Board of Health  Tuesday, January 16, 2023, 1130 Suite 230, Tamarac Center  Present: Bob Campbell, Erik Stone, Dan' Williams, Ross Herzog, Michelle' Wolff  Staff: Laura Boshert, M.D., Mary Higgins, R.N., Austin May Bob Campbell called the meeting to order at 1139.  Review & Approval of Minutes  October 17, 2023, minutes were reviewed. Motion by Erik Stone to approve the minutes.  Seconded by Dan Williams. Minutes approved as presented. Directors Reportpresented byl Michelle Wolff  Reflections: from last year, things that went well and things that did not go well. Challenges included staffing, lost most seasoned staff members, huge learning curves  resulting in al lot of growth. Focusing on cross training.  Gaps & needs:  CPED & Family Planning: Michelle took over as interim director member started in Aug 2020; newest employee started Sep 2023  WIC: Federal Funding is still upi int the air  Training: loss of seasoned staff requiring lots of training of new: staff, most senior staff -Overhaul of Public Health toi include OcAswpOcCurepacN facility resulting in overall improvement oft the overall friendliness and appeal of the work environment, Electronic Health Record: Have had to postpone live date due to holidays and facility painting. There are also some integration issues with Medicaid and CDD Lab that need tol be worked from CureMD sidel before we can go live. There have also been some additional costs that we were not made aware of. We hope to go live before the -Health Fair: Hosted our first one: since Covid, not a big turn-out, but still good and we -Rural Vaccine Barriers discussed. Since Covid, CDPHE has puti in place many policies that have created barriers to takingvaccine off-site to host rural clinics. While CDPHE encourages getting out vaccine tol hard-to-reach areas, they! have put in place barriers, such as LPHAS needing to getadvanced permission from CDPHE, tol host off- site vaccine clinics. In addition, the CDPHE vaccine van that is supposed to support rural vaccine clinics, has been spending a lot of time along the Front Range instead. CDPHE van has cancelled 2 or 3 times on us scheduled events leaving us hanging.  staff morale has improved  end of January.  gave out about 20 Flu vaccines.    Homebound patients have been impacted because the state had issues with the community paramedics taking vaccine from the clinic to the patients' home. The paramedic was allowed to, give the fluv vaccine, but not Covid. These are policies Commissioners discussed Teller County BoH providing a letter along with other rural counties toi the. Jill Ryan and the Governor's office requesting al looki into the process of how CDPHE processes hinder support for getting vaccine out to rural communities. Michelle mentioned that currently, the southern part of Teller County is int the redi for school vaccines. Having less barriers to get vaccine out the community would help. Michelle described how Kim, ourir immunization coordinator, & Laureen Murray, the CCVS school nurse, have been creative and worked to get kids in through the School Based Health Center forvaccinations during school hours with parents signed consent. That has relieved the barrier of parents working and being unable to gett their kids to the clinic. Dan' Williams reiterated getting al letter out to the. Jill Ryan & the Governor's office to get awareness on state policies negatveylmpactingrunal medicine. Michelle agreed to draft the letter for the board to get the process started. DrE Boshert reiterated that during Covid, there were problems with storage and transport of Covid vaccine during Covid, and there were some outside clinic bad players that mishandled vaccine and created these policies. She shared that local public health clinics who are all trained in storage and handling of vaccine should not be treated the same as outside clinics and have to ask permission from CDPHE to hold off-site Cross training: We are cross training with zoonoses, and water borne illness with communicable disease. Would like to see more cross training with Environmental Health workflow to include restaurant inspections. Keri is trying to cross-train into septic Restaurant Inspections: Keri is drowning ini them due toi the surge in food trucks. Ice Castles has increased food trucks also. May need another position to keep up with the increasingworkload, even if starting part time. Dan requested it be added to the Public HIPAA Compliance: Michelle brought up a gap inj policy related to HIPAA compliance monitoring. She addressed that nurses know HIPAA on aj professional side, but from the business side we are not as1 familiar. We are seeking assistance through ai third-party vendor to ensure we arei in compliance with all the regulations. Clayton, from IT, has some background in HIPAA and has been doing research to help us. We may! have found a vendor and Michelle is hoping to use grant funding to payi fori it. Dan asked for clarification oni if we are creating our own policy or following current state and Federal Regulations. Michelle clarified that we need to show proof that we follow the guidelines through documented training and other mechanisms that we want to puti in place. We are looking at a software  created by CDPHE, not laws.  clinics. She supported revisiting thei issue with CDPHE.  