Arapahoe County Board of Health - Regular Meeting

What are the photos of you? You're the ones with the they played soccer.

They did last last in the spring, I guess. I coached this, so it was cute. It was a fun little

Her son played soccer before, like, a fortune. Oh, yeah.

She I grew up playing. So I was, like, so excited when they were finally like, yeah. We'll play soccer. It's been, like, literally every other sport, like lacrosse, football, basketball. Like, every other sport was like, come on. Play soccer. They both play football.

They did. They didn't love it.

I started coaching other sports because I was like, alright. I'll push live football.

Like, I can figure that out.

Because I didn't think they'd ever play soccer at best.

You check.

Right. Okay. I

think she Did she get a bit?

That? She did not get a on the meeting. Michelle Dora? Oh, wait. Who is it? Weinbron. Yeah. Yeah. Yeah. Oh, okay. She are you talking to her now? Yeah. Do you wanna just make sure she can hear and is

they agree to me. They have I can hear.

Because she's on. She

was waiting for it.

Right? Oh, she also okay. Good. Sorry. I can hear that. Oh, okay. Yeah. She probably was just like, what's going on? Because I didn't start it until we finished what was going on. So You know what, though? The only thing is because I'm doing it on this

well, I think I should

be able to share my I just wanna make sure she can see it. If she can only see, like, through the camera what's on the screen, she might have to pull up and scroll through the agenda packet. I think I should be able to share, but just so I can make

Yes. Chris is talking. We still don't critique. Yeah. She's solving a role of the self problem in the County. Thank you, sir. Good afternoon. I'd like to call the Arapahoe County Board of Health business meeting the border. Miss Banks, will you please call the roll?

Yes. Director B. B. Kleinman? Here. Director Sean Davis?

Here.

Director Christine Burroughs? Here. Director Mark Levine? Here. Director Mark McMillan?

Here.

Director Terrence Walker?

Here.

And director Michelle Weinrob? Online.

I'm here.

Name. Michelle. I'm here.

Would like, I would now like the the directors in the room to introduce the staff that are present today.

Quickly introduce a couple of folks who are, standing in for a couple of our directors who are out today. So first, Kristen Meyer with the health response division, and together with with

health

to

be here.

Opportunity. Dylan Garrison, I manage our consumer protection program, primarily food, body, and art. Happy to announce that Diana Rochas is here. She's a water specialist. Anna Gurkin, who's our water supervisor, and Melissa Rosner, who's our manager in communicable disease and epidemiology, all in home protection and response. Great time.

So yeah. Thank you. Welcome. Thank you for joining. I'm gonna ask some Please

get your phone with our supervisor from Reduction.

Yeah. And did a lot of

a street return.

Yeah. Just not. So now I'm a ask for a motion, for approval of the minutes. I move the board of health to approve the September 2025 meeting minutes as presented. Is there a second? Yep. Motion made by myself and seconded by commissioner Martin. The dean of Fayette McMillan. All

in favor, say aye.

Aye.

Any opposed? Hearing none, motion passes. Next is our public comment period. Hannah, do we have anybody? Next is the director's comment. At this time, the board of directors are invited to share insights from community leaders and partners to gauge the current state of the community. So we'll start with you, Mark.

Thank you. A couple of things in my head. We had a thank you to Phoebe for introducing me to folks who are at Wilton High School, Beth Best, who has program where they're called, around workforce development and providing opportunities for students in six or seven different areas. So I spoke with this week, and, really, one of the path that wear is I'm on the College State University advisory committee for undergraduate education for environmental and And, really, looking to introduce high school students to environmental public health. And so having a conversation with Beth, suite of curiosity. So we got a couple of things in our sheet.

Great. So I'm pretty excited about that.

We at Denver are finalizing our strategic plan, and I am really encouraged by in terms of our focus on environmental health and environmental justice. And there's a important community engagement piece there for the metrics. I'm so excited about that. I don't wanna get ahead of the details because that will be announced this week, I believe. And then lastly, by May, working with environmental health directors, folks like Dylan and others who support so much in this case, we're dialoguing the resources that local public health agencies and funding and so forth.

And I'll be part of the updated presentation next week of the court of directors meeting. Very mindful of, like, how we recognize the limitations and what we're dealing with that. So hearing from many of the LKGs in terms of resources, programs to cover, finding shortfalls, and so forth. Be good to have all the information in place, and then, there'll be some steps from here

in terms of what we're

doing for staff. So I'm excited about that just to make sure that local agencies, can be well funded for the variety of responsibilities that that you all have. So those are my. Vivi?

Well, this Saturday, Doctor. Sarah is having a new clinic with, But for all the parents and others who don't fit, I mean, those those slots, doctor's care will see if I need to just do our own thing. Because I think that there's gonna be a lot of safety net clinics kinda having to do the thing because it's the general public. So I think that's positive. So if you know anyone, can give us a call down the list, and we're do it like a. Oh, okay. But I'm also excited because my next about will start from TV. Yeah. I'm a little bit overwhelmed, but Long vision. Here. But

Okay. Okay.

But I'm not supposed to wait for doctor. And, so I'm excited about that. But I'm I'm also doing a lot of work on with other people in health care that are very authentic, insurance industry, hospitals, physicians, and those people all trying to get together and talk to each other about where we can find some commonality on the policy side and future leadership fairly picking who's running for governor by encouraging those that are running for governor to consider health care as one of their priorities. And then what because currently, we have a an administration that does is a really good health care first. Other things that are really important, of course, so I'm not putting down education.

We don't know. But we need someone, in that position who will choose people who wanna put health care. Agenda and then working with the foundation about how they wanna help contribute to and fund efforts. I think it's exciting work, great to see. It's really never happened like this before.

Those of us who have been around a long time know about the two zero eight commission and other state efforts to more broadly support insurance coverage for more populations. We lost ground and losing ground, like, we don't lose ground. So how do we motivate kind of ground up that people get together and not fight with each other, not somehow find the company around the insurance industry.

That would

seem like a naughty word, but I think it's the future, and the hospital. I'm excited about that. Yeah.

Two things going on. I think the biggest one is, as people know, as the board of health, I'm I tell people I'm responsible for also listening to the medical director. So when somebody asked me my cue, somebody said that they heard that there was news around Tylenol and autism, and I said, well, I checked with our medical director, who happens to be doctor Chris Urbina, and he said the there is no research and there is no correlation, so I feel very comfortable in putting that out in response to representing the whole Arapahoe County, but that is good knowledge. And and then the second thing, I'm part of a caregiver's group that's working similar to be the around testimony we're meeting with Hip Hop in the Governor's Office. And so I've been tasked with representing, basically, caregivers for, people with special needs or, in this case, autism.

And so there's a lot of legislation surrounding APA and a lot surrounding by, like, the approval and the need for it. And so, I've been having a lot of conversations, with other caregivers, the state and then, advocacy groups just about my personal experience, related to that. My son went through about ten years of service of ADA, and I tell people that one of the things I learned is good, bad, right, or wrong that put him in a box, and it and it doesn't allow us to see him as a full person. And so I'm a huge fan of developing social skills and looking at him as a child, not just as a individual with autism. So separately than my role is on this board, I'm speaking a lot as a caregiver, but really saying they need to address him as a person.

And then, you you know, just like us, I think we all have weaknesses. Nobody wants to undergo thirty hours of training to, quote, unquote, fix us. And I said, just like, you know, with us, I don't think it needs to be fixed. I think there's things it needs to be improved, but not fixed. And so they magnified that voice and put me on a few platforms and try to expand that message. But after ADA serves a purpose, but we really aren't going at looking at their strengths and what they can do so much as focus on fixing them, which is older models in our world. So that's one thing.

I'll pick up on what you were just saying because, one of the the committees that I serve on, for Medicaid is looking at disability competent care.

Mhmm.

