Arapahoe County Board of Health - Regular Meeting

And the white seller, members of our health plan team.

And I have Carrie Molton. She is our sexual health nurse manager and harm reduction nurse manager.

Next item is to approve the October meeting minutes. Can, can I get a motion to, item in Florida Health to approve the October 2025 meeting minutes as presented. Is there a second? Second. Second. Motion made by myself. Second is by Terrence Walton. In essence, for public comment, do we have anybody in the queue?

Not today. Yes.

Thank you,

And then you can vote on me.

All in favor? Aye. Any opposed?

Thank you. None, motion passes. Next is the director's comment. At this time, board directors are invited to share insights from community leaders and partners to gauge the current state of the community. And I usually think it's Michelle that we've got to get for a few minutes, so we'll start left to right this time.

You two can go first.

Excuse me. Not a party. It's been really young. The board's very busy, but I'm familiar with it. Okay. But

I

think the biggest thing is that we had a summit at the October, an aging summit that we invited Mark was there. We invited a bunch

of folks that we considered to be, like, nontraditional for it, which

I think everybody is just

eager first if we're all aging.

We're just gonna have to

be reminded everybody again. So it

was a great conversation. We had some great feedback and

be able to utilize some

of those, like, nontraditional corporate partners. Yeah. Okay.

Oh, and yesterday was Mark's birthday.

Happy birthday. Well,

that that I can vote next year. Oh, okay.

Yeah.

Back and play. Actually, I I

having birthdays is a wonderful thing. Yeah. You just don't want them to stop. But sometimes it's amazing when you look at the numbers. Yeah. You know? So I'm I'm in the amazing. I've been hanging out with Christine too much. Yeah. And and

we actually Sorry about the background noise.

I'm listening to our board

of health. We have it once a month. We're talking, and I barely listen. Multidisciplinary. Sorry to hear about your mom. My mother-in-law We're gonna turn the volume down. Sorry. We just have someone online that's not muted. So that's what you were hearing.

We were talking about we're looking for a speech friendly health department.

Yeah.

Mhmm. Which is sort of neat. But what does that really mean? And what is it that we can do to encourage age friendliness in Arapahoe County? And it occurred to me, and I've been thinking about this one for for a while, I'm getting to the age, my wife and I, we're, you know, you've got to be very cautious around the house.

Our house has stairs, got portal rugs and a variety of other things. And how come we're not living in an age friendly house? Mhmm. Now we can move to an age friendly house, but mommy wasn't our house age friendly when we bought it years ago. And I wonder whether or not there's an opportunity for us to suggest to the, Arapaho County commissioners that they consider looking at the building code to see if there's an opportunity to build age friendliness into the building code so that people can't age at home.

So, that's my suggestion. I like that.

Yeah. We

can make you the head of the committee.

We're gonna have seventeen minutes. It's it's

not our perfume to change building codes. Yeah. So this kind of will be passed on Yeah.

To people who can. Yes. So I would say two of the biggest events over the past week, one was positive and one, what I would call somewhat negative. The positive one was senator Bennett was at an event for a law firm talking about his platform for governors. And the biggest thing he emphasized, of course, that everybody knows, is Medicaid is gonna play a huge a huge issue in, I think, the race for governor but also discussions.

And so part of when we asked him about his strategy or what he thought could be done, part of what he emphasized is that he thought there needed to be more focus dedicated to public health, and there needed to be more of a focus on prevention. And so I thought the job was, you know, excellent news. And then a bunch of people came to me with hypothetical situations questioning what would happen if, just say, hypothetically, an employee poured bleach on a vendor's Hypothetically. Hypothetically. Yeah.

Hypothetically, how would how would we perceive this? So one of the things I communicated is, without getting into specifics, that I told them we represent Arapahoe County. Hopefully, Arapahoe County will treat, individuals, residents, members very differently. So on those grounds, without getting into any details, I don't believe that it is our role. When we first started, I don't know if all of you know, we were highlighted on the news for our food inspectors, the first year when we converted.

One of the things the food inspector there was two food inspectors. One of the things they pointed out, they said our role is public health, and so we already are viewed negatively as government in coming in and trying to control. So we one of the things we're trying to do is change that narrative and have people think positively about what we do. And there's a lot of ways where we can help food. And so our our job is to oversee it.

Of course, we have to make sure that food meets standards and all those other things, but we're not the police. And so we we play a very different role, and I thought that was really insightful because all of the people that they inspect has thought very positively about how they were interacting with. And so I was just saying I just reminded us that, yes, we're public health, and, hopefully, along this journey, we can work with the public as opposed to being a few of them. So that was my whole.

I think most of you know I'm on my sabbatical in, a month in. The last month going to work, I use that loosely, at the Colorado Health Foundation every day to get a better understanding of how they make decisions and distribute money and how they live their voice of racial justice and health equity and how many of us can use the privileges that we were born with to advance the needs of certain population. And this moment had so much political energy activity. And so that has been probably one of the most enlightening parts is to be an environment that's a 100% living, not just, like, 10% here and let's get that done. And so that that's been

a

really meaningful thing and and has really been helpful. I hope it'll be helpful in my role in community on how they decide to be how they make decision. It's just a just a very different than they're thinking. And so that's been very but starting at the end of this week, I I'm just not vacation. So Chocolate. Chocolate. You're happy.

It's a well deserved vacation.

Cheers, Ed. It is been that's all I'm saying.

It's wonderful. Thank you. Good afternoon all. Good to see you, folks. Two things came in my head. One is you've obviously seen the director support. You know, John and I, we serve more official roles now in the Colorado director in environmental health. And that was it. Well, that I have there is to strengthen local public health. And so really excited about the work that we're doing to assess local agency capacity and resources and so forth, the idea of taking requests forward in different manners.

And so it's sort of behind the scenes and not as sexy, but I'm really excited about it in terms of hoping to create more foundation and more funding sources for for local agencies. So it's been a big push for me. One personal note, you know, I've really appreciated the the knowledge that I gained from being on the board, particularly as it relates to harm reduction and the story that Michelle's shared with us a couple of months ago. It was related to urban our country. I took training this week, and it was powerful and motivating, and it helps me to be a better ally from this type of space.

