevention messages to providers. And then we also do kind of our summer safety, different summer season messaging as well, including messaging on prevention for westbound virus just again knowing if if it's identified somewhere, it's likely circulating in a lot more places because our poor traps are only poor traps in a very large long county.

Yeah.

I think in the future, we could bring we've got some great expertise on staff who could do, like, a deep dive into not just what's now, but the work that they do with vermin and critters and If someone is

bitten, is there a cure?

Like antibiotic cures? No. Nothing.

So the person's gonna get sick and might die. Like with encephalitis? Yeah.

I don't know, Chris, if you wanna talk a little more about it.

Sure. I think prevention is the key, and I appreciate doctor Levine's suggestion. And we'll really look at that because I do think every year it's different. And I think that challenge is is how we we send out information and people actually receive the information. We do work with our infection control folks at most of the health facilities, and we get them that information. I think your suggestion is good, and prevention is really the key. Unfortunately, there's no treatment. And so I think we do our best to try to get the information to try to prevent it. And you see it a lot. I mean, I look at it every year. The challenge is do people take that advice and then run with it and try to protect themselves? So good suggestions, and we'll follow it up.

Yeah. I think that would be

good. A good idea. That should.

So in probably early in the year too, maybe either before we

Before the

before we hit the season. Yeah. Okay.

You know? But listening to our environmental health staff is is really interesting.

It is.

That's fascinating. The last thing I just want to mention is Becca Miles, one of our immunization nurses, received the Lillian Wald Award in public health in The Rockies. Wow. So really proud. We actually had two individuals who were nominated, and Becca was not awarded with that.

So we're going to move into executive sessions over the axol staff. Yeah. Go ahead. So those online so Martha, Chris, and Mark, there's another link that you should have. We're gonna move to that link, please. Thank you.

Hold on one second. I need Sean to read the motion before we go into Okay.

I move that the board of health go into executive session pursuant to section 24 dash six dash four zero two subsection four b and four c of the Colorado revised statutes to obtain legal advice regarding and to discuss a public health investigation for potential rabies exposure that is confidential under section 24 dash seventy two two zero four subsection two a subsection nine of the Colorado revised statute. I seek a second and

We need

our board members back.

Oh, yeah. Mark?

Mark, can you second that?

He may have gone to

the other. Oh, okay.

Sorry. I tried to.

No. That was that was my fault. I thought we were I

forgot about the motion. Yeah.

I thought I was gonna make sure we got in it to actually do it, so that was my fault. Mark. Mark. Phoebe, can you second it?

Yeah. Second.

So second it by BV Kleinman. So

Ready to go.

Yeah. We

still need

everybody. Aye. Aye. Any opposed? Hearing none. We are now in executive session. Because when do I agree to?

Hold on. I need I need at least four four votes because we need two thirds

of the quorum. You just said Of course.

Okay. Christine said, I it's four.

Okay.

You wanna know what you agreed to?

We're executive executive session.

If that was the case, but Okay.

I'm gonna hop off and go on the

next one. Your bank account information, so thank you for that. So we can we can