What is disability competent care? There are so many different disabilities. There are so many different perspectives to look at, and I'm quite naive to a lot of these issues. So I think we're in the position and the the committee that I chair for Medicaid is is learning. So if you are aware of any issues we would recommend that we look at or perspectives that we investigate, I would welcome people's info.

That's one. Second, I've gotta tell you that I've been turning up with Christine a little bit too much.

I didn't hear you. And one

of not where to go. Is that?

One of the things that we've been talking about is the people who are being disenrolled from Medicaid and SNAP starting in January as work requirements. Mhmm. Not everybody is in a position to find work. We were talking about the challenge you have at the reservation where there are no jobs available. So how can people get work? But there's an alternative to not being disenrolled, and that's community service.

Mhmm.

And I I wonder whether or not that's something that the health department might consider getting involved in in one way or another. One way is simply to become aware of what opportunities there are for people to do community service. We know that there are a lot of community organizations that are struggling to get volunteers. And I I I wonder whether or not we have an opportunity to help in one of two ways. One is simply being aware of the connections that are possible to make, and we do see someone who's at risk of losing, let's say, their snack benefits to alert them to what's going on.

The other is it's an opportunity for the health department itself to get some free labor? Are there ways that we can use, you know, volunteers, to be our representatives into their communities in one way or another free labor. And I wonder whether or not that's something that we should consider developing over the next couple of months so that it's something that is aware. And the third thing that I wanna talk about is something that came up in a a meeting that I had with the commission on aging subcommittee. There are not very many senior centers left.

There needs to be a lot more. And I wonder whether or not there's any opportunity to encourage the development of senior centers and to include with them safety net health care where, you know, in particular in this day and age when there is electronic connection to the medical record, the the providers could be anywhere and still participate as part of their safety net organization. So is is it possible for us to encourage the development of senior centers or or having a health presence at the senior centers that there are and be able to provide better services to our central population. So Yeah. So those are some of the things that have been on my mind, and I hope I didn't cross any.

Yeah. You're done.

Mark is the cochair of our long term services and support subcommittee of the, which is why, tomorrow will be day number three in a row of me and Mark and his two meetings together. So which is why he's concerned about crossover. Things that are on my mind lately, One is, I just wanted to give a big shout out to Melissa Scott who's not in the room right now, but, yeah, let's let's give her some big steps. She just, finished up some dementia related, work with the community. She held a fantastic brainstorming session at FEMA's library that I was able to participate in, and she's put a really fabulous action plan around community engagement for brain health.

Like, how what are are specific action steps that we could do as a health department and as the board of health, and as community members to promote brain health without, like, I don't know, without necessarily policy specific policy changes or or, things that are sort of out of outside of our locus is controlled. So please share with Melissa. I've shared with her many times, but always happy to share more with Melissa about how great she is. Mhmm. So that was number one.

Number two, from the state level, we are, of course, watching the government shutdown. I we got some word from FNS this morning yesterday, about SNAP benefits potentially not being accessible come November depending on how long the shutdown lasts. And so more information to come on that. I I almost didn't share that because I don't have enough information about it, but I think it's critical as folks are coming to you all that we're in the loop on your immediate services. The program will absolutely know what's going on there.

It's it it gives me heartburn thinking about it. So that's one of the things that we're watching, really. And then lots of, like, aging stuff going on. So I feel like everybody said, before the holidays, we gotta get all of our, like, conferences and retreats and all these things happening. So October is just rocky. Feel like I'm taking my head off a little bit. But we're here. I want you.

I'm not sure if you're familiar with NOSI or the NHSE, which is a National Association of Healthcare Service Executives. Essentially, it's an organization for black Trump Care Executives. It's it's a national organization. There's a there's a Trump Care Colorado. I was just elected to sit in that board. Yeah. I think that's know. I think it's a volunteer in that board. I don't know if it's a oh, But what it does is it gets me seated at table and hear the issues going on there, and I'm curious to see how what the crossover will be like when I hear issues. Keep here, issues here inverse there, and then what

the crossover is gonna be. So, I don't think

it starts until next year, but I'm looking forward to that new endeavor. So that's

Thanks time.

Thanks the time. I was so impressed with the event that you participated last year through CDU. Yeah. Is it downtown? Is there a seventh annual? If there is, I assume there will be. It's a normal thing every year, but I I don't know.

Okay. Michelle, do you have any updates?

Hi, everybody. I'm so sorry I can't be there. You know, I I've heard a lot of the same issues that are really troubling everybody there as it relates to benefits, our students with Medicaid, our families with SNAP. We can we can barely keep, food and other toiletries and resources in our 20 pantries in Cherry Creek Schools, and so I share your concerns. And, so food insecurity is definitely on our minds as it relates to our 53,000 students and the entire county.

And I think that I think that the more, partnerships we can make, to BB's point, and to everyone who's doing outreach across organizations and across demographics, I think the better we're gonna be. You know, I appreciate as you know, putting these all these ideas in the heads of our our amazing staff there at Arapahoe County Public Health, but we have to reach out to the profit sector and and be relentless in in saying, while we're in this tenuous time and moving forward, we need we need those public private partnerships. And so any of any opportunities that I can help with or that I may come to you all to ask, I just think that that has got to be top of mind as we end this calendar year and start, you know, looking ahead. So those are all on my mind as well.

Okay. Well, thank you for that. Thank you for your input. There are no general business items at this time. We're gonna now move into our study session time. The first study session is the presentation regarding environmental health, and Kristen Byers offers me.

Hello, everybody. We're gonna talk a little bit today just about our process for calculating the cost, and then we'll be ultimately come to the board of health to ask for as recommendation for the fees? We're not gonna talk dollars and cents today. This is more about the process. How do we get there? What do we consider? But I think it'll be high level, but I think a lot of important. We're gonna just start by talking about the few different types of fees that we have. We're gonna talk about the history, what have we done since we've been a health organization, what's our approach to fees, then we're gonna wrap up with the next steps and first questions. And please feel free, obviously, asking them to point before they you have to wait till the end or if there's something that you can expand on or provide more clarification.

There are two different types of fees for environmental health. There are sort of two buckets I would consider. One are fees that are set by the state. These are typically gonna be related to food, but we have no control over those. We we charge the fees that were charged.

And then what was what's most germane to this group are gonna be the fees for I don't where the board of health sets the fee. These are things like childcare, pools, everything outside of the RFP sphere except for work, special The fees that are set by statute, again, are specific to retail food establishments, states or licenses, plan review applications, fees that there's a lack of compliance, the civil penalties. Those caps are gonna be defined by statute. There is a triennial process. I mean, they have to do it at least every three years.

They certainly do it more often if there's a compelling reason to do so, but at a minimum, it's going to be every three years. It is a stakeholder process that's involving CBT, health agencies, retail food industry with a lot of information gathered as a part of the channel review. And there was a fee increase approved in 2025 that goes into effect. Actually, part of it went into effect in September 2825 this year, all the way through 2026. So we've a 25% jump.

The next year is gonna be a 17% jump and then a 70 20% jump after that. So they're trying to phase it to make it a little easier for businesses to to manage instead of a large increase. And since the 2025 review, the prior one was approved in 2016. It was also a phased increase that was increased between 2017, '18, and '19. So it has been a while since any fees have been increasing. These are. Just give me a number like that. The 25% increase, is that $5 or is that 50?

The current fee for your new corporate establishment, zero to 100 seats, it was $3.85. And now it is 4 I actually should know what's on my head, but I wanna say it's 65, 70 something like that. And that's your most common. Yeah. And that goes up with you next year. I

have a chief, chief that I'm happy to distribute to see if people have a sense for what's coming, in the coming years. And, again, just a reiteration, are the ones that are out of our scope, but hopefully, we understand the fees that we can partner together on are, fees that are indicated by this statute, they are to offset the actual or direct cost of services. We can't double charge for things we wouldn't want to innovate, obviously. The statute this particular statute that we're going to apply to body art, childcare, schooling, schools, hourly services. But, again, this this particular one, we don't have direct cost.

