Arapahoe County Board of Health - Regular Meeting

Sound like it looks good. I mean, I gotta take it off the paper. Okay. Shushan Davis.

Present.

Director, B. B. Kleinman. Director, Christie. Present. Director, Mark Levine. Eric. Director, Mark McMillan.

Excused and Absent. Absent and excused.

And then director, Terrence Swaffer. He is not. Here. Yep. Oh, there he is.

And director, Michelle Weinoff.

Absent and excused. I would now like to ask the directors in the room to introduce the staff that are present. Michelle?

I'm wondering board of health member.

Manager.

Beautiful disease epidemiology manager.

Thank you.

Hi, Emily. Hi. I'm here today. Wendy Nadine, nurse manager standing in for miss Melissa and Talitha. We're out on spring break. Okay. But we have a new nurse with NLP who's joining us, Amy Wigant. So she just started and great onboarding activity to bring her back. Welcome, Andy.

And we have Anthony Sotelo, security safety with us again.

He should be a regular part of the meeting.

Alright. Yes. We can see what he thinks. The

next item is to approve the February meeting minutes. Ask for a motion.

Move. Second.

Second.

All in favor? Aye. Any opposed? Hearing none, motion passes.

I'll jump in. Taylor Roberts is here, Jimmy, representing partnerships planning partnerships and community health promotion for Heather.

Okay. Great. Welcome, Taylor.

Do miss Hannah, do we have anybody in the queue for public comment? We do not. Okay. The next the next is the director's comment. At this time, board directors are invited to share insights from community leaders and partners to gauge the current state of the community. And I'll go from my left to right. So starting with Christine.

I am cheating. I made my notes for this one. The Colorado Commission on Aging is hosting a job fair for older Coloradans, older workers. On April 30, I will share all of this information. It's technically hosted in Nevada, but anyone can join. One of

the things that one of

the reasons I'm sharing now is because one, we are looking for employers who are looking to hire older workers, number one. And number two is the commission is doing some work around training and, like like, preparation for this job fair. So they are hosting some sessions around personal branding and interviews and resumes and things like that that I will share with Jennifer that to share out with the group. So if you have clients or other folks that you encounter who are older and are looking for a job, we would love to touch base with them.

I'm. So I can't think of a thing to say. It's so weird.

What what's on with

the state and Medicaid and how it's affecting clinics?

And it really is. The loss for us at the clinic for Medicaid income is just overwhelming. And and I think that that's why I'm somewhat not sure what to say. You just think as far

as It it just I'm saying we hear about it, but to be able

to hear firsthand from you

So that patient is still coming.

Yeah.

They're the same patient is still coming. What's changed if they don't have a payer source? And I think public health has that experience, but I think all around the state, there's really no one that's not feeling that pressure of how do we continue to do what we our mission is, what our vision is, what we're set out, and and to do it without the reimbursement. Some things that doctor's care has chosen to do and maybe others is to really more aggressively take private insurance. An exciting thing I think that happened today, and I appreciate this, is that Colorado Access is creating another plan on the exchange.

What I hope is that that plan will be better than the plans that are there, which have these huge deductions. And and speaking to Colorado Access, which is reaching that where they say it will be. They promise it will be. And so I haven't seen it. I I hope that when we see it, it will allow more people to have coverage. And then yes. The good thing about Colorado Access is those that provide health care are already a part of their network. So we won't have to recredential. We won't have to do a lot of the hard work that goes into accepting people with different products. So I'm ex like, to me, that's kind of a high point in a moment of a lot of long.

Anyway, that's fine. Thank you.

Thank you for that. Yeah. And I would piggyback on that and say for me, the biggest issue in the community continues to be the state budget along with Medicaid. And the biggest issues inside of Medicaid that we're preparing for that'll be interesting to see how Arapahoe County deals with us to work requirements. You know, that's gonna take place.

Every group developmental pathways is in Arapahoe County, and me being on both sides, being a client, because my son is on the waiver program, being a client in addition to talking to the clients, and then in addition to sitting on the other side, I would say the public is probably at a 10%. They hear a lot about it, but they really don't know the changes and understand how it's gonna impact them personally. And then I would say at the state, just from what I hear, I don't have a lot of faith that Hip Hop is going to navigate the changes successfully because of how they operate. And so I think who I think a lot of this one fall on public health. And so I have faith in Arapahoe County, and I have faith in all of the workers in Arapahoe County.

I feel our our public health department does an excellent job. But I think this year and next year, we got our work cut out for us with all of the changes on the horizon. And so just to commend the staff for the great job y'all have been doing navigating a very turbulent environment related to funding being cut, related to not knowing if you have a job, not knowing if public health gonna be around. But yet, every day, y'all show up and serve the community. So thank you all for that. I'd like

to echo all that. This morning, Wendy attended a presentation, Kim Bemestefer, the head of about the huge budget issues that the state is facing. And since Medicaid is such a large percentage of the state budget, it's going to have to shoulder an awful lot of budget shortfall that we are seeing. So we are really in for some very, very difficult times. On on another thing, I I want to as as I think many of you know, I've been supportive of the work that's been going on the Arapahoe County Food Security Coalition.

And I just wanna commend those people, people in the community as well as the people from here at the county health department who are all working together as a good team to try and do something that's very important, but also very difficult. They're thinking the need for funding, which is going to require convincing some of the cities in the county to do some ordinances that will enable us to get some funding in one thing or another. It's very challenging, but the way that the community is coming together to support all of that is very impressive. So there are some bright things as well as some scary things that are going on in the world.

Terence, does does Terence have any comments? Give him the opportunity for that. Hey. Sorry. Sorry. Couldn't be here. I'm actually home with a sick kiddo, but no updates on my end. Okay. Okay. Thank you.

Next, we're gonna move into our general business item, and so we're gonna start with on-site wastewater treatment since hearing implementation. And, Monica, could you set the foundation for the hearing?

Yeah.

So we're gonna require statutes 25 dash 10 dash one zero four. Paragraph two requires the board of health to hold a public hearing on any proposed rules or amendments to the OWTS regulations. It also requires that we provide notice of the time and place of the hearing at least twenty days before the hearing in a newspaper of general circulation. Our notice was published in the Littleton Independent in the February 26 publication, And, of course, our notices are also published online, and we are here for the public hearing on the proposed changes on these regulations.

