Arapahoe County Board of Health - Regular Meeting

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

Director B. B. Kleinman.

Excused, and absent and and excused.

Director Sean Davis.

Present.

Director Christine Burrows. Present. Director Mark Botin.

Here.

Director Mike McMullen.

Here.

Director Mike McMullen.

Here.

Director Michelle Weinbach.

I'm here.

I would now like to ask the directors in the room to introduce the staff today.

Extremely introduce Sandy Nadler with extensive experience security, and she is going to be onboarding

Cool, Dan. It's it's near and dear

to all. So

excited to finally introduce Steve.

I'm Steve.

Steve. Yeah. You you will get to know him soon. Additionally, Derek Arrington, our emergency preparedness response manager, along with Melissa, our communicable disease epidemiology

That's meant to be a frequent flyer. The

next item is to approve the November meeting minutes. As for a move for the board of health on the November 2025 meeting minutes as presented. Is there a second? Public health leaders carry back all of the time responsibility. Their decisions quietly shape whether families have safe food and water, whether outbreaks are contained, whether parents can assess support for their children, and whether communities facing the heaviest burdens of illness are finally seen and prioritized in times of crisis.

In times of crisis and in fiery seasons, the quality of leadership in public health is felt in very real, very human ways. For more than a century, public health bankers have reminded us that this work is inseparable from justice and the conditions of people's lives. Rudolf Virchow, often called a founder of social medicine, famously wrote that medicine is a social science and politics is nothing else but medicine on a larger scale. His insights still guides us. Public health leaders are not just managing programs.

They are navigating policy, power, and resources in ways that can either reinforce inequities or begin to repair it. The late global health leader, Paul Farmer, pushed this further asking, if access to health care is considered a human right, who is considered human enough to have that right? Leadership in public health in Arapahoe County then is about insisting that every life in Arapahoe County is human enough. Residents who may not trust institutions at all. It asks a leader to translate big ideas like health equity, social determinants, and community voice into daily practices that staff can see and communities can feel.

This evaluation is grounded in that understanding. It reflects the board's collective assessment that Jennifer Ludwig is not only meeting the technical requirements of her public health needs now more than ever. The full board of health of Arapahoe County Department affirms in the strongest terms, the exceptional leadership that Jennifer Ludwig has brought to Arapahoe County Public Health this year. This has not been an easy season for public health federal executive orders, funding cuts, partner layoffs, and even a federal shutdown have all created uncertainty and strength. In the middle of all of that, Jennifer has a historically been left out, left behind, or left unheard.

As board member Christine Burroughs notes, Arapahoe County Public Health is lucky to have Jennifer at the helm. Board member Terrence Walker adds, as a public health leader, I truly believe she is second to none. She brings a thoughtful, strategic approach to every challenge and consistently demonstrate a strong commitment to the residents of Arapahoe County. Board member Michelle Weinbach affirms that Jennifer has provided a clear and compelling vision that guides the organization through change and uncertainty while maintaining a strong focus on long term community well-being. Board member Mark McMillan echoes this confidence observing that Jennifer has done a strong job in leading Arapahoe County Public Health since its creation and that Arapahoe County Public Health is now viewed as a strong and well respected model for other local agencies.

And I'm gonna let my other colleagues finish giving some comments on the passage to Mark Levine.

Taken together, these are not just compliments. They are a collective expression of deep trust. Board of care, Sean Davis, notes that Jennifer has carried this.

Mhmm. To equity.

In terms of leadership and vision, across our essential job functions, Jennifer has demonstrated a rare combination of strategic thinking and day to day reliability that is felt by staff, community partners, and the board. She is, in the words of Christine Burrows, futuristic and innovative in identifying new strategies to support the community. And she seems to have a handle on where to take the organization as Mark McMillan also notes. Michelle Weinraub highlights Jennifer's ability to balance strategic innovation with grounded operational oversight, accelerating progress across all core public health functions. Terrence Walker underscores that underscores that what stands out the most to me is her leadership.

She is a calm and steady leader, especially given the many challenges she faces. In moments when other leaders might react out of fear or fatigue, Jennifer responds with clarity, compassion, and a long view. She has built and grown a staff of thoughtful, competent people who are empowered to contribute to developing and accomplishing the department's goals with both confidence and compassion. As board member Mark Levine observed, she is a remarkable leader as evidenced by the stability and dedication of the staff. Christine?

On operations and staff development, Jennifer has done the unglamorous but essential work of building a stable, healthy foundation for our workforce. The department now carries dozens of complex public health function, and as I point out, the department has dozens of functions, and and Jennifer manages them with That ease is not about be things being easy. It's about Jennifer's ability to bring calm order and direction into very complex work. She has a strong high performing leadership team, and as I noted this is so funny to read. Jennifer has a strong leadership team and empowers her team to implement meaningful programming.

Terrence emphasized that she encourages collaboration among her team and allowed them to solve problems, present solutions, take credit, and ultimately grow. My two years on the board, I have spent no turnover on your on your leadership and engagement. As doctor Levine observes, the department operates with personnel working together without.

Jennifer is consistently person centered in how she interprets it. Christine captures this well. She is person centered and considers the needs of the team of her team and her community when making decisions. I add that her professionalism, compassion, and genuineness is unmatched, and that we are lucky to have her and blessed to work alongside her on this journey. These are strong worries from seasoned leaders, and they are earned.

Jennifer works hard to ensure that policies, schedules, and expectations reflect the realities of staff and residents. She has shown up in town halls, site visits, puddles, and one on one conversations, not just to deliver messages, but to listen deeply. Staff see and feel that their experiences matter. The listening that listening has translated into concrete changes, clear expectations, stronger communication, and more attention to the realities faced by frontline staff. Jennifer understands that if we want equitable outcomes in the community, we must first create an environment where our own staff is safe, supported, and seen.

The culture she's building is one where people can bring both their skills and their community to work. Michelle?

