Arapahoe County Board of Health - Regular Meeting

Good afternoon. I'd like to call the Arapahoe County Board of Health Business meeting to order. Ms. Bates, will you please call the roll?

Director B.B. Kleinman. Here. Director Sean Davis.

Here.

Director Christine Burrow. Here. Director Mark Levine.

Here.

Director Mark McMillan.

Here.

Director Terrence Buckman.

Here.

And Director Michelle White. Here.

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

Okay. Well, Steve, we haven't seen you.

Please be kind.

Alyssa and Brooke as well, but just welcoming them back for our CHIP presentation.

And then from Community Health Nursing, we have Laura Breyer-Gon, also part of the CHIP presentation.

Okay.

Executive Team Anthony, Security, Safety, come here.

Welcome back. Welcome. Okay.

The next item is to approve the June meeting minutes since we didn't have a July meeting minutes. I'd like to add for a motion to move for the Board of Health to approve the June meeting minutes as presented. Moved.

Second.

Motion made by Mark and seconded by BBM Christine.

All in favor say aye. Any opposed?

Here none motion passed. Next is our public comment period. Do we have anybody in the queue?

We have? Did you have the July meeting?

Yeah. Oh, that's right. We did have a meeting. Can we can I get a motion for the July meeting minutes? Second. Motion made by Christine and seconded by Mark McMillan. All in favor say aye. Aye. Any opposed? Hearing none, motion passes.

Now we move to the public comment.

No, I don't see it in the public.

And the next is the director's comment. At this time, the board directors are invited to share insights from community leaders and partners to gauge the current state of the community. And so this time we're going to go right to left since I used to go left to right. So we're going to start with Michelle. Hi everybody.

Welcome back to school year. I would say, I would say every district in Arapahoe County is back in school this week. I'm not incorrect. Today was the first day for Cherry Creek for all students. We did a staggered start. So that those freshmen can have a day to themselves at high school. Sixth graders can have a day to themselves at middle school. And kindergartners come on Wednesday and cry in front of everyone. So my daughter being a teacher was girding herself for her little candies. And she sees them all. She's a music teacher. And she was very excited to have her little babies. What's on my mind related to the starter school and our families in Arapahoe County is the economy and needs of our families. And I know that that is the work that you all do every day, all day. That's why you're in service. And I'm so grateful that you are. We had amazing representation from Arapahoe County Public Health on Saturday at Overland Prairie Campus, Overland High School and Prairie Middle School, where we walked 3,100 families, total people, kids and parents and guardians, to our second annual student family resource fair. And at that fair, we handed out 2,000 packpacks with school supplies. We, meaning Arapahoe County Public Health, Stride and CDPHE administered immunizations. Stride saw kids for well-kid physicals and sports physicals at no charge. C-Core Cares was there and provided two weeks worth of groceries to 180 families. We pay for that, but obviously our families do not. This is only the second year we did this. Last year, we had about 1,200 people. We bore the double debt in one year, and I think we all know why. It's not because they want to have to do this. While we're grateful that we have the ability to do that for our families and so grateful for our partners, including ACPH, I just think it's really important as we start the school year and start this program to really be cognizant that everything we do and every decision I make at work and everything we do here at this board will affect a family one way or another. And sometimes we can't do it all, but boy, we sure should really go to bed every night having tried. So I just want to thank you all for being in service because it is really hard. in good times and this is another really hard time i would i would liken it to a hard time like 2020. i really would it just looks and feels differently and at least we get to be together in the work but um these are times for us to really stand together so that we can do certain um along the same lines as at the summit game uh last week and there is a

There was a family who was like, oh, my gosh, I just can't believe that that summit has donated the stadium to the trigger schools district. They're the richest district and you have been so proud.

Well, actually, let me tell you about the needs of the community, blah, blah.

So I put on my walking out to my car. I wasn't what I was going to say, but. Oh, like, I needed to share that. I have been thinking a lot about long-term services and supports, caregiving, how we make the systems work for everybody along the same lines of the economy and not being able to afford care. Really, really challenging. Colorado Public Radio is hosting an event on August 30th, which is a Sunday, next week. about caregiving and they're doing like a showcase of resources for caregivers, family caregivers in particular. I'm speaking on a panel with AARP and a couple other folks in the community about caregiving. They're doing like an Aging Matters segment, live taping. So it's like $5 to come, but it's in Highlands Ranch. It's not too far away. And it has, I think, some really great resources and opportunities for caregivers, especially folks who are caring for older people. So come check it out. Awesome.

Last week, I guess was actually the week before, I attended a summit at the Bioethics Center at the Anschutz campus where I'm located. It was a neuro-inclusive design summit. Neuro-inclusive. So it was really looking at the intersection of health with architecture and design. something that we don't always think about. But it was fascinating. It really was that you can design a building to be comfortable for people. But what do you do, for instance, with the neuro-inclusive design where you might have, and actually the focus of the meeting was on people with autism, some of which are hyposensitive to everything and others are hypersensitive to everything. And how do you design something to be able to be inclusive to the entire population in a way? And I was amazed at the expertise that they were able to bring together of people who have been thinking about this for years and something that is now and active support from the Bioethics Center, recognizing the fact that architecture and design are humanities, care about people, and in an appropriate kind of a manner. So it was just thrilling, and I just thought I would mention it to everybody. Thank you.

Of course, I'm focused on the loss of Medicaid revenue and the safety net and the impact that that's having. Doctors Care has done a lot of work in looking at the numbers, doing the math, and realizing that actually our Medicaid population is increasing, but the reimbursements are decreasing. So we have this past year 16% more Medicaid patients, so people on Medicaid, but we're being paid 23% less with those same people. And the long-term impact of that is going to be just an increasing number of uninsured. As we see come October when people lose, more people lose Medicaid and may qualify for some subsidies, but only for a really short period of time until January 1 when subsidies go away. And that's just going to force so many more people on the uninsured, which is an impact that public health is going to feel and much of the safety net. So that's my downside. My upside was that I had this great meeting with FreeBC, and I know that Wapanoe County Public Health is also a part of that. And you're probably seeing so many people, not just women, but all women who are looking for reproductive health services and an avenue in. And it's just so positive how they are using social media to get people to come through the door and And when I was asked to communicate with them and looking at how I can support their fundraising efforts so this program can keep going on, they have some, they've got another year of funding, which that's a positive for those of us that are playing this, but they're looking to make that happen more strategically long term. I walked around, I've been gone for two weeks, I came back on Friday and I just walked around my office and talked to people and said, what's your experience? And I'm sure you're having the same thing. It is just so positive. It's so nice when our frontline staff can say yes instead of no. And there's just so much no that goes around that it's just joyful to talk to reception and medical assistants and medical providers who say, yes, we can do this. This is an easy avenue in. And we get so little of that right now in health care. It's just so much melanoma. So I wanted to end with my, that's a real positive. And they're doing stuff that's going to help us continue to do the work that we're doing and opening doors. And just on Friday, we had four free BC patients. I mean, the numbers will continue. And I didn't have the bandwidth to deal with all the other days of the week, generally. I was really excited that Friday was a good day for me to walk around and ask those questions. But it is really nice to say yes.

I think the biggest issue that happened, well, about two weeks ago, three weeks ago, I was in Washington, D.C. I'm also on the board of ACLU. We had our biennial conference. And as part of that, one of the session, I'm also the affiliate equity officer for Colorado. And so in the meeting with all of the other states, they asked me to lead the meeting, but then also to give a case study of my experience. And so unbeknown to this group, I chose Arapahoe County in the board chair and my experience on how I feel we have navigated or addressed equity also in the context of DEI. So one of the things I pointed out is I feel we have excellent leadership. I feel the staff is amazing and I feel even with all of the political attacks all of the negative attacks at the federal level, the director and this whole organization has stood fast, maintained a commitment and also reinforced from your leadership that we are prioritizing this. And then the question became, well, what about the board? And I said, well, the board drives it. And I said, my co-workers are absolutely amazing. And so I sat down and I thought, you know, that went pretty well. and every other state except for colorado stood up and said we are having a horrible time and so i was like oh So that didn't go the way I planned. But the lesson is we live in almost like a bubble, meaning every state, they're saying this is the worst of times for us. You know, we were there and we were focusing on two immigration bills that we're supporting. But I told people, if you come to Colorado, it is what you hear. I said, we are in favor and irregardless of the political orientation. I said, the department supports equities. the individual supported and we walked to talk. And so it was, you know, afterwards, I think I convinced about a hundred people to want to come to. I didn't say you had the job. We hear all of this news and all of these issues that we're facing as a state to know that we work for, you know, that there is a health department and we're doing our part in our world is very nationally.