Okay.

Gosh. I think Monica just summed it all up. I don't so, yeah, today, we're here for the hearing and adoption of the updated Arapahoe County on-site waste wire treatment system regulations, and these updates are designed to update our regulations with the state's most recent changes with regulation 43 while it's still maintaining our local authority.

So

as we talked about at the study session last month, we have gone through all of our stakeholder in process, and we were able to finalize our draft and send that to CDPHE for approval. They approved that draft with some really minor changes and also some kudos back from them too on on the work that we did, so it was pretty good. And so next year, we are at the adoption hearing where we will incorporate all those mandatory state required changes and then also continue with some of the opt ins that we had initially in our our past draft of the regulations and then also considering the new opt ins, to to align with, regulation 43 and then as well as, some of the, industry best best practices here in in Arapahoe County. And then also just some clarifications that were made through the regulations to clear up some of those gray areas over there. As part of the the board packet, the BSR did discuss fiscal impact.

There really isn't any fiscal impact with the adoption of this or potential adoptions regulation. We can do it with the existing staff. We don't have to change our program up at all. We can just keep going forward as normal, with some of these, changes that actually makes some of our processes easier. Our staff recommendation is to adopt the proposed septic I'm sorry, on-site wastewater treatment regulations and the revisions as presented. And there is a requested motion for you to consider.

To adopt the proposed revisions. Before we move to I

wanna make sure there is no bank for the public comment we have to make sure that there is no public for this approach. Oh. Okay. Okay. Go ahead, Christy.

I move to adopt the proposed revisions to the Rappa County OWTS regulations. I'll second it.

All in favor, say aye.

Aye. Any

opposed? Hearing none, motion passes.

We

haven't seen Steve 42.

So we have four study sessions. We're gonna move into the first study session, which is the fourth quarter financial update by Brianna.

Now transition. Yeah.

Thank you. Who does well, congratulations on how much like, when you all started as

a new thing, it's

like, no. We never really do any of that. I don't know how many hearings. You've just adopted. Yeah. So we can credit to you all, and thanks for all.

It's a

very active yeah.

We just use you as as an example in our board training about, like, how well prepared we are to make decisions because of you.

So All good.

And then you walked in.

And then you walked in.

In your director's comments, you guys pretty much covered my financial presentation. So we can just so we are here to do a year end, twenty twenty five year end financials. And before I dive into the numbers, I do wanna take a moment to acknowledge the work that went from all of our staff that went into an incredibly smooth year end process that we had in 2025. And it was truly across the board. It was from staff doing very tight turnarounds to enter their employee reimbursement forms to business support who had an even tighter turnaround to get those entered, worked with vendors to get invoices at a reasonable time, and then our finance team within public health that did November and December invoicing for our grants reimbursements in about a quarter of the normal amount of time.

And all of that accumulated to kudos from the accounting department at the county level that we had a smooth, non like, no issues, no journal entries that had to be corrected. So it was just I have to acknowledge the work that went into that, and kudos to our staff for doing that.

So

for revenue, we collected essentially a 100% of our budgeted revenue, which is excellent. Of that $15,000,000 of that was grant revenue. So and then within the expense category, we're about at 90 just under 96% for $24,000,000 of total expense with $20,000,000 of that being salary and benefits. So we're still sitting right at that 85%, which we've pretty much historically sat at. Within this, this is just the more detailed budget to actions table.

I would want to call out to your point, maybe our Medicaid line, we're at 88.8%. This is our first, and I'm using air quotes, normal year for billing Medicaid. So the original budget was an estimate. It was our best guess at what we thought we could do. So I'm not concerned at that number. My concern is kind of the ongoing uncertainty around what that number might be in '26 and going forward. And so I'm just I'm calling that out because it's very low compared to the rest of the categories, which are exactly where we expected them to kind of end up.

And what did you put in for

the twenty sixth budget? It would have been almost flat. I'd have to go look at Yep. The same. That's what's going on.

And so then speaking of. This is a summary table of our we monitor all of our funding individually by funding stream, and we've done this since the 2025 when everything kind of went a little cattywampus on us. And Does that work? Cattywampus. Oh, god.

I've heard that. We won't die first. Gain a matrix by funding source, and we keep it with all of our data points. And those include things from, like, communications from our funder, changes in staffing at our funder's level. If our funder makes a a one off comment that they haven't heard from their contact at the federal level, anything that could indicate we might have something going all the way up to we've been directly notified we will have a cut.

So we take lots of pieces to analyze this. And so that's what you're seeing synthesized into this table. And so we've had already for '26, '27, three funding cuts that we've been noticed of. The first one is within our cancer prevention and early detection line, and it's a 72% cut or about $26,000. The caveat to that is that that program has a sister program, it's called eCast, and it receives throughout the year.

They kind of recalibrate and reallocate funds, and we tend to get additional funds. So this one is it's a lot of money and there might be a different story at the end of the year. And then the next two programs are both within our harm reduction program. One is our chat funding, which we received a 15% cut or about $23,000. And then our STI prevention and control funding, was a 76% cut or about $36,000. Again, the silver lining is is that that program received a nature grant that more than covers those reductions. Not ideal because there have been a hope to expand

Yeah.

But at least helps that not be as painful this round. So so those are the links specific to us funding. You've all mentioned the state budget. So I wanted to give a quick update on that. JBC is doing figure setting, and they were so at the apologies. Context. The governor's budget included the $3,300,000 reduction to local public health. That was a continuation from the special session reduction. JBC voted on that line item, and they were deadlocked. So it's a three to three vote.

The comments were incredibly heartwarming to local public health. The group as a group, we have done a phenomenal job working with our legislators to, like, help them understand our value. So it didn't pass because they have to they have to pass unanimously. They will have to revisit it, but the hope at this point is that it might be a lower reduction. Okay. So if nothing else, the comments were wonderful to listen to. So yeah. That's great. And then you all mentioned that we're at a $1,200,000,000 reduction or deficit. Tomorrow, the revenue projections come out there anticipating it to actually be worse because that projection was based on no recession.

If there is a recession, it could be significantly worse. We more to come. This so I did wanna review our public health fund fund balance. This is an unaudited. We are actually currently in the middle of the audit, but it is a a fairly sound projection as of 03/06.