So thank you to all the harm reduction team and to to Michelle for for for doing this for this. Appreciate it.

Okay.

So now we're going to move to our achievable fifth. The first item is use of reserve funds for personnel use. Okay. So

we put this on the agenda anticipating that the shutdown, the government shutdown, continue and that we would need to use our public health funds in light of not having funds coming from the federal government or the state in planning for December. Thankfully, the shutdown ended, and the other good news is that food assistance programs, including Wake and SNAP, are funded through the fiscal year, so that's September 3026. In the event, however, though, that something changes, we thought it would still be good to proactively bring forward and formally vote on the use of public health funds in the event that we need to dip into those funds for personnel given uncertainty that continues to come our way and could change, we could obviously refer that back to you in the meeting only as that that time frame needed. It might it might be worth just proactively putting it out on the table for things like support and approval of these funds in the event that were to happen again, whether be WIC or another program because we've had twice now instances where all of a sudden we were faced with the potential of not having funding or just partial funding.

So that is the ask. It's that we just made it official. Obviously, there would be communication with our liaison, and we will bring it back to the Board, a decision or an action.

Any question from I

guess I'm I am not totally sure I understand. We are voting to, like, generally say that we can use reserve funds, but then we'll also vote if what if if it happens?

No. It would you wouldn't vote again to I'm asking for the vote now k. To be able to use funds, say, if, you know, in it happens after the December board meeting, but we need them for January so we think we would know that we could use them for January. We would come back to you in January and say, thank you. From November, you would allow us to do this.

We had to dip into reserve funds for the month of January. Okay. So it's preempting the need to do it, anticipating that hopefully we don't, but I it's hard to know what would happen. But we would we would make sure that you're notified ASAP at the next meeting that we've done that, and if we needed to go beyond refund on at that point, we wanna, you know, pay things out of those. It's just with, you know, the situation.

So right now, we're we're just thinking it would be a month at a time, but it's it's. What's the question? When it came to snap and then they're very desperate situation. Just I need. But not tonight. I know there's so many pieces that are the. There there may come a time. There's some pieces that comes, but there might not be the same first piece as it was. I can't mind enough. I mean, maybe be left alone and having to look inside instead of having their support for this question or whatever.

Right? I can't give an example, but if it would say spoon inspections, they tend to get inspected. But That's true. Five. But say it was something like that that, unfortunately, I could go a month, not safely, because we never was not inspecting the last time to to the center or whatever. But it's not the same urgency as getting food distributed to those family. And and you would be left, Jennifer, having my mom was so long. Well, student's patient is going to that step. Does that make sense? And I maybe understand here.

I think, obviously, the role is to, you know, to be that backup support, so you're not caring among. I think an example that we were faced with earlier this year was with emergency preparedness. That we were not planning on those funds not coming, and they did end up coming, but we thought we would very quickly, and we had jumped on the call with Mark to me. This is this was not in our plan, but we think we may have to take action and go to the board. So I I appreciate, and I think this wouldn't be done just on my own.

I we would we would reach out as as Mark is our finance liaison and have, you know, some conversations that were clear and and you felt confident. And I think by making this action, it is your moment. Support. Yeah. So that I can use that judgment, like, if if this was unexpected or we can't, like, get through with one month.

It's the timing of calendar year, fiscal year that can make it messy. And it's hard, and I know it is kind of weird to be doing this now with knowing what funding is about other things, and they still don't have we don't really have a continuing resolution until we meet January. So it is very possible that any anything's So, like, it would before we made that decision, we would have a conversation with Mark just to make sure that this is within the confines of what you all give you, but which promise today, making sure that we're, you know, staying within our options.

And I would just say, anytime or monthly after, the budget committee, meets, Mark does an excellent job of filling in the committee saying this is what, you know, we talked about. This is building the ad. And then I tried to also communicate that with the board, but I think Mark has been fabulous as well. Representative for the budget being so active and really thanking through the way that things are going to impact us physically. And so my response,

in addition to your leadership, you probably had

100% confidence in new markets. So that was, think, part of the reason why I felt comfortable in asking what we needed.

Uh-huh. I I I don't see any reason why we can't prove what the screen suggested. But in the event of another emergency that might help them, do we have the opportunity to meet in between our regular meetings?

Absolutely. Yes. We can call an emergency meeting with the board, which we posted twenty four hours, I believe. Mhmm. And or we could call it wouldn't have to be an emergency. It could be, you know, we need to meet with you next week. We just have to post it ahead of time, but an emergency meeting could be sourced in twenty four hours. So in the event that that would have not been absolutely.

Right. And I I wonder whether that would take care of other contingencies that neither of them in slightly were talking about. So I believe it's been both given the accepted recommendation or affirmed regarding the message. Sean,

I have to say. Five money. Uh-huh. So a little bit more of a context in which we've been around it all year, so there is good FERPA. So I don't know if it's 2.6 or 2.8 over the next one. It's

2.6.

2.6. There's good money there. Mhmm. The emergency requests that were potentially in front of us were they see we're calling to achieve 100,000. Yeah. So, you know, it's a it's less than 10% of the reserve budget. Reserve budget is there for these kind of kind of situations. Jennifer, you know, good about PPV and moving forward price, and these were kind of the cost. But there is some survey still, it makes sense for some flexibility. And lastly, I would add to what we discussed today.

You know, we see routine updates and some routine update on the the risk table. Yeah. That's pretty clear. That that's up until you send. Hopefully, you can see things coming down about the price increases, those things. Don't have a lot of it in front of but I think there's enough tools and money to make people request enough kind of agents That might mark on some, support kind of the request. I

move, for the Board of Health to approve as necessary the use of Arapahoe County Public Health Reserve Funds for compensation of public health staff impacted by any future federal government shutdown, subject to prior notice to the Board of Health and agreement by the Board of Health Finance Subcommittee for such use of the funds. Is there a second?

To our oh, got a vote. Yeah. Good night, Michelle. Is

there a is there a time

frame on that?

Like, are we voting for, like like, we're gonna approve this for a month, and then we're gonna talk about it at court meeting? Or is it just like we're gonna I feel I guess I feel concerned about approving it, like, on the whole versus unless it's like a time bound.

There it was not written with the time, but you could friendly amendment at the time.

Can we time bound that for, like, a like, a one month

Yeah.

