Board of Health - Regular Meeting

Good afternoon. Carly, would you like to unmute and confirm that I can hear you and you can hear me? And you'll need to unmute from the X panel if you haven't done that already.

Let's get our work. Thank you, Logan. How's that?

That's good. Thank you very much. And I'll go ahead and start the recording. Thank you.

Tracy, do you hear me?

Patricia's running late.

Oh, I did not hear that. I heard you say something.

She said she's running a few minutes late, had to take an important call, but she's on the road now. Be there in a few minutes.

Right. Thank you. Three.

Three. Okay. Oh, I was counting jets. I was like, there's three people over there.

So hot lately. So short of rain.

It's dark.

It's so dark.

I hope so.

Well, somebody told me it failed yesterday.

Well, town, I went to pick up my daughter by Riverview, and their parking lot was flooded. And my in-laws were at my house and said it dumped at our house, and it did not rain on both sides of us.

Nothing in the middle, I know.

Like, I know it happens, but when you hear it, it's so weird. I know.

My wife said, I was like, I'll say, it's just pouring in town.

Are you sure? Winch town. Yeah.

Is that true? No, it's okay. We were supposed to get like two weeks of rain, and now it's just every day or something.

Yeah, we got cheated like a week ago. It wasn't supposed to be all rainy.

It's supposed to be good. And the weather has to keep it together.

Well, the problem is you get way too much all at once. Yeah. Like, yeah.

Thank you all.

Logan, this is a sound test.

I can hear you. Thank you. Thank you. We're ready to begin.

Okay, good afternoon, everyone. Our apologies for the delay in starting our meeting. We'll call this meeting to order. Today's August 20th, and time is 1.10. For the special meeting, we'll call the County Board of Health. For purposes of roll call, we'll start to the right. If we can introduce board members that are present. I am Patricia Spanach-Wall, Board of Health, and we'll start to the right. Wendy Rice.

Roger Ennis, board member.

Okay. And no, we do have Avery Sheldon, excused absence. And is Kathleen on? She's supposed to be remote.

Yes, Kathleen is with us remote and as a panelist.

Perfect. Kathleen, can you introduce yourself?

Hi, this is Kathleen McInnis, board member.

Thank you. Hi, Kathleen.

Can we work on her audio real quick?

Yeah.

Thank you, Kathleen. Can you unmute yourself and do a sound check again?

Yes, sorry. I'm on multiple devices. Let me work on that.

Okay. While Kathleen works on her volume, we'll check in shortly. We're going to go through and do the approval of the agenda. I have a motion to approve. the agenda as presented.

Do I have a motion? I have a question. Is this where we need to change the fact that two of us weren't at the fifth, or is that subsequent? That's further down. Okay, then. Well. Yeah.

If you would like to remove

Perhaps the minutes from June 16th, since only two of you are here on those, you could do that at this time.

If you'd like to carry on and vote with only two of you present, then you can leave them as they are and go ahead and approve the agenda as presented. Is that your question? That is my question. So this would be the time to alter the agenda.

And it's probably something that...

I think the right thing to do would be to remove that one item.

So you would need to recommend removing the June 16th meeting minutes from the agenda?

Yes, I'd like to make that... from this meeting agenda to be voted on on a later date.

And then you'll ask for a second.

Is there a second? Second. Perfect. All those in favor, please say aye. Aye. Aye. Aye. Thank you. And just to backtrack, my apologies, we do have a quorum right now for decision agenda moving forward, since there's three of us present. And we'll table the June 16th meeting minutes, so the agenda will be amended with the removal of June 16th. We don't have a quorum currently to approve those. Thank you. At this point, we'll move over to public comment. Actually, let's go through the... conflicts of interest, if there are any perceived or conflicts of interest that anyone needs to announce. Hearing none, we'll move forward with approval of the meeting minutes. Approval of the meeting minutes. So we'll go through, I think we can do in One fails to, or we could do either one since we have everyone here to do the form. So I will take a motion to approve the meeting minutes from December 9th, 2025, January 15th, 2026, April 16th, 2026, all of which board members attended. We do have a horn since we have four of us present. My apologies, four of us present. So I will entertain a motion to approve those meeting minutes.

I'll make a motion to approve the meeting minutes as we have them as written for December 9th, 2025, January 15th, 2026, April 16th, 2026. Okay.