And then for OWTS, Perceptive, it is primarily it's basically the same with the exception that you can include indirect costs for for the BTS. What are hourly services? Sorry. It could be hourly inspection costs, plan review. So if there's a new facility opening and they go outside and they spend four hours with those types of things.

It's nothing good with sexual appeal.

Alright. And

just to click that, miss, for direct cost. So these are things tied directly to us for their services, mileage, time spent for hourly employees doing inspections, those types of things. And then indirect costs are gonna be things like utilities, renting buildings, those types of things. So most types of fees that we have control over includes directs. Only OWTS is gonna include the the direct discount.

For history, when Arapahoe County Public Health formed, there was no data to do any sort of calculations on. We used the best proxy that we had, which was the Tri County data. We came to the board. We recommended that we adopt the same fees that they had. That happened, and that's what HPP used in the charging sets we would open.

We are going to be doing a cost and fee review this coming spring. That's what this is the preparation for. So people sort of have the foundation when we're coming in and actually asking for any changes. It will be based on three full years of data that we have gathered in our actual operations. I did wanna add one more thing, specific to the timing of the increase for fees that are not RFP.

So RFP, what I've seen is it tends to be big groups. So when they're they're updating them, they're updating large amounts. But for the ones that are governed by the board of health, they seem to be more, sporadic, meaning the you know, one program will do it one year, the next will do another year. OWTS has had increased there's no changes actually as recent as 2021. That's actually a slight, very modest decrease, somewhere like $3, $5, almost $20.

But by and large, most of the programs have not had changed since 2017. Some of them are in 2020. So it's it's less root, for the guidance that we're gonna be talking about. For our approach to fees, first, we're gonna start off with the foundational how much did it cost us to provide this service? That's a pretty straightforward process. We're gonna talk about that here in a minute, how we're calculating. And then where the complexity comes in is the approach to these, meaning how are we considering impact as a community and those type of things. We'll talk about that in a little bit more depth here in

a moment.

We are wanting to come back to the board in May with recommendations for changes to fees. And we're going to, obviously, open an up review discussion, and then we're gonna ultimately ask for approval in June. For calculating the cost of services, we have a standard tool tool that we're gonna use across programs. And there is a three year average to help sort of smooth out the spikes and valleys. This is not real data.

This is just an example of data and how we would utilize it. First and foremost, we start with the direct costs that we are tying directly to the offering of that service, and then we're going to remove fees that we've already collected. So if there are hourly fees for plan reviews or those types of things, we don't need to recover that cost, so it's excluded from this calculation. We're going to then divide it by the number of units. So this could be, inspections that occur.

This could be licenses. Whatever the unit is for that particular type of program, we're gonna come up to that certain unit cost for that year. We're going to average that out with the two prior years. So we have an average of the three following years, which is our three year unit cost. We're gonna look at it in comparison to our current fee, apply our approach to fees, which, again, we're gonna talk about here in a little bit, and then come to the board and say, this is what we feel like is the appropriate fee for us to ask for.

We do have some calculation guardrails. Clearly, accountability is critical. We wanna make sure that everything is documented and was received for using standard financial practices. No duplication. So if the, you know, state or federal has charged somebody for it, we're not gonna charge them for the same thing. And, obviously, we need statutory alignment. We need to only do we have a direct or the indirect cost as appropriate for the various program. I'm gonna talk about also not exceeding the actual cost of the services. We need a comparison to the families around us. And if JEPCO charges this much, just so we have some reference point, like, we're not so it might cost us more.

We'll be able to justify that, but we're not used to mail for that to keep charging. Sure. And we we did meet with a couple other counties just in our preparation for this just to get a sense for what is their process. So why was there's something we've learned from them. But I think they're in a a similar space now also, so it'd be interesting to to get to that financial because it's it's not really available, at least for, you know, a couple nearby.

As far as our approach, of course, we need to meet the statutory obligations. We are trying to focus on a full cost recovery. However, we don't wanna do it in a way that causes businesses to not be able to offer these. So this is where the parts of fee recommendations comes in. The the cost is impossible. Not much that you can do about that. But how much we're asking people to pay for the services, that's what we need to do a lot of digging and really applying these these processes. We are gonna have a data informed approach. We are focused. And, of course, we're gonna be aligned with, like, priorities.

We really have to find the balance between having sufficient financial means to offer to continue to offer those financial services, but also share community well-being and accessibility to to the services that we offer. And in that area, we don't ever judge the success of the the one taxi makes a million dollar a year and one makes $10,000. We don't take it. That that's kind of sometimes an equity issue that tattoo parlor doesn't know where it's in a business. Right? In addition,

we have not done that, but it's in its. Right? Some sort of sliding scale potentially. Yeah. We thought about that, but, you know, find across the board is very difficult, but certainly.

And also what's practical. What what is appropriate? You know, if we do a sliding scale, what sort of information do we get? This is that that that's absolutely in the process of our discussion is what does this look like? How do we articulate that? What is right for us? What is the fairest for all of the individuals that that needs to get into their services? That could be an equity line. Absolutely. Yep. Absolutely. And that's, to just be totally transparent, that is that is still being taken out. So this is the the beginning part of that process. We've done a lot of thinking Yeah. Researching, really trying to get a sense for that. But I think especially as we are going through the process, it's gonna really help us both what that could be.

Great. It's been a little bit too. You know, I love the question. My bad, this question prior to this presentation, this is one of the big things that jumped out at me. Right? Yes. What is that process of defining an equitable approach to these and whether it's just at scale? Otherwise, I do think that brain trust of the board may have two thoughts in this space as well. And I'm excited for this conversation because I think it's appropriate. Maybe thinking about, again, the scale. Where does it whether that may be to think you're getting for Yeah. For this? Because I do think that's really important part of the

Absolutely. As you mentioned, if there are ideas, people have done, you know, experience doing this, whether it was successful or not, and it's ultimately Mhmm. Lessons for us to learn. So we are all ears, in different sort of experiences that or even ideas that we can consider, as we're doing this process. Mine would be to go to the last, point you have, which which services are considered programs

that serve community members directly? Because for me, this is, like, that two part of the more individualized as opposed to, like, a pair of the program to where the community member is benefiting directly. Would, you know, just to give that's different from the network perspective. And it wasn't because of, you know, tattoo. There are certain individuals.

Within the yeah. They you know, to change their care. Yeah. So, typically, it's gonna be, the WTS, the subject in the short term, the ones that are most directly impacting the community and perceptive individuals. So, right, like, if you have a feeling system and you can't financially fix it, it doesn't what's so

Are we going to is that we're gonna be posting sessions before, like, on the previous side? Public forum? Yeah. Yeah. This is And I was okay. Can we have a I I don't wanna create extra words, but can we have a public forum on the Eastern Plains and some kind of context to hear from the residents out there as it pertains to the septic system, because I would hate for us to just say make a decision without their input because this mainly just affects deal. Right? And so I know there's some nuances, you know, to that. So so it would be interesting. Even if they can't attend even if there's a way we could ask in writing more, like, through the web page or something just to be able to take their

they probably do.

Yeah. So we have met with some team members to talk about, we have a community post question. We're thinking about putting something like that. So we put it in the newsletter. We put it on social media. So we don't have that nailed down yet. I'm not making sure what question is the right question certain questions to ask. But it's absolutely part of this. Us understanding what are people most concerned about, what impact is the most directly. So that's not quite fully

Yeah. That's fine. Thank you.

But I think it's a really astute comment there, Sean, in terms of let's connect with who's sort of most impacted. Mhmm. And that example is perfect. Well, same thing too, you know, restaurants. I I can't remember the the breakdown and, like, how the percentages of different industries or, you know, how the fees are coming in. But be mindful of, like, a little bit of stakeholders over to try and find a way to engage in in that credit. As a group, we're gonna do a reasonable part to do some. Alright.

