Board of Health

*”PRN” is a medical term meaning “as needed.”

Tri-County Health Department Board of Health Meeting

Date / Time: September 9, 2021 at 4:30 p.m. Via Zoom Webinar *Public access: https://zoom.us/webinar/register/WN_VEkA0LmpTYutzpdbvpszBw Or join by phone: (669) 900-6833 Webinar ID: 975 9780 9792 *Panelists (i.e., Board members and TCHD executive staff) will receive their own unique link to the meeting via e-mail

Agenda PUBLIC MEETING

Call to Order Dr. Kaia Gallagher 4:30 p.m.

Roll Call / Introductions Dr. Kaia Gallagher 4:30-4:35 p.m. (5 min)

ACTION ITEMS (by Statute)

Approval of the Minutes: a. August 12, 2021 b. August 16-17, 2021 c. August 30, 2021

Dr. Kaia Gallagher 4:35-4:40 p.m. (5 min)

Review of Financial Statements Dated June 30, 2021 Ms. Monique Didier 4:40-4:45 p.m. (5 min)

Study Session: Proposed Budget for Fiscal Year 2022 Ms. Monique Didier 4:45-5:05 p.m. (20 min)

Appoint New Board of Health Secretary Dr. Kaia Gallagher 5:05-5:10 p.m. (5 min)

Reschedule November Board Meeting (falls on a holiday) Dr. Kaia Gallagher 5:10-5:15 p.m. (5 min)

INFORMATIONAL ITEMS

Annual Update: TCHD’s Harm Reduction and HIV Prevention Program

Dr. Lauren Mitchell 5:15-5:25 p.m. (10 min)

Public Health Improvement Plan Progress Update: Health and Food

Ms. Jill Bonczynski Ms. Caitlin Matthews Ms. Lilia Chavez Bernal

5:25-5:45 p.m. (20 min)

COVID-19 Update: Communitywide Trends and School Specific Metrics

Dr. John Douglas 5:45-6:25 p.m. (40 min)

EXECUTIVE DIRECTOR’S REPORT (To Be Read, Discussion PRN*)

Dr. John Douglas 6:25-6:30 p.m. (5 min)

TCHD Recognized as Statewide Leader in Workplace Health and Safety

New Title V Priorities for Serving Children, Youth, and Families

New Class of Dietetic Interns

Update on Employee Turnover

Update on New Financial System Implementation

Electronic Medical Record System Process Update

https://zoom.us/webinar/register/WN_VEkA0LmpTYutzpdbvpszBw

Childhood Vaccine Coverage Rates: 2020-21 School and Licensed Childcare Facility Data

September is National Preparedness Month

OTHER ITEMS

Set Agenda for the November 2021 Board Meeting All 6:30–6:35 p.m. (5 min)

Board Member Remarks Board Members 6:35–6:40 p.m. (5 min)

Closing Remarks Dr. Kaia Gallagher 6:40–6:45 p.m. (5 min)

Executive Session for Consultation with Legal Counsel Dr. Kaia Gallagher 6:45-7:05 p.m. (20 min)

Adjournment Dr. Kaia Gallagher 7:05 p.m.

Board of Health Meeting August 12, 2021

Minutes At a regular meeting of the Tri-County Health Department (TCHD) Board of Health, held virtually via Zoom, there were: Board of Health Members: Janice Brainard, RN, Arapahoe County Present Thomas Fawell, MD, Arapahoe County Present Kaia Gallagher, PhD, President, Arapahoe County Present Linda Fielding, MD, Douglas County Present Julie Mullica, MPH, Vice President, Adams County Present Kim Muramoto, RN, Douglas County Present Zachary Nannestad, MPH, Secretary, Douglas County Absent Rosanna Reyes, RN, Adams County Present Julie Schilz, RN, Adams County Present Executive Management Team Members: Michele Askenazi, Director of Emergency Preparedness, Response and Communicable Disease Surveillance Present Heather Baumgartner, Director of Community Health Promotion Present Lisa Bolstad, Administrative Assistant Present Jill Bonczynski, Director of Nutrition Present Ronnae Brockman, Executive Assistant Present Monique Didier, Director of Administration and Finance Absent John M. Douglas, Jr., MD, Executive Director Present Mame Fuhrman, Director of the Office of Human Resources Present Penny Grande, Director of Nursing Present Brian Hlavacek, Director of Environmental Health Present Jennifer Ludwig, Deputy Director Present Kelly Weidenbach, Director of Planning and Information Management Absent Call to Order Dr. Gallagher called the meeting to order at 4:30 p.m. Introductions Breanna Paderewski, Budget Analyst, introduced herself and stated that she was attending the meeting on Ms. Didier’s behalf. Ms. Baumgartner introduced Grace Soulen, Health Equity Initiatives Manager; and Emma Goforth, Mental Health Initiatives Manager.

Board of Health Minutes August 12, 2021 Page 2 Closed Board Executive Session MOTION: Ms. Mullica moved to go into Executive Session with legal counsel to discuss COVID-19 mitigation strategies in schools. Dr. Fielding seconded and the motion passed with a unanimous affirmative vote by the Board of Health members. Mr. Overton invoked attorney-client privilege under Colorado Revised Statutes (C.R.S.) 24-6-402(4) to discuss legal matters related COVID-19 mitigation strategies in schools. The Executive Session was held from 4:05 p.m. to 5:15 p.m. Upon return to the public meeting, Dr. Gallagher announced that the Board would hold a public comment session on Monday, August 16, 2021 to hear public comment on a proposed school mask mandate. Meeting information will be posted on TCHD’s website on August 13, 2021. Approval of the Minutes of the July 8, 2021 Meeting MOTION: Dr. Fawell moved to approve the minutes of the July 8, 2021 meeting. Ms. Muramoto seconded and the motion passed with a unanimous affirmative vote by the Board members. Public Hearing: Proposed Environmental Health Fee Changes Dr. Gallagher opened the public hearing at 5:18 p.m. The public hearing was duly advertised in the legal notices section of the Denver Post on Sunday, August 1, 2021. Pursuant to C.R.S. 25-1-508(5)(j) and C.R.S. 25-10-107(1), the TCHD Board of Health may assess fees equal to actual and direct costs. TCHD proposed the Board keep Environmental Health program fees at the 2020 level with the exception of a slight decrease for OWTS “New” or “Repair” permits. Dr. Gallagher verified that no one from the public was present to speak on this issue and closed the public hearing at 5:29 p.m. MOTION: Ms. Brainard moved to adopt the proposed 2021 Environmental Health Fee Schedule. Dr. Fielding seconded and the motion passed with a unanimous affirmative vote by the Board members. Fiscal Year 2022 Budget Update Ms. Paderewski presented updated fiscal year (FY) 2022 major budgetary dynamics to the Board. Changes to the planning assumptions presented at the July 8, 2021 Board of Health meeting are a proposed county per capita increase of $0.07 (previously $0.05) and a mandatory 0.5% increase in employer contributions to the Public Employees Retirement Association (PERA) effective July 1, 2022. Update on Community Health Assessment Process Callie Preheim, Population Health Epidemiologist, provided an update on TCHD’s Community Health Assessment Process.

Board of Health Minutes August 12, 2021 Page 3 ACTION ITEM: Ms. Reyes to provide names of community-based organizations serving populations, including agricultural workers, that are minority led. COVID-19 Update Dr. Douglas provided an update on the COVID-19 pandemic and TCHD’s response efforts. He discussed case numbers and other relevant data, COVID variant surveillance and tracking, vaccine breakthrough infections, COVID vaccine uptake, TCHD’s vaccine strategy for hard-to-reach populations, and current local mask requirements in schools. Update on Board Gatherings Dr. Gallagher discussed Board survey results on self-assessment topics and options. Three of nine Board members responded to the survey. The Board elected to postpone further discussion until the direction of TCHD and its counties is decided. Executive Director’s Report The Executive Director’s Report contained updates on TCHD’s Senior Dental Program, Front Range ozone levels and TCHD staff guidelines, a summary of infectious disease activity both locally and statewide, Workplace Wellness Initiative funding, a planned TCHD website refresh, and an announcement about TCHD’s upcoming virtual All-Staff Meeting. Set Agenda for the September 9, 2021 Meeting Agenda items for the September 9, 2021 Board meeting include: 1) a study session on TCHD’s fiscal year 2022 proposed budget; 2) review of quarterly financial statements; 3) a COVID-19 update; 4) an update on TCHD’s Syringe Access Services program; 5) a closed executive session to discuss the Executive Director’s performance review; and 6) an update on TCHD’s Public Health Improvement Plan Priority Area 3: Health and Food. Board Member Remarks/Closing Remarks None. Adjournment MOTION: Dr. Fawell moved to adjourn the meeting at 6:48 p.m. Ms. Schilz seconded and the motion passed with a unanimous affirmative vote by the Board members. ______________________________ ______________________________ Kaia Gallagher, PhD, President , Secretary

Board of Health Meeting and Public Forum

August 16-17, 2021 Minutes

At a special meeting of the Tri-County Health Department (TCHD) Board of Health, held virtually via Zoom, there were: Board of Health Members: Janice Brainard, RN, Arapahoe County Present Thomas Fawell, MD, Arapahoe County Absent Kaia Gallagher, PhD, President, Arapahoe County Present Linda Fielding, MD, Douglas County Present Julie Mullica, MPH, Vice President, Adams County Present Kim Murimoto, RN, Douglas County Present Zachary Nannestad, MPH, Secretary, Douglas County Present Rosanna Reyes, RN, Adams County Present Julie Schilz, RN, Adams County Present Executive Management Team Members: Michele Askenazi, Director of Emergency Preparedness, Response and Communicable Disease Surveillance Absent Heather Baumgartner, Director of Community Health Promotion Present Lisa Bolstad, Administrative Assistant Present Jill Bonczynski, Director of Nutrition Present Ronnae Brockman, Executive Assistant Present Monique Didier, Director of Administration and Finance Present John M. Douglas, Jr., MD, Executive Director Present Mame Fuhrman, Director of the Office of Human Resources Present Penny Grande, Director of Nursing Present Brian Hlavacek, Director of Environmental Health Jennifer Ludwig, Deputy Director Present Kelly Weidenbach, Director of Planning and Information Management Present Others Present: Randy Dement, TCHD’s Legal Counsel Sid Overton, TCHD’s Legal Counsel Sara Garrington, Emergency Preparedness and Response Manager, on behalf of Michele Askenazi Call to Order Dr. Gallagher called the meeting to order on August 16, 2021 at 4:00 p.m. Public Forum: School Masking Requirements Oral comment, both in favor and against a mask mandate in schools and childcare centers, was heard from members of the public.

Board of Health Minutes August 16-17, 2021 Page 2 Executive Session with Legal Counsel MOTION: Ms. Mullica moved to go into Executive Session with legal counsel to discuss matters related to public health orders. Dr. Fielding seconded and the motion passed with a unanimous affirmative vote by the Board of Health members. Mr. Overton invoked attorney-client privilege under Colorado Revised Statutes (C.R.S.) 24-6-402(4) to discuss legal matters related to public health orders. The Executive Session was held from 5:33 p.m. to 7:37 p.m. Motion to Suspend Meeting Until August 17, 2021 at 4:30 p.m. The Board members returned to the public meeting following the Executive Session with legal counsel. MOTION: Ms. Muramoto moved to suspend the Board meeting and reconvene on August 17, 2021 at 4:30 p.m. Dr. Fawell seconded and the motion passed with all in favor except Ms. Reyes who opposed. Meeting Reconvened The Board reconvened via Zoom Webinar on August 17, 2021 at 4:30 p.m. Roll call was conducted and all nine Board members were present. The Board members discussed their reasoning for being for or against a mask order in schools. MOTION: Ms. Mullica moved to authorize and direct the Executive Director of Tri-County Health Department, in response to the COVID-19 pandemic and to support and limit interruptions to critical in-person learning, to issue a public health order requiring the use of face coverings for all individuals, over age 2, in all indoor school and child care settings located within Adams, Arapahoe and Douglas Counties. Per Board of Health policy, counties have the option to opt-out and if a county exercises that right, it does not preclude any school, school district or childcare facility from following this public health order. Ms. Schilz seconded. The motion failed with a four-to-four vote with Ms. Mullica, Ms. Reyes, Ms. Schilz and Ms. Brainard in favor and Dr. Fawell, Dr. Gallagher, Dr. Fielding and Ms. Murimoto against. Mr. Nannestad abstained and stated his employment with Douglas County School District posed a conflict of interest.

MOTION: Ms. Reyes moved to postpone the vote until it could be determined whether Mr. Nannestad’s abstension changed the denominator for the outcome of the vote. The motion wasn’t seconded.

Ms. Brockman explained that the Amended and Restated Bylaws of the Board of Health of Tri-County Health Department required a majority affirmative vote of the Board members present for a motion to pass. With nine members present, five members would be required to vote affirmatively in order for the motion to pass. Therefore, Mr. Nannestad’s abstention has no effect on the vote’s outcome.

MOTION: Dr. Fawell moved to authorize and direct the Executive Director of Tri-County Health Department, in response to the COVID-19 pandemic and in the absence of an approved vaccine for children under the age of 12 years, to issue a public health order requiring the use of face coverings

Board of Health Minutes August 16-17, 2021 Page 3 for all children aged 2 years to 11 years, as well as all individuals working or interacting with children aged 2 years to 11 years, in all indoor school and child care settings located within Adams, Arapahoe and Douglas Counties. Per Board of Health policy, counties have the option to opt-out and if a county exercises that right, it does not preclude any school, school district or childcare facility from following this public health order. Said Public Health Order to become effective at the start of school on August 23, 2021. Additionally, public health data to be continuously monitored until the Public Health Order is rescinded, based on the ongoing data. Dr. Gallagher seconded. The motion passed with a six-to-two vote with Ms. Mullica, Ms. Reyes, Ms. Schilz, Ms. Brainard, Dr. Fawell and Dr. Gallagher in favor and Dr. Fielding and Ms. Muramoto against. Mr. Nannestad abstained and stated his employment with Douglas County School District posed a conflict of interest.

Adjournment MOTION: Dr. Fawell moved to adjourn the meeting at 5:22 p.m. Mr. Nannestad seconded and the motion passed with a unanimous affirmative vote by the Board members. ______________________________ ______________________________ Kaia Gallagher, PhD, President Secretary

Board of Health Meeting August 30, 2021

Minutes At a special meeting of the Tri-County Health Department (TCHD) Board of Health, held virtually via Zoom, there were: Board of Health Members: Kevin Bracken, Douglas County Present Janice Brainard, RN, Arapahoe County Present Thomas Fawell, MD, Arapahoe County Present Kaia Gallagher, PhD, President, Arapahoe County Present Linda Fielding, MD, Douglas County Present Julie Mullica, MPH, Vice President, Adams County Present Kim Muramoto, RN, Douglas County Absent Rosanna Reyes, RN, Adams County Present Julie Schilz, RN, Adams County Present Executive Management Team Members: Michele Askenazi, Director of Emergency Preparedness, Response and Communicable Disease Surveillance Present Heather Baumgartner, Director of Community Health Promotion Present Lisa Bolstad, Administrative Assistant Present Jill Bonczynski, Director of Nutrition Present Ronnae Brockman, Executive Assistant Present Monique Didier, Director of Administration and Finance Present John M. Douglas, Jr., MD, Executive Director Present Mame Fuhrman, Director of the Office of Human Resources Absent Penny Grande, Director of Nursing Present Brian Hlavacek, Director of Environmental Health Present Jennifer Ludwig, Deputy Director Present Kelly Weidenbach, Director of Planning and Information Management Present Call to Order Dr. Gallagher called the meeting to order at 4:00 p.m. Introductions Dr. Gallagher welcomed Kevin Bracken to the Board of Health. Update on COVID-19 Trends: Overall and in School-age Youth Dr. Douglas provided an update on COVID-19 trends and discussed the benefits of masking.

Board of Health Minutes August 30, 2021 Page 2 Reconsideration of Current Opt-out Policy Dr. Douglas asked the Board to consider rescinding its “Opt-out Policy” which was adopted in November 2020. The policy, which gives County Commissioners the ability to opt out of the application and enforcement of countywide public health orders, has created concern and confusion among local officials and residents and has severely limited TCHD’s ability to carry out its statutorily required public health duties. MOTION: Ms. Mullica moved to rescind the Policy Regarding Issuance of County-wide Public Health Orders, the Board of Health policy allowing County Commissioners to opt-out of the application and enforcement of county-wide public health orders, that was adopted by the Board on November 6, 2020. Ms. Brainard seconded. The motion passed with a five-to-three vote with Ms. Mullica, Ms. Reyes, Ms. Schilz, Ms. Brainard, and Dr. Gallagher voting in favor and Dr. Fawell, Dr. Fielding and Mr. Bracken voting against. Dr. Fielding alleged that at least one Board of Health member is compromised due to complaints related to their Board of Health duties that had been filed against their professional license. She stated that this is a class 4 felony under Colorado Revised Statutes (C.R.S.) 18-8-306, Attempt to influence a public servant, and declared the meeting compromised and tainted by an atmosphere of coercion. Dr. Fielding demanded that the meeting be canceled until the status of “those Board members” was resolved. Randy Dement, TCHD’s legal counsel, stated that these allegations constituted a legal issue and should be discussed in executive session. ACTION ITEM: Dr. Gallagher to convene an executive session of the Board with legal counsel to discuss Dr. Fielding’s allegations. MOTION: Dr. Fielding moved that this meeting was improperly called as an “Emergency” meeting and, as evidenced by the meeting content, there was no reason to have this meeting on such short notice. She further moved to terminate the meeting at once and declare everything discussed void until the Board reconvenes at its normal monthly meeting. Mr. Bracken seconded. The motion failed with a two-to-six vote with Dr. Fielding and Mr. Bracken in favor and Ms. Mullica, Ms. Reyes, Ms. Schilz, Ms. Brainard, Dr. Gallagher and Dr. Fawell against. Dr. Fawell stated that, per the Bylaws, a “Special” meeting of the Board could be called with at least 72 hours advance notice. Dr. Douglas stated that a special meeting was justified due to rising COVID-19 rates and two counties opting out of the August 18, 2021 public health order. Reconsideration of School Mask Mandate Dr. Douglas asked to Board to consider rescinding the August 18, 2021 public health order and issuing a public health order requiring the use of face coverings for all individuals, aged 2 years and older, in all indoor school and childcare settings located within Adams, Arapahoe and Douglas Counties. Dr. Douglas cited rising case rates in children, increasing school outbreaks, and the need to keep children healthy and in school. MOTION: Dr. Gallagher moved to authorize and direct the Executive Director of Tri-County Health Department to rescind the Public Health Order Requiring Face Masks in Schools and Childcare Facilities issued on August 18, 2021 and, in response to the COVID-19 pandemic and to support and limit interruptions to critical in-person learning for all

Board of Health Minutes August 30, 2021 Page 3 students, replace this existing order by issuing a public health order requiring the use of face coverings for all individuals, aged 2 years and older, in all indoor school and child care settings located within Adams, Arapahoe and Douglas Counties. Order shall become effective at 12:01 AM on Wednesday, September 1, 2021 and shall stay in effect until December 31, 2021, unless amended, extended, or rescinded. Health data and community conditions shall be monitored daily while this Order is in effect. Ms. Mullica seconded. The motion passed with a five-to-three vote with Ms. Mullica, Ms. Reyes, Ms. Schilz, Ms. Brainard, and Dr. Gallagher in favor and Dr. Fawell, Dr. Fielding and Mr. Bracken against. MOTION: Mr. Bracken moved that, should the numbers drop in the next week or two, a review and removal of the mask mandate happen immediately. Dr. Fielding seconded. The motion failed with a two-to-six vote with Dr. Fielding and Mr. Bracken in favor and Ms. Mullica, Ms. Reyes, Ms. Schilz, Ms. Brainard, Dr. Gallagher and Dr. Fawell against. Adjourn MOTION: Ms. Reyes moved to adjourn the meeting at 6:08 p.m. Ms. Schilz seconded and the motion passed with a unanimous affirmative vote by the Board members. ______________________________ ______________________________ Kaia Gallagher, PhD, President Secretary

1

June 2021

Financial Executive Summary

For the second quarter of 2021, TCHD’s revenue, not including budgeted use of fund balance, exceeded budget by $708K, while expenditures were under budget by $1.7M. Net income year-to-date through June is $2.4M. The Board Fund is reported in program 132.