So that was news to me. Thank you. Nice to see some of you from Grappler County Public Health and some new faces too, so welcome. A lot of neat things are going on with Sydney County, Denver, air and water quality. One that I'm really intrigued with right now, so my team has responsibility for sampling and reporting on the 18 lakes in Denver that we have some jurisdiction over. Everything from Sloan's Lake, which would be In the news, as it always is, with the Dragon Boat Festival, but even like Summit Lake up at Mount Blue Sky. And I've been challenging my team to think about how we tell our story, not just to sort of collect data. And maybe this is sort of telltale to all things in public health that we do behind the scenes. And so we are pivoting more and more to using story maps and found that really effective. We have a MPH intern, and she's just about to graduate. And she's putting together this really neat fact sheet for us about E. coli and picking up after your pets. And it's called, There is No Poop Fairy. And I love it because it's... data. An E. coli value of whatever may not be much to me, but how do you resonate that? We've done some other things in this space with harmful algae blooms as well, because folks may know they're extremely toxic to dogs. So we've seen plenty of experiences, unfortunately, where parents are happy to let their kids play in that water, but he mentioned that it's toxic to dogs and there's Snatch their dog out of the water.

I'll leave it at that.

I'll leave it at that.

I learned that.

I will leave you with there is no such thing as a Cooper.

I think I mentioned before I was a part of NAHSE, which is a professional health care organization organization. focus on the advancement of Black leaders in the healthcare space. So we're hosting a webinar on August 27th that is open to the public. It's called Mission and Margin by Patient-Centered Care of Healthcare's Best Investments. And I can share it out. I can send it to Heather. You can send it to Jennifer. You can send it to everyone. If you want to join, it's free. If you're part of ACH, you can get educational credit for it. But we have a great panel. It should be a really good conversation about just... patient center care. So I will send that information out. Is that time? It is 11 to 1, 11 a.m., 1130 a.m. to 1 p.m. Thursday? It is Thursday.

Okay. So you just have to register.

It's free. Thank you. We're going to move into our general business item. Our first item is on-site wastewater treatment system by a new presenter, Steve. Want to take it away?

Hold up. There's a script for this hearing that you'll need to read.

Okay. Okay. So we're about to enter an enforcement hearing. This is a hearing before the Arapahoe County Board of Health regarding an on-site wastewater treatment system at 23900 East Ohio Avenue, Aurora 80018. At the last Board of Health meeting on July the 6th, 2026, this board issued a public health order finding that the OWTS at this property constituted a public health nuisance in violation of the Public Health Act and OWTS regulations. In authorizing the start of civil penalties to be assessed, property owner Fernando Avina Garcia was also ordered to take immediate steps to repair the septic system and bring it into compliance. The purpose of this hearing is to receive an update on any progress made since the July meeting and to determine next steps. Arapahoe County Public Health staff asked for this board to issue a cease and desist order. The Board of Health has full authority to conduct this matter under the Colorado Revised Statute, Sections 25-1508, Subsection 5-25-1518, and 25-10-106, and the Arapahoe County OWTS Regulations, Section 19.3. The tone of this hearing will be informal. First, we will hear a presentation from Arapahoe County Public Health staff. Then we will take comments and hear from the property owner if present, and ACPH staff may then respond to the property owner's comments. Ms. Monica, can you please lay the foundation for this hearing?

Pursuant to the Arapahoe County OWTS Regulation Section 19.3, as well as Colorado Revised Statute Sections 25-10-106, which requires that 48-hour notice be provided to the property owner. And we have given him more than that minimum. And that notice was both mailed as well as emailed to the property owner.

Now we will hear a presentation from Arapahoe County Public Health staff. Please make sure you introduce yourself before you begin.

Thank you.

Steve Chevalier, Maryland Health Management Chair. I also want to reintroduce Connor Durkan. He's the Water Quality Supervisor. When I use the term we in my presentation today, it's mostly Connor doing all this work. and then also wanted to introduce uh demetrius andrews to from our zoning division within public works thank you if it's okay with the board i'd like to pick up from the last uh meeting that we had on july 6th and move forward in time there um on july 7th we had our signed order which we then mailed via certified mail first class mail and also emailed the property owner Following that, we wanted to make sure that they received the notice. We called the property owner on July 13th, left a message. We called again on July 14th and left a message. Then Connor was able to make contact with the property owner to discuss the hearing as well as the notice. The property owner, At that time said he didn't receive any email from us. During the phone conversation, he started looking through his email, phone disconnected. Connor tried calling back again. He didn't pick up, so he left another message just asking for the property owner to call back so we could discuss what the requirements were and what was included in the order. After that, we didn't have any contact with the property owner. We did reach out again this Monday to make sure that the property owner was aware of the cease and desist hearing today. Similar scenario, Connor was able to make contact with him. Again, he said he hasn't been reading his emails. He is a truck driver. He's not home to receive the mail and the phone disconnected. Connor called back, left a message, didn't get a call back, and then Connor also texted over the notice appearing today. So he was fully aware of what was going on through many different channels. Prior to Monday, Connor also did a drive-by of the property from a public right-of-way to see if there was any change in the situation from that public right-of-way view. Until August 6th, to make all the corrections included in the order, we are asking for this board to consider cease and desist, just since we have attempted many different ways to achieve compliance and we're at a roadblock being able to communicate.

Thank you.

We think the OWTS at 23900 East Ohio Avenue unless and until the property owner complies with the July 7th, 2026 public health order. And so we'll kind of reassess that it completes all the requirements of actions and obtains ACPH approval for use of the OWTS. We're also to require the property owner to meet the requirements of the July 7th, 2026 public health order. And so we'll kind of reassess that. and then also continue the civil penalty for $50 a day until the Board finds that the property owner is in compliance with the Public Health Act, the Colorado On-site Wastewater Treatment Act, and the Colorado County WTS Regulations, and the July 7, 2026 Public Health Order and Civil Penalty Assessment. I don't have any better news to provide to you regarding compliance, but that is what we said. Thank you.

I don't know if it's a food, but so we move forward on this. Then it's become a law enforcement. It moves away from Arapahoe public health to law enforcement or to public works or who takes it.

Okay. So you have all received a proposed public health order that I have drafted. And so we can go through that to kind of, um, It follows the request that staff is making, but it includes just additional findings. And so if you have that in front of you, I think it's easier if I go through that. And then as we go through it, questions will come up about what that means and how it's actually enforced.

Well, we wait. That's a part of there. Yeah, that's a part.

Yeah, it's all part of the conversation. We can either go this way or you can go through those four bullets in the script. And so, yeah, it's essentially all broken out on things that you all need to discuss and make decisions. No, that's fine.

Steve, is there anything else you want to add or? No, there's no additional information that I'm able to provide. Okay. And so now for the board's purposes, there's four issues that we have to decide. The first one is should the July 7th, 2026 public health order and civil penalty assessment remain in effect? So do we want to start with Michelle? What's your response, Michelle?

Well, I mean, just in terms of how much effort they have gone into... reaching out to this family. I mean, I know how families feel when they feel backed against the wall, even though we're gentle, we're professional, we're problem solving. And so, I mean, I think it does have to, whatever the next step is, that is the next legal step, whether it's by policy or by law, I think, I mean, the other thing that is frustrating, while I definitely feel empathy toward the family for feeling stuck, and I know, you know, it's like, you've got bills and you've got other things and we don't even know what those other things are you do get in the habit of saying i can't do one more thing i cannot handle one more thing but but that has to be true for this staff too so i feel incredibly protective of our staff's time and their worth in this because when you've done absolutely everything and gone beyond and beyond and beyond and there does have to come a time where you go you have to move this because you have a whole other job to do not just Every family is important, but they are but one, right?

Yes.

Yes. Yes.

Christine?

Yes.

Yeah.

I don't know why I'm struggling is because I don't feel like I understand the end.

Like these are the beginnings, but I need to know the end of this. We agree to all these things and the end result, I just feel like we need to put the end result out on the table because we're taking this family out of there.

So we're not there yet. Okay. So the first question is, should the last month's order just stay in effect? And the $50 a day continues to just accrue. So yes.

When does it become due?

We'll talk about it. I mean... And does this go to collections? Like, is this going to ruin this guy's credit score? Not at the moment, no. And I'm thinking about equity here.

So at this point, it's just accruing, right? It's like this ongoing thing that we're keeping track of how many days it's been, but it's not impacting anything. It's not impacting the property. It's not impacting its credit score, anything. It's just sort of an internal ledger. That's where.

And what is the amount current? July 7th. Are you having Steve? Yeah. Instead of just. Yeah. And just know.

Yeah.

You are welcome to ask any questions to people along the birth process. So it's not, you're not limited to wait. So I encourage you to ask additional questions as they come up.

Do we need to, sorry, question. Do we need to go through all of these right now or can we talk about them and.

However, you want to talk about 1st, we can both we can do that.

