Arapahoe County Board of Health - Regular Meeting

Everybody ready? About ready? Yeah. I'm a call the meeting to order. 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 Sean Davis?

Here.

Director B. B. Kleinman? She's here. Is here. Christine Burrow? Here. Director Mark Levy? Here. Director Mark McMillan?

Present.

Director Terrence Walker?

Here.

And director Michelle Weinbach? I'm here.

I would now like to ask the directors in the room to introduce the staff that are present today. Uh-huh, miss Chef.

Great. I'd like to introduce Melissa Orozco, our communicable disease epidemiology manager, of course, Steve. Hi,

Paul. Operations manager, and Dylan Garrison, environmental health manager. Welcome.

I

will introduce Talitha. The apple is here for community health nursing, and Taylor Roberts here for partnerships planning community health promotion in. I think we got it all.

Thank you. Thank you.

The next item is to approve the April meeting minutes. I'd like to ask for a motion to approve the April meeting minutes. Second. Second. Second. All in favor, say aye. Aye. Seeing none, motion's passed. Do we have anybody for public comment? No public comment. Next, the director's comment at this time. Board of directors are invited to share insights from community leaders and partners to gauge the current state of the community. And I'll go left to right, and then we'll go online. So I'll

start with Mark. Hi. Thank you, sir. Well, in the previous meeting, I talked a little bit about a concern that I have had about self dealing within health care, something I've been working on with Medicaid and trying to get them to pay attention to. I've also been working on workforce and other issues in rural care, particularly the rural care of the older population.

There's some work I've been doing in association with with Pristiq and the commission on aging. It's a huge difference in the ability of our rural community to care for people not only because of the lack of providers, which is which is starved, but also because of lack of well developed community resources, at and and things like that. So there's a lot of work to be done just to keep the keep people healthy.

Every year, Stryker does this thing called the National Fellows Course, which we're inviting all these fellow these surgeons who are in the fellowship and are ready go in the doctor's ceremony. And so since you're right now, our our world is focused on our as they have been going to educate all these doctors as they go into the world of their own practice. So, like, that's really the biggest thing right now in the world of Shaker. More personally,

today's my ninth wedding anniversary. Oh, right.

So the biggest thing similar to Margaret, for me, the the thing that came up this month, May so May I think May 5 was miss missing murdered indigenous women's day. And so I worked with the lead for Colorado New Mexico on that, and they were just going over some of the statistics. And one of the things that I found beyond alarming was when they were looking at abuse among Native American women, the number was eighty five percent of women that went through. And so just thinking about that, and I thought our numbers, you know, in the African American community were high, and it was, like, in the thirties. And so when you look at eighty five percent, what the trajectory is like in a lot you know, because I I do work with KCA, which is the elementary school.

The charter school is the only charter school, I believe, in the nation on the reservation on the Ute Mountain Ute down in Toyok. And so just looking at their opportunity and looking at the other project. A few years ago, a bunch of people had talked about or issue among African Americans with slavery had you know, came up. And one of the things they mentioned is, well, people don't talk about it, but women are being trafficked today. The number in slavery are as high or as high.

And so one of the things, you know, they asked me is, what are you doing about that, or what do you do about that? Because if it was African Americans, would you stand up? And I said, you know, for me at that time, it really caused me to really just say, think about it because they named two of the locations in Denver that are high traffic areas like truck stops. And I said, I consider myself, not to use slang, but, like, white in that sense because I wouldn't know what to look for. I couldn't tell if a person is in distress or anything.

And so I was like, I'm totally oblivious to that world. And so it really caused me to try to spend a lot more time working with those populations, understanding what's going on. And so I just use it as an opportunity to say it's one more area that I have to do more. And so that's, you know, one of the reasons it's, you know, personal to me because I felt, you know, very ignorant in the area and not knowing what to look for and not doing anything. So a

key part of

the work I do is with that population just because I feel like, you know, they're lost. And then I think June, like, June 5 is the 100 and well, it was 1924, so, like, a hundred and something years they got the right to basically, their citizenship. And so just to think about in our parallel with African Americans and what we went through, but just since 1924, we gave them the citizenship. And if you just think about what that means, a country that they own, we gave them their citizenship. So it just speaks to what we're fighting against.

And I tell people I continue to fight the good fight, and I always maintain hope. So We should be I believe hope. Christine?

I the said your plan on eating is a governor's wildly important goal, a wig, which is, like, such a silly term. The wigs. But we're about to close out

our way. We're about to complete our poll, which

is really exciting. The last piece of the puzzle is that we need folks to respond to our survey on how the NPA is doing. You go to aging.colorado.gov. There's a big yellow banner on every single page of our website.

You can click it and talk about the plan. Yeah.

Congratulations. It's awesome. Thanks. Wait. Yeah. Wait. Wait.

Like, I need any more hair.

One thing about this season, and it's in my world, it's graduation season. Right? So many folks I know are celebrating, but it's not just, you know, 18 year old seniors in high school. It's the the time where kindergartners finish and fifth graders and eighth graders and twelfth graders in college. It's the first time in, I think, three years I haven't been traveling for a college or grad school graduation with my own family, so that's kind of nice. And it's retirement season where I work, so a lot of people are retiring. With

all those graduations I talked about, I gotta pay for that. But

it you know, when you spend any time with those kids, and I was just looking at Christine's beautiful sons

and spent some

we got

to spend some time with my own daughters this weekend. My older daughter or my younger daughter ran the cool facts, the full marathon. And my older daughter came in from DC where she lives and works to surprise her sister. Oh. And so much promise, right, when you think of all those people I just mentioned, kids, people who are retiring, and, you know, when you're in a graduation, you see that sea of kids and and just all that promise.

And and talk about hope floating, I I believe in that too. I I implore the adults. I wish there were some county residents on the call, but I implore our residents to remember that promise and think about the promise of those kids and what what they deserve, what every single one of them deserves. And I believe if we could just get to some common ground thinking about those kids and our retirees and each end of the spectrum, that perhaps we might be able to quiet down the noise and fight down the magnets a little bit

and get back to that promise. You running for office?

I'm You got my vote.

Very happy.

Baby or Mark? Baby?

I'm gonna skip because I'm driving. I'm really close, but this is not.

I'll go. Thank you. One big effort that folks are probably aware of in city and county Denver is the data center moratorium. So Mhmm. Denver City Council voted 13 to zero to have a moratorium on data centers. As part of the the process, I have a role as subject matter expert on environmental issues. I'm really proud to be a part of that. There was a lot of discussion, and this is public knowledge. I'm not sharing inside baseball in terms of potential outright bans on data centers in Denver as you look at just the the consequential nature of these facilities. So it'll be a long process.

Anticipate probably a year, maybe longer. And a lot of passion, had over five dozen individuals who came and testified in this space. Probably 90 or 95% of them were in favor of the moratorium. It was a six hour meeting to make sure that we all heard from the public on this really important matter. Excited for where it goes from here, but this is something that's really critical. The one facility that has gained a lot of attention is in the an environmental justice neighborhood that's already been disproportionately impacted. So I'm glad to see the city take an important stance in this space. Still a lot of work to do. Excited about some some next steps here. Thank you.

Thank you for that, Mark. The next, we're going to move into our general business item. The first one is the approval of separation agreement for directors of public health, and Monica's gonna present.

Thank you. So this agreement is really mistitled. Oh, dear, miss sweetie. Very much so. Think of it more like a prenup.

So it's Be careful now. All the department directors in the county have an agreement that if they are let go by the county, then they will get a six month separation agreement. And so that's what that's what this is. And and the county attorney's office has realized that there's four directors that just when they were hired, the agreement was never executed, and so we're just kind of going around and getting these done. And so for the public health director, it's the board of health that has the authority for signature on this, and so that's why it is being brought to you.

So the question is if we don't fund, does that mean Jennifer will have to get to stay with us forever? No. But

We'll be

Oh, no. Well, in that case, we're we're we're pretty happy. So if the if the any of the members have to make a a correction because I'm gonna make

a motion Just with the title. Yeah.

I know. Yes.

I I read the title. I

warned staff. I was like, please, whoever is coming, please let them know. Like, this has to be done in a business meeting. Said, Monica, do it really well. This one's gonna panic. There's no separation. Yep. But it is. Yeah.

I move for the board of health to approve and execute the separation agreement for the director of public health department. Is there a second? Second. Seconded by Terrence. All in favor, say aye. Aye.

Aye. Any

opposed? Hearing none, motion passes, and Jennifer will be with us the next ten years.

Limiting. No.

It's at 8PM on the morning.

Yes. And definitely. And we're we're now gonna move into our study session time. The first study session item is an open question and answer of the proposed environmental health theme by Kristen Byers.