Yeah. I'm gonna read a

few things that I wrote because I think that's more representative of my voice. So I I under public health and community impact, I said that what underscores your leadership has called includes cultivating and strengthening bio partnerships with local government and private partners, schools, health providers, and community based organizations, ensuring services remain responsive to evolving needs. Over the past year, I noticed the manager and executive department had significant operational transitions, successfully stabilizing a new public health infrastructure, that's my feet, right, while launching initiatives that will have lasting positive impacts such as expanded maternal and child health outreach and enhanced emergency preparedness programs. These are not abstract achievements. They translate into parent parents.

They translate into partners who can access service I'm sure I think my autocomplete said parents. That's where I live. Into partners who can access services more easily to communities who are better prepared for emergencies and residents who fill their health department. And I also wanted to read, and this is on page seven under emphasize Jennifer emphasizes the deep commitment to health equity, and it's evident in how she intentionally elevates the voices and experiences of historically underrepresented communities, builds programs that reduce barriers to care, and actively integrates community input into decision making. Her work building equity focused community advisory relationships shows her understanding that public health is strongest when residents feel seen, earned, and valued.

You can see the theme throughout all of the society. That is the kind of leadership that changes not just programs, but power dynamics and trust. The last thing I'll share is that I observed that Jennifer's communication with the board is consistently timely, detailed, and focused on supporting informed governance, and that she readily welcomes feedback and incorporates board perspectives into strategic direction without losing sight of the York City.

Perfect. I'm gonna take it, Anthony. There were a couple highlights that changed out of the meeting. Jennifer, thank you for an outstanding year. It was a pleasure to have an opportunity to reflect, you know, in terms of time here.

There's a couple of things that we've said that I wanted to emphasize that, you know, your your leadership you're service. Clearly, you exemplify that. And it's reflected too in your amazing staff and the work that they they do. Other thing that I really love about leadership, but it's also, like, you help us understand the why. Not just the what, but the why and tying things back to the core public health services that I hope there any offers, you know, as I've been sharing.

I mean, so I thought I was bringing up earlier in the things we do admire. This is holistic work that they set out there, services that they provide me. And I have no doubt that this comes strong from your leadership. So thank you for an exceptional year. I'm not gonna read all the pieces. I wanna save some surprises in your Yeah. But I will say it's been a real honor to be be part of this, and thank you so much for your service.

And so thank you.

Mhmm. Yes. And that

was one of the we don't get to evaluate the staff just so you know, or we would have also we make very highly of the staff. Not only are y'all capable, but y'all are community oriented, and y'all really put an emphasis on really meeting the needs of all Arapahoe County residents. And so I tell everybody, when you look at how the organization is run, you might be a public health department. What I see is a high performing organization. So thank you from the boards, from the bottom of the board's heart

for the work y'all do. Could Josh show up quick? Okay.

But we have no general business items. We do have few study session. The first study session item is the fiscal year twenty five forty three financial report program. Hey. Alright.

I know. It's not your name. Sorry. It might not work.

Hold on just one second. Okay.

So while she's working on that, so we're gonna review the 2026 budget. We do have a quick update. The board of county commissioners passed the twenty sixth fiscal year budget on December 9, and there is minimal changes.

You should be good. Oh, Other way. The redirection. There you go.

Excellent. Alright. So the only change from the budget that was presented to the board of health to budget that was passed by the board of county commissioners was finalizing the total comp package. So if you remember in the last presentation that we still did not have our final total compensation numbers that was being recommended by human resources. In this budget, they came forward with a recommendation for a 1% across the board market adjustment for all staff and then a 3% merit pool for staff performance reviews.

So that compensation adjustments are are incorporated into this budget, as well as the approved packages from the EDC, which includes our the funding for the emergency preparedness manager position, funding for the healthy building specialist position, and then one time funding for both our sexual health and immunization clinics as well as the food security coalition director position, as well as the verbal request that was made during the EBC presentation for the county to cover the fully funded portion of the total comp package. So traditionally and historically, the county covers 30% of the total comp increase. It comes out to approximately $900,000, give or take. This year, that is what it came out to. The county would cover 30%.

We made the verbal request during that presentation for them to cover the full amount, and that is reflected in this budget as well. They approved that. Okay. Perfect. So in a year over year comparison, you'll see in the column for FY '26, that is the budget approved. And then in the differences, you'll really see that difference in public health funds total, so $1,800,000 increase. The majority of that is that one time funding for the total comp package. So we won't see that ongoing necessarily. However, it is a support for public health for next year. Alright.

Moving on to the quarterly financials. So this is our third quarter, financial review. We've collected just under 85 percent of our budgeted revenue. We would anticipate this. As you will remember, we collect our fees heavy in the year. We collect all of our county contributions early in the year, so we see a, front loaded bell curve on our revenue. So this does not concern me. We are spot on for where I'd expect us to be in the year. We have our reimbursable grant revenue and vital records revenue that will continue to come in at the same level each month through the end of the year. And then on the expense side, we're spot on.

You can't get much better than 7575% of the way through the year, so, that is excellent. Looking at this is just the detail of that previous slide. So you'll see, fees for service were at 94%. That's where you'll find our fees. And then under the county general fund, that's our county contribution line.

So, again, that's all been transferred into our fund, and that's what we'd expect to see. If you look at that one line, services and other were at a 105% of our budget. So as a department, we are budgeted enough funds. We're bottom line budgeted. Meaning, we don't have to meet our budget for each program within the system.

We have to meet our bottom line budget. So that's not concerning other than we are trying to accurately report. So what we do when we do our budgeting process is look at our actuals and then try to put our budget into that correct pot. So we will continue to get better each year at having the budget reflect where our expenses are actuals. And so then we wanted to do some updates on our grant funding.

So actually, our funding in general. If you remember during the special session over the summer, the legislature sent, we were dealing with a budget shortfall. The legislature sent one third of that budget shortfall back to the governor to reduce expenses. That was a total of approximately $250,000,000. One of the line items that the governor selected was the local planning and support dollars within CDPHE, and that took a $3,000,000 cut, 15%.