No, I guess I am struggling with. I think to be these point, I'm struggling with the steps of, like.

What these mean for the big picture, so the original what we're going to do is implement the cease and desist order. So that's the final step for us.

That's the goal is to it?

Yes. Yeah. At the end, there's a proposed order where we're going to move to basically implement the cease and desist order. And so it requires Board of Health approval to do that.

You look at this second to last paragraph. That paragraph scares the bejesus out of me. Yeah.

Like I am like a man. It's true. It's true.

Or, well, I don't know what paragraph for you 120 days in jail. Oh, okay. So, I mean, that's. That is for violations of any public health orders. You can go either through a similar criminal proceeding or a civil proceeding. And so the criminal proceeding is that it is a. um misdemeanor to um it's a class two misdemeanor to violate a public health order and so that's one of the tools in the toolbox that you can go to court and see and ask the court to um essentially find a person guilty of a class two misdemeanor and the maximum allowed um for for whatever the punishment is, is up to 120 days in jail or up to $750 or both. So that's the max that the court has discretion to go as far as sentencing.

$750 would be in addition to the $50 per day.

Yes. And we are not asking to go to court seeking a misdemeanor charge. This is something that is included in the order that is issued to the property owner, letting them know that this is a serious situation. And these are the options that may ultimately be on the table. But yes.

Is that defining statute?

Yes.

It's not our pullout.

Right. And we also informed him what implications there are for his failure for the accumulating $50 per day. Where does that go and what are our responsibilities and opportunities?

Yeah. So the $50 per day is under the OWTS regulations and statute. To actually reduce that to something that means something, Christine, we do have to go to court and it will be then reduced to a court judgment. That court judgment, the statute allows either for garnishment of wages for that amount to be paid, or it becomes a judgment lien that is added to the property.

If we go down this path, I just want us to know, I do need to know where I'm going. If we go down this path, it kind of leaves our hands. It leaves public health hands and goes into the courts or law enforcement or something, and they can decide to do this.

Yeah, it's not us deciding to do it. Right, right. If we just have a cease and desist saying that it's moving up the process, the first step is we have to pass an order saying basically they're in violation of public health and we're trying to get them in compliance.

And we're also saying that it's unhealthy for people to live there.

Yeah. So I understand the hesitancy as far as like we're saying like jail and fine. But the path to not go to jail is really easy. Yes. Steve. Yes. So like, if you don't want to, if you don't want to go to jail, fly to Steve and we're good. Well, not, I mean, not we're good, but like, you don't like, there's not the, so it's like, he's not helping himself here. And so like, I, I personally find it hard to feel bad for someone who's just ignoring all the opportunities given to him to not go to jail for 120 days.

Yeah, and I am not asking for you all to approve for me to proceed with any criminal action here. Okay. The only thing that the draft order includes is a request for a finding that last month's public health order is to continue in effect. The $50 a day will continue to accrue that you issue a cease and desist order, which would mean that the property does have to be vacated. because you cannot have a home that is uninhabitable without appropriate wastewater disposal. And then to approve for us to put that into effect. So that would mean if we are reducing that assessment to go to court and get a judgment lien for whatever that amount is. to work with because it's an unincorporated Aurora. It would be working with our public works department to potentially condemn the property in some way. I was speaking with the public works attorney this morning and they had mentioned that public works has authority to turn off water for a home. And so like things like that, that can be put in place so that the cease and desist actually is implemented because you issuing an order doesn't really mean anything, right? If they're just going to ignore it and continue living there and continue using the septic system and continue not having fencing up. So we need a mechanism to actually start enforcing this. And so those are all just various avenues for how to do that. And yeah.

In 30 days, then, is it our responsibility to go out and see if the place is vacated, or do we refer to the sheriff, or how does that work?

It would be us, and then Steve and I would work together to figure out, you know, is our next step to work with Public Works? Is that the easiest way of going about this? Do we go to court as the first measure? So all of those things have not really been decided for sure. But those would not be things that you're necessarily involved in. We can keep you in the loop as far as like updating you.

But the department, the health department is still engaged in this. We haven't dropped the ball simply by passing this.

No.

But it is, they have 30 days to come into compliance and then the cease and desist would kick in And that's when we would make a decision with leadership on, okay, what are the various things that we can do and what's the easiest way to get compliance? And so, yeah, it can be working with public works. It can be going to court and reducing the assessments to a civil judgment. It can be going to court and asking for an injunction to implement the cease and desist so that in addition to having a public health order, you also have a court order that says you are no longer allowed to stay at this property and issuing a essentially like a warrant to evict the homeowners and that's when the sheriff's office would go and serve that. So those are all options.

the balance on their $50 a day is $2,100 right now.

Other comments? Questions? Comment. Good questions from my colleagues here. Some of the questions I think are making some assumptions about this homeowner's ability to pay, which I feel like I've heard anything that indicates one way or the other. The fact that they're not getting back with staff, may be indicative of something, but we don't want to make any assumptions about why this property owner hasn't moved forward. I agree with Terrence that a simple call probably would help. It doesn't obviously stop the process, but the fact that the homeowner appears to make no attempts to even communicate with the county, like what are my options and so forth, speaks to reticence. And so... Again, important questions, but it's a pretty threshold issue for me where it wouldn't get back with staff. And it is totally a public health threat. They can expand on that a little bit, but. It seems very black and white if I can use my peers. Yeah.

I would feel very, very differently if Mr. Garcia, I think his name is, had just said, hey, yeah, I don't have the money. I think all of us would feel very differently, and we wouldn't be charging $50 a day. It would be a very different situation if he just picked up a phone call or not disconnected two times. That's very different than what he's doing is very different than someone who's actually trying to help the situation.

We did hear that in the communication that he couldn't afford. He got some weird quotes. That's true. But he did say he couldn't afford that.

And more or less, yes.

I think that Connor and Steve were probably coming in with a carrot of this is how we want to help you, but also sending a cease and desist and a public health order kind of feels like a stick. I don't know if I'd call you back. Like, to be honest, I mean, I think that is scary. If I can't afford a $30,000 septic system, I probably wouldn't call you back.

How would you recommend we proceed? Would you just say, let me live there? Because our interest is public health.

Our interest is totally public health.

I mean, because the other issues y'all are raising, in the instance, as you're describing where you wouldn't call them back, I find that hard to believe, but I don't think I mean, in all honesty, right? Meaning we don't have any other options. As Terrence said, when somebody refuses to communicate with us and basically says, I'm not following the law, I'm not even going to communicate with you. At that point, we're giving them additional excuses for why what they're doing is okay. I mean, at that point, he's at the point where they want to work with us. I think we can re-engage and have the conversation, but at the point where they don't even meet with our staff and we're spending the extra time, similar to what Terrence was saying. My thing is, what else could we do on that side?

Steve, you actually did have, or somebody from public, did actually talk with this person, is that correct? Yes. And what was the conversation? What did he actually say?

When we first started engaging with him, he said that he wasn't... able to afford what the quote was that he got for repairing the septal system. He was aware that there were issues with it. And then he asked, what would happen if I don't repair it? And so Connor walked through some of the process. We were hoping to reconnect with him after he looked for some additional bids. He said he was gonna reconnect with us after that, and that's when communication dropped off. Following that, when we started trying to ramp up for this hearing, we'd reach out, or for the prior hearings too, we'd reach out and have a short conversation, like I mentioned, and then the phone would disconnect, and then same thing happened. So the conversations were short, they were civil.

Conrad, I don't know if you have any additional detailed add.

Yeah, I mean, the first time I spoke to him, I talked to him about initial steps and showing progress and addressing the issue. First initial step I asked him to take was to apply for a repair permit to repair the tank as he was working on finding a contractor. Our minor repair permit is $415. I said, that's a good initial step for you to take to show that you're willing to fix this. And it didn't really go anywhere. So I think that's really all I had to add.

I think what my sensitivity is, there's so many new stories about what HOAs. This is different. This is public health. The HOA is taking over control of warehouses, especially in certain neighborhoods where people really can't afford to do the maintenance and fixing and things like that. And the press is terrible. Those stories, you really feel for the homeowner more than the HOA. This is different. This is public health. Those are safety issues, too, for neighborhoods. And public health doesn't get involved in things. So that's where my... I feel like we're between a rock and a hard place. I don't think this family can afford to fix it, though I agree. If they had just gotten the permit, that would have just said, okay, I'm willing. Can you help me figure this out if he hasn't done it? I don't have an answer. We just have this HOA.