Is there a second? Thank you, Wendy, for the second. All those in favor, please say aye. Aye. Aye. Aye. I do want to make one comment to the meeting minutes. A shout out to Carly. Meeting minutes are not very easy, and I will say we had some very lengthy meeting minutes, especially with our quasi-judicial hearing, so hats off. I can't imagine how long that took. Thank you. A very long time, I'm sure. There might have been some blood, sweat, and tears. Okay, moving forward for public comment, I'd like to open this section of the meeting for a public comment portion. I'll ask Logan to facilitate the public comment section for remote attendees. I'll pass it over to you, Logan.

Thank you. Welcome to the public comment section of the agenda, providing you with the opportunity to express your views on issues within the board's jurisdiction that are not covered in today's agenda, as well as items that are on the consent agenda. If you wish to speak on an item listed under the decision agenda, please wait for that item to be called. To make your comment virtually, please either raise your hand in Zoom using the raise your hand button at the bottom of your screen. If you're on the phone and would like to make comment, please press star 9 to let me know that you'd like to speak. And if you're in the room and would like to make public comment, you can raise your hand and the board will call on you to make your comments. To ensure that your comments are officially recorded, please state your name before speaking. Each speaker is allowed a maximum of three minutes and the board may limit comments on any given topic to no more than a total of 10 minutes. If these time limitations are insufficient for expressing your thoughts, alternative channels such as submitting written comments are generally available. According to Colorado's open meetings law, formal actions are restricted to the agenda items. As decisions require advance notice, the board may not take action on any items not listed on the agenda. To maintain a professional atmosphere, please address your comments exclusively to the board. And the board may limit comments deemed irrelevant, repetitive, or beyond the board's jurisdiction. And nobody has raised their hand virtually to make public comment at this time.

Thank you, Logan. Is there anyone in the room wishing to make public comment? Seeing none, I'll close this section of the public comment portion of this meeting, and then we'll move down to our presentations. So first and foremost, presentation to Dr. Marjorie Crystal. I'll pass it over to you, Tracy.

I'm going to share my screen, I think. I'm going to try to do that. I say that.

Or not. All right.

I will skip that part. Hold on. going to have Carly to the rescue. So as you all know that Marge attended her resignation in April of 2026 and this presentation recognizes Dr. Crystal for her service so I have a few words and I would like to bring Dr. Crystal up here. Marge. I'd like to invite Dr. Crystal up. It is not often that somebody has the opportunity or the challenge of serving as the inaugural medical officer for the new public health agency. And we are incredibly fortunate that the person is willing to take on that for La Plata County Public Health brought decades of medical and public health experience, a deep knowledge of this community, and a longstanding relationship throughout the local healthcare system. You helped us navigate the transition from San Juan Basin Public Health and establish La Plata County Public Health as its own agency. Even though we had some foundation to build from, there were many things we had to figure out and establish for ourselves. Your experience, judgment, and commitment were invaluable throughout that process. That commitment continued even as you prepared to leave, as you helped us make connections to ensure a strong medical leadership would continue. You left a lasting mark on this department. This small token of our appreciation, I hope, represents what I have come to see in you, the many facets, your interests, your strengths, and your commitment. It is inscribed with thank you for the work that you did, for the person that you are, and for the difference that you made at La Plata County Public Health. Marge, we are grateful that you were our inaugural medical officer. Beautiful. And I would ask if we could possibly get a picture with Marge standing up there with the Board of Health, if that is possible. Can one of you guys take this?

Isn't Dr. Criswell supposed to give a speech now?

If you guys would like.

It's beautiful. Yeah, that's gorgeous. I love that.

It's beautiful. So if you don't, do you want us down here? Yes, that would be great.

If you don't know, Marge has had a lot of different things that she's done in her life, but one of the things that she has done is flowers. So I thought that that was particularly brilliant.

That sounds fun. We're going down. We're going down.

We have multiple cameras. OK. Scooch in your ideas.

Paparazzi.

Which way do we look? I know, paparazzi. Do we look in the middle? Look at Tiffany. Just pretend you're on the red carpet.

Everybody look at Tiffany, not me. One, two, three.

Perfect.

OK. One more. And thank you. We've got Kathleen in the background on this video. That's great. Very cool.

Thank you. That's great. I don't know.

That's perfect.

I used to grow them, commercially sell them, and then sort of flower design or person for weddings and events.

Yeah.

Very cool. Right?

Yeah.

and staff honored me this week earlier with a little goodbye as well. But thank you very much, and thank you for your dedication and commitment to public health. The board is an integral part of making the whole operation work, so I will remain a champion of the department. Easy to do. All right, thank you.

Thank you so much for all of your work. Absolutely.

All right, guys, carry on. Okay, moving down to Planning and Sustainability Division Public Health Improvement Plan update for 2026.