So they passed that directly onto locals as we expected, and that came out to approximately $226,000 for us. In the governor's 2627 budget that was released on November 1, that cut was continued. So we see that ongoing now. CALFO is engaged in advocacy to possibly restore this. However, with the state looking at a billion dollar shortfall again, I've not I don't think there's a lot of, anticipation that that is gonna be happening this year.

We received notification from our, CHAP, HIV funding, within the state that they are anticipating a 15 cut. What is so nice about this notice is that they actually gave it to us for our July renewal. So we've gotten more than six months' notice, which was greatly appreciated. The program at the state level has also been working with us closely, with all LPHAs closely, to help support in other ways. So if the program has extra funding, they're allowing you to roll it over within that year.

So that's it's just been a great relationship and very much appreciated. As you all are aware, uncertainty continues at the federal funding, so we monitor as closely as possible. We do have good news. Our STEP funding is getting an increase. This year for 2627, renewing in July, is an $88,000 increase and projected more in future years.

So that's excellent news. Additionally, we have multiple grant fund grant applications out for supporting our current ongoing programs as well as the chronic disease pilot within our community health program. That is a noncompetitive grant, and it starts in January for us. So that's an excellent new program that we're working on.

Go on. I just put the evidence. The tobacco funding, this is a double edged sword. So it's great news that we're getting funding, but this is tobacco tax. So the fact that tobacco tax is increasing to increase the product money means that more money or more is being purchased, and it could be vaping. So this is an area that, you know, we will it's great. We can expand our efforts, and and it helps us in, you know, in considering where we're losing funds. But at the same time, it means that more products are being purchased. So and then the chronic disease pilot is really exciting. It's broad.

It's a new framework that the state health department spent a lot of time doing stakeholder engagement events. We were heavily involved in in developing the framework or or adding feedback to the framework. So I'm really excited because this gives us great opportunity to really think about, again, what it is that we need in our community and how do we do that. So we've got this six months of planning and then anticipate another full twelve months of funding. So these are good, and, you know, it always means that there's need in our. And

then I can't do a presentation without these reps. I do wanna call out. I recognize I missed q two. We are presenting q three data. And I did wanna call out on the revenue side, if you add up the insurance, which includes all of our Medicaid billing, which is phenomenal, our fees for service and our grant revenue, we are making up 65% of our revenue. Historically, we were sitting at, 70%. So we are seeing that shrink begin to happen, and we're relying more heavily on account contribution.

Any questions? Question about the community service line in

the beginning. The yeah. I so what's this? Those are categories within the SAP system. K. And they're duplicative activity accounts within other lines. And what we're having happen is people will pick, like, food services even though we use that in our in one of

the other categories. Okay. So we're working on getting that taken out. So So it doesn't represent the reduction that No.

It does not. It's let's go back

to that. No. We

don't No.

I know. And then we are working

on that. Are you talking about this I or all the way back on the budget?

I think all the way back on the budget. Yeah.

Because the number's small.

Yeah. Because the number went from 55 to nine.

Yep. And so if you notice, we increased our supplies line.

Mhmm.

We are correcting it's that it's the correction. Okay. Putting it into the the correct account versus the random

I just wanted to make sure that the budget passed didn't Yeah. No. We did not. I figured we would be talking about it.

We did not raise. Okay. Cool. Cool. Cool. Cool.

Any other questions? Thank you. Our second study session was Yeah.

Go on. I know we talked a little bit off offline. Just, folks may recall the board and the think may remember this discussion on the revenue we voted about that that provision. It's a really good conversation with Marilyn and Jennifer, since that vote. And you do a really nice job of explaining, like, how that process can work. And I wonder, not to put you on the spot for the full board if they could they could hear that in terms of, you know, how that'll work. I think there's some really great questions, right, in terms of, like, how how it'd work at the end of the day. So even a sixty second flyover, guess, the the board in the same same space. Do you want me to Sure. So

this is if you recall last month, we I asked you or put forward a a vote to be able to use the resorner funds in the event that there was another shutdown or we need us to do that, and it was preempting something that we might need to use quickly because of the timing of that meeting versus this meeting and wanting to, you know, make sure that in a formal setting, we voted on it. We did it. Right? We did it. Yeah. It was recorded. It was messy. I will own that. And it by the time we brought it forward, the shutdown had ended. We knew we didn't need it.

We knew we would be funded for breakthrough the end of next the end of the fiscal year. And in hindsight, you know, maybe we should have thought to pull it, or we could have presented it differently. I think in the future, four processes. First, our process would be talking with Mark before bringing it to the full board, making sure if we had to go into an emergency session, that might have been a better way of doing it, focusing it, going into an emergency session. But in the future, we would bring it in the time that we would need it.

So it would be probably likely going into an executive session because we would be talking about personnel, then coming out of executive session making a having discussion so that it is public, taking a formal vote at that time as opposed to the way that we went out of this time. Trying to be transparent and open, and it just came out really clunky. So And it was a good lesson learned. Again, all things that we haven't known that we would need to do and working through. So I appreciate the conversation, the grace.

And if, fingers crossed, we don't have to do that next in this coming year, likely, it very well could happen. And so lesson learned, we will we will follow the process of doing it all in one meeting, so the executive session and the vote. Because we could have done that, and we just ran into. Better process, I said

And no blame for that at all. I just wanna make sure the court heard things. But we could come up on that again. I would think, for example, like, continuing resolution of congress, the CR doesn't pass in January. New York could be we could just we could be weeks out from that kind of scenario. So appreciate the explanation. Thank you. Thank you, Sean. Thank you.

Thank you.

So the second study session item is the OWTS regulation adoption primary timeline presentation by a new member. Steve is going to.

Okay. See if you can go do you have the clicker? Okay. See if you can skip. You're on the right line.

There we go.

Alright. So this briefing is to provide you an early overview of the required 2026 update to our local on-site wastewater treatment system regulations. CDPHE wrapped up their revised early revisions last year for regulation 43, which is the state on-site wastewater treatment regulations. And from that, it kicks off a process for all the counties to then adopt their local regulations that either meet or exceed those standards that are set. So today is just an introduction.