So March 6 is when I finalized these numbers, so they could have changed a little bit. But as a quick reminder, the Board of Health put a policy in place in 2023 for us to carry four months of our appropriated expenditures for that year. So that's on the very bottom of this table. You'll see our target fund balance. It's gonna fluctuate each year because our appropriated expenditures fluctuate each year.

Because that comes out to about 34%. In 2023, again, as a reminder, the county contributed a million dollars to establish our fund balance. So we contributed 1.7 almost 1.8. A million of that came directly from the county. For 2025, we're projected to contribute a little less than $900,000 And the reason being is that at the March, we have to take any of our unavailable revenue, which is any of our AR, so our reimbursable grant invoices that have been distributed for 2025 that haven't been paid has to be deducted against our fund balance.

We'll still get the cash, and that will be collected in '26. But from, like, the point of time to close the books Okay. That is why we have to do that. As you can see, on March 6, we were at a $147,000. We invoice approximately a million dollars a month. So our funders are responsive. Our team is very responsive at getting checks booked in so that we can report it appropriately. So we are contributing to our fund balance, which is still a positive. I will take this moment to kind of reiterate, if you remember from our 2026 budget session, we talked about how each one of our grants are tending to be flat funded or reduced. And so our indirects are being squeezed.

And you're seeing that in the reduction of our contribution to fund balance while we're still contributing, which is great. It is going down. So it's just kind of reiterating that that is still continuing to happen.

And that's it. Did you

say we are contributing to the fund balance, Vishen?

It's gonna be 9 I should have I need to add another line now that I was saying this out loud. It's 917,000 minus the $1.47. So it's gonna come out to that, I guess, about 700 and Okay.

I don't have a question, but I would just comment. I think, like you said, for everything that's going on, it's really good to know that we have options. Yes. So it it makes the board feel a little relieved to know that it's not a dire situation.

So Yes.

Thank you for that. Yeah.

And through as Brianna mentioned, you know, the matrix of the PP and I I mean, we're running scenarios constantly whenever we hear or we learn something. We've been applying for grants like crazy. Two big grants that are we won't hear about until May are a little bit nerve racking just because the timing of that up against when our current funding ends. So it's just this constant, like

Yeah.

It's been shuffled. But we compared to where we were last year, we were saying no and halting everything and and very reactionary this year. We're like, you know, lessons learned from last year is that we went in this spiral, and then things didn't happen or we get the funding. And so we just kinda let it ride until, you know, we're planning and preparing, and there's tons of analysis happening. But we are kinda just letting it ride this What's the two grants? They're both for through well, it's the Colorado opioid abatement. One is the infrastructure fund Okay. Which we have received funding for which bought that Prevention Point Mobile.

Okay.

And then through that, under a different entity is the Resilient Colorado grant. It's a new grant. We applied to that.

Okay.

So we won't be here until May on number one. Okay. And is that money flowing to the state from someplace else? That is the opioid settlement company that is managed through the attorney general's office and then goes statewide.

Yeah.

I think what didn't I would want to say Mark isn't here, but he contributes a lot to you know, from the board's to making sure that we're looking at the finances and that asking the questions from the board as a whole. So although he's not here just for the record to say thank you for his contributions to the board and keeping us up to date and really asking a lot of the hard questions.

Yes. Yes.

Thank you. K. Thank you. Mhmm.

And and our third our second study session is an update on the Englewood move by.

Hi. Welcome. Okay. If you remember, we are we're on the final stage of moving. So when we first became a health department for just Arapahoe County, we had lots of different moves happening. This is our final final phase, and we're off and running on that. Just as a refresher, our current offices are we have the Aurora self that has been stable. We just had some new staffing that we had nurse family partnership move into there, and then we also offer WIC services. That's at Hamden And Chambers. We also have the Altura office, which is our Colfax And Chambers office.

That is our largest public health office where we have all of our services are represented there.

That's the building that had the housing next to it. Yeah.

They closed that housing? I think it's no. They've done they did and remodeled,

and it's They've

opened and refurbished it and

Looks good. No issues that I'm aware of. Electricity. Ownership. Oh, yeah.

Okay. That's okay what happened, but it I think they

had to sell it in. Yes.

Yeah. So Altura, that also had a few moving pieces in the our initial puzzles. And then Lima here, Lima and Arapaho, that was this one was our biggest move from Lima to here. And last but not least, our cute little Inglewood office at Broadway in Bellevue is moving to Arapaho Plaza, and that is mostly clinical services. So we have maternal child health, so Wendy's house there, WIC services, immunizations, and sexual health.

That building has been there since the sixties, and so it's been well established in the community. So I will talk a little bit about our plans to do communications around that. And so, again, Aurora South moved to Altura, all of those different moves. And this is where we're at for our Inglewood move. Architecture firm has completed their design and built it out in collaboration with our staff. They our staff have been really on board looking at the designs, raising counter heights, moving things. So it's been really a great partnership with our facilities team. How many people?

Bodies. Bodies. Like you.

Basically, not that many because we share staff between our Englewood office and our there's a lot of shared staff. But probably 20 ish,

I guess, 21 is

probably solid. Like, WIC staff are always there. Nursing staff comes and goes. So it's it's a moving target.

And it's it's big enough to have the patient come in or the client.

Oh, yeah. Yeah. Yeah. So it's nice. Nice. It's really nice. Yes. Yeah. We're getting the whole floor of one of those units at at APZ. So it'll be designed differently, it will it'll be really, really nice and fit all of the services that we have.

And would it be completed? Could we should we do it for them?

Absolutely. So right now, we are looking at third to fourth quarter. We have an project manager who's very, like, third or fourth quarter. She does not wanna give any comments. The date we're using in our head is September. There will be times where we can and there is probably about this size of meeting room there, so

we could probably post the end of the year, we'll have a meeting host as well. And then go downtown Littleton afterward. Yes. Or just after my doctor has. Yeah. Right. Yeah.

You might have question. Go to the beer garden there.

No. I don't know. So many options from there.

Once that we get to a place, we'll bring staff in. We did that here with hard hats just so staff can start to see it. So we'll work all of those and probably mid to late summer as well. The budget was approved. The contractor was selected. And, again, the timeline now is quarter three or four. Once we get that solidified, we'll keep giving updates. Consider considerations again, this building has been here since the mid sixties. Many families and community members hear about it from word-of-mouth. They're just used to it.