In the instance where they can't get it fixed, what would you propose we do? Just long-term, if they don't have the money, would you say we just wait until they

Do you have an answer? I don't have an answer, but one of the things that options that we had talked about last month was with the nuisance finding the statute does allow for the agency and the board to remediate whatever that nuisance is. And so that gives you all the ability to make a decision. Like you had asked somebody to go in and put up the fencing. Um, and and we agree that it's, it's not a good idea for. Arapahoe county public health employees to do that, but. But an option can be for a 3rd party to we can. Again, if the property owner doesn't allow it, then you have to go to court and get a court order, but the court can essentially say. Have a 3rd party going and put up fencing and whatever that costs. It's added as a special assessment lien on the property. But then again, it's money that the county is fronting to put up whatever it is that we're doing to try to at least bring it to a minimum level and then hope that

But that doesn't address what in my mind is the core issue is people living on that property. It's not safe for them. It's not safe for the community. And putting up a fence, but the people still living there doesn't do anything.

My response to that is we're going to end up, the county's going to end up doing that anyway, because even if these people move out, It's not safe. And public health is going to continue to say it's not safe for the neighbors and the people around it. So there's no other choice. This guy is off the property. The county is going to have to, as public health, we're going to have to recommend to the county that they put up a fence to protect the community.

At least access to the site. It still doesn't address the crime.

No, it doesn't fix the crime. But access to the site, which is one of the initial things that the department did ask.

people put up a fence and you put up a couple cones but didn't we decide that the the threat to public health was the fence but ultimately i think stephen connor said that like because the property is so large there's not a huge threat from a septic system leakage standpoint to the public other than the people who live there is that correct But we're not worried about neighbors having issues with switch.

Not at this point, right? Didn't we eventually it ultimately it could because 1 is ready to collapse.

Yes, there's a potential and then it's going to impact. It will actually impact the home, but it's not like a force meeting.

Where, but we will have to.

We're going to move forward on this because ultimately it's still not safe for animals and children who might be one. So the county is going to want to put some money out. But that's not a decision for right now, is what you're saying. In some ways, it feels like it. If we all agree to this, the next step is that these people are going to move out and we still want the environment to be safe.

That's it. It's really quick. I mean, this is a property owner, not a renter. So I think assuming that he's going to move out is, I think, I'm not sure that that's the right assumption. Assume that he's going to move. We're not evicting him. It is a cease and desist, but it is moving us into that next step. And as he purchased this property with a big hole in the ground, and as a property owner, it is the responsibility a property owner to repair. So I don't know what his options are. I think we're also making assumptions that he can't afford it. He did indicate that it was expensive. Yes, it is regardless, but we're making assumptions that he can't afford it. So I think we have a lot of assumptions that we need to probably check. And we need to, like, figure out the PI, like, what is the process, what are the laws and the regulations that we have to protect the public's health and to protect the safety around this huge hole that's in the backyard?

And he is the occupant? He's the only, there's one person who lives there?

There might be two people that live there, you know, so far, but he also might be renting out, looking to rent out the property to...

But it's public works, but shuts down water more difficult.

I mentioned it at our last board meeting and maybe I wasn't clear. Depending upon how we're interpreting public health, it's an issue that, in my opinion, affects at least 40% of owners. If your septic system goes out with the cost, aren't necessarily in a direct Financial position to be able to review that. And so you're right. That's why I said down the line, we really need to think through how public health will address it. But it is a real issue. I want the Eastern plans or, you know, on the eastern part of the state. And so when you think about the cost, even an urban area, so somebody got to spend twenty to forty thousand dollars to get something repaired that. serves the function of a septic we don't face in an urban area because we've got the water system. So it is, it's a real issue out there.

We know whether his water system is a utility based or not a well. It's a private well.

So if we don't approve this cease and desist, what's the other option?

Like, we don't approve it if we don't agree that we need to do is like, oh, then what what's next? They continue to try to reach out. They can like, what's. What's the alternative?

Is there an.

What is the alternative? I mean, they continue living there, right? We can still proceed with the civil penalties, reducing that to judgment. You can still do that. And. you can still continue to have a conversation of whether public health can go in and remediate to some extent or not. That's about it.

So I think at the end of the day, we should make a decision.

I feel like we're making it a lot more great than just do it or not. And I was like, all right, the payment and I just felt like all of those are so far down the road. It's like, do we see this or not?

Versus the alternative, which I feel like is not a good alternative, in my personal opinion.

It's true. Whether we do it now or we do it 30 days from now, it's going to be... Something literally has to give.

My hope is that once you start pushing and becoming more aggressive with it, that it will force him to engage. And we can come back and update you on where that process is and keep you in the loop as far as like how far we have gone, but I don't know where it's gonna go, right?

Is the continuing occupation of the land adding to the pressure on this faulty septic system in a way that will make it deteriorate more quickly?

Yes, the continued use of the system will create the chance for it to just quickly

And I don't think we have any alternative but to I would like to move that we accept the orders as written.

But don't we don't I haven't done we'd have to read.

Well, can we just go through the order? Yeah, I triple that you all are approving.

Yes.

So the findings are that the first one is just that the property owner was given appropriate notice regarding this hearing. Second is that we have the public health order that was issued last month and that that is going to stay in effect. Recognized number three is a recognition that the property owner has made no efforts to remove or prevent or remediate the issues that have been identified. and that the $50 assessment is just going to conclude. Paragraph 5 is a finding that the regulations for OWTS specifically require that no one can maintain a dwelling if it is not equipped with adequate facilities for sanitary disposal and therefore, because that's the case for this property. The property is unfit for human habitation. And then the order that is being issued is continuing to order that he come into compliance with last month's public health order that the property owner has 30 days and then the cease and desist goes into effect, which also then means that they formally have to vacate the property. And then authorizing for public health to coordinate with any appropriate agencies, such as the courts or other departments or the sheriff's office to start whatever proceedings to enforce the cease and desist.

Yes.

Does that mean that he could camp there?

Yes.

So it's not either, but in terms of camping on.

No, there can't be one RV there. That's a total zoning violation, so they couldn't do that.

Because it says construct or maintain a dwelling or other occupied structure. But if he doesn't have a structure other than just a sleeping bag.

It wouldn't. So the zoning issue would be separate than an OWTS issue. It would raise other. Other violations.

Okay.

Not for public health, but for them.

Yes. Yes.

So we're comfortable. I'm going to read the order. Everybody fine with that?

Okay.

I move for the Board of Health to approve the public health order to cease and desist to be issued to Fernando Alvina Garcia for the OWTS at 23900 East Ohio Avenue, Aurora, Colorado 80018. Ask for a second second second by parents all in favor say aye. Any against say nay.

Motion passes of six in favor one day.

And then. Then you want to move Jennifer to the second item?

Yes.

So we're all now we're going to move to the fiscal year 2026 budget adoption and Brianna is going to present the budget.

And while Hannah is pulling that up, I need to take a moment just to recognize that stuff and the hard work that went into building this year's budget and the constant changes and the roller coaster that has been 2026. It is still changing, even information that we learned this morning. Thanks, Steve.

Thank you, sir.

Thanks for being on. Sky's Gone Camping.

It has been just a ton of work. I mean, we start working on the budgets. I mean, it is a year-round process, but we really started working on them early. And Brianna and her team and all of the directors, we've just put in a lot of thought and energy and care and concern into what we're presenting today. And there's a chance that it could evolve and change again. But I just wanted to recognize the staff for the hard work. And I mean, Brianna's team and all of the directors. And directors working with their management teams, their leadership teams, it's been... It's been a huge lift to be as thoughtful as we are trying and to keep public health whole. We're still a young health department. We're still growing. The county is growing, and our budgets are shrinking. So how do we do that and be very thoughtful and innovative and meet all of the needs? So I think this budget reflects that, and a lot can change between now and the end of the year when it gets adopted. So thank you.

All right, I'm going to try to keep it succinct and just highlight the big changes that have come next. I did want to take a quick moment and do a positive financial update. So, in July, the county presented the 2025 audited financials. This was the 1st year that the health department participated in the single audit process. It was our WIC program. That is our largest federal grant, although nowhere near the top 10 at the county level.

It is our largest.