You'll see the full draft at the February study session where you'll have to see me again and then followed by a formal adoption hearing in March. So these regulations are grounded in the OWTS Act through CRS twenty five ten one zero one, and that requires every local board of health to adopt OWTS regulations that are at least stringent as stringent as regulation 43. That is that statutory alignment is not optional. It's something that we have to do. And then the purpose of these regulations is to protect groundwater, prevent contamination, and ensure a consistent and safe and and safe wastewater treatment in areas that are served by central sewer.

So as I mentioned, CDPHE wrapped up their revisions last year, and they were adopted June 15. Then every county must adopt trinket regulations within one year of that date, and so we have to adopt ours by 06/15/2026. So we'll be ahead of the game if we're able to get them adopted in March. Using our local regulation or updating I'm sorry. Updating our local regulation isn't discretionary.

It's if we don't adopt a regulation that meets or exceeds regulation 43, like CPH is statutory. It's already under that CRS to assume as force management permitting responsibilities, something that we don't really want for the future. So there are a few major areas where regulation 43 was revised and where we are then required to update our local rule. The state made some extensive updates to definitions, site and soil evaluation standards, setback tables, design standards for tank and distribution systems, and then criteria for advanced treatment systems as well. They also revised the variance section to narrow the type of variances that can be granted.

If you recall earlier this year, we brought up a variance case to to the board. Again, our local regulation must incorporate all these changes directly. None of them none of the items that were revised in regulation 43 could be admitted omitted or we can look at it. And this slide separates what we do locally already from previous opt ins and what we propose to add. So we already operate licensing programs for contractors, installers, cleaners.

We require transfer of title inspections, operate our use permit inspection program, and then maintain local variance procedures. These are all more protective than state minimums, and we propose to continue those. We're also proposing several new local opt ins under regular four regulation 43 that are allowed. These help to improve clarity aligned with current practice and industry standards, but are also addressing some reoccurring challenges that we're seeing operationally in the field. So one of these items would be, like, allowing administrative reduction in property line setbacks.

That's something that we wouldn't then have to bring to the board and something that we can do administratively and leave some of the tougher decisions for for the board around enforcement hearings. They would also clarify bedroom count expectations and rooms would require effluent filters and alarms. It's also prohibiting pit privies, which is your standard outhouse on top of a pit, and slit trenches, which we just don't see in Arapahoe County, something we see over the months. So these additions help to strengthen enforceability and then also reduce ambiguity in the permitting process. We do plan to have a a really strong stakeholder process just because these regulations affect homeowners, contractors, engineers, realtors, county departments that we work with here.

So a strong outreach plan is going to be essential, and that's something that that we are in process of right now. So the draft regulations were posted to our website on December 2. Those are all open for the public to see. And then the formal comment period will run from January 5 through February 4, and we'll host two stakeholder meetings for that. One will be in person here, and then another one will be virtual.

Once we publish the draft regulation, we'll have an opt in summary and then a one page fact sheets and online push notifications through our through email and through social media, so we're gonna con. And this outreach that we're doing here mirrors what other counties have already done. So Adams County has revised and adopted their revisions to the on-site wastewater treatment regulations, and we're doing something similar to what we did too since we we share professionals that cross those valley county lines, so that'll be familiar for them. So your responsibility for the board of health, these are all statutory responsibilities regard related to the program. So you must hold a public hearing, review and consider public comments, and then adopt OWTS regulations.

And, again, these responsibilities come directly from the act, and, unfortunately, you can't delegate those. February 18 is a study session where we'll walk through the draft regulation in more detail, and then they provide you with an update from our stakeholder sessions that you can consider. And then the March 18 hearing is when adoption would occur. And with that, I will open it for questions.

Steve, do you know the hours yet? Do you have public meetings?

Yeah. I give me a second. I can get those for you.

I don't have them pull up right now.

No worries. I'll get you. I I may I may sit in just a little bit in that space. I see too that you're gonna they report out sort of the summary of what you hear. So they may not need to, but I have failed to be in the.

Sure. Absolutely. Thank you.

Yeah. I'll I'll get back to you, Mark. I'm sorry.

No. No rush. No. Thank you.

Are you this you must have been.

No. Okay. But well, you're gonna always be surprised. A lot a lot of what we're doing is there's a lot of cleanup in our local regulations. I do anticipate comments around regulation 43, but we can't we can't change any of that. But there were some some significant changes in there. If there was anything that was gonna be more contentious, it would probably around the requirement for alarms on septic tanks and filters for septic tanks. But other than that, I don't think we're we're doing anything that's way out of the norm.

Steve, on one of your slides, the question prompted some I mean, one of the slides about the opt in, is there, like, a menu of what the candidates can select, or is that so how do you how do identify it?

Yeah. I wish it

was money. That'd be a lot easier, but it's it's written within the language of the regulation. So it will say counties may blah blah blah. And that's where we get our our our notice that we can decide either way how how we wanna move that that regulatory piece.

Thank you. Additional comment? Thank you, Steve. Thank you. Thank you. You. And we're going to move into our third study session, which is a presentation on the Arapahoe County Public Health legislative policy engaged by Jenny.

Alright. Thank you. So Brianna and I are gonna tag team this. We anticipate a robust legislative session and wanted to share just with you in advance so that, as you know, it's kind of piggybacking on see in advance kind of getting your heads up on what's coming. Next year is a heavy engagement with the Board of Health, so our agendas will look different than they may have this year.

There's a lot of environmental health with adoption of fees, the regulations, and then I anticipate part of the nation being really busy. In the past couple of years, we've reported out in the director's report that activities or the bills that we're watching. We really matured in our organization around legislation and become more advanced. And so I the recording will hopefully, that will be. It'll also help us identify early in the process where there might be engagement from the board of health, where we might need letters, maybe testimony, we can them in.

So we're trying to get that kind of it. Although a lot of it is just Yeah. So we just wanted to share I mean, this is the we wanted to share with you structure and policy in general. Next slide.

Sorry. Hold on.

Okay. Okay. Go ahead. Okay. So we've covered just the role of polytomic policy, what we are doing.

