LARIMER COUNTY BOARD OF HEALTH – December 12, 2019
The Larimer County Board of Health (Bo H) convened its regular meeting at 6 :21 p.m. at the Larimer County Courthouse, 200 W. Oak, in the Carter Lake Conference Room.
Dr. Bernard Birnbaum
Janna West Kowalski
Executive Secretary: Tom Gonzales
County Staff: Andrea Clement-Johnson, Kelli Curl, Jim D evore, Stacie Hougard, Shaun May, Kim Meyer-Lee, Katie O’Donnell, Sara Rhoten, Kori Wilford, Averil Strand, Lorenda Volker, Laura Walker
Community Members: Tina Soriono
Approval of the Minutes
ACTION: Dr. Bernie Birnbaum made a motion to approve the November 2019 minutes, Brian DelGrosso seconded the motion.
The motion was unanimously approved.
Public Comment - There was no public comment.
Financial Report – Stacie Hougard, senior accountant with the county’s finance department, provided a fund analysis through October 2019. Mr. Gonzales thanked Stacie for providing support during the department reorganization. As of July 2019, intergovernmental revenue is now being recorded when the money should be received as opposed to when it is actually received. Ms. Hougard is currently working on processes and updating budgets with the program managers in the department. Mr. Gonzales updated the BoH on the process of hiring an accounting manager, first round interviews with candidates are scheduled for Dec. 20.
Request for hearing regarding Environmental Health fee schedule - Mr. Gonzales asked for the BoH to set a meeting date to hold a public hearing to present an Environmental Health fee schedule. It was decided to set a public hearing during the regular BoH meeting on January 9, 2020. Mr. DelGrosso asked that the presentation of the fee schedule to the BoH include justification for the fees, the last time the fees were updated, and a comparison for what other counties are charging.
ACTION: Dr. Birnbaum made a motion to set the hearing date for January 9, 2020, Janna West Kowalski seconded the motion.
The motion was unanimously approved.
Board of Health Bylaws review and update - The BoH provided updates and additions to the current bylaws. Mr. Gonzales and staff will incorporate the suggested updates and additions in an updated draft and send them to Jennifer Lee before the next BoH meeting. The BoH will then vote to approve the bylaws at their next meeting.
Public Health Director performance review process - The BoH discussed how they would like to conduct a performance review for the public health director. For this year, the BoH decided to use the priorities set in the strategic plan as the expectations for the public health director. In future years it is recommended to have a conversation between the BoH and the public health director to set priorities. Dr. Birnbaum suggested gathering staff feedback within the evaluation. Ms. Lee asked that Human Resources develop a process to gather staff input. Lorenda Volker said she would check on the procedure for executive session and the performance review process. Mr. Gonzales suggested getting feedback from community partners and stakeholders, the BoH decided to do a key partner evaluation every two years. At the January BoH meeting, members will review the first-year deliverables, and get a report back from Ms. Volker on how to gather staff feedback and the rules on executive session for a performance review. The BoH will plan on doing a performance evaluation in February or March.
Approval of BoH 2020 meeting schedule -
ACTION: Teri Olson made a motion to approve the 2020 Board of Health meeting schedule, Janna West Kowalski seconded the motion.
The motion was unanimously approved.
Director’s Updates - Mr. Gonzales gave a year in review presentation that highlighted the accomplishments of the department in 2019.
Goal: Strengthen LCDHE’s workforce to improve public health and environmental quality
2019 Annual Work Plan Objective Goal and Result:
- By December 31, 2019, the Environment Health Planner will complete LC Supervisor Training and at least one other leadership development training.
- EH Planner completed the 3-class series "Supervisor Essentials" provided by Human Resources in February, March and April of 2019. EH Planner also attended the full day Regional Institute for Health and Environmental (RIHEL) Leadership is for Everyone in April 2019.
- By December 31, 2019, The Environmental Health Planner will attend the Colorado Environmental Health Association (CEHA) and American Planning Association (APA) Colorado Annual Education Conference (AEC) for continued training and job proficiency.
- The EH Planner attended the CEHA AEC September 17-20 in Keystone, Colorado. APA AEC was the same week as CEHA and therefore was not attended.