And that was presented to the Board of County Commissioners in July. There were no material weaknesses and no significant deficiencies. So that's as good as it gets in an audit. And I did want to take a moment to call out the finance staff for us, because at the same time that we were doing the county's single audit, we were also selected for the CDPHE financial monitoring process, a desk audit of WIC. So at the same time that they were doing that, they were participating in the desk audit, which also came back with no findings, a low risk rating, as well as a glowing review of our processes. And so that was very, it was a great little bow for the team. And now that we have audited financials, we can review our fund balance for 2025. It's going to look just slightly different because I needed to accurately add the numbers together. So all the numbers are the same. I just was not adding back in. the unavailable revenue. So as a reminder, unavailable revenue is the point in time at the end of March in the next year. So for 2025's fund balance, it was March of 26, was the amount of cash that had not been collected on our invoice reimbursable rents. Nothing unusual here. We invoice approximately a million dollars a month. So this is not a terrible AR to be outstanding three months later. And it's just a point in time. We will collect the cash at this point. We've actually collected all of this cash. But it just is not, at that moment in time, not available to us. Committed fund balance is what I've always been presenting to you as fund balance. Really what we need to be presenting is total fund balance, where we're adding unavailable revenue to the committed fund balance. The committed fund balance is Basically, at this point, what we're shooting for is our target fund out. So we, the board has. Pass the policy we are building to a targeted fund balance. So that's where anything that gets added to fund balance will go into that bucket until we reach our targeted fund balance, which as a reminder is 34% of our appropriate expenses. So I have a table at the bottom for each year what we're targeted. Once we reach that level, then we will get another little fund balance bucket that becomes uncommitted. And so then that's where the board would have. We want you to do this or staff could come to you and say, we would like to do X, Y and Z and here's how we'd like to put it. So. We're several years from that, but that is where we're so. We, and we have to get the. On to the budget, you want to take a moment and just do a reminder of the county's budget process. So, every year we are assuming flat budget and then any changes to our. Our new expenses, I should say, and that's I want to differentiate that because of our priority 1 ask, but new expenses must come as a package or request and we must balance. So our revenue must or our expenses must equal our revenue. So, and then just a reminder of the timeline, this meeting, hopefully we are adopting the proposed 2027 budget. Otherwise we're all seeing each other again later this month, which I don't think anybody wants to do because we must pass a budget by September 1st. And then we present to the executive budget committee at the county level on September 10th. And so. Hopefully by the second or third week of, I'm sorry, the third or fourth week of September, we will have our recommendations from the Executive Budget Committee. That's what goes forward to the Board of County Commissioners. Who's that? This year consists of Commissioner Carrie Warngully, Commissioner Jessica Campbell, Director Todd Weaver, Director Michelle Holstead, and Treasurer Westenberg. Um, and then the Florida county commissioners receives the budget in October, and they must pass the legal budget by December 15th. And I believe they have it scheduled to be voted on on the 11th of December. So.

I'm going to join if I may, I'm going to join staff. That looks like the budget request. Okay.

Okay. And that's 2 days after or 1 day after it's the next day.

It's the next day. Okay.

We won't know the decision from the EBC at that point either. I think you're going to get into that now, like what the staff are presenting to EBC with their support.

As every department is doing that. Correct.

Those six people or whatever have to package it. Correct. And they have to balance the larger budget. So no envy of that job. All right. Exactly. Yeah, exactly. Okay, so this is the largest change if you remember to from the budget that was presented in June, the priority 1 request. At that time, we had basically talked about this request and had said that we were going to do this as a verbal request that mirrors what we did for our twenty twenty six budget. And after presenting to the board, we had several conversations with our county budget partners as well as county leadership and made the decision that this funding package was actually significantly more important and needed warranted the priority one ranking. And so what this is, is this is fully funding our total compensation changes every year. And so currently the way we are structured is when the county passes a merit market, medical benefits, anything in that realm increase, the health department receives 30% of that increase in ongoing funding. And In a perfect world or historical world, I should say, we would have received small incremental changes to our grants increases to our grants that would have been increased our indirects and would have helped us absorb that other 70% of that increase. And since we, since inception at, we have not seen that happen. And I think I've talked at nauseam about that. And so we use as our kind of standard example, it is our largest clinical grant. It is our 2nd, largest grant in total. And that has had a 7% decrease over the last 4 years. That's just 1 example. And so. Kind of looking at that as their department, we, when we opened our doors, we were 60% grant funded just slightly under that. And now for 2027, we're projecting to be 47% grant funded. So. It's a significant change and so we are making this our priority 1 package, because we want to have the conversation at a strategic level with the to change how they're funding our compensation within public. That's the largest change to the budget package and what that did is then move all of the other packages down 1 slot. So we still have stabilization. It is our 2nd priority package and this aligns with our. Counterparts and other where we are asking for our WIC managers and leadership to be funded under general fund. And so that would remove them from the WIC grant spending and allow that program to stabilize and remain whole.

So, 400,000 of those managers to move into the general.

Is yeah, 3 leadership positions that are currently funded on the WIC program. It's all in their benefits included. So. All right, and then this 3rd, priority request is an expansion of our family connects program and this is for 1 full time nurse that would allow an expansion of 350 additional annual home visits as well as point 5 business support.

Our.

Priority for is the clinic operations. So, as a reminder, we requested clinic operations support for both our immunizations and sexual health clinic in last year's budget. And that was awarded at a 1 time basis. They did a word half of what the original ask was, and we found that that seems to be a really good number. And so we are just moving forward with that as an ongoing request.

So 250,000 is a half from the original.

Correct. We'd asked for 250,000 for each clinic and they awarded 125 to each. And so our priority five is an expansion. It is an environmental health, environmental health, land use and built environment. And there's one FTE ongoing. Priority six is the harm reduction capacity. And so this is not a new FTE. What we are doing here is as a percentage, our harm reduction program has been hit the hardest in reductions. And so what we're requesting here is to move the supervisor's salary to general fund, which would then bring that expense off the grants, bring up the grants to be able to continue to purchase the supplies and necessary activities within the current grant funding.

Number seven wasn't in the first number. Like in the three people that you were moving into general operations from a different program.

That was just WIC.

That was just WIC.

Correct. Yes.

Number seven is an expansion. This is a new FTE for injury violence prevention specialist. Number eight is a new FTE for a rural outreach specialist. And I did clip through those because I presented in detail in June. So if you have any questions, please. Part of the county's budget process guidance this year was that we continue the 1A activity that was initiated last year where we conducted an activity where we went through our should dos, could dos, must dos, should dos, could dos. And there was a matrix we developed that was submitted to the committee. And they asked us to revise that. And essentially identify anything that was funded last year, which many of our requests were. Anything that we have either determined doesn't need to move forward or could move out several years, which we indicated on our matrix, or items that were listed last year that we do still believe are in the appropriate place and should be funded. While we are requesting these, they are not at the highest priority ranking that the county has asked for. So They were included in our in our total budget package that was submitted to the county and will be included in the presentation. So I wanted to accurately reflect the numbers. But these are the, the 4 additional packages that were included.

Is it accurate to say that. Part of the strategy here too is to find the pump for the bucket community. So they. example, like not to fund like these four packages that they'll see it and they won't be surprised, for example, when we come back next year. So it's getting ready for a future request.

And I do appreciate the process that they put in place with the matrix because it gives us a place to kind of be able to point back and say, look, this was on Even on the WIC stabilization, that was on our request last year. It was different, but we were asking at that time for WIC support. And so it does allow kind of that history to be carried forward in one snapshot.

All right. Sorry, I clicked the wrong way.

Okay.

Okay. So this table reflects all of the changes and just a little bit of truing up. And so I'm actually going to talk through the revenue side. The expenses are aligned. And so at the top level, you'll see our grant funds. Those are reduced. That is exactly what we anticipated. And it is leading into kind of the conversation around the 47%. On the next line, you'll see the fees for service. So that is an increase. Most of that is driven by the retail food legislation that was passed last year that stepped the license fee. And so this is year two of that increase, as well as the fees that this board passed. The increase, it was approximately $35,000. That is included in there as well.

Does that include... a clinical provider uh billing medicaid and others um it does yes that's it has that been steady or is that going up or down

Year over year, we have seen an increase. I am anxious to see what happens this year versus last year. So we had an on-ramp of billing. So in 24, we didn't do any billing. And then in 25, we were able to back bill for 24. So we had a nice little increase. And then now we'll get to kind of see what that level's off at. And then, unfortunately, we'll see the Medicaid provider rate. I actually wrote down, look at what you were talking about. That was a good one. In the miscellaneous revenue category, we have things that include, we get some small amounts of foundation funding, as well as every year we do get our portion of the investment earnings on the fund balance. And so in year one, it was $85,000. Last year, it was like $165,000. So it's a nice little chunk of money that we do include in our revenue projections. I'm going to skip over the public health fund balance for 1 moment, go through the public health general fund, and then get back to the fund balance. So, looking at the 1st line, the 6M dollars, all of this is what we are requesting from the county and some of it's ongoing and kind of assumed continue. So the 6M dollars is what we open the doors with that the county contributed. The ongoing due to merit and market is that 30% year over year that we've continued to receive. And then the ongoing budget asks is the total of all of the packages that we are going forward with that are ongoing. And then we have one $30,000 request in our low priorities that is one time. So that is our public health general fund. And then we've included public health fund balance. So what we are asking for is the authority to spend up to $402,000 out of the public health fund. So this is money we would withdraw from that $2.8 million bucket that we just talked about. And I want to be super clear on what that request is. This is not for new projects. It's not for new expenses. It would be for current ongoing expenses. If we needed it. And so why I say it that way is when you're looking at a 27 budget, we're basically projecting to December of 27, right? You need to know what your expenses are going to be through the end of that year. When we have lots of variables, we could have vacancy savings in a more ideal scenario. We might have a new funding stream with increased indirects that would, all of those would reduce the amount that we could need to spend out of fund balance. So So, if in an unfortunate scenario, we needed to spend more, we would have to come back to the board and ask for additional authority to spend out of the fund balance.

