Arapahoe County Board of Health - Regular Meeting

Director Reedy Kleinman is in absent. Director Sean Davis Do not see him online yet. Is delayed and may be absent in this case. Okay. Director Christine Burrows. Here. Director Mark Levine. Here. Director Mark McMillan. Here. Director Terrence Walker. Excused. And director Michelle Weinbach. I'm here.

Excellent. Thank you. I would like to pivot now to staff introductions and ask the directors in the room to please introduce their staff. Who will present today? Please.

Great. Some of our frequent flyers, happy to I know you

missed him last time.

Steve Chevalier, environmental health manager

Melissa Orozco, Clinical Disease Epidemiology Manager, along with Dylan Garrison, Environmental Health Manager, who you

will be hearing from later today.

I have Mikayla Brands, community health promotion specialist senior. Michelle Ebendik, also a senior community health promotion specialist. And then Wendy Mady, who is their manager. She's the manager of family and community services that we've told you. And then Rebecca Rapport and Felix, also senior community health promotion specialist.

And I have Anthony Sotelo, our safety and security.

Very nice. Thank you. Any other introductions today?

I would like to introduce Taylor Roberts who has been here with us before, but he is sitting in for Heather today.

Thank you. And I feel like Steve should have a permanent place of entertainment.

I'll be back.

I'm the girl too, too.

It's always nice to see everybody. Thank you so much. Pivoting to a motion for approval of minutes. I move for the Board of Health to approve the December 2025 meeting minutes as presented. Is there a second? Second. Thank you. Motion made by Mark McMillan, seconded by Doctor. Laveen. Thank you. All in favor, aye.

Aye.

Opposed, say nay. Hearing none. Thank you. Next is our public comment period. Folks are invited to speak to the Board of Health about any topic related to public health. Ms. Ross, is there anyone signed up for this public comment? No. There are none. Thank you.

And I'd like to thank Ms. Ross and others for keeping me organized. So thank you so much. Next, if I'm doing this correctly, is the director's comment. This time, board director invited to share insights from community leaders and partners to gauge the current stage of the community.

I think last we started here.

Does that sound right? So, Michelle?

Hi. Hi, everybody. Know we have so much on our minds as it relates to this work that it's almost impossible to narrow it down. Today, for purposes of what I do and how it affects this work with Rockville County Public Health, I'll talk a little bit about for a minute about our unhoused students, and those fall in different categories. I think a lot of people in our world think of kids only, families identified under the McKinney Vento law that provide certain services and access to families that fall in that category.

What we are seeing right now, at least in Cherry Creek schools, and I think across the county, it's probably pretty consistent. We've talked partners in Aurora and Sheridan and Englewood. And we are noticing a decrease in those documented under McKinney Vento, but an increase in those documented under unaccompanied youth. And that is usually a very small number. And in pre COVID times, that meant mostly kids who were seeking emancipation, and that is no longer true.

Those are almost entirely student children who are seeking to live in the metro area without an adult because their adults are no longer here. And I guess what I wanted to say about this is it's important to understand the context of data just as much as it is to understand data. And when you look at those McKinney Vento numbers not meeting state projections and not meeting projections for our school district, for APS, for others, and I would assume for DPS as well who has the highest number of McKinney Vento students in the metro area, probably because they're the largest. It it it it needs to be acknowledged, understood, and then services provided to students regardless of whether they fall into that federal mandated program. And we're working to do that.

It's hard to find a shadow. Right? And so I would just put that on your radar. It's certainly on ours that anyone seeking services, whether it's through harm reduction, through WIC, through any of the other myriad services you provide, that could be a growing case as we wind our way through this administration.

Thank you. It was a very nice holiday break, and I haven't been doing as much as I perhaps have been doing before. One thing that I would like to mention is I ran across an article which I shared with with Christine regarding the necessity for seniors to get immunizations. When we talk about immunizations, we usually think about children, but it is also enormously important for the senior population. And there's been some recent medical literature about how immunizations can keep people in their home and prevent them from needing to be hospitalized because hospitalization for any reason is a indicator an influence upon people's inability to remain at home.

So I just wanted to mention that, and I don't know what opportunities we do have as a health department to be able to encourage that, but it is something that I think is important.

So hi, everyone. I was at the Consumer Electronics Show earlier this month in Las Vegas, which is, like, the wildest experience. It was there was a 141,000 attendees and 4,100 exhibitors in Vegas. So it's just, like, nuts, and then I have the Vegas nuts on top, which so I, like, get into my hotel room at night was like, oh, I need to send. But one of the things that I really noticed that, like, my public health brain was thinking about, a lot of the tech and innovation that we are looking at was very much lifespan driven.

Instead of last I went last year as well, and a lot of it was like, here's a piece of technology for an older adult, and here's a piece of tech for somebody with disabilities. And so much of this, like, we've seen this sort of transition to a lifespan approach to keep us all healthy as here's my soapbox again, we're all aging. So, yes, as we speak, we're all aging. And Thawiya thought that was such a fabulous, transition to see, especially, like, as we in public health, try to make the case the business case for public health when it's so hard to make the business case for, like, how many diseases we've prevented with vaccines or how many, like, you know, how much harm we've, you know, prevented, etcetera. So I I was excited to see industry kind of following those following along with that.

And then the other thing that I'm have on my radar is the Colorado Division of the Deaf, Hard of Hearing, and Deaf Blind is putting on a summit in April, one for providers who work closely with folks who are deaf or hard of hearing on Friday one Friday afternoon, think it's the eighteenth. And then a summit for community members who are deaf or hard of hearing or deaf blind who need access to resources and opportunities. So I will be I will share some more information with Jennifer. But if you all have clients that you're working with who are deaf or hard of hearing who could utilize support, we would love to have them. We're also looking for exhibitors. So if you guys are like, have access to resources that people could tap into, I'd love to chat further with you on that.

That's my gosh. This baby noise is so fun.

Really like baby at work day.

Next meeting, make it

official. Yes.

You know, from my standpoint, I'm I'm really feeling very privileged right now working. So I'm with Denver, Department of Public Health and Environment. I'm in the environmental side. And one of many projects we're working on right now is really to our strategic priorities and specifically environmental protection, community engagement, environmental justice, and so forth. And so we had a kickoff meeting today in terms of how we're gonna measure into this space and actually develop an environmental quality index that we can use to really, you know, not only measure where we're at, but also drive better outcomes, you know, within social determinants of health and so forth.

So very new in the process. There will be a community engagement piece to it, but really excited to see us move in the direction. A lot of good models out there, and so it may be looking to continue around Bell County or national international models for us to look at. But really really need kind of a intriguing new chapter for for us right now. So Any comments or questions for the board on any of those updates? Hearing none. No? I have a couple follow-up for you offline on that.

Thank you Alright. So

I'm gonna go ahead then and move us down to the Joan joint. Didn't wanna miss again any entries.

She had not joined yet.

Okay. Thank you. I'll turn the task every time we break. Alright. General business item, there's one business item, the election of our board chair and vice chair for the 2026 term. Folks may know, but just so we level set, Sean has expressed a desire to continue as her board and chair and to continue to serve as the vice chair for the 2026 term. But definitely would wanna open it up for for discussion or any feedback before we You're not seeing none. So I moved to elect Sean to yeah.

You might not put the agenda chair. I'm

just excited. I moved to elect Sean Davis to continue to serve as board of health chair,

sales people.

Like, talking well about them behind their backs.

Telling we have a second or third. Mark, you wanna choke them? There we go. So we do have a a motion made by myself and Christine as a second. All in favor, please say aye.

Aye.

Anyone opposed, please say nay. Hearing none, let it be official.

Not good. Yeah.

We're smart like that.

That's a good

hang reference. Good job. Yeah. I would say so impressed

with Bibi and Sean and and their role, and it was very appreciative of their leadership. So thank you to both of them for their work. Moving into the study session. Our first study session is a core spotlight on maternal child health. There's a slide deck for that.