So I'll just add a quick layer of foundation. So this is a follow-up. We said we would bring it back. If you have any questions or concerns that have come up since last presentation, we allotted 10 for q and a. If there's anything else you would like to add that may have changed from last month, but if there's nothing I checked the surveys. There was one that there's no ability to add. We prioritize food and subject symptoms, which,

you know,

was different than what the other one were. But when we asked a question about subsidization schools, it didn't rise to the top. So nothing nothing meaningfully different than what we've heard. No

discuss Okay. So we'll we'll move into our second study session, which is the core metric spotlight on the communicable disease epidemiology by

Melissa. Beautiful. I'm gonna click out of the little bit thicker today.

So hi, everyone. My name is Melissa Orozco. I'm the communicable disease epidemiology manager. Our program is housed within health protection and response division alongside environmental health and emergency preparedness and response. While I'm immensely proud to share about our program today, I really just wanna highlight our incredible staff on our program, Jeremy, Shelby, Maddie, Alex, and Nina, who really make all this work possible. It's not gonna be to present on it, but

they do all the incredible work.

And I'm sure if you've listened to me do a presentation before, you've heard me mention that I will be referring to data, cases, outbreaks, but I'd always like to acknowledge that these are real people and lives and families behind each of these numbers. They're not their experiences cannot be understated, but, also, there's been as well. But starting off with some stories for our program just to kinda before we jump in through the data, really what is the program. So just a few that were submitted by our staff that I'll read directly. So over the past three years, I've built a strong partnership with the Arapahoe County Detention Center as the communicable disease point of contact.

This partnership is grounded in trust, consistency, and shared purpose. Beyond coordination, we've developed genuine relationships and care for one another. Across all ACPH programs, we've created a strong public health support system for to protect one of our most vulnerable populations and highlighting that correctional health is. And then one that was from one of our residents, a recent client was scratched by a bat outside of her home. She was nervous and overwhelmed about the process for getting rabies vaccines and was also traveling to New York during her vaccine schedule.

I explained the process, and he called to her, provided the vaccine options for her doses in Colorado, and called the New York City Department of Health to find out where she could go while she was on her trip. She was able to get all her vaccines on schedule. She sent a really nice text, which reminded me of how impactful our work would be, and I've included a screenshot of the text from the resident which says, I know you said it's your job, but I just want to tell you that I've never ever, ever received so much care and kindness from my government agency in my life. I didn't expect your advocacy, and I so appreciate it. You have helped me take it very sil seriously because of your example of your diligence. It's a big thank you again,

and I hope you have a a great Yeah.

Sounds great. I think it just really highlights, like, the impact that we can have with our partners, but also our the relationship that we can build with the connection with our residents. Next slide, please. So looking at our metrics, the first metric that we use to track just the impact communicable diseases have on our communities in order to protect the health and safety of County residents and the general public. We're using this information really to prepare staff for upcoming and new infectious diseases, provide necessary education so staff can appropriately respond to those diseases, and then educate the public on what illnesses are impacting their area.

And we also wanna make sure that we're maintaining proper staffing capacity to effectively respond to, you know, disease threats. And so we continue to monitor disease trends over time compared to the previous years to understand the impact these things have had such as, you know, seeing impacts with climate change, travel, spillover events, and vaccination rates in their communities and how those are impacting the the time the amount of illness that we're seeing. So the data that you're seeing on this slide represents all investigation data from 2023 through the first quarter of this year, including an average line for each year. We decided to use an average to visualize these changes over targets because we didn't feel that it was appropriate to set target of illness that we want in our community. Of course, we want zero, but we also realized that that's that's not realistic.

So that's why we're kind of using an average to to visualize that. So these data include the number of Colorado reportable conditions, outbreaks, and animal investigations, and animal investigations include both domestic animals, so a dog bite, or rabies, reservoir species that are completed by our program. It's important to note that in Colorado, we share investigation responsibility with CDPH and at the local level. So there are certain conditions that we follow-up with and certain conditions that the state health department follows up with. So this is only representing what our our core team is doing.

As Raja can see, we've been monitoring a fairly significant increase in our workload since 2023. Some of these increases have been attributed to several measles responses that we've talked to a few times, increases in respiratory outbreaks over the past few years. And, really, one of our main program goals since we opened our doors as a new health department has been really building strong relationships with our community partners. And so I do wanna mention that a possible increase in outbreaks would be because our community partners feel comfortable reporting to us. They know they use the report to us, and they know it's not gonna be a punitive response, and we're gonna work with them on mitigating the illness.

So while that will that does not impact the report, the the reportable conditions, increase of using over time, it's possible that outbreaks have increased just because our partners know who to work with and that they feel comfortable doing so. And then as I talked about, just understanding our resource needs of our our staffing and capacity to respond to all of the illnesses within a reported time frame. Each of the outbreaks and reportable conditions have a required time frame that we're supposed to respond to them very from immediately reportable, so we need to be responding to them right away versus we might have four business days to follow-up. We just wanna make sure that we're meeting those time frames.

Yes. That's a pretty dramatic from 2004 to 2005 to 2025. The do do you have a breakdown to better explain it and particularly the the marked increase also in the first quarter of this year?

Are are

we going to see a further increase, do you think? Do you have any explanation for what's going on?

Yeah. We can certainly, in a future meeting, look at a breakdown of illnesses. I would say a lot of these increases are related to I mean, we are seeing a general increase in illness overall, and it does account for outbreaks as well. But we've had a lot of measles responses in in '25 and '26, and what is also captured in here are all of the contacts from those investigations. So we might have had actually, I can't remember, maybe five pieces of measles last year. I'm sorry. I'm losing track. Top of my head. But then we have hundreds of contacts that are exposed, and then those require contact tracing investigation. And that's captured here so that we can see the amount of people that are impacted by all these responses and the workload that it takes on our team to do all that outreach.

So that is certainly driven from some of that, and we've had the sales responses within the first quarter of this year to to drive some of that. Also, for the first quarter of twenty twenty six, we've had a a a pretty significant influenza year. We've had a lot of influenza outbreaks and hospitalizations due to influenza, and so that's definitely captured within the first quarter of.

But the trend upward trend could be

a result of just more as well, not necessarily more z, but just more reported on cities.

For outbreaks, we would anticipate that any increases we're seeing in our reportable conditions would be a true increase because laboratories and providers have always had the requirements to report those to us, and a lot of commercial laboratories just haven't automatic process. So any increase there, we would expect as a true increase. Whereas, outbreaks, they could definitely be partnering relationship building that has led to

and

then our separate second metric that we're tracking for our program is to look at the amount of events and trainings that our program has hosted or presented at where we're providing preventative communicable disease education or we're sharing communicable disease data. And as I've talked about, the one of our goals is really to understand how we are working with our community. It was really, you know, developed so that we can understand how preventative, communicable disease education is being disseminated across our community and works towards that goal of us, like, developing that trusting relationships so that they feel comfortable reporting to us so that we can really mitigate disease spread. Because a lot of facilities can feel a little intimidated to report an outbreak, you think it'll be punitive. So that's that's part of the intention behind this goal.

And we also wanna make sure that we have insight into the areas of Arapahoe County that we are engaging with to advance our efforts to ensure equitable access to public health services across the county. This is a new program metric, so we decided not to include a target because we didn't have any previous data or standards or requirements to base them on. So we just really wanna get a baseline of what our program is doing. And we've averaged two to three, like, formal events per quarter, including including community partners such as our infection preventionists at our hospitals, health care coalitions, schools, child cares, detention facility, our community mental health organizations, military staff, and gunner control. While this continues to be an important goal for our program, we have encountered a bit of a gap with this metric because most of our work is spent on the phone.

We are our team is on the phone all the time talking to residents, community partners, You know, he's just worried people who wanna call in, and this does not capture that. So, really, our team is spending their whole day providing preventative, you know, disease mitigation, medication to community partners and residents, and this isn't captured here. There's not a great way for us to capture all those different interactions. So these are truly just one of those more formal events. And then as we've seen in the previous slide, our increase in our workload does impact our ability to host more formal training events.

So it's something that we're gonna continue to monitor over time of the, you know, intention of this specific metric for our program that isn't really measuring what we will get to measure for our program versus something to adjust going forward.

Where would you say is the most what part of the county and which group do you think where is the most need to develop the strong and trusting relationships? Where do you think the the most work needs to be done?

It depends on the, maybe the community organizations that we're talking about. I think there's just you know, we're still relatively new as a health department, so I think there's just over time across all sectors of our county. It's just gonna take time to build that trust. You know, I think there are some school districts that we work with really closely and some that are still hesitant to work with us after COVID. So I think there's some work to be done there.