And we we talked a little bit about it. So this part of this conversation, but, obviously, none of the tools in our tool set is you wanna. Next few slides aren't particularly useful in this presentation other than just as a reference. I know everybody got the specs in advance. So if you wanted to get a better sense for what types of fees are included in the in two different sort of buckets that we talked about.

This is gonna be the set of fees that are set by the state legislature that should out of scope for our conversations. And the next two slides are the fees that we are going to be potentially coming to the board to ask for some adjustments for in May. And as far as timeline and next steps. So the the first was familiarizing everybody with the process. That's what we're doing now.

Just the high level one on one. This is what we're doing for cost calculation. This is how we're going to be I'm still looking forward with the fee recommendations, that will occur in the board of health session in May 2026. We're gonna present those recommendations for those new fees. We will have specificity around dollar success at that point.

We'll obviously call out what they were, what they're requesting, but nothing is changing. That meeting, obviously, will be open to the public, so that would be another way that if somebody has, you know, some feedback that they would like to provide, they'll have that opportunity. And then we will come back that next month and seek approval for the roast beef. So, obviously, if there's any questions or concerns or things that we can address between May and June, we wanna make sure that communication is open so we can make sure that we're prepared for whatever we need to decide. Certainly, we

show the. You're disappointed in your support and a resistance to this, one, to the apes themselves or to the process of Well,

I can tell you this. We just for the the fees that we don't control, the the board of health or the the RFP fees, we sent out a notice just to the stakeholders in advance of billing them for it saying this has come. The response is not great. They were it was not particularly well received. We got some very colorful responses. So, you know, things are financially challenging for a lot of people right now. Asking people for more money, it's gonna be tough. And that's that's part of the challenge of deciding what these fees should be. We also have increased costs, but we don't wanna make. So it's yeah.

I that whether people will join the board of call sessions to to weigh in, I don't know. But that's where we're trying to find other mechanisms for them to to weigh in.

You tell them to call call it a restaurant association. We we were a major player there, and probably the reason that the fees were stalled for several years. So what ends up to be the 75 or 80% increase in three years. Outside looking in through the. And the CRA back to the phase two on that.

One question on the timeline. I guess it's you know, respect what it what it means. I mean, it's two things. One is so so important as, you know, I meet with Christian and others and anticipate doing doing something about it again between now and now and and May to offer some some suggestions. But from May to June, it feels like a pretty tight tournament for some recommendations.

And so is there is there ability to either present in April so there's an opportunity to hear the board and make some adjustments? And then we or maybe some other approach or just because I anticipate just based on the the light conversations we've had so far that the board would have some good thoughts in this space, and I don't know if there's enough time between May and June to respond to the feedback. So I I asked that question very respectfully in terms of your busy schedule and your team, but also participating in some questions of the program.

Sure. Very reasonable question. We need to make sure that the process works for everybody. So for us, we need to make sure that the books are closed so that we can calculate the cost, so we can do all the other things as well. So I'll definitely go back to the team, see if it is feasible to do in April. So we're thinking that April for presentation in June for potential review and approval would be a better time frame. Is that or are we talking even prior to April? No. Because then it gives us some time in May if we want to have further discussion. Okay.

Do you think we should delegate that to the budget subcommittee? We do.

We're good. Good. We can't ask it, Justin. No.

Good. That's just a wine that gets involved right up on it. But of convenience.

Have to take this on. Yes, sir. No. And then they after joining Christmas, I know it's been a Yes. Blessing to work without a. I'm just thinking just enough lead time Yeah. To people's point. So That's April presentation, the board can digest. Maybe we have some initial reactions in the third. More discussion in May and then set so you and your team up for, you know, bringing this to the board and g for

And it gives the public new opportunities to come forward. Yeah. Sure. Okay. Collect over and ship feedback. Positive. And then you or you can encourage them to come to when they need it. So I'll I will definitely chat with the team, see what the the timeline of when the books are closing, all that looks like, and if that's possible, actually. That's awesome. Thank you.

Crystal, I'm curious about the unit costs and how much they change about it's I mean, besides labor and staff time, like, what else goes into that unit cost? And is there a reason why we need to look back multiple years if it's mostly tied to staffing cost that is gonna go up anyways? Totally. And Dylan, like, definitely feel just good to add in here. But, like, first, we're definitely more open.

We didn't have very many that's true. We didn't have very many facilities. Mhmm. So the the volume of the inspectors in the facility, it varies quite a bit, especially because we're new. I think it'll probably be less volatile, not as when we're established, but we're still staffing up and and building additional factors, which means there's additional effect. So gotcha. Okay. That makes sense. Yeah. Thank you.

Thank

you so much.

It might be that we may not have the concrete numbers of the public health, but we can come back with, and we'll have it to your point of time. So we'll we'll work on it internally, that is gonna be fine. Let me know and and why, and we can just ask you. Thank you.

So the second study session is harm reduction, and Alicia is going to be presenting.

Yep.

It should just keep yeah. Yes. Hello again, everybody. It's Emily Tuskeel. Yeah. In case you forgot, we're to present you. Alicia Tacon, I use she and her pronouns, and I'm the harm reduction program supervisor. So today, I will be talking a little bit about our core measures for 2025. And, admittedly, a couple of the slides, I updated them a little bit ago because I have the images. So what you'll see is, quarter one and quarter two. I'm to share some quarter three numbers or send that out separately. Yeah. Thanks, Phil. I'm happy to speak. So I will not talk too much about the program specifics today.

It's gonna be a little bit more high level, a little bit more general about our program. But, as always, if there's any questions, please don't hesitate to ask. I really wanted to start with the definition of harm reduction because I think it is important for us to ground ourselves in this definition and know, like, why we do what we do. So the definition from National Harm Reduction Coalition is that harm reduction is a set of practical ideas, strategies, you know, interventions aimed at reducing negative health effects, specifically with substance use and sex. So that's kind of our bread and butter.

However, harm reduction can be with a very broad definition, and it can be applied to a lot of different behaviors. But for us, substance use and sex is kind of that big one. And then part part of the reason for that is because harm reduction really was started as a movement, built by people who use drugs, people that were impacted by, HIV and AIDS in the eighties. So it's really important for us to kind of, like, remember that history, know why harm reduction exists, why we are in the room at. And so the, I guess, goals of our program is really to meet people where they are to reduce barriers to resources.

We do, as a reminder, we provide rapid testing for HIV, hepatitis c, syphilis, and gonorrhea and chlamydia. We also provide those, specific tools for safer substance use and opioid overdose prevention. Naloxone, testing strips, syringes, things like that. And then we also act as a point of connection for folks to provide referrals, resources to other services. And a little story time.

I think it's a little fun. So once upon a time in the old days, aka our trifamily days, our program participants were requesting supplies other than syringes. When I first started in 2021, it kind of seemed to be, like, here and there. And by the time we dissolved Tri County, it was a pretty regular request from a lot of our participants. So, specifically, folks were asking for smoking materials to smoke their drugs more safely.

And at the time, we were really unable to provide that to them based on some liability concerns. But one day, the Colorado paraphernalia laws changed, thankfully, and so it expanded paraphernalia exemption, protections for folks as long as they were receiving supplies from an approved syringe exchange program. And that really called out the Glassware piece to things, so locating pipes and whatnot. It is it also expanded, drug checking exemptions and, just kind of clarified some of those tools a little bit more clearly. So when that changed, we said it's time we're gonna do this.

And as of January 2025, we started, distributing smoking supplies, and just some other safer use supplies for folks. And since then, we this has been a record breaking year. We have seen such huge increases in participants accessing our services. So some of this data that I have is, through the August, yeah, August 31. So a lot of these numbers have increased since then.

But as of from January to August 31 of this year, we've had 866 newly enrolled participants, and that is huge for us. I think that was, like, kind of our total encounters at Stray County for, like, eight years. So huge for us. We've also had about a hundred and eighteen people tested for HIV, hep c, syphilis, gonorrhea, and chlamydia. And I think the importance of this is just showing that, you know, we're out there.