Am I doing it right?

And that concludes our presentation.

Okay.

Sorry? Yeah. But it's a.

Okay. Sure. I'm just gonna come back. Okay.

It should be just too much. Oh. Moving. Close.

The peanut is neither a peen or a nut. Discuss.

This time, we at least have video and sound. But, you know, we can't have it all. No. No. Can't. There we go. Woo hoo.

All right. Hello, everyone. I'm Michelle Evindick. I'm with our Maternal Child Health Program.

And I'm Nikki Abrams. I'm also with our Maternal Child Health Program.

And Rebecca over there is our other teammate. And we make up the Maternal Child Health Program. So the Maternal Child Health Program is a program and a funding stream. And it dates back to the Social Security Act of 1935. Our maternal child health funding is to focus on the system.

So we are looking at the forest of trees and saying, why are these, leaves dying over here and why aren't they thriving over here? What can we do to improve the system, and address those leaves? And so our work is really to identify, areas that we can improve, and often that is through doing some of the work with our partners who provide the direct services. So we'll talk a little bit about our work and then some of the things we've done in the last year in the maternal child health program. So our core measure is percent of key activities that we complete each quarter in our action plan.

So we have an action plan that comes down from the State Health Department that we develop that are built off of national and state performance measures. And so the three areas that we focus on are economic mobility, access to supports, specifically focused in children with special healthcare needs, and then social emotional well-being. And then within each of those areas, we have key activities. And so because we do systems work, it's really hard to count it. And so we said how many of our key activities are we going to complete each quarter?

And so our funding goes from, October 1 to September 30. So you'll see that's why it's climbing. And we set our, measure to be 80% because we will never complete all of our activities as many of them are ongoing. Just because our funding quarter or year ends doesn't mean that our work stops. So if we were here today to show you, it would plummet back down because we started a new, funding cycle for what is quarter four for core, but quarter one for maternal child health funding.

But this is kind of where we're at, and we thought it'd be helpful to kind of share some of the projects we've done over the past year. Talk about Family Connects as that was our hugest, our biggest, program that we launched this year, and then kinda where we plan to go in the next year.

Thank you. So one of the most fun things that we get to do is work with community based organizations and do sponsorships for them when they're doing work that improves the well-being of, kiddos and their families. And so I will just kind of run through some of those sponsorships. This is not a complete list, but, wanted to kind kind of highlight the diversity of the kinds of things that these community based organizations are doing and, how much they can do with a very small amount of money. So that picture that you see where they're all sort of holding hands out in the field on the bottom right, that is a mental health circle that went up on me go have hosted.

So that's for caregivers of kids who speak Spanish, and they had 18 different participants, explore the role of caregiver emotional well-being and supportive relationships, and strong Latino communities in helping children grow and thrive. And what they learned from that is that they they need to do a lot more, like, community building and education around this topic, but that there was huge interest and excitement about it. So that was really cool to see. The top right corner is a picture of the Families for Resource Center's first birthdays, more black birthdays bash. And that is basically

a big birthday party.

They had over 50 families come, and it's designed to raise awareness about the high rates of black infant and maternal mortality and morbidity, as well as to connect community members with kinds of resources that they might need, and to strengthen partnerships with other organizations that are dedicated to improving Black maternal and infant health. The big picture here is from El Grupo Vida. They did a disability inclusion event. So over 40 youth and adults with disabilities, as well as their parents or caregivers attended a day long event offering multiple enrichment activities designed to promote creative expression, social connection, and self advocacy skills. We know that when we make the fabric of the community stronger, everybody does better and gets much better access to resources.

There are so many more examples. Adam's Purpose hosted a bereavement gathering particularly high five families who have survived the loss of a loved one. And Mama Bird hosted a black breastfeeding week celebration that had art and poetry and a celebration of black breastfeeding. We sometimes also sponsor internal programs and trainings, so we did sponsor an intimate partner violence training for nurse home visitors across our nurse home visitation programs because that really came up as a need that they were encountering in the community and wanted more awareness and skills and tools and information about. We also sponsored a WIG lactation skills training, and so that 32 people were able to learn how to better support lactating parents in their journeys, which was really fantastic.

Firearm Violence Prevention Workshop is another one. We also sponsored the Autism Store to do an accessible play date for families with children and youth with special healthcare needs, and, a family navigation fundraiser. So I'll stop there, but just to give you a sense, these organizations are doing amazing work in the community, and sometimes even a thousand dollars or $5,000 can really make a very far reaching impact. So that's great.

And I'll just add that none of them received all of them were less than $5,000 sponsorships, and they were able to do that impact of work.

Okay. If you could go

to the next slide. Yep.

So we did two bigger projects as well. One of them was a community tax ambassador community of practice. This is work that I led with the five agencies listed on the top. So Adams County Health Department, Arapaho, and JESSCO, we, as maternal child health programs, we came together and selected five community organizations to be ambassadors for tax outreach as they really know their community and have trust within their community. And so we worked with them to educate them, train them on what tax outreach looks like, where to file taxes that are no cost or low cost.

And so that was from January to April 2025. And then we also did a summer community practice with them as well to really help them develop deeper skills of what does it mean to be an ITIN filer and how do I get legal support in making a decision if I should file my taxes or not. So really diving deeper into some of the concerns that are coming up within the community. And they came out with action plans for what their tax outreach will look like, which has launched this month. So we are continuing to work with these five agencies and really put the trust with them in disseminating that information to the community.

And we also did a VITA tax site last year with human services, and we had eight days where we had tax services at the CenterPoint that were no cost to communities. So these partners really helped us lift tax work within the community and help families get ahead and get lifted out of poverty. All right.

And I'll talk about the doula training that we sponsored. So Colorado Medicaid has covered doulas for their members for a little bit over a year, and we wanted to look at how accessible doulas actually are to people giving birth in Arapahoe County. So we did a little math, and we figured out that we would probably need about a 138 doulas in Arapahoe County alone if we wanted to serve about half of the burning people covered by Medicaid, which sounds like a lot, and it's actually not impossible. Like, that's not thousands. Right?

At the time when we did that math, there were about a 100, Medicaid approved doulas in Colorado overall. But a lot crossed county lines. A lot will serve, like, Denver and Arapahoe. And now it's looking more like a 140 statewide, so it's growing fast. But we wanted to make a dent in Arapahoe County.

So we basically worked with eight different community based organizations that were doing either community based doula work already or related work like lactation support. And they had networks of people who were interested in being doulas, who were already part of the communities that they were serving, and we had them recruit those folks. And then we sponsored a training that Elephant Circle ran for them. It was four days of training, which is, you know, a pretty big commitment on their part and not not as much of a barrier of, like, going to college, for example. Right?

So it was a more accessible sort of economic opportunity path as well for those doulas. So we were able to train 22 doulas through that. They did receive stipends for their time. And, because we know it's not just the training, but they also have to get in their birth experiences, they have to, gather a whole lot of paperwork to, enroll as Medicaid providers, we also worked with some of these organizations to specifically provide mentorship and ongoing support over the next year with them. So we'll be following up on that. It'll be six months pretty soon, and then, we'll follow-up again at twelve months. Yeah.

Are Google certified? How do you know that your training has been effective and it's a good doula?

That's such a good question. So nationally, there is no doula certification because they're considered nonclinical professionals who provide emotional and physical support to birthing people. However, if you wanna get paid by Medicaid, you do need to be certified. And so HCPCS has a list of approved doula certification organizations that they are constantly updating. Elephant Circle is one of them, And they make sure that the curriculum is aligned to sort of the HIPAA standards, and then, they have to that's one pathway.

Then then they then they have to attend at least three berths, do a CPR class, and, have liability insurance. The other option is if they've done 10 births and get, like, a whole bunch of letters of recommendation, they can also do that. That's not very common. It's, like, a very, very small percentage of the ones.

And of the one the duelist that you have trained, have they all successfully been certified by Medicaid?