You know, in terms of our animal controls, fast abilities across the county of staffing capabilities, and so I think there's work to be done there. So I I think different organizations have different needs of where we, you know, still need to work on that relationship building, and it's it's very variable depending on the groups that we're talking about.

Next slide.

Yeah. So looking at some of our working opportunities. So some of challenges, I've mentioned, really, we're just monitoring that significant increase in the seasonal overall and kinda what that trend might do over the next few years. You know, we didn't have complete data, you know, prior to Arapahoe County to really monitor. It's gonna take a few years for us to know if it's a true trend or, you know, I think really what's gonna happen with measles is gonna be important to, like, you know, how that that continues to increase or or hopefully decrease.

And so with these increases can come constrained staff capacity at times. So especially when we're activated and responding to incidents such as measles, we continue to experience limited resources and support options for individuals and families that are impacted by isolation and quarantine, you know, and the needing to stay home from school or work. So that continues to be a challenge that we just try to work with our community organizations and what resources they have available to help support folks who who need to stay home for an extended period of time. And then, of course, we we have experienced some staff burnout. We have increased workload, responses, increased hours, which is a really big focus for us.

It's priority, you know, prioritizing our residents and also the our staff as well. And then our our second metric that I just talked about, challenges, just capturing the true numbers of

our educational

interactions. Some of the actions that we've taken to continue to work towards this, we've really increased our coordination with our communications and other county departments to help support preventative education opportunities and message sharing. And in the past, we've worked with open spaces to help share, you know, interacting with wildlife, and it's rainy season, like, kind of in the open space area, and a lot of work with our animal control and our detention facility out there. We were fortunate that we were able to hire a fifth epidemiologist in the fall of twenty twenty four to really support this increased workload. And we just continue to evaluate workflow prioritization, especially during incidents where we can so that we can just continue to support the park communicable disease work and our requirements and actions there while also balancing.

We're not a good team. So, you know, the the time offer goes well. And then we have been able to as I mentioned, we've been able to find some really creative solutions partnering with community organizations to support residents and families, such as, like, mortgage assistance, food delivery, housing support, just to try to to help folks through the resolution of quarantine. And then as I mentioned, just the commitment to our continuous focus on staff well-being really prevent some of that burnout. And just trying to, like, what does this mean for our team?

What are the priorities for each person? Really wanna give a big shout out to Jess Gomez who has been doing a a series with our team and several other programs throughout the health department for well-being and resiliency to really support our our staff well-being piece. And then we just continue to focus a lot of our efforts on partner outreach and relationship building to support. And then some of our our path forward and our wins. You know, I think most important is we continue to support our residents and facilities with infection prevention and disease mitigation every single day.

We are a twenty four seven team, so we're on call. So we are available to support our community anytime they need it. And so I think that that is our biggest takeaway, and that's something that we're continuing to be so proud of. I have to put our one of our one of my my big wins and for our team is we just have such an incredible team, just truly dedicated individuals who are are just so wonderful to work with and so dedicated to protecting our community and lifting each other up and just really supporting each other through the through some of the difficult times. And even with our increased workload, we continue to reduce all of our cases within our state required time frame.

So even when we are activated, we have, you know, have systems in place to make sure that we're still responding to routine work within our required time frame while we're responding to something as measles. And we just continue to feel that relationships and trust within the community are just growing with each interaction. I do feel like even and I think some of the reporting is part of that, but I think we've really developed some strong relationships with community partners. And each of our interactions, even with our residents, they just continue to feel better each time that I think people are really certain to hopefully trust the health department, especially post COVID. It'll be a little bit of rebuilding time.

And then just we have we feel like we have really strong partnerships with our counterparts across other LHAs and CDPHE, which is so unique in Colorado and just folks who are just so willing to jump in and support each other. When we are impacted with the measles response, other counties have jumped in to help support interviewing our residents and vice versa. I just think it's really it's really unique and special that we have such a strong relationship with our counterparts across the state since we know illness does not stop at county lines. It's really a big effort that we keep together. And just a huge one is just the continuous support and commitment to our staff just on the thirteenth so

they work each other through

through each day. Some of our opportunities, you know, as I'm sure for many of us, you know, we just have continued opportunities for workload prioritization and workload management where possible and where we can. Continuous partner and community engagement is something that's always an ongoing effort and just really working to continue to enhance those relationships. And once we have the relationships,

we're going to maintain

them and maintain that trusting partnership. And then just supporting each other is always a priority and something that's also never done, not because

we just continue to improve and

care for each other.

Any questions?

I noticed that you may have another so smoothly with for so long. It might be it it it might be interesting.

Yes. New relationship opportunities and also a big thank you to to Chris. I think Chris is, like,

part of our team.

We've had a really close relationship with Chris. So, you know, well, knowing him still, Chris is. Give

a shout out to.

Maybe we could stay.

Yeah. That's fine. It's

been good. Happy ten years.

Any other questions, comments? Thank you. Thank you.

Thank you.

Our third study session item is the introduction of a review of the Board of Health Bylaws by Monica.

Alright. So I hope all of you have a copy of the bylaws in front of you. And so by statute, you all are required the board is required to have bylaws in effect. And we have had some minor changes over the years, nothing too substantive. But my thought is I can go through here and talk about the various sections and what is required to be in here, what is in statute, and then what are things that you have discretion on to change. Alright. So the name, obviously, the Board of

Health

of County, the purpose is set forth in statute. The board is made up of members that are appointed by the board of county commissioners, and the BOCC also sets term limits for the board members. The duties and powers are all set forth in statute, so this is just summarizing what is what is in statute. Section five is about conflict of interest and ethical conduct, and here, we're just referencing that Arapahoe County informs with the ethics rules that are in the Colorado revised statutes. And then if there are any conflicts that come up for any of the members that you will bring that forth and potentially recuse yourself from voting if there is a conflict.

Then moving on to article two. Yeah.

Allowed to add to any other, Monica? Yeah. Okay. I just have, like, so for section two purpose Mhmm. One of the things like that, the board shall carry out its responsibilities in a manner that promotes health equity, community trust, transparency, prevention, evidence informed decision making, and accountability to all residents of Arapahoe County with particular attention to communities experiencing disproportionate health burdens. So it just speaks more to what, you know, we do

and what we stand for as a county.

Yeah. Sort of a vision statement of the board of health. So if you wanna make changes, we will go through all of this, but then I would ask you guys to send me your red line track changes. Okay. Once we have that, we can come back and talk about what all the various proposals were.

And and then before it's finally adopted, then it will need to be sent to the board of county commissioners to for them to just weigh in if they have any concerns with what what is being added or taken out. And then we could come back and have a final vote on it. Okay. But our if if you all have any questions or thoughts on Sean's proposal right now, we can talk about that right now. But otherwise, just feel free to send me your red lines. I like it.

I think it aligns with what we've been talking about for several years now in terms of putting equity in the.

So

moving back to article section one. Mark has his hand up, so I'm just gonna

Thank

you. I just wanna make sure I was clear. I cut out a little bit. So, Sean, I caught most of what you said and and agree with what you'd indicated there. Is that into the purpose section is where you're envisioning that sort of vision statement? Okay. Thank you.

So article two section one discusses the designation in terms of office that there will be a chair and a vice chair for the board, and those positions are elected annually on our first meeting in January. And

And I also do uh-huh. What? Do we need to have timing on that? Timing. Like, that

we will elect a chair and a vice chair in January in the bylaws or cannot just be at our

So it it does say that it will be elected annually at the November 1 ending of each calendar year. So yeah. And then the last sentence talks about that the officers may be reelected and that the same person can serve in the position for three consecutive terms. And so if there's any thoughts on changing that, we can certainly talk about it, but that's what originally the thought was is that for continuity that a person doesn't have to be reelected every year, but they can be for up to three terms. Section two discusses qualifications.

And, again, to be a member of the Board of Health, you have to be appointed by the board of county commissioners. Duties of officers, which is for the chair and the vice chair, they are the ones that meet with the public health director and set the agenda for these meetings and as well as have the responsibility to run the board of health meetings and to ensure that everybody on the board has the chance to speak freely and have their input heard. And they are also the signatory for the Board of Health. Article three discusses meetings. So regular meetings by statute, you all have to meet at least once every three months.

Given the scope of everything that Arapahoe County Public Health does, we meet once a month. And and it also discusses that the meetings will be video conferenced or telephone conference is also available and that we will comply with the open meetings records law, to make sure that notice is provided to the public in advance. Special meetings are also available, and those just are additional meetings that may come up as necessary. And we will follow the open meetings law for that, which is just requiring notice to be posted twenty four hours in advance. And there's a location on the Arapahoe County website where all of our notices are and agendas are posted, as well as the video recordings of our meetings are located there as well.