We're going to talk about the tracking and the role, and reporting, and then just a few bills that we anticipate. Next slide. So we do play an active role in policy both at the municipal and at the state level, and in some cases with federal partners. We're active with our federal WIC programs, advocating, signing letters a lot recently with family planning at the federal level, whether we're monitoring, watching, we're on work groups. There's several of us who are heavily involved with NACCHO and work groups and policy with NACCHO.

So really keep keep tabs on that, but we, you know, we work at all levels of policy. Our focus, public health focus, is on education. And, you know, we don't lobby. We educate, and we do provide training. We do want staff to know what they can do on their off time and what they can do as an employee.

Because what they can do as an employee varies on how they're funded and what what it is that they're doing. So we do provide training every year and then also, you know, covering what county allows. And we do want we do want our employees to be engaged at other levels and just making sure that they they are aware of what they can do. February so we do our monthly for full town halls. Our February will be a review of legislation and advocacy.

And Monica and Taylor Roberts who under Heather's division will be providing that presentation. So we did this this year, and I think we'll do a refresh next year. But I think it's really helpful to staff. Next slide. So some of the our roles and active participation, and this is just a few.

I mean, we do have there's a a lot, but Brianna will talk briefly about the her role on the Calvo policy group. The board of commissioners, I meet and this was where it was I had a pretty big learning curve in my first year of engaging with the commissioners because we had not this was not a role that we took at Tri County, but I learned very quickly. There's a we I spent significant amount of time doing this during the legislative session. We have an internal team that meets every Friday, and it's my peers at community resources, public works, human services, the commissioner's office, our lobbyists, and I think that's we meet every Friday to talk about bills that we're gonna take to the commissioners that next Tuesday that we that there may be a position that we want them to take. And so there's a lot of work that happens between that Friday and Tuesday, but it's every single week for the whole session.

So I have a lot of face to face time, and I think it is has been really good. We've added we are we respond as our big P policy group, which is Arapahoe County Public Health. Big fancy name, big P policy. Mhmm. Because we couldn't come up with anything else, and then it stuck.

But this is where we really advanced in which we're as a a working group. This group meets every other week or as needed to talk about bills that were specific to us that may have been flagged by the commissioner's office through the policy analyst or something that we're watching. And we want the commissioners to take a position. And so we will trigger something, but we we will talk internally. There's a lot of looking at Steve because a lot of this usually falls on Steve's shoulders.

Because so many environmental health, whether it's air or whatever it might be, Dylan Garrison is now a member, and he's gonna be very, very involved this next year, and you'll see why we can get to the end. So the team will meet. We'll talk about bills. We're analyzing, you know, determining the impact that it would have because that's what the commissioners want to know is what is the impact that this bill will have on our operations. Fiscally, it has to be good, bad, and so we do have to quickly do a lot of analysis.

So we'll be tracking all of that. And then other work that we do might be national advocacy. There's a lot of statewide groups that we are involved with. And then if there's a a day at the capital, you know, harm reduction has taken part in one. Colorado Public Health Association sometimes does a day at the capital, and we'll we may participate in things like that. You know, focus on education, whatever that program. So quickly, Brianna, do you wanna talk about the policy group? So CalFo has

a dedicated staff member within their structure focused on policy. They also contract the lobbyists. And so what they did was they put together a a group, of members that participate. It's a biweekly meeting during session and then a monthly meeting over the summer. And they that group actually takes the positions for CALFO. So if a bill comes forward and CALFO takes position, that group is the one that reviewed it and votes on it. I'm not a voting member, but I do attend every meeting. And that is where we get kind of heads up from legislation coming that we might need to be worried about or concerned about or watching, and then we kind of plug that in within this team. So it's been incredibly helpful and informative group.

Mhmm. So

within internally for ACPH, within our big p policy group, we modernized this year with our tracking and reporting. We've put the tracking into Smartsheet, and this gave us an opportunity to automate quite a bit of the work that has to be done. So we have an amazingly dedicated staff that have added this to their jobs. So we do not have a policy person internally. This is staff that just have a a passion for this work.

And so there's quite a bit of information that gets pulled together specifically for Jennifer's work with the board of county commissioners. And the Smartsheet is you'll is creating places where you're automatically reminded to update something after it cleared committee or checked it at cleared committee, things like that. And this will allow us easier reporting for board of health, for county commissioners, etcetera. And then, additionally, we have put our positions. So as I believe, what we've decided was that if the county commissioners take a position on a bill that we brought forward, that has gone into our core metrics.

And so the the idea was that what can we actually influence? We can't influence necessarily the course of the bill, but we can influence whether the board of committee commissioners takes action.

So Or any, like, actions that we may take as staff. Like, if we write letters, we're calling legislators, we are booming rings, testifying. It might be Board of Health. Like, if you take action, we're gonna we're gonna record those as actions and have a metric. Because it it's hard to measure, you know, have a measurement legislation, but it's such a huge part of what we do for five months. We want to measure it and then look to see areas. And just Smartsheet was a huge QI project. It's gonna be fantastic. We're really excited about this year. Yes.

Alright. And so then we're we anticipate these three categories. We have. If you remember last year, there was legislation to expand the Cottage Food Act. That bill

did

not lead the committee, but it only did not lead committee by one vote. And so it was incredibly close, and council was the only organization that showed up in opposition. And so they took a real proactive approach over the summer and and formed a tassel horse and reached out to the legislature legislator that brought that legislation forward. Dylan Garrison participated in that group, and they had very positive conversation and interaction with the legislator to the point that they have now rewritten the bill and approached CALFO to review the workbench. So there was quite a bit of positive interaction there.

So we will see this bill come forward again. We are hoping to see the, recommended wording that moved out of that task force, but just the fact that the legislator was willing to engage. We do know more raw milk is coming back. In fact, it was included in the governor's budget. There is a carve out within the Department of Agriculture for a $175,000 to stand up raw milk.