Our front desk office support coordinators, people come in and they're like, I know there's a dental office back there. There's not anywhere. So it just is really a piece of the community. And so we're well aware of that and have a lot of plans to try to address that starting now. So we're already meeting. Camille's gonna be our amazing project manager again. She's who did our previous moves. And we're already meeting every other week with our comms person and already have flyers developed. And so a lot of pieces are coming on. So we are looking at signage at Englewood and our new location.

So it'll be, like, public health coming soon, some type of banner, which will help with the drive bys and and letting the community know. Direct communication to clients as they are scheduling follow-up appointments, and then we also will be doing some mailers as well to some of the clients. It's each each department and each client is a little bit different at how we're gonna message them. And so we're already working on that. Social media and website including stories of generational families.

So we're looking for some families that have been there for a long time to be able to try to build some media around that as well. Email signatures, those will be sent. Letters, again, sent from the programs, flyers at local libraries, rec centers, and medical offices that do a lot of referrals to us. We'll be able to offer that electronically as well as a paper one as well. Google searches and maps that we have to wait till we get a little bit closer just because you don't want that too early and people going to a location.

One nice thing about this move, it's not fantastic, but that building will still be Arapahoe County Building, and it is only about a mile and a half away if anybody does go there. When we moved here, that the old Willow Building was a rental, and we don't have this many direct services here, but people were going kind of the wrong places for Vital Records. So, hopefully, we can avoid some of that from lessons learned. And then the AC Weekly and Board of County Commissioners backpockets is a little messaging that we do as well. And then, again, we're having these bi biweekly meetings with comms to talk about different options and what we should be doing.

And then with staff, ongoing communications, clear expectations, and project manager Camille Adams that has met with all of the groups. I think she might have one more meeting left. Lots of lessons learned, lots of communication, and moving forward with that. So hit the timeline. So contracting and final construction plan that is already going and meeting with all of the staff. April through August, construction will begin, attend owner architect contractor meetings. So Camille and I will be invited to those. Those are weekly. They just give updates, and it's pretty good to learn. And if they have questions, it's they're fascinating, very different

than what we normally do in health.

Like, HVAC and walls moving to what kind of carpeting and lower barriers. So we'll start to do those as soon as those start up and then continue our communications plan.

Any questions? This is coming out of the county budget. This is one part of the yes.

Part of it. And the county has a facilities plan. They did an assessment, and they rate each facility based on certain criteria. And the Inglewood office rates the worst of the entire county portfolio. But which is really hard because staff love that building.

The

staff who work there really own and takes so much. Like, they love that building. Yeah. So it is not just that we're moving. You know, all everything that it takes to move is a huge undertaking and an incredible change management and or like, it's a project management. It's huge. But to let go of something that has really been, like, I mean, core Yeah. Has been And for our clients who generations Yeah. Have been there. So it is it was easy to leave the Willow office and come over here.

I think, you know, none of us loved the fountain that was there and then the fairy garden. And they're like, it was really pretty easy to come over here. Then the gazelle scene. Seems like it's gonna be hard.

I just think the county is they've already had some initial meetings about what to do with it. That's county owned property. And so they have some interesting ideas, and they're working closely with with the city of Englewood and trying to do some sort of unique things that I think yeah. Because these all the options on the table seem pretty great for public health and for Yeah. Access and Yeah.

The community resources will be taking the lead in the summer through the summer doing, like, community and trying to think, like, what what could that become? How would they finance it? What are the options? What did the community need? I they just don't wanna see what turned into another car lot.

Yeah.

Gas station. Yeah.

Yeah. But it's in Englewood. Right? It's on the Angola side. Yeah. Yes. It's on the Littleton side. It can't be a gas station.

No. They don't allow it. Oh, really? No.

It's in Fosterville's our last gas station.

Oh, okay. Yes. City of Englewood has been sort of at the table having some conversation.

I just learned that.

What would you like to see at BCP?

That show that should be something.

Something that could generate dollars for the county is what I would like to see.

Okay. I did ask some places to be on the I would love to stay.

Yeah. Looking at different alternative housing, access Loves and housing. Housing. Mixed housing. Yeah. Some mixed housing options could really That seems to be their top priority.

Well, and it's you know, because the building is up front, and then the whole back is parking lot. So it takes up that whole it's a really nice lock down. So there are potentially could be some really cool options. Yeah. We'll keep you posted. Maybe I don't I'll I'll talk with my counterpart at community resources, and maybe we could come in and use our two to three time per Yeah. Key or charrette. That's how I would do.

So

our first study session is the legislative update by Jennifer.

Okay.

We this time, we emailed it to you. Don't think I'm trying different ways of of of work, but there's just a it was good. A few bills. Sure. Playing around with this until

I find the sweet spot.

And then it'll be May and over. It's great. But we, I mean, we are following and tracking and watching a lot of bills, but really just three that I'm gonna talk about today. First, the immunization bill, which was senate bill 32 passed. So doctor Urbina testified.

That's why they

have.

That's why They testified.

I think he was there like, how long were you? Eight hours?

Yes. But I only spent time working only with an hour and a half.

That is the absolute truth.

And I got to see a lot of old friends. Yeah.

But it did pass. So that is good news. It was a a good bill. So it's on its way to the governor's office.

And then He will sign it.

Mhmm. He will. Do think so. We haven't

heard any indication that he's left.

Good question. He's been a libertarian.

Yeah. He has. So it's this

He probably will.

I think this one. I'm because well, I don't know. I should've Yeah.

He definitely very vocal

on access to vaccines Yeah. In general.

So And that's what this is. Yeah. Creates more Ensures access too. Yeah. Yeah. I'm not too worried about it.

Health has supported in joining the World Health Organization on the immunizations. So, like, I think I think this is something he's supportive of. Okay.

Yeah. And we haven't heard that

it would be vetoed, so

I feel pretty good about it. Versus the expanding cottage foods. Yes. Our Dylan Garrison, our environmental health manager, did testify against the bill. So the county took a position opposing it. CALFO did change to a monitor after some amendments were made. We kept our oppose position, and Dylan did testify in opposition. He did a great job. But the bill did pass in committee, which we expected. There's a lot of support behind this bill, including the governor.