Mark, I noticed you had your hand up. Are you did you wanna add something?

No. I pulled it down. Thank you.

Section four, quorum for meetings. So to have a formal open meeting, you do need to have a quorum of the board, which is for you all on at least five and oh, sorry. Four. And as well as to vote on any item or any motion to pass, you would need to have a platform. And then to enter into executive session, you do need to have two thirds of the board present and and to vote to vote in. So

If on the special meeting this one isn't a special meeting, but one of the thing is if we could mention in times of emergency, there's been a few times we've had to called. So if we could, like, speak to that, like, during a declared emergency disaster, disease outbreak, or urgent public health matter, the board may convene special meetings as permitted by law and may use remote or hybrid participation methods to ensure continuity of governance. The public health director shall keep the board informed of significant emergency actions, risk, communications, and resource needs.

Okay. Yep. That sounds good.

For conduct of meetings, we referenced the Robert's rules, which we went over a long time ago, just how we make motions. And if there are public comments that we generally limit them to three minutes per person. Go ahead. Go ahead, Mark.

Regarding section four on the quorum, I'm thinking about that because it I think it's the first time in three years I've been remote. Would there be value in adding language that a quorum does include individuals who are joining remotely? Just to bring some clarity and some transparency to that section, or is that not necessarily warranted? Thank you.

I mean, we can certainly add it. I think that it's covered in sections one and two referencing that meetings can be held by via video conference. And so anybody that is attending by video conference, is

if you're still sound, it is present.

Thank you.

Yeah. We can we can add language about attendance electronically.

Yeah. And just specifically,

you know, to the core section.

Thank you.

I'm

sorry? I just said thank you. Yeah.

My recommendation was specifically, you know, bringing clarity to section four on the quorum that, for example, a board member can participate and vote virtually.

So voting is referenced in section six that you do need to have a majority for a a motion to pass. We can add oh, this already has language about the voting of board members in person or video conference or teleconference is permitted.

I'm seeing that now. Thank you.

Yep.

So, interestingly, the voting of board members by proxy is not permitted. So Is a county thing? No. It's a statute thing.

Yeah. Would

it be any different if the person's avatar was there?

Yeah. Because I think that's gonna be emerging. That's exactly

six months.

Yeah. Section

seven discusses meetings of minutes. So we record meetings of our minutes, which is really we have a reporting of of the meeting that is put with the agenda as well as for any general business items. Hannah does take notes, and those are reflected then in the meeting minutes of if there was any actual substantive discussion on on topics. We don't do that for study session items, but we do do it for business session. Article four discusses committees, and this is distinguished from internal committees within public health, like we created the financial committee that Mark is part of.

This is more if you all decide that you wanna have a smaller group committee created of board of health members, that that then you would need to have at least two people from the board be on this committee that you can focus on special topics if you so choose to do that. And I have in the past brought up whether you all wanted to get rid of this section, but it was thought that let's just leave it in because we may, in the future, at some point, decide we may wanna do that. But so it it remains for now. But it will be treated just as another board. Article five is about records.

So

the Monica? Yeah. Yeah. We have Did I

hear you clearly

I'm sorry. Did I hear you clearly say that the financial the finance committee, sort of the subcommittee is not a committee per article four?

Correct. That is an internal Arapahoe County Public Health group that you are just part of to represent the board, but it is not a committee of the board of health.

So a committee of the board

of health would be would be at least two of you.

As long as we just keep it to me, it's it doesn't become a committee. So lowercase c.

Yeah.

Yes. Works

for me. I got a great team around me. We're not a committee. We're just a great team.

We are a great team. It's really, you know, best practice and something that FAB like, we're following for FAB and RMS and FMRS. So it is a best practice. And we created it, but I hadn't thought about it as a separate so little c committee. Mhmm. Yeah.

Thank you.

Records are maintained by the public health director really by the agency, and, the department is treated as the custodian of all records. There's a reference to the Colorado Open Records Act and that the Board of

Health will comply

with it as well as that the minutes and records of our meetings are subject to the Open Records Act. And a reference to the fact that the bylaws will be adopted and approved by the Board of County Commissioners. And then finally, article six discusses the authority for these bylaws, which is set forth in statute that you are required to have it, that you have the ability to amend it at any time.

Mark, can I see something else?

Yes. Mark.

Please go ahead and finish that on article six, Monica, and then I have a a new question.

Okay. And then to amend the bylaws, it will it does require a vote of at least two thirds of the board members. So that's just so that it represents the majority of you, not just the quorum.

Can we put it in there to review the bylaws? Because we

don't have any plans. So, like, maybe every other year or every three year, bylaws have to

be reviewed by the board. Mhmm.

I mean, we can review it annually as well, like, in January when you all vote.

That would be good.

Do you wanna include that? Mhmm. Okay. So that you all know going into January, hey. Let me see if there's something that I wanna add to the bylaws.

Does this call for a motion? To amend the bench. To amend the well, for Sean to sign it.

Once it's approved, yes. To approve.

Yes.

Well, whoever the chair is of it. Mark, what was your question or comment?

Yeah. Thank you, Monica. So my participation in other boards in the past has has brought up a question for me in terms of liability that the board may have in terms of some of the decision making. And I wonder if you could speak a little bit to that, Monica, in terms of any any liability that the board or individual board members may have for, for example, for decision making, or decisions rather that we make. And Yeah. You know, if that's something that warrants going into the bylaws, it provides some transparency in that that that place. So I could expand on that a little bit, but I wonder, Monica, if you can respond to that for the board.

Yeah. So we can include something in in the bylaws. It is part of the public health act. There it specifies that the board of health members are essentially treated as government employees, and you do have protections of CGIA, which is the Colorado Governmental Immunity Act. And so in that regard, your decisions and involvement on this board is protected and subject to the limitations on liability.

The only except for if liability is waived in in your case, it wouldn't be. There's specific way there's waiver for various things, like, if you operate a motor vehicle or there's various exceptions. For you all, the only exception would be if your conduct is willful and wanton. If you do something that's not I'm very if you're prejudiced or wanton. Yeah.

Yeah. Willful wanton conduct is is a waiver or there is no protection from liability under the CGIA. But aside from that, you all do fall under the protections of that statute.

So we might have to discuss your coverage, Mark, because she said there is contingencies.

But, of course, I would suggest that, with with consideration from the board and, feedback from the board that there's some additional language that goes through the bylaws. I think it I think the point the point on liability and just even the the short response that you provided there, Monica, is really helpful. And so future board members, you know, can understand the role and responsibility and also sort of the the their obligations and and liability there. So just like we had a a friendly amendment to the bylaws earlier, I I could see a couple sentences or even a paragraph appropriately placed into the bylaws that that provides a little bit more context to that liability piece afforded to board members. But I kinda welcome feedback from my my my colleagues.

If we could add the I think, like you said, speaking to what you're talking about, Mark, if we could add language around what the public outstating that the public health act protects us and what what it actually says in the bylaws, I think that would be good.

Yes.

Yes. I can include language from the Public Health Act as well as the Colorado Governmental Immunity Act that would apply to you all and specifically, like, what the exception would be.

Thank you.

The only thing that I

see potentially missing is, like, a nominations process. Like, we don't really have a nominations process for officers. It just is, like, we're, Sean Wavy or Cherigan, which is fine. But is there

It's up to you. I don't

really know how a nomination process would

work. I mean, I just look at it the

way that the BOCC does it, and it's just sort of, like, internally, they just say, hey. Who wants to be boarded here? There you go. Right. But if you wanna make it more formal, it's

I think we need to.

We could I mean, I sit on the boardroom. You have a nominating committee, which would Right. Be that would be one of the committees. Two of you, then you're seeking talking with each other. Who wants to do it this year? Then you present the slate, and then you vote on it. So it could be very formal if you wanted to. We could add. That's it. Like,

it's that seem, but it strikes me that we don't have a strategy outlined other than, like, maybe you're in your head share.

Well, so actually

Yes. We did. Have five more

years. Yeah. Talk about it. So normally, happens, Christine, we we gauge interest in DMV. And then I also talked with the members and volunteered to coach or just say walk them through so so that we're not just

leaving people that could yeah. I

don't think this needs to be in the bylaws, and I think that we the the timeline is different than the bylaws. It's typical when, say, September comes, we we put a request out to the board. Is anyone interested? And then at the October meeting by the October meeting, people of interest have even talked to Jennifer or Sean or me. And and if we don't get interest, then we start you know? But we found on people and so people know what the next years is gonna look like by the December meeting. So, you

know, the time of the afternoon. But not Not

a bible. That's a rule. It's a

rule. Not in the bible.

Yeah. Like that. Right.

But do we need do

we need to write out that rule and have it as a form of rule?