We're reaching people who need to be reached, and this is a really targeted intervention that was requested by our participants. So we're taking their feedback into consideration, and within reason too. If it was still illegal, we probably wouldn't be distributing it. But, know, doing what we can within reason to meet their needs, which has ultimately impacted our core metric goals, and then we're also addressing the fourth wave of the opioid crisis. So this graph, it's a little small here.

But, basically, the fourth wave is that red line stating that, you know, opioid overdoses have been increasing as you know, but it's getting a lot more common for opioid, overdoses to be associated with stimulants as well. So we're seeing, fentanyl and methamphetamine overdose is happening at the same time, fentanyl and cocaine Really showing that. Yeah. And I can

also send that out separately.

To read it to you, did you have a question?

Yeah. What's SSP?

The range service program. So it's shortened. Sometimes it's also denoted as SAP, syringe access program. But, yeah, SSP, syringe service program. So our first metric, it is really about optimizing our interventions.

We are counting the number of unduplicated folks that are enrolled to our program. And so that includes, unduplicated syringe access program participants and then the testing program participants. Those are kind of two different pieces of our program. And, again, we're really just wanting to make sure that we're reaching folks that are most vulnerable to HIV and opioid overdoses by enrolling them in our program, chatting with them, getting what services, might be beneficial for them. And this is really important because, again, they're getting access to lifesaving care, lifesaving tools like naloxone, substance use disorder treatment, referrals, HIV care, just anything to really support them in that moment.

And I have that piece of nonjudgmental nonforcer services. Because for us too, it's really important that folks can access these services regardless of what they might be ready for or not be ready for. They can just exist in our program and and get services. I think that's part of the reason we've seen so many people is they like us. We haven't had any complaints so far.

Yeah. And the goal is really to reduce opioid overdose deaths and prevent new HIV infections in our public county. And I will say, since checking the updated data, we are just about at that, second yellow dot of the target for number of unduplicated enrolled notes. It's the target was 654, and our, actual count was 648. So just under that target, but, again, still seeing increases of.

What's our capacity? How many, participants can we support?

Great question, and I think we're getting to a point of recognizing, like, what our capacity is and what it good and should be. We've definitely been seeing large increases in our drop in hours, specifically in Aurora. I was there last Friday, and I think we had 60 people in the span of three hours. So very busy. The team is definitely feeling a lot of increases, both positively and negatively. But I don't think it's, like, this is how many folks we can see. It's just in that span of three hours, for example, once it's 04:00, we lock the door. If there's folks still inside, we'll see them, but, otherwise, folks will just miss service.

And just to expand on that, we I don't know about capacity, but in Aurora, when you look at how much it's increasing, I would say it's really something for health that needs to make status slightly different. We're not at the table understanding how bad it's getting the force being pushed out in Denver. I contacted harm reduction, the street attorney, and at that time, we were seeing one overdose maybe every other week or once a month. Now is up to probably Wednesday. So it is I mean, kids are watching, you know, grown people, you know, literally pass out in our parking lot.

So I would just say talking to the other people around the community, it is exploding. So I'm hoping to do a better job. They they do fabulous job.

And do you integrate your services collaboratively with Adams County, particularly in Yeah.

So the Greek fraternity specifically is Denver, but, yes, we're actually scheduled there next week with our local unit. And, we had a chance, there was a syringe access program summit for all state with syringe access partners. So we participated in that a couple of weeks ago and kinda did some of our Denver partners, and they're actually gonna be joining us, next week. And then for Adams, we've had some street outreach collaboration, some, event collaboration. So I think we're still working through the logistics of what that looks like because to their right across the street from holdback. So we still wanna make sure folks get served on both sides and not be, oh, your Adams. Know? And so we kinda figured out

Yeah. Because if they're if they're not holding up their side of callbacks, that would be more yeah. They lost the street. Yeah.

We're they have, I think, 15 harm reduction staff members. So So they have three times as many staff members as we do. So I was very surprised. So we can definitely link them.

And

our second measure is really trying to kind of cultivate those relationships and whatnot. Our metric is the percent of services that were provided to people who identify as black indigenous people of color. And so we, one, wanna make sure that we are providing services in a culturally and realistically appropriately. And then we know that folks that identify as black, indigenous, native American are experiencing higher rates of overdose deaths and HIV infections. So we wanna make sure that our services are equitably addressing those racial disparities.

For the third quarter three period, our data point is, again, right at that baseline. It decreased slightly from quarter two to quarter three. So quarter three was fifty eight point four percent, and our target or baseline is fifty eight percent. So we're still meeting that target, but, we can definitely do a better job of making sure that we are reaching folks a little bit more that don't identify as, basically.

Do we include sexual as one of the measures that we track?

Necessarily for us on in the 100 options. I don't know sexual health does. Okay.

Yeah. That's what I'm remembering. And so I should say that we partner and it is a relationship for KeriType, where we actually send out nurses.

That's a whole another presentation.

Don't know.

So so the integration of the the clinical disease screening and access to mental health resources and substance use resources is tight. Okay. Yeah. And we have

our internal public health measures, and successful participants successfully into the sexual health program is something that we do track Hold on. Just to know how many folks are are getting services. So some learning opportunities. There's been a lot of challenges, including really just huge increases in need for participants. We do have a lot of folks that are experiencing homelessness, housing instability, food insecurity.

So just so many more needs aside from their substance use that they're seeking with us. And, again, we have limited funding, limited staffing, and so that has really created a lot of challenges. Again, the increased co in overdose deaths for black, indigenous, people of color despite national declines, so that's definitely a challenge. Like I said, we're trying to kinda figure out how we can, I don't wanna say target that a little bit more, but, you know, get folks what they need? And then there has been some more just increased hesitancy around harm reduction interventions both locally and federally.

So that is a kind of an uncertain challenge that we don't really know what's coming. But based on everything that I think has come down from Medicaid to, I mean, everything, I think we can expect some changes for sure. But we work again on with things are moving semi slowly now. Some of our actions are really to use rated funding and just using those multiple funding streams to offer a variety of services, supplies, reach as many people as we can, and utilize a different funding stream. So like I said, we do partner with sexual health, and so we're able to lean on the specifically, like, syphilis funding from the state, their title 10 funding for sexual health and reproductive health services, and then also using our harm reduction and opioid overdose grants to kind of serve the safe people, which seems like we get enough services.

So that's something we've been doing. And then, again, leaning on partners to really expand our capacity. Transportation does continue to be a barrier, and we know not everybody's coming to our fixed site. So where else can we meet folks and go directly to the community with some folks? And then continuing to just really advocate and educate on harm reduction interventions, our programs specifically, what we do, what we still do, why funds should be greater than one another.

And then that last little bit is like I said, it's a little bit dated, but in quarter one to quarter two, we had a 129% increase in participants accessing services for a total of 623 unduplicated enrolled participants. That has definitely since increased. I guess, I've even seen so much more so many more votes. And then through 2025, have that study baseline of about 58% folks identified as black.

Oh, sorry. Go ahead. And then I just wanna Yeah. Do a shout out.

Yeah. I had a a question. You were talking about hesitancy both locally and federally, and then you mentioned the state. But are there more local than the state hesitancies that are affecting the program? And if so, what are they?

Yeah. That's a good question. I do think we do have a lot of great partners at the state, both at, like, CEPHE employees and just, like, a general, I guess, agreement of, you know, providing home reduction services. So I think it does come down a little bit more locally. I think maybe

I'm not sure

if it's municipalities, but I think that there are some more, like, conservative folks in city councils, and then, like, rumors get out about what we are. But a couple months ago, there was a rumor that a syringe or a seed injection site was opening in Middleton. So there was a lot of backlash from, just, like, community members even though that wasn't true. And so I think just some of the, again, rumors that come out, what people think harm reduction means, and then that local kind of disagreement with it or Mhmm. Yeah. Not really understanding exactly what we're doing and then bringing that thing to city council and those, like, more

Are there things that we might be able to do either as a board or as a

of the

the health department to counter them.