So we can discuss? Okay. So I would like to add a friendly amendment to add a one month time down,

and Monica, tell me how I should

say that.

Wait. What are you trying

Yeah. Let's

Well, I

guess I guess if we're if we're saying we are are approving the use of reserve funds, Mark was saying that, like, for one month, reserve in this emergency case was, like, 10% -ish of our reserve. Are we saying that, like, we're just gonna use the reserve until we figure out what's happening? Like, what if what if something goes on for, like, six months and it, like, feels like an emergency, but then we're just, like, using our reserve funds? I feel uncomfortable with that. Think You you Let me just clarify. Yeah.

So the most of the

way that it's written is that it will require prior notes to this board before, reserve funds are used. And so you would know about it the month before or or as it's happening, I suppose. Right? And so if you have a situation where it's beyond a month, then let's say we get to the next month, you all will send out or Jennifer will send out a a notice email to say, this is still ongoing. We still have need for for funding. You can come back and say, can we set this for our next meeting? Okay. Right? And so you'll always have that prior notice and then request to have a deeper conversation. Okay.

So if we're if we're using reserve time, we can have that in, like, Fannie and the item. Yeah.

Yeah. I

can't remember that. Yeah. Yeah.

Okay. But I would say also remember the finance subcommittee meets Yep. Go over it. So he not to speak for him, but he is being very thorough. Think he would walk us through everything, the implications. And so it's not like they have a blank check. It has to go over the finance subcommittee with the different he plays out the different scenarios, how it impacts us, how long were you thinking Okay. And so all of the things. Am I correct, you know?

Yes. And I and I agree. I thought about that as it would be proposed on leverage. But I think because the board has a chance to basically approve the request, if they do so on a monthly basis, it does this time. I think it doesn't the time bounder. K. My bigger concern is it would be, like, what is the request? So as soon as a million dollar request, that's a different model than what we talked about so far. So the two we've had that have potentially been put on the table if they did the most of 10%. So by a friendly manner, it might be there's a potential limit on to what that looks like.

But, again, the board's gonna get to vote on it. So the the request is the duration is too long or the request is too big. That's an opportunity to keep giving a whole bunch of our email.

Okay. Can you read the motion one more

time? Okay. Thanks.

Moving forward to help with the purpose necessary use of, Rampo County Public Health Reserve funds for compensation of public health staff impacted by any future federal government shutdown subject to prior notice to the Board of Health and agreement by the Board of Health Finance Subcommittee for such use of the funds. Okay.

It's it's just compensation.

Yes. Okay. No. It's not at any time.

Alright. I'm good. Yeah.

I'm good.

And remember, it wouldn't be until the next meeting of the board anyhow, which we could take whatever action is a process.

That's what I was wondering if we needed to put language in there that says it's until the next board meeting.

But it's it's on it says it's not gonna

I need to a

call. K. Well, I'm ready.

Thank you. Thank you for your briefing. So

all in favor of the motion passes?

Aye. Any

opposed? Hearing the motion passes.

Thank you.

So now we're going to move into our study session time. The first study session is a core metric presentation spotlight on sexual health care. Welcome,

Hi. Thanks for having me. My name is Carrie Knowlton, and nice to meet all of you. Think that I'm the nurse chair for harm reduction and sexual health. I think that we still is here presenting harm reduction last month, and so I'll just.

Jennifer, can help me? So, well, we're just gonna start it with the story. So just some background on our sexual health clinics just to refresh everyone's summary. We have two clinics, one in Aurora, one in Inglewood that provides, sexual health services, including birth control, STI testing treatments, cervical cancer screening, breast cancer, mammogram referrals, and a variety of, sexual health services to all doctors. But we, have two core metrics.

One is really based on volume of client interactions that we have. So not just our client interactions in our clinics, but, we've also expanded a lot in the last few years to various outreach. So we provide syphilis treatment in the community, which I know I talked to you all about before. We're doing STI testing and treatment in the jails. Our essential health nurses are working with the harm reduction team to provide us the testing and treatment, at harm reduction services.

So, one of the measures is just the volume of clients that we're seeing, the number of times that we're interacting with patients. Another core metric for us, which is more of a, measure of acuity and for the health of the community that we're seeing is the number of our patients that are receiving the. So I can estimate that, like, ninety nine point nine nine percent of our patients qualify for Medicaid or some type of Medicaid, either regular Medicaid or we see a very large number of patients who are immigrants from other countries, maybe recently carried on citizenship status, but qualified for what's called family planning limited benefit. So there's a lot of talk in the news and a lot of misinformation in the news about what a deaf community is most qualified for and don't qualify for that in Colorado, all people qualify for family plan services to be covered under, because family setting Medicaid or emergency Medicaid or cover all Coloradans. So almost all of our patients qualify for some types of Medicaid.

Despite that, barriers, there's a lot of barriers to to enrolling in Medicaid. Our country is low, so only about well, you'll see the numbers for less than 2525 is actually obviously. So just an example of a patient that we might see in our clinics. A 17 year old teenager comes here, to Aurora from Venezuela, comes in for a pregnancy test, learns that she's pregnant, that she's a minor, and she's pregnant. Even though she doesn't have citizenship status, she's eligible for cover all Coloradans.

She then lives as her baby after she turns 18, and when she does that, she receives emergency Medicaid with family planning limited benefits, which means that she can then doesn't get all services through Medicaid but receives family planning services. So because of that, she can come back to our clinic. She can choose to get an IUD tell me another pregnancy until she gets ready, and she can also get other services that we provide, such as cervical cancers you may need, SMA, HIV testing. We can provide this care for free whether she has Medicaid or not. We offer services on a sliding scale. But if she has Medicaid, we can then bill Medicaid and get reimbursed.

Are Mhmm. Any of these programs under the facts of the the governor recently was doing submitted, I believe, a plan to the legislature to limit funding in Medicaid and probably cover all Colorado, one of the items that is being restricted or even terminated.

I think it is completely changing. I did not see that cover of Coloradans was completely eliminated. The family family benefit was in there, but it was preserved. I was actually surprised to see that it was preserved. They did cut money for it, but the the rationale for that that I heard was that it's so underutilized.