So. If it's more than the 402 use.

Correct. Yes. As part of the board's approval of the budget today, that would also include the board's approval for the use of the public health fund balance as well.

Correct. I'm seeing this right. You know you're guaranteed the $6 million, but you're asking for $11 million from the county.

Yes, and actually we're really guaranteed $7.6 million because the second number underneath the $6 million, we track it all separately so that we can very clearly point back to where was there an increase, what year, what request. So there's a nice messy spreadsheet if you are ever interested.

But it's still your million. That is correct. And we got 500,000 last year? No, we got more than 500,000 last year. I guess I'm trying to reconcile the...

557 number with the 3.4. I see 5M number.

I would have. Yes, totally fair question. I'd have to go back and look at how the packages were delineated. So, like, for example, last year, 1 of the packages that was funded was 1 time funding for well, the clinic operations funding, for example, was 1 time. So that's why it falls into the 970 versus the 550 or 7000. Within the $550,000 would be things like the funding for the industrial hygienist position that we received last year. And I was just typing a whole bunch of things out to Penny and most of it is out of my mind right now. So I'd have to look back and look, but that's why there's differences there. We just have more ongoing budget asks this year.

Correct.

We have a significant one time. Yes, we have a significantly larger. Do we have a sense of like how many we'll get? I do not. I mean, historically, we've seen that approximately half of our packages have been requested, have been funded, and we've never requested this large of a dollar amount. Yeah. So, and ongoing that they would commit to.

Correct. What is BTS?

Oh, I'm so sorry. That is budget development system. That is the system that we enter all of our budget process into.

Yeah.

So, apologies.

To the If I may, another comment there. I mean, I've long thought of public health as sort of a benefit to all of the public in that sense. And so I've been a strong proponent of thinking about general fund dollars, things like this. I mean, I get the argument on not using general fund dollars, but general fund in my mind routinely speaks to the benefit of many as is public health. And so it's both endorses requests in front of the support in this space and the emergency preparedness is a great example where I can imagine for a second that that wouldn't be a general fund on the grid.

When we were Tri-County Health, what was the ongoing? Was it $6 million? Because it was a lot less than that, wasn't it? That they contributed to Tri-County for like $4 million.

Yeah, so they knew going in.

ABC has a question. Does ABC have the ability or the kind of fishers out the ability to line out and strike things? So to Bibi's question. Yes. They've made a bill like K6 million was nice startup money, but maybe this year's like 5 million. Now the contribution, do they have that kind of flexibility?

I mean, yes, they control the budget, so they could do that. I think the flat funded portions are reasonably comfortable to assume they aren't going to touch that. They do get very creative with the packages. So just easy example, last year we requested $250,000 per clinic. They came back and said, we're going to be happy. So they do get creative that way, but I don't, in our history, they have not gone back into one of our current budgets and taking something that's ongoing funding.

There's really no downsides for us to request $3.5 million. No. Right? There's no downside because we want that. We want these things. Unless any of us are saying we don't want it. One of those priority items, right?

Yes. Yes. Yeah. Yeah.

And I can click through the last two pretty quick. Maybe. Are there any additional questions about the budget from Brianna? No. Or could we have to move a motion to adopt it? Okay. Okay. I'll move for the board and help to adopt a fiscal year twenty twenty seven.

But that's I think we have a it's just the pie charts. Oh, yeah, you're fine. Okay.

So, just different colors.

This is just detailing out the revenue. This does go into our total grants, breaking up federal, state, and others. This is where you'll see that we're just over 47% of our grant funds. I will say that our fees for service, which includes retail food, vital records, our nursing fees, et cetera, we've maintained at 10%, just slightly under. So that is at least a positive in my mind. Um, and then last 1 is expenses. So.

What are the thoughts you might go back to that slide? Right? There is supposed to be a call to the ritual. Food establishment, disability, restaurant, home fees increased in each of three years. This is the first year. This is the second year. Second year. So we'll see yet another bump.

Correct. And their percentage is on top of the increase. So it was a total of a 75% increase when you added that up. But when you actually do the compounding, it comes up to like 82%, I think we figured. Okay.

Okay. And just to remind the board, this is the budget committee is the only committee where we have an official board member on and board member who was very thorough of. Manages to the penny, so I feel very and him representing. Yeah, and so it's very different meeting. We're a part of the process to making of the process and he reviews everything and any issues. he's willing to speak up on behalf of the board. So thank you for your time. I literally just said that.

I just said that under my breath. We're so busy. I will have a vote on it.

I think I made a similar comment when we saw the preview of the budget two months ago.

was a jack of time. I mean, Brianna and her team, Tracy leadership, Jennifer, I mean, take great care, do share responsibility with the budget. And sometimes they have some nuanced questions and Brianna is very generous to take me a little bit deeper as need be. So I feel very confident with the team has developed and very confident in the budget. I don't know what the executive budget committee will do. Those are issues outside our hands. But I'm also optimistic in terms of how we're approaching the September meeting and trying to tell our public health story. So the budget is my full support.

Okay. So with that said, I move for the Florida Health to adopt a fiscal year 2027 budget as presented and direct the public health director to submit the proposed budget to the Arapahoe County Board of County Commissioners. Can I get a second? Any opposed, say nay. Hearing none, motion passed. We're now going to move into our study session. The first study session item is the annual CHIP presentation and Heather, Alexa and Grace will present the CHIP.

This doesn't require any of folks. We might have those. So feel free to let me know if we could put it into or follow up a different way. I did want to start off by saying thank you so much to the board members. I know you've heard us say this before, but it is absolutely genuine that I don't think any of us have experienced as active and supportive of the board. And we see it. We see you in the committees and bringing ideas and inspiration to us all the time. So it means a lot to us. So thank you. So today we're excited to share some highlights as well as updates on that we've been hard at work engineering to ensure that the CHIP is highly relevant and reflective of current needs, capacity, and the opportunities. As you know, we're about a year and a half into our first CHIP as an agency. A personal reflection. So when Colorado began doing these CHIPs, the LPHS, over 15 years ago, There was a fair amount of stability in terms of the objectives. With some modest changes, they could be pretty durable over a few years. You also know that in the last year and a half, we have been living in a very dynamic environment, not only for ourselves, but for our partner organizations. And so that really did necessitate us taking a fresh and in-depth look at what we had developed over a year and a half ago to just really make sure that it's meeting the needs of residents as best we can so in addition to the successes we'll walk through new objectives continuing objectives completed objectives and those that have been refined or sunsetted for one reason or another um i would like those slides oh yes thank you i'm in charge of those um

I thought this was all going to be in your head.

A big shout out to the health planning team, all of our subject matter experts and implementers, who we call CHIPplementers. And also members of the leadership team. Everyone played important roles in making sure that this work was reflected some guiding principles that Alexa will speak a little bit more about in a moment. An additional important consideration for the refresh was continuing to improve our practices when it comes to communicating in plain language. The book is really excellent at always driving us to do better in that area. So wanting to challenge ourselves to represent this work and communicate it transparently with less jargon, fewer unnecessary words, and even simplified graphics. So I'm going to pass it over to Alexa. So let's start with our new visual. To make the CHIP more responsive and simpler, we have updated our CHIP graphic, which highlights our two priorities, economic well-being and safety, and then brings in some examples of social determinants of health that public health can impact in order to move the needle within these two areas. So economic well-being and safety. Next slide. I'm going to move through these kind of quickly because we have a lot of good stuff to share. So as a reminder, these two CHIP priorities rose to the top as we looked at current data and listened to community members during our community health assessment. And what that looks like in action is that CHIP priorities, the objectives that are in the CHIP priorities need to be relevant, collaborative, data-driven, and like Heather said, flexible to emerging needs. which is why when we sat down with all of the CHIPL mentors, we came out with much more attuned set of objectives that we're really excited to bring to you all and move forward with. And then next slide. The last dot to connect is while public health, us right now, we don't currently give people money or like physically keep them safe, we do address social determinants of health that help them live that safe and flourishing life. So when someone's basic needs aren't met, they are less likely to live healthy and to be able to participate in the workforce, creating a potential cycle of financial instability. And similarly, when people are unsafe or proceed to be unsafe in their communities or engage on unsafe behaviors, they will face those barriers to keep them from living their life. Our work is often going to be, you know, looking at those social determinants of health instead of maybe directly impacting somebody's economic well-being or physical, emotional well-being. You know, impact safety, it's going to be all of those other things that can influence that. So, moving on to another topic. A few successes that we wanted to highlight, and I know you've been seeing information about some of these in the director's reports every month as we go along, but we have some fresh information. So to strengthen our capacity for injury and violence prevention,

The ICH team in Family Health Nursing applied for and was selected as the sole national recipient of the capacity building grant through the Safe States Alliance. Really proud of that.