I will pass it over to Tracy to give a staff report.

So it has been a little while since the Board of Health has approved the La Plata County Public Health Improvement Plan. So I have invited Shannon Shropshire. who is our public health planner, to come and give you an update on our public health improvement plan. So I'm going to invite her up here and she will provide that update and I'm gonna get the Zoom set back up so that she can share her presentation with you. So Shannon, if you wanna join me up here while I get that reset up. I'm going to need you to promote me again too. Oh, I see.

There you go. Thank you. One moment. You should see that now.

Yep. Shannon's got that.

As has been mentioned, I'm Shannon Shropshire. I'm the Population Health Planner with La Plata County Public Health Department. Though my title and employer have changed, I have spent 10 years serving the residents of La Plata County in public health. I'm going to give a little bit of a background of information as far as the timeline, what a FIP is, what our priorities are, and then feel free to stop me with questions. So in 2023, San Juan Basin Public Health completed a community health assessment with the help from a class at the Colorado School of Public Health. We went through a prioritization process after that, and the San Juan Basin Public Health Board of Health did approve a public health improvement plan. since they felt the need to do that. In 2024, we updated the community health assessment with just data from La Plata County, and then there had been more recent secondary data that we updated, and then it was published on our website in the spring of 2024. Excuse me. And then in 2025, in February, this board approved our public health improvement plan. So based on... And then this plan is current from 2025 through 2029. And then, so our priorities are access to care and prevention services, behavioral health promotion, and climate and health. Just a reminder, a FIPP serves to inform, engage, and mobilize our community, align policy and community efforts, investigate and address social determinants of health and health inequities, outline shared action plans for public health agency and community partners, such as hospitals, schools, transportation, and environmental groups, support grant applications with data and information, and inform and engage with the state public health improvement plan to strengthen partnerships and maximize efforts. So this presentation will include some progress updates along with the problem statements and objectives and strategies for each of the priorities. kind of how we're doing, where we're at in that process, and then programs involved in each of the priorities. At the end, we can kind of talk through some next steps and opportunities. And so the graphic on the right represents the eight phases of the CHAP cycle, which is the Colorado Health Assessment and Planning Systems through the Office of Public Health Practice, Planning, and Local Partnerships. The phases include, one, plan the process, two, equity and community engagement, three, conduct the community health assessment, Four, assess capacity. Five, prioritize issues. Six, develop a plan. And phase seven and eight, which are shown darker here in color, which is where we're at in the implement, which is implement, promote, and monitor, and then participate in the statewide public health improvement opportunities. So as a reminder, so this is our problem statement for access to care and preventative services. Access to care is a fundamental determinant of public health outcomes, despite significant advancements in medical technology and healthcare delivery systems, barriers to accessing care persist, leading to disparities in health outcomes across different populations. In La Plata County, challenges exist in accessing adequate health care, which is a critical component of overall community well-being. Key issues include geographical barriers, economic barriers, cultural and linguistic barriers, systemic barriers, and health literacy. Consequences of inadequate access can include poor health outcomes, health disparities, economic burden, and reduced quality of life. So here we see some access to care prevention services, objectives and strategies, and sort of where we're at in the process. We've sort of divided this into three categories, whether that's we're doing something about it, we're planning something, or we're partnering and working through our partnerships for something to occur. Given everything that's going on in our community with our partners, as well as everything that our staff does, these will be some examples of how we're doing these