There's this pot of money, and it has never been spent because people aren't aren't signing up for the service. So it's my understanding that they were cutting the money, but based on how they recover they will recover the number of people that are but things are changing daily. So then Uh-huh. So the bigger threat is not what's Colorado doing. It's the way Colorado gets the money to do the work, And Colorado, that means it gathers money, sends it to the feds, gets it matched, and when it comes back, the money that was Medicaid is still covered Medicaid, and then the match covers some of these other footprint.

And so that's the biggest threat, instead of the Fed, because one of the things that Fed is very is that people might, as I can point on mute, would get any kind of health care that even looks like it runs seven months. So that's when I go. That's that message that's skewed, and that's, I think, the big threat to Colorado. It's all others feel good about getting our money. They collect it from hospitals. You know, that's how hospitals about it. But the hospital's like now. We might didn't like it in the beginning, but they like it because then they get paid. Mhmm. You

know? Right.

And he goes there and comes back. It's the hospitals, not Medicaid. So I think that's the bigger threat to this program and other, like, an online program. That's. And I made him really wrong, but that's how I I think I'm gonna pick this as the core measure this was before. There's yeah. It's absolutely so the metrics. The first metric is just the number of planning interactions that we have. So that demonstrates the quality of services that we offer and also just how well our staff replies are we are we seeing the need. And so we are very much exceeding that goal.

I think the reason for that is the goals were based on previous quarters. And every quarter since Rockville County is open, the central health center is expanded and seeing more clients and getting busier and busier. Part of that is word-of-mouth. Part of that is the the outreach that we're doing and the fact that we're we're going to have to get fast and fall in there. So so that's good news for our kids.

Percent of clients with Medicaid, like we said, this demonstrates the status of access in our community. It also demonstrates how effectively we're billing Medicaid, how how how well we are checking someone's Medicaid eligibility. It's a it's a really complicated process. It kinda takes a lot of time for clients for our medical assistance. So just how effectively we are doing that and helps us know opportunities to increase revenue and then to improve our waste. More people. So we're exceeding our goal. Our goal was to have 17 our our baseline was was low. It was, like, 13%. Our goal was to have 17% of people.

We're exceeding it at around twenty percent, which is great, but it still means that there's seventy eight percent of our patients that could qualify for some type of Medicaid are not are not receiving that. So great that we're exceeding it, but there's still a long way to go. So lots of reasons for that. You can't force people to o'clock. Well right.

I mean, that's so that's the challenge. There's there's uncertainty, and there's also very legitimate mistrust of government programs. And so that's that's a challenge, and they're you know, we'll never get to 100% because of because of that. So what we're doing to address it is just continuing to educate patients and provide support. We've really internally in the clinic improved the way that we verify Medicaid eligibility so we can maximize those clients, the billing, and the revenue for those patients who do have Medicaid. We started back billing. So Medicaid, if someone acquires Medicaid after the date of service, you can back bill up to ninety days. So we've started doing that. That, I think, is a definite thing that has changed me. I think Medicaid is is reducing that.

Medicaid on federal levels, reducing that to thirty days, but not until next October. So until then, keep doing that. And so our data, there's so many unknowns and changing things, so I don't know. The data for the Medicaid piece is a little bit difficult to interpret, but they do really reflect, I think, our improved billing practices, probably not more community access and more people to find that. And like I said, it still means that there are lot of people that qualify for this, you know, like, talk.

And so going forward, our our patient volume is increasing. We're serving more and more people, which is great. We'll continue to advocate for expanded access, continue to examine our processes.

The second study session is a presentation on the Arapahoe County Public Health Ambassador Program by Heather.

Awesome. Thank you. And this feels to me like a great connection point to the directors come to the. It's a part that it, you know, represents all of our collective commitments to how we show up, how we build our work foundation of equity. Grace and I will walk through the purpose of the program, the process and the reports we've built related to it, how we are looking to see examples, multiplying all the things, and then, some of the input and observations that we may have pulled together as well as what is next.

So as you know, we rolled this out during the first few months of our first year and have made a statement built on the philosophy that each interaction that a deaf person has anywhere is a chance to build or maintain strong partnerships and advance equity. It's how we show up doing our very best to connect and build trust. We cultivate our ability to do this well in part through a commitment to capacity building in public health competency, like communications, public health community partnerships. So on this slide, we see the goals. Together, APP has stopped all to really increase our delegation with deeply build trust and partnering others to emphasize the assets of the county.

And, really wanting all staff to embody that fact that we are all ambassadors, whether it's through outreach or relationship building or customer service. So no matter what role you're in, you can be a very strong ambassador for the agencies, for public health overall and the campuses. A couple additional things, is that we wanted to make the process of identifying relevant trainings more efficiently and effectively. As you know, there's a lot out there, and it can take time. Every month's busy.

We're trying to meet goals related to our positions and wanted to reduce some of the time if it could be helpful to our staff. So we pulled together, a curated and continually updated list of trainings from trusted sources that, for the most part, are offered at one of our lowest cost. In addition, we obviously want to inspire new ideas and continue this improvement in our work as well as because the Public Health Organization Board requires a workforce development plan. From the beginning, we wanted to make sure that we are positioning ourselves to meet those requests, also part of our offerings. Some of the strategies that we're using to reinforce this and build it out, are prioritizing a culture culture of listening and learning.

One example of this is the Jennifer Kennedy advantage to the. And so part of me, we're going to every building, putting down the staff together to hear you hear, What's your advice from for the agency or any elements of it? One of questions was a lots of bidirectional. And then building access to resources and systems that can help them even though we've a very updated set of information about all of our programs we took place to our or our organization to find itself inside of that. I mentioned the curated training options and trusted sources, and then also supporting sharing and doing business.

So things like, you know, we give suggestions to staff about how they might use team check-in soon for other company. And some of the groups that very specifically incorporate that into the and then ensuring accountability. So how can we make sure this comes alive? And one way we've done that is to have it be the one common goal that's in everyone's performance plan. So there's goals that folks set not only related to first time exams and just didn't have to be, but then I actually printed out copies of you guys if you wanted to see your feed, and I just noticed some

of the text came through. It's in Wingdings or something like that. Ignore that part.

I'm not sure of that part.

We're just gonna bring you

a copy if you wanted to look through some of the things.