The positive note that I will say is that so much of the advocacy that's been done with the joint budget committee in the last several years has helped them connect all these dots. So unprompted during the CDPHE briefing, they asked the question, so the governor has a $175,000 here, but we're cutting local public health. Please make that make sense. And so that is another demonstration of the advocacy that has happened and the education that's happened that they're now connecting those dots and are advocating for us. And so we know this is coming back.

We will see what happens. And so then as I I reminded everyone during the budget presentation, we also have the local public health funding that was cut. CALFO did officially take position of opposition against that cut this last meeting two weeks ago. But as I stated in the previous presentation with a billion dollar shortfall, I'm just not sure that there's going to be anything to restore the funding. What the hope is is

that there won't be additional funds. That's just one. That's I think that was it. That might be the last. Okay.

Yeah. That's the thing that

I have.

Okay. Was there another one that was supposed to be in there?

I think I couldn't remember if we had one on the quest for questions. Yeah. Okay. So we're done. We're You know, has there been a change in leadership for the committee that will review the raw milk legislation that comes to us? At that, I don't know off the top of

my head. There's been so many changes.

I know. Sometimes kinda why I'm asking and not to put Jen's spot. No. Because I obviously don't know either. I can check them. We were just, you know, sidebarring over here that every year this comes up. Mhmm. Just never understand. I'll just never understand how this makes it into the budget. Okay. And I

find it interesting. There was I don't know there was an MMWR. Something came out recently about how long it stays, like, HPAI or other things that they're finding in raw milk. Mhmm. How long it's staying.

I saw that because Yeah. My cousin And I thought you doc, if you

There's like, nope. Great. There's so much evidence

behind this. That's just crazy. Perplexing. Yes. And to have money attached to it is insane. Well, enough. That's what's really concerned about this, and it is in the conference. Mhmm. So this clearly don't work. But I love that that question was stood up. It was it was very encouraging. That is encouraging. So we will see, but there has been a lot of turnover. There's there will be a lot of scourning in the first few weeks. So, I mean, obviously, we'll be keeping very close tabs on this and watching it, and health will be too.

Second, Sorry.

He kicks off. Number 14.

We can. Board members have any questions about Ron Milk or the concerns about college student expansion?

No.

The like, how you're tracking all this legislation, like, of kind of SENS bills and then the, like, legislative liaison, like, board and county pensioner SENS bill, but then Steve is also responsible for, like, all the wastewater bill, like, environmental. Like, what does that look like?

So we have this phenomenal staff member, Jody Fisher, who likes to monitor. So she plugs in as much as she can. So it's kind of a broad net. K. And then we will review, and then we all hear it from different places. So Steve might get heads up. Dylan might get heads up. Taylor frequently gets a heads up. And so then that will get plugged into the tracker. Calpho might be the first place we see it. So when they send their agenda out, I review to make sure that everything that they're talking about is an arch tracker. And then sometimes it does come from your boarding hand commissioners, and so Jennifer is the

first one to kinda get us going, and we get it in the.

So it's multifaceted how it gets in there.

The 800 people built last year, like, it's so it's so many to monitor.

There's you can put in a search form that's in Yeah. Holding out, and that's a lot of them through the commissioner's office. The business analyst will something will trigger, and he'll send them to me, I'll let him know. You know, this is not relevant. And so we'll just take it off the list. So a lot of them just come through and reread them and realize just because it has the word health in it doesn't mean that it's necessarily related to work. It is it's a lot to keep up with. It's a ton of work. And toward the end, it just is absolutely. Thank you.

So I look forward to a different way of of reviewing reports and seeing updates next year in the director's report, and this will help the think the Smartsheet will help us be a little bit more timely so that if there is an opportunity there were a couple of times last this last year, it would have been great to have had somebody on the board of health testify or write letter, and we just didn't have enough time to pull together the tracking points for you. So I'm hoping that this will help us be be prepared pulling this talking point, send it to you if you so you can call, write letters, or test. We're hoping this just gets us in a bit more proactive thing. With

the board study go ahead, Mark. That's the state legislative issues. How about local things that happen within the municipalities in the in the county?

We do use the big key group to talk what's happening at the local level. But we are definitely more organized, and it's an expanded group with our big key policy group. But, you know, do you wanna talk a little bit about Leslie For and her other's example, Leslie, know, checks the the agendas. So it's it takes a bit of time, but, you know, trolling them all, seeing what's on the agenda, and sometimes, you know, we figure out what's gonna

be in

committee beforehand. But we do try to track those. If anyone knows of an efficient way to do that, let me know. But it's we took online and then kind of ever hit them into a spreadsheet. So we are monitoring. We may be active with the municipalities on boardmences or policies, but it is a lot more with 13. It's it's a bit more to

Well, I I know that the food security, coalition is thinking about a a sweet and beverage, feed or something trying to do that. Did we get any support for how to present something that we're thinking about as a potential policy change and how to present it. And is there support for that kind of activity?

Still in the works. They're very much pulling together information of giving legal opinions about what might be most optimal to pursue most likely the MetroICities area to begin with. So putting together a plan, and I think it'll it'll be unfolding over the next year, but we'll definitely keep you updated. Still some questions we need to make sure to make sure what's for everyone out to know. And we would bring that to the Board of Health as a study session.

It would go to the commissioner as a study session. May there may be some, you know, technical assistance and sort of to just help, but there's a lot of steps that would have to happen before that. And we may look to see what kind of technical because it's that's really big and takes a lot of big effort. So we would be looking to see where we could pull into technical assistance, but there would be a lot of a lot of things in between now and actually, that's not

And now is my concern. How do we fill in those blanks? Yeah.

We're working on Bob and Bolden have a plan for sure.

So regarding this Smartsheet, do you envision that that's something that's being shared, like, with the and the version, or is that just purely meant to be internal only for tracking?

I'm sorry. Smartsheet, can it be shared with the board, or is that just I'm not sure. Can share it

with the board, especially the reports that we're generating for you. Yeah.

I mean, the reports, for sure, we can. When you go in and live, do it. I'm not I'm sure I think there is a way. We just I think I'm not gonna do it. Yeah. It's easy enough. Don't get me started on Smartsheets. So It's Brianna's favorite thing.