I really appreciate that. And, yes, I think education is huge. Because, again, there's a lot of folks that think they know what a redemption does or what it means, but it's really based on myths and and rumors. And so really bringing to the table, like, this is what the team does. This is what our goals are and why, you know, why we do care about

the community. I think a lot

of the negative connotations associated with harm reduction is, you know, increased drug use, increased crime, and just, like, you know, you're gonna bring more, like, undesirables to the community. But at the end of the day, these are our community members. Folks care about their health. That's why they're accessing services. And we are, again, working to reduce opioid overdose deaths, HIV infections. We're getting folks rides to ID appointments, to substance use providers. You know? Like, we're doing so much more than just distributing syringes. Or

Do you have good information about the effects of the harm reduction program on crime for instance?

We don't have one internally, but I know there are studies about, like, about that kind of nationwide or for other parts of the country. So we can look into that and maybe get that too. There's some some great articles.

We also have some, basically, slide pages on reduction of diseases in between decreasing all all as well as increasing mental health as well as substance use. Do you have that data? Do have those sheets?

Again, not internally, but, yes, there are plenty of articles Yeah. Yeah.

I think that would be very useful. So if if the conversation ever does come up, that we're

prepared for it. You know?

And we do have an internal kind of, like, one pager fact sheet of, like, harm reduction, like, what to know about harm reduction. And it does pull from some of those data pieces in those articles, but it's like a nice Arapahoe County documents. You can kind of slide it

to that's across the table, and they can bring it up.

Thank you.

Yeah. It's great it's great to share, Gordon.

We can share that. We also in response to the rumors and talk of the safety injection studies of not understanding what our harm reduction does versus what it is. And every time a a bill is introduced in legislation, it creates some stir around what harm reduction is. So the team created what is harm reduction and what it is not. And it's a great build on future, so we can we can provide you the link to that and then affection.

We can develop one with some of our data because the team has really done phenomenal work in the last two years. We we got the Colorado opioid funding, and it got prevention points, and then with the local regional opioid funding, hiring staff, really been able to significantly increase outreach and, outreach. So we'll look at that, and then I'm gonna be here next year. We haven't done with the board of health resolutions or populations. So it would be a way of recognizing the work of harm reduction.

So I'm I've been exploring around with some like, what would we want? The only proclamation we do with the commissioners is around.

And

because that one is highly important to me. And I think there could be some things to, you know, activate the board of health and use it as, like, all the social media points. Mhmm. So.

So

I will look at what might be some propositions that we agree to the board of health minister to recognize work such as harm reduction, especially And I wanted to really quickly acknowledge Alicia and the hard work that she and team did. We just recently got approved the one more year of funding through the, region nine Arapahoe County regional opening week payment meeting. We went in with double the funding request. We were asked to come back with a new lower amount, but we did. We went in bold.

It was a little bit much to the piece of hesitancy, not understanding and appreciating the work of redemption. They were really hesitant to for our our increase of twice the amount, but they did it is an increase about about 25%. So we do have an increased funding from the ROAC that will start next year. Somewhere. Yeah. I don't think next month. Next. Yeah. Like, here. So Alicia did a great job defending our proposal and answering some really, really hard questions.

No. Can say just look at know, you if you look at the learning opportunities under the data insights, a 129% increase in participants in one quarter. So it just speaks to

the need, you know, and how we

You're right. It's you know, that is huge. You know, a 129, you know, 600 people. Good work, and congratulations.

Yeah. And it's

a great segue into our path forward. So definitely, looking for more collaboration opportunities, okay, start to our partners, different service providers, just really anybody that we can work with to to serve our folks, and really sustaining growth as well. Because, like I said, we're a team of five, and so it's definitely challenging if somebody calls out or, you know, if we're all booked to doing something, across Caracao County, and then we need to, you know, turn down certain events and things like that, and then establishing more sensitive lens of community to see greater program impacts. So what I mean by this is really engaging our participants a little bit more. Again, harm reduction was built by people who use drugs for people who use drugs.

So making sure that our participants do have a seat at the table and can continue informing our program, continuing to see the the benefits to the program, not just in terms of supplies, but, like, creating that sense of community here on this together. And then some wins, like I

said, you've had teleprogram growth, and there

was a period where every month, we were breaking our own internal records of participants served. So that was a huge win for us. Chris kinda spoke to some of this, but some of the service expansion we've been able to do this year is, we started offering pregnancy testing in January as well. We were able with, some of our opioid abatement funding to expand our, STI testing from lab based testing to then doing rapid on-site, testing for gonorrhea and chlamydia, getting results in thirty minutes, and then initiating treatment with our sexual health RNs, and then kind of developing a rapid response for syphilis, like I said, using some of their specific syphilis dollars from CPHE. And one data point that I think is really important is in 2024, I think there was twenty four participants who were referred to sexual health for treatment, and nobody got services with them, basically.

Whereas in 2025, we had a hundred percent of our participants at least be contacted with sexual. So that can be treatment initiation, completing treatments, anything like that. And so huge difference in in our ability to to get folks that wraparound service. And then we placed six of our nine public health kiosks for increased access to no loss or other, harm reduction of free sex supplies. Our sixth holding base was actually at judicial services here on the campus. Oh. So, you know, incarceration can be a overdose risk. A period of incarceration can be overdose risk, and so ensuring that folks that might have some history with incarceration and just, you know, the the system in general have access to naloxone, safer sex items, test shifts.

Yeah. Could you tell me what percentage of the funding that does go to at a time of effect? Whether it comes with a shake or whether it comes Probably 25% with the new doing it's a little bit, but it's right in the age considered. Oh, it's full.

And that is specific to HIV testing. So if that one doesn't include any of our service programming or other HIV, Colorado HIV and AIDS prevention program is HIV and, Syracuse. Does that feel like a friend? Yes. I would say yes. Yeah. We so that client is kind of a different fiscal cycle than mutual. So it starts in April and goes through the March. Mhmm. So when we got our funding in April, I think it was, like, a 100 per not a 100%. It was, like, 50%. Until, like, September or something like that. Mhmm. So, luckily, we were able to get the full amount of funding, but there was

a period there where we weren't sure how long they were gonna have. And in the president's proposed budget, many of those lines are laid down completely. Now congress has come back and reinstated a lot of them, so probably it's been clear as much. It's really hard to see if the specific lines have been reinstated. Mhmm. And we don't know. Thank you.

We placed six of nine kiosks. How about the other three?

Yes. So the other three, I think we just had a little bit less capacity in terms of, like, staffing, supply distribution. With a lot of the funding cuts we've seen at the state level, a lot of our supply supplies have been impacted. So, our naloxone is from the CDPH, naloxone gold fund, it's a little bit specific for, you know, direct to be given to people that are directly impacted by opioid overdose. So are likely to experience an overdose or likely to respond to an overdose.

And sometimes we have community members who may not, like, categorize themselves as as bad, I guess. And so they might just wanna cure it or, you know, wanna have it just in case. So we've kind of had to limit how much naloxone we can distribute to community events like that. And we've had to purchase some of it, and it's very expensive. I think the generic version of naloxone was $30 a pack, and then the name brand, I think, is, like, 24 or 48. So it's very expensive for us to to buy that. And then, like, that one of our funding is kind of uncertain, so we wanna make sure we have funding

for our program and our participation.

So the other three are waiting with funding before they can be implemented.

I would say for sure.

And then also just, like, finding willing partners. There was a point where we had a lot of interest, and we reached out to some partners. There were people who kind of brought it to their leadership and then took a pause on it. And then there's other folks who we just kind of

never really heard back from.

We were

like, hey. Do you wanna do this? Let us know. And so

we just have that early at.

Mark? Lucy, thank you so much for the presentation. I've learned so much about hormone reduction since joining the board and appreciate your good work there. And folks may recall too. Michelle gave us testimony a couple months ago in terms of her her experience. They're actually inspired me to sign that opportunity in terms of the Haloxyn they have that By next month, in all honesty, it can get a little intimidating. Mhmm. I'm glad for probably dumb reasons. But just recognize it's an important part of your health. I'm excited for the training.