things, but it will not be an exhaustive list. So, promote access to affordable healthcare and prevention services. So, identifying options for resource navigation, something we're doing. And I'm glad both Rosalind and Tiffany are here and they can back me up if I missed something. But so we have a care navigator that walks people through the steps of Medicaid. We work on breast and colon cancer screenings. We work with Mercy on funding opportunities for our clients and then pregnant women improving pregnancy outcomes. So an encouraging and increase in providers in the area is something we're partnering with. We participate in quarterly meetings hosted by AXIS about industry and education in their workforce convening, which is a grant that is facilitated through Project Run. We promote language access across healthcare settings, increase access to the language line with technology that allows clients to speak with an interpreter that they can see on screen. We have a Spanish-speaking health insurance coverage guide, and we trained a WIC educator that speaks Spanish. Increased trust in the healthcare system in La Plata County. Invest in community outreach and engagement. We have staff that regularly goes to the family center, that meets with people at the fort, goes to compañeros. We created an internal process to document events staff are attending for better collaboration. We're working on a plan to do an every other week partner check-in. so that people know like who people are reaching out to and what they're talking to them about. So programs have a better understanding about who needs to know what. Engaging with constituents of La Plata County. Now Tracy's attended the VOCC meeting, on the road public meetings, regularly presented at Rotary. I gave a presentation this morning on suicide data to the La Plata County Suicide Prevention Collaborative. Increase in health coverage rates in La Plata County, increase awareness of resources. So through open enrollment, we host office hours, enrollment events, we go to the family center. This year we'll have somebody both at the clinic and at the subtle office that'll be able to walk people through enrolling in insurance. We do social media posts. We have staff that was able to do a training on how to use your insurance, especially for Medicaid, as well as doing a provider training, providing health coverage and enrollment support. We're a certified assistance site through Medicaid, able to do presumptive eligibility, trainings around family planning, so reproductive health, contraception, STI testing, And then optimizing local partnerships, something I consider us to be partnering with, both when we do colon cancer screenings, chronic disease screenings, the clinic does targeted outreach with They have regular meetings with access to walk through troubleshooting with and cross uses or programs. They have partnerships with the Plot of Family Medicine, Four Corners OBGYN, Southwest Women's Health Associates is a new partner. And then an increasing access to health education and resources, ensuring high quality external communications and resources, So we recently hired a communications contractor. We have an upcoming spokesperson training. And then providing up-to-date information to community members and partners. That's passing on air quality alerts or health alert networks that we send out to providers, among other things. So this next slide shows all of the programs, maybe not all of the programs, but some of the programs that are involved in access to care and prevention services. I've talked a little bit about most of these. The clinic also does contraception, and they have technical assistance providers for STIs, communicable disease with vaccines, including rabies PEP. They're the only clinic that can provide drugs for syphilis. And then, of course, measles prep, all of that process that they went through. Family support provides education and resources to clients using the language line when necessary for home or televisits. Health insurance literacy, we've already talked a lot about. With oral health, they have medical and dental integration pilot. The clinic's handing out oral health kits for seniors and kids and talking about that during appointments. We also have a regional oral health grant where right now we're working on a needs assessment and hoping to incorporate dental care into mental and behavioral health. Primary care, excuse me. And then with harm reduction, they regularly ask about whether or not a client or a participant has a primary care provider, as well as handing out harm reduction supplies and test strips. Any questions about access to care prevention services?