Would you feel more comfortable with it right now? I I I'd say it's up to the group. We have total discretion. It's up

to y'all now. Do we have a

rule up to it? I guess we do have.

I our operating maybe then.

We have we have right down the middle.

Right? Don't be. Don't be.

That's right.

Oh, yeah. I mean, I think the September deadline, that's more of, like, your internal, like, best practice is how we're gonna handle this. But I'm not sure that it rises to the level of it having to be in in the year.

And and it could be on the agendas. Like, know, we keep a year's worth, and we could say whatever. This month, it's on the agenda for discussion, and then we can solve. Yeah.

We can do it that way. Like, I mean, we plug in budget, officer selection Right. Nomination. That could just be part of the timeline, and then we fill in the gaps. Yeah. I think that we can we can do that when we create the 2027. But well, we'll add that if it isn't already for the rest of for this year, and then we'll just it'll be the following. Okay. Yeah. Yep. We can do that. Easy.

So in September? Or do

we need four month I mean, we have meetings September, October, November, December. Are we concerned with I don't know what the date on the December meeting is. It's sometimes it's the third. It is the third week is the week of Christmas, then we're we can have trouble getting people. So we might have I don't know what their dates are. I think it's gonna be the the sixth

The sooner the better in case just the And, also, if nobody wants to, then the chair and and vice chair have to start talking to people. Yeah. So you know? And if we have a sense of who wants to serve come January and and we know that in September, then we don't have to bring it until January unless there's term

of the board. So my preference

is to always do things earlier because then we have plenty of time to

Well, and especially if there was because our first year, Sean and I, we had a lot of after the first year, had a lot of turnover. So county commissioners needed their time too,

k, to go through a process. Right.

That Okay. Become our standard.

So I think, Sean, you've been keeping a list. So if you want to send Yeah. Out the or send me the red line Mhmm. Then I can at least then even submit it to the VOCC to ask if they have any questions. Sure. And then at our next meeting, assuming I'll have heard back from them, if they're all good with all of that, then we can come back,

and you will vote on adopting it. That'd great. Sounds good. Speaking of the comments? Yes. Can you send that language to everybody? Mhmm.

Yeah. So we're gonna move into our fourth study session, which is the legislative update by. Thank

you. Hi. Don't worry. I'm simplifying discuss officer roles in September. Alright. Am just giving you a verbal update because there was not a whole lot that changed from last month's printout. And session ended last week, and there were a total of 626 bills introduced this year. Public health, we reviewed approximately a 100 of those bills there in our tracker. We actively tracked 14, monitored six, and took action on three. And most of those were introduced early on.

And the one so I'm gonna highlight two bills. Senate bill 32 was promoting immunization access. That is the bill that Chris testified in support. There was a lot of action around that bill. It did pass in March, and the governor signed into law.

And then, yeah, that was a huge win. House bill twenty six ten thirty three was expanding the Cottage Food Act. Dylan served on a task force with CALFO and testified against the bill. The BOCC voted against the or took a position against the bill. It was it was all over the place.

It landed in appropriations for a really long time, and we thought that and hoped that maybe that would kill it. But because it this was a a priority bill, what they had done is there was an earmark for raw milk, and they killed any chance of that bill, moved that earmark over to cottage food. So it was just kind of a wash, and it passed. The good news, I guess, is that there were a lot of amendments, and we were very active in those amendments. We being Dylan, the task force in CALFO Okay.

Working along with Arapahoe County lobbyists knowing that, you know, we had taken an opposed position, worked on their end too. But some of the key amendments and some of the key things in the bill, if it were to pass, you know, at least some of those amendments made it in. But producers must register annually with the state health department. There's a cap of a $150,000 in earnings, which is huge. The current Cottage Food Bill Act is 10,000 per product.

A 150,000 is big, but they can't do that. It does limit to one food type up to five flavors. So that was also highly contentious at the beginning because it was unlimited. So I don't know what one how that will change with five flavors of one food type. It can still require a lot of different

components. May ask a question about that 150,000? Is that, like, a net that they make or a gross that they I mean, it seems like a big number for someone selling burritos or canned salsa or something. But, like, how are they gonna monitor? Like, someone buys a $100,000 in product. I mean,

Right? It's it's sort of a guideline that hopefully people will follow. It's in our system, Bill, in many ways. Okay. But it does send a message. It does set a guideline. It does set a thought down. That's the idea. And to your point, no one's gonna come anywhere near that. If they were, they'd move into a mobile unit or a restaurant.

Mhmm. Yeah. The bill does require food safety courses and education. So our CSU extension office offers those already for cottage food vendors or those who want to be. So now it they will have to expand their curriculum to include cold and hot temperatures and how to, you know, move food safely. So that is, you know, an additional work for them. But their classes are always full. They're well attended, and they do a great job. Yeah.

And and there's no really need to monitor. So I'm one person, and I have five businesses. Five burritos, five tortillas, you know, five salsas, but I'm one person. But I set up five

Five menus. Jennifer's comments, you're required to register with the state. So I wonder how they would look at that if you were trying to sort of do five different or multiple types of TCS foods as the same vendor. That sort of defeats the intent of the bill. I wonder how that would play out, but I'm sure folks will look for the polls.

Yeah. Because when you go to a farmer's market, like, one table has 10 different products, not flavors, different products.

And Right.

So I I don't know how they'll

So, yeah, I think the important distinction is the traditional carnivorous foods, which aren't TCS, right, aren't time temperature control for safety. They can do those sort of unlimited. But if they are doing TCS foods as one food item with five flavors, and they deviate from that, there is language in the bill that allows us

to find them, and it

could affect the registration at the state. So, again, there are some guardrails, but we'll see how we're doing.

But you could be a a mom, a dad, and six kids each have each could be registered and be at

the same table. So both confessions. Well, this will be a system that There's a There's a lot of details, and and that's where the money went to the state health department to Right. Manage this program. So and as Dylan said, there was language added, I think, kind of at the eleventh hour that allows some local not controlled, but local inter action.

If we have local action, a complaint or concern or an issue, it does allow us to charge fees for violations. We can do inspections, but we you know, that's inspecting home kitchens. That's probably not gonna happen. But it, you know, it did allow some local action in coordination with the state. So that could be good or bad.

Because if someone gets sick in Arapahoe County, you'll be tracing

we received a call that they linked it to Yeah. A cottage food vendor, then we would look into it. But I think that's gonna be really hard. Okay. I think, you know, people, as Melissa can say, you know, trying to do food recalls of where you ate three days ago, a week ago in a food, like, a cottage food burrito, like, may not rise to the top. They're gonna blame the most recent restaurant that they were at.

The accountability piece is there's

a labeling requirements. Always have been. The registration number needs to go on that label. At least there's some availability of the trades. But, yeah, questions about time, resources, funding, that's a big concern.

And one thing in this bill, it explicitly says it does not allow the sale of raw milk. Imagine that that would probably could pop up again next year, but, you know, we will have a change in leadership. Mhmm. So we'll see if that pops up. But at least it explicitly says that this is, you know, this is not the loophole to sell raw milk.

Mhmm. So that was we knew it was gonna pass, but working on and working with the sponsors and our lobbyists to get some of these amendments put in was important. It landed in a a decent place. And then the last thing I'll highlight is the the long bill just because the funding cuts do impact us. Mhmm. And we talked a little bit earlier, but maybe you were not with us. So there was a $3,000,000 cut to local public health agencies. That's across the board. It's a continuation of last year's cut. It's a little bit less of a cut.

I mean, it could have been worse, but it's still we'll still see a reduction, not an additional reduction. And that's the one that they negotiated with me. They they were able to negotiate with

They negotiated a decrease in the Decrease.

Decrease. So we went from

$3,000,000 to $1,500,000.

Oh,

so that's better.

Yes. Yes. It is, actually. It was really good. And there was a yes. Yes. So the JBC was highly very supportive of local public health. Mhmm. But given the the state budget deficit, like, where do you take from? Right.

So nobody won. A hard

time synthesizing fans of local public health and then shredding it.

Yeah. Yes. You know what I mean? Yeah. Which I got in. I get it. Yeah.

I'm good that they're proponents of LPHAs, but maybe don't then shred what our constituents need.

Yeah. It was time. Really interesting listening to any of the JBC members and and what they were struggling with and where do you cut it, especially looking at the the biggest areas on the budget, which is why they looked at the $10,000,000 from the tobacco and chronic disease funding, which they moved to fund preschool. And then but then the state health department was able to find the funds to lessen that reduction to grantees. So we are getting a reduction in our tobacco grant and our chronic disease grant, but it's much it's on an increase, and it's much smaller than what we expected.