Not yet. So we need

to follow-up with them. I believe February is the six months. But usually, it takes quite a while for them to get their three births in because they have to find a birthing family who wants a brand new doula, and then they also don't get paid for that time. And so it's a pretty big barrier in that sense. So they're working with some of these organizations like Elephant Circle, Mama Bird, Families Forward to get those referrals because especially for folks who don't have Medicaid but can't afford a private doula, those are kind of those in between people who they can kind of get their practice families in with and then enroll as a Medicaid provider. So they're getting there. They are. Good. And they're doing their births, but it's kind of a slow process.

Yeah. What's the how many doulas do we have in the state of Colorado that, like, could potentially be Medicaid providers versus, like, outside of the 140, I think you said that are Medicaid providers.

So do you mean, like, how many are do are working as doulas but aren't enrolled as as many providers?

Yeah. Yeah. I don't know. That's a great question.

Like, who's gone through the elephant circle prob like, program that has not gone through Medicaid to be a Medicaid provider.

Yeah. It's quite a number of people. Yeah. And that's because Colorado Access and HCPUV and some other organizations, they provide initial funding for that training upfront for some people, and there's, like, a lot more kind of hand holding needed. Like, doulas are community aunties, basically, right, who aren't necessarily used to, like, Medicaid paperwork and billing. And so that's one of the reasons that this kind of more intensive mentorship was intentionally built into this program is because, like, a lot of

people just get overwhelmed. Mhmm.

So DDPHE has done a fantastic job of sponsoring some, like, guides to support doulas and then providing one on one support. They've done it for, like, I think, 85 ish doulas to actually get them enrolled. That's great. So cross county collaboration is also pretty important there, but a lot more.

There's a lot of people in

the pipeline right now. Cool. Awesome.

Thank you for those questions. Well, I

do have one more, and that is that how do we know that the doulas are doing a good job? Are there any quality metrics or things that you can follow to make sure that the people who are doulas in Arapahoe County are doing what they're supposed to do?

Yeah. So to my understanding, Annette Daly at Hickpuff is the one who is leading that from their perspective. I think and I don't I don't wanna speak incorrectly about what Hickpuff is doing. But to my understanding, they are starting to collect some of those metrics and the satisfaction results with that and also some of the outcomes around, like, reduced cesarean births and, exclusive breastfeeding outcomes, lowered, postpartum depression and things like that. So I don't know exactly what metrics they're using, but I I do know that they're working on it.

And how about doulas in the county who are not certified by Medicaid? Do we have any insight into their effectiveness?

Yeah. So there have been quite a number of studies on the effectiveness of doulas. I would sort of point you to one of my favorite little one pagers, is by a place called Evidence Based Birth, and they collected some research on it. So, like, overall, the randomized controlled trials and things like that show that they are quite effective in reducing cesarean rates and, maternal morbidity and mortality as well, as well as postpartum outcomes around breastfeeding.

I'm I'm I'm aware of that. Okay.

But but specifically, people who claim to be doulas Mhmm. And are getting performing those services but are not certified by Medicaid, do we have any insight into whether they are doing a good job, or are they interfering with people's course?

With the so you mean, like, when people are hiring private doulas? Yes. Okay. I don't think that kind of information is collected that I know of. I mean, I would assume mostly the doulas get referrals, word-of-mouth. So if they were doing a horrible job, I would assume people would not tell their friends to go get that doula, but, there is not necessarily statistics that I know of on that particular population of doulas. But they're not clinical. Right? So I

I understand, but they have an effect.

Yeah.

Yeah. And the effect can be usually positive. It's possible there could be negative effects.

Yeah. And they have a scope to stay in within their dual code of practice and ethics. And so if they're not staying in that, I would assume that the providers would politely ask them to leave the room. But

yeah. I mean,

they're really there to empower the birthing person to make their own choices.

Sure. Yeah.

That's fine. Thank you.

Okay. It's it's an interesting question. Sure. Yeah. So we were also very excited with this dual program that all 22 of them completed the training with a 100% attendance.

About 10 of them are speak fluent Spanish, so that was great. It was a bilingual training with, interpretation in the moment. And then after the training, another piece that we're working on to try to make this more sustainable is working with AVWorks to meet with, four of the local HIGPF approved doula training organizations to get on the list, to then be able to use it workforce dollars to pay for trainings like this in the and so that is kind of a complex layered thing, but it is it is slowly moving along. Yeah.

I don't think there's anything else to say about that.

That was probably more information than you

ever needed about the list. Sorry. Yeah.

We we

can go to the next slide.

Wanna take this one? You want me to

Oh, yeah. Sure. Since time from talking anyway. Okay. So this is Family Connect. I'm sure you all have heard of Family Connects before, but we did launch it, sort of at the August, September. And it is a no cost to the families voluntary nurse home visitation program that supports families with newborns in the first weeks after birth. So usually that visit is three weeks after birth. Our catchment area is families who give birth at Denver Health and live in Arapahoe County. That's about 840 families a year, so not not a small group of people.

And in the first three months, and these numbers have already changed since we submitted the the slides. I think we're now at 47 families served in about six languages. We've trained two staff members as certified lactation consultants. And we launched a resource finder, which is related to Family Connects because we need to have one for Family Connects, but we broadened it by making it accessible and sort of a collaborative effort with the whole ACPH world, all of the different programs. And then shout out to Michelle and Rebecca for figuring out all the braided and blended funding streams.

There are at least five different funding streams. We've applied for now three additional grants, because we just have one full time nurse on this program, and there are enough babies being born that we definitely need at least two. Mhmm. So we are working on securing funding for that. But even in these first months, our nurse has been amazing and really shows why that three week point between birth,

where you're twenty four seven in

the hospital and the six week postpartum appointment, is so important. So she's caught an an infant in respiratory distress, that the family didn't necessarily know it was that big of a, you know, warning sign. And then she also identified a mom with postpartum preeclampsia who actually had to be hospitalized immediately Mhmm. After she found that finding. And then undetected fever in a newborn, and then just a lot of work with social determinants of health.

So housing, food, diapers, transportation, safe sleep access to pack and plays, and car seats. So she's I mean, truly, I kind of joke that she's a hot social worker because she is doing so much more than just good clinical sort of hair there. But we're getting really great feedback from the families, and eighty five percent of them are completing the survey afterwards, which is a really high percentage, especially for this population that's has no sleep and new babies and a lot of stressors. And I think that just speaks to the trust that she is building with those families, which who are majority Spanish speaking, but with quite a range of other languages.

What else would you add about Family Connection?

I will add that Jennifer, Monica, Melissa, Brianna all have been a huge kudos because our team is relentlessly applying for grants. Last week, we somehow survived, but we submitted three grants. One of them had a 20 page narrative. It was intense, but we applied last week to the Colorado Department of Early Childhood. We did a civic solution grant with the Department of Local Affairs.

We submitted a Colorado access proposal, and then we have a telegen grant that we submitted last fall that we'll find out hopefully in February. But kudos to our leadership to put up with us because we have request after request after request very last minute to submit these grants because I think we all believe in the success of the program and that our community will benefit from it if we can find funding for additional staff to hire more nurses.

I have a question about the housing stability. Can you expand on that a little bit? Yeah. Envision just

like So there's

It says there, but go ahead, please.

There are a couple of different issues that have happened. So for example, with the deportation situations, if the primary briber in the family is detained by federal agents, then that leaves but usually the mom of the baby without a way to pay rent, and sort of sustain that. And so that's been sort of the our biggest housing crisis that we've seen. But it can also be issues like substandard housing issues with, like, bedbugs, and, eviction notices that are, like, either potentially legitimately legal or maybe not. I need referrals to sort of legal support around tenant rights.

So, yeah, affordability of housing has just been really hard for people. And lack of theme to support housing for clients. I mean,

I think there was one client who probably spoke with six different community agencies and was just being bounced around from place to place to place and ended up being one of our Whispering Pines family. So we went back down that loophole. So it just is there's just not resources out there, and families are in high stress situations, and the the agencies that we rely on just don't have the funds.