Any questions?

Behavioral health promotion problem statement. Behavioral health encompasses the promotion of mental well-being, the prevention and treatment of mental disorders, and the support of individuals in coping with stress and enhancing their overall quality of life. Factors contributing to poor behavioral health include socioeconomic disparities, stigma, a lack of access to quality care, and insufficient public awareness. Again, this is, so I split behavioral health promotion into two slides, mostly because I think there's more on the list as well as there's some combined categories. So reducing substance use in La Plata County, providing access to naloxone and best practices on how to use safely and effectively, providing naloxone to harm reduction participants and partners in the community, So some of those partners have been MANA and the Community Investment Alliance. We do trainings on how to use it. And that's regularly been to like Hilltop House as their staff has turned over. as well as like the Department of Human Services. Promoting available resources, referring clients to other programs available in the community, whether that's dental, mental health, primary care providers, housing, urgent care, or the emergency department. Implementing harm reduction education and outreach. Staff regularly tables at the Durango Resource Fair, Green Chili Fest, tabled at Pride events, prioritizing access to care for substance use issues and mental health. We're both partnering and planning. We participate on S.W.O.R.D., the Regional Opioid Abatement Initiatives. We have a Harm Reduction Advisory Committee, Beyond Labels, which is a stigma reduction campaign. We partner with Access, Porchlight, Denver Recovery Group, and then through one of the suicide prevention collaborative work groups, we're working on increasing access for Spanish speakers. I'd also like to note that Mercy's implementation plan, their three priorities are access to health care, mental health, and substance use. And as far as their mental health goes, with their implementation plan, they're looking at zero suicide, and they're also working on an anti-stigma campaign. Reducing overdoses in La Plata County, providing access to naloxone and best practices on how to use safely and effectively. I already kind of talked about that. Implementing harm reduction programming, we do every day. Distribute fentanyl test strips to key community partners and community members. We do a lot of outreach with partners and then We also distribute test strips to community partners for secondary distribution. So increasing mental wellness in La Plata County. I think we're both, we're all doing partnering and planning as far as reducing stigma, both previously with the war coalition, focusing on targeted outreach with the Spanish-speaking population through this suicide prevention collaborative. I mentioned Mercy is working on an anti-stigma initiative. We worked on an employee wellness initiative. with four partners in our community, and then doing things like stories over stigma for Light Over Shadows Day. Increasing protective factors around social connectedness, both previously with the ROAR Coalition, Suicide Prevention Coalition, we're partnering with Team Up. They got the EPIC funding that we previously had for the ROAR Coalition that has a lot of youth pro-social involvement. We participate on their steering committee, as well as we're going to be working with them on their assessment. Decreasing suicides and suicide attempts in La Plata County provide awareness of services available. Again, I think we're doing partnering and planning through the Employee Wellness Initiative, Suicide Prevention Collaborative Workgroups, partnering with Access and, again, with Beyond Labels, promoting and increasing protective factors, subcontracting with the Rainbow Youth Pride event and being able to reach high-need populations, providing community helper suicide prevention trainings. We have a work group that's focusing on this, the Suicide Prevention Collaborative, and staff has done multiple mental health first aid trainings, I've done a couple for the community that have been online. I did one with staff at ASH, with staff at Manna, and then with staff at the Southwest. I have the initials, but I forget. I didn't write down what it was. And then staff has also done Comet with a couple of churches that have requested the training, and the Comet training is changing our mental and emotional trajectory. I think we've talked about a lot of these programs already, especially with harm reduction and primary prevention with suicide prevention. STEP, which is our tobacco programming, has been working with schools. They do regular retail scans. They have youth advisory councils. We've talked a lot about health insurance literacy in the clinic already. And then family support services, which is WIC, NFP, and Safe Care. They regularly check in on their moms when they're doing regular visits. Questions about behavioral health promotion? Climate and health problem statement. The ever-changing climate poses significant and multifaceted risks to human health in the United States, affecting populations differently based on a variety of factors, including age, socioeconomic status, geographic location, and existing health conditions. The impacts are wide-ranging, encompassing both direct and indirect effects. health outcomes impacts can include a temperature related death and illness air quality impacts vector borne diseases water related illness food safety nutrition and distribution mental health and well-being I think climate and health has been is is a one of our priorities that has opportunities for growth I think a lot of the Objectives and strategies here you'll see are in the planning stage. So I think this has been something that through the last year has been more of a challenge to work on outside of our programming. Increased public awareness and education about the health impacts of a changing climate. So I'm just going to cover the ones that I think we're actually doing something in. Provide education and trainings around environmental impacts. You know, we've done some radon trainings. We have radon test kits, healthy homes programs. There's education and gives out products. Then I think increased community engagement in climate and health-related initiatives is something I see us as partnering in. Staff participates in the CDPHE work group around climate and health community practice. Preventing and mitigating exposure to harmful pollutants in the built environment. Again, the Healthy Housing Program is working on that. And then preventing and mitigating the prevalence of mental health issues and chronic health conditions exacerbated by climate change. Being improved surveillance of heat-related illnesses. It's something that the communicable disease staff has regularly asked me to check in on since I have access to our which is our surveillance system, to see if there were any emergency department heat-related visits, as well as it is a state priority for their ship. I somehow did not include all of the programs that I think are involved in this, not only the ones you see here with Healthy Homes Communicable Disease and Consumer Protection, but also I think as we saw with the flooding and Viacito, our on-site wastewater treatment, and our water lab both had a hand in helping people recover from that. And then I see with, you know, I think it's more the EPR aspect of the communicable disease piece, but preparing for outbreaks, the measles monitoring, the Ebola monitoring, and with consumer protection continuing to monitor enteric diseases or illnesses which are more likely to happen in hotter months, which as we talked about before, the meeting got started about how hot it is and how it seems that that may continue. That concludes my presentation. I'm happy to talk about what I think maybe you haven't seen as far as the data piece goes. We've done a lot of work on our internal SharePoint pages that has a landing page for a public health improvement plan and then a page for each of our It lists a lot of data. It is where those, it's where these are housed. It has a lot of like secondary information that I've updated recently since that data for 2025 just came out about a month ago. My next project is updating what is on our website, our public facing website, as that is more challenging since it involves other people. But that's my September project. We also just recently, well, yesterday, applied for preventive block grant funding for next year where we'll continue to work on the public health improvement plan as well as our data modernization initiative and working with hopefully increasing data literacy within our programs.

Thank you, Shannon. Any questions for Shannon?