I see it exciting. That's great. I was just thinking about team. Those are notes. No. Can absolutely

do it. Don't track them.

Give itself where you either where the the board may have, like, expertise or perspectives on on bills. And I agree just that this this flurry for '26, and then the last, you know, couple weeks of the session, have more ready access to that sheet of the. It only picks off the back of this to the team here. I don't want credit work.

Well, Okay. This one fits in. If you're not able to get into it, we can troubleshoot it, but it's a lot, you'll see, of information. But it's pretty easy to follow-up too, and your insight would be helpful. K. I'm going to switch to participating online since I need to leave. Yes. Okay. But, yeah,

I hear that there's audio issues.

It's a report study session item.

Wanting to start with our permission of it. This we're highlighting all of the moments of opportunity of giving back to the community that other teams have done. It's I mean, throughout the year, the teams engage with different nonprofits and and groups that this month or between November and December and going into February next year, we've we've done a lot of giving back and some unique things. Working with Project Cure, we have one of our staff members organized a a luncheon creativity time to create cards for the troops. It was actually, a radio station was organizing this 10,000 cards for the troops.

And so during our lunch hour, we just sat and made cards, and she took them to the radio station. So that was a fun way of of giving back and recognizing and thanking our troops. Wake is gonna be volunteering for at Village Exchange Center for that happening yesterday. Birthday. Yeah. Excellent. Yesterday, the health protection response division met, and they had different stations set up for Crave Hospital. Yes. They're with care and project Angel Heart. So lots of fun in team building and in getting that.

So I just wanted to highlight the work that our team, even though we feel like we are also in the community, but giving that to others in the community. And then what's new in 2026 as a new community benefit, So we have been doing since we opened, we have allowed staff up to four hours of administrative time because, as you can imagine, most of our staff are fully grant funded, and so they have to code their time to the grant, but we would allow up to four hours of volunteer time that they would code to administrative time to allow them to volunteer and do that. The county starting in next year is is getting eight hours of volunteer time for all in four weeks. So really excited about that. And there will be looking at doing that.

May not work for everybody, but we will be able to all employee needs, like, volunteer time because you're COVID. So we will see at certain points of the year, like, the how many hires along with your family have the county gave back to. Pretty cool new benefit for them to place. So I wanted to highlight that. And then under the program updates, partnership plan, community health promotion, speaking of of policy at the municipal level, we have been working with Aurora Public Schools and the world partners on.

And the youth were present they presented to Aurora City Council at the beginning of this month, and there was an article in the we included the pictures from the article, but the students at city council talking to and the concern that they have, and they're asked to counsel consider on tobacco retailers. So I think that's pretty it's exciting. I love youth engagement and civic leadership, and it's great to be a part of that. Really excited about that. And we'll see where that takes in with new leadership.

We'll see where we go when we have this year. It's been tabled. The item has been tabled several times, so we're hoping that it may actually be able to get traction, especially with you leading it. And then our immunohutrition division, I wanted to recognize Grace. She's one of our work supervisor RDs at our Inglewood office, and she just recently became our one and only international board certified lactation consultant. It's a big deal. Yeah. And that's, like, you know, that's that's, like, nice. It is really exciting. So we just learned we were at, I think, Inglewood Yeah.

With doing our don't ditch the director's Zoom. Need some very consultant. But it's a lot of hours long experience. And she's also the one who spearheaded the baby. So she's got the Facebook page. I mean, she's just dynamite.

So

really proud for that. And I will also highlight I think I highlight this every single month that wake enrollment was the highest. So, again, you know, great that people are finding us, and it shows that there's still there's great need in our community. And we're allowed to be there. So we continue to be extremely busy.

We're just out there. And then I wanted to highlight we have highlighted Nikita was here earlier. She just came from the part of the with our Family Connects and Maternal Child Health. Just wanted to so this is the universal home visit program and our partnership with Denver Health. So every baby born at Denver Health in Arapahoe County has the opportunity to have a home visit from our visit nurse in that program.

You don't have to take it, but in just I mean, it just launched late fall, and we've had a. And they it's just a significant program. So in the, there's a lot of mission moments, good catch moments for that program for only being in its first quarter. The ninth first quarter. Excited about that program, and it's I think it's we'll have.

There's, like, some, like, catches on that. You have 40 you have 40 visits, and there's been, like yeah.

Oh my gosh. It's 20%. Yeah. And we've already just identified ways that if we we'd want to be able to do more. The intent of the program is just one visit. She's really having a hard time. Was like, keep going back. Keep going back. But, yeah, one visit is making a huge impact. Oh

my gosh.

I know. If if you

think it's a hard burden. Think of, like, of the people who don't get those visits.

It's huge. Can't wait for you to tie that to how they're doing. Yes. Yeah. And it's not income eligible. Like, it is for anybody, and it doesn't matter if it's your first or your eighth baby. You have the option to have an option because you're overwhelmed regardless. Missed things. You're so tired. Missed things. Yeah. So it's a phenomenal program, and we are definitely seeing early returns.

On this. And is there an opportunity to consider again for the expanding it so that it's just not Denver Health, but other.

I think this is a. And there are certain and it's really hard to get funding data from hospitals, but we know a lot of babies Arapahoe County babies are born in Denver Health, so they are partially bullying it. I think there are six different funding streams. Yeah. A real mismatch of funding sources.

We were determined to get this started, and so we've been very creative with the funding. We would love to see a steady stream of funding to be able to, expand and work with other hospitals. It's just we wanted to get it started because now we have really great data that we can take to other hospitals and say, these are the catches that we are getting on one single visit. Here's how we're improving. Here's how we're keeping folks out of the ED.

And so I think now that we if we can get, you know, a few more quarters of data, then I think we will have enough to take to a hospital with a proposal. But right now, we don't have enough, and Denver Health was a very willing open partner. And we're we're one of a few several how many counties are doing this now? So we're one of four. So it's not widespread across the state, but we'll be able to get some really good data that we'll be able to hopefully diversify the funding.

Another happens is with diversification might be health insurers. That's what I was just

gonna say, Doctor. Lapin.