Are there models think about those comments. Are there models out there in terms of, like, navigator services? Like, give me just that example you gave right there, the sort of bouncing around. Imagine it's exhausting and, you know, trying to explain to your story. Are there are there navigator programs as well?

Yeah. There are a number

of navigator programs out there. One of them is the DHS, the Arapahoe County DHS family navigators, and then there's a number of other ones. The challenge is when nobody has the assistance funding for the actual rent to get paid. Like, there's not that much that the navigators can do. And so these rental windows will open up for, like, you know, one day that you can all apply, and then there's a lottery to see if you maybe get it. And if you are undocumented, may or may not even be eligible in the first place. And even if you are documented, your chances of getting it are pretty low. So I I think the navigators are doing their very best. Mhmm. But there's just so much more need than there is material support. Thank you.

Next slide. Okay.

So learning opportunities and next steps. What have we learned in the past year, and where are we headed, and how are we gonna continue to reach our 80% goal for our key activities? As we already said, we know that Family Connects needs additional funding for nurse FTE. We are actively looking for funding. We feel very supported by leadership in this process.

February will either have a ton of funding or no funding, depending on what happens with these programs. We know that our funding goes so much farther with our CBOs. What they can do with less than $5,000 is just incredible, and the connections they have with the community and taking into culture and linguistic needs and whatnot, they are just so responsive. And so we really believe in this model of continuing to put any funding that we have for sponsorship and community engagement back into the community. And then we know that their systems level work is hard, and it's really dependent on so many factors.

We had a stop work order in September on one of our events, and then it was, oh, just kidding. You can get year two on it. So, you know, with the systems work, we're kind of riding a mini wave compared to what leadership is riding. But of all the different changes, as we continue to try to build these strategic partnerships and try to really expand our work and who we have strong relationships with because that's what's going to get us through and keep us leveraging our work. Any questions?

I just wanted to add, if I may. I've been so impressed with Brianna, Tracy, Jennifer, as I I've worked to the capacity on the budget subcommittee, but just the dedication of that space. So cut his fingers crossed, also there's a great team behind me. The scenes working hard to support staff.

Yes. We definitely appreciate them. You bring out lots of team messages from me. So it's irresponsible.

Don't yell.

So no comments or questions? No. All right. Thank

you so much.

Appreciate it. Our next session presentation is on National Radon Action Month. Dylan, you're up.

Great. Thanks, Mark. Julie, am

I driving? I'm gonna drive for you. Great. Okay. Thank you. Thank you.

Yes. Thank you for the time. I appreciate it. I'm probably out of three minutes for us here.

Last year's last year.

And I think the presentation will pop up here any minute. Here we go. Yes. Happy National Laid On Action Month to January. Again, appreciate the time to talk about this briefly.

Next slide, please. I suspect this will be a bit of a review for many of you here in the room, but figured we could quickly touch on what radon is and why it is a public health concern. Radon is odorless. It's invisible. Can't taste it, and yet it's a radioactive gas that is commonly released from the natural decay of uranium that exists in rocks, primarily, sometimes soil and water as well.

Over time, they can enter homes. They can enter buildings. They can enter schools, child cares, through those small cracks, because there's holes in the floors, and it gradually accumulates to those higher levels that can eventually lead to higher concerns. And the way radon is measured is in picocuries per liter, and the EPA has established a threshold or an action level of four point o pico curies per liter as a level at which you should be concerned or more concerned. So that's the threshold that we use to sort of generate action and move forward potential mitigation.

So that's a general synopsis of what radon is. So next slide, please. The reason we're concerned about radon, as I'm sure many are aware, is because as it starts to accumulate to those higher levels in indoor spaces, breathing it in releases those radioactive particles into the lungs, which over time can cause damage and potentially lead to lung cancer. In fact, EPA estimates that radon causes about twenty one thousand lung cancer deaths in The US every year, of concern for sure. And a different frame on that is in The United States, it's the leading cause of lung cancer among nonsmokers.

Certainly a concern. And then from coast to coast, we're looking at about one home in every fifteen that has high levels of radon. So above that four point o threshold that the EPA has established. And the kicker is anyone can develop cancer from renal exposures. No one's immune to this, so it's out there and anyone can potentially develop cancer.

So that's why we're concerned. Next slide, please. If you zero in on radon levels, radon prevalence in Colorado and Arapahoe specifically, the numbers are a little bit more stark, actually. I mean, you're looking at about one in every two homes, so fifty percent of the homes here in Colorado have elevated levels of on. So, again, above that four point o.

And specifically in Iraq, though, it's similar to the state in general. CDP, she estimates that about half of the homes here in the county have high levels of rate on. So a concern nationwide, yes, but even more of a concern arguably here in Colorado given the higher levels of rock that contain that uranium in the state. So that's why we do a of focus on this. So next slide.

So what are we doing about it here in Colorado? We were fortunate enough to receive a small grant from the state health department to do a wide range of radon work. And some of the things that we're doing to get at this is number one, raise awareness and encourage mitigation throughout the county. Specifically, we've been able to enhance our web page. Our comms team has been fantastic in doing that.

A lot of good progress there. You'll see newsletter articles pop up every now and again bringing attention to radon. So that's another way we're trying to get the word out there. And during January in particular, we are boosting our social media posts to again get the word out there and spread the word that, hey. It is National Radon Action Month. Here are some of the things that you can do. So we've taken action through raising awareness. The other piece of the campaign is providing free radon test kits. Most of these kits are relatively inexpensive, so we're able to get several 100 of them. And members of the community can request a free test kit, go online, fill out a form, we'll ship you a kit.

And then if you set it up, you can send it and get get your results in the mail. So pretty select. And the other piece of this is reaching out to our in home childcare providers. Our standard childcare, Steve can talk more about this, are actually required to do radon testing, but these in home providers are not. So we'll have a lot of kids that go to these in home providers, and most of the care takes place down in the basement, the lower levels where those levels can be higher. So what we're really trying to do is to reach out to this group in particular to offer a free presentation on radon. Hey. Here's what it is. Your evaluation concerned, and get a free kit in their hands and do this testing. What we're finding is that most of them are pretty well aware of this, thankfully, and they've done a lot of testing already, but their handful haven't.

So we've been we've been really reaching out to that group to try to encourage education and action on it. And then new this year is a collaborative effort with other local health departments, five other, in fact, to pull together a common slogan around radon and slap it up on a billboard. And it's gonna right in your face. So yeah. So I'm I'm not sure if anyone's familiar with the Piper Inn. Okay. There you go. Mark, the barkings out of Piper Inn. Yeah. Okay.

I can trust that. It will determine whether

your order is the right Piper Inn order or not. Next

slide, please. You will see a billboard that looks very similar to this. We didn't mince words. Radon causes cancer. Prevention is easy. And you will see this throughout the metro area. In fact, you should see it in Adams, Jeffco, Groomfield, Denver, and Boulder. Although, quick caveat, Boulder does not allow billboards in the city and county. Well, so they did it on bus ads and bus stops. But same idea.

So you really want to get this idea out there universally to spread the message and kind of have a uniform approach to this. What's nice about this is if you go to that link there, that URL, you can order a free test kit that they will send directly to you. And, if you do the diligence of setting it up and returning it, they'll provide return postage for you and get you your get you your results. So I think we had several 100 test kits available, first come, first served to folks in the county. And, this is sort of a metro wide initiative. So we'll see where it goes. Adams did this last year. They helped initiate this. They said it was pretty successful. So see what our numbers look like.

But, yeah, it's fun working with other local health departments, collaborating, getting the message out on a broader scale. Next slide, please. Fortunately, getting rid of Raynaud is relatively straightforward. Right? It's achieved by installing a system that essentially removes that buildup from the house and just vents it to the outdoors.