At the December 2020 meeting, the BOH adopted the 2021 budget totaling $55,486,920. In July 2021 the BOH approved a supplemental budget package for $11,305,797. The Revised budget for 2021 is now $66,792,717.

Revenue

Revenue through the month of June 2021 totaled $33.1M, which was greater than budget by $708K. The most significant revenue variances include:

• Public Health Emergency Preparedness (Program 520) – received additional funding for COVID-19 response.

• Retail Food (Program 630) – 70% of annual revenue collected in January, variance due to expenses managed for rest of year.

$4,000,000

$4,500,000

$5,000,000

$5,500,000

$6,000,000

$6,500,000

$7,000,000

$7,500,000

January February March April May June

2021 Revenue Budget vs Actual

Budget

Actual

2

Expenditure

Expenditures totaled $31.8M through March, which was less than budget by $1.7M. Major expense variances include:

• Public Health Emergency Preparedness (Program 520) – wage expense greater than budget due to new funding for COVID-19 response.

• Information Technology (Program 950) – annual Microsoft licensing fee; firewall and VPN licensing due to COVID/teleworking.

Actual revenue vs expense through June 2021

Overall, the actual net income year-to-date for the first six months of 2021 is $1.4M. The net income year-to-date includes the planned use of fund balance.

$3,000,000

$3,500,000

$4,000,000

$4,500,000

$5,000,000

$5,500,000

$6,000,000

$6,500,000

$7,000,000

$7,500,000


2021 Expense Budget vs Actual

Budget

Actual

3

This bar graph exhibits straight-line results for actual cumulative revenue and expenses.

Other Financial Items

Tri-County Health Department (TCHD) continues to invest a portion of the fund balance with Chandler Asset Management in a $6 million-dollar bond portfolio and has $5 million invested with JPMorgan Chase in a laddered CD portfolio. (These investments were initiated in April 2015). TCHD also has approximately $4 million invested with CSafe, which operates similar to a money market. The chart below shows investment earnings for the past four years:

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

$8,000,000


2021 Monthly Revenue and Expense

Revenue

Expense

$1,000,000

$6,000,000

$11,000,000

$16,000,000

$21,000,000

$26,000,000

$31,000,000

$36,000,000

Jan Jan - Feb Jan - Mar Jan - Apr Jan - May Jan -June

Cumulative Revenue and Expense

Revenue

Expense

2020 Earnings 2019 Earnings 2018 Earnings 2017 EarningsCsafe 24,143$ 89,697$ 79,400$ 40,572$ JPMorgan Chase 101,779$ 151,121$ 87,329$ 42,165$ Chandler 189,169$ 207,457$ 96,618$ 36,393$

315,091$ 448,275$ 263,347$ 119,130$

4

GASB 72 requires investments be reported at fair value, so market fluctuations can cause a drop-in value even though the investment has not been liquidated.

Jan - June 2021 Earnings

Csafe 824 JPMorgan Chase (2,966) Chandler (11,535)

(13,677)

Tri County Health DepartmentStatement of Revenues and Expenditures - 8-PB Rev Exp Prog w Budget - Program Groups

From 1/1/2021 Through 6/30/2021

Percent of Total 2021 Percent of TotalBudget Actual Variance Budget Budget Budget

Revenue130 EXECUTIVE 524,136 524,136 - 100.00% 1,048,272 50.00%131 METRO DENVER PARTNERSHIP FOR HEALTH 32,004 62,002 29,998 193.73% 64,000 96.87%132 BOARD FUND 7,500 7,500 - 100.00% 15,000 50.00%140 COMMUNICATION 184,872 184,872 - 100.00% 369,737 50.00%220 WIC 2,699,142 2,733,630 34,488 101.27% 5,398,285 50.63%222 WIC CENTRAL REFERRAL SYSTEM 50,550 50,804 254 100.50% 101,097 50.25%226 WIC PEER COUNSELOR 112,038 104,304 (7,734) 93.09% 224,067 46.55%238 HUNGER FREE OUTREACH 52,518 58,089 5,571 110.60% 105,037 55.30%240 DIETETIC INTERNSHIP 68,250 41,783 (26,467) 61.22% 136,496 30.61% 1242 DRCOG AHC MODEL - CLINICAL PARTNER 82,008 81,164 (844) 98.97% 164,015 49.48%245 ADAMS CO FOOD SECURITY 40,002 40,511 509 101.27% 80,000 50.63%270 BABY & ME - TOBACCO FREE 10,428 10,752 324 103.10% 20,852 51.56%290 NUTRITION ADMINISTRATION 83,706 88,256 4,550 105.43% 167,408 52.71%330 HEALTH PLANNING 73,860 73,860 - 100.00% 147,709 50.00%332 WORKSITE WELLNESS - CCPD 150,150 131,506 (18,644) 87.58% 300,300 43.79%335 COMMUNITY NUTRITION 207,978 207,978 - 100.00% 415,951 50.00%336 HEALTHY BEVERAGE INITIATIVE - CCPD 26,700 41,588 14,888 155.76% 53,395 77.88%337 DIABETES PREVENTION - CCPD 167,502 170,500 2,998 101.79% 335,000 50.89%338 ADVANCING BREASTFEEDING IN COLORADO - CCPD 68,922 88,976 20,054 129.09% 137,839 64.55%351 TOBACCO 659,040 752,341 93,301 114.15% 1,318,077 57.07%356 SAMHSA GRANT 84,438 67,043 (17,395) 79.39% 168,881 39.69%357 COMMUNITIES THAT CARE 181,428 191,745 10,317 105.68% 362,852 52.84%358 MENTAL HEALTH PROMOTION 60,330 60,330 - 100.00% 120,656 50.00%371 MCH CHILD/ADOLESCENT 133,824 125,616 (8,208) 93.86% 267,650 46.93%372 MCH WORA 123,198 121,252 (1,946) 98.42% 246,397 49.21%373 MCH MEDICAL HOME 78,870 70,263 (8,607) 89.08% 157,743 44.54%374 NENS REFERRAL GRANT PROJECT 5,208 3,514 (1,694) 67.48% 10,411 33.75%390 COMMUNITY HEALTH PROMOTION ADMINISTRATION 155,016 155,016 - 100.00% 310,027 50.00%411 CLINICAL SCHOLARS 32,832 24,278 (8,554) 73.94% 65,664 36.97%415 CORE TB CONTROL 142,908 142,908 - 100.00% 285,811 50.00%420 ADAMS MOTHERS FIRST 308,148 286,132 (22,016) 92.85% 616,294 46.42%424 ARAPAHOE MOTHERS FIRST 69,714 88,844 19,130 127.44% 139,422 63.72%

COMMENTS- BASED UPON YTD BUDGET VS. YTD ACTUALYTD Revenue variance threshold: -$25K and -10% under budget, or +$50K over budget

TRI-COUNTY HEALTH DEPARTMENTRevenue and Expenditure Statement

Year-to-Date For the Period Ending June 30, 2021(50.0% of Year Complete)

Year-to-Date (2021 JAN - JUNE)


From 1/1/2021 Through 6/30/2021

YTD Expense variance threshold: -$25K and 10% over budget, or +$50K under budgetCOMMENTS- BASED UPON YTD BUDGET VS. YTD ACTUAL

1 Tuition expenses to hit in August versus June

425 CHILD FATALITY PREVENTION 33,492 32,244 (1,248) 96.27% 66,984 48.13%426 ARAPAHOE NURSE SUPPORT 571,566 607,106 35,540 106.21% 1,143,134 53.10%427 DOUGLAS MOTHERS FIRST 71,982 64,193 (7,789) 89.17% 143,967 44.58%428 ADAMS CHILD NURSE LIAISON 167,042 179,939 12,897 0.00% 334,083 0.00%440 HCP 318,786 291,030 (27,756) 91.29% 637,577 45.64%450 HEALTHY COMMUNITIES 121,638 121,641 3 100.00% 243,276 50.00%451 REGIONAL HEALTH CONNECTORS 152,946 170,148 17,202 111.24% 305,893 55.62%455 NFP CONTINUATION 1,601,856 1,504,608 (97,248) 93.92% 3,203,712 46.96%457 MIECHVP 458,400 387,110 (71,290) 84.44% 916,801 42.22% 2460 IMMUNIZATION AND CLINICAL RESPONSE 3,066,184 2,882,141 (184,043) 178.21% 6,132,350 89.10%461 CUSTOMER SUPPORT CENTER 161,154 161,154 - 100.00% 322,299 50.00%469 HIV AND STD 382,350 281,842 (100,508) 73.71% 764,691 36.85% 3477 SEXUAL HEALTH 1,913,256 1,692,286 (220,970) 88.45% 3,826,519 44.22% 4490 NURSING ADMINISTRATION 642,116 605,238 (36,878) 100.00% 1,284,222 50.00%492 NURSING SPECIAL PROJECTS - 2,385 2,385 0.00% - 0.00%495 ARAPAHOE SENIOR DENTAL 221,730 212,703 (9,027) 95.92% 443,456 47.96%510 COMMUNICABLE DISEASE 256,854 276,675 19,821 107.71% 513,711 53.85%520 PUBLIC HEALTH EMERGENCY PREPAREDNESS 9,963,422 10,498,160 534,738 2,934.55% 19,926,841 1,467.28%530 CRI 126,768 133,925 7,157 105.64% 253,537 52.82%550 NSSP 87,504 136,085 48,581 155.51% 175,004 77.76%551 SYNDROMIC SURVEILLANCE SUICIDE PREVENTION 100,758 199,467 98,709 197.96% 201,520 98.98%552 OVERDOSE DATA TO ACTION 75,000 51,791 (23,209) 69.05% 150,000 34.52%590 EPRCDS ADMINISTRATION 104,460 104,460 - 100.00% 208,917 50.00%610 ANIMAL CONTROL 2,952 2,952 - 100.00% 5,897 50.05%613 VECTOR SURVEILLANCE 32,856 32,856 - 100.00% 65,700 50.00%617 DISEASE PREVENTION 28,374 28,374 - 100.00% 56,747 50.00%620 AIR POLLUTION 15,906 49,455 33,549 310.92% 31,811 155.46%622 INDUSTRIAL HYGIENE 44,190 35,701 (8,489) 80.78% 88,361 40.40%630 RETAIL FOOD 1,431,612 1,914,346 482,734 133.71% 2,863,211 66.86%640 CHILDCARE 133,542 120,153 (13,389) 89.97% 267,077 44.98%643 BODY ART 16,140 32,346 16,206 200.40% 32,274 100.22%645 RECREATION 70,116 105,853 35,737 150.96% 140,229 75.48%650 LAND USE 423,150 501,072 77,922 118.41% 846,307 59.20%

COMMENTS- BASED UPON YTD BUDGET VS. YTD ACTUALYTD Revenue variance threshold: -$25K and -10% under budget, or +$50K over budgetYTD Expense variance threshold: -$25K and 10% over budget, or +$50K under budgetCOMMENTS- BASED UPON YTD BUDGET VS. YTD ACTUAL


From 1/1/2021 Through 6/30/2021

2 Revenue less than budget due to less billable expenses than forecasted.

3 Revenue less than budget due to less billable expenses than forecasted.

4 Actuals less than budget primarily due to lower than budgeted personnel costs

653 WATER SUPPLIES 58,812 45,651 (13,161) 77.62% 117,613 38.81%657 WASTE WATER 285,762 409,686 123,924 143.36% 571,521 71.68%668 SOLID & HAZARDOUS WASTE 103,272 80,752 (22,520) 78.19% 206,523 39.10%683 ROCKY MOUNTAIN ARSENAL 103,080 69,548 (33,532) 67.47% 206,161 33.73% 5687 HOUSEHOLD AND HAZARDOUS WASTE ROUNDUP 154,236 149,558 (4,678) 96.96% 308,451 48.48%690 ENVIRONMENTAL HEALTH ADMINISTRATION 521,124 521,409 285 100.05% 1,042,241 50.02%692 MEDICAL MARIJUANA MANUFACTURER 5,004 3,752 (1,252) 74.98% 9,994 37.54%695 EH INFORMATICS 164,670 164,670 - 100.00% 329,330 50.00%696 SPECIAL PROJECTS - 1,000 1,000 0.00% - 0.00%710 EMPLOYEE HEALTH & WELLNESS 55,362 55,362 - 100.00% 110,719 50.00%720 HUMAN RESOURCES 278,838 278,838 - 100.00% 557,670 50.00%790 FRINGE BENEFITS (687,312) (687,312) - 100.00% (1,374,620) 50.00%810 FA OPERATIONS 1,538,502 1,538,767 265 61.20% 3,003,241 30.60%820 FA ADMINISTRATION 301,896 277,958 (23,938) 61.53% 603,781 30.76%821 EARNINGS ON INVESTMENTS 175,002 15,516 (159,486) 8.87% 350,000 4.43% 6840 FA FACILITIES 225,426 225,426 - 100.00% 450,846 50.00%860 FA PURCHASING 69,528 67,026 (2,502) 96.40% 139,045 48.20%870 FA ACCOUNTING 375,594 371,632 (3,962) 98.94% 751,183 49.47%880 FA VITAL RECORDS 675,000 775,700 100,700 114.91% 1,350,000 57.45%890 AGENCY ADMIN SUPPORT 1,317,216 1,317,216 - 100.00% 2,634,423 50.00%895 REGIONAL PUBLIC HEALTH SERVICES

COUNTY FUNDS - ADAMS 1,910,748 1,910,745 (3) 100.00% 3,821,490 50.00% COUNTY FUNDS - ARAPAHOE 2,384,652 2,384,652 - 100.00% 4,769,304 50.00% COUNTY FUNDS - DOUGLAS 1,275,258 1,275,260 2 100.00% 2,550,519 50.00% STATE FUNDS 941,220 952,287 11,067 101.18% 1,882,445 50.59%

899 GENERAL FUND ALLOCATION (10,631,934) (10,632,090) (156) 100.00% (21,263,864) 50.00%910 MEDICAL EPIDEMIOLOGY 114,252 114,252 - 100.00% 228,502 50.00%930 HEALTH DATA AND GIS 220,914 221,112 198 100.08% 441,823 50.04%950 INFORMATION TECHNOLOGY 752,484 752,484 - 100.00% 1,504,958 50.00%990 PLANNING & INFORMATION MANAGEMENT ADMINISTRATION 257,106 257,106 - 100.00% 514,210 50.00%

Total Revenue 32,421,034 33,128,896 707,862 162.88% 64,767,962 81.44%


5 Primarily due to decreased personnel costs and indirect expense.6 Investment income less than budget due to market fluctuations


From 1/1/2021 Through 6/30/2021

Expenditure130 EXECUTIVE 524,136 451,417 72,719 86.12% 1,048,272 43.06%131 METRO DENVER PARTNERSHIP FOR HEALTH 32,004 42,087 (10,083) 131.50% 64,000 65.76%132 BOARD FUND 7,500 - 7,500 0.00% 15,000 0.00%140 COMMUNICATION 184,872 27,455 157,417 14.85% 369,737 7.42%220 WIC 2,699,142 2,733,628 (34,486) 101.27% 5,398,285 50.63%222 WIC CENTRAL REFERRAL SYSTEM 50,550 50,084 466 99.07% 101,097 49.54%226 WIC PEER COUNSELOR 112,056 102,882 9,174 91.81% 224,067 45.91%238 HUNGER FREE OUTREACH 52,518 60,974 (8,456) 116.10% 105,037 58.05%240 DIETETIC INTERNSHIP 68,250 63,891 4,359 93.61% 136,496 46.80%242 DRCOG AHC MODEL - CLINICAL PARTNER 82,008 81,358 650 99.20% 164,015 49.60%245 ADAMS CO FOOD SECURITY 40,002 40,511 (509) 101.27% 80,000 50.63%270 BABY & ME - TOBACCO FREE 10,428 10,326 102 99.02% 20,852 49.52%290 NUTRITION ADMINISTRATION 83,706 84,284 (578) 100.69% 167,408 50.34%330 HEALTH PLANNING 73,860 52,464 21,396 71.03% 147,709 35.51%332 WORKSITE WELLNESS - CCPD 150,150 165,441 (15,291) 110.18% 300,300 55.09%335 COMMUNITY NUTRITION 207,978 56,011 151,967 26.93% 415,951 13.46% 7336 HEALTHY BEVERAGE INITIATIVE - CCPD 26,700 41,989 (15,289) 157.26% 53,395 78.63%337 DIABETES PREVENTION - CCPD 167,502 170,458 (2,956) 101.76% 335,000 50.88%338 ADVANCING BREASTFEEDING IN COLORADO - CCPD 68,922 88,976 (20,054) 129.09% 137,839 64.55%351 TOBACCO 659,040 752,286 (93,246) 114.14% 1,318,077 57.07% 8356 SAMHSA GRANT 84,438 66,643 17,795 78.92% 168,881 39.46%357 COMMUNITIES THAT CARE 181,428 191,745 (10,317) 105.68% 362,852 52.84%358 MENTAL HEALTH PROMOTION 60,330 31,808 28,522 52.72% 120,656 26.36%371 MCH CHILD/ADOLESCENT 133,824 125,625 8,199 93.87% 267,650 46.93%372 MCH WORA 123,198 121,252 1,946 98.42% 246,397 49.21%373 MCH MEDICAL HOME 78,870 72,908 5,962 92.44% 157,743 46.21%374 NENS REFERRAL GRANT PROJECT 5,208 3,412 1,796 65.52% 10,411 32.77%390 COMMUNITY HEALTH PROMOTION ADMINISTRATION 155,016 136,196 18,820 87.85% 310,027 43.93%411 CLINICAL SCHOLARS 32,832 12,987 19,845 39.55% 65,664 19.77%415 CORE TB CONTROL 142,908 - 142,908 0.00% 285,811 0.00% 9420 ADAMS MOTHERS FIRST 308,148 263,858 44,290 85.62% 616,294 42.81%424 ARAPAHOE MOTHERS FIRST 69,714 66,051 3,663 94.74% 139,422 47.37%425 CHILD FATALITY PREVENTION 33,492 41,741 (8,249) 124.63% 66,984 62.31%426 ARAPAHOE NURSE SUPPORT 571,566 498,754 72,812 87.26% 1,143,134 43.63% 10427 DOUGLAS MOTHERS FIRST 71,982 59,641 12,341 82.85% 143,967 41.42%428 ADAMS CHILD NURSE LIAISON 167,042 155,887 11,155 0.00% 334,083 0.00%440 HCP 318,786 291,030 27,756 91.29% 637,577 45.64%450 HEALTHY COMMUNITIES 121,638 107,020 14,618 87.98% 243,276 43.99%



From 1/1/2021 Through 6/30/2021

7 Under budget primarily due to personnel costs8 Expenses over budget primarily due to marketing expenses for the Evolution paid media buy.9 Haven't used any of the budgeted Contract Services - Medical/Dental to date.