So thank you very much. I know it's really important, the work that you're doing. So thank you, Shannon. So a lot of information there. Is there one area or two areas that you really feel like you've made kind of market measurable improvement, things that you're

I think, well, I mean, I think we know the clinic rocks it with everything that they've started doing. Part of, as far as the evaluation piece goes, is that, you know, we started a lot of new programs. So collecting primary data from that, where, you know, we're only in year two of some things, year three of others, but year one for some. So one, figuring out what we're collecting. I think as you see in the director's packet where you're saying, I can't even make pretty charts yet because we only have information from two things. So expect those. But yeah, I think both with... behavioral health promotion with what has been accomplished with the suicide prevention collaborative, you know, hosting the summit and just the involvement we've gotten with the community and then everything that the clinic's been able to do.

That's awesome. So my second question, is there an area or a couple areas that you feel like, man, we need to make more significant progress in that would help the residents of the county, just top priorities like, well, these are a couple areas that I've

kind of keep me up at night i i we've got to make more progress on that um i don't know that i would would i can pick one thing off you know i think that um you know what the clinic does and and now with our new health insurance coverage um guide being able to Make sure people know how to use their insurance and that they know what's available to them not just through like Colorado Whatever it's called But also like Yes, and then knowing what you can and can't do with Medicaid and the providers that are available and I think Some changes in the Colorado Health Access Survey are showing that rural residents are still struggling with having a harder time. And that also leads to a lack of... It's harder to get providers here because we have a lower funding pay structure. And so there are a lot of factors that go into that. So I think we do what we can and address...

I think the harder part about this too, Roger, is that you're looking at a community plan in which we contribute some things and partners contribute some things. And then you look at the ecosystem in which the mechanisms in which there are investments and priorities. These priorities were picked by the community. You guys adopt the plan. all of these, and then you look at the bigger ecosystem out there in La Plata County, and you think, okay, so climate and health is a priority, but where all are the investments going on? And climate and health is a priority for the Board of County Commissioners, and what is their definition compared to public health's definition of climate health? So it's hard sometimes when those things don't sync up. And the hospital has a different cycle of health assessment or community assessment than we do. Access has a different cycle of community assessment than we do. So sometimes we may be passing a little bit where if things were a little more synchronized, there may be a bigger, deeper impact in some of these things, like behavioral health, right? It's just the nature of things, unfortunately, and I think we all see the challenge in that, and unfortunately is sometimes the nature. Just the understanding of that, I think, sometimes helps realize that the needle isn't necessarily going to be visibly moved in the five-year cycle that we have. And in five years, these priorities may be very different, given the focus of it.

What are priorities, and then where are the things that we have control over? Those are leveled to the top of all of the work stream that everybody does, all the great work they do. It shouldn't be on areas that we just can't make much of an impact in as much as we want to. Just focus on those areas that are priorities, but we have impact. That's right.

And that is part of the comprehensive program. program planning process that the department intentionally took the first year and a half with our programs to really prioritize what are our problem statements, where are our impacts, how are we investing with our efforts, and where do they fall on the spectrum of these priorities? What are the contingencies, I always call them dependencies, So what needs to happen before or after our interventions to make sure that they're the most effective? And if those dependencies aren't there, do we continue to invest in them? Because if the flour is missing from the recipe, is the recipe gonna be successful?

Makes perfect sense, yeah. Thank you, yeah, appreciate all you've done.

Patricia Savantual, on the climate items, do you do any work with four core for referrals, for modernization, and then also the Colorado Department of Energy also had lots of grants for space units and things like that. So that transfers also to rentals, particularly on Medicaid,

I would say if we are, I don't know about it. That doesn't mean we're necessarily not as far as like some of the communications that we've had with our Healthy Homes program. But I think I think it's part of why a lot of that stuff is still in the planning phases is because it's just like it hasn't been an opportunity that like we've been able to move forward with yet.

Yes. Workforce is a really great resource. So I definitely encourage not only because it's one to give up work.

So, yes, we do work with Fort Worth. And our Healthy Homes program can only go in owner-occupied homes. We cannot go right now into tenant-occupied homes. And I do know that there is...

you know, impact your mental health, you're not comfortable at home, you can't sleep, sleep deprivation, all of that stuff really plays into like the overall health of an individual, so just something, my thoughts. The other question I have is I know we did, you did hire a Spanish-speaking gal, male or someone for WIC, and then also the health insurance literacy. How has that improved capacity? Have you seen an increase? I know you don't have like data points to show

I would let Tiffany speak to the health insurance literacy piece of it, but I think as far as our WIC Spanish-speaking staff also works with NFP, and so they've been able to take on, I would say, probably a fairly large caseload, probably.

Yeah, it's at about 80% of what capacity will be because she's still training.

If I could ask you to speak up, please. Sorry, Roslyn.

I'll take you to speak up while you're down. You can be very loud if you want. Sorry.