So our timeline started when we opened. As I mentioned, we started the ambassador's program to help us focus on building community connection. Our staff took a pre survey before they completed the ambassador's training program, and then they took a post survey. And we use that data Heather and I got to present at we're talking about options in 2023. So we use that pre and post data.

And since then, in '24 and '25, we've updated the guide that you're seeing, annually to add new trainings that are the output claims that have been discontinued or have ended for whatever reason. And then, also in those monthly meetings, we encourage staff to share their learnings and find ways to move them into action. And we also did mention it sometimes on our town hall and then, of course, as part of our performance team. And then our quarterly poll survey also includes some opportunities to collect staff reflections and suggestions related to the ambassador's program. The ambassador's program is based on the core competencies for public health professionals.

You can see them on the slide, and we have selected three of those. So this is a a framework for the workforce development, training, and action, and they're based on the 10 essential public health services. We chose to focus on communication skills, health equity skills, community partnership skills, and we added a competency this year around quality improvement. We felt that these competencies actually get students in being a better health ambassador. And you'll see in the in the guide that you're looking at, you can see which competencies each training touches on.

So for

staff next slide, please.

Is is the clicker not working? I did I just had to click back into it, but I think it should be working now. Yep.

Alright. So you would as a staff member, you would review the list that you're looking at and select trainings to complete. The minimum is just to complete one training, and you'll see they range in time commitment, and being virtual or in person. And then four is the recommendation so that you get to complete one training for each competency that we're focusing on. You may get that, put by your supervisor and add it in your annual performance plan, and then complete the training and participate in some of the implementation and reinforcement activities.

So we have an idea implementation sheet, which is a list of recommendations that helps you move that from theory to practice. And this is a list of lots of program resources that people help staff build supported with us through the program. We have approximately 35 trainings and the goal setting template for staff so they can review and get supported with the competencies. And then the the last place that we have to discuss and troubleshoot and reinforce is are those two monthly community groups that I mentioned, company action teams and the community engagement share.

And let me briefly share a couple of examples of trainings that staff have identified and ways they are reporting those learnings. So you're all aware that we were excited to see the launch on these advisory boards. And the the team, as they were looking ahead to the creation of that, wanted to be very intentional and make sure they were ready, and the infrastructure and the the plans were ready to receive these students and guide them well. And so some of the things that they did to prepare were a book book club of using a book that Sean recommended with zero to 25, the science of motivating young people. That was very helpful to them.

Also, a couple trainings of protect, prevent, and flourish, which highlights the vitals of connected relationships in cultivating protection and preventing risk and promoting flourishing of youth, as well as a training on simplified language communication. So being reverb about choosing directions of usage. Also, several of our staff completed the national age friendly public health champion training series, which helped the agency qualify for our insurance public health center of our profession. And then about 25 staff also completed the briefing agent training with Christine, both of which help help me build a version of efforts that we are programming members of this fall, like our healthy agent community meetings and community engagement mastery training series that we are delivering with our teams and buyers, as well as an upcoming training in December on strategies to protect and empower older adults against fraud and scams. And so just a lot of learnings to then, you know, be sharing with others.

Also, Danielle Henderson in our early childhood program put their expertise in motivational interviewing to work throughout things that are leading up to launching school inspections by meeting with educators, asking open ended questions, seeking to understand where those things may face, like the high cost of chemical waste, aligning personal motivations, and building collaborations. As part of that effort, they are to further mock inspections to help space prepare for the inspections and remove some of that potential fear of judgment. Growth identified a training series focused on people genealogy, which I have not heard of before, which teaches ways to improve public health effectiveness by better tracking, analyzing, and responding to trends and narrowly on the monitor. And so she has used this to inspire and inform the creation of our community self survey, which she administers going out to the field, getting requesting feedback from individuals who have sent up for that. And two of our nurse come visitors, nursing visiting team, team members, pursue scholarships to expand community education through postpartum support and national support and to improve our ability to provide culturally responsive care that addresses disparities and satisfaction by persons of color.

They we take it really appreciate it because the course was taught by persons of color with a focus on scoping the needs of five top families. Anything using your shoes wouldn't have that at work. I do always stop there. Have their own examples, but just let me know if you have any questions from him. We can seek out those answers.

And I'm gonna transition to a little bit of the input and observations that we've collected along the way. So initially, during that first year, we did a a little bit of proof of concept. We wanted to know how does staff feel about this? Is this important to them, and do they feel like it is helpful to their work? During that first year, 65% of staff agreed that my efforts related to communication, health equity, or partnerships have become more effective since working with ACTH.

72% agreed, I feel supported by ACTH to be an ambassador for our agency, and 84% agreed it's important is important to me that my employer prioritized with an active and supportive advocate. One thing that's is that these results were among our 75% of our staff, which are individual contributors. The surveys were slightly different because we use data from the public health foundation that targets the the learning questions based on the role. I will say for the supervisors, these numbers weren't as high, and we, you know, we've we've looked it on the fact that possibly because they wanted different types of supports or maybe more challenging coursework. So we looked at that to try to make some tweaks on the following.

They're having more levels that entry level courses, that type of thing, and more support for for customers. On an and on a quarterly basis, so this is to share some of the ways we try to track this. As you know, we're to be really careful without over surveying staff. So we we don't do pre pre and post over here. But these are some things that we take a look at to gauge progress.

I know how I could be advised to my role and or the work that I do. So you can see strong strong sentiment in in terms of agreeing or strong group. That's it. I have or I know how to find resources that can help me to incorporate equity into my work. Also very high on agreeing.

And then my program uses recent community feedback to improve the value of the way we work. This has a little bit more distributed, data, and so it's something that we are continually look continually looking at how we can build that up. As you know, our we have some groups that are new this year as well as the community pulse survey. So looking for more ways that we can directly take communities back, make changes in place based on that information. Some of the reflections are that, by and large, on the right track, always can be making improvements to the effort. But as a foundation, it it seems to be supported and represent the values that

we're trying to bring

to the community. We received a fair bit of community and partner appreciations, particularly during those first years when we were, you know, asking, you know, how are how are you receiving it, and how how are you doing with PR showing? Statistics. And then increased connections across the county. The intentionality of it and some of

the the mapping that Grace

is doing, for example, has helped us really make sure that we are having a presence in all parts of the county. There's always competing business days, so we try to do a good job of of weighing those. Intentional and scaffolded trainings be scattershot, and I think, you know, I think we all know that. It's one of the things that's a little bit challenging with this. We are wanting staff to sort of opt in, and choose what makes the most sense for them in consultation with their supervisors.