10 Actuals less than budget primarily due to decrease wages due to COVID response

451 REGIONAL HEALTH CONNECTORS 152,946 27,859 125,087 18.21% 305,893 9.10% 11455 NFP CONTINUATION 1,601,856 1,506,453 95,403 94.04% 3,203,712 47.02% 12457 MIECHVP 458,400 387,131 71,269 84.45% 916,801 42.22% 13460 IMMUNIZATION AND CLINICAL RESPONSE 3,066,184 2,798,905 267,279 173.07% 6,132,350 86.53% 14461 CUSTOMER SUPPORT CENTER 161,154 1,139 160,015 0.70% 322,299 0.35% 15469 HIV AND STD 382,350 275,447 106,903 72.04% 764,691 36.02% 16477 SEXUAL HEALTH 1,913,256 1,521,005 392,251 79.49% 3,826,519 39.74% 17490 NURSING ADMINISTRATION 642,116 495,152 146,964 81.81% 1,284,222 40.90% 18492 NURSING SPECIAL PROJECTS - 2,583 (2,583) 0.00% - 0.00%495 ARAPAHOE SENIOR DENTAL 221,730 199,680 22,050 90.05% 443,456 45.02%510 COMMUNICABLE DISEASE 256,854 258,551 (1,697) 100.66% 513,711 50.33%520 PUBLIC HEALTH EMERGENCY PREPAREDNESS 9,963,422 10,472,776 (509,354) 2,259.87% 19,926,841 1,129.94%530 CRI 126,768 133,925 (7,157) 105.64% 253,537 52.82%550 NSSP 87,504 85,869 1,635 98.13% 175,004 49.06%551 SYNDROMIC SURVEILLANCE SUICIDE PREVENTION 100,758 65,288 35,470 64.79% 201,520 32.39%552 OVERDOSE DATA TO ACTION 75,000 51,791 23,209 69.05% 150,000 34.52%590 EPRCDS ADMINISTRATION 104,460 78,227 26,233 74.88% 208,917 37.44%610 ANIMAL CONTROL 2,952 17,648 (14,696) 597.82% 5,897 299.26%613 VECTOR SURVEILLANCE 32,856 43,697 (10,841) 132.99% 65,700 66.50%617 DISEASE PREVENTION 28,374 8,765 19,609 30.89% 56,747 15.44%620 AIR POLLUTION 15,906 89,608 (73,702) 563.36% 31,811 281.68% 19622 INDUSTRIAL HYGIENE 44,190 40,606 3,584 91.88% 88,361 45.95%630 RETAIL FOOD 1,431,612 913,063 518,549 63.77% 2,863,211 31.88% 20637 INSTITUTIONS - 162 (162) 0.00% - 0.00%640 CHILDCARE 133,542 95,333 38,209 71.38% 267,077 35.69%643 BODY ART 16,140 7,789 8,351 48.25% 32,274 24.13%645 RECREATION 70,116 47,615 22,501 67.90% 140,229 33.95%650 LAND USE 423,150 359,966 63,184 85.06% 846,307 42.53% 21653 WATER SUPPLIES 58,812 60,385 (1,573) 102.67% 117,613 51.34%657 WASTE WATER 285,762 293,789 (8,027) 102.80% 571,521 51.40%668 SOLID & HAZARDOUS WASTE 103,272 71,514 31,758 69.24% 206,523 34.62%683 ROCKY MOUNTAIN ARSENAL 103,080 70,231 32,849 68.13% 206,161 34.06%687 HOUSEHOLD AND HAZARDOUS WASTE ROUNDUP 154,236 55,488 98,748 35.97% 308,451 17.98%



From 1/1/2021 Through 6/30/2021

11 Lower than budgeted personnel costs and primarily due to COVID response

12 Lower expenses due to vacancies in program

13 Lower expenses due to vacancies in program

14 Expenses lower than budget due to COVID IZ spending for response work

15 Underbudget primarily due to wages due to COVID response

16 Actual billable expenses less than forecasted primarily due to COVID response

17 Lower than budgeted personnel costs and primarily due to COVID response

18 Lower than budgeted due to personnel costs primarily due to COVID response

19 AQ position budgeted in program 650 expensed in 620

20 Lower than budgeted primarily due to personnel costs, EHS staff still in response

21 Lower than budgeted primarily due to personnel costs, relates to comment 32, AQ position coded to 620

690 ENVIRONMENTAL HEALTH ADMINISTRATION 521,124 388,028 133,096 74.45% 1,042,241 37.23% 22692 MEDICAL MARIJUANA MANUFACTURER 5,004 836 4,168 16.71% 9,994 8.36%695 EH INFORMATICS 164,670 140,375 24,295 85.24% 329,330 42.62%696 SPECIAL PROJECTS - 4,058 (4,058) 0.00% - 0.00%710 EMPLOYEE HEALTH & WELLNESS 55,362 46,815 8,547 84.56% 110,719 42.28%720 HUMAN RESOURCES 278,838 296,232 (17,394) 106.23% 557,670 53.11%790 FRINGE BENEFITS (687,312) (414,627) (272,685) 60.32% (1,374,620) 30.16%810 FA OPERATIONS 1,538,502 1,425,073 113,429 56.68% 3,075,906 28.34% 23820 FA ADMINISTRATION (2,591,860) (729,308) (1,862,552) (152.92)% (5,256,264) (76.46)%840 FA FACILITIES 225,426 167,561 57,865 74.33% 450,846 37.16% 24860 FA PURCHASING 69,528 55,115 14,413 79.27% 139,045 39.63%870 FA ACCOUNTING 375,594 412,205 (36,611) 109.74% 751,183 54.87%880 FA VITAL RECORDS 636,060 503,096 132,964 79.09% 1,272,029 39.55% 25890 AGENCY ADMIN SUPPORT 1,317,216 138,582 1,178,634 10.52% 2,634,423 5.26% 26910 MEDICAL EPIDEMIOLOGY 114,252 1,763 112,489 1.54% 228,502 0.77% 27930 HEALTH DATA AND GIS 220,914 152,232 68,682 68.90% 441,823 34.45% 28950 INFORMATION TECHNOLOGY 752,484 1,066,863 (314,379) 141.77% 1,504,958 70.88% 29990 PLANNING & INFORMATION MANAGEMENT ADMINISTRATION 257,106 242,034 15,072 94.13% 514,210 47.06%

Total Expenditure 33,433,410 31,757,453 1,675,957 131.35% 66,792,717 65.68%

NET DIFFERENCE (Revenues minus Expenditures) (1,012,376) 1,371,443 2,383,819 (2,024,755)

PLANNED USE OF FUND BALANCE 1,012,376 - (1,012,376) 2,024,755

NET DIFFERENCE - 1,371,443 1,371,443 -

Total Revised Budget vs YTD Actuals: Revenue 66,792,717 33,128,896 (33,663,821) Expenditures 66,792,717 31,757,453 35,035,264 Net Difference - 1,371,443 1,371,443

Fund Balance Beginning of Period 1/1/2021 25,981,992


From 1/1/2021 Through 6/30/2021

YTD Fund Balance Change 1,371,443 Fund Balance End of Period 27,353,435


22 Primarily due to personnel costs, staff in response23 Under budget in software and leasehold improvements24 Less than budgeted wages due to staff vacancies25 Under budget primarily due to personnel costs26 Haven't used budgeted amount of contractual services to date27 This is due to COVID-19 response., staff charging time to COVID28 This is due to COVID-19 response., staff charging time to COVID29 Primarily due to delay in phone system migration from CenturyLink to Vonage, paying for both systems at once

Tri-County Health Department2022 Proposed Budget

Jennifer L. LudwigDeputy Director

Monique DidierDirector, Admin & Finance

• Proposed Per Capita Increase of $0.07− $110,308 proposed per capita increase− $47,102 population increase

• Market Rate Wage Adjustment of 4%• Anticipated Health Benefit Increase of 9%• General Fund Operation Budget Increase of 3%• COVID ELC Funding - $15.8m• Public Health Transformation Infrastructure Enhancement Funding -

$2.4m• PERA 0.5% Increase – Effective July 1, 2022

FY 2022 Budget Planning Assumptions

*Source is General Fund RevenueFor all sources of revenue, FY 2022 Budget reflects a 4.67% revenue decrease over FY 2021 Revised

FY 2022 Proposed Revenues by Type Total of $ 63,673,406

FY 2022 Proposed Expenditure by Type Total of $ 63,673,406

Summary of Budget Changes

SUMMARY OF BUDGET CHANGES 2021 TO 2022

Summary of Budget Changes


Proposed Budget Summary

** COVID-19 Specific Funds

Division: ALL AGENCYFY2020ACTUAL

FY2021REVISED

FY2022PROPOSED $ %

REVENUE:COUNTY $ 10,956,329 $ 11,141,313 11,298,723 157,410 1.41%

COUNTY - PROJECT SPECIFIC** 2,062,645 2,938,053 2,946,810 8,757 0.30%

FEDERAL FUNDS 235,394 407,681 420,443 12,762 3.13%

MEDICAID FUNDS 242,304 489,991 429,309 (60,682) (12.38%)

FEES 4,392,412 4,708,802 4,678,463 (30,339) (0.64%)

STATE CONTRACTS 9,329,726 10,717,018 11,534,189 817,171 7.62%

FEDERAL PASS THRU FUNDS 22,829,326 12,398,377 11,878,494 (519,883) (4.19%)

OTHER GRANTS / CONTRACTS** 1,010,568 20,004,490 17,024,738 (2,979,752) (14.90%)

OTHER REVENUE 355,477 398,075 398,075 - 0.00%

FUND BALANCE USE - 2,024,755 1,500,000 (524,755) (25.92%)IN-KIND REVENUE 1,154,627 1,564,162 1,564,162 - 0.00%

TOTAL AGENCY REVENUE $ 52,568,809 $ 66,792,717 $ 63,673,406 (3,119,311)$ (4.67%)

FTE's 390.96 389.08 386.25 (2.83) (0.73%)

Benefits as a Percentage of Wages 30.01% 30.17% 28.87%

Increase / (Decrease)

Proposed Budget Summary

** COVID-19 Specific Funds

Summary: Forecasted County Population Change: FY 2021 to FY 2022

FY21 Forecast from May 2020; FY22 Forecast from May 2021

Population Forecast Source: State Demographer, Colorado Department of Local Affairs.FY21 Forecast from May 2020; FY22 Forecast from May 2021

County FY 2021 FY 2022 ChangeAdams 538,238 535,839 (2,399)

Arapahoe 671,733 674,057 2,324

Douglas 359,228 365,937 6,709

Total 1,569,199 1,575,833 6,637

$ 47,102

$ 110,308

$ 157,410

Overview: FY 2022 Request for County General Funds

• County budget increase:

• Forecasted population-based increase of .42% to match three-county population increase of 6,637

• Per-capita rate increase from $7.10 to $7.17

• Total County budget increase

TCHD Per Capita Rate History 2011 - 2022

$6.43

$6.29 $6.29

$6.38 $6.38

$6.51

$6.66

$6.72

$6.84

$7.10 $7.10

$7.17

$6.00

$6.20

$6.40

$6.60

$6.80

$7.00

$7.20

$7.40

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Proposed2022

Summary: Proposed FY 2022 County Appropriation

FY 2021 FY 2022County Adopted Proposed ChangeAdams $ 3,767,828 $ 3,821,490 $ 20,476

Arapahoe $ 4,702,358 $ 4,769,304 $ 63,685

Douglas $ 2,486,143 $ 2,550,519 $ 73,249

Total $ 10,956,330 $ 11,141,313 $ 157,410

Proposed Use of IncreasedFY22 County General Funds

Merit increase (4%) $89,666

PERA Adjustment – July 2022 (0.5%) $67,744

Total $157,410

The total adjustment for Merit Increase is $632,987. As seen above $89,666 of the adjustment is covered with the county general fund. The remaining $543,321 will be offset by making adjustments in the agency budget.

Covered by County General Funds

Merit increase (4%) $543,321 Covered by TCHD Budget Adjustments

QUESTIONS?

Proposed Revised 2022 2021 Change

REVENUESIn Kind Revenue 1,564,162$ 1,564,162$ -$ Fund Balance Use1 1,500,000 2,024,755 (524,755) All Other Revenue 60,609,244 63,203,800 (2,594,556)

Net Revenue 63,673,406$ 66,792,717$ (3,119,311)$

EXPENDITURESPersonnel

Labor (w/ 4.0% Merit) 25,933,672$ 26,108,015$ (174,343)$ Benefits 7,486,227 7,876,721 (390,494)

Total Personnel 33,419,899 33,984,736 (564,837)

Contracts 12,088,583 16,307,007 (4,218,424) Operating 12,127,984 12,985,812 (857,829)

Total Contracts/Operating 24,216,567 29,292,819 (5,076,253)

Capital Equipment/Leasehold Improvements Capital Software $4,201,779 1,575,000 2,626,779 Capital Equipment $21,000 163,000 (142,000)

Leasehold Improvements 250,000 213,000 37,000 Total Capital Equipment/Leasehold Improvements 4,472,779 1,951,000 2,521,779

In Kind Expense 1,564,162 1,564,162 - Net Expenditures 63,673,406$ 66,792,717$ (3,119,311)$

Net Revenue (Deficit)/Surplus -$ -$ -$

Notes:

Beginning Fund Balance UseNet Changes from

FY21CABO - HCM Implementation and 10 Yr Subscription Cost $1,500,000

Capital Equipment/ Leasehold Improvement BreakdownCapital Software

CABO - Financial System (Asked in 2020, Carry Forward) $1,140,774Nursing E.H.R. - Implementation and 5 Yr. Subscription Cost $841,005EH Decade System Replacement $125,000

IT Software and appliances (hardware)Site Firewalls (improved access for non-admin sites) $150,000Storage Area Network $150,000Administration Conference Room A/V Upgrades $100,000Switch Refresh (improves network traffic) $100,000Informatics Server Optimization $50,000Server Room UPS Replacement $45,000

Commerce City TCHD Building Move $250,000Vital Record Vehicle Request $21,000

TRI-COUNTY HEALTH DEPARTMENTBUDGETARY DYNAMICS

PROPOSED FY2022 BUDGET OVERVIEW

As of: 09/01/2021

Proposed RevisedREVENUE FY2022 FY2021 Change Explanations

COUNTY 11,298,723$ 11,141,313$ 157,410$

COUNTY - PROJECT SPECIFIC 2,946,810 2,938,053 8,757

Adams County Child Nurse Liaison (+$371K) Started in FY 2021.

FEDERAL FUNDS 420,443 407,681 12,762 Changes in Multiple Divisions (+$12k)

MEDICAID FUNDS 429,309 489,991 (60,682) Medicaid reimbursement rates dropping

FEES 4,678,463 4,708,802 (30,339) Various Fee Changes (-$30k)

STATE CONTRACTS 11,534,189 10,717,018 817,171 State Infrastructure Bill Funding Increase (+$2.4m)

FEDERAL PASS THRU FUNDS 11,878,494 12,398,377 (519,883)

Projected WIC (+$248k)PHEP (+$54K)Other (+$484k)

OTHER GRANTS / CONTRACTS 17,024,738 20,004,490 (2,979,752) COVID-19 (Total FY 2021 $19m, Proposed FY 2022 $15.9m)

OTHER REVENUE 398,075 398,075 - No changes

FUND BALANCE USE 1,500,000 2,024,755 (524,755)

IN-KIND REVENUE 1,564,162 1,564,162 - No changes TOTAL REVENUE 63,673,406$ 66,792,717$ (3,119,311)$


PROPOSED FY2022 PROJECTED MAJOR REVENUE CHANGES

Proposed Per Capita Increase of seven cents (.07)Change in PopulationAdams County (-2,400)Arapahoe County (+2,300)Douglas (+6,700)

As of: 09/01/2021

Proposed RevisedEXPENDITURE FY2022 FY2021 Change Explanations

Personnel Costs 25,933,672$ 26,108,015$ (174,343)$ Reductions in Staff and Vacancies

Fringe Benefits 7,486,227 7,876,721 (390,494) Reduction in Staff and Vacancies

Contract Services 12,088,583 16,307,007 (4,218,424) State Infrastructure Spending (+$2.4m)COVID-19 Spending (-$3.7m)

Travel 528,651 503,460 25,191 Increases in Multiple Divisions (+$25k)

Supplies-Program 4,109,117 4,761,641 (652,525) COVID-19 (-$650k)

Operating 5,737,871 5,781,438 (43,567) Decrease in Multiple Divisions (-$43k)

Other Costs 83,323 88,858 (5,535) Changes in Multiple Divisions (-$5k)

Equipment (Non-Capital) 1,669,020 1,850,415 (181,395) Budgeted Equipment needs FY 2021, not needed in FY 2022.Software/System (+$3.6m)IT Hardware (+$545k)

Capital/Leasehold Improvements 4,472,779 1,951,000 2,521,779 Other (+$271k)

In-Kind Expense 1,564,162 1,564,162 - No changes TOTAL EXPENDITURE 63,673,406$ 66,792,717$ (3,119,311)$


PROPOSED FY2022 PROJECTED MAJOR EXPENDITURE CHANGES

As of: 09/01/2021

Population Changes (from TCHD budget) (from State website)2021 2022 Forecasted Population 3- County

Budgeted Forecasted Population Increase PopulationPopulation Population Increase Percent Increase %

Adams County 538,238 535,839 (2,399) -0.45%Arapahoe County 671,733 674,057 2,324 0.35%Douglas County 359,228 365,937 6,709 1.87% Total 1,569,199 1,575,833 6,634 0.42%

2022 Percent 2022 PROPOSED %of 3-County 2021 Adopted 2022 PROPOSED Increase Per Capita Per CapitaPopulation Appropriation Appropriation Amount Rate Increase

Adams County 34.0% 3,821,490$ 3,841,966$ 20,476$ 7.17$ 0.53%Arapahoe County 42.8% 4,769,304$ 4,832,989$ 63,685$ 7.17$ 1.32%Douglas County 23.2% 2,550,519$ 2,623,768$ 73,249$ 7.17$ 2.79%

Total 100% 11,141,313$ 11,298,723$ 157,410$ 1.39%

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County Per Capita Revenue Projections

2022 PROPOSED BUDGET BOOK

September 2022

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Tri-County Health Department 2022 Proposed Budget

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QUICK REFERENCE GUIDE

There are two tools that will help locate information in the 2022 Proposed Tri-County Health Department budget book.

1. The Quick Reference Guide, which shows where to find answers to commonly asked questions, along with section references and page numbers.