No, thank you.

Hi, Rosalind Penny, Community Health and Wellness. Our Spanish-speaking WIC person is still slightly in training, and so she's at about 80% of full capacity for the amount of time that she spends in WIC. So she's eight hours a week in WIC, and that should be a caseload of about nine a day, and she's at about seven right now.

uh tiffany roberts health access and communicable disease manager i think that hiring a spanish speaker position um and we it's evolved already and she's been here about 10 months um just in the nature of once you have it you recognize the needs even greater than you may be thought ahead of time so her position has been reworked into a health coverage and care coordinator so she's actually split half time between doing care navigation to reduce barriers to care and improve the continuity continuity of care continuum and helping with health insurance enrollment. So it's been absolutely phenomenal to see the change. So I think one thing is just relationship building. There's a lot of studies that show that interpretive tools are great, and they are, and it's critical that we have those. But when you actually have a bilingual provider, because we've also trained her as a medical assistant, rendering care in someone's native language the health outcomes are so much better so she has a very natural ability to be able to connect with people and make them feel safe and comfortable and just have those conversations in real time between someone else versus having an iPad in the room or having a third person there and I think when there's concerns about culture and safety having that safety and that recognition of one's native language has been really helpful so there's been a great amount of trust building within the community. We are seeing a huge intake. Roger was asking about how busy we've been. We're seeing a big uptick in walk-ins and a lot of people are Spanish speakers because they're like, okay, I feel safe. I feel comfortable here. They can meet my needs that I know that they're going to understand what I'm asking. So we're even seeing an uptick in our services. But what's really cool about how her position's been braided is She can do one or the other. So sometimes she's in a medical assistant role. She's seeing a patient. They don't have insurance. And she's like, have you heard about emergency Medicaid? Have you heard about regular Medicaid? Have you heard about Omni salute? Have you heard about the family planning limited benefit? And she can just really quickly start to. assess someone's health coverage and maybe even add that on shannon mentioned presumptive eligibility which allows us to start people who would be eligible for medicaid on medicaid that day for 45 days while their process their application is processed so in some cases you can even get someone insurance that day to pay for the visit that they had not to mention they now have medicaid for 45 days that they can take anywhere and then the reverse is true so sometimes she's seeing people who are here for a Medicaid consult and we're like oh you haven't been to the doctor for five or ten years we could get you on our schedule we can start with something simple like immunizations not that that's simple but you know we can start with something really see where your needs are and then help navigate you not only to insurance but to a primary care provider a medical home so I think that's been really instrumental to our flow and how we approach issues and I think it's had a really significant impact on reducing barriers to care and I think the flip side is given her specialty with language and the populations we're working on, we've also developed a lot more specialized knowledge of some of the plans that might be more applicable to people who speak Spanish or are newer to the United States, things like Omni Salute, for example. which is a specialty plan on the marketplace, it's really complicated and changes year to year, or emergency Medicaid or Medicaid, you know, or alternative payment plans if someone really doesn't identify or qualify for any of those. So not only, I think, do we have stronger relationships and better patient outcomes and better access to care, I think we also just have a lot more specialty knowledge of these really specialized, sensitive, complicated systems, which really better serves those who have been typically underserved in our community.

Thank you, Jenny. That's great to hear. Like, really exciting. Yeah. Thank you.

Yeah, that's awesome.

Any other questions? All right. Thank you, Shannon.

Yeah, thank you.

Okay. We are going to move to the consent agenda for the approval of resolution of Board of Health 2026-05, adopting the Board of Health 2027 meeting schedule. Is that accurate? Meeting schedule and designated public place for Board of Health meeting notices. Do I have a motion to approve the consent agenda as presented?

I will make that motion to approve that as presented.

Perfect. Is there a second? Second. Thank you, Roger, for the motion. And Wendy Rice for second. All those in favor, please say aye.

Aye.

Aye. Kathleen, aye. Aye. Yes, aye. Thank you. Okay, consent agenda is approved as presented. So we are moving down to the decision agenda. I want to jump down to the decision agenda, like budgets. I love budgets. Okay, consideration and acceptance for the 2027 proposed public health department budget. Tracy, may we have a staff report, please?

I will pour you with the... statutory language that you all know by heart by now, which is that you have to do this pursuant to the statutory authority. Again, the department and all of the staff have contributed to the development of the budget that you see before you. There have been no changes since you reviewed the budget on August 6th. The budget is the complete financial plan to fund the department for the next fiscal year. I do want to underscore that this is a draft budget and it will be recommended to the Board of County Commissioners. The Board of County Commissioners will then take this budget and they will use this as the starting place for the department's budget and they will take it into consideration They will potentially make adjustments to this based on the rest of the budget negotiations with the other departments within the county. So you may see changes to the public health department budget in the total budget that will be adopted by the Board of County Commissioners on December 15th when they have to approve their final budget. Are there any questions for me about budget?