Sometimes that doesn't mean that their whole team is taking the same training thing that they can reinforce it with one another. Or sometimes they may not have time to take multiple levels. But as much as possible, we're, you know, trying to get them both stories and. We saw modest self reported competency meetings. So when we went back and asked the staff, how did you improve in each of these very specific competencies that map back to the particular activities under each of these?

We do see gains, And then we appreciate having some increased recognition revenue as well when the time comes to what's appropriate for us and low budget. That was a good one. So what's next? We'll be adding new competencies annually that align, hopefully, in a smart way with our agency's business needs. On deck, as Grace said, for 2026 is quality improvement.

Very proud of the launch of our performance management plan over the past year, and using all of that great data is a really rich opportunity continue identifying where are those quality improvements, bringing supporting staff into that. And those show up in domains too. That is that is everything. Yeah.

Do do you track the programs that the staff accesses, and is that an insight into how the staff feels the needs and etcetera? Do you expect it?

No. No. And I would I would like to. We've we've talked about it. How what's the best way to do that? One possibility is to survey everyone and ask them to, you know, pop in for us what they've taken. Something I have been meaning to look into is to see if our learning management system can pump this back to us. I think maybe it can. It would be just part if we did it that way, just being part of the pictures. Another reflection we have is that staff have been doing a fantastic job of identifying their own trainings above and beyond what's in the curated list. And so unless we ask them to solve for input, we would probably miss a lot. But I'd like to do that too. It'd be great to see.

Yeah. Of course, would not be anonymous. Right. Sure.

Yeah.

With that, I'll let that be a good idea. I have a question, but I would just say great job on the program. You know, you

really built it out and put a lot of work into the show. Great job. Thanks.

Each of service providers. Who provides the training?

The the places we looked at, the regional public health training centers was a big source. Places like a show, ASTO, CDC, our our own learning management system, coaching or the in the national training system. Mhmm. So

so it's a hard job to

It's not hard. I'm a trusted source there. Which I think is why it's also hard to track because we do leave it very open to whatever like, where you are in your journey and what you need and what you have time for. And we realize that we just don't feel unless it's through a county sponsored group and parasite training or in the the learning management system, which we can pull reports, it is hard to track. And you realize that after Yeah.

Trying to pull. I'm not taking it. I do appreciate as as other news, when kicked off as a new health department. We wanted everybody to be a public health ambassador with very intentional goal of bidirectional communication and. Heather and Grace and Brooke really took this and created a whole program that we've continued, and we, you refresh every year, have a different focus. Everybody's required to have their. I like how it aligns with accreditation if we need if and when we go for accreditation. So if we really have to work

and so.

One of them to recognize their role as.

Absolutely. I was super excited for this this conversation. It was going through the on the slides a couple of days ago. Because Denver has a lot of attention on in this space as well. You know, we have a proportion of resume development team and get to participate on that. That would be really interesting maybe on a little bit. And you probably maybe you could do that to you.

I would say, have put up on Razi's. The room was it was a pretty big session. It showed a lot of interest in this, so people kind of figuring it out. And if you'd be happy to reach through some other news.

Any other questions? Thanks, Achin. The third study session is to hear the October 2025 Director's Report on June.

Thank you. So I focused most of my comments on the work that we've been doing, most recently with food security and counties. And to share I know I did send out an email, but we're working on pulling together a bunch of DLS. So the county, for a team of directors, it was human services, community resources, the commissioner's office, communications, and myself, pulled together, how can we quickly get money out into our community and those who are serve the highest need in our community and would be the least likely to receive state funding. So at the same time, the governor was requesting $10,000,000 from the joint education or community.

Mhmm. And we knew in our region, money would go to the Rockies. It may or may not get to some of the agencies that we are aware of who feed a lot of our community and our trust. So in working just through connections or organizations that always have agreements with the county through agent agencies or other means, we identify a number of food banks, school districts, and other nonprofits where they could quickly mobilize, get money out the door, and serve families. So it was a really quite amazing movement that I think felt really good starting to get some of that data back, and it's pretty amazing how the people modernized and how much other community partners.

I mean, churches were quickly jumped on it, and, you know, there were a lot of agencies out there doing things on their own. It's amazing. Communities will come together. Now we're we are looking at how do we sustain that effort even though WIC fortunately was always funded. SNAP, it was a short period of time.

But, you know, for some families, it was 600 or more, and that is significant. And so it you know, what we were able to do is just a drop in the bucket and how do we sustain that because there was a need before all of that happened, and they're still breaking. So we're looking at systems in the long term, how do we how do we do that? One of the effort that is underway right now, it is just. And it's they're actually stealing it from something that Denver has done.

And this was back in 2018. They had an initiative called No Plate Left Behind, and it is a way of reducing food waste. So we're resurrecting that for a rational economy. And it does happen already. Like, there are organizations that will go around and and get food from grocery stores that normally would that would go to landfill, and then they distribute it.

So we'd like to see that on a larger scale. So working with Leslie Levine and and the Arapaho Food Coalition, we've been inquiring of who would like to partner with us on this. So food banks or entities that give food back out and serve people directly. You know, who's willing to work with us? And then we will find and work with the markets and try to connect markets with pantries to get food out to people.

So it's a food, and you're really more looking at the system. So you're hopefully reducing food waste, things that end up in the landfill, and getting them to people who need to eat. So we're we're Hannah's helping that effort and looking to see so it's funny, but that has a more has a likelihood of being sustained longer than these. And with that, I emailed earlier that 9NEWS picked up on this and Kyle called the feature me the micro getting campaign tonight that will benefit the Raffinha County Foundation so money can go back out into our the the community partners that we've been funding. Or money.

Do you have any idea I don't wanna say successful. You chose dance, food dance, and food because you assumed that we did relax and we get the ball play, whatever that portion was. Give everybody an idea how successful we were in choosing. Right? As we we chose some, I read the one, you know, read the ones you listed.