- By December 31, 2019, apply for a grant/scholarship to provide funding for programmatic training for Healthy Communities staff.
- Healthy Communities' program coordinator received a scholarship through the Rocky Mountain Public Health Training Center and the Patient Navigator Training Collaborative to attend a four-week online course in Level 2 Care Coordination for experienced patient navigators. This training makes her eligible to take Colorado Health Navigator Assessment and achieve formal recognition by the Colorado Department of Public Health and Environment as a patient navigator.
- By December 31, 2019, complete participation in pilot program for on-line interviewing for selected enteric illness reports.
- This has been completed and we are pursuing participating in another Colorado Department of Public Health and Environment pilot program for Campylobacter cases
- By December 31, 2019, evaluate the use of the “establishment violation history dashboard” in ECHO in the Department’s efforts to reduce the occurrence of foodborne illness risk factors and improve operators use of active managerial controls in retail food establishments. This would be part of our effort to meet FDA’s Voluntary National Retail Food Regulatory Program Standard 9, and our AFDO grant obligations. (Consumer Protection Team)
- The dashboard has been incorporated into ECHO and all staff have access to it. With all of the training of new inspection staff, the dashboard could not be utilized to the extent as hoped. Based upon recommendations from the ECHO development team the dashboard was put on a "public domain" platform not in “private domain”. This resulted in cost savings and there was not a need to use AFDO grant dollars.
- Several Reproductive Health program staff (both clinicians and health educator) participated in a webinar training about vaping use, products, and the pharmacokinetics and pharmacodynamics of the various devices and products. Health impacts and current research were included in the presentations, underscoring the importance of discussing tobacco use (including vaping) with the reproductive health clients.
- Several staff recently completed Incident Command System (ICS) 300. This was an intensive two-day course that provided training and resources for personnel who require advanced knowledge of Incident Command System (ICS).
- The Colorado Department of Public Health and Environment (CDPHE) conducted audits of Consumer Protection’s food safety program for compliance with FDA’s National Voluntary Standards; #2 Trained Regulatory Staff and #3 Food Safety Program Based on Risk and HACCP Principles. The audits were a requirement of the Food Protection Act that 70% of Colorado’s retail food programs meet these standards by December 31, 2019. Successfully passed both audits.
Goal: Strengthen capabilities to collect, analyze, share, and use data to make decisions
- As the momentum around data sharing and developing a data strategy continues to grow in Larimer County, the Office of Public Health Planning and Partnership utilized their technical assistance provided by the Colorado Equity Compass grant to provide training around equitable data collection, sharing, use and visualization to over 20 data users from many organizations around the county. The goal of part 1 of this 2 part training is to expose data users to equity and explore ways we can build a data strategy that includes equity for all people in Larimer County.
- As part of the Air Quality Contract with the Colorado Department of Public Health and Environment (CDPHE), LCDHE’s Air Quality Program reviews and issues burn permits. Larimer County issued 918 burn permits in 2019. For the past 1.5 years, air staff have been working with County IT and local Fire Districts to develop an online application for burn permits. The new system enables LCDHE and fire departments to communicate more readily between themselves for review and approval efficiency. The online application goes live on Jan. 1, 2020.
- Environmental Health staff have updated the food safety field inspection application, data system and our website to accommodate the new inspection rating and enforcement protocols associated with the Food Protection Act. These changes are mandated by the Colorado Department of Public Health and Environment (CDPHE) effective January 1, 2020.
External Goal: Strengthen LCDHE’s capabilities to provide information on public health programs and issues to external partners
Internal Goal: Strengthen LCDHE’s internal communication capabilities
- As part of the LCDHE Solid and Hazardous Waste (SHW) program, staff are tasked with reviewing methamphetamine property reports provided by Industrial Hygienists to verify compliance with the Cleanup of Methamphetamine-Affected Properties (6 CCR 1014-3). In March 2019, new staff were tasked with reviewing these reports for meth-affected properties but there were no written policies or procedures on how to complete this. To resolve this, staff created written procedures and compiled resources for training and reference which have assisted in reviewing 42 industrial hygiene property reports and 42 response letters in 2019.