So it is it passed committee. It is now in appropriations and probably won't be heard until the long bill is introduced. And I It's a Does it have a fiscal It does. It has a fiscal note close to $200,000 or credit. 200,000.

It was originally a carve out that the governor had put into the part the Department of Ag for raw milk. And so it was a compromise from that perspective that they are not running raw milk this year in lieu of getting Jesse Jesse getting this bill passed. So Yeah.

Okay. Some of the amendments he supports. Yes. And he supports this bill. And some of the amendments did get made, but we haven't seen the final draft of the bill.

You know, early on, it was limit limitless. There were no limitations on what could be included in this expansion. We believe that we were able to get it to one item up to five flavors or they're working on or is it five flavors of or five items, one flavor each. That's where we don't know what the where the language has landed. It if appropriations doesn't kill it, it will likely pass. Yeah. But we'll see where we end up with appropriations.

Okay. So I'm trying you can make have, like, five different flavors of muffins, but only make muffins, or you could make blueberry muffins, blueberry scones, blueberry pancakes. I'm

yeah.

I think tamales. So and it was not just tamales on even though it nowhere

the bill fights about tamales.

But it was dubbed the tamale bill. So if we think, like, you could have you can sell tamales under this with flavors of tamales. Okay. Or chicken tamale, beef burrito. Like Okay.

Oh, yeah. Yeah.

Okay. Yeah. That's helpful. So things that are it's our concern was it's riskier food chance that, you know, the temperature control versus, you know Muffins. Yeah. Yeah. Okay. So we'll see where I mean, we continue to track and watch, but it will if it doesn't die in appropriations, it we're not there. I would count on it passing. And then the last one is it's a child care provider and licensing bill.

It was senate bill 20. And we didn't take a position on this one. CALFO had taken a position of amend, and then because Steve thought language in there that could have had an impact on us. So Steve worked with CALFO. It was amend, and those changes were accepted for the most part.

Kind of.

So it is moving for well, it is it's also in appropriations. How does it change licensing? Because we have licensing now. It changes the inspection. Okay. Work would have.

They were looking at changing the prioritization of inspections for Oh. For new facilities. And then also looking at fees too. The way that it was written, it looked like it there's potential or potential confusion around us being able to charge fees for our inspection services. It wasn't directly related to the title 25 or CDPHE or anything like that. But just the confusion that it could create is enough for concern. So

that one I've looked at the most recent fiscal note, and it's a little confusing. It was a huge, huge fiscal note. So I might have had chance

to talk about it at Cathos. I'm not sure what. Eliza usually is what we get in sight.

Yeah. It changed. I because of the size of the fiscal note, I I mean, it that might kill it. But I it was confusing to see. It looks like they've shifted they've moved money Mhmm. To cover it, so I don't know where that money comes from. So we'll we'll get more information. We're following it only because it could have a minor impact or, you know, it could change how we work. So but it was Steve was very astute in seeing this and saying this language doesn't work.

And Mhmm.

Because I don't think it was on Calvo's radar originally at all. And then I didn't one more. I just because it's kind of not funny. But The there's a bill. It's senate bill eleven thirty.

It's public restroom baby diaper changing stations. I mean, the the intent of the bill is good. It requires baby changing stations in restrooms, whether it's women's, men's, nongender restrooms in all public spaces. The county took an amend position because the state excluded themselves from the state and because of the cost, but yet the rest of us are required to do this. And so I don't know what will happen.

I haven't seen the amendments go forward, but the county did take an active position to amend to require the state to also follow this bill. Yeah. Because if we have to do it, they better do it.

Yeah. Definitely.

So it's just interesting the commissioners.

So just public buildings like public government, not just every public, but like a restaurant is a public building. Mhmm. So then they'd have to put a changing station in the men's room and the women's room. It's I think just one. Yes. I think it would be.

So it would be you know, every any business is gonna have to add them. Most of the county's buildings already have many. But I we calculated how many we might have to have to do. And then there's some regulatory pieces to it, which, you know, as a county not set up to regulate that every restroom has on. So, yes, the oversight. And then for the state to exempt themselves from it did not go over well with the. So we'll see where that goes. But, you know, the intent of course, you know, we support the intent of the bill to make that accessible and to make it, you know, across the board. But

And then there'll be no fiscal note except for them. Passing what money issues. Yeah. So

that is that's it for my update for legislation of what we're watching. Anything else?

Questions? So the fourth study session is the director's report. Right, Jennifer?

Thank you.

So starting off with our our mission moment. This month, we're highlighting a story from our nurse family partnership. So as you know, the nurse family partnership, they establish relationship with the families that are going to the child turns to. So oftentimes a lot, you know, they're going in, assessing, making referrals, checking for development. But one of our nurses went in and completed the mental health screening on the mom and noticed or indicated that she was experiencing significant daily anxiety.

At the time, she was not ready to talk about it or to seek support. When the nurse went back in that time span, she independently like, had thought about it and independently sought out support and, you know, looked at treatment and medication options and said it was because of the visit and then, you know, her processing what had been shared that, you know, she really wanted to be more brave in raising her her child and parenting her child. So it was, you know, that visit and the the comfort and the you're not pushing and not you know, just being a support system. So this is not uncommon for NFP, but I at one of our recent don't ditch the director forums Yeah. They shared that story, so I wanted to share it with you all.

I thought it was Yeah. It's for them, they just this is what they do Yeah. Yeah. And don't think to share these stories. And oftentimes with our staff, we go to every that's weird. You know, what are your success stories? Big, small, what are the mission moments? And these are things that they do just every day and don't think about it. And until they tell us and we realize, like, this is so heartwarming. This is the stuff that, you know, really matters to the community. This is what gets people out of bed and helps them Yeah. To be the best parent that they can be. So really proud of the

work that we do. And

then just highlighting, you know, kind of thinking going back to the training that we had with Pamela. Every month in the director's report, we do bring forward to you the highlights of the community health improvement plan. So the headlines for this month, have in economic security and community safety. So I'm gonna highlight those in our reports so we are making that connection. And to start well, first, I want to give kudos to Penny and thank her for her hard work on the creating the request for qualifications for chief medical officer. That is how

we're gonna be

able to.

I think so we've helped with that recruiting. Well, we're hassling the same person.

Yeah.