It's pretty straightforward and typically consists of a fan, fan that runs all the time, that pulls up that accumulation, just vents it through the ceiling, through the side of your house, to the outdoors. And there's usually a suction point towards the basement. They put the pipe into the ground to pull up that radon gas. And it really goes a long way towards reducing that accumulation in basements. Challenge is it's not exceedingly expensive, but it does cost something.

And, you know, prices range from 1,000 to $3,000. So depending on the meetings, it can be prohibitive. But generally speaking, it's pretty accessible and very effective at reducing. Next slide. So what can we collectively do about this? I think it boils down to three things. Essentially, getting the word out there. Right? Just educating folks on what radon is. I think there's more and more people are aware, but especially in Colorado where we have higher levels, just spreading the word.

Doing that testing is really important. It's the only way to know if you have a radon in the house. Again, you can't see, you can't smell, you can't taste it. So one way to really know is if you do the testing, yeah, Do we know where the radon is high within the county? Good question. Yeah.

So the state people report their good question. They do, actually.

So the state maintains a map. It's an interactive map, and you can go on to the map and look at it by county. I mean, I think even areas within the county, you can get a feel for where those tests came back positive to get a feel where the higher numbers are. It's it's random. It's sort of all over the place. But, yeah, they they are maintaining a running map. As they get those numbers, they continue to update the map so you get a feel for where that is.

So there are no particular hotspots that we need

to pay attention? No. It's it's again, hit or miss, but it's it's yeah. Pretty evenly distributed throughout the state. Good question. Yeah, Mark.

You know, there was a when we got our home about fifteen years ago. Had a radon tested. It came in well below what what the number was. Right. We sort of one done, or is there a recognition to revisit? Range. Yeah.

So great question. So these test kits, different shapes and sizes, the ones we provide is sort of one and done. Right? What you see on the screen are meters that actually record radon levels in running time. And what you'll see is that the numbers do fluctuate. Okay. They fluctuate with season, interestingly, primarily because during the winter months, which is why national radon actually moves in January, people tend to keep doors when those close. So the gas tends to build up. Numbers tend to be higher. But as you move into spring into summer, people open windows, open screens, get that circulation in the house, tends to blow the gas out.

So it's a really good idea to continually monitor. They recommended you kinda regularly monitor the house to sort of see what those numbers are as they fluctuate. But if you're doing the one and done, certainly do it in winter when windows are closed. Right? You're likely to get those higher numbers, and then maybe once in the summer as you wanna get get a balance. Having But those running meters is really helpful because

it gives you that sort of that data over time. Yeah. We purchased our home in May, so it makes me think probably the windows were had been open. It was in the back of the year, I recall.

Right. Exactly. Tend to be lower during those

barely below four. So I wonder how does one get one of those constant monitors things?

Those are available for purchase. Pretty much, you know, any vendor is happy to sell you one. And I think, you know, you can get one for around a $100. Know, it's not externally expensive, but some just plug into the wall. Yep. And you'll see that data continue on the monitor. And then I think you can download that data too. Right? I got into your smartphone, get the app on there, sort of see the see the variation over time. K. Kinda select. Yeah. But I think that probably the best way to go. Right? Sure. Get that continuous reading for sure. And then lastly, mitigation. Right? If you do have high levels, mitigation is very effective, relatively inexpensive, great way to get rid of that, that rail and gas. Great.

The last thing I wanna call your attention to is LIRMA or the low income radon mitigation assistance program the state has available. They do make money available to qualified applicants to assist with rate on mitigation costs. They need to meet certain income thresholds in order to be eligible, but they're just finding out there for people who might have a harder time paying for some of these systems. So they do make an effort to do that. And, Julie, next slide, but I believe that's it. Questions, comments. I appreciate your time.

The the correct answer is wings and fried rice.

The correct answer is wings and fried rice.

Good to know. Things are

too serious. Wanna dig give

a teachable moment myself. Okay. I was gonna do the same. Yeah. And

Special leisure wings. There you go. Very good. Yeah. Thank you, gentlemen. Yeah. Thank you

very much. Appreciate the time. Thank you.

Pardon? Never been in the Piper Inn.

Oh, yeah. Check it

out. Yeah.

It's a

great place for me. 91960.

It's actually where we Yep.

I've been shirt yesterday.

Oh, okay. I'm not opposed

to taking my baby to the bar, you know, but it's fine.

I

don't know if it's

not that far. K.

It's a great place. No. We should go afterward.

Not a great place. We'll go we'll go look at the billboard. Yeah. We're gonna we'll go oh,

road trip. Road trip.

Field trip to go see. March. It's a war church.

March. We're gonna

need to

specify the budget.

We cannot specify. Our

third study session is on the February Just breathe. The honorable general Jennifer Ludwig. Excellent. That actually that was not in your order. Just Thank

you.

Not the purpose.

I don't know.

A gazillion times, ma'am. I wanted to share with you all. I normally don't get, like, really into the administrative wing it's with you, but I do think this year, in reaction to last year and even just what Michelle had said about how we had a stock work order and then, oh, no. Just kidding. We don't.

And, you know, last year, we all experienced the fits and starts. And so I thought it would be relevant and important to share with you all the direction we are taking this year and how we are looking at 2026 because it's relevant when we are faced with hard decisions and then also to how we're leading the organization. So in October, the executive team had an off-site strategic planning day to really reflect on 2025 and where we wanted to go in 2026 using our quarterly poll survey data Mhmm. That we very intentionally asked some questions to help guide 2026. So we looked at the year and realized that we we cannot keep that pace.

We've been keeping that kind of pace since actually March 2020, and then we had a discussion. And then we started a health department, and then we had it's just been nonstop. So it was Penny who said, we need to just breathe. And we have taken that and are running with it because it is really appropriate for a lot of the ways that we want to think about how we approach this next year and come out as resilient as we did at the end of 2025, 2024. So and really thinking long term how we come out ahead of this, not just for this year, but in the several years to come.

Next slide. So our focus know, we really wanted to learn from what went well in 2025 and what didn't, and how do we create that path forward that really provides some stability and opportunity while not overwhelming anyone. And we had the whole year was just a constant. And the first part of the year, we reacted fiercely to everything that happened, and it caused a lot of stress and anxiety for staff, for leadership. And we've realized, like, after the first quarter, we cannot we cannot do that.

So we changed our our direction then, but we wanted to be more intentional for 2026. And we will have things that we have to respond to, but we wanted to take out that reaction piece. But we need to create that space to breathe. And so our focus this year in prioritizing decisions and actions must support delivering strong performance. We have been employee focused from the day we opened, so we want to continue fostering employee stability and then prioritizing our routine work.

And that will require us to be strategic and plan, use our resources wisely, and think about how we allocate resources and where we allocate resources. And then continue to be innovative in our approaches even though we're, you know, telling people, like, just breathe, but innovate. There's still space for them, and we still want to do that because that creative side brings joy to work. And there's ways that we could be thinking about to look differently, whether we're forced to or because we want to. Thanks.

So the guiding principles and our leadership agreements to staff, and this is the entire leadership team in working with our leadership team, is to provide quality public health services to the community. That is key. We have that is what we do. That is our mission, our goal, to maintain a positive work environment. I'm really proud of the work culture that we have in public health, and I think that has been evident in our pulse survey results.

And then most recently, the county in September, there was a county wide employee engagement survey. And I shared today the overall results with the leadership team, and we support, like, how people feel about the work that we do, ninety nine percent. Oh, so That's a high five. And the way, like people. Coworkers, teamwork, like, like, 96% positivity.

So we really have a very strong culture in public health, very tied to our mission, tied to our teams, our coworkers. And so that has to we have to keep that focus because that is what will keep people wanting to come to work when they feel very attached to the work that they do and to the team they work with. And then we have to align activities to resources. So meaning we're we can't continue, and we can't keep doing more with less. We have to make hard choices at some time at some point because things are shifting.

So we have to continuously align that. And then tracking performance. It is a big focus this year of mine. We just launched last year our performance management system, and so we, you know, are not at the point to drop that. Like, we we have to track our performance for a lot of reasons.