He's getting a little anxious.

I did have an experience a couple months ago. Downtown Denver. I wanna be better prepared to tell people what to do. Yeah. So, you know, the discussions on harm reduction, Michelle's testing are just. Thank you.

Thank you. And thank you for, you know, taking that step to learn. And I think, like, you asked about, you know, what you can do as work help things like that. You know, just stepping in when you can, and we feel comfortable and like, that creates domino effects for people you know, the community, you know, Don't be intimidated. That's why I tell participants all the time. I'm like, you can't mess it up. Really, you can't. Especially if it's nasal, just spray it in their nose and, like, kinda let it do its magic. If that's all you do, that's okay.

That's very comforting.

Thank you.

Yeah. Transparency, Mark. When I was down there, I told them, so there's two caveats I tell everybody, and, you know, who come to No.

I'm going this advice over here. No. Just no. Don't don't scare me off.

No. No. No. I would say but, no. You know, I tell them, you know, to the participants, you do not want me administering anything. I live in the suburbs, and so I am gonna mess it up. And so with the training, absolutely. And that's one thing, I think, like you said, when you see I think, like you said, I'm actually I would join the training, but it is. And we had a case, and it was an emergency. I instantly called Jennifer, and then she was like, I think you might wanna reach out to Chris. And so I'm calling Chris, and this guy had, like, an issue on diabetes. And so I would agree. I think it's good for us, you know, to participate. But I think unless you are in that environment, when it happens, it you just like, what in the hell would you want? So, Yeah.

You know, it's different when you got time to sit and think about it, but when you see somebody just say ODN and, you know, just shake it. So it it's a very different experience. So but, yeah, thank you. Yeah.

Think you it'd be quick to expand on that too. So was downtown, and I saw there was actually two individuals that were down. And I walked past, and I'm like, no. I'm not walking past. Checked on them. I called them in one one of the questions that they they asked me is am I carrying naloxone? Yeah. Oh, it caught me in the car. I'm like, no.

Yeah.

Right. Yeah. Yeah. Yeah.

Oh, sorry. Go ahead. Michelle, you're gonna

Okay. First of all, I appreciate the presentation. I think this is great information and very useful. And something you said earlier as far as, I think, especially this this program in particular, as far as misinformation is, like, has a has a high probability for the the public just to not understand what it is. Like, we're just giving up free models for whatever.

And so what I I think about myself. Like, I'm out having conversations and I'm talking to someone and they say that, me not being the the the harm reduction professional and that person understanding nothing about harm reduction, like, what in that's in that moment, like, should I say, what is, like what's the one liner from from your seats that should I be saying to that person and say, no. They're not gonna they're not just giving a opinion. Like, this is harm reduction. Harm reduction is this. Like like, what what is that what is that thing?

I mean, I think what I've learned is, like, being very gentle. I think I just become very passionate, I won't be, no. You're wrong. You know? But I've learned that there are not effective ways to communicate. So just being you know, I understand your concerns, and maybe I encourage you

to learn more or, you

know, I encourage you to, like, talk to a harm reduction person. The harm reduction action center downtown, they're always doing tours and, like, welcoming people into their space. We can also do that. We've never done it before, but, you know, just encouraging them to to challenge that way of thinking, and just saying, you know, like, harm reduction is so much more than that. Because it it really is, you know, from the supplies we give out to the conversations we have. Like, it is so much more than just just pack the syringes. Have a good day. You know? So I would say something along those lines maybe. And I would also encourage folks to, like, check, like, the language people are using.

I think that there's a tendency to, like, refer to people who use drugs as, like, really harmful words. Like, even amongst our participants, they're like, I'm a junkie. I'm I'm a tweaker. You know? And even just challenging them to say, hey. No. You're not. Like, you are using drugs. Like, you're not you are not your drug use, and not to think about yourself that way and not to think about other people that way too. So I think that adds a lot of stigma and bias over, like, oh, that person is this. That person you know? So I think that you hear those words as well, like, challenges. And, hey, actually, it's kinda. Don't say that thing. That helps. But you see me think about, like, what is my one designer?

That is that is so cool. And just as a like, as a whole, I think, like, for me, if I'm talking to someone out in public or my family or whatever, it's hard for me to put it into words like what I'm hearing just so I can say something. So, you know, that

that's that's

that's that's what I have on it. It's just it's hard for me to put it into words, like, all information I'm getting. Like, hearing that that one liner from the the experts here in the group itself will need at least to be able to then say that to the joke about it.

Depending on who you're talking to, also, you know, harm reduction prevents disease. And as public health, that's you know, our goal is to protect health and protect people and prevent, and it prevents. And that might be, you know, the simple one, and it's so much more than that. But at the at the root of public health to have reproduction of this, the prevention of

to your family, you can say similar to our kids, it's similar to saying, if you give kids condom or promoting, you know, to them to have sex, you're like, no. We understand what's going on, and so we understand the consequences that they're not using it. It was almost like a form of prevention. There are some people who are totally against them. Like, my kid don't do that. They're like, okay.

So you might accomplish that. Well, you get you get you know what

I'm saying? And so I tell people, it is along those lines where we used to think, you know, give out condoms. You know? It's like, oh, that's some, you know, slam. It's like, no. They're already doing it, but we need come up to date. And like you said, with with drug use and other things, it's like, yes. It is happening. We want them to be a lot safer and to be in a lot healthier environments.

One of the biggest things is to get each to share a needle, and that's you know, that creates a lot of it's easy to turn in.

A lot of illnesses that we actually I

I also think that that understanding where they're coming from is probably the most essential thing. You learn that right before the you know, Maybe they had had struggled with having a loved one die or or having somebody who's struggling with substance use or struggling with mental illness. And understanding that that this substance use is a chronic disease. Mhmm. And and that that you want people access to services that prevent them from getting further help.

And, also, if they choose to, we can services to deal with their offline issues. We can get access to them. It's good to reach reaching people in there as well as the person sitting in front of not really understanding this is a chronic condition. But, really, people need help at getting them to the right resources.

Couple of things from Michelle. Texting me. So at Washington State Board, you still have to have a a board policy regarding, Naloxone, and

that changed.

Do you know when or what the is there a need for policy to provide?

And there's, like, state standing orders. Is it

important to say? We don't have lot

of standing orders. So, Michelle, we we have standing orders in the state. But it Can you

guys hear me okay?

Yeah. Hi.

So there used to be when and I'm when I say this maybe about four years ago, was probably we were coming out of the pandemic. There was, there was state legislation that allowed nonprofits to access doses of naloxone, not maybe in you know, it might not be nearly enough of what, you know, Arapahoe County Public Health needs if they had written a a commitment to usage and training into their board policies. And I I I've been texting with Jennifer the last couple minutes. That may have changed, but I think it's worth revisiting, just to make sure that we're not missing that opportunity. And then my other question was and you may have put this on the slides, and I'm sorry, I'm trying to keep up, but, approximately how many doses were distributed in maybe say, like, the last six months or a year?

Because that gives me an eye that gives me thoughts about, you know, frankly, outreach to that public private partnership I'm I'm always thinking about now.

Yeah. Yeah. That's a great question. And it wasn't on the slide, but I can pull it up. It's in our

public health measures. So give me one second. Hold on.

We're not the only Michelle, we're not the

only ones providing on something. Know, shared schools and the safety folks do it now.

Sure. It's

pretty widespread more than and schools do it now. You you guys have.

Well, we yeah. We do.

We do. And we have benefited from that policy, the state policy, because we then you know, we were paying for it out of pocket for our nurses to have, and then we really wanted to have more doses than 65 clinics afford, and we wanted to be able to put them in trainers' bags and take them on trips and sport sporting events. And so then the state came up with that policy requirement. So then our our attorney wrote a policy that our board of education approved, and then for two or three years, we we enjoyed getting our supply from the state at no charge. I don't know that that still exists, and I have to check my my work because I can't remember if we had to pay for the last the last shipment for our for our school year or not, but but it would definitely be worth looking into.