- Healthy Communities provided training and communicated information to seven new technicians at the Larimer County Department of Human Services in December on Healthy Communities, WIC, Prenatal Plus, Nurse-Family Partnership, Reproductive Health and Immunization services at the Health Department. Many of their clients are also eligible for a variety of Health Department services of which they may be unaware, making this an important linkage for the community.
Goal: Develop and maintain strong relationships with key community partners to support public health
2019 Annual Work Plan Objective Goal and Result:
- By December 31, 2019, develop a plan to support a comprehensive plan for human sexuality curriculum in Thompson School District and Estes Park School District.
- The Reproductive Health Program continues to work with Larimer County school districts to assist with the ongoing assessment, implementation, and evaluation of sexuality education programs and curricula. These efforts promote alignment with Colorado’s Academic Standards for Health and compliance with Colorado’s Youth Wellness Act, which provides funding to rural communities through a grant program. LCDHE will encourage Estes Park schools to apply for these funds. Currently, LCDHE is partnering with Trailhead Institute to assist Thompson School District administrators in developing a comprehensive long-term plan to update human sexuality education curricula.
- By December 31, 2019, build or maintain a sustainable, strong, and broad local coalition of tobacco control advocates.
- The Community Tobacco Initiative (CTI) has utilized existing coalitions, including Communities that Care, Youth Action for Health, and the Loveland Youth Advisory Commission to build strong, local tobacco control advocates. In addition, a CTI staff member has been actively involved in the Loveland task force that is working towards youth access policies. Utilizing existing coalitions that have similar goals, rather than creating new ones, has been successful for this work.
- By December 31, 2019, recruit, mobilize, and build capacity among a group of stakeholders through the Communities That Care (CTC) process.
- Communities That Care has engaged over 40 partners county-wide, from seven different community sectors, to take part in this process. Through this process, participants have gained skills in data assessment, resource assessment, and advocacy. Participants have also developed content-specific skills related to tobacco prevention, social emotional learning, and positive youth development which are being used to support local policy and systems changes.
- By December 31, 2019, hold information sharing in-person meeting with local RAE representatives, care coordination teams, and interested LCDHE programs.
- Healthy Communities staff have attended two community meetings with the four care coordination teams of the Health First Colorado (Colorado's Medicaid program) RAE (Regional Accountability Entity - Rocky Mountain Health Plans) in Larimer County.
- By December 31, 2019, increase cross-sector partnerships by adding at least two new sectors by facilitating data working group, Community Engagement Working group and a Built Environment leadership team.
- The Built Environment leadership team has recruited three new participants; one from the North Front Range MPO; The City of Fort Collins Air Quality Program Manager; and the City of Loveland Development Review Center. The Built Environment Community Engagement Working group has also added three new participants; from City of Fort Collins Communications and Public Involvement Office, City of Fort Collins Utilities, and SummitStone Health Partners.
- By December 31, 2019, evaluate Nurse-Family Partnership (NFP) community advisory board representation, identify additional desired partners, and recruit at least three new strategic partners for the board.
- In October, the newly revamped advisory board, which is now a maternity coalition that includes, but is not limited to, Nurse-Family Partnership (NFP) inputs, was launched as an introductory meeting. We have recruited four new partners not previously included in our past advisory group and will be working on a vision, mission, and shared focus plan in January (our next meeting).
- By December 31, 2019, strengthen systematic support for Tuberculosis (TB) prevention in community partners and private health providers by refining education strategies identified in the Salud pilot project and reaching out to at least one additional private medical group to explore implementation of the TB elimination effort in their practice.
- Educational materials for TB testing and treatment algorithm have been shared with local staff education coordinator; questionnaire administered to physician education coordinator regarding feasibility of testing and treatment at their facility. Results were shared with Colorado Department of Public Health and Environment (CDPHE) TB program.
- The Health Services Director is a member of a committee that includes Sunrise Health Care, Thompson School District and other community partners who are exploring the opportunity to offer school-based health services to students enrolled in the Thompson School District. The committee developed a survey that will go out before students leave for the Holiday Break to assess the support/interest of families within a 2 mile radius of the proposed site located between Conrad Ball and Mary Blair schools.