Any discussion on the budget? Proposed budget? Seeing none, may I have a motion to approve the proposed 2027 Public Health Department budget?

So I move to accept the proposed 2027 Public Health Department budget and direct staff to present

all those in favor please say aye aye aye so proposed budget will move forward to the board of county commissioners thank you everyone and thank you to Tracy and all of everyone within the department as well as the county and finance you know it is a team effort takes a village and I think it's really nice to go into this upcoming year fingers crossed with no not scrambling to be in the Black. How's that? Or the green. However you want to look at it. So, thank you. All right. Moving down to our reports. Anyone have any board reports, board members?

None.

Kathleen, anything for the board? No.

Okay.

All right.

No board reports. We'll pass it over to Tracy for a director report. You were provided with the written director's report. I will not go over it orally, but I will entertain any questions that you all have about the written director's report.

Patricia Sepanchewal, thank you, Tracy, for providing that. I guess my question is, at one point, are you going to do a formal presentation PowerPoint in the coming months?

Yes, I think that you have requested that they be presented written for the majority of the time. I did give you the first one as a PowerPoint so that you could decide whether that was the kind of format that you wanted. And so, yes, I will do that at your request. I can do that.

Thank you.

I do have some updates that are outside of that written report, if I may. Please, if you have any other questions about that specifically. Okay. I'll wait to see if you have any other questions.

No questions.

Okay. I do want to update you all on the federal budget, if I may. So both the Senate and the House have passed continuing resolutions for the 2027 budget. And I do want to let you know that because what that does is it does... allow that the federal budget will be um covered through december one for the eighth and one through the 11th of december 2026 for level funding for all of the budget items that includes public health. So I just want to let you know there is always some question about what funding levels will be for public health in the coming year. Now that doesn't mean some things won't change necessarily. So we don't know actually what public health funding levels will be, which means there could be changes to our budget in the coming year. We have had some Questions about what notices of awards will be coming up because our federal grant funds obviously come in in May, April and May in the 2027. So there will be continuing negotiations because they were not the same budget bills that were passed. But I did wanna update you that there were continuing resolutions passed. So we are not looking like we're facing children administrative funding, and while we don't administer the SNAP benefit, it did affect significantly the supplemental nutrition program, which is administered out of the Department of Human Services. So I did want to just update you on that so that you were aware that those continuing resolutions were passed.

Thank you, Tracy, so much. We don't usually have our finger. I don't usually have my finger on the pulse all the time. Or should you have to? Any other questions for Tracy? Moving down to attorney reports.

No attorney reports.

Okay. With that being said, we are at the end of our agenda. May I have a motion to adjourn? And actually, I need a motion to go into executive session. That's right. Yes. So at this point in time, before we adjourn, may I have a motion to go into executive session? Who has the script? For personal matters. So I guess pursuant to, sorry let me grab this really quick. So pursuant to Colorado Revised Statute 24-6-402, For, upon the affirmation vote of two-thirds of the quorum present, Wilpota County Board of Health will hold an executive session to discuss the matters identified below. The motion to hold an executive session shall identify the statutory provision authorizing the executive session and shall identify the particular matter to be disclosed in as much detail as possible without compromising the purpose for which the executive session is authorized for, and that is for personal matters pursuant to CRS 24-7. evaluation of public health director. May I have a motion, please? I guess not.

So I will make that motion to go into executive session as described.

Yeah, then maybe read out the part that's highlighted there.

Regarding personnel matters pursuant to CRS, The purpose is for preparation and performance evaluation of the public health director. Is that what you're saying?

That's correct. And a second?

I'll make that motion.

Perfect. Thank you, Roger, for the motion, and Wendy for the second. Okay, we are going to move into executive session, and then we will take a vote. Take a vote. All those in favor, please say aye.

Aye.

Aye. Aye. Perfect. Hearing none opposed, we'll move into executive session. At the same token, we will need to adjourn our special session.

Well, let's just go into e-session here, and we'll note the time.

Cool. All right, time is 2.10. Going into executive session, and we will adjourn our special meeting. So thank you all for attending, and we'll pause for a quick minute. Recording stopped.

much process well done and i've sent a note to julie she'll come on up okay perfect all right here it is so we'll take a minute