Not you. You're hassling the same person we're

Oh, yes. Yes.

Okay. And we give them all different times. Like, every three hour a week job.

Tuesday, we have some good candidates.

Yes. So if you do I mean, as you're if you send it out and people are have questions or the bid itself is keeping them from applying, ask them to to direct questions or email Nancy Allen directly, the purchasing agent, and she can help guide through. Mean, it's we have to do the process.

Yeah.

But I It's cumbersome.

I I looked at it, and I was like, oh my god.

And, you know, we made it as as as painful as we could. Well, did you put

it in AI and say, can you boil this down to one page and just do it as a cover letter?

She can she can help it. Somebody through. Really, and, like They

don't have to go through.

If the whole reason then they don't apply is because of our process, like, we can but they have to go to her. As staff, we can't talk to any potential candidates. But I wanna thank Penny for her work on that. Another with the a chip highlight is this when was it? February 26 in this room, we held the second convening of the health care leaders roundtable. Terrence and Bebe Bebe was there as doctor's care. Terrence was there as our board of health. Yeah. But we had great representation. Yeah.

More diverse, a larger group. We had the health clinic in out of Byers that was there, the Dawn Clinic. Yeah. Aura Access, Aurora Mental Health, CEO of a rural hospital. Yeah. Kevin Strauss out of Lincoln Health. Okay. And, I mean, we had a great great conversation. We talked we asked, you know, what what are the challenges, and then what are the silver linings? What can we work on together?

Yeah.

So between now and June, which is our next meeting, Heather and I are going to do some key informants with individuals to really dig into some of the really amazing ideas and opportunities that they will bring to the table and thoughts. You know, how do we how do we better utilize students and the energy that they bring? How do we work together to think about message? Medicaid obviously was the biggest elephant in the room that we were all talking about. Like, how do we how are we gonna work on that?

So it was a it was

a great meeting and a lot of commitment and enthusiasm to come back.

Yeah. Was Well, hey. Supposed to

pay that for three to three times, of course.

So that was Okay. Then, Sean, in your update, you mentioned developmental pathways, and I didn't put it in the report, but it triggered. I attended well, actually, Wendy connected me to a meeting with developmental pathways, human services, Aurora Mental Health, All Health, Florida Access, and human services. Developmental pathways hosted the meeting and led, but it was a lot of the same things that we discussed at the health care round or health care leaders roundtable. Medicaid, how it's going to change for people on long term care and with especially.

So it was a great meeting. There's a second one coming. I'm not able to attend, but Laura, Don, our regional health connector will be there. Are you also able or is Laura just representing? Yeah. Okay. So that was a a really nice connection to these. That it just helps us see bigger picture even though, you know, they are very much direct service, the the people around the table, but it was it was really nice to be at that table. We'll continue to work with them.

That's been good. Does Stride community health centers represent?

Not at the developmental pathways meeting. We invited them. They came to our first route health care leaders meeting. Allison wasn't able to come to the second one. So

Are they engaged closely with what we're doing?

Go ahead.

We've been sending them more referrals. We've had multiple meetings with them to kind of develop a relationship around patient contacts, and I think that's been positive, and now we're doing more. I think that's probably the most important thing that we can get our clients, whether it's immunization, communicable disease, or sexual health to get a primary care home. We also refer, of course, be. Yeah. But so I think it's getting better. We had some rocky road there for a little while.

Yeah. I forgot.

Lot of meetings. A lot of meetings. Yeah. And not really any action. So it's getting

You have a facility very close to your main facility.

Within, like Yes. That's right. Yes. Yeah.

We're close enough. Mean

Yes. Close. And Jill just met with one of their docs week. It made how much of? She she also was with on the sugar sweetened beverage meeting that we're we're a part of.

Okay.

And, actually, our our nurse that's the Family Connects nurse, she actually spent about four hours a week there for about six weeks Okay. As part of her Family Connects onboarding, and Meg was also I think she could be, like, a provider champion we might lean into because she's also because what what they realized is we had a lot of information to share about community supports for families that they were really interested for Kenna to bring in to them each week and talk with their providers about. So I do think she's a real potential provider champion.

Yeah. And Michelle said told me that she's doing her I don't know. To get her what is she getting in? She's getting a master's in nursing. Oh. She's getting a

is she gonna walk Yeah. No. She is doing her

Yeah.

I can't remember what it Nurse practitioner? It must be because she's already She is a nurse.

Yeah. So I think Michelle. Michelle Library.

Oh, yeah.

Oh. Oh. She's getting and she has to do a certain number of hours, and she's doing it at Stride. Well and Stride is the school based health clinic provider. I would say provider to provider. And we have worked very hard in the last three years to improve the referral line and

improve

relationships and who's who working on points of contact. We did meet and greets. I mean, we we have worked extremely hard to open up those lines. So from provider to provider for the sake of clients, I do think that that has improved in that better. It it's kinda hit and miss at other levels.

Mhmm.

She was thinking And

I'll just say in response to that. The the notion is if you don't have anything positive to say, don't say anything at all. Would not be saying anything. That communicates my personal experience.

What I'm just curious why you asked. I'm sorry? No.

I'm just I'm curious why you asked about it.

Because we we in all of our discussions, I've never heard of a connection, a meaningful connection. I would think that the health department and the community health infrastructure in the county should be working very closely together, and I I just had never heard of it.

It's getting better. I normally would champion that. In this instance, I would not feel comfortable referring to, to be honest with you, just based on a lot of in addition to personal insight. So just, you know, honestly, that that is troubling for me. So it's beyond and the CEO and the COO didn't respond after Michelle contacted him. So just know to me the trust level is about one or two with them.

Something to monitor and doing, you know, see

what we can do to help. K.

The next two things I want to highlight. Actually, everything I'm highlighting we're looking at is some new exciting opportunities that either we have sought and received or have come our way. The first one being the overdose fatality review team. We were asked, one of nine, by this state health department to pilot the an overdose fatality review team. So thinking similar to child fatality prevention review and looking at overdose, and there's some funding there's was funding that came with it.

Quite a bit of work because in you know, child fatality is set in statute. There is statute that allows counties to do overdose fatality, but it doesn't mandate it. And there's no system set up for it, especially in Colorado. I'll be meeting with the county in North Carolina next week, I think, to talk about how they might do theirs just because it's the only state that mandates it is Arizona. So what's great about child fatality is it all feeds up into a national system, and then you can look at policy nationally, and and that is, like, the true prevention.