I'm sorry?

That's just what I

was gonna say.

Yeah. Right. UnitedHealthcare. Yeah. Kaiser.

If you can save them money, can prevent hospitalization.

You can

burn the hospital. Yeah. And I get their attention for fun. Yeah. Okay. Sounds great. We have not explored that. We did get funding from Colorado Access, but we have not explored insurance. So so thank you. Because we this is this is definitely a program that we want to be able to to keep and expand.

I think there is going to be need, and it's it's having really amazing outcomes so far. Finish on that time. And then also in the community health nursing division, I wanted to highlight some work that our regional health connector has been doing and a great I mean, it's a huge partnership regional with health departments and hospitals on a firearm injury prevention campaign. So we launched in November on firearm injury prevention, I think was November 18. We locally, we partnered with our sheriff's office and the DA and launched a social media campaign and put a bunch of stuff on our website, including our newsletter.

It was very low cost because we didn't have a budget for it. We did receive a mini permit that we weren't able to take home visits with visits and members. So it was a great partnership through the hospitals and local public health agencies. They identified where we have similarities in our community health improvement plans. Very organic.

Let's let's do this thing, and we did something. And I think that will continue. So we're really looking at where we have opportunities to collaborate, connect, especially. There may be more that comes out of that, but that was a a really cool project to work together, and it was nice to work locally with. But I was looking to have that.

So I think there is a campaign. I can't remember who created it, but it's basically we can all agree like, the thing that we can all agree on is safety. And so I think that was part of the messaging. It's not about where you thought. It's about the safe.

Take a putting the locked axe to actual use would be much higher if people get it from a retailer or somebody who's a gunman that make it rather than somebody who's,

you know,

Yeah. Project is the one we could be looking into. Yes. Okay. In the last couple of minutes, I wanted oh, I also wanted to point out two more things. Harm reduction also comes like, every month seems to be their busiest month, but, again, October was a very busy month for them. I think word-of-mouth, they're they're out and about. They're a trusted source, So we are seeing more and more numbers coming in, and they are definitely at capacity, but really doing great work. And I think it's a testament to Alicia and her leadership and the workforce she's doing in the community. So shout out to her.

And then I wanted to recognize two of our staff in the emergency preparedness and response program. So they were selected for this new governance board or a new group called Women of Emergency Management. So our emergency program, this program is a 100 it's for a 100% women, and it's basically a male dominant field. And so this organization, which was organized by a partner that, you know, we've all known in the field for a long time out of Larimer County, but it is really grown to to support women in the industry to help grow women in that career path. And two of our specialists, Lindsey Brown and Serena were selected to be on the corrections board.

So really excited for them. Great leadership opportunity and to help foster their development in emergency preparedness and emergency management because we would hate to see really an amazing individual, an amazing woman.

So

really excited to see what was frequent. And then I wanted to ask Michelle to give just a couple of minutes update on as always, Melissa's report is phenomenal. Tons of information on clinical disease, but there's a lot out there right now. So

I

thought it'd be good. Michelle could share just a a quick update.

And so I was going to give an update, and then Melissa said I can bring the most current information and data if you'd like. So getting it straight from the source, she was joining

us today.

I think our our our biggest update right now is really surrounding outbreaks. If there are, you know, you have seen or have heard, we're really experiencing a pretty early and increased flu season this year, and we are certainly seeing that. This continues to grow almost seemingly every minute, but we have 61 active outbreaks right now. Majority of those are in school settings followed by child cares and then long term care facilities. Over half of our outbreaks are flu, and then we're unfortunately seeing, like, GI and norovirus increasing as well, and this will be coming in tandem.

So a little bit of our kind of just an update on where we're at for our outbreak season. This year, we've already had a 182 outbreaks reported, and seventy six of those have come since September, majority of those have been at school settings. So I think we're really just seeing back to school, a lot of respiratory illness starting to circulate. A lot of it seemed to be right after the Thanksgiving holiday as well. So, really, shout out to all of our school partners, Michelle and Al.

You're working really closely with Maddie. Your team is working really closely with Maddie. Obviously, I know that they are swamped as well, but our team is really doing a great job putting this down top of top of all the outbreaks. But I think it's just something we'll just continue to keep an eye on. I think just is really growing in, especially with our kiddos, but really seeing that that starting in our long term care.

How do you define a break?

Yeah. It depends on it depends on the setting and the pathogen. So it's very variable depending on what that looks like. So, like, flu, it can be five cases in, like, a specific setting like classroom or, like, norovirus is only two cases in a specific setting. So it's it's variable, but we'll work with the facility to determine how it where it might fall back.

Just be any challenges after the the fault, the wounds are breaking out? Yep. Eventually.

I know. Think it's I'm just gonna

be back. You're not honoring it. It's just that. Yeah.

I think transmission in the school setting will obviously that will help transmission in the school setting for sure. But families are gonna be traveling, exposed, you know, flights or with families at holidays. So I think we'll just kinda wait and see. I think that's what we saw with Thanksgiving. Sometimes some years, we see Thanksgiving is very helpful in the school setting, seeing transmission break. I think this year, it did the opposite that everyone was traveling, and there was a lot of exposure during holiday travel that then came back to school. So I think I think we'll see. And then I know something our team is really talking about is what are the impacts on our older populations from families gathering at holidays and what impacts we'll see. And

And I just wanna echo things to your team because prompt, timed, consistent, accurate information is what we you know, what our families deserve. Right? And and we always get that from your team. So I know they're working really hard, and I'm also worried about after the winter break because people will travel to states that are have a less interesting flu vaccination rate than we, and they have measles outbreaks. We won't want to stop all of them. There are two. Yeah. I did. Thank you. But thank you for all you're doing.

Well, we have to now move into an administrative session where the board will, go over the executive director's review.

Spoiler alert. Yes.

We don't have to be. No. Okay. So, Sam, y'all have a happy holidays, and y'all are welcome. So enjoy an early break. Thank you all. Thank you, everybody. Thank you all.

Yeah. Yeah. Alright.