inspections.  Health strategic plan ifi it's not already, to ensure budgeting.    program that builds a structured policy for us thatwill document training and other compliance. We can'tjust say we are following HIPAAregulations; we need tol be ablet to prove iti through documentation. Dan asked what the costs are. Michelle answered we have had quotes from $8,500 to $30,000. The company will provide an internal audit to look atl EHR, physical layout of computers screens, and the like. Kylei is ordering screen covers for the front desk. Dan asked if the budget would come from IT orv where. Ross said itwill be under al linei item and ongoing ont the budget. Dan wants to make sure that all software is compatible with all other county software. Michelle said we're looking at an annual subscription with county fee caps for budgeting purposes. There should be no additional costs to add the Teller County Sheriff Office or TCDHS, who alsol have HIPAA compliance needs. Thisi is a project we need to do this year to make sure our patient heatth Security: Michelle is planning toi install security cameras at TCPHE. Michelle described a couple ofinstances where we have had issues in our office area. The example was a domestic dispute between persons who were not affiliated with our clinic yet came into our building and then took off. There have been times when our door has been left unlocked by housekeeping. This is also a security HIPAA issue. Vaccine is expensive and could be lost if ar refrigerator door is opened and left open. Ross said organization wide, they are looking to at better security for county facilities. Michelle said she wants to better protect county assets and provide increased safety for patients and staff.. Michelle had written the cameras into a grant and Kyle had told her there is already the infrastructure available to connect them. Dr Boshert shared concerns that she hopes the clinic will remain  information is secure.  welcoming to clients.  Broadband: TCPHE broadband will be increased to 1 Gigabyte this year, which is 201 times fast than what we currently have. This will hopefully fix the "sits & spins" problem we've Continuity Binders: With losing our seasoned staff, we realized there was a knowledge void. The staff are putting together binders about their specific jobs and processes, so that any one of the nurses/staff can picki it up in the absence of another and run with the Vital Statistics: Michelle and Stephany Kees from the Clerk & Recorders Office have agreed for Public Health to take back the' Vital Statistics, where it generally resides in normal circumstances. There will need tol be some training provided from the state and Portable oxygen: The BoH would like to see: some type of oxygen canister exchange program ini the county as part of our frontier medicine support. Dan brought upi that we have an older population, many on oxygen, and not a good system for people to be able to get exchange tanks in contingency: situations the county. While people should be planning fort this, often they don't. We alsol have home bound. The current solution is for people to  been having.  program. This will also help orient future staff.  transferring of the files. That will happen int the near future.    drive down the pass which is often not practical or safe. The topic has been brought up in EMS council, medical directors, the hospital, other venues, but after 7 months there is no plan. Dan asked if Public Health could reach out and work with EMS and medical directors toi find a solution to this problem of how can we get a tank exchange here? Mary mentioned she thought the best place to house such a program would be under Community Paramedics. Michelle mentioned that maybe Senior Coalition can help deliver the tanks. Community Health Assessment Plan (CHAP): Michelle-As an organization team last year we completed our first CHAP. This was the third one since the requirement started. The first one was in 2013. They are due every! 51 years, SO we'll be starting another one in two years. Action plan is a working document, and we continue to work toward achieving those goals. The focus is on mental health, substance use, around seniors, veterans, and youth. Suicide Awareness: Planning our second symposium, March 1, 2024, at' Woodland Park Community Church, program will include presentation on human trafficking, firearm prevention initiative, breakout sessions for PPR, ACES, Veterans, and faith-based topics. Region 16 Opioid Abatement Council: Work for all 51 focuses was complete in 2023, RFIE was released in December, applications will be reviewed early next month,  Bob wants a sustainable program, not just a stop-gap fix.  Will also have some sexual assault survivors.  announcements will go out in March.  CSUI Ripple Effect- Pilot program: It's expanded beyond just 4H members, Michelle is part ofthis, facilitator training is complete. Will start with 4H and then expand to other  communityyouth.  