If overdose fatality can get to that point, it could take a long time, but this is this is where you start. So we were pretty excited. Did not really have the capacity. We have hired a consultant who has been who was previously employed at Arapahoe and previously Tri County. She ran the child fatality review teams for a long time.

Incredibly brilliant in this space. So we have hired her to take this scope and help set up the process, the procedures, the like, figure out the framework for it. We won't be actually conducting any meetings, any reviews. Her that is not her job. She is to set up the foundation for us as we think about how would we fund this and, you know, how which cases would we we review?

How would we get that data? So it's really exciting, and and we're not sure how we will be able to sustain this. I have some ideas, but shouldn't this be a statewide effort, not an account? I think what they're I don't yes. And I'm not sure, ultimately, what the state has planned. It rolled out very, very quickly. We're not sure. I think we're the largest health department that was asked. All the others are small rural health departments.

So I'm not sure how they decided who they were going to ask, and it was a very, very, very quick turnaround. So I think they needed it out the door. Part of the is to to get them all out. So, absolutely, yes, it would be ideal for every health department as maybe it was possible to feed into a state system that could then start feeding into national system. The trends and what did we miss? What were you know, what are the populations that we're seeing? Where we where should we be? So it, you know, it will be years before we get to that money. Okay. You need so much data to be able to start looking at things.

But that is, you know, beauty and the with the incredible child fatality review as parallel as it is what comes out of it. I'm not just a savings. And we're hoping that we can see this in the return. We just have to put that to see this. So I'll have some ideas on what is good. Is it

about the volume the volume of of of the dose deaths in the calendar?

What about it?

The volume. How many are cleared?

Oh, wait. That's it. I don't remember. It's big. I can agree. It's high. It's really big. Yeah. It doesn't We would not usually I don't think we could could not review all of them. That's part of what our consultants will be. Like, how would we identify which cases get reviewed? And is it a percentage? How many times would we need to do a review? Because it's a large number, and we have one of the largest in the state.

One one would think that maybe a a portion of the county should be done as a pilot rather than taking on the whole county at once.

Yes. Well, we'll we'll see how we need to look at because, you know, it would be, like, like, isolated that you would look at thus, and then we'd go for that, like, how would it be balanced selection? Would we pick up that is a geographic? That's what we need to learn through this pilot and learn from the intent is all of the nine pilots would create a good community that was. So a community.

Not a community of excellence, but, you know, looking to call it as a cohort to learn from each other. And then, you know, it's only it's only good if you're using the same criteria. Because if we're using those criteria, they're using that, and we're feeding this data that they have that. They don't talk to each other. We can't make policy. This is for the work that suicide prevention did two years ago in terms of I mean, I know that was more of a national thing, but it was the same kind of thing. So that went out, but the data is national. Was a little similar to that. I think has I think some of the. Some of that have looked at. Take on the.

Just something

In terms of. I don't know as well. Yeah. Yeah. So we're excited about this and more to come as we learn. And it might be that we're not in a position to sustain, but then we would have the framework. So at some point, that somebody becomes available through the. It becomes a mandate. Would have not we would be ready to go. It's just it's quite a bit of work.

And the

contact goes through the August. So the. Congratulations to the tobacco teams. So to to the the retail tobacco retail form is you wrote a letter of support passed on on consent agenda. So that went fantastic.

So we sent. That's really so soon. But that was really late. And municipalities. That we need to own the securing the regional the transportation assistance grant program.

We're very low, but we have received this funding. So it's not that funding. It comes to us in books like tickets that we can give to clients. And we coordinate this way more about for public health team services and community resources. So we would like to give them the books of tickets to get to their clients, and then we just report. Those well, the first year might be the one and only in our third year. It's valued at around 42,000 $43,000. It's not the those certificates. That's 1,550. That's not that's.

Something else that was really exciting that we wait after, and we thought the team is, you know, quite chance or they don't know if we had a chance of the doubt And the maternal child health to apply for state state state state state technical assessment team staff. Increased capacity for injury and prevention. The chip and work that they have done doing that. Oh. It's a long shower, we were selected.

So I was saying, congrats. It notes on the work that they've been doing in the child control. Violence prevention and. So it really does have a ramp in their application as. So that's exciting. And then we work also to in sexual health, highlights a new program for free birth control. People, it's through a phone app. It's really cool. It really appeals to, younger. But right now, the pilot is only for 18 and over.

But probably 18 to 34, and it is the the TikTok ish using videos, but real people talking about their new experience and getting an IUD or next. And they can get blood control directly. They're really off if they don't need to be seen in that clinic. If they need an implant, then they'll have to go to a clinic. We will need one of the clinics. Yeah. Oh, and maybe there tomorrow. Yes. I will. Mhmm.

So there's a lot of pickup that information sessions we are looking to call and upstream as I forgot one, Sean. You may have known we did not have a communicable disease report this month because the team was extremely busy with the missiles. And they said, just come and give a date, and we've we'll catch you up next month. But it was it's a lot to put together, and the team was incredibly overwhelmed. But Melissa is here, and she gave a verbal update when we're now at the missiles.

Yeah. We've got to write a little bit of, like, a high level view on results and also just more, like, you know, things going on. I would just like to start off that

we were referring to a lot

of numbers, like, case counts, but I just really like to call out that there are people in lives behind all the numbers and just really significant impacts to those lives and families, you know, for the illness that they experienced. So for measles specifically, just kind of starting off with some of our national data, we've had pretty big increases in our first almost three months of the year. So far nationwide, we have one thousand three hundred and sixty two cases this year across the country. So really surpassing where we were this year, mostly, trend for the remainder of the year. There's a lot of smaller ongoing outbreaks across the country since it three cases is considered an outbreak.

But, really, we are really focusing on some of our kinda large ongoing outbreaks across the country. There's still really large ones, the Utah, Arizona border, in Florida associated with, you know, South Carolina. That's a really sizable outbreak that surpassed the case counts of what Texas saw last year. So it's a very, very large ongoing outbreak there. Looking at Colorado, we've had 11 total cases, so far this year, 10 of which are outbreak associated, really impacting the Bloomfield Boulder Adams, kind of Northern counties of the earth and all associated with school.

Ten of the eleven cases in Colorado are unvaccinated school age students. There is one individual who was vaccinated with one in MMR that was at. So it's a pretty high level of exposure for that for that individual. County has had one case this year. It was a resident of ours that actually spent their entire infectious period in California.

So we can probably about full exposures related to that, but we've had pretty, large impacts for an out of state resident that spent time in our infectious in Arapahoe County and in Temera Church service, in Arapahoe County, which was what initially did our activation. So so a lot of work, going on with that. I just wanna mention that both the public up north and our exposure in Arapahoe County have greatly impacted schools, so far this year. So even our church exposure, there is a school associated with that church. So really different than what we saw last year with our measles.

We didn't, fortunately, last year have any schools impacted with measles, and then nearly all of our cases this year have impacted schools. So a really big change in, I think, some preparedness opportunities that we've been working through of our school readiness and conversations with those schools, conversations with some of our partners around how that looks different with those school settings. So so far, just the responses just so far and far along this year have had really large impacts on families, all LBHAs, hospitals, schools, community partners. And looking at, Raffinville County so far, just looking at how we've responded with our activation, we've set 633 person hours just for our up on the county for our activation, the results this year. So a really large amount of hours, and our county has been not as impacted as part of the.

So I know CDPHE is gonna be reaching out to LPHAs to get an estimate on hours everyone has spent because I think they're interested in looking statewide. So with our three months and company, the resources and time that this is. So some of are watching really closely. As I've talked, we've really been working with our partners or schools, our travel care, some of those preparedness efforts. I think we're really watching the analysis.

So we'll explain, like, travel is going on and what impacts we can have. Think state explained the progress in traveling mode as well. And just wanna really shout out all of our internal teams for our activations. These are huge, huge efforts in, like, organizations, APR, community safety, equity, doctor Ravina, our leadership, communications, like, just so many people are called into these responses. It's a a really a really big list to protect our communities.

We've only been doing these also, but looking at just some of the things we've been working on, we continue to see flu positivity, and some outbreaks have a fortune that appears to be declining. With those outbreaks declining, we are increasing seeing increases in outbreaks related to COVID, RSV, coronavirus, GI, and then we're starting to see a big shift towards our rabies season. So probably March through September is related to to rabies. We've had such a warm winter. So maybe we'll just kind of see what pans out for rabies season this year, but we are starting to see increases with, yep, with wildlife.

At first, I saw my first bat the other night, so it's like it's here. I got something back. So we're also working with and are going to kind of join up on some prevention messaging so we can view a little bit of. And then sort of mentioned, we'll provide a more formal overview for next month and then we're going on. How do you answer

Good. This question I had is the like, you have an estimated cost just for the measles component, like, how much your cost is when we have to go through the contact tracing and all that. And then if students are involved, does that change the cost estimates of how much we have to spend a day?

Brianna, I don't know if you have we haven't lost estimate. We haven't assessed it yet. We've done it previously. We could some of those and share those with you of what we've done previously. We will get the estimate, but we haven't assessed it yet because we're still kinda aimed at In the middle of. So that's why that track I mean, the minute eight that's initiated or that we activate. So the spreadsheets start tracking a time. I mean, we currently it's just because we do that. We know that there's not time that we're gonna reclaim. Right.

But for the purpose of packing time, the cost to, you to get back to the state or use it in budget. Mhmm. We do. We are able to calculate that. We can use it for then we have that earnings incident with the puppies. Mhmm. Probably, we will say, you $20,000 that cost us just in time.

Yeah. That's right. But you're asking a good question, And that that's why there's a con common churches, the New Pantry's. And

then without context, and you can see them those contact with small family.

Right. And then another thing I was, you know, saying is do I haven't even communicated that to the public because, like I said, I hear certain about leases that people might understand some of the dangers related to how serious it is. But like you said, when if they understand the time out of school, that this is 2130, I think it really was going to, you know, the calculation of should we be doing more to really, you know, raise the alarm about this.

Yeah. And I think that's something our schools are doing. I a good double flipping push that messaging out. So I know I know there's been efforts to communicate that to the public, and I think there's opportune opportunity. But learning from that outbreak of what's going on out of North, I think start out of schools of, hey.

This is this is what this really looks like. This is the big impact even if they've only heard about it, you know, secondhand. And so I think they're able to then continue with their, you know, of what the impacts really are. We the team just attended actually a webinar from Children's Hospital earlier today. They did they're working on some really interesting modeling of the impacts of outbreaks in foods and how trouble with health interventions of when we host vaccine clinics versus, like, we have no intervention or, we are keeping kids out of school.

What that looks like for the amount of days that kids are out of school and new types of families. And is helping to do some of that modeling to help some of the messaging, because that's really helpful of showing, like, the different interventions that we can do to keep kids in school. It makes a massive difference Yep. Than other those that kids. So I think that I think that is missing.

The the other challenge is that the vaccine hesitancy, this information and disinformation that's out there. But that's one where the other less middle issue can ask about that the cost is. Yeah. And that that the cost is the hospital, it's, So then then you have this argument against each other. It's very difficult if you let somebody who has their side of things about that I believe.

Yeah. And and it's about them, but it it certainly doesn't translate to the community. That's a social and economic impact. Yeah.

So it's been some really great public health wins that have come out of the most recent responses related to some of the vaccine hesitancy. There's been really amazing conversations going on with families who are now impacted with it, who are making a different decision as maybe we had made before. Even with our our church exposure, our immunization staff who set up a vaccine clinic at the church within twenty four hours notice, like, did such a great job talking to families about, you know, vaccine hesitancy and the importance of receiving vaccine, and thirty nine people came to receive post exposure prophylaxis at that time. And don't have the numbers right in front of me of the age breakdown, but I would say, like, ninety, like, eighty percent of those were school age students who then came and got vaccinated and had never been vaccinated before. I know Broomfield and and and Adams have had similar conversations with families who they are now in quarantine or isolation, and they're now going to have that conversation about vaccinating kids.

They only once they're out of quarantine, and I think that that will I think we can build on that and continue to have impacts there.

Thank you for that. Thank you for that presentation. We've had an executive session. Yeah. Okay. So the good news is we are done. Yes. The bad news is we were gonna make everybody stay here to work.

Yeah.