2. The Table of Contents, which outlines the entire document. If you have this question Refer to Tab Page (s) How much is in the 2022 Budget? 2022 Proposed Budget 25-37 How was the 2022 budget developed? Budget Message 14 What is Tri-County’s budget process? Budget Message 14 What is the budget process timeline? Budget Message 15 How much is budgeted by division? Department Budgets 39-152 How much is budgeted by program? Department Budgets 39-152 How are division and program budgets presented in the budget book? Budget Message 14 What are the types of revenue? Budget Message 11-12 What are Tri-County’s financial policies? Budget Message 12-13


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TABLE OF CONTENTS QUICK REFERENCE GUIDE ....................................................................................................1 TABLE OF CONTENTS ...........................................................................................................3 2022 BUDGET MESSAGE ......................................................................................................7

INTRODUCTION ....................................................................................................................... 9 ABOUT TRI-COUNTY HEALTH DEPARTMENT ......................................................................... 11 REVENUES .............................................................................................................................. 11 FINANCIAL POLICIES .............................................................................................................. 12 BUDGET PROCESS .................................................................................................................. 14 BUDGET TIMELINE ................................................................................................................. 15 BASIS OF BUDGETING AND ACCOUNTING ............................................................................ 15 FUND BALANCE ..................................................................................................................... 16 MISSION, VISION, VALUES, AND GUIDING PRINCIPLES ......................................................... 17 PUBLIC HEALTH ACCREDITATION .......................................................................................... 18 PUBLIC HEALTH IMPROVEMENT PLAN AND STRATEGIC PLAN OVERVIEW .......................... 19 TCHD BOARD OF HEALTH ...................................................................................................... 21 ORGANIZATIONAL CHART ..................................................................................................... 22 OFFICE LOCATIONS (MAP AND ADDRESSES) ......................................................................... 23

2022 PROPOSED BUDGET .................................................................................................. 25

SUMMARY OF BUDGET CHANGES 2021 to 2022 – CHANGES TO REVENUE /SOURCES OF FUNDS – COUNTY PER CAPITA CONTRIBUTIONS .................................................................. 27 SUMMARY OF BUDGET CHANGES 2021 to 2022 – CHANGES TO REVENUES /SOURCES OF FUNDS .................................................................................................................................... 28 SUMMARY OF BUDGET CHANGES 2021 to 2022 – CHANGES TO EXPENDITURES ................ 28 2022 PROPOSED SOURCES OF REVENUES CHART................................................................. 29 2022 PROPOSED SOURCES OF GENERAL REVENUES CHART ................................................ 30 2022 PROPOSED EXPENDITURES BY TYPE CHART ................................................................. 31 2022 BUDGET COMPARISON – REVENUE BY PROGRAM ...................................................... 32 2022 BUDGET COMPARISON – EXPENDITURE BY PROGRAM ............................................... 35

1 - OFFICE OF THE EXECUTIVE DIRECTOR ............................................................................ 39

BUDGET SUMMARY – EXECUTIVE DIRECTOR DIVISION ........................................................ 41 BUDGET SUMMARY – EXECUTIVE DIRECTOR ........................................................................ 42 BUDGET SUMMARY – METRO DENVER PARTNERSHIP FOR HEALTH .................................... 43 BUDGET SUMMARY – BOARD FUND ..................................................................................... 44 BUDGET SUMMARY – COMMUNICATION ............................................................................. 45


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TABLE OF CONTENTS 2 - NUTRITION DIVISION .................................................................................................... 47

BUDGET SUMMARY – NUTRITION DIVISION ......................................................................... 49 FUNDING SOURCES CHART – NUTRITION DIVISION ............................................................. 50 BUDGET SUMMARY – DIETETIC INTERNSHIP ........................................................................ 51 BUDGET SUMMARY – WOMEN, INFANTS & CHILDREN (WIC) .............................................. 52 BUDGET SUMMARY – BREASTFEEDING PEER COUNSELOR PROGRAM ................................ 54 BUDGET SUMMARY – WIC CENTRAL REFERRAL PILOT ......................................................... 55 BUDGET SUMMARY – HUNGER FREE COLORADO OUTREACH PROGRAM ........................... 57 BUDGET SUMMARY – DRCOG ACCOUNTABLE HEALTH COMMUNITIES .............................. 58 BUDGET SUMMARY – FOOD SECURITY ................................................................................. 60 BUDGET SUMMARY – ADMINISTRATION .............................................................................. 61

3 - COMMUNITY HEALTH PROMOTION DIVISION ............................................................... 63 BUDGET SUMMARY – COMMUNITY HEALTH PROMOTION DIVISION .................................. 65 FUNDING SOURCES CHART – COMMUNITY HEALTH PROMOTION DIVISION ...................... 66 BUDGET SUMMARY – ADMINISTRATION & GENERAL .......................................................... 67 BUDGET SUMMARY – ADVANCING BREASTFEEDING IN COLORADO ................................... 68 BUDGET SUMMARY – TOBACCO EDUCATION AND PREVENTION ........................................ 69 BUDGET SUMMARY – COMMUNITY NUTRITION .................................................................. 70 BUDGET SUMMARY – DIABETES EDUCATION PROGRAM .................................................... 72 BUDGET SUMMARY – HEALTHY BEVERAGE INITIATIVE ........................................................ 74 BUDGET SUMMARY - MATERNAL AND CHILD HEALTH (MCH) PROGRAMS ......................... 75 BUDGET SUMMARY – SUBSTANCE USE PREVENTION ......................................................... 77 BUDGET SUMMARY – WORKSITE WELLNESS ........................................................................ 79 BUDGET SUMMARY – MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION ............. 80

4 - NURSING DIVISION ....................................................................................................... 82 BUDGET SUMMARY – NURSING DIVISION ............................................................................ 84 FUNDING SOURCES CHART – NURSING DIVISION ................................................................. 85 BUDGET SUMMARY – DIVISION OPERATIONS ...................................................................... 86 BUDGET SUMMARY – ARAPAHOE COUNTY SENIOR DENTAL PROGRAM ............................. 87 BUDGET SUMMARY – ADAMS COUNTY NURSE SUPPORT CONTRACTS ............................... 88 BUDGET SUMMARY – ARAPAHOE COUNTY NURSE SUPPORT CONTRACTS ......................... 89 BUDGET SUMMARY – DOUGLAS COUNTY MOTHERS FIRST ................................................. 90 BUDGET SUMMARY – CHILD FATALITY PREVENTION REVIEW ............................................. 91 BUDGET SUMMARY – NURSE FAMILY PARTNERSHIP ........................................................... 92 BUDGET SUMMARY – PUBLIC HEALTH NURSING CLINICAL EDUCATION ............................. 93 BUDGET SUMMARY – HARM REDUCTION AND HIV PREVENTION ....................................... 94 BUDGET SUMMARY – IMMUNIZATION AND CLINICAL OUTBREAK RESPONSE .................... 95

TABLE OF CONTENTS


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BUDGET SUMMARY – HEALTH ENROLLMENT TEAMS AND REGIONAL HEALTH CONNECTORS ........................................................................................................................ 96 BUDGET SUMMARY – SEXUAL HEALTH ................................................................................. 98

5 - EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICABLE DISEASE SURVEILLANCE DIVISION ........................................................................................................................... 99

BUDGET SUMMARY – EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICABLE DISEASE SURVEILLANCE DIVISION ....................................................................................... 101 FUNDING SOURCES CHART – EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICABLE DISEASE SURVEILLANCE DIVISION .......................................................... 102 BUDGET SUMMARY – PUBLIC HEALTH EMERGENCY PREPAREDNESS PROGRAM.............. 103 BUDGET SUMMARY – SYNDROMIC SURVEILLANCE PROGRAM.......................................... 105 BUDGET SUMMARY – SYNDROMIC SURVEILLANCE SUICIDE PREVENTION ........................ 107 BUDGET SUMMARY – CITIES READINESS INITIATIVE .......................................................... 109 BUDGET SUMMARY – COMMUNICABLE DISEASE ............................................................... 111 BUDGET SUMMARY – ADMINISTRATION ............................................................................ 112

6 - ENVIRONMENTAL HEALTH DIVISION ........................................................................... 114

BUDGET SUMMARY – ENVIRONMENTAL HEALTH DIVISION .............................................. 116 FUNDING SOURCES CHART – ENVIRONMENTAL HEALTH DIVISION ................................... 117 BUDGET SUMMARY – DIVISION ADMINISTRATION & INFORMATICS ................................. 118 BUDGET SUMMARY – CHILD CARE PROGRAM.................................................................... 119 BUDGET SUMMARY – FOOD PROTECTION PROGRAM ....................................................... 120 BUDGET SUMMARY – GENERAL ENVIRONMENTAL SERVICES ............................................ 122 BUDGET SUMMARY – INDUSTRIAL HYGIENE PROGRAM .................................................... 123 BUDGET SUMMARY – LAND USE PROGRAM ...................................................................... 124 BUDGET SUMMARY – ROCKY MOUNTAIN ARSENAL .......................................................... 125 BUDGET SUMMARY – SOLID & HAZARDOUS WASTE PROGRAM ....................................... 126 BUDGET SUMMARY – VECTOR SURVEILLANCE PROGRAM ................................................. 128 BUDGET SUMMARY – WATER PROGRAM ........................................................................... 130

7 - HUMAN RESOURCES DIVISION .................................................................................... 132

BUDGET SUMMARY – HUMAN RESOURCES DIVISION ........................................................ 134 BUDGET SUMMARY – EMPLOYEE WELLNESS ..................................................................... 135 BUDGET SUMMARY – HUMAN RESOURCES ....................................................................... 136


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TABLE OF CONTENTS

8 - ADMINISTRATION AND FINANCE DIVISION ................................................................. 138

BUDGET SUMMARY – ADMINISTRATION AND FINANCE DIVISION .................................... 140 BUDGET SUMMARY – FINANCE AND OPERATIONS ............................................................ 141 BUDGET SUMMARY – VITAL RECORDS ............................................................................... 143

9 - PLANNING AND INFORMATION MANAGEMENT DIVISION ........................................... 145

BUDGET SUMMARY – PLANNING AND INFORMATION MANAGEMENT DIVISION ............. 147 BUDGET SUMMARY – HEALTH DATA AND GEOGRAPHIC INFORMATION SYSTEMS .......... 148 BUDGET SUMMARY – DIVISION ADMINISTRATION ............................................................ 150 BUDGET SUMMARY – INFORMATION TECHNOLOGY ......................................................... 151 BUDGET SUMMARY – MEDICAL EPIDEMIOLOGY ................................................................ 153

GLOSSARY ....................................................................................................................... 154


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2022 Budget Message


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Introduction We are pleased to present the proposed FY 2022 Tri-County Health Department (TCHD) budget to our Board of Health and Adams, Arapahoe, and Douglas Counties. This document reflects our overall Department budget, as well as program descriptions and division-specific budgets. While it is largely based on activities by our divisions in effectively carrying out our traditional core public health functions, it also reflects our response to the unprecedented COVID-19 pandemic as well as continued efforts to address strategic priorities outlined in our Public Health Improvement Plan. The priorities of our Plan include Access to Mental and Physical Health Care Services, Mental Health, Health and Food, and the developmental priority area, Health and Housing. Overall, our proposed FY 2022 budget reflects a decrease of $3,119,311 (4.67%) from our FY 2021 revised budget. This is due to the difference in COVID funding received. In addition, to support our budget, TCHD is requesting an increase in county funds based on population increase as well as a per capita rate increase. TCHD is requesting a seven-cent increase, taking the per capita rate from $7.10 to $7.17. Our counties have a forecasted increase in population of .42%. TCHD is requesting the associated total appropriation increase of $157,410, with $47,102 of the appropriation increase due to population. The remaining $110,308 is attributable to the per capita rate increase. As illustrated by the response to the COVID-19 pandemic, TCHD continues to strive to address ongoing challenges and to remain prepared to respond to emerging issues. Among others, these include:

• Intermittent outbreaks of serious communicable disease issues such as measles, mumps, viral hepatitis, Legionnaire’s disease, West Nile virus, Tularemia, and E. coli and other foodborne illnesses,

• The impact of electronic smoking devices and vaping in our communities, especially among the youth population,

• The need to respond to the leading preventable causes of death and disability: tobacco use and obesity,

• Growing recognition of food insecurity as a challenge for many of our residents, • Emerging recognition of the need to address mental health and substance abuse as

important public health issues, • The ongoing epidemic of opiate overdose due both to misuse of prescription opiates and

increases in the use of heroin and other injectable opiates, • Ongoing need to work with emergency preparedness and response partners to address

natural disasters (i.e., wildfires, tornadoes, flooding) and epidemics, • Increased opportunities to collaborate with other partners to improve population health

through improved interactions with the health care delivery system, better analysis and dissemination of health data, and more strategically targeted communications.

In addressing these challenges, TCHD continues to rely upon and seek support from a variety of major funding streams, to include:


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• Categorical state and federal funds (e.g., family planning, maternal and child health,

immunizations, WIC), • Fees for specific services that are mandated by state statute (e.g., restaurant licensing

fees, individual sewage disposal system permitting fees), • Vital Records (birth and death certificates, now available at three TCHD offices), • Reimbursement for personal health services (e.g., family planning) generated by both

client payment as well as third-party billing, • Grants and contracts, • State, Local Planning and Support funding, • County per capita contributions for public health core services and categorical county

funding for specific programs (e.g., Nurse home visit, Dental services for seniors). Because over 75% of our non-county per capita funds are categorical and thus restricted in terms of the services we are able to provide, county per capita funding continues to be especially critical. It helps us maintain vital infrastructure and build organizational capacity, which allows us to respond to ever-changing local needs and emerging strategic priorities. In addition, county funding may sometimes provide a financial match for some of our outside grants and contracts, creating leverage and synergy in providing additional services that could not have been provided with county dollars alone. In addition to the priorities outlined in our Strategic Plan, TCHD will continue to provide a wide variety of core public health services to the residents of our region. These include, but are not limited to:

• Provision of vital records • Restaurant inspections • Onsite waste water treatment system approvals • Childcare center inspections • Consultations on environmental exposures • Land use consultation • Methamphetamine laboratory clean-up consultation • Emergency preparedness and response • Disease outbreak identification and management • Analysis of community health data • Tobacco prevention • Injury prevention • Sexual health • Immunizations • Maternal and Child Health (MCH) services • Women, Infants and Children (WIC) program • Nutrition education • Public communication


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About Tri-County Health Department Tri-County Health Department (TCHD) serves over 1.5 million people in Adams, Arapahoe and Douglas Counties, and offers over 60 programs/services ranging from birth certificates, immunizations and health care referrals, restaurant inspections, and infectious disease investigations. TCHD operates out of 11 offices in this 3,000 square mile area and has included in its jurisdiction 26 municipalities, 15 school districts with more than 360 public schools, and 12 acute care hospitals. Tri-County District Health Department began operations on January 1, 1948 and initially served the 160,000 residents of Adams, Arapahoe and Jefferson Counties. Jefferson County separated from Tri-County in 1958 to form its own local health department and Douglas County officially joined Tri-County District Health Department on January 1, 1966, creating the current jurisdictional structure. Revenues Forecasted revenues for FY 2022 are estimated to be $63.7 million. This is a decrease of 4.67% as compared to the revised revenue projection of $66.8 million for FY 2021. This decrease in revenue is primarily changes in funding for the COVID-19 pandemic response. Additionally, as noted above, TCHD is requesting an increase in county funds based on estimated population increase of 0.42%, as well as a per capita rate increase of 0.07. TCHD is requesting a per capita rate of $7.17. This represents an overall proposed FY 2022 county appropriation increase of $157,410 over FY 2021. Tri-County Health Department receives revenue to fund operations from a variety of sources, which are listed below.

County Appropriations – These are the funds provided by Adams, Arapahoe, and Douglas counties for core public health services. County Program Specific Funds – Funds provided by individual counties for specific programs. Funds are restricted to these programs. Grants/Contracts – Funding from foundations and other organizations for specific programs. Funds are generally restricted to these programs. Fees/Donations – Fees and donations collected while performing specific public health services (e.g., restaurant inspections) for the public or private businesses. State Funds and Federal Pass Through Funds – Funds received from the Colorado Department of Public Health and Environment (CDPHE) and other state agencies. This includes State Planning and Support for general public health services as well as program specific funding for programs in various TCHD divisions.


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Medicaid Funds – Nursing funding provided through joint federal and state government cooperation. These funds are received from providing direct services to qualified patients. Use of Fund Balance – Operational funding provided from the TCHD Fund Balance for capital improvement purposes (i.e., facility renovations, information technology updates, other capital replacements). In-Kind Revenue – Non-cash income that takes the form of provided supplies or free rent. In-kind revenue is offset in the budget by an equal amount of in-kind expense.

Financial Policies Tri-County Health Department has enacted financial policies to establish objectives, standards, and internal controls as well as to help frame resource allocation decisions for agency funds. The following policies are outlined below: Fund Balance Policy, Investment Policy, and Purchasing Policy.

Fund Balance Policy – The purpose of this policy, in accordance with Governmental Accounting Standards Board (GASB) Statement 54, is to ensure the financial security of TCHD through the maintenance of healthy fund balance reserves, which will guide the creation, maintenance, and use of resources for financial stabilization purposes. The TCHD Board of Health (BOH) reviews and approves annual budgets and fund balance allocations with the authority to set aside funds to be designated for specific purposes. There are five categories comprising the fund balance, which represents the equity available to finance expenditures for routine or emergency purposes:

• Non-spendable Fund Balance includes items not expected to be converted to cash in

the near term (e.g., inventories and prepaids), or funds that legally or contractually must be maintained intact.

• Restricted Fund Balance includes amounts that can be spent only for the specific

purposes stipulated by constitution, external resource providers, or through enabling legislation (e.g., debt covenants reserves, TABOR reserves).

• Committed Fund Balance includes amounts that can be used only for the specific

purposes (e.g., emergency operating and compensated absences) determined by a formal action of the TCHD BOH. The same formal action must be taken to remove or change the limitations placed on the funds.

• Assigned Fund Balance consists of funds intended to be used for specific purposes but

do not meet the criteria to be classified as Restricted or Committed (e.g., facilities master plan projects, IT infrastructure projects, capital replacement projects).


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• Unassigned Fund Balance is the residual classification of the General Fund and includes all spendable amounts not contained in the other classifications. This category also provides the resources necessary to meet unexpected expenditures and revenue shortfalls.

Investment Policy – this applies to the investment of TCHD funds, including short-term operating funds and long-term reserves. Overall, the investment policy must consider the liquidity needs for conducting daily operations as well as cash needs related to short-term needs, and long-term objectives including large information technology purchases and capital asset acquisitions. Investment activities should:

• Preserve capital and protect investment principal, • Maintain sufficient liquidity to meet anticipated cash flows, • Attain the market rate of return, • Diversify to avoid incurring unreasonable market risks, • Conform to all applicable State statutes and Federal regulations, • Use low investment and management fees, • Invest funds in fiscally sound, reputable banks, investment pools and brokerage

firms.

Purchasing Policy – to promote maximum value and economy for TCHD through fair and competitive processes, which promotes confidence in TCHD financial practices. This applies to goods or services purchased by any person employed by TCHD for work related matters, regardless of the source of funding. All expenditures shall be made in compliance with applicable Colorado Revised Statutes, OMB Uniform Guidance (2.CFR.200) and adhere to all TCHD policies and procedures related to purchases of goods and services and the expenditures of approved budgets. Expenditures must also comply with specific requirements as determined by specific funding sources in established agreements/contracts. Purchases are to be made in an environment of full and open competition, while ensuring the best interest of TCHD with regards to quality products and services, prompt delivery, and fair and reasonable pricing. All purchases and agreements should be free from any conflict of interest for any TCHD employee or BOH member and support ethical standards.


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Budget Process Tri-County Health Department is required to adopt an annual budget per Colorado Revised Statute (CRS) Title 29, Article 1, Section 103. The budget must include: proposed expenditures and revenues for the budget year; estimated beginning and ending fund balances; and, corresponding actual figures for the prior fiscal year and estimated figures for the current fiscal year. CRS Title 29, Article 1, Section 108 requires the TCHD BOH to hold a public hearing on the matter of adopting the proposed budget and subsequently adopt the budget after an affirmative vote of the majority of the board. TCHD budgets annually on a calendar basis, January 1 to December 31. Budget revenues are identified by source. Expenditures are identified by agency, division, and program groups. For each of these groups, revenue and expenditures show the most recent completed and audited fiscal year, the current budget year, and the proposed budget. The budget must be balanced with expenditures not exceeding total anticipated revenue or general fund allocation. Divisions and Programs Presented Within each TCHD division’s budget section, there are program narratives for major programs, an overall division budget report, a pie chart of divisional funding sources, and individual budget reports for significant divisional programs. The last revenue line on each budget report page displays the amount of required general funds that are used to fund that program/division. If this amount is a negative number (denoted by parenthesis), that program/division contributes to the general fund instead. These general funds include county per capita; state, local planning and support funding; vital records fees; interest and investment income; and fund balance usage. The percentage of county and non-county general funds used is also listed at the bottom of each budget report page. Budget Amendments Amendments are made as new contracts or contract amendments are received during the year. These are presented to the BOH at the October meeting for approval.


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Budget Timeline The annual TCHD budget process starts each spring and is completed in December. The process for the 2022 budget is outlined below. February

• Present Budget Calendar to BOH April

• Division Directors and Program Manager Budget session May

• Meet with BOH Budget Committee to review budget • Late May/Early June – County Leadership provides “Priorities and Policies” or Budget

Guidance documents to internal department directors June

• BOH Meeting – Present the 2022 budget dynamics document • BOH Meeting – Rubin Brown, LLC presents 2018 year-end Audit

July • BOH Meeting – 2021 Supplemental Budget resolution presented to the BOH based on

new/renewal contracts and grants August

• Finalize budget data and prepare for September presentations September

• BOH Meeting – Present the proposed 2022 budget • The proposed 2022 Budget is presented to Adams, Arapahoe, and Douglas Board of

County Commissioners October

• BOH Meeting – 2021 Supplemental Budget resolution presented to the BOH based on new/renewal contracts and grants

November • Finalize budget data and prepare for December presentation

December • Tri-County Health Department BOH adopts 2022 budget

Basis of Budgeting and Accounting Tri-County Health Department uses the modified accrual basis of accounting for both budgeting and financial statements. Revenues are recognized in the accounting period when it is earned while expenses are recognized in the period when the liability is incurred. The budget is used as a legal instrument authorizing the expenditure of public funds, as an accounting framework for allocating fiscal stewardship, and as a management tool for planning the direction for utilizing revenues.