- The Office of Planning and Partnership is collaborating with Department of Human Services on a grant focused on community voice to prevent entry into the Child Welfare system. Primary prevention for mental and emotional wellbeing and primary prevention for child welfare have strong overlap. The Public Health Planning Supervisor attended a kickoff conference with the Director of Child, Youth and Family Services and the Director of the Center for Social Work Research to prepare for the five-year grant.
- The Health District of Larimer County and LCDHE are co-recruiting for individuals with experience using drugs for LCDHE's Community Advisor roles to support the opioid response and The Health District's Community Advocate positions on the Mental Health and Substance Use Alliance. The goal of co-branding and co-recruiting is to streamline efforts and avoid confusion in our target population. Northern Colorado Health Network is leading the outreach effort for these roles as the trusted agency for this target population.
- The Communicable Disease team continued site visits with long-term care facilities to promote partnerships and better reporting of illness from these sites. Members of the CD team met with new management from Sierra Vista Healthcare Center.
- LCDHE, Larimer County Department of Human Services and Larimer County Behavioral Health Services, recently pulled together all the Community Health Improvement Plan partners to share their program performance metrics and identify the key evaluation metrics that are most common and useful for programs who are providing professional training, providing services, enhancing community collaboration, advocating for policy change, increasing their organizational capacity, implementing new practices, or implementing a public awareness campaign. The hope is that these identified metrics will be used by the Department of Behavioral Health Services and are the beginning of a longer-term strategy for CHIP partners around sharing and comparing programmatic data to show impact and better serve our community.
- Environmental Health staff presented information on the proposed Transfer of Title process for OWTS to the Loveland Berthoud Board of Realtors on December 5, and the Fort Collins Board of Realtors on December 10 to gather feedback on how best to develop the program.
- Environmental Health staff met with the owners of Splash Pool Services, public pool owners and the largest public pool management company in Northern Colorado, to discuss plans to begin a public pool inspection program in Larimer County. The meeting went very well; they are supportive and gave good feedback regarding fee structure.
- Environmental Health continues to support the Larimer County Planning Department on the development of land use regulations related to Oil and Gas production and development. The second draft regulations are set for release on Jan 3rd, to be reviewed by the Planning Commission and Board of County Commissioners. The Commissioners will then attend a Joint Work Session on January 8, 2020, to discuss the draft regulations with Planning and Environmental Health staff.
Goal: Increase awareness of health equity issues, its systemic causes, and opportunities to foster health equity
Goal: Remove barriers to healthcare and community resources to improve health outcomes among health disparate populations
2019 Annual Work Plan Objective Goal and Result:
- By December 31, 2019, reverse the trend in declining patient numbers who receive qualifying family planning services.
- The decline has not reversed. Long acting reversible contraception and reduced required pap testing has decreased the number of client return visits. An error in the way data is uploaded from our local computer system to the State’s iCare database was recently discovered and may be responsible for some of the decline. Marketing and outreach strategies were added to increase new clients from an average of 37 new clients per month in 2018 to 49 per month in 2019. Social media followers have increased. Clinic services were offered on a walk-in basis and by scheduled appointment. Efforts in this area continue.
- By December 31, 2019, pilot and measure the effectiveness of meeting customer vaccination needs by expanding weekday hours and/or offering key Saturday clinics, and partnering with Reproductive Health.
- Immunizations partnered with reproductive health for two Saturday clinics in the spring of 2019. Immunizations also held three Saturday walk-in clinics (two in Fort Collins, one in Loveland) in the fall of 2019 in conjunction with school immunization exclusion deadlines. Additionally, as of December 2019, all reproductive health clients are being screened for Hepatitis A risk factors and are offered immunization if indicated.
- Staff from Built Environment, along with the planning and social sustainability departments at the City of Fort Collins, have formalized conducting a Health Impact Assessment (HIA) on two affordable housing policies (inclusionary zoning and impact fees). Staff will work closely with the consultant, City of Fort Collins staff, and an advisory group to complete the HIA prior to March 2020.
- Healthy Communities provided in-depth Health First Colorado (Medicaid) and CHP+ application assistance or Presumptive Eligibility services to over 100 families in 2019, giving them faster access to medical benefits such as prenatal care and helping overcome barriers caused by language or literacy issues. Many of these families included pregnant women or children with special needs, who might otherwise be unable to access important medical care.