CSU Rural Artl Project: A community engagement project. TCPHE received funds to hosta series of community conversations to come up with a community-Dased project. Itwill be focused on oury youth because of thei focus on youth due tol having the greatest need based oni information the Mental Health Alliance meetings. Kids will have input on what they want to do with guidance from the adults. Meeting with the kids will be hosted at both TCSO and John Wesley Ranch. The hope is an enrolled 4H member will bring a non-member. 1st Comic Book Project-Comic Connection Pilot Program: POC for this program is. Jennifer Aengst from CSU, funded by CDPHE. Program is happeningi for rural counties Eagle, Lake, & Teller. Dates from. Jan-May 2024. The goal is to decrease the stigma around mental health issues and increase sense of belonging. Rural adolescents are thei focus due toi isolation, fewer available services, & other factors. Jennifer has partnered with the local libraries in Cripple Creek & Woodland Park and some youth groups. Comic books are a great wayt to share resources in amore engaging way. Comics are relatable, accessible, and inclusive. Topics included depression, anxiety, and other topics. There will also be free little libraries that offer free books toi touch on the same topics and mayil include difficult topics for kids to  meeting is Feb 25, with project completion by. June or July.    talk about. The purpose is to get kids to open up and talk to someone about theirf feelings and reduce stigma. The librarians for each libraryhave chosen the books. If parents have concerns about the topics, they can be referred back toi the librarians ort to the CSU POC.  This is not a Teller County Public Health & Environment program.  Program Updates:  Child Fatality 2023: Reviewed 2023 Legislative reportto include suicides, Narcan, seat belt safety. Michelle said each department; gave inputi into what they were doing in response to each topic during the last Child Fatality Council meeting. Another meeting next month which will look at another death review, that was not a suicide. We continue to push out Narcan and assist other entities int the county with gettingi itt to include standing orders or connecting them withi the state to gets supply. Fort this year, we will continue to participate and provide evidenced based guidelines, to include mental health work with youth and community connectedness. We continue to do harm reduction and suicide Communicable diseases: Summary of cases of diseases reported last year reviewed, except for STIs. Discussed TB cases and the amount oft time-consuming work needed on the part ofthe nurses for each case. Direct Observation Therapy process explained to the Animal Bites-2023: 851 total bites to included: 68 dog bites, 14 cat bites, 1 horse, 1 mouse, 1U unknown. Local ED sending incomplete reports. We have provided education on the need for Tetanus boosters to the ED. While normally 10-yearintervals, the CDC recommends 5 years between if the event is an animal bite. No cases oft human rabies in Teller, but we did have one bat test positive for Rabies. We did have one Rabies Post Exposure Prophylaxis from an individual who received a dog bite while on vacation in  prevention. Suicides are down compared to previous years.  BoH. TB is ont the rise in Colorado.  another country.  Covid 19-Emergency: The emergency lasted 1169 days, Colorado ranked 14th lowest ini the nation for deaths. LPHAS delivered more than 12.7 million doses of covid vaccine and performed more than 21 million PCR tests. LPHA's were presented Covid challenge coins Goals for 2024: We will transition into the new: state communicable disease information system Epitrax, formally known as CEDRS. Mary sat on the state working group for Epitrax. Continue to work and network with other LPHAS and develop partnerships with our counterparts tot tapi int to support & knowledge. No dayi in Public Health ever: seems to be the same and we are always learning. There has been a lot of turn-over with the state.  from CDPHE. Teller County received 6 coins.    mergeneyPeparedness:  Exercises & Training: We attended several exercises. Mary has attended a full-scale MCI in Park County and also the ELI Paso County Airport exercise. Michelle participated ini the Mine exercise. The mine exercise was hosted by. Jeremy Dewall and co-hosted by Pulsara, which is a patient tracking system. Patient tracking and HIPAA questions came up during the exercise regarding roles and responsibility for ESF 8 and Public Health. Patient tracking is an ESF 8 role. We participated in at tabletop active shooter at TCSO involving Charis. We did some MCI training and bombing incident1 training which turned out to be more first responder & law enforcement than medical. We have done Access and Functional Needs training, behavioral health training toi include Motivational Interviewing, Trauma informed Care, Stop the Bleed, community educational outreach, a FEMA class on Training  Preparation and Planning.  