I mean, we use that data to be able to justify the need for more staff or to shift general funds over to a program that's traditionally been grant funded because we have that performance. We can show one way or another the outcomes that we're having. And then our commitments to staff is to continue to be transparent, encouraging that bilateral communication. We have lots of different methods in which we we communicate or sit and listen with staff, share, you know, very visible, and then providing that space to breathe so that we are our actions are showing that, and we're allowing that for staff.

You have a question there? So that's on that last slide. I don't know. Kind of the between the

two columns. Will you go back while I thank you.

Yeah. My question to you, Vicky. On the tracking performance and being transparent, so those dashboards, for example, like, shared with staff and they could kinda see how things are working out, or is that is that the performance piece really more to leadership level?

No. So the, like, the the presentation that Michelle and Mikaela gave today on the core metrics, that's part of our visibility of showing what they're tracking. Mhmm. This year, we planned we are hoping our goal is to have dashboards. The team is working on that, and it's on the back end. Building it out is harder than we expected. The idea is for it to be more visible. It depends on what what program and what team. Like, reduction has a very visible board outside their office of what of their metrics and how they're tracking it and the the visual that they use. But the goal of this year is for it to be visible at all levels of the open decision.

Great thinking. Okay. So wind based and tough decisions, which I know it will happen at some point this year, we needed not necessarily a matrix or a decision making tool, but we needed to set some standards. If this is Mhmm. We need something.

Otherwise, everything will become a priority, and we'll end up in reaction mode as opposed to responding. So our priorities in making decisions when faced with them this year is, is it statutorily required? Is it a core foundational public health service? Is it part of the community health improvement plan? Are we addressing high acuity of need?

Is it work that's required by grant deliverables? And then we have to consider community political will as part of those decisions. It's just a reality of where we are right now and what what we have to look at. So those will be the core of how when we are thinking about what we have to do, we're having to shift, we're having to say no, if we're having to reduce because of funding. This is how we look at it. Yes.

I would think the hardest thing of these things to obtain is the community and political will. The community will, in particular, the political will is probably more apparent. But how do you how do you access the community will?

So we've been and that's another thing that we have been engaging more with community and wanting to do more of this. We're

we

do our little community survey. The county has a community survey. We're working with the Arapahoe County communications department on a a pretty big communications campaign or that will be coming this year to really boost public health messaging. Most people don't even know that they use public health or recognize public health. So making sure that the community knows who we are, what we do.

They still may not utilize our services or think that they do, but if they eat out at a restaurant, if they go swimming, if they there's so many things that people that public health touches that nobody realizes. So it's gaining that support for in the event, and it might be community partners that we need to call on, not necessarily just thinking about our residents, but community partners. So there is an effort this year in really promoting county government in general. And then there's a handful of tracks with public health that we want to get messaging out there to continue to build that trust, which the community engagement survey was neutral on public health, which is actually probably good. It wasn't negative on public health.

So we we need to just get more people to know about COVID and county government in general. I think people don't realize or understand what the county does. And so there's there's effort out there to

or there will be funding. And

it is hard. Mhmm. Yeah. It is. Yeah.

Jennifer, when I read this slide originally when it was centered around before I entered, I read some was kinda like a raking in the framework. Just did I understand it correctly? Starting with things like absolutely have to do because it's required by statute. Is that the proper way for her to interpret a table for that list?

I wouldn't necessarily consider ranking because it will depend on what the decision that we're faced with is because and, actually, statutory mandated is hard because really not much is statutorily mandated for public health. The CHA on the CHIP and a budget. Like, I mean, that's and we that's the Public Health Act of 2008 was set to for public health agencies to be responsive to their community. And that's why we have to do a community health assessment and a community health improvement plan in five years, is because every county is different, and public health is there to respond and provide for their county. And so you look at, you know, every single health department in the state looks very different because of what we provide based on what the county needs.

Oh, child fatality prevention review is a statutorily required program. And so other than that, there's very little. And so we could, you know, we could have not included the Community Health Improvement Plan because that's statutorily required, but it's also a board adopted plan, so focus to that. So it's not necessarily in that order. It would it would be determined by or would depend on what program or what funding source or what issue we're dealing with.

But looking at all of those, taking into consideration, how does this decision look when we're faced with having to consider? Trying to think of an example of, like, what we might be faced with, you know, the program cut or elimination. Like, how does that fit into all of these priorities? Yeah. Next slide.

What does it actually mean? And this this slide in presenting this information to staff was actually driven by a staff question, which I really appreciated was, like, what does just breathe actually mean? We can't slow down. We've got a lot of work to do. And it was it was a great check for me. Like, you're right. It doesn't mean slowing down. So we have a lot of work to do. We are still understaffed. We have a lot of need, and that isn't changing at all.

So it is not slowing down. It is not removing work, but it might mean saying no to new opportunities or if we can't apply for a branch or we can't start a new program or we may not be able to participate. You know, we're already looking at the events that we've done in the past. We just don't have the capacity to prevent that burnout. So it is possibly saying no, which is, I think, one of the hardest things for public health to do.

And especially those of us, me, who gets excited about new shiny objects, it's really hard. And I, you know, I hate saying no to any idea or enthusiasm that staff might have about something, but this year is going to be one of those. And we take a hard look at, do we have to do this? Is this helping? Is it adding capacity?

How do we sustain it? And we may have to say no. But what it does mean is advocating for public health, and that is both at the community level, making sure people know who we are, what we do, how we help them, even if they don't come ever step foot in buildings. Bless you. And then with for funding, as you know, our funding of the state it's it's a hard year because our state finance budget issues are tremendous.

Public health has been cut to a huge percentage, and so we have to continue advocating for that. So that is what it does mean for for me, especially, and for our staff. That's that is our grounding theme for the year to hope hopefully ground us all and keep us all centered and moving forward and focused on our mission as opposed to, like, trying to tune out what we can. Because if the roller coaster and the whiplash is you know, the Samsagrams got pulled and then, oh, never mind. You can have your money again.

So it's just going to be that constant. So how do we tune that out, stay focused, stay grounded, and continue to breathe?

Are there notes, questions, Shubhrant?

I just wanna I wanna just applaud the the recognition of of the need for grounding Mhmm. Because I think sometimes, maybe not in our world, but in I'll say in the corporate world, that's not only is that not allowed, it's discouraged, and it's looked as weakness or whatever your bottom line is that. I've been very fortunate. Lived my whole life in the nonprofit sector. I think I I tell the story that my husband's lived his whole life in the profit sector, so I could do just that.

And that is his way of giving back to to in a way of what we try to do every day in this world of service. But if you don't stop and you don't breathe and you don't take a minute to assess and reassess and be realistic in this time, it I mean, it's not sustainable. It's not sustainable. We have to be sustainable because people are counting on us. Right? And so if we don't take care you know, it's a whole cliche list you could go down, your own life vest, your own oxygen mask. But if you don't do it, you cannot care for the people you care for. And what you guys do is lifesaving work. And so if you're going to provide lifesaving work, then you have to provide for your own lifesaving. Right?

So I appreciate that you've taken the time to do that and that you shared it with us.

Awesome. Thank you. We're moving us into our diagnostic study session. Jennifer is director for.

Excellent. Thanks. So it's not in the report, but while Felix is still here, I do wanna talk about our work program because I'm proud of it being something that we were able to bring over from the county health. The county did not have policy that allowed bringing your bank to work. And so we introduced it, and we did study sessions.

I don't remember how many study sessions we did at the BOCC and having to probably with actually a lot of a lot more work than what Just kidding. I was thinking. But the county is really diverse in the work that they do with, you know, human service studies, the sheriff's office, the coroner's office. So ultimately, it landed on if you can if you can do it, your department or office can do it, then you adopt the policy. You manage it. So we manage it ourselves. I didn't even need to ask me, so I was kind of talking about it. I can't I don't remember how many infants we've had at our agency since we opened, but a good number. And it's just and, we love it. It's just so much fun.