We we will be fine in those programs. We just have to delay a little bit in hiring or delay implementing some work, so we are not worried about those cuts. And then, of course, the biggest hit to the health care coverage in general and how that impacts us, Medicaid, the 2% reimbursement comp for health care providers. There are some carve outs. We're not sure how really it will hit us, but Medicaid is not our biggest source of revenue.

We do bill, and we're very active in billing. And I think we'll we will continue to be able to bill. I'm just not sure what that what will happen is more of a trickle down effect for people who choose not to reenroll on Medicaid and we don't work it, like, lose their Medicaid benefits or no longer eligible. And if we can't bill, we're still seeing that population. So that's where it's the trickle down effect that will impact us.

And then there was limits placed on reimbursements for family members serving as caregivers, funding restrictions for services to children with special needs, and then benefits and services scaled back for people involved and cover cover all Coloradans, and then they placed an enrollment count of 25,000 children. So those change or, yeah, those impacts budget decisions will have an impact on this, but we we will not as bad as in some areas. CALFO usually puts together, like, a a final report after the session, and that highlights all the public health wins. God, is Google being there? There would be a number of others.

So once we get that, I will share that with you all. It is not done yet because session just ended, but it was quite the session. And I just I'd shout out to, like, this whole group here and to Brianna who ran our big p policy group this year and are creating the spreadsheet in which we were able to track, communicate back and forth, tag each other. It was really a great way of of staying up. Yeah.

Early on, it was really busy for us. We continue to look at and review a lot of bills and, you know, does this have an impact on it, like, a direct impact on us? If it didn't, then we moved on. Or if it did statewide, like, Steve would provide comment to CalFoak who would then take it over to the sponsor. So there was a lot of action that, you know, maybe we we gave a lot of expertise and guidance on, but that's what it so much better, I mean, compared to our first year, like, how we have matured as a policy group, given that we don't have a policy person.

Larger health departments actually have a policy person. So we are all the policy selective. So just thanks to all the team for real. You know, meeting every other week and staying up to date on bills. Change the name. The policy selective. Yeah. Policy. Oh, I like that. It's better than big p. It was It's a copy of

very Star Trek.

Logo. Yeah.

We should probably shout out Joni as well. Oh, yes. Doesn't function without Joni's work.

Thank you. Yeah. Joni is one of our office support coordinators, and she used to work as an aide at the Capitol. Mhmm. Very savvy in the policy world, and and she every bill came up that she was entering it. She was tagging. She was I asked her very quickly this morning, how many bills? She came back right away. 626. She's super helpful and insightful, so she's fantastic.

She's your board queen. Mhmm. If you're a star

oops. Star Trek. Star Trek. Yeah. Star Wars all the way. Okay. Hidden expertise that we didn't know we had until we started down this work and and when she was she compared her yeah. But her past lives, all of the things that she has done has been phenomenal. So okay. That's that's it.

Any other question? So our last one, our fifth study session is the director's report.

Okay. So I'll start with our mission moment. So this is from the past month from the last time we met, and we're highlighting family connects. We have reached we've seen our had our one hundredth home visit survey and keep in mind, we just launched in September. Yeah.

We have one nurse in this service. This is the universal home visit program for any family that was delivered at Denver Health and in Arapahoe County visit. They have the opportunity to have a home visit three weeks after delivery. And so we serve 90 different families in six different languages. And and what really, what's fantastic is the home visit nurse, in 97% of those visits, experienced at least one need that during the immediate postpartum period, and seventy one percent had at least one urgent or significant need.

So she's able to help navigate, make resource connections. And then based on or what you know, identifying a need, they created IKEA here together, a family connection space created for families who find themselves in isolation. Mhmm. So it started out virtual, and they're really having some great outcomes from that. So just another, you know, identifying and need taking initiative.

And this is one of the programs that, you know, the funding is severe like, blended and braiding. We never know what we're gonna have for funding or not. So we would in the early success, really, feel that this is has true public health intervention opportunities. And Okay. So excited about that.

I'm gonna move into administration updates. Just highlight a few of the things that, as a team, we've been up to and what I've been up to. So I mentioned last month that commissioner Warren Goli and I were accepted into the NACO Public Health Leadership Academy. We had the kickoff meeting on April 21, and it was just really high level overview. And then we, at 01:00 today, we had our first, like, virtual session.

You'll be headed to DC the first week of June for a three day in person with the 11 other counties that were selected. So looking forward to that. The agenda is pretty intense. But it should be really, really interesting. Just the virtual session today was pretty enlightening on how different the commissioners work with their public health director in America. I'm pretty I'm really close with our commissioners and work with them frequently. And so I feel like they know what we're doing. I know what their priorities are. We've aligned our CHIP with their priorities. Even, actually, our chip was done beforehand.

It was their Arapahoe forward, you know, the alignment made. So, you know, just hearing how different counties work, it'll it's gonna be really interesting. Today was kinda level setting. I thought we'd talk about public health.

Yeah. But I think you you have to you have to own that success because you built those relationships Yeah. Because you prioritize that when you became director and when they be a replica became its own entity. You don't make that a priority from the beginning, then that doesn't matter how not willful and not wanting people are.

I think through the day, as you could tell,

it won't happen. Okay. Yeah.

The other Colorado counties? There's one in Delta.

Oh,

so the other ones are just all over The US? All over.

Yep. Wow. And from very small to, I think Yes. It's in The largest, which I can't remember which county it was, but it's, like, one point something million. That's the largest county.

And the south, I think,

is 15,000. Mhmm. So it's all in the.

And and we're kind of in a unique situation that the county commissioners really had to embrace this, where if it's been generations of that's how it's been done. Yeah. So in some ways, we got to build from in a very short period of time with expectations, you know Yeah. Out of crisis came. Agreed.

Well, what do hope to accomplish in Washington?

So we when we leave Washington, we need an action plan to that we will work on in the community, but an actionable action plan with an actual with strategies. Our we in our application, we had to include the public health issue that we hope to work on. And in our application, we talked about being new and coming off the tails of COVID, a dissolution, starting new, and building trust. Mhmm. And not just trust in public health, but trust in government.

Mhmm. Because community surveys show that Arapahoe County residents are Good. About government. Like, it's just the kinda middle of the road. So can we get them more excited about their government, local government, and understanding what local government does? I people know roads. They know bridges and infrastructure parks, but do they understand, like, all of the other things that government does? So the hope is to have, like, shared understanding, looking at what policies impact best practices from other counties, like size, similar. I think what's unique or what's hard is all counties are unique. Mhmm.

Even just in Colorado, but how government is structured across the The United States is different. We're very decentralized. Centralized states are gonna look very different. So the hope is that we are the goal is to have an action plan that we can work on collectively and as a county, not just public health, but working with communications and other departments on building trust and also raising awareness about local government to to be more excited about

I'm the I'm glad you're not going there to lobby. Okay. Oh. Things to learn.

Yes. Yes. Oh, yeah. It is workshop. It is very much. And when I say intense, like, it is, like, all of these sessions of digging deep. Another update. Arapahoe County this year introduced the new benefit for employees of eight up to eight hours of volunteer paid volunteer time. So we were doing that informally since we opened with four hours, but the county it is eight hours of volunteer pay time. And to kick it off, we had our Effingham County Days of service, week long days of service during April during national government month.

And it we had 11 so what they did is they coordinated with nonprofits that could handle large groups of volunteers. So we had 11 nonprofits that had volunteered to for for to bring in volunteers. And countywide, there were a total of 339 volunteered by a 122 staff. That was the whole county. There were about, I think, 20 employees, something like that, from public health who volunteered during that week. Our

a lot of

staff, you can volunteer anytime in the year for any organization, so we didn't submit

it to them. It was just a big kickoff.

Is it eight hours annually? Eight

hours annually. Yeah. So you can use it in whatever chunks make sense and for a nonprofit organization. Our harm reduction program was one of the 11 volunteer opportunities, and they have a small team come out and volunteer to help put kits together. So it was pretty

cool. And

then one other update, Arapahoe Forward Forum. So this is the Arapahoe Forward is the board of county commissioner's strategic plan and has five priority areas, two of which are most definitely hit public health. That's economic stability and then safe and healthy communities. And it's part of their performance program, and it's it's new this year. And at quarterly, they have these updates, and they changed gears this week or this year and are doing trying a new format, and they're doing it in form fashion.

So kind of like it it's a panel, and we've had two so far. The first one was early in the year and just this past couple of weeks ago bless you. Our programs were highlighted in the safe and healthy communities priority area. So it was public health, the sheriff's office, and human services were the panel. And so Heather and Rebecca were our representatives and talked about how we partner with other departments, how we partner in the community in areas and programs that we do that directly impact economic or safe and healthy communities.