Yeah. And eligibility has changed. It's that tier. I think there's four tiers now. Don't quite remember where schools land on that tier system, but I think there's still potential to get it for free from the state. I think it's very on their supply and if they have enough supply to, I mean, go around for all of the tiers. To answer your question, though, so in 2025 total, we've distributed 7,311 naloxone kits. So that's 14,000 or so. That's to participants, community partners, stocking our kiosks, all within naloxone.

Thank you. Thanks for looking that up.

Thank you. Yes. If

there's additional questions afterwards, I have my contact info as well as the team contact information. So that's our shared, email and then our shared phone number line. So you can reach out to me. You can reach out to any of us. And I added this picture because I think this just speaks to our team. Yeah. Yeah. Yeah. It's such a good time, and we're all very close. And this is us just cracking up as a little reason. Just enjoying each other's

Well, thank you very much.

So Jennifer is gonna catch us up because Jennifer made a ten minutes late. So the third session is here in September, October 2025 for breakfast before. I will. But

all as I always wanna share about our mission. First is our nurse liaison program. This is a program that we have in July and had to restart not restart, but start the program in a much smaller city. Mhmm. But they have done a tremendous job of pulling together and providing very comprehensive services and have been really innovative in what they've been able to to do with such amazing staffing. I think what's really telling me really important is measuring up engagement rate. I think at one point, we were looking at 30%. They're at 82%. So Engagement. Right.

So, really, just hats off to leadership, Melissa, and how the he was typing this handle and rebuilding that or building and. And then they also have initiated asking about workers because it isn't just work working with the campus community on the top of coaching and working with the workers. I just really, impressed and proud of that team because overcoming such great challenges, and then really what they tell me. And then the next one, I think we have talked about baby cafe through the program, but it continues to be wildly successful. Each time they go to baby cafe, they get more participants, and they had excuse me, have eight in.

Eight of them is a 23 total. And grandchildren. Just yesterday. But a success story about a mom in tears. Yeah. Feeling and then working with the the weight team or the the educator, the dietitians, and then helping through the breastfeeding. It has really provided that here in the Brooklyn Science Board, so it's hugely successful. And they've been, recognized in the release or it's it's attached in the report. It'll come out. It's not on the website yet, but they'll be recognized, as part of the work they did during breastfeeding week.

And then the last one I wanted to highlight, because it's been such a a work in progress with the school inspection program. They have been, it was one of the things that Tri County did not do. Somehow, when we made the shift to Rockland County, we inherited it as not a delegation, but it somehow was in our contract. And they saying, you know, they really took it. They spent a whole year plus developing relationships, setting the foundation, explaining, like, what will happen, when it will happen, how it will happen.

Then they did mock inter mock inspections last year, get some schools to participate in mock inspections. They started the program this year, and they would had great response. And because of the relationship and the work that they went to start it, like, we didn't just go in and say we're doing this, but they they've really built the foundation and the relationship, and it's going really well. And I so kudos to that team. So those were our mission wins for the that period of time from last month to this.

And then I did wanna call out the work, with Street Fraternity. So that connection has been not just with harm reduction, but also now this faculty and able to work, and they recently engaged me. It was 22 participants engaged in, like, q and a session and looking at that smoking and vaping, which is a huge issue. So thank you for that that connection. Really made some great headway with relationships.

And then I wanted to bring attention to, an event. So doctor Levine is on the Food Coalition and one of the committees, but there's a free community forum on October, at South Fellowship Church, from eight to ten in the morning, and it is, hungry for change, uniting uniting to food end food and security in our community. So a lot of the work of the food security coalition. But, if you want more information or need more, let me know, and I can Sure. Yeah.

No problem. Yes. We can do that. And then we'll talk more about this, but I did wanna raise attention to the government shutdown when the impact is in the half too big. Right now, that is the only program that we are watching and can screw up, but I'm sorry. The state health department, it was set up. Of all of the state health program programs, it's a shout out to Colorado State program. They had messages ready. They had plans ready. If this and that, this and that.

So we were well aware. We knew what was going to happen. And then the they asked JBC to fund the the benefits. So state had funding to fund waste in, like, personnel for the October. But, typically, when a government the government shutdown, this can't be issued.

State stepped up, the state of Colorado, $7,500,000 to ensure that Wake families continue to receive it through October. So that was huge. Not too many states any other than Colorado do that. So really appreciate the statement for the sake of our families. And then also wanted to let you know, in the 2024, HCPCS designated breastfeeding support or lactation support as a fillable.

And so we've been working, and we are gonna start piloting and, part of Bill, mostly working with the baby cafe, and the and stuff. So we're build our best service, which will be great.

And we have, you know,

a great billing team. Yeah. But we'll actually be something we wanna highlight next year Okay. During one of the financial updates because they've done. So those were the main things I'll commit to.

She passed away from she passed passed sun. No. She didn't. I know. Five minutes. We did. But I

do wanna point out, Steve is not here. He said so as well. Yeah. But Greywater, the resil the resolution was approved yesterday, and he had sent it to them last year. It's the the the there's a copy of it in the packet. That was the one that it has now been approved and has a number, but that's the one we have with the VOCC. So thank you. Okay. Now One

super quick one. So thank you for clarifying that November event. The events I've been able to attend so far in my my board capacity Mhmm. Been really awesome. If there's any way to a little bit more lead time on those, like, you know something that's even, like, two months out, to hold calendars, I want to create a lot of work that, at least for me, that could be better fighting chance to come and attend and represent.

Sure. We can we can do that with collecting those and giving those to you prior to the direction support. So

we're about to move into executive session.

No.

No? She'll wait to

We did the business No. Items. When do have this?

Oh, you do? And

I'm I'm bringing this up now because we're a little bit ahead of schedule for a reason. In January, you all will vote to elect the chair and the vice chair. Phoebe will not be with us for our December meeting or January meeting, and so we are wanting to get some information from you all prior to that, election for the chair and vice chair. Sean and Bibi have both indicated interest in serving as chair and vice chair again for 2026. Our bylaws indicate that they can only hold and not put people you all can only hold officer positions for three consecutive years.

That will be the third year for both. So Hannah is going to send out an email after, this meeting asking if there's interest for anybody else who would who may be interested in serving as chair or vice chair next year. And really importantly, in 2027, we would like to know does it mean that you're committed? But if there is if you are interested, because you will absolutely have to, be, like, be a chair or vice chair in 2027. And Sean has been the succession planning.

So if we know that you may have an interest in serving in that role in 2027, we can work on 2026. So learning some some training or development. So Hannah will send out an email with just asking for interest by no means of commitment, but that will also help us in planning for this very well. Is it any observed? Could be maybe be fair in front of them if it's any other inflection?

Just saying

vision. So, theoretically, maybe it could be if he's if he I think you can. You just can't Oh, you can't just I guess you just swap. Basically, I just did. I said theoretically

slide and dabble over.

Especially after the second year. It's been on the board for seven years now.

She said we want to groom. Yes. That's Board members. And

the board of county commissioners probably appointed Phoebe and Terrence for another five years, not

officially. It did not. It did. It was Monday yesterday.

Oh. I saw it. Congratulations. You're Yeah. I just saw it. We we don't manage that side of it. But so congratulations. You're. We'll start 01/01/2026, and it's for five years.

So well, congrats. So thank you.

And that is it. Now we can now it's your side. Okay. So I'm going

to move that the board of health go into executive session for form section 24 dash six dash four zero two of the Colorado revised statute to discuss personnel matters concerning the federal government shutdown and impacts of staff funds. There a session? Thanks. Sorry. Motion made by myself and seconded by, b b Klein. All in favor, say aye. Aye. Any opposed? Hearing none, we're in executive session.