Maybe some of them were able to get some of that or none. We I don't know yet if any of them were old. Most of the when we we did survey before we entered into agreement with them, whether or not they get food from Food Bank with the Rockies or how that works. And, like, Village Exchange Central was one of our our partners. And they don't.

They they have to buy their food from food and their agreements their agreement is not great. So and they serve so many of our county residents. Well, it will not stop. It's it's five weeks. Yes. But it was something I can't I didn't work directly with that. Mhmm. We we were pretty strategic. They may have received someone that's been too big in the Rockies, but we also you know, they're they're we're starting to collect the data now to find out, you of the funds. And how entities were funded was different based on how they served, whether it was, like, per meal, per box, per or if it's a lump sum.

And we are starting to collect that data now. So we will have some impact impact report that we prepared for the commissioners. When I see that, I can share with you all. We've been asking for weekly data, but by the time the checks got out, got to people back, like, it it's all over the place. Yeah.

So we are trying to measure the impact that this initiative had just for the county. And I also think it's quite delayed getting 10,000,000 out, so I don't even know how far reaching that has been. I haven't seen any news on that. I bring that up because this could happen again, and it would be nice to have a little package for lack of a calendar so we can move faster. I think that's part of the challenges in anything like this is whoever moves fast gets it.

Yet there is a constant need for food distribution. You know, we just saw a temporary rise, but it doesn't go down zero ever. So there is a continuing scene for us to evolve ways of increasing the effectiveness and efficiency Mhmm. Of food distribution. I also suspect that if food bank or the Rockies got a sum of money for money for food Mhmm.

That

they wouldn't be charging full price for it as their normal price when they distribute it to other agencies. So it will trickle down in appropriate kind of way. But I think there's a huge opportunity for us to involve better ways of sharing information that can save us a lot of money with this literature. Just if nothing else, the shared knowledge of, you know, where the food needs to be when, collaborating on moving the food from The Rockies with a place where it needs to be distributed, etcetera. Why does each agency have to do that?

Maybe there's a lack of a way of being able to organize that and save some of the overhead that these agencies have. So there's a huge opportunity, but it takes a lot of work to be able to do that. And I I must commend the the wrap up old food security coalition who is taking active steps to to do that in the western part of our county. But it's something that needs to be implemented, I think, throughout.

Not to duplicate, which is because Denver has a new place. It's something that I was asking. I went we had an opportunity to close their facilities a month and so on, Bob. Very impressive. I mean, huge. Okay. So I'm glad. But but they're as full as they can do. Like, they can't place on that on the panel, which would be the. That's the point of.

I think that is part of it's it's and I think part of why it's easier it's a lot of logistics to move food from one place to another. You have to check out vehicles, volunteers, and capacity staffing a month. So it, you know, might be easier just to toss it than to try to move it from one place to another. If it's near being, like, it's perishable, you have to use it quickly. So that's but there's a lot of momentum right now because food has never been talked about so much that I can eat.

And we're jumping on the the fact that it is front and center. So these people are motivated right now. How do we sustain that, and how do we, you know, think about the systems that can sustain that? And it is happening a little bit here and there. We had the opportunity earlier this week. C4 Campus. Had a mobile here on this campus. And it's incredible. Nice. It's really cool. Get that.

But they we get them. Oh. We I mean, we pay for the food, but they come to one of our campuses once a month. Yeah. And it turns out.

Mhmm. I can imagine. And at a school with a huge reserve. Yeah. So it it was really cool to see the the mobile, but they they also they do have volunteers who will go around and pick up food that would be wouldn't have gone to base, and then they take it to their they have a giant store. It's huge. Yeah. Huge. It's It's huge.

Well, we're we're models. We've become like microcosms with theirs. Yeah. And that that would be my suggestion to your question mark, is is that I would I would use them as a model because they have not been doing this so successfully for so many years. The the private partner public partnerships they have with existing chains, like, have a big deal with Trader Joe's. They have a big deal with Safeway, and we find their food to be much more culturally responsive than buying in bulk from food bank or lobbies, to

be honest, because it just doesn't serve our. We found that through touring of the. Everyone gets loud. Yeah. When they come in

Because Trader Joe's donates their hours that they would absolutely be throwing away that are, like, three days old, and they're beautiful. They're beautiful. And they need them water. It's a beautiful school. They also do a backpack program there, and that was my other thought too is if that's if sustainability is a a long term goal, helping helping school districts or libraries or after school centers, anything sustain a backpack program, especially for the weekends because we know we're getting kids they're coming to school, getting them breakfast and lunch. But backpacks for weekends or winter break or any other back school break is just would be an amazing partnership.

And just one of the I saw the website in backpacks and sign in Yeah. Which is it says that it's located in your app. Basically, we're running. Yeah. Yes. We that was one of the many things that we funded was backpack society. It was for Littleton School District Yeah. The funding went to backpack society. So they and we've we've done work with backpack society. It is it's I mean, there's no stigma. You get a backpack. Yeah. We can. So just wanted to share with you, like, that a lot happening on the Disney, but it was happening. It is an ongoing thing.

I also just really quickly wanted to acknowledge the opening of the Aurora Regional Navigation Campus. It opened yesterday. Yesterday. It technically sits in Adams County, but would serve Carrapaho County individuals. It is for adults only, so shelter. They have up to 600 beds. They have three tiers of beds. So the first larger is just army cot style. I think it's two fifty beds. And that's tier one.

It's overnight shelf, very basic. I mean, it's two cold meals a bed. Then as you can advance into tier two, which is more like dorm where they would, you know, bed and the little cubbies, you but you have to work toward tier two. And so there's some level of commitment to case management, and working toward recovery. And then in tier three, it is your own hotel room. It's former Crowne Plaza and Complex Center is what they renovated. And This is a lot. This is Kaufman. Yes. Yeah.

Yes. But it Douglas County, Adams County, and Arapahoe County all invested into in Arapahoe County and a significant amount of money into this venture. And I am very hopeful that it is successful. I like the the model that it has. Tier three is you have committed to job training, going to work.

It is not free. Once you're in tier three, you do pay 30% of your income back to the center. And it's but it's hot meals. But in addition to the shelter and housing is a navigation center, and we will have I have records there twice a month. And it it's a huge need for individuals who are experiencing mold since maybe they have nothing on their body other than what they're willing to a job, not to have the certificate or to get ID.