Medical Reserve Corps (MRC): Wel have a unit coordinator, James Lawson, who was our Covid Test Lead. He has offered to volunteer and take ont this role. We resurrected our old paperwork: and is nowi int the review process. It has been reviewed by legal, our emergency manager, and the EMS council. We are: starting out with a tiny staff and are looking fori more volunteers. For training we will participate int table tops and full scale as the opportunities present coordinated through OEM and LEPC. We want to combine trainings to meet the Public Health Emergency Operations Plan: Will need to update it this coming year. Will also review our COOP and update it with the current team. We need toi figure out what we would take if we had to evacuate the office. The last time we did training, we had different staff members. We have a draft, but we need to scale it back because iti is tool big. Access & Functional Needs (AFN): We are looking to begin at train the trainer program. We want to get outi in the community and begin training others. The CERT team needs the info for evacuations and putting some of the responsibility back oni the residents but helping Trailer & Decon Bay: We still need to get them cleaned out. May want to sell thei trailer. Colorado Emergency Management Conference (CEMA): Mary will be attending the CEMA  deliverables for the grants.  them gett there through training.  We) just need time to geti it done during betterweather.  conference with OEM next month. Environmental Health:  Restaurant Inspections: First year of limited effects of Covid on the restaurant inspections. Inspections reverted back to an unannounced and routine schedule with the primary focus on high-risk facilities. Post Covid inspections saw higher rates of food mishandungvoations. Keri has focused on educatingnon-complant entities and retail    staff. Keri has been proactive in getting permit notices and violations of late fees toi food establishments. Keri is gettingcompliance: with the establishments and Austini is  supporting herwhen needed.  License fees: CDPHE is raising license fees significantly. Current rates are $350-$400. Austin clarified that het thinks it will be at fee in legislation, not CDPHE policy. There were questions about where the additional dollars would be going, tot the state orto the counties Temporary Food' Vendor Ordinance: Austin & Keri are working on this. Itis drafted and will go to Legal for review. Autin & Keri have tightened up some of the definitions. Once legal Staff Development: Keri is studying for her Registered Environmental Health Specialist Wastewater: Keri continues tot train in OWTS and conduct soil analysis. Conducting water sampling chloride for TCWU. Updated board on Regulation 431 for 2025. Setbacks for water  that must perform the work with the food estabushments.  approves, it will come back to the board for review and approval.  (REHS) and will take a test at the end of next month.  sources and wastewater systems will remain the same.  Immunizations:  -Training: Kim, our Immunization Coordinator, completed the Immunization Quality -Getting kids upi to date on theirvaccines, Kim & Laureen Murray have worked to make it more convenient to get kids in during school hours for vaccine updates and reduce the burden on working parents. Consents & approval obtained from the parents prior. For state map up-to-date childhood vaccines, Teller County was int the Orange, but Cripple -Working on scheduling improvement for more availability of appointments. The problem was that all the vaccines rolled at at once, Covid, Flu, and RSV. The nurse responsible was part-time then, the other nurse retired, sO making Kim at full-time position has helped 2024 improvement plans: We are adding additional clinic days, implementing EHRto help with scheduling and prearrival paperwork registration. Kim will be attending the CDC Pink Book training this summer, networking with the schools to strengthen relationships. 2023 Christina has learned fiscal components and has more autonomywith her 2024 will focus on more cross-training andi training of the front desk staff & learn billing. Wants to have more of a presence ini the schools and working on school connections.  Improvement CDC program  -HPVand MMR needed al boost and have now increased rates  Creek is sitting at Red and needed attention. This program is helping.  and we were able to add additional clinic days.  Reproductive Health: programs.    WIC:  - Great overall 2023.  - Clients are up to 290 clients from 252.  -Big Federal funding changes are coming down. Unknown how it will impact the program at1 this point. Will most likely involve partnering with another agency. Lots of mixed messaging with frequent changes in guidance. Ithas been frustrating. We mayl lose our dietician, Kelly due to program/funding cuts.  - Michelle wrote into the CDC infrastructure grant for. Jill's position to bei full-time including benefits minus the other' WIC expenditures. Int the end, we may need to partner with El Paso County to be able to access their dietician for our high-risk clients.  Budget Review:  -Budget spreadsheet presented. No Concerns. No MRC money spent through November. CPED spending has been slowed. Dan asked if the board needs to provide HIPAA software funds. Michelle responded that she has puti in a request for OPHP through CDPHE1 to adjust the CDC Infrastructure Grant to put software in this year. Itr may need to be a supplementa. request. Itmay eventually need to be put into the Public Health budget on  going.  Public Comment: None  Meeting Adjourned: 1311 Tues. Jan 16, 2023  Respegttulysubmitted by Michelle Wolff, DirectorTCPHE  Wloa9y Date  Coy