So as part of that opportunity, we had about six months of an assessment phase where we were engaging with a team of experts from across the nation, kind of an ongoing interview process to assess our capacity, our infrastructure, and our partnerships and come up with a set of recommendations. And that site visit just occurred in the past couple of weeks. So building on that, we will be creating a plan, as you've seen, requesting financial support for that as well, and tapping into their technical expertise over the next year as well. I'll also mention that a lot of work that we're excited about and proud of in the older adult space. Melissa held several community listening sessions with older adults, including on the Eastern Plains. And then also along with several partners, including CSU Extension, offered a 10-session aging mastery program in Byers, where there was a lot of sharing of wisdom, gaining of tools and skills, And we were thrilled to hear that there's even an alumni group that decided to keep meeting those participants even without our involvement, which is exactly what we would love to see.

And are those materials that we continue to make available through our website or otherwise?

The aging mastery?

Correct.

You know, the national group that made this available is actually sunsetting the program. This was the last year I'm sure you could speak about it much better than I can. We are, as we are working with CSU Extension, they would be taking the lead on developing something similar that could kind of take its place.

That's yeah. building a program that they're calling Longevity Lab. And I can't remember what lab stands for. It's an acronym, but it's basically aging mastery, but it's more Colorado centric. And so that is like a proprietary program that is leaving, but we will have something new, I think in the next 12 months.

Thank you.

And you're familiar now with our Family Connects program. And one element of that was kind of an offshoot where folks who are participants can join up in person and through virtual meetups, also through WhatsApp, connect, learn, and access resources, like participating in sing-alongs even, and presentations on transportation access. All of here together. The program is co-designed and is even co-facilitated in Spanish by an alum of the program. I know you're familiar with the work that we've been doing. This was an intensive effort in partnership with the City of Aurora and Aurora Public Schools and Adams County Health Department, along with Aurora Partners for Thriving Youth to work on ordinance passage for tobacco retail licensing to curb youth vaping. The City of Aurora really sees that as part of their safety focused efforts. And we're still involved in that effort helping them look at ways to evaluate and track the outcomes and support enforcement, even though we won't be doing enforcement directly. Laura and Brooke and others, along with 13 entities, so metro area local public health agencies and hospitals partnered together last fall on a coordinated six-year fire and storage campaign. So you probably saw some of the social media, et cetera, related to that. We were thrilled to be able to do that together to really leverage dollars and get some better saturation of the messaging. And on an ongoing basis, this is something we've done for several years, and sometimes we've been, I think, even one of the only financial supporters of this, and we're able to do it through our tobacco control grant, is supporting safe zones. events throughout the summer that are hosted by Compound for Compassion, a nonprofit, creating a safe space for youth to come together and connect. A couple of the highlights we wanted to share related specifically to economic well-being, although as you can see, there's just so much crossover with all these, it's almost hard to categorize them. Over 137 visits to postpartum families were provided through Family Connects during this reporting period. As you know, they include home safety assessments, screening for perinatal mood disorders, substance use, intimate partner violence, really robust wraparound set of services along with referral to resources. And resources to launch Family Connects was also increased by $112,000 thanks to our ongoing partnership with Colorado Access. So very grateful for having that ongoing partnership where we're looking at similar goals and seeing how we can leverage our resources. One other partnership we wanted to mention related to the RAE was intentional efforts to provide clear, consistent messaging on upcoming changes to Medicaid. So having conversations to say, okay, what's your best source and framing and tactics for sharing this information? And let's make sure it's aligned, including with state messaging. And really impressive results related to the promotion of the Family Affordability Tax Credit by the MCH team. So really 45,000 families benefited. This is something that we are able to work on through our Title V Block Grant and really hope to keep growing that. And through our hunger relief efforts, this is going to be an effort that actually continues to grow, but three of the emergency food providers improved the quality of their food and beverages distributed in Englewood, Littleton, and Sheridan through supportive practices through the coalition to revise policies, so trainings, samples being provided.

So a question on the 44,000, what does it mean they were credited back? So with their tax return or how did that work? Decredited back to $126 million.

Yeah, that's assistance on tax return.

Oh, assistance on tax return. Okay.

That makes sense. To your question, is that too many documents in the pocket? Yeah, thank you.

A lot of folks not knowing that they can access those and how to go about it, untapped opportunity. Over $42,000 in RTD bus tickets were distributed to residents through a partnership that we had with Arapahoe County's Department of Human Services and Community Resources. And just between January and June, 4,500 vaccines were administered during over 1,500 client encounters, majority uninsured and Medicaid clients. I was very excited about that effort. Obviously, far more throughout the entire year. And you probably were just talking about the resource hub, which is something that, as you know, we've been looking to give referrals to trusted sources. there can really be, I guess, a lack of trust building and follow through if those resources aren't vetted. And you can really trust that folks are going to get what they had planned to when you send them there. And so this is a system started through the MCH team where we have folks throughout the agency who are helping that trusted resources on a regular cadence. So we can be very confident when we are sharing this with our clients that something good will indeed come out of it. And also excited that folks like Doctors Care and City of Aurora and Community Resources are joining us.

It's really impressive. The most impressive resource I've seen in a long time.

Thank you.

And increased resources for Baby Cafe, which Jill can speak to much better than I, but really we're hoping to continue to increase this because we've just gotten such great feedback and boosting participation. So you'll be hearing more about that in the future. And we have been able to leverage a new grant through CDPHE supporting chronic disease prevention that through a very robust community engagement process throughout the past six months, we are going to be able to invest more resources and FTE in food access and distribution and community clinical linkages related to chronic disease.

And last successes slide we'll share.

As you know, we are, we love being in the community and we are doing it a lot. And if we're, even if we're talking simply about community engagement events, it's a very large number. And there's also this carve out a very intentional engagements that raise cultivates to make sure that we are holding these up against what we've committed to in the CHIP in terms of priority populations, priority geographical areas. And these are a couple of those events that she made sure that we were coordinating across the agency so that we were staffing them according to their interests and also what we're promoting through the CHIP.

That Soccer City event was incredibly impactful for MKV families.

It's amazing to hear. Sure.

Michelle, I'm sorry, repeat that for me.

The Soccer City event for McKinney-Vento families, families experiencing homelessness, was incredibly enriching for many of our families, and it made them feel perfect.

I was going to ask this question during the director's update, but I'll ask it here, too. When I see these opportunities, for example, like there's this Lowry coming up here next week, I plan to go. to that. I think we've had a little bit of conversation about this in the past. I don't want to take care of the board members, but if we can contribute in that space, if there's value shown up, I don't want to create work. If we can add value in that space or help build out some of those community networks, do we need to know what those are or if they're supported in that space and Yeah, the soccer event you mentioned, Michelle, it sounds pretty cool. Again, I'm going to go to the Lauer event. I don't think I'm going to the official cast yet and decide on that. But I think wherever we can add values, the board members, that would be fantastic. Let's go with the processes for how they're calendared or what have you.

Sure. Anytime you hear about something that you feel like maybe could be a fit, reach out directly to Grace, and we can definitely get you hooked up. And she can always answer questions too about the events that are coming up.

My question is actually different. My comment is different. It's not like, hey, this is coming up and I've seen it. I've seen that invitation in the director's report from Grace, which is awesome. I'm thinking more of how we become aware of things. I'm going to go to the Lowry event next week. And I missed it last year because it was only 10 days out. And when I saw it in the director's report, I could not make it. My intent is to go this year. My question is, is there a calendar or

that Arapahoe County Public Health maintains where you can, maybe the board, again, I'm going to try to create a word for my, I think that would be a better question for Hannah and Jennifer, meaning, yeah, because they communicate more so with the board if they could send out something to us.

I wasn't thinking necessarily just in terms of the chip, I think that highlighted that opportunity for the board.

Yeah, good question. We do have a very detailed spreadsheet where those things get tracked and lived. but it might be a matter of which you probably wouldn't want to access to. I'm not sure how often we even know about things far in advance. Even things that are annual often aren't the date or the location isn't finalized until about a month or two out. But do you want to comment? It's on Teams.

So I don't know about adding an external person. We can look into it, but I do have a calendar.

And usually every month I include the past events I attended in the past month, as well as the future events I'm attending in the coming month, up until the next Board of Health meeting. And I do have things out through February right now. So we have a lot of things in September. We're going to Bennett Days, a Food Justice Festival.