So they I'm just proud that we brought that to the county. And I know other departments are using it So they can think public health.

For the

record, it's super cool.

I know. It's so fun. It is fun. It changes the mood instantly Literally. Of a meeting.

Literally. I was coming to yell today.

No. He said

no yelling, ma'am. Okay. So in the report, I did wanna the our mission moment, I wanted to share with the harm reduction team. So we've are under Taylor, Betsy, and her CALI group, which is the participant advisory and leadership initiative. It's a group of harm reduction participants.

They hosted a winter solstice dinner in partnership with Access Point at the street fraternity, which you might be you may have heard Sean talk about. So we've been Sean has told us in, and we've done some harm reduction in education and the locks and training for street fraternity. They hosted a dinner on December 18, so it's the day after our board of health meeting last month. And they served about 50 to 75 on house community members along that East Colfax corridor. They were able to get all of the food donated.

The staff worked it and and interacted. It was really a heartwarming event and some fun pictures, which I got too late to put into the packet. So my apologies. So we can share the pictures next. It was really cute. Is there anything else you would want to add, please? Sorry.

It was great. It was a lot of hard work to put it. You know, the radical county team went out and supported it really well and we canceled overseas. Everybody got supplies. Everybody got the music. Yeah.

They got food as well as it's warm winter here. So it was really

cool. So thanks to the team for putting that together.

And then under program dates administration, I wanted to share with you. I am a voting member on the Regime Opioid Abatement Council. And this last month, this last meeting, we approved three new brand TVs. One of them is One Chance to Grow Up for their marijuana opioid prevention campaign. They were there were four proposals.

We funded three, and one we already fund the region already funds two prevention campaigns. This will be our third prevention campaign. And so I'll be meeting I'll be pulling all three agencies together next month to coordinate and collaborate to make sure that the messaging complements one another as opposed to competing. They're different target audiences and different messaging. So Arapahoe County will be saturated with messaging on opioid prevention, marijuana, for both for youth, young children, the party age group, and then caregivers and parents.

So we've got, hopefully, the whole it covered with different campaigns that have all the data is really, really good for all three campaigns. And the two campaigns that we've already run-in Arapahoe County had tremendous results. Like, the click through rate, the open rate, really, really amazing. So and one chance to grow up their T on THC campaign has similar results, so I'm confident that they'll be able to do some

really good

work in their face.

They've had they've had they presented to many groups with inside Cherokee schools, and I know I know the leaders, the the staff leadership there. And they've also had very good results. Parents or guardians are really thirsty for that information. Good. And a vehicle to say no. I'm excited to work

with them. And we funded them at their full request, and they were the only one that got their full funding. So I'm excited, which also shows the investment that Region nine has in prevention. And then I wanted to highlight, we Penny is planning to give a full update to you all in March, but did wanna share that now that the county budget has been approved, Inglewood office the move out of the Inglewood office is moving forward, but we'll provide or Penny will provide an update in March so that you're aware of anticipated timeline, what it looks like, and just because it's yet another huge change management. And we have been at that Eagle Ford office since the sixties.

So it's gonna be a big adjustment not just for but for the our community too. Tell them it's not. I mean, and we've seen generations of clients, like Yeah. From, you know, grandmas, bring it like, it's it's gonna be a big deal. It's wonderful. Mhmm. But I like them. So that's wonderful. Yeah. And then I wanted to highlight in the in the nutrition division.

When we were Tri County Health Department, Jill had the Diatetic Internship Program, which was a ten and a half months internship part of their for diabetics. And we don't have that now. But Children's Hospital has an internship program, and we have an affiliate agreement with them. And so we are now in a position to be able to precept dietetic interns. And she'll have you have the first three dietetic interns from September to January, and they do a one week rotation with us.

They get exposed to WIC, public health clinic, and then they do grocery store tours. So it's a great opportunity to work with interns, but also to expose to the public health side of it, which they may not get. And so they may you know, once like, they may be a partner. They may remember, like, oh, you know, this great program where you can do referrals for, it might be a great channel for employment. So it's, you know, it is a lot of work, but we love the opportunity.

We're also doing clinical rotations or will be in community health nursing. So also another opportunity to expose public health and hopefully potentially recruit. And then so it'll be fall of this year when you'll have another group next. Excited about that. And then I just wanted we are working on a year end review with more data, but one one there's a couple of data points I wanted to pull out.

They are in the report. But we'll have a more comprehensive year end review of all of our stats. But the immunization program administered 12,146 vaccines A lot. During three thousand eight hundred and sixty two patient. So huge number of vaccines.

We are definitely a critical access point for community members. Fifty eight percent of children served by our immunization program are uninsured and also two thirds report that they do not have a medical home. So we definitely fill that gap. And sixty percent of all program patients speak a language other than English, and which is why you'll see if you ever look at our budget, why we have such a huge line item for language language line and other spaces. And then I'm not gonna read through all of them because it would take too long, but I do wanna point out the environmental health programs, inspections, review numbers, the sheer volume of members.

And, you know, we we started out way understaffed over the years. We have slowly been able to build up FTE in environmental health. We did hire three this year, so that was great. I I'll ask you to look at because really spectacular numbers. Mhmm.

I do wanna point out invoicing, annual environmental health licensing invoices went out. So this is the season. Today launches the courtesy call campaign to hopefully get people to pay by the January. Otherwise, they start facing fines, and that could be 500 civil penalty for an operator food operator. But for bodyguard operators, it is a penalty of up to $2.50 per day.

And if they don't pay, it could be revoking their license. So, generally, by March, we have a 100% of full compliance, and we are hoping for in this year too. So that and that processing systems are getting better every year, but it's still a significant lifting for the staff who are doing the courtesy calls.

The the dialing for dollars?

Uh-huh. Exactly. That's what we should do. So to make fun make it fun. And then I wanted to note that as you may recall, last month during the board of health meeting was also the day of that high wind, and they did the public safety power shut off.

And we had all of the tech issues, which I do think was the wind. We're like, we've never had tech issues like that before. While it didn't affect us, I do think wherever the inner Internet was down in a lot of places, so I think it affected us. But our emergency preparedness and response team was activated during that event, and they were in the county's emergency operation center tracking, providing updates, following. Because in the event that there was significant power outage for days on end, it affects going like, your food in your refrigerator could affect water.

It could affect a lot of things. So mental health gets pulled in. Emergency preparedness is pulled in, so we were all watching it in the event that people would be out for days. It could also I mean, our concern would be restaurants and childcare facilities too. And then moving into the communicable disease update, and I just wanna highlight, and then I'm gonna turn it over to Melissa.

But if you did not see, the team managed a 199 confirmed outbreaks in 2025, but they completed 1,825 case and contact investigations compared to 582 last year. So that is a two hundred and fourteen percent increase and a lot, probably with measles, changed a lot of things, but we are a team of five. And so they are superhuman, and that that those numbers are remarkable. Another reason why we want to track performance. And and these numbers are important because it can help us identify where we need additional resources.

But I'm gonna turn it over to Melissa to highlight a few things.

Thanks, Jennifer. Yeah. So in our report this past month, we just kinda did an overview of all of our work for kind of we kinda bucket our program into three main categories. It's reportable conditions, so, like, our case investigations, our contact tracing work, our outbreaks, and then rabies gets its own special. So it gets its own area.

And as an urban mentioned, we're really seeing an increase, especially with our reportable conditions and our outbreaks, which we'll talk a little bit more about 214 increase from '24 to '25. With all of our data, I just wanna caveat that we're we're gonna need a few more years of data to understand if it's a true increasing trend in illness in Arapahoe County, also seeing what's going on in Colorado to help influence that. Because we're we're only three years of, you accurate data across all of our different kind of program categories to understand is a true increase, is it post COVID, you know, something that we're really seeing with our outbreaks and trying to understand, are we seeing an increase in outbreaks, or is it an impact that we have spent so much time since the start of our Arapahoe County building our relationships with our community partners, our facilities. We have changed our approach in how we work in each of our school districts so that we can have a trusting relationship so they feel comfortable reporting to us. So are we seeing an increase in outbreaks?