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Fund Balance Tri-County Health Department maintains a fund balance in accordance with the TCHD Fund Balance Policy. The chart below shows the estimated fund balance at the start of 2022 and projected fund balance at the end of 2022. The change in fund balance is due to the outlined capital projects below.

* Revised to reflect FY20 Audited Financials

Fund Title TypeFY20 Audit

Balances Revised FY21*Proposed FY22

DesignationsProposed

Change

Inventory Reserve Non-spendable 254,172$ 254,172$ 254,172$ -$

Pre-paid Reserve Non-spendable 604,434$ 604,434$ 604,434$ -$

Total Non-Spendable 858,606$ 858,606$ 858,606$ -$

Emergency Operating Fund Committed 10,390,436$ 10,390,436$ 10,390,436$ -$

Compensated Absences Committed 1,452,347$ 1,452,347$ 1,452,347$ -$

Total Committed 11,842,783$ 11,842,783$ 11,842,783$ -$

Facil ities Leasehold Improvements Assigned 979,100$ 979,100$ 979,100$ -$

Capital Equipment-IT Assigned 583,387$ 583,387$ 583,387$ -$

Capital Software/Systems Assigned 259,088$ 259,088$ 259,088$ -$

Total Assigned 1,821,575$ 1,821,575$ 1,821,575$ -$

TCHD Operating Unassigned 11,459,028$ 11,385,273$ 9,885,273$ (1,500,000)$

Total Unassigned 11,459,028$ 11,385,273$ 9,885,273$ (1,500,000)$

TOTAL 25,981,992$ 25,908,237$ 24,408,237$ (1,500,000)$

Beginning Fund Balance UseNet Changes

from FY21CABO - HCM Implementation and 10 Yr Subscription Cost $1,500,000

Capital Equipment/ Leasehold Improvement BreakdownCapital Software

CABO - Financial System (Asked in 2020, Carry Forward) $1,140,774Nursing E.H.R. - Implementation and 5 Yr. Subscription Cost $841,005EH Decade System Replacement $125,000

IT Software and appliances (hardware)Site Firewalls (improved access for non-admin sites) $150,000Storage Area Network $150,000Administration Conference Room A/V Upgrades $100,000Switch Refresh (improves network traffic) $100,000Informatics Server Optimization $50,000Server Room UPS Replacement $45,000

Commerce City TCHD Building Move $250,000Vital Record Vehicle Request $21,000


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Mission, Vision, Values, and Guiding Principles Vision Optimal health across the lifespan for the populations we serve. Mission Promote, protect and improve the lifelong health of individuals and communities in Adams, Arapahoe and Douglas Counties through the effective use of data, evidence-based prevention strategies, leadership, advocacy, partnerships, and the promotion of health equity. Values and Guiding Principles Values for the agency are demonstrated in the behavior and decisions of all our employees and in how we conduct our efforts in the communities we serve. TCHD, its Board and its employees have adopted these eight core values that guide behavior, organizational policy, and decision-making. These values not only apply to how we interact with each other internally, but how we treat our partners and clients externally.

• Respect – We treat others with the same dignity as we wish to be treated. We honor the whole person and recognize the importance of work-life balance and diverse perspectives. We recognize the power of teamwork and appreciate the unique contributions that each member of a team can make.

• Integrity – We maintain consistency in what we say and what we do. We uphold high ethical standards and maintain accountability to each other and the communities that we serve.

• Courage – We stand up for what is right in the face of adversity. We communicate openly and welcome honest feedback. We advocate for those who cannot do it for themselves.

• Excellence – We strive for the highest quality in everything that we do. We pursue opportunities and seek creative and innovative solutions to the challenges that face us.

• Leadership – We believe that everyone can be a leader. We empower others to act; we encourage everyone to reach their fullest potential; and we model our core values.

• Collaboration – We seek to sustain and enhance the reach and impact of our efforts through the respectful engagement with community partners (local, regional and state).

• Stewardship – We maintain stewardship of public monies and facilities through active management and always striving to provide targeted, high quality, and cost-effective services for the community.

• Innovation – We seek and encourage innovative approaches to address public health issues, reach diverse communities and improve agency operation.


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Public Health Accreditation The Public Health Accreditation Board (PHAB) nationally recognized Tri-County Health Department in November 2017 for demonstrating excellence in the field of public health. Earning National Accreditation for five years means that TCHD meets or exceeds the rigorous standards established by the non-profit, non-governmental PHAB. TCHD was noted for its strong quality improvement culture, for using evidence-based practices in our programs and strategies as well as for our strong relationships with our community partners and the Board of Health. The achievement of National Accreditation and our annual reporting to maintain accreditation continues to help guide our work to better protect, promote, and preserve the health of the people in our community.


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Public Health Improvement Plan and Strategic Plan Overview Public Health Improvement Plan Priorities Our 2019-2024 Public Health Improvement Plan includes three primary Priority Areas and one developmental Priority Area. These include: Access to Mental and Physical Health Care Services, Mental Health, Health and Food, and the developmental priority area, Health and Housing. Activities in each priority area shifted in 2021 to focus on the impact due to COVID-19. Housing, food, access to care, and mental health have become more critical than ever during the response to COVID-19. These key drivers of health have been central to the COVID-19 human needs response as the impacts of this virus have tested our economic and social structures in deep ways. These efforts will continue through 2022. The vision for each Priority Area is listed below.

• Access to Mental and Physical Health Care Services Vision: In a healthy community, all people across the life course, regardless of their income or other circumstances, can access high quality physical health, mental health, and substance use services.

• Mental Health Vision: In a healthy community, positive mental health and social connections allow people to have the mental and physical energy, vitality, and resilience to live joyfully and cope with the stresses of life, work productively, and make meaningful contributions to their communities.

• Health and Food Vision: In a healthy community, all residents can access safe, nutritious, affordable, and culturally relevant food and are able to practice healthy eating habits.

• Health and Housing Vision: In a healthy community, quality, attainable housing is available and people have the tools and resources to stay in their communities and feel connected to their neighborhood.


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Strategic Plan In 2019, TCHD embarked on a strategic planning process for a six-year agency-wide strategic plan. While a lot of progress was made in 2021, some of TCHD’s strategic efforts were paused due to the COVID-19 response. Activities will continue, or resume, in 2022 dependent on the agency’s capacity to shift resources from the COVID-19 response. The Priority Areas include Employee Retention and Development, Excellence in Business Practices, Strengthen Organizational Culture, and Partner for Healthy Communities. The Priority Areas help support, either directly or indirectly, both our core services as well as the implementation of the Public Health Improvement Plan. The plan provides the agency with a roadmap that allows the agency to navigate changes in the complex environment of public health at the local level and further allows TCHD to take action on critical issues and to advance our mission, vision and values. The full Strategic Plan can be found here.

http://www.tchd.org/DocumentCenter/View/6413/2019-2024-Strategic-Plan


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Tri-County Health Department Board of Health

The Board of Health of the Tri-County Health Department is comprised of nine members: three each from Adams, Arapahoe and Douglas Counties. Board members are appointed by their respective County Commissioners and serve five-year terms.

Adams County Arapahoe County Douglas County

Julie Mullica, MPH Term Expires: Jan 2022

Vice President

Kaia Gallagher, PhD Term Expires: Feb 2026

President

Linda Fielding, MD Term Expires: Jan 2023

Picture not available

Rosanna Reyes, RN Term Expires: Jan 2025

Thomas Fawell, MD Term Expires: Feb 2022

Kevin Bracken Term Expires: Jan 2024

Julie Schilz, BSN, MBA Term Expires: Jan 2026

Jan Brainard, RN Term Expires: Feb 2023

Kim Muramoto, RN Term Expires: Jan 2025


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TCHD 2022 ORGANIZATIONAL CHART

Note: This is the current TCHD Organizational Chart and determines how the subsequent division budgets are organized in this budget book.


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OFFICE LOCATIONS

There are currently 11 offices located throughout the Tri-County region. Each county provides at least one office for use by TCHD at no cost, but there are many expenses that are paid for by the Department to meet the needs of programs and projects located in these offices. TCHD leases the other offices, which requires the Department to negotiate the leases and pay rent out of available funding.

• Administration & Vital Records (Leased) 6162 S. Willow Drive, Suite 100 Greenwood Village, CO 80111 303/220-9200

• Aurora East: Colfax/Chambers (Provided by Arapahoe County)

15400 E. 14th Place, Suite 115 Aurora, CO 80011-5828 303/341-9370


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• Aurora South: Hampden/Chambers (Leased)

15192 E Hampden Avenue Aurora, CO 80014 303/873-4400

• Aurora West: Alton/Colfax—WIC Services Only (Leased)

9000 E. Colfax Avenue, Suite 105 Aurora, CO 80010 303/361-6010

• Brighton—WIC Services Only (Leased)

30 S. 20th Avenue Brighton, CO 80601 303/659-2335

• Castle Rock & Vital Records (Provided by Douglas County)

410 South Wilcox Castle Rock, CO 80109 303/663-7650

• Commerce City & Vital Records (Provided by Adams County)

4201 E. 72nd Avenue, Suite D Commerce City, CO 80022-1488 303/288-6816

• Englewood (Provided by Arapahoe County)

4857 S. Broadway Englewood, CO 80113 303/761-1340

• Lone Tree (Provided by Douglas County)

9350 Heritage Hills Circle Littleton, CO 80124 303/784-7866

• North Broadway Office (Leased)

7000 North Broadway #400 Denver, CO 80221 303/426-5232

• Westminster (Leased)

1401 W 122nd Ave #200 Westminster, CO 80234 303/452-9547


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2022 Proposed Budget


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2021 2022 Population 3- CountyBudgeted Estimated Population Increase Population

Population Population 1 Increase Percent Increase %Adams County 538,238 535,839 (2,399) -0.45%Arapahoe County 671,733 674,057 2,324 0.35%Douglas County 359,228 365,937 6,709 1.87% Total 1,569,199 1,575,833 6,634 0.42%

2022 Percent 2022 Proposedof 3-County 2021 Adopted 2022 Proposed Increase Per CapitaPopulation Appropriation Appropriation Amount 2 Rate 3

Adams County 34.0% 3,821,490$ 3,841,966$ 20,476$ 7.17$ Arapahoe County 42.8% 4,769,304$ 4,832,989$ 63,685$ 7.17$ Douglas County 23.2% 2,550,519$ 2,623,768$ 73,249$ 7.17$

Total 100% 11,141,313$ 11,298,723$ 157,410$

Notes:

Changes to Revenues/Sources of Funds - County Per Capita Contributions


1. Preliminary 2021/2022 population projections, based on estimates from the State Demographer's Office, increase the population base by 6,634.

2. The FY 2022 proposed County Appropriation of $11,293,723 is a 1.4%, or $157,410, increase over the total County Appropriation amount from FY 2021. Of the $157,410 increase, $47,101 is atributable to the population increase. The remaining $110,309 is based on the seven cent per capita rate increase.

3. The FY 2022 proposed County Per Capita contribution rate of $7.17 represents a .07 increase over the FY 2021 rate.


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Changes to Revenues/Sources of Funds 2021 2022Revised ProposedBudget Budget $ %

County Per Capita $ 11,141,313 $ 11,298,723 157,410$ 1.41% County Project Specific $ 2,938,053 $ 2,946,810 8,757 0.30% Federal Funds $ 407,681 420,443 12,762 3.13% Medicaid Funds $ 489,991 429,309 (60,682) (12.38%)Fees $ 3,358,802 3,328,463 (30,339) (0.90%)Interest Income $ 80,000 80,000 - 0.00% Vital Records Fees $ 1,350,000 1,350,000 - 0.00% State Contracts $ 8,834,573 9,651,744 817,171 9.25% State Planning and Support $ 1,882,445 1,882,445 - 0.00% Federal Pass Through Funds $ 12,398,377 11,878,494 (519,883) (4.19%)Other Grants & Contracts $ 20,004,490 17,024,738 (2,979,752) (14.90%)Other Revenue * $ 318,075 318,075 - 0.00% Fund Balance Use $ 2,024,755 1,500,000 (524,755) (25.92%)In-Kind $ 1,564,162 1,564,162 - 0.00% TOTAL REVENUES $ 66,792,717 $ 63,673,406 (3,119,311)$ (4.67%)

* Other revenue includes rebates and refunds

Changes to Expenditures 2021 2022Revised ProposedBudget Budget $ %

Wages $26,108,015 $ 25,933,672 (174,343)$ (0.67%)Fringe Benefits 7,876,721 7,486,227 (390,494) (4.96%)Contracts for Services 16,307,007 12,088,583 (4,218,424) (25.87%)Operating - Travel 503,460 528,651 25,191 5.00% Operating - Supplies 4,761,641 4,109,117 (652,525) (13.70%)Operating - Expenses 5,781,438 5,737,871 (43,567) (0.75%)Operating - Other Costs 88,858 83,323 (5,535) (6.23%)Equipment (Non-capital) 1,850,415 1,669,020 (181,395) (9.80%)Capital Equipment 1,951,000 4,222,779 2,271,779 116.44% Leasehold Improvement - 250,000 250,000 0.00% In-Kind 1,564,162 1,564,162 - 0.00% TOTAL EXPENDITURES $66,792,717 $ 63,673,406 (3,119,311)$ (4.67%)





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* General Revenue


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2022 BUDGET COMPARISON – REVENUE by PROGRAM

2020 2021 2022CODE DESCRIPTION Actual Revised Proposed $ %

130 EXECUTIVE * $ 1,008,895 $ 1,048,272 $ 3,695,421 2,647,149$ 252.53% 131 METRO DENVER PARTNERSHIP FOR HEALTH * $ 39,000 $ 64,000 $ 66,500 2,500$ 3.91% 132 BOARD FUND* $ 12,000 $ 15,000 $ 26,000 11,000$ 73.33% 140 COMMUNICATION* $ 374,376 $ 369,737 $ 397,209 27,472$ 7.43% 220 WIC GRANT $ 5,468,023 $ 5,398,285 $ 5,721,789 323,504 5.99% 222 WIC CENTRAL REFERRAL SYSTEM $ 81,839 $ 101,097 $ 106,813 5,716 5.65% 225 COMMUNITY INNOVATION $ 15,749 $ - $ - - 0.00% 226 WIC PEER COUNSELOR GRANT $ 192,513 $ 224,067 $ 221,226 (2,841) (1.27%)238 HUNGER FREE OUTREACH $ 102,458 $ 105,037 $ 159,803 54,766 52.14% 240 DIETETIC INTERNSHIP * $ 130,023 $ 136,496 $ 143,617 7,121 5.22% 242 DRCOG AHC MODEL – CLINICAL PARTNER $ 39,334 $ 164,015 $ 59,000 (105,015) (64.03%)245 ADAMS CO. FOOD SECURITY $ 62,024 $ 80,000 $ 80,000 - 0.00% 255 CARES ACT THORNTON FARMERS MARKET $ 45,623 $ - $ - - 0.00% 270 BABY & ME - TOBACCO FREE GRANT $ 25,114 $ 20,852 $ - (20,852) (100.00%)290 NUTRITION ADMINISTRATION $ 156,093 $ 167,408 $ 167,422 14 0.01% 330 HEALTH PLANNING * $ 102,050 $ 147,709 $ 143,307 (4,402) (2.98%)332 WORKSITE WELLNESS - CCPD $ 246,946 $ 300,300 $ - (300,300) (100.00%)335 COMMUNITY NUTRITION * $ 417,788 $ 415,951 $ 444,945 28,994 6.97% 336 HEALTHY BEVERAGE INITIATIVE $ 40,132 $ 53,395 $ 56,503 3,108 5.82% 337 DIABETES PREVENTION $ 261,704 $ 335,000 $ 344,000 9,000 2.69% 338 ADVANCING BREASTFEEDING IN COLORADO $ 91,084 $ 137,839 $ 138,932 1,093 0.79% 348 GUN SHOP PROJECT $ - $ - $ 20,000 20,000 0.00% 351 TOBACCO - GRANT $ 969,649 $ 1,318,077 $ 1,318,075 (2) (0.00%)353 DRUG FREE COMMUNITIES $ - $ - $ 125,000 125,000 0.00% 354 OPPI OPIOID $ 396,334 $ - $ - - 0.00% 356 SAMSHA GRANT $ 118,812 $ 168,881 $ 168,881 - 0.00% 357 COMMUNITIES THAT CARE GRANT $ 326,391 $ 362,852 $ 207,295 (155,557) (42.87%)358 MENTAL HEALTH PROMOTION $ 130,000 $ 120,656 $ 130,960 10,304 8.54% 364 AGING INIT - MATTER OF BALANCE * $ 71,496 $ - $ - - 0.00% 371 MCH CHILD HEALTH/ADOLESCENT $ 222,265 $ 267,650 $ - (267,650) (100.00%)372 MCH WORA $ 334,493 $ 246,397 $ - (246,397) (100.00%)373 HCP MEDICAL HOME $ 147,227 $ 157,743 $ - (157,743) (100.00%)375 MCH COMBINE $ - $ - $ 1,306,374 1,306,374 0.00% 374 NENS REFERRAL $ 5,691 $ 10,411 $ - (10,411) (100.00%)390 COMMUNITY HEALTH PROMOTION ADMIN * $ 274,845 $ 310,027 $ 406,090 96,063 30.99% 411 CLINICAL SCHOLARS * $ 35,614 $ 65,664 $ 54,216 (11,448) (17.43%)415 CORE TUBERCULOSIS CONTROL * $ 288,692 $ 285,811 $ 285,811 - 0.00% 420 ADAMS MOTHERS FIRST $ 493,551 $ 616,294 $ 567,856 (48,438) (7.86%)424 ARAPAHOE MOTHERS FIRST $ 117,224 $ 139,422 $ 141,922 2,500 1.79% 425 CHILD FATALITY PREVENTION * $ 65,803 $ 66,984 $ 67,042 58 0.09% 426 ARAPAHOE NURSE SUPPORT $ 824,825 $ 1,143,134 $ 1,146,419 3,285 0.29% 427 DOUGLAS MOTHERS FIRST $ 85,676 $ 143,967 $ 141,069 (2,898) (2.01%)428 ADAMS CHILD NURSE LIAISON $ 7,815 $ 334,083 $ 371,236 37,153 11.12%



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440 HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL

$ 553,897 $ 637,577 $ 613,399 (24,178) (3.79%)450 HEALTHY COMMUNITIES (EPSDT) * $ 477,152 $ 243,276 $ 329,561 86,285 35.47% 451 REGIONAL HEALTH $ 327,125 $ 305,893 $ 316,491 10,598 3.46% 453 2020 CENSUS OUTREACH $ 41,129 $ - $ - - 0.00% 455 NURSE FAMILY PARTNERSHIP CONTINUATION GRANT $ 2,858,118 $ 3,203,712 $ 3,391,117 187,405 5.85% 457 NFP MIECHVP 1 GRANT $ 753,872 $ 916,801 $ 969,116 52,315 5.71% 460 IMMUNIZATION CORE * $ 3,005,189 $ 6,132,350 $ 3,743,222 (2,389,128) (38.96%)461 CUSTOMER SUPPORT CENTER $ 362,335 $ 322,299 $ 2,500 (319,799) (99.22%)469 HIV AND STD $ 566,251 $ 764,691 $ 793,184 28,493 3.73% 477 FAMILY PLANNING TITLE X * $ 3,496,168 $ 3,826,519 $ 3,674,681 (151,838) (3.97%)492 NURSING SPECIAL PROGRAMS * $ 3,852 $ - $ - - 0.00% 490 NRS DIVISION ADMINISTRATION* $ 1,040,219 $ 1,284,222 $ 1,279,437 (4,785) (0.37%)495 ARAPAHOE SENIOR DENTAL $ 457,873 $ 443,456 $ 446,452 2,996 0.68% 510 COMMUNICABLE DISEASE $ 496,684 $ 513,711 $ 580,859 67,148 13.07% 520 PUBLIC HEALTH EMERGENCY PREPAREDNESS GRANT $ 12,950,464 $ 19,926,841 $ 16,800,195 (3,126,646) (15.69%)530 CITIES READINESS INITIATIVE GRANT $ 260,910 $ 253,537 $ 306,120 52,583 20.74% 550 SYNDROMIC SURVEILLANCE GRANT $ 415,860 $ 175,004 $ 175,004 - 0.00% 551 SYNDROMIC SURVEILLANCE SUICIDE PREVENTION $ 86,771 $ 201,520 $ 201,520 - 0.00% 552 OVERDOSE DATA TO ACTION $ 104,642 $ 150,000 $ 150,000 - 0.00% 590 EPRCDS ADMINISTRATION * $ 192,941 $ 208,917 $ 221,239 12,322 5.90% 610 ANIMAL CONTROL - BITE ACTIVITIES $ 8,832 $ 5,897 $ 6,687 790 13.40% 613 VECTOR SURVEILLANCE - INSECT $ 25,542 $ 33,758 $ 39,587 5,829 17.27% 614 VECTOR SURVEILLANCE - MOSQUITOES $ 52,616 $ 31,942 $ 48,438 16,496 51.64% 617 DISEASE PREVENTION - GENERAL $ 84,307 $ 56,747 $ 60,158 3,411 6.01% 620 AIR POLLUTION GENERAL $ 94,857 $ 31,811 $ 16,502 (15,309) (48.12%)622 INDUSTRIAL HYGIENE - GENERAL * $ 67,446 $ 76,656 $ 79,858 3,202 4.18% 623 INDUSTRIAL HYGIENE - COMPLAINT - BILLABLE * $ 5,447 $ - $ - - 0.00% 627 INDUSTRIAL HYGIENE - RADON * $ 12,232 $ 11,705 $ 14,109 2,404 20.54% 630 RETAIL FOOD - GENERAL * $ 661,799 $ 2,863,211 $ 2,998,522 135,311 4.73% 631 RETAIL FOOD - INSPECTION $ 1,763,135 $ - $ - - 0.00% 632 RETAIL FOOD - SPECIAL EVENT $ 4,000 $ - $ - - 0.00% 640 CHILDCARE - GENERAL * $ 112,271 $ 267,077 $ 285,981 18,904 7.08% 641 CHILDCARE - BIENNIAL INSPECTION $ 51,755 $ - $ - - 0.00% 642 CHILDCARE - ANNUAL INSPECTION $ 68,415 $ - $ - - 0.00% 643 BODY ART - GENERAL * $ 10,569 $ 32,274 $ 32,956 682 2.11% 644 BODY ART - INSPECTION $ 33,860 $ - $ - - 0.00% 645 RECREATION - GENERAL * $ 29,292 $ 140,229 $ 146,295 6,066 4.33% 648 RECREATION - POOL-SPA INSPECTION $ 80,570 $ - $ - - 0.00% 650 LAND USE - GENERAL * $ 669,965 $ 846,307 $ 905,362 59,055 6.98% 653 WATER SUPPLIES - GENERAL $ 74,383 $ 86,768 $ 92,667 5,899 6.80% 656 WATER SUPPLIES - PRIVATE * $ 18,079 $ 30,845 $ 36,082 5,237 16.98% 657 WASTE WATER - GENERAL * $ 174,435 $ 563,759 $ 601,581 37,822 6.71% 658 WASTE WATER - BIO SOLIDS * $ 6,176 $ 7,762 $ 17,636 9,874 127.21% 660 WASTE WATER - OWTS NEW INSTALL $ 310,571 $ - $ - - 0.00% 661 WASTE WATER - OWTS LICENSEE $ 6,435 $ - $ - - 0.00% 662 WASTE WATER - OWTS REPAIR $ 118,040 $ - $ - - 0.00% 663 WASTE WATER - OWTS USE PERMITS $ 79,900 $ - $ - - 0.00% 668 SOLID & HAZARDOUS WASTE - GENERAL * $ 74,067 $ 78,764 $ 102,385 23,621 29.99% 669 SOLID & HAZARDOUS WASTE - DESIGNATED SOLID

$ 10,134 $ 12,667 $ 13,525 858 6.77%

677 SHW - LOWRY SUPERFUND * $ 36,832 $ 71,366 $ 70,000 (1,366) (1.91%)



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678 SHW - TIRES * $ 1,840 $ 16,258 $ 12,000 (4,258) (26.19%)679 SOLID & HAZARDOUS WASTE - SEDALIA LANDFILL * $ 4,764 $ 11,251 $ 10,000 (1,251) (11.12%)680 SOLID & HAZARDOUS WASTE - TOWER LANDFILL * $ 10,591 $ 16,217 $ 10,000 (6,217) (38.34%)683 ROCKY MOUNTAIN ARSENAL MOA $ 116,582 $ 206,161 $ 218,923 12,762 6.19% 686 HOUSEHOLD CHEMICAL ROUNDUP GENERAL $ 182,913 $ 91,901 $ 45,180 (46,721) (50.84%)687 HOUSEHOLD CHEMICAL ROUNDUP EVENT * $ 26,867 $ 216,550 $ 187,628 (28,922) (13.36%)690 ENVIRONMENTAL HEALTH ADMINISTRATION * $ 748,474 $ 1,042,241 $ 1,291,672 249,431 23.93% 692 MEDICAL MARIJUANA MANUFACTURER * $ 11,289 $ 9,994 $ 10,502 508 5.08% 695 EH INFORMATICS* $ 389,161 $ 329,330 $ 370,630 41,300 12.54% 710 EMPLOYEE WELLNESS* $ 109,962 $ 110,719 $ 118,442 7,723 6.98% 720 HUMAN RESOURCES* $ 535,248 $ 557,670 $ 598,103 40,433 7.25% 790 FRINGE BENEFITS* $ (1,089,109) $ (1,374,620) $ (2,649,113) (1,274,493) 92.72% 910 MEDICAL EPIDEMIOLOGY* $ 210,629 $ 228,502 $ 239,286 10,784 4.72% 930 DATA ANALYTICS* $ 516,591 $ 441,823 $ 534,483 92,660 20.97% 950 INFORMATION TECHNOLOGY* $ 1,558,002 $ 1,504,958 $ 2,168,975 664,017 44.12% 970 HUMAN PAPILLOMAVIRUS* $ 4,852 $ - $ - - 0.00% 990 PLANNING & INFORMATION MANAGEMENT

ADMINISTRATION * $ 432,854 $ 514,210 $ 570,798 56,588 11.00% 810 FA OPERATIONS * $ 2,627,278 $ 5,027,996 $ 6,698,040 1,670,044 33.21% 820 FA ADMINISTRATION * $ 616,754 $ 603,781 $ 626,882 23,101 3.83% 820 INTEREST INCOME $ 315,091 $ 350,000 $ 350,000 - 0.00% 840 FA FACILITIES * $ 443,163 $ 450,846 $ 699,786 248,940 55.22% 860 FA PURCHASING * $ 118,645 $ 139,045 $ 145,908 6,863 4.94% 870 FA ACCOUNTING * $ 742,945 $ 751,183 $ 769,386 18,203 2.42% 880 FA VITAL RECORDS $ 1,485,549 $ 1,350,000 $ 1,350,000 - 0.00% 890 AGENCY ADMIN SUPPORT $ 273,721 $ 2,634,423 $ 305,801 (2,328,622) (88.39%)899 GENERAL FUND ALLOCATION $ (17,724,768) $ (21,263,864) $ (22,184,235) (920,371) 4.33% 895 COUNTY AND STATE PER CAPITA FUNDS - 0.00%

ADAMS COUNTY $ 3,767,828 $ 3,821,490 $ 3,841,966 20,476 0.54% ARAPAHOE COUNTY $ 4,702,358 $ 4,769,304 $ 4,832,989 63,685 1.34% DOUGLAS COUNTY $ 2,486,143 $ 2,550,519 $ 2,623,768 73,249 2.87% STATE PLANNING AND SUPPORT $ 1,916,010 $ 1,882,445 $ 1,882,445 - 0.00%

TOTAL REVENUE $ 52,568,809 $ 66,792,717 $ 63,673,406 (3,119,311) (4.67%)


Revenue codes with * indicates that General Fund Allocation is used for full or partial support of the program


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2022 BUDGET COMPARISON – EXPENDITURE by PROGRAM

2020 2021 2022CODE DESCRIPTION Actual Revised Proposed $ %130 EXECUTIVE $ 782,304 $ 1,048,272 3,695,421 2,647,149$ 252.53% 131 METRO DENVER PARTNERSHIP FOR HEALTH $ 62,658 $ 64,000 66,500 2,500 3.91% 132 BOARD FUND $ 2,733 $ 15,000 26,000 11,000 73.33% 140 COMMUNICATION $ 87,825 $ 369,737 397,209 27,472 7.43% 220 WIC $ 5,467,844 $ 5,398,285 5,721,789 323,504 5.99% 222 WIC CENTRAL REFERRAL SYSTEM $ 81,839 $ 101,097 106,813 5,716 5.65% 225 COMMUNITY INNOVATION $ 17,828 $ - - - 0.00% 226 WIC PEER COUNSELOR $ 192,513 $ 224,067 221,226 (2,841) (1.27%)238 HUNGER FREE OUTREACH $ 99,721 $ 105,037 159,803 54,766 52.14% 240 DIETETIC INTERNSHIP $ 125,362 $ 136,496 143,617 7,121 5.22% 242 DRCOG AHC MODEL – CLINICAL PARTNER $ 45,149 $ 164,015 59,000 (105,015) (64.03%)245 ADAMS CO. FOOD SECURITY $ 62,024 $ 80,000 80,000 - 0.00% 255 CARES ACT THORNTON FARMERS MARKET $ 45,623 $ - - - 0.00% 270 BABY & ME - TOBACCO FREE $ 25,114 $ 20,852 - (20,852) (100.00%)290 NUTRITION ADMINISTRATION $ 144,977 $ 167,408 167,422 14 0.01% 330 HEALTH PLANNING $ 89,269 $ 147,709 143,307 (4,402) (2.98%)332 WORKSITE WELLNESS - CCPD $ 249,255 $ 300,300 - (300,300) (100.00%)335 COMMUNITY NUTRITION $ 205,648 $ 415,951 444,945 28,994 6.97% 336 HEALTHY BEVERAGE INITIATIVE - CCPD $ 40,132 $ 53,395 56,503 3,108 5.82% 337 DIABETES PREVENTION - CCPD $ 262,070 $ 335,000 344,001 9,001 2.69% 338 ADVANCING BREASTFEEDING IN COLORADO - CCPD $ 91,064 $ 137,839 138,932 1,093 0.79% 348 GUN SHOP PROJECT $ - $ - 20,001 20,001 0.00% 351 TOBACCO - 2012 GRANT $ 969,649 $ 1,318,077 1,318,075 (2) (0.00%)353 DRUG FREE COMMUNITIES $ - $ - 125,000 125,000 0.00% 354 OPPI OPIOID $ 396,334 $ - - - 0.00% 356 SAMHSA GRANT $ 118,812 $ 168,881 168,881 - 0.00% 357 COMMUNITIES THAT CARE $ 320,145 $ 362,852 207,295 (155,557) (42.87%)358 MENTAL HEALTH PROMOTION $ 105,766 $ 120,656 130,960 10,304 8.54% 364 AGING INIT - MOB GRANT $ 48,834 $ - - - 0.00% 371 MCH CHILD HEALTH/ADOLESCENT $ 222,265 $ 267,650 1,306,374 1,038,724 388.09% 372 MCH WORA $ 334,493 $ 246,397 - (246,397) (100.00%)373 HCP MEDICAL HOME $ 147,227 $ 157,743 - (157,743) (100.00%)374 NENS REFERRAL GRANT PROJECT $ 5,691 $ 10,411 - (10,411) (100.00%)390 CHP ADMINISTRATION $ 257,652 $ 310,027 406,090 96,063 30.99% 411 CLINICAL SCHOLARS $ 35,614 $ 65,664 54,216 (11,448) (17.43%)415 CORE TB CONTROL $ 285,811 $ 285,811 285,811 - 0.00% 420 ADAMS MOTHERS FIRST $ 493,141 $ 616,294 567,856 (48,438) (7.86%)424 ARAP MOTHERS FIRST $ 115,361 $ 139,422 141,922 2,500 1.79% 425 CHILD FATALITY PREVENTION $ 82,915 $ 66,984 67,042 58 0.09% 426 ARAP NURSE SUPPORT $ 781,010 $ 1,143,134 1,146,419 3,285 0.29% 427 DOUG MOTHERS FIRST $ 84,552 $ 143,967 141,069 (2,898) (2.01%)428 ADAMS CHILD NURSE LIAISON $ 7,815 $ 334,083 371,236 37,153 11.12% 440 HCP $ 553,897 $ 637,577 613,399 (24,178) (3.79%)450 HEALTHY COMMUNITIES (EPSDT) $ 341,346 $ 243,276 329,561 86,285 35.47% 451 REGIONAL HEALTH CONNECTORS $ 116,301 $ 305,893 316,491 10,598 3.46% 453 2020 CENSUS OUTREACH $ 41,051 $ - - - 0.00% 455 NFP CONTINUATION $ 2,858,830 $ 3,203,712 3,391,117 187,405 5.85% 457 NFP MIECHVP 1 $ 754,065 $ 916,801 969,116 52,315 5.71% 460 IMMUNIZATION AND CLINICAL RESPONSE $ 2,392,847 $ 6,132,350 3,743,222 (2,389,128) (38.96%)461 CUSTOMER SUPPORT CENTER $ 223,818 $ 322,299 2,500 (319,799) (99.22%)469 HIV AND STD $ 564,321 $ 764,691 793,184 28,493 3.73% 477 SEXUAL HEALTH $ 2,645,033 $ 3,826,519 3,674,681 (151,838) (3.97%)490 NURSING ADMINISTRATION $ 1,016,386 $ 1,284,222 1,279,437 (4,785) (0.37%)492 NURSING SPECIAL PROGRAMS $ 4,454 $ - - - 0.00% 495 ARAPAHOE SENIOR DENTAL $ 457,873 $ 443,456 446,452 2,996 0.68% 510 COMMUNICABLE DISEASE $ 335,634 $ 513,711 580,859 67,148 13.07% 520 PUBLIC HEALTH EMERGENCY PREPAREDNESS $ 13,443,529 $ 19,926,841 16,800,195 (3,126,646) (15.69%)530 CRI $ 260,606 $ 253,537 306,120 52,583 20.74% 550 NSSP $ 415,947 $ 175,004 175,004 - 0.00%



36

2020 2021 2022CODE DESCRIPTION Actual Revised Proposed $ %551 SYNDROMIC SURVEILLANCE SUICIDE PREVENTION $ 86,771 $ 201,520 201,520 - 0.00% 552 OVERDOSE DATA TO ACTION $ 107,528 $ 150,000 150,000 - 0.00% 590 EPRCDS ADMINISTRATION $ 96,828 $ 208,917 221,239 12,322 5.90% 610 ANIMAL CONTROL - BITE ACTIVITIES $ 24,312 $ 5,897 6,687 790 13.40% 612 ANIMAL CONTROL - WILDLIFE $ 347 $ - - - 0.00% 613 VECTOR SURVEILLANCE - GENERAL $ 34,248 $ 33,758 39,587 5,829 17.27% 614 VECTOR SURVEILLANCE - MOSQUITOES $ 29,258 $ 31,942 48,438 16,496 51.64% 615 VECTOR SURVEILLANCE - RODENTS $ 8,727 $ - - - 0.00% 616 VECTOR SURVEILLANCE - BED BUGS HEAD LICE OTHER NON-DISEASE $ 589 $ - - - 0.00% 617 DISEASE PREVENTION - GENERAL $ 7,054 $ 56,747 60,158 3,411 6.01% 618 DISEASE PREVENTION - FOODBORNE COMPLAINT $ 6,604 $ - - - 0.00% 619 DISEASE PREVENTION - OUTBREAK $ 1,954 $ - - - 0.00% 620 AIR POLLUTION GENERAL $ 115,183 $ 31,811 16,502 (15,309) (48.12%)622 INDUSTRIAL HYGIENE - GENERAL $ 45,235 $ 76,656 79,858 3,202 4.18% 623 INDUSTRIAL HYGIENE - COMPLAINT - BILLABLE $ 707 $ - - - 0.00% 624 INDUSTRIAL HYGIENE - COMPLAINT - NON BILLABLE $ 277 $ - - - 0.00% 627 INDUSTRIAL HYGIENE - RADON $ 8,113 $ 11,705 14,109 2,404 20.54% 630 RETAIL FOOD - GENERAL $ 1,135,510 $ 2,863,211 2,998,522 135,311 4.73% 631 RETAIL FOOD - INSPECTION $ 532,579 $ - - - 0.00% 632 RETAIL FOOD - SPECIAL EVENT $ 1,056 $ - - - 0.00% 637 INSTITUTIONS AND PUBLIC ACCOMMODATIONS $ 692 $ - - - 0.00% 638 SCHOOLS - GENERAL $ 16 $ - - - 0.00% 640 CHILDCARE - GENERAL $ 53,986 $ 267,077 285,981 18,904 7.08% 641 CHILDCARE - BIENNIAL INSPECTION $ 17,241 $ - - - 0.00% 642 CHILDCARE - ANNUAL INSPECTION $ 10,779 $ - - - 0.00% 643 BODY ART - GENERAL $ 6,004 $ 32,274 32,956 682 2.11% 644 BODY ART - INSPECTION $ 5,847 $ - - - 0.00% 645 RECREATION - GENERAL $ 15,505 $ 140,229 146,295 6,066 4.33% 648 RECREATION - POOL-SPA INSPECTION $ 63,501 $ - - - 0.00% 650 LAND USE - GENERAL $ 450,582 $ 846,307 905,362 59,055 6.98% 651 LAND USE - APPLICATION $ 130,736 $ - - - 0.00% 652 LAND USE - COMP PLAN UPDATE $ 79 $ - - - 0.00% 653 WATER SUPPLIES - GENERAL $ 85,048 $ 86,768 92,667 5,899 6.80% 655 WATER SUPPLIES - PUBLIC COMMUNITY SYSTEMS $ 702 $ - - - 0.00% 656 WATER SUPPLIES - PRIVATE $ 16,135 $ 30,845 36,082 5,237 16.98% 657 WASTE WATER - GENERAL $ 237,015 $ 563,759 601,581 37,822 6.71% 658 WASTE WATER - BIO SOLIDS $ 1,948 $ 7,762 17,636 9,874 127.21% 660 WASTE WATER - OWTS NEW INSTALL $ 161,747 $ - - - 0.00% 661 WASTE WATER - OWTS LICENSEE $ 6,510 $ - - - 0.00% 662 WASTE WATER - OWTS REPAIR $ 41,004 $ - - - 0.00% 663 WASTE WATER - OWTS USE PERMITS $ 72,221 $ - - - 0.00% 665 WASTE WATER - SEPTAGE MANAGEMENT $ 289 $ - - - 0.00% 666 WASTE WATER - SEWAGE SPILLS $ 12,522 $ - - - 0.00% 668 SHW - GENERAL $ 52,212 $ 78,764 102,385 23,621 29.99% 669 SHW - DESIGNATED SOLID WASTE DISPOSAL $ 1,892 $ 12,667 13,525 858 6.77% 670 SHW - METHAMPHETAMINE $ 7,983 $ - - - 0.00% 671 SHW - METHANE $ 6,525 $ - - - 0.00% 672 SHW - SPILLS OR INCIDENTS $ 3,396 $ - - - 0.00% 673 SHW - CSI LANDFILL CONTRACT $ 102 $ - - - 0.00% 674 SHW - HIGHWAY 36 LANDFILL CONTRACT $ 97 $ - - - 0.00% 676 SHW - EAST REGIONAL LANDFILL $ 544 $ - - - 0.00% 677 SHW - LOWRY SUPERFUND $ 29,473 $ 71,366 70,000 (1,366) (1.91%)678 SHW - TIRES $ 1,840 $ 16,258 12,000 (4,258) (26.19%)679 SHW - SEDALIA LANDFILL $ 4,645 $ 11,251 10,000 (1,251) (11.12%)680 SHW - TOWER LANDFILL $ 4,008 $ 16,217 10,000 (6,217) (38.34%)683 RMA MOA $ 106,640 $ 206,161 218,923 12,762 6.19% 686 HCR GENERAL $ 54,677 $ 91,901 45,180 (46,721) (50.84%)687 HCR EVENT $ 45,805 $ 216,550 187,628 (28,922) (13.36%)690 ENVIRONMENTAL HEALTH ADMINISTRATION $ 570,429 $ 1,042,241 1,291,672 249,431 23.93% 691 WATER SUPPLIES - PUBLIC NON-COMMUNITY SYSTEMS $ 484 $ - - - 0.00% 692 MARIJUANA MANUFACTURER $ 418 $ 9,994 10,502 508 5.08%



37

2020 2021 2022CODE DESCRIPTION Actual Revised Proposed $ %695 EH INFORMATICS $ 198,593 $ 329,330 370,630 41,300 12.54% 696 EH SPECIAL RESPONSE $ 393 $ - - - 0.00% 710 EMPLOYEE HEALTH & WELLNESS $ 42,098 $ 110,719 118,442 7,723 6.98% 720 HUMAN RESOURCES $ 550,137 $ 557,670 598,103 40,433 7.25% 790 FRINGE BENEFITS $ (946,037) $ (1,863,738) (2,649,113) (785,375) 42.14% 810 FA OPERATIONS $ 2,517,234 $ 5,027,996 6,698,040 1,670,044 33.21% 820 FA ADMINISTRATION $ (3,695,175) $ (1,466,491) 976,882 2,443,373 (166.61%)840 FA FACILITIES $ 373,067 $ 450,846 699,786 248,940 55.22% 860 FA PURCHASING $ 118,043 $ 139,045 145,908 6,863 4.94% 870 FA ACCOUNTING $ 723,369 $ 751,183 769,386 18,203 2.42% 880 FA VITAL RECORDS $ 1,106,524 $ 1,272,029 1,346,878 74,849 5.88% 890 AGENCY ADMIN SUPPORT $ 847,753 $ 5,543,813 305,801 (5,238,012) (94.48%)910 MEDICAL EPIDEMIOLOGY $ 43,323 $ 228,502 239,286 10,784 4.72% 930 DATA ANALYTICS $ 247,736 $ 441,823 534,483 92,660 20.97% 950 INFORMATION TECHNOLOGY $ 1,570,227 $ 1,504,958 2,168,975 664,017 44.12% 970 HPV $ 5,018 $ - - - 0.00% 990 PIM ADMINISTRATION $ 292,382 $ 514,210 570,798 56,588 11.00%

TOTAL EXPENDITURE $ 47,938,823 $ 66,792,717 $ 63,673,406 (3,119,311) (4.67%)



38



39

Office of the Executive Director


40



41

OFFICE OF THE EXECUTIVE DIRECTOR

Division: 1 OFFICE OF THE EXECUTIVE DIRECTORFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $ %

REVENUE:COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - 2,400,000 2,400,000 0.00% FEDERAL PASS THRU FUNDS 25,000 50,000 50,000 - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 25,000 $ 50,000 $ 2,450,000 2,400,000$ 4800.00%

FTE's 7.68 8.01 8.09 0.08 0.96% Benefits as a Percentage of Wages 34.34% 34.50% 35.96%

EXPENDITURES:WAGES $ 525,364 $ 895,420 $ 954,744 59,324 6.63% BENEFITS 180,398 308,899 343,316 34,417 11.14%

Total Personnel $ 705,762 $ 1,204,319 $ 1,298,060 93,741$ 7.78% CONTRACTS / SERVICES 173,119 165,700 2,736,000 2,570,300 1551.18% TRAVEL 1,064 17,518 18,565 1,047 5.98% SUPPLIES 4,094 11,610 10,810 (800) (6.89%)OPERATING 49,100 75,862 97,745 21,883 28.85% OTHER COSTS 2,382 22,000 23,950 1,950 8.86% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 935,521 $ 1,497,009 $ 4,185,130 2,688,121$ 179.57%

CAPITAL & LEASEHOLD IMPROVEMENTS $ - $ - $ - -$ 0.00% IN-KIND EXPENSE - - - - 0.00%

TOTAL DIVISION EXPENDITURES $ 935,521 $ 1,497,009 $ 4,185,130 2,688,121$ 179.57%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE 1,409,271 1,447,009 1,735,130 288,121 19.91%

TOTAL AGENCY NET $ 498,750 $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)

% of Total Expenses Funded by County General Funds 109.5% 79.2% 34.3%% of Total Expenses Funded by Non-County General Funds 41.2% 17.4% 7.2%



42

Executive Director The Executive and Deputy Director are responsible for providing strategic leadership by working with the Board of Health and the Executive Management Team to establish long-range agency goals, strategies, plans and policies. The division also houses the Policy and Public Affairs Officer who leads agency-wide efforts addressing community-based policy development and implementation; serves as the TCHD liaison with federal, state and local elected officials; works with agency leadership, staff and the board of health to develop and implement policy; and acts as an agency spokesperson in settings related to policy and relationship building. Funding Source(s): Required General Funds

Division: 1 OFFICE OF THE EXECUTIVE DIRECTOR - Executive Director (130)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $ %

REVENUE:COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - 2,400,000 2,400,000 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ - $ - $ 2,400,000 2,400,000$ 0.00%

FTE's 5.06 5.09 5.09 (0.00) (0.07%)Benefits as a Percentage of Wages 34.27% 34.30% 35.77%


Total Personnel $ 638,003 $ 868,676 $ 937,983 69,307$ 7.98% CONTRACTS / SERVICES 122,369 110,000 2,675,000 2,565,000 2331.82% TRAVEL 709 10,744 9,903 (841) (7.83%)SUPPLIES 2,873 6,610 5,810 (800) (12.10%)OPERATING 17,552 42,242 56,425 14,183 33.58% OTHER COSTS 799 10,000 10,300 300 3.00% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 782,304 $ 1,048,272 $ 3,695,421 2,647,149$ 252.53%


TOTAL DIVISION EXPENDITURES $ 782,304 $ 1,048,272 $ 3,695,421 2,647,149$ 252.53%






43

Division: 1 OFFICE OF THE EXECUTIVE DIRECTOR - Metro Denver Partnership for Health (131)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $ %

REVENUE:COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 25,000 50,000 50,000 - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 25,000 $ 50,000 $ 50,000 -$ 0.00%

FTE's 0.00 0.00 - 0.00 0.00% Benefits as a Percentage of Wages 0.00% 0.00% 0.00%

EXPENDITURES:WAGES $ - $ - $ - - 0.00% BENEFITS - - - - 0.00%

Total Personnel $ - $ - $ - -$ 0.00% CONTRACTS / SERVICES 50,000 50,000 50,000 - 0.00% TRAVEL - - - - 0.00% SUPPLIES - - - - 0.00% OPERATING 12,658 14,000 16,500 2,500 17.86% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 62,658 $ 64,000 $ 66,500 2,500$ 3.91%


TOTAL DIVISION EXPENDITURES $ 62,658 $ 64,000 $ 66,500 2,500$ 3.91%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE 14,000 14,000 16,500 2,500 17.86%

TOTAL AGENCY NET $ (23,658) $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)




44

Division: 1 OFFICE OF THE EXECUTIVE DIRECTOR - Board Fund (132)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $ %

REVENUE:COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ - $ - $ - -$ 0.00%

FTE's 0.00 0.00 - 0.00 0.00% Benefits as a Percentage of Wages 0.00% 0.00% 0.00%

EXPENDITURES:WAGES $ - $ - $ - - 0.00% BENEFITS - - - - 0.00%

Total Personnel $ - $ - $ - -$ 0.00% CONTRACTS / SERVICES - - 5,000 5,000 0.00% TRAVEL - 3,000 4,950 1,950 65.00% SUPPLIES - - - - 0.00% OPERATING 1,400 - 2,400 2,400 0.00% OTHER COSTS 1,333 12,000 13,650 1,650 13.75% EQUIPMENT (Non-Capital) - - - - 0.00%









45

Communication The Office of Communications works to promote healthy behavior and reduce public health risks as well as educating the public through proven and diverse communication and marketing strategies. It also provides media and marketing training to staff. The activities of the Communications staff include; strategic communication planning; media relations; public information; adherence to brand standards; social media; measurement and evaluation of marketing and communication campaigns; media monitoring; oversight of the TCHD website and Intranet; marketing for TCHD programs and services; graphic design and production of brochures, fact sheets, collateral materials, and reports. Communications staff also work closely with regional partners such as cities and counties, schools, community partners and state and federal government to align and share public health messages. Funding Source(s): Required General Funds

Division: 1 OFFICE OF THE EXECUTIVE DIRECTOR - Communications (140)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 67,759 $ 335,643 $ 360,077 24,434$ 7.28% CONTRACTS / SERVICES 750 5,700 6,000 300 5.26% TRAVEL 355 3,774 3,712 (62) (1.64%)SUPPLIES 1,220 5,000 5,000 - 0.00% OPERATING 17,491 19,620 22,420 2,800 14.27% OTHER COSTS 250 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









46



47

Nutrition Division


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49

NUTRITION DIVISION

Division: 2 NUTRITIONFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 62,024 80,000 80,000 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 58,515 63,500 63,500 - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 5,742,374 5,619,511 5,943,015 323,504 5.76% OTHER GRANTS / CONTRACTS 166,906 388,713 325,616 (63,097) (16.23%)OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 6,029,819 $ 6,151,724 $ 6,412,131 260,407$ 4.23%


EXPENDITURES:WAGES $ 3,483,008 $ 3,475,492 $ 3,867,796 392,304 11.29% BENEFITS 1,211,008 1,206,400 1,398,293 191,893 15.91%

Total Personnel $ 4,694,015 $ 4,681,892 $ 5,266,089 584,197$ 12.48% CONTRACTS / SERVICES 82,993 226,153 100,727 (125,426) (55.46%)TRAVEL 7,347 12,447 25,917 13,470 108.22% SUPPLIES 34,148 55,620 48,248 (7,372) (13.25%)OPERATING 65,720 60,772 58,352 (2,420) (3.98%)OTHER COSTS 1,047 2,006 2,006 - 0.00% EQUIPMENT (Non-Capital) 3,855 3,803 (818) (4,621) (121.51%)

TOTAL DIRECT EXPENSES $ 4,889,125 $ 5,042,693 $ 5,500,521 457,828$ 9.08%


TOTAL DIVISION EXPENDITURES $ 4,889,125 $ 5,042,693 $ 5,500,521 457,828$ 9.08%

INDIRECT ALLOCATION $ 1,355,417 $ 1,354,564 $ 1,159,149 (195,415)$ (14.43%)GENERAL FUND USE 227,601 245,533 247,539 2,006 0.82%

TOTAL AGENCY NET $ 12,879 $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




50


51

Dietetic Internship The Dietetic Internship, started in 1980, is a public health-based program accredited by the Accreditation Council for Education in Nutrition and Dietetics of the Academy of Nutrition and Dietetics. TCHD’s internship is the only program in the region to offer a public health emphasis. The ten and one half month tuition-based program trains six nutrition professionals each year, many of whom seek subsequent employment at TCHD and other Colorado health departments. Dietetic interns increase our community nutrition outreach, partnerships, and education. TCHD is proud of the 100% pass rate on the registration examination for dietitians. Graduates have career opportunities in a variety of positions in public health, community, healthcare, and business areas; hiring graduates when possible saves recruitment and training dollars. The dietetic internship has been nationally recognized for fiscal responsibility by being awarded a National Association of County and City Health Officials (NACCHO) Model Practice Award for the cost/benefit analysis of the internship and training interns on financial analysis. Funding Source(s): Required General Funds, Tuition/Fees, In-kind Services

Division: 2 NUTRITION - DIETETIC INTERNSHIP (240)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $ %

REVENUE:COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 58,515 63,500 63,500 - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 116,586 $ 122,429 $ 129,342 6,913$ 5.65% CONTRACTS / SERVICES 45 1,000 1,000 - 0.00% TRAVEL 637 2,124 2,101 (23) (1.08%)SUPPLIES 1,198 2,250 2,250 - 0.00% OPERATING 6,206 7,687 7,918 231 3.01% OTHER COSTS 689 1,006 1,006 - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









52

The Special Supplemental Nutrition Program for Women Infants and Children (WIC) The WIC program at TCHD provides monthly nutrition education, breastfeeding support, referrals and food benefits to over 20,500 women, infants, and children in our three counties through individual and group counseling sessions. There are 10 WIC clinic locations as well as a WIC presence with community partners (Children’s Health Clinic and Stride), Health and Human Services, and community based organizations. Over $12.2 million is added to the local economy of TCHD’s three counties each year through the foods WIC clients purchase directly, which include fresh fruits and vegetables and whole grains. It is estimated that for every WIC dollar spent, clients spend an additional four dollars while at the store. WIC increases access to fresh fruits and vegetables through three community gardens with local partners to promote healthy eating and physical activity: Adams County School District 27J in Brighton, and Anythink Library in Commerce City. TCHD also helps to host two Healthy Farmers’ Markets in Adams County with Anythink Libraries, American Heart Association, City of Thornton and local farmers. The WIC program’s primary focus areas are nutrition education, breastfeeding promotion and support, referrals to community partners, and obesity prevention. Funding Source(s): Restricted Federal Funds


53

Division: 2 NUTRITION - WOMEN, INFANTS & CHILDREN (WIC) (220)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 5,468,023 5,398,285 5,721,789 323,504 5.99% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 2,997,080 $ 2,865,087 $ 3,282,927 417,840 14.58% BENEFITS 1,045,245 1,002,251 1,204,245 201,994 20.15%

Total Personnel $ 4,042,325 $ 3,867,338 $ 4,487,172 619,834$ 16.03% CONTRACTS / SERVICES 72,675 211,749 74,000 (137,749) (65.05%)TRAVEL 5,574 2,500 16,800 14,300 572.00% SUPPLIES 25,276 42,152 39,860 (2,292) (5.44%)OPERATING 41,947 32,142 29,142 (3,000) (9.33%)OTHER COSTS 358 1,000 1,000 - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 1,279,689 $ 1,241,404 $ 1,073,815 (167,589)$ (13.50%)GENERAL FUND USE - - - - 0.00%

TOTAL AGENCY NET $ 179 $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




54

Breastfeeding Peer Counselor Program Breastfeeding Peer Counselor programs have proven to be successful in providing breastfeeding support and increasing initiation and duration rates. In an effort to increase breastfeeding initiation and duration rates in the WIC program, TCHD began a Breastfeeding Peer Counselor Program in April 2005. Each of the 10 WIC clinics has at least one designated breastfeeding peer counselor. Peer counselors are available to support pregnant and breastfeeding mothers 24 hours a day by phone, text, email or in person sessions. They teach breastfeeding classes, lead support groups, organize Facebook Live presentations, find community resources, and coordinate client care with WIC educators and dietitians. Peer counselors utilize an automated texting platform to send educational texts at regular intervals throughout the prenatal and postpartum periods and allows two-way texting between the peer counselors and program participants. Funding Source(s): Restricted Federal Funds

Division: 2 NUTRITION - BREASTFEEDING PEER COUNSELOR PROGRAM (226)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 192,513 221,226 221,226 - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 114,911 $ 127,102 $ 128,315 1,213 0.95% BENEFITS 27,741 36,832 32,656 (4,176) (11.34%)

Total Personnel $ 142,652 $ 163,934 $ 160,971 (2,963)$ (1.81%)CONTRACTS / SERVICES - - 9,412 9,412 0.00% TRAVEL 101 1,276 644 (632) (49.53%)SUPPLIES 89 580 380 (200) (34.48%)OPERATING 4,194 5,345 7,544 2,199 41.14% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 45,478 $ 52,932 $ 42,275 (10,657)$ (20.13%)GENERAL FUND USE - 2,841 - (2,841) (100.00%)

TOTAL AGENCY NET $ - $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




55

WIC Central Referral Pilot The Colorado WIC State Office at the Colorado Department of Public Health & Environment was awarded grant funding from The Colorado Health Foundation to pilot a centralized referral process. The pilot aims to improve and centralize processes for referrals from health care and community partners that screen for food insecurity to equitably maximize program access for eligible participants statewide. The State Office oversees the pilot and provides funding to the TCHD WIC Program to hire and supervise the WIC Engagement Specialist positions. This position will manage incoming WIC referrals for 8 local agencies: 1- TCHD (Westminster Clinic only) 2- Baca, 3- Clear Creek, 4- Larimer, 5- Northeast, 6- Otero, 7- Park, and 8- Summit. The Colorado WIC Program receives referrals from Colorado PEAK and WIC’s online referral form (www.ColoradoWICsignup.com). Referrals are routed by zip code to Local Agency Inboxes within the WIC Referral System (WRS) at www.healthinformatics.dphe.state.co.us - a secure, online database. The WIC Engagement Specialist call all referrals and will also implement and utilize a two-way texting platform to see if it increases responses from referrals. Funding Source: Restricted grant funds

http://www.healthinformatics.dphe.state.co.us/


56

Division: 2 NUTRITION - WIC CENTRAL REFERRAL SYSTEM (222)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 0 - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 81,839 - - - 0.00% OTHER GRANTS / CONTRACTS (0) 99,661 106,813 7,152 7.18% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 81,839 $ 99,661 $ 106,813 7,152$ 7.18%


EXPENDITURES:WAGES $ 49,536 $ 57,549 $ 63,559 6,010 10.44% BENEFITS 17,308 20,143 20,066 (77) (0.38%)

Total Personnel $ 66,844 $ 77,692 $ 83,625 5,933$ 7.64% CONTRACTS / SERVICES 2,406 7,669 7,201 (468) (6.10%)TRAVEL - - - - 0.00% SUPPLIES - - - - 0.00% OPERATING 2,019 2,550 2,550 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 10,570 $ 13,186 $ 13,437 251$ 1.90% GENERAL FUND USE - 1,436 - (1,436) (100.00%)

TOTAL AGENCY NET $ (0) $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




57

Hunger Free Colorado Outreach Program Currently, only 23% of TCHD WIC participants report receiving SNAP benefits compared with the state average of 30%. TCHD’s Nutrition Division has received funding from Hunger Free Colorado to cross train four WIC educators (2 FTE total) to assist individuals in completing SNAP applications. These WIC educators will provide remote and face-to-face SNAP application assistance at TCHD WIC offices, in grocery stores and, potentially in medical provider offices. TCHD’s goal for this one-year grant is to complete 636 SNAP applications. This project aligns with our Public Health Improvement Plan (PHIP) Food Access priority area to increase enrollment in Federal nutrition programs in Adams, Arapahoe and Douglas counties. Funding Sources: Restricted Grant Funds

Division: 2 NUTRITION - HUNGER FREE OUTREACH (238)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 102,458 105,037 159,803 54,766 52.14% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 86,102 $ 82,392 $ 128,323 45,931$ 55.75% CONTRACTS / SERVICES 332 3,985 7,964 3,979 99.85% TRAVEL 423 3,547 3,424 (123) (3.47%)SUPPLIES 110 1,042 1,042 - 0.00% OPERATING 3,719 4,523 4,523 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 9,035 $ 9,548 $ 14,527 4,979$ 52.15% GENERAL FUND USE - - - - 0.00%





58

DRCOG Accountable Health Communities (AHC) Health-related social needs (HRSNs) matter. Convincing data demonstrates that HRSNs, sometimes referred to as social determinants of health (SDOH), affect healthcare outcomes causing illness, suffering, premature death, and increased health care costs. HRSNs need to be addressed to improve individual outcomes and community health. The Denver Regional AHC is a regional network of health, community and public partners working to create a clinical-community continuum of care to better address individuals’ HRSNs. As part of a national effort funded by the Center for Medicare and Medicaid Innovation (CMMI), the Denver Regional AHC seeks to demonstrate the value and total cost savings of meeting HRSNs through community resources. By collecting regional data on identified HRSNs, services rendered, and corresponding health impacts, the AHC hopes to acquire the evidence base needed to inform future policy, allocation of funding and services to better address HRSNs and community health moving forward. TCHD is screening Medicaid and Medicare clients seen in our Nutrition programs for HRSNs (i.e., housing, food, utilities, transportation and safety needs). Clients are provided appropriate referrals and patient navigation services and will enter data into the AHC Portal for reimbursement. Funding Source: Restricted Grant Funds


59

Division: 2 NUTRITION - DRCOG ACH MODEL (242)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 39,334 164,015 59,000 (105,015) (64.03%)OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 39,334 $ 164,015 $ 59,000 (105,015)$ (64.03%)

FTE's 0.00 0.82 0.72 -0.10 (12.44%)Benefits as a Percentage of Wages 35.00% 35.00% 36.45%

EXPENDITURES:WAGES $ 21,558 $ 89,009 $ 30,150 (58,859) (66.13%)BENEFITS 7,546 31,154 10,989 (20,165) (64.73%)

Total Personnel $ 29,104 $ 120,163 $ 41,139 (79,024)$ (65.76%)CONTRACTS / SERVICES 131 600 - (600) (100.00%)TRAVEL 182 - - - 0.00% SUPPLIES 43 5,258 2,766 (2,492) (47.39%)OPERATING 1,190 500 - (500) (100.00%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) 3,855 - - - 0.00%

TOTAL DIRECT EXPENSES $ 34,504 $ 126,521 $ 43,905 (82,616)$ (65.30%)


TOTAL DIVISION EXPENDITURES $ 34,504 $ 126,521 $ 43,905 (82,616)$ (65.30%)

INDIRECT ALLOCATION $ 10,645 $ 37,494 $ 15,095 (22,399)$ (59.74%)GENERAL FUND USE - - - - 0.00%





60

Food Security This Adams County funding supports 1.0FTE and operational costs to coordinate and participate in multiple programs to increase access to food and improve coordination and systems. In 2020, the position helped to coordinate weekly produce boxes to 51 WIC families out of the North Broadway location; coordinate and market the TCHD Community Gardens; and help implement, coordinate and track data for the Healthy Farmer’s Markets in coordination with American Heart Association, Anythink Libraries, City of Thornton and Lulu’s Farms (including Adams County CARES dollars). This position is also helping with dual enrollment into WIC and SNAP through community hubs and begun work with local community colleges. The position will continue to coordinate across community based programs and aims to develop programming and services to reach community members who may be experiencing food insecurity. Funding Source: Restricted County Funds

Division: 2 NUTRITION - FOOD SECURITY (245)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 62,024 80,000 80,000 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 56,122 $ 71,697 $ 79,370 7,673$ 10.70% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 301 1,500 1,448 (52) (3.47%)SUPPLIES 5,000 1,650 - (1,650) (100.00%)OPERATING 601 1,350 - (1,350) (100.00%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - 3,803 (818) (4,621) (121.51%)

TOTAL DIRECT EXPENSES $ 62,024 $ 80,000 $ 80,000 -$ 0.00%


TOTAL DIVISION EXPENDITURES $ 62,024 $ 80,000 $ 80,000 -$ 0.00%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE - - - - 0.00%

TOTAL AGENCY NET $ 0 $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)




61

Division: 2 NUTRITION - ADMINISTRATION (290)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:




EXPENDITURES:WAGES $ 89,740 $ 117,166 $ 115,842 (1,324) (1.13%)BENEFITS 39,445 39,167 40,305 1,138 2.91%

Total Personnel $ 129,185 $ 156,333 $ 156,147 (186)$ (0.12%)CONTRACTS / SERVICES 7,404 1,150 1,150 - 0.00% TRAVEL 129 1,500 1,500 - 0.00% SUPPLIES 2,413 1,750 1,950 200 11.43% OPERATING 5,846 6,675 6,675 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 144,977 $ 167,408 $ 167,422 14$ 0.01%


TOTAL DIVISION EXPENDITURES $ 144,977 $ 167,408 $ 167,422 14$ 0.01%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE 156,093 167,408 167,422 14 0.01%





62



63

Community Health Promotion Division


64



65

COMMUNITY HEALTH PROMOTION DIVISION

Division: 3 COMMUNITY HEALTH PROMOTIONFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS 118,812 - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 32 - - - 0.00% STATE CONTRACTS 2,235,534 2,611,811 2,465,533 (146,278) (5.60%)FEDERAL PASS THRU FUNDS 669,476 514,047 974,143 460,096 89.50% OTHER GRANTS / CONTRACTS 188,906 222,276 245,384 23,108 10.40% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 1,568,878 $ 2,031,649 $ 2,037,153 5,504 0.27% BENEFITS 524,228 672,877 726,714 53,838 8.00%

Total Personnel $ 2,093,106 $ 2,704,526 $ 2,763,867 59,341$ 2.19% CONTRACTS / SERVICES 915,751 510,072 993,424 483,352 94.76% TRAVEL 7,278 52,718 40,613 (12,105) (22.96%)SUPPLIES 91,355 114,636 134,542 19,906 17.36% OPERATING 206,232 260,257 201,046 (59,212) (22.75%)OTHER COSTS 195 100 100 - 0.00% EQUIPMENT (Non-Capital) 7,492 2,200 3,000 800 36.36%




INDIRECT ALLOCATION $ 582,205 $ 697,968 $ 673,772 (24,196)$ (3.47%)GENERAL FUND USE 938,457 994,343 1,125,302 130,959 13.17%

TOTAL AGENCY NET $ 247,604 $ - $ (0) $ (0) 0.00%



66


67

Administration & General The leadership and administrative team provides oversight and support for planning, implementation, performance management and quality improvement of Community Health Promotion activities and programs. Additional responsibilities include financial oversight, grants and contracts management, ensuring adherence to agency policies and processes, administrative support, and advancing prioritized efforts to support the TCHD Strategic Plan and Public Health Improvement Plan. Funding Source(s): Required General Funds

Division: 3 COMMUNITY HEALTH PROMOTION-ADMINISTRATION & GENERAL (390)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 252,302 $ 296,745 $ 392,427 95,682$ 32.24% CONTRACTS / SERVICES 503 2,000 2,398 398 19.90% TRAVEL 34 500 483 (17) (3.40%)SUPPLIES 1,092 5,327 5,327 - 0.00% OPERATING 3,722 5,355 5,355 - 0.00% OTHER COSTS - 100 100 - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









68

Advancing Breastfeeding in Colorado The goal of this project is to transform communities to support health by reducing barriers to breastfeeding and promoting breastfeeding-friendly environments. This initiative is part of a regional collaborative funded through CDPHE’s Cancer Cardiovascular and Pulmonary Disease Grant Program. Partners include Denver, Jefferson County, Boulder County, and Tri-County health departments. The program’s target settings are childcare providers and medical offices that serve low-income families. Team members collaborate closely with staff working under TCHD’s CCPD-funded worksite wellness initiative. Existing coalitions, developed under the worksite wellness initiative, are leveraged to support and facilitate the objectives of the breastfeeding initiative. The Colorado Health Institute serves as regional fiscal manager. Funding Sources: Restricted State Funds

Division: 3FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - 137,839 138,932 1,093 0.79% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 91,084 - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 41,753 $ 66,618 $ 79,796 13,178 19.78% BENEFITS 14,614 23,316 19,854 (3,462) (14.85%)

Total Personnel $ 56,366 $ 89,934 $ 99,650 9,716$ 10.80% CONTRACTS / SERVICES 3,263 8,192 - (8,192) (100.00%)TRAVEL 29 1,629 311 (1,318) (80.91%)SUPPLIES 3,049 5,167 3,427 (1,741) (33.68%)OPERATING 7,615 1,488 - (1,488) (100.00%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%





TOTAL AGENCY NET $ 20 $ - $ (0) $ (0) 0.00% (Revenue minus Expenses & Allocations)


COMMUNITY HEALTH PROMOTION-ADVANCING BREASTFEEDING IN COLORADO (338) Increase / (Decrease)


69

Tobacco Education and Prevention Tobacco Education and Prevention Partnership team members focus on evidence-based policy, systems, and environmental change strategies as well as community engagement and education for decreasing youth and adult tobacco and nicotine use. Efforts focus on policy changes to prevent youth access to and initiation of nicotine products and the elimination of secondhand smoke and nicotine aerosol exposure. Staff work through strategic partnerships to promote smoking cessation among target populations and support school districts, public housing authorities, detention facilities, youth-serving organizations, healthcare providers, and municipal governments and other community agencies. In addition, staff collaborate with and help coordinate agency-wide chronic disease and injury prevention activities through multi divisional work groups. They also continually seek to build and nurture partnerships with community organizations that promote chronic disease, injury, and tobacco prevention. Funding Source(s): Restricted State Grant Funds, Required General Funds

Division: 3

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 969,649 1,318,077 1,318,075 (2) (0.00%)FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 969,649 $ 1,318,077 $ 1,318,075 (2)$ (0.00%)



Total Personnel $ 361,760 $ 617,759 $ 617,474 (285)$ (0.05%)CONTRACTS / SERVICES 239,720 142,356 241,377 99,021 69.56% TRAVEL 1,482 14,094 11,303 (2,791) (19.80%)SUPPLIES 27,440 40,800 34,300 (6,500) (15.93%)OPERATING 157,937 201,446 155,174 (46,272) (22.97%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - 2,200 3,000 800 36.36%

TOTAL DIRECT EXPENSES $ 788,339 $ 1,018,655 $ 1,062,628 43,973$ 4.32%


TOTAL DIVISION EXPENDITURES $ 788,339 $ 1,018,655 $ 1,062,628 43,973$ 4.32%




Increase / (Decrease)COMMUNITY HEALTH PROMOTION- TOBACCO EDUCATION AND PREVENTION (351)


70

Community Nutrition—Policy and Systems Change Through Advocacy and Education Staff collaborate with early childhood, school district, and workplace partners to promote sustainable, evidence-based healthy eating and active living policies and practices. Technical assistance is provided to assist organizations with assessing current practices, adopting and implementing long-term changes, and connecting with additional resources to meet identified needs, which leverages and extends grant-funded efforts. Education includes coordination of TCHD participation in community events, provision of train-the-trainer sessions, and production of communication tools and educational materials that increase TCHD’s visibility and provide value to partners. Registered dietitians bring a public health lens to community organization boards and committees, actively collaborate on Healthy Eating and Active Living messaging campaigns, and provide data and subject matter expertise to inform public policy and proposed regulations. Examples include serving on early childhood councils, school wellness committees, chamber of commerce committees, parks and recreation collaboratives, and other community coalitions. Staff convene external partners and internal cross-program workgroups to enhance planning and coordination of TCHD’s advocacy and education with childcare and school sectors. Funding Source(s): Required General Funds


71


FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 203,024 $ 406,503 $ 435,513 29,010$ 7.14% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 486 2,748 2,682 (66) (2.40%)SUPPLIES - 1,800 1,600 (200) (11.11%)OPERATING 2,137 4,900 5,150 250 5.10% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







COMMUNITY HEALTH PROMOTION-COMMUNITY NUTRITION (335) Increase / (Decrease)


72

Diabetes Education Program The Diabetes Education Program has implemented programming with funding through CDPHE’s Cancer, Cardiovascular, and Chronic Pulmonary Disease Grants Program since 2015. TCHD partners with primary care practices, community based organizations, recreational centers, businesses, and churches to outreach, recruit, and offer Diabetes Self-Management Education (DSME) and the Centers for Disease Control and Prevention’s evidenced based National Diabetes Prevention Program (NDPP) – Journey to Wellness. TCHD is a recognized DSME site with the American Diabetes Association and has full recognition for the NDPP through CDC indicating attainment of all program benchmarks and provision of evidenced based education to the community. Residents in the prioritized neighborhood clusters of southwest Adams County and northwest Aurora experience higher diabetes burden and health inequities. The program also screens for food security and housing barriers, and assists clients with navigating the health system. Program staff conduct outreach to educate the public on the importance of NDPP and DSME and to enroll eligible clients, including through targeted outreach to eligible WIC clients. TCHD has increased access to the Spanish-speaking community by providing the NDPP in Spanish and connects clients with resources and information on navigating the health system. This program work supports the Food and Health priority in the TCHD Public Health Improvement Plan. Funding Source: Restricted State Funds


73


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 261,704 335,000 344,000 9,000 2.69% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 187,278 $ 223,057 $ 174,983 (48,074)$ (21.55%)CONTRACTS / SERVICES 1,890 6,680 20,352 13,672 204.67% TRAVEL 1,454 7,162 1,663 (5,499) (76.78%)SUPPLIES 3,407 6,846 67,902 61,056 891.85% OPERATING 6,047 8,063 8,141 78 0.97% OTHER COSTS 106 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%





TOTAL AGENCY NET $ (366) $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)


COMMUNITY HEALTH PROMOTION-DIABETES PREVENTION (337) Increase / (Decrease)


74

Healthy Beverage Initiative The Healthy Beverage Partnership (HBP) has conducted efforts with funding through CDPHE’s Cancer, Cardiovascular, and Chronic Pulmonary Disease grants program since 2015. TCHD is one of four metro area public health agencies collaborating regionally as the HBP to increase access to healthy food and beverages and to decrease consumption of unhealthy food and beverages. Sugary drinks are the largest source of added sugar in the U.S. diet and the single largest contributor to daily caloric intake, contributing to type 2 diabetes, obesity, heart disease, and tooth decay. Health implications of sugary drinks disproportionately impact low-income communities and people of color. HBP is building on the organizational policy work and Hidden Sugar media campaign by increasing community knowledge and capacity around municipal policy change supporting healthy restaurant children’s meals. This program advances goals of the Food and Health priority of the TCHD Public Health Improvement Plan. Funding Source(s): Restricted State Funds


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 40,132 53,395 56,503 3,108 5.82% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 31,350 $ 42,046 $ 47,744 5,698$ 13.55% CONTRACTS / SERVICES 2,900 300 - (300) (100.00%)TRAVEL 229 2,132 - (2,132) (100.00%)SUPPLIES 1,187 2,669 2,722 53 1.99% OPERATING 817 1,394 900 (494) (35.44%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 3,648 $ 4,854 $ 5,137 283$ 5.83% GENERAL FUND USE - - - - 0.00%

TOTAL AGENCY NET $ - $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)


COMMUNITY HEALTH PROMOTION-HEALTHY BEVERAGE INITIATIVE (336) Increase / (Decrease)


75

Maternal and Child Health (MCH) Block Grant Child and Adolescent Health TCHD leverages funding from the Maternal and Child Health Block Grant to support a variety of efforts focused on improving child and adolescent health. Work in this area includes a focus on early childhood developmental screening and referral and reducing bullying and suicide in youth. TCHD staff work with partners across the early childhood and youth systems in all three counties to identify gaps, and improve and align support and services, for children, youth and families. The majority of the program is supported financially by the Federal Maternal Child Health Block grant (Title V), administered by CDPHE. This program work supports the Mental Health priority in the TCHD Public Health Improvement Plan. Funding Source(s): Restricted Federal Funds, Restricted State Funds Medical Home for Children and Youth with Special Healthcare Needs TCHD leverages funding from the Maternal and Child Health Block Grant to support efforts aimed at improving access to and coordination across medical care and community resources for children and youth with special healthcare needs. TCHD staff work with partners across the system of care for children and youth to remove barriers to quality care. The majority of the program is supported financially by the Federal Maternal Child Health Block grant (Title V), administered by CDPHE. Funding Sources: Restricted Federal Funds, Restricted State Funds Perinatal Health TCHD leverages funding from the Maternal and Child Health Block Grant to support initiatives to improve the health of women of reproductive age. Current priorities include increasing identification, screening and referrals for women experiencing maternal mood disorders, increasing support and services for women who misuse substances in the perinatal period and decreasing the disparity of infant mortality. The majority of the program is supported financially by the Federal Maternal Child Health Block grant (Title V), administered by CDPHE. This program work supports the Mental Health priority in the TCHD Public Health Improvement plan. Funding Source(s): Restricted Federal Funds, Restricted State Funds


76

Division: 3 COMMUNITY HEALTH PROMOTION-MCH (375)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 34,510 157,743 457,231 299,488 189.86% FEDERAL PASS THRU FUNDS 669,476 514,047 849,143 335,096 65.19% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 703,986 $ 671,790 $ 1,306,374 634,584$ 94.46%



Total Personnel $ 468,288 $ 482,682 $ 499,790 17,108$ 3.54% CONTRACTS / SERVICES 115,654 14,995 550,436 535,441 3570.80% TRAVEL 1,612 8,584 5,156 (3,428) (39.93%)SUPPLIES 881 4,242 4,700 458 10.80% OPERATING 7,240 4,984 11,930 6,946 139.37% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) 7,492 - - - 0.00%

TOTAL DIRECT EXPENSES $ 601,166 $ 515,487 $ 1,072,012 556,525$ 107.96%


TOTAL DIVISION EXPENDITURES $ 601,166 $ 515,487 $ 1,072,012 556,525$ 107.96%






77

Substance Use Prevention At the request of the County Commissioners, TCHD facilitates the Tri-County Overdose Prevention Partnership (TCOPP), comprised of partners across the three counties coming together to address opiate use, prevent initial use, reduce and prevent deaths, and provide for a supportive community. This partnership looks at multiple levels of prevention including intervention and treatment. TCHD supports a community coalition facilitated by Douglas County Schools utilizing SAMHSA’s Strategic Prevention Framework to assess the community, plan evidence-based interventions, and evaluate success. TCHD also administers a grant to work with community coalitions in Western Arapahoe County and along the I-70 Corridor using the Communities That Care model with the goal of reducing youth use, misuse, and abuse of substances. This program work supports the Mental Health and Access to Care priorities of the TCHD Public Health Improvement Plan. Funding Source(s): General Funds, Restricted State Grant Funds, Restricted Federal Funds

Division: 3

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 722,724 362,852 207,295 (155,557) (42.87%)FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 3,226 - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 268,358 $ 198,798 $ 191,718 (7,080) (3.56%)BENEFITS 90,963 69,579 69,881 302 0.43%

Total Personnel $ 359,321 $ 268,377 $ 261,599 (6,778)$ (2.53%)CONTRACTS / SERVICES 315,495 166,992 16,950 (150,042) (89.85%)TRAVEL 1,669 8,765 8,678 (87) (0.99%)SUPPLIES 17,070 2,400 12,384 9,984 416.00% OPERATING 9,922 17,177 2,190 (14,987) (87.25%)OTHER COSTS 89 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 102,181 $ 46,850 $ 48,801 1,951$ 4.16% GENERAL FUND USE 98,824 147,709 143,307 (4,402) (2.98%)



Increase / (Decrease)COMMUNITY HEALTH PROMOTION-MENTAL/BEHAVIORAL HEALTH PROMOTION, SUBSTANCE USE PREVENTION (354, 355, 357, 359, 330-334, 330-339)


78


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS 118,812 - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - 168,881 168,881 - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 10,563 $ 20,362 $ 21,312 950 4.67% BENEFITS 3,697 7,127 7,769 642 9.01%

Total Personnel $ 14,260 $ 27,489 $ 29,081 1,592$ 5.79% CONTRACTS / SERVICES 100,212 126,428 126,918 490 0.39% TRAVEL 142 2,493 2,788 295 11.83% SUPPLIES 484 1,700 1,700 - 0.00% OPERATING 2,023 3,650 1,355 (2,295) (62.88%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 1,691 $ 7,121 $ 7,039 (82)$ (1.15%)GENERAL FUND USE - - - - 0.00%



COMMUNITY HEALTH PROMOTION-SAMSHA GRANT (356) Increase / (Decrease)


79

Worksite Wellness TCHD enhances worksite policies and practices through outreach to local and regional employers with funding provided by CDPHE’s Cancer Cardiovascular and Pulmonary Disease Grant Program. Through active facilitation of five coalitions, TCHD provides training, technical advising and financial opportunities to support employers in the process of implementing breastfeeding and healthy food and beverage-friendly policies and programs. Project partners include local chambers of commerce, the American Heart Association, Kaiser Permanente, Aetna, Health Links, and many other local and regional stakeholders. Coalitions include public and private employers from the greater Metro area including Jefferson, Boulder, Broomfield