It should be in the Director's Report. So if you see something that interests you and it's coming up, send me an email. Okay.

We can come up. I mean, Hannah and I keep in the calendar of all of the agenda items. I think we've had a call and then worked with Grace of looking at the things that we know for sure every year that we're going to. But I think we can be more intentional about making sure you have when we have advance notice and we think it would be very powerful or it'd be great to have board representation.

We'll be more intentional about too hard to just like a monthly similar to how we sent out for the meetings that these are the events we weren't communicating with you monthly.

So it's all it is is 1 more conversation with grace to say, hey, what have you got going on? Yep. That seems like a good 1 for the board. We got this. So, I think we can do that without adding you to teams because it'd be that'd be too complicated.

Yeah. Yeah. I mean, if that's easy enough, I like the idea of, like, an attachment or things. I'm about to go and just think about where we can influence possibly just like, for example, I can mention a food justice. I was talking to the Denver City Council. Hey, do they about food deserts in Denver? And I'm like. What can I do in my office with Denver space? Very little. Basically to Denver, but if there's something we could do as a board to support the really important work. Of you all that that's kind of where I'm coming from. So there's a simple way.

And there may be an event that month that seems relevant, but when, like, monthly, we can connect to say, these are all the things that we know of right now where public health will be tabling an event. And. but you all know when and where, and if you are able to pop in, we'd love having you join us at the table.

Do you want an RSVP scene or comment?

Yes.

I was going to suggest that you have that, because we didn't surprise you.

May I make a couple of, one is a very minor word thing. On your first slide, you talked about the social determinants of health. A lot of people are changing from the word determinant to drivers of health. And I think it's an important perspective because determinants means you can't change. It's determined. A driver you can work with and evolve. The second question is in our development and maintenance of our community health plan, do we subordinate with the other community health plans that are made by providers of care, the AAA, and other activities that are also doing community health plans. And does working with them give us an opportunity to develop partnerships, perhaps working with others who work on things that are common within our clinical community health plans.

Definitely. That sometimes looks different from year to year, but the past two years, I want to say, we've had a really strong group of the health planners and other members of health planning teams meeting in the metro area, meeting together with the lead planners for the hospitals who are doing that similar required work. And so they have a crosswalk of where we have similar priorities and then also work to gather detail on an ongoing basis of what that work looks like and then figure out, okay, so can we actually collaborate on something? So like the firearm and actually just this week, the group is going to be submitting a grant to work collaboratively on some social connections work. Another area where we know there's such a need and there's really a dearth of grant funding out there or the entities that have grants, the number of applications just far outpaces what they can. So one that we hope will be successful. We could see if potentially, I don't know if we have to bring the idea to the group to see if they'd be comfortable with us sharing kind of a crosswalk of the different entities It's all public information. So maybe that could be, might be interesting for you to see. And then I was just going to mention the engagement of youth is something that we know needs to be done with great intention. And we've wanted to onboard ourselves to that really strong way. And so, you know, this has been the first year we've had a youth advisory board. We've also started recruiting youth and engaging them in multiple areas of the ship, including some of our community education, tabling events, that type of thing. So that's been fun to grow.

So I will, Sean, as a chair, this is, we're about halfway through the presentation.

I'm noticing time. So I do want to be respectful of time and staff. I mean, a lot of work has gone into this, but work, I mean, we've been doing this work, so it doesn't change between now and next month and there's nothing to vote on, but What is your preference? Would you like us to power through, go through, go over time, or hold the second half and come back next month?

I would say hold the second half and come back next month because it's good information.

Because we're moving into some of the new work that we're doing, so I really want to give time for the staff to elaborate on what's new, what's sunsetted, and why. Okay.

All right, we'll come back here.

Wait, I'm just a clarification for your youth.

What age does youth go up to?

Our youth advisory board, and those are paid staff members, you know, low number of hours throughout the year, certainly, but 16, 16 and up. I'm going to forget the The cut off, I want to say 21.

Okay, so we'll pick up.

At the new objectives in September, I will. Move some things around and we will get you all in and September and we'll put it closer to the. Thank you. I appreciate your flexibility.

Yeah.

No one will follow you.

Make sure it works.

Okay. So I just wanted a lot of what I was going to mention Heather did talk about. One of the highlights I wanted to bring up was the visit that we had from Safe States. Yeah. They only select one site, but we were, we are the first local public health agency that safe, safe stakes alliances. They've worked with state health and they worked with hospitals and we're also the first agency that they've worked with that doesn't have a dedicated injury balance prevention program. They work with existing programs and staff. So this was a new experience for them. It was certainly new for us, but it was very, So the team worked for four months in advance of the week-long site visit. Lots of interviews, lots of meetings. I think I attended three or four of the interviews and then was there for the week-long site visit. It was incredible, truly, truly incredible. The report is still in draft form. We have 20 days. I think that 20 days is almost up. It'll be probably next week. And then once that's finalized, we'll be able to share with you what the report is. So it's based on four principles. They'll have their recommendations for us. And then from that, we will convene as an internal team to develop a plan and start figuring out what we can do without funding, what funding this will help us leverage funding. And we can also use it. I mean, these are best practice recommendations, but it was really a trip. It was an incredible visit and their observations were wonderful. And we'll share that with you when we get it.

So do you think, or did they say explicitly that they opted to do this with us because they want to build capacity and be a future grantor or be able to translate what they think we're capable of doing if,

the county commissioners would fund some of this do you know that's unusual to come where they're that you don't have that department i know you think there was a motive there yeah besides being x don't know i mean i think they were very open to seeing you know they knew we were very transparent so should we that is our work in this area and so my impression was they just wanted to like I think that's better. Like, I mean, we're a new health department. We don't have a program. We put in a great application. Like, I think all of the things that it was a new area for them to work in. So I think they might also be trying to dip their toe into working with, you know, it was, it was learning on both sides, but what a, what an amazing, I hope you guys have soaked that in, right.

To like, to be selected without that separate department. in a three-year-old LPHA. I mean, you know what I mean? Like, that's amazing. That's a big deal.

And I also wanted to highlight, so it was incredible. And there were a lot of opportunities within that report that support our budget ask. And some of the things in that report, they were very intentional about what they put in their report as recommendations because they know the direction that we are trying to go in. I believe it may be talked about, but in the report, and I may have mentioned in other meetings, we are, we've participated in a pilot. We are one of nine local public health agencies around the state to participate in overdose fatality prevention review planning and to look at what that might look like. And we are moving into implementation. We have received word that we will get funded from the state health department, partial funding. It doesn't near cover the total cost. They have not yet received their notice of award from CDC. So we have the intent to be funded. We don't have the funding, but we believe in our public health minds and our hearts and our passion that this is something that will make a difference. So we are moving forward. Alicia, who I think you all know, will be our coordinator for overdose fatality prevention review. So that will really kick off September when the pilot ends at the end of this month. So we're moving forward with that. Really excited about it. It's going to be hard work getting it off the ground. And there's a lot of logistics that still have to be worked out. because it is a wicked problem and it's huge and it spans every demographic. So working through that will be incredible. And I appreciate Penny is executive sponsor. Melissa is taking a tremendous leadership role in this working with Alicia to get this going.

I have a question. You just said, but it's not going to fully fund it.

No.

So who's going to, it's part of our, Are harm reduction capacity asked? Because if you don't get that asked, get partial funding, you're kind of in a difficult position.

We will. So that's why it's one of our priority asks is to move her into general fund. And this came out. The notice of award, it probably it's likely to happen. And I was looking at other funding. And then we'll be bringing to you scenarios of what the what ifs. That's next. Yeah. Yeah. One last thing, because hopefully it's on the news tonight. One of our employees in emergency. No, it's a good thing.

One of our emergency preparedness and response professionals, she's a liaison officer in her role here.

As part of training, she was invited to respond to the Golden Mountain Fire as a trainee for one of the teams. So she went down. She responded. She was at response for two weeks, slept in a tent, worked 16-hour days for two straight weeks, sleeping in a tent. But she did the lunch and learn today. It was fascinating. She learned a ton. So now she can serve as a liaison officer in other responses. But the news... I had three or four stations show up and film it, do interviews with her. So there will hopefully be a story. Um, and there were other, other employees from the county and other counties that responded, but we pitched the story and Serena will be highlighted. So I just wanted to let you know, hopefully be on the news tonight.

And I would just say, uh, before I close the meeting, um,

similar to echo jennifer's responses thank you heather alexa and grace all of the work and everybody who worked on the chip but we were a huge part of the planning and to see it in implementation in the programs highlighting the community and really putting a focus on that is very impressive so thank you as far as the evidence with that the meeting is adjourned

Thank you.