So we worked out we are we are in a formal agreement with Advanced Pathways, who is the top of your conference center. And we will we're trying it out for a year to see how well it goes and what we're able to do. I think Ashley was incredibly creative because we also have to get paid. We can we can write off vital records. So she negotiated a deal with Advanced Pathways to make sure that we are able to pay for the birth certificate. But we'll have courier.

She's also kind creative in how she's providing services there because of the security around the paper. All the departments say how she's providing services.

Yeah. So it'll be it'll be the only service that we provide right now, and part of it is just it's really sticking with it being in Adams County's jurisdiction. Mhmm. So we're careful with what we are doing. Right. And by the way, that would be a great step. So we are excited about that. And then last thing I just wanted to point out is in the report we've mentioned about a firearm injury prevention campaign that we are creating. Well, it launched yesterday. Yesterday was the official kickoff for what was Firearm Engine Prevention Day.

So that was the launch of that campaign. We are looking at probably several messages throughout probably a long period of time. But, locally, we are partnering with the sheriff's office and the DA on this on the messaging, and we put up a new page on our website around firearm prevention. Our big focus is well, all of our focus is around safety and gum lots. We received a mini grant to be able to purchase gum lots.

We've been able to do that in the past, and it's it's really popular on on home visits. Like, we've we've been able to get get it out. I don't I don't know if that month's over. It's I thought we were since we did history week, but a lot. So we've added to that. And this is a regional effort, so it's all the, like, the regional health departments and hospital systems are collaborating.

Do you have any data as to how many of those slots get in the

units? No.

I I wonder how many are actually They have good

intentions, but they're not bad.

I'm sorry? They have

good intentions, but they don't necessarily use it.

Yeah. I don't know what to see if that data is available as a not from the ones that we distribute, but in general, the people are we see one how often we it. And so, you know, this is all also part of our one of our partnership priorities, so most.

Okay.

We're now going to move into a brief announcement session. Doctor. Urbina will be giving us

an update, an opinion we'll follow-up with a timeline. So thanks for allowing me to speak to you about those directly. You're welcome. As you know, it's been three wonderful years. Been great for the last.

Two. But I have I have to say this time to to I've had seven unsuccessful attempts at retirement. So I think this is it's time to do it. My last day will probably be sometime this summer of the fall of next year. It'll give us some time to recruit somebody. And if if need to, we'll be happy to participate with training somebody new. And if if it's somebody experienced, we won't have to do that. I doubt they're gonna be able to provide us someone who's handsome as.

Maybe smarter, but not I

mean, this is to you.

We can see someone with more hair.

Staff. I I think this has been a real joy for me to work with this team. It's it's one of the best, if not the best. And it will always be my favorite part.

So

so thank you very much for your time and support.

We wouldn't be here without No.

You listen. And I'll I'll I'll just say, you know, as part of the insight you may not know, when we originally, were a health department, we had deliberations over who the medical director should be. We had another candidate who, two of the commissioners absolutely opposed to. And

then So a second choice?

Was that what you're Well and Jennifer said, you know what?

Well, we didn't have

it. Right. Unlike how well there's this wonderful guy we're looking into named Doctor. Ervin, and we were like, Chris? She was like, yeah. If he has a lot of we were like, done. Done.

Done. He did. His

name needs no introduction, but I would say you working with us and just, you know, everything you brought to the staff, to the board, and just your whole aura has really helped us, and you bring a a warm energy and really have shared your knowledge and brought us along. And so you will be missed. I am gonna be honest and say, I am intentionally gonna sabotage your Yeah. But said that you stay. If I'm successful, we will allow somebody else, but it it will be hard to replace, and we've made great contributions, not just to Arapahoe County.

For those of you who don't know, I also have a close friend, who's a physician, and doctor Urbina is he was like almost like his mentor. He was like, you know, what doesn't get talked about is the way that you've mentored younger physicians and really helped them along the way. So they said not only, you know, are you a, you know, a great champion of public health, but a great person. And so a lot of times, that doesn't get talked about. So thank you very much.

Fair hitter. Thank you.

And you will share a little bit more, but we'll find next year. We'll do one. Have an official retirement party. And some of us, sadly It

has to be any general party.

But I I do recognize that we're sharing in quite a bit advanced, but wanted to make sure that you were here when we heard and also so that you can share the timeline of of of our next steps. Yes. So it's a contract that works under. It's a beautiful look through our contracts, you know, again. So we asked for that.

Like, little place at it. So we already shared this print part with doctor Venus, but in case type of send up an update for other patient thing. And then we'll have to run to Tony and Dan, and then we will start very officially in January. So we're likely right now. And then hopefully, we need to have it posted in March.

As well. Tell you, I just feel so blessed that you agreed, and I know the guilt of living in West Palm County, which you feel like you've had to do it. But if you felt bad for us, you know, I have it's just need to share so much wisdom and calm during the time that felt.

I wanted to make the announcement for you over here. Thank you. Any

other comments?

You.

Well, I'll be hanging around. Makes sense.

Now what's the next nonretirement adventure?

Lots of opportunities for sure.

They will not see you working anyplace else,

though. Yeah.

Yeah. Have to remember because Kevin retired for the last thirteen years.

That's I'm saying. Like, I don't have something coming up. Like, I have an adventure that's not work related. Otherwise, you're gonna be you're gonna be working somewhere else. Yeah.

Yeah. No. One more.

There was there was a recent opportunity with someone named Amos that I said no to. Oh, okay. Absolutely. Well,

you may wind up just volunteering.

Oh, yeah. Well, I I do that now.

Yeah. I do a

lot of fun stuff.

Yeah. I I've been there, and I've done that. And, yeah, it's actually more rewarding.

Absolutely. Yeah.

But once again, can we get back to those meetings again? Don't have an executive session, but we are we do have an administrative item. So at this point, No. So I'm gonna go over it. Oh, she did.

She was sick, which is really

somewhat intentional for no. I'm joking. So I'm gonna review it with the board because I

don't know. So and you were

Yes. So the staff, how the staff can meet. Thank you for the very exciting. Thank you. And, also, we have to