Or are we seeing an increase in reporting because people know they need to reach out to us and they feel comfortable doing that? So it's gonna take us a little bit of time to understand what the cause of that is. We're certainly failing out with our case investigations. Most of that last year really was driven by measles. You know, we had just a handful of confirmed cases in Arapaho County, but a really large amount of suspect outbreaks.

All providers are in the state. They're very heightened and aware of any rash illness, and so they're calling us for all those suspect outbreaks, that's a significant amount of time that we're spending to understand what's the concern level. What do we have a real concern for a potential measles case? And then a really large amount of contacts, related to them. I think so much when we talk about measles, we talk about the cases, but most of the work with the measles investigation is all the contacts. And so really, really significant amount of work for measles. So we will see what measles looks like for 2026. Across the country, measles has been very significant in January, so we

will just keep an eye

on Colorado, and what happens there. And then outside of measles, we're we've had a large increase in our respiratory hospitalizations, so COVID, flu, RSV, and pertussis as well, and that's not unique to our county. The state isn't calling it a true increase post COVID just yet, but we are trending in an upward trajectory for pertussis. So we'll see we'll see what's going on with our outbreaks as a relation to that. And then our rabies work has been fairly stable.

It is a significant portion of our work in the summer, but it was fairly stable. We had a little bit of a decrease this past year, but really that was because last 2024 rabies season, we had the rabbit puppy incident, which really increased the works. Now we're kind

of returning more to our normal

as expected. So we'll see what 2026 brings, but appreciate the shadow. We have such an incredible team of five dedicated epidemiologists who just work tirelessly every day and come every day prepared to handle our increased workload. Yes.

Question question and a comment. Question is, are you seeing a trend with ages of folks with pertussis with the with the outbreaks or breakthrough?

Yeah. So it's something it's something we're watching. Right? I would say, like, anecdotally, don't have the data to

look it up right

now, but we have seen kind of an increase in our high school, middle aged to high school age Kiddos, that's where some of

our outbreaks have been.

We had two outbreaks of pertussis in 2025, and they were one was in elementary school, and then one was a high school. So we are seeing single cases a little bit more in high school. Some of our school nurses that we've worked with have, you know, shared with us that they feel there's an influence with vaping and and the impact of pertussis and other illnesses, of course, as well. It's just something that has come up quite a bit, actually, so it's changed our approach of how we've been working with schools. So we're keeping an eye

on it.

Yeah. Because I've heard that trend too. I mean, obviously Yeah. Firsthand. But that's that will be new interesting data to follow nationally. Well, as much as we can follow national data. State data, our data because that will be a that's a sea change in that. I think that could be an interesting thing as we look at vaping prevention and and, you know, getting kids off of

that crap.

And then my comment is, yeah, you guys are incredible. You do build amazing relationships with nurses, with directors. It's just okay to let her today, so thank you so much. So let's prevent more flu outbreak at an elementary school. Good job. So I'm just we're just so grateful because your turnaround time and your the way you guys talk to everybody is always fine and nice. And we know we know how busy people can get impatient, and you guys are never that. And so just grateful for that Yeah. Relationship. Yeah.

Any other comments or questions? I too was stunned when I read the report. I actually reread a couple of those lines to see the the numbers, you know, how staggering they were and realizing that the increase in staff is not always commensurate with the workload. So Mhmm. I believe to to the to all teams in responding in these these public health plans, for sure. Anything else?

That's it.

Great. Thank you so much. Do we have a need for a check up session?

No. But there is one more agenda item, a legislative update Oh. A new topic that we've added.

Yes, please. So

and for all fortunate, this was something I think we decided on at our with the chair and vice chair to add separate instead of putting it in the director's report from January to May, we just have a bit of separate discussion. Since sessions started last week, a ton of bills, like, a 100 bills have been introduced. I don't I don't know. It's probably a lot more by that. I know. It hasn't. So they were Like, if they were then not. They warned us that drafting is probably backed up.

Yeah. So Second wave is coming.

Yeah. I'm sure. But in even in the first couple of days, we our tracker I know starting next month, I will have a report for each of you that will be part of the packet separate from the director's report, but there's not enough in there to actually print a report or pull out a report. But I did want to highlight, as expected, the cottage food expansion bill was introduced. Dylan is on the task force that worked all summer with the rep in and what was introduced is not at all what we need to know or expected.

Oh, sorry. So there will be a lot of work in working with the sponsors on the language, and we will move it forward. We might move it forward to the board of county commissioners next week, probably not yet take a position. CALVOH needs to weigh in the Colorado directors of environmental health meet on Monday to talk about it. So we might recommend amended language.

It's you know, we're we're waiting on that one, but it was not what the team spent all summer working on. It's pretty much what it's like last year's. So we'll work on that one. There are there's a child care licensing, one that Calpo and Steve have been talking about and looking at. Steve has asked some very good probing questions about that one.

And then there's one on measures to improve maternal black maternal health equity. And I'm sure I'm interested in that one and waiting to get a staff opinion on that. And probably, it won't be one I don't anticipate CALPO taking a position on because it doesn't quite align with the CALPO policy priorities. So we depending on the bill language and what, our staff experts think, we might move it as Arapahoe County Public Health forward to the board, of commissioners. Nothing yet has shown up that we were are asking for the board of health action quite yet.

Dylan will be pre representing Arapahoe County Public Health on a panel for, raw milk in February. No milk has been introduced, but there's an education opportunity, and Dylan will be on that panel. So really glad to have him representing our agency and really for all of the environment. So that's it for legislation right now. I'm sure we will have more next month, and we'll by next month, we'll have a report for you.

Thank you. Any comments from what? There is none. Thank you. And I saw the nod that there's no executive session, so don't believe this is anyone.

Did Felix tell you?

Yes.

Oh, he did.

I I I am still doing.

With them?

So I did I did have a couple quick items that were off off the good thing. And so one particular order, there was something I received an email about a board of health annual training. And so I think it's really more for the where it's for the board. So I think there should be an effort to use one of our study sessions here in the next couple months to group training in that space. So I just wanna make sure If you had received that email, kind of the thoughts. Some more time there.

Yeah. That's right. Tenants are clicking to March. K. March from two to three? Yeah. From two to three using that that hour time frame. And we would do it in person as long as everyone's available. I just need to double check with Sean.

Perfect. Thank you. Good. There was an email about a field trip, so don't if there's any more information on on that to log calendars.

Yes. For the Aurora Navigation Campus. We were not super lucky or in finding a time that worked for everybody, and the Aurora Navigation Campus has some growing pains right now, and so we might wait we might wait until April and May to to schedule that. Let them work through some of their bugs, then we will I would love for you to see it. It's it's really cool, and I think they need to they need some time more time.

And they're very open to having us come up and visit, but I think it would be better. And we're trying to avoid, like, the morning commute and evening commute because of where it is. It's Mhmm. The evening commute would be horrific. So Yeah. That's why I suggested doing it earlier in the afternoon. I know that takes time out of your day. So we'll probably go back out and do another poll when he gets back.

Sounds good. More more to come.

Yeah. Thank you for bringing that back up.

And really appreciate too the the update in terms of kind of street fraternity in New Penn that are reminding me of, hopefully, get a right kid's closet.

Oh, yeah.

And so, you know, kind of a challenge to my my colleagues on the board. Somebody could probably explain a bit on that, but you don't have opportunity to think there. By clothing, you know, probably of all ages, I'm guessing, you're

a 100. Mostly adults.

Mostly adults.

That's what I meant adults. Adults

who wear kids clothing. Definitely. Yes. Put that out there. Speaker.

And last and lastly, a special thanks to Julie for recovering today, and it just made my world over here as well. So thank you, Julie. Appreciate your.

Yes. Thank you, Julie, for filling in. Thank you very much.

If there is no other business, we are adjourned.