So it really just a great way. All the elected officials are at that meeting and staff. It's it is an internal meeting open to the it would be open to the public because all the elected officials are there, but it's it was great to highlight our programs and the work that we do with other departments like the sheriff's office. And one another fun event that I wanna highlight. Grace isn't here, but Grace is our health equity and community engagement specialist coordinator.

She and the health equity coordinator for the county created a belonging trivia event Uh-huh. Where they it was over the lunch hour. They did it. They I think it was here on this campus. And they had you know, it was pop culture, history, food, music, and more all related to DEI topics. They had 50 staff from across the county attend, and there is another one planned. It's happening right now, actually, or it happened today. So I don't know how many people came to that one, but they both told me that it was fantastic. People had a great time. They learned a lot in in a very interactive way.

So it was pretty fun. And moving on into nutrition, I wanna highlight the grocery shopping tours. So part of one of the grants that we have, we partnered with Village Exchange Center to do grocery shopping tours, which is really important with WIC and the WIC app, knowing and understanding how to use your WIC benefit, how to use the app, what foods are allowable to kinda demystify and to provide education and help people because it it can be very intimidating. But they've had 13 tours with 70 families. And in April, the largest was 11 families attending the tour.

So it's a great opportunity to to help people feel less intimidated using their WIC benefits because that is a metric that we track, and we want people to use all of their food benefits. And Does it change,

like, what they're eligible for?

Because, like, with with UnitedHealth, the issue they have is with the new card, you can go to the same store two separate times, and one time it might be approved by an item, then another time, it it might be rejected.

Yeah. So No.

They're very specific in the foods they can, but based on their day how to worry about their infant, a child, what

they get, breastfeeding, different types of foods or amounts might

vary, but it's their this foods out of

the lab don't change. They do time from time. We find we can set new criteria such as some

of our yogurts, but Okay. They just they're they're not if they have a on their phone.

Thank you. Our nurse nurse liaison program, I wanna highlight their increase in metric. This was one of the programs or the program that had a significant reduction in workforce last year because those are funding decrease, which was cut two thirds. So it was incredible, but their resilience and how they have been able to work with human services on the new focus of home visits. So it was a it was a huge shift, but the team really was very resilient.

And they have moved from the family engagement rate was, like, 69% up from 63. So it's a 6.24% increase. And then their home visits completed with the caseworker increased from 54% to 62%, so an increase of 8%. So just really want to recognize that team for the work that they have done to rebuild after such a really traumatic decrease in their colleagues and staff low or the total shift in program goals. And I mentioned and, Phoebe, you're aware of this, I mentioned last time we are participating in FreeBC, which is a web based app that provides free birth control for and telehealth for those who are eligible.

We signed on immediately. As soon as we heard, we jumped at the opportunity, and we did receive, I think it was $10,000 to help cover the cost. We've had three clients so far. It kicked off May 1. So it's only three weeks in, and we've already had three clients.

And that program saved them anywhere from $76 to $262. They would have been out of pocket, and we were able like, one was a removal of an IUD and replacement of that IUD. So save them the cost by going through this free BC program. So we're excited to see where that goes. And if these early wins I mean, hopefully, the the program will continue in front

of them. Do they have more?

Yes. Okay. Yeah. Through upstream? Yep. That's that's funding. Okay. Yeah. It's through upstream that caring for is our link. And then it's a few on from health protection response, they received a grant for PFAS to test it was $10,000 to test 10 surface water locations throughout the county. So we we applied last year, didn't get it, and this year, we did. So this is a continuation of work that we have done. So excited that

we got done that for now.

And I think we got one, and then we applied and didn't get it. And then they came back to us and said, but, actually, we could do this instead.

Oh, okay. Great. Yeah. Mhmm.

Good. And since it's at least forever chemicals, that's what you're talking about, and now there's gonna be a change in the environmental laws, and we can see more forever. And how we part

of it, they want us to review, like, information related to it and how that applies to what we're doing. Okay.

So the.

And then the early childhood in schools program highlight their visit with Englewood Public Library. So I received an email from their director who's fairly still new, I think, within a year of her job. And she just wanted to talk about which had some very specific public health concerns, but wanted to also, like, talk about how do we partner, how can we work together. So I went and met with her and her team, and their concerns were, like, more bed bugs, lice things, like hygiene, general hygiene, cleanliness, how to so I brought in environmental health. They went and met with her and had a great meeting, talked a lot about, you know I think they shared, you know, how the standards for childcare and other settings.

So it really helped them with all of that. But then our that team does they have a lesson plan that they use. It's called Six Simon, and it's a book that they read, and it's germs. And Mhmm. They mentioned that they could come in because the library has story time, and it's very, very popular. Mhmm. They draw in, like, 30 families. So we offer that we could come in and do and do education on handwashing and all that. So they were very excited about that. So we have a a new partnership with Inglewood Libraries, which we hadn't done before.

And it made us think about maybe, you know, we do a quarterly meeting with schools. It'd be great to do the same with libraries because they're they're dealing with a lot of the same things just in a different way. Our emergency preparedness program presented at the nature preparedness summit. So I always like to highlight winter staff. An abstract is accepted, and they do formal presentation.

And this was on our public health incident response and support team, the first, which is our team when we're responding to an incident. So they they shared on how we started that, how we are activated, what kinds of activations the team has done. And the reception of that session was extremely positive, so it was well received. And then the team, along with our communications, county communications team, participated in the National Disaster Medical Response System, full scale exercise at DIA. I think it was in the Denver Post.

I was trying to remember where I saw it. I saw it in multiple places, but I think the Denver Post reported on it. Lots of lessons learned, but it simulated a 100 patients arriving at DIA. So they tested triage, assignment to hospitals, tracking, and public messaging, and

then relocated. Like, a 100 people dropped off with haunted virus. Or no. Like an injury.

It was more injury. It was full scale of wounded military members from foreign conflict. It's been No. If it

was years. This is a This is going that's been

going on for years. Okay. Yeah. It would be that would be very different if it were, like, we are receiving people from a ship ship with some type of an outbreak or being very different, like, it were Thank you for communicating.

So that moves me to

our communicable disease update. Yeah. We still have Melissa here. So I I'm gonna point out one thing that we have had our a one confirmed skunk test positive for rabies, and it was a bit earlier than we normally see. News went out. We did do education. We always have that, but, you know, that's why we message about don't touch baby wild animals. Make sure your pets are vaccinated. I think it's really important. So we did that earlier than normal, but I want to just open it up, and then I have one more update after Yeah.

After that. But any questions that you all have about anything in the recent news or anything in the report?

Go ahead, baby. Go ahead. Yeah. Open that can of worms.

I'm going on a cruise.

Bright day.

Constantly wash your hands.

Not a virus. It's like the

Yeah. We're all ears. We need to be That's the base of

the pants. Because that happens on the ship. Yeah. Right? And on the ship, not like someone got off the ship, exposed themselves, and got I owe people.

Wash your hands and don't touch it.

A taste of granola bars.

Oh,

yeah. Obviously, 100 virus is. So, know, actually, our communication team and the community disease team put together some very nice information. Will put it on the website. Is it today?

Today. I think it's

on It it went up actually on Monday afternoon. Yeah.

But, anyway, it's very good public. And and and we we get a case with lots of information. Yeah. And and, you know,

I think it's important to note that the strain that we have in Colorado is very different than the HIV strain and is not meaningful. And the one we

have in Colorado, there is an anapdim. I mean, the the antibiotic. I thought there was one kind of

There's still no treatment because if they get ARDS or any severe respiratory disease, it's really supportive. That's Oh, jeez.

Well, that's the Ebola.

Ebola is it.

They've been to people. The

new Ebola, they don't have strain is not one of the vaccine. Okay. Yeah.

So so we're watching it very closely. Everybody wants a great donation.

I'm gonna address it with Douglas County when if it happens in 10, they don't have a protocol. I

should say follow-up, Jeff. We had I think it was over a hundred cases in the last thirteen years Of that's local in. Yeah. So you just need to know it's here. Mhmm. It's not new, and that's it's all over the Southwest. Okay. Oh,

I'll be going down there. And

this new concept, the the one that was on the ship, people gave it to each other, where the ones that are here, I thought it was directly.

Correct. You actually been actually sleeping or playing with. It's

gonna be. Don't it. Don't you. I'll let you live too.

Yeah. And so that's where you'll find we we update and the reason that's pusher that we updated news post about specifically is we've never really discussed the differences between the Andes strain in South America that has the potential for person to person in these quarters versus

Sure.

Seeing no gray strain here that impacts the four corners area of The United States that is not known to be person in person. So we added that specific distinction and comes creating nice little visual handout. And

Yeah. Anyway,

so that that hopefully will help clarify and

share our understanding that we do

we do see this every year. It's just

Yeah.

It's the It's it's the biggest risk. Unfortunately.

And our challenge is always often because of mistrust related to COVID. Yeah. You always wanna get out information that's accurate and

not

confusing and very clear. Because people are gonna need to be. Yeah.

And, you know, it was really unfortunate with the deaths that were serious with that.

And so we just wanna make sure

everyone understands we're taking it seriously,

and it's a very different

That's

Is there anything that makes the Southwest unique to 4 Corners? I I don't know. You know, I

think it probably has to do with the dry conditions. You know? Because it's first to snow in Northern New Mexico. Okay. And the 4 Corner area is. And now it's endemic. And so it's I think it has to do with dry conditions, heavily populated role of rodents. People not necessarily unsanitary conditions, but people are rodents thrive, and then they collect droppings for a long period of time, and then people clean them up. So Okay. And that's what

those movie stars have. I forgot.

Correct.

Yeah. Change. Yeah.

Do you want anything else that I missed?

Just gonna ask, miss John, you can ask about kind of the the response a little bit. So even though they're rare in Colorado, we do get, you know, cases reported every year. Usually, in Colorado, and the response looks the same for all the health departments. There's always, like, an IV, like, medical disease component that's, like, interviewing the family, understanding if they traveled or, you know, if they have, did they recently clean out a shed or something and working with the health care provider really closely? And then separately, there's usually an environmental health assessment. So environmental health staff and or communicable disease staff will, like, actually go on-site to the family's home or, you know, where they may have been exposed to actually look for, like, rodent activity and then to provide an education

education that we put in the future. No more question.

Till next month. I know you are.

So we've been actively monitoring everything, and we'll keep you posted Yes. And in the and updated if anything. I mean, normally, if with coronavirus, we it really we wouldn't make much of it other than do education. But because of the scare with the ship and where immediately people went to is this next pandemic? That, you know, it it's just timing of seasonally, this is when we would see it. So Yeah. It it makes messaging challenging, and, normally, it would be something that we actively report. But Yeah. Communication and education is big. So we have updated our website.

It's on our news feed and the weekly wrap up that was created. So Yeah. That's good. Yeah. A comparison. So this is on our on the public health page of the website. So a lot of this is is hot off the press of me today. So thank you for pulling that up. So that's my full report. If you don't have anything else, any questions for

I think I forgot the timing on this. That's my next update. Oh,

it's not

in the report because we Okay. Published the report before we executed contracts. But I do have an update on the search for the CMO. We have received seven applications, which is fantastic. Mhmm. And we did four interviews, and we have selected doctor Paul Mayer. He is currently serves as chief medical officer for Larimer County and El Paso County. So he will serve as scholars as well. And there's, I think, some benefit in having in serving those roles. He's been doing this for how long?

A long four or five years. 10. 10. 10. As CMO, but he's been a physician for a long time. Yeah. He worked in migrant health in Oregon. He's bilingual. Really great demeanor. He's he has served as our backup for Chris when Chris goes on vacation, so we had some interaction. We were we were familiar with Paul. Like Chris, he goes by Paul. He, you know, wants to be called Doctor. Maynard. Very approachable.

Sexual health, TB, communicable disease. I mean, immunizations. He's got expertise across the board. Yeah. And he ran the process with purchasing and had created so when we received our bids, created a Qualtrics form, and so we had 12 staff members review and provide comments. So when we went into the interviews, we took all of that into consideration. So feel really good about Doctor. Mayer. I think he's gonna be a fantastic So he's Langmuir County. What else did you say? Oh, Bell Paso. Oh, Bell Paso.

We're, like, in the middle. Yeah. He's gonna drive.

The distance. I like being in my

He's the 0 I 25 Corridor. Mhmm. Yeah.

Mark has a question. Mark?

Yeah. Yeah. A couple things. Just the discussion regarding sort of the challenges where, you know, antivirus, for example, and and others, I think I heard a comment in the room about the challenges it creates, which is true, but I also think it provides some opportunities as well in terms of thinking about lessons learned from COVID as one example on how we message and so forth. So I'm not lost on this group for sure, but I do think there's some opportunities here as well.

And then a couple of other things before we sign off just in case. I wanted to thank Hannah for, you know, creating this opportunity for for me to participate today. This is actually the first time I recall that I've been participating like this. And so I'm looking and participating today not only as a board member, but as a member of the public. And so I don't know how Mhmm. How many folks participate as members of the public, but this is an awesome forum. And I know things don't happen by chance, so thank you, Hannah, for that. And kudos to all those who are behind the scenes to make this happen and make this information available publicly. Two other quick things, if I may. One is and you're probably still gonna announce it.

I think doctor Abina's event is on June 10, I think it is. And so and doctor Abina, I really wanted to thank you publicly here, and I'll see you on the tenth as well. I I I trust. But for all of your leadership with Arapahoe County and decades in this space, Colorado's public health is better because of you, and I really do appreciate it. So I don't I think the Board of Health convened after that June 10 event, if I remember the dates correctly.

So, again, I just wanted to thank you for for for your service. And then lastly, I have in my head, and I was trying to check my calendar real quick too, that there's a state of the county event. I think it's, like, June 16, and, Brianna or maybe Jennifer can correct me. I think I attended that last year, and it was pretty if I remember that same event from last year, it was a pretty awesome opportunity for me as a board member to meet others from across the county. And so I'm hoping to participate again this year.

We're gonna learn a lot and and really had a a good chance to meet others within Arapahoe County who also serve our communities. So it's a little bit of a plug if that's the same event that I'm thinking about that attended last year. But, again, thank you, Hannah, for for today. And and, you so much for your service.

Thank you. And, yes, you're right. It was state of the county, and it is June 16 in the morning. I think

it starts at eight.

One more update on the CMO transition from Yes. So the party is the tenth. Be there, v squared. One. Right? And we have a start date of June 1. So we will we already have an email set up for doctor Mayer, cell phone, computer, so they'll get all of that. And then Doctor. Will meet with us as well, and then we'll meet in the afternoon. And later that afternoon, I'll send out an email saying Doctor. Mayer is now who you're gonna call. Doctor. Will be behind the scenes and be able

to use your questions. We do

have a transition plan and well, because Doctor. Mayer has been here for us, there's still a lot, like, crazy amount to learn, but it will it'll be pretty as easy as it possibly could be to the weekend. Do wanna add anything?

No. I I did put put together a little draft orientation that puts in all the key key messages and who the key people are and and all the division leaders that we've used in. So I think it is going to be relational. Yeah. Obviously, he actually gets an old Mhmm. And that's a secretive success as you know. It is it's getting to know people and working and developing new relationships. And and I think you'll be excited about meeting him. And they'll be excited. He'll be a great addition, and I'm I'm thinking he's happy. And we're very fortunate. It's it's gonna be a smooth transition. I'm excited.

I do think he's planning to attend the party in the. So, again, not the reason to

be there. So, of course,

If you're not, I just wanted to say thank you. Is one of the best words I've ever worked with, frankly, you know, in terms of your active participation, your interest, the commitment. You know, you just don't see that. I've worked at a lot of

Yeah. There's a lot them.

At the state level, at the local level, you guys are in. I think you take these commitments very seriously. Mhmm. Just wanna.

Let me work for her when we joined.

Yeah. And

yet now I'm writing yours.

I would echo

the One last thing. You know, I I gentlemen, I'm gonna hold my surprise. Everybody asks me what I'm gonna be doing next, and I'm gonna tell you on June on June 10.

I'm not gonna tell you. You

better not be working for anyone else.

Have a.

Yeah. But I wouldn't just a reminder. Uh-huh. You all should have received an email from Leslie Meyers with the link to the predictive index survey. I didn't get I

have to update that.

You didn't get it?

It actually doesn't come from Leslie. It comes from Access yeah. And it was the Arapahoe County PI survey. Look in your spam. I will. Or It's the Wednesday. Sent it up yesterday. They came out yesterday. Yeah. Yesterday. Yeah.

Guess Okay. That's helpful. Yeah. I'm sure when. Yeah. If you

didn't get it, send me an email. I don't know.

Thank you for the.

And then it'll Usually, it only lasts a couple days, the link, and then it resets. Yeah. Yeah.

If you can't find it or it's not

in your spam, let Hannah know, and she'll help navigate that. But just make sure you take that by what's the deadline? Yeah. Soon. Sometime. Seven. That's okay. Do it in seven days. Don't know. Because I think she'll she'll do all the analysis, and this will be we'll be doing an PI workshop from two to three at our June meeting. So that will be a little bit fun. It's gonna be the board, Hannah and me, and then Monica as the team. So

it'll be fun. Mhmm.

Okay. That's it, Sean.

Thank you.

So now the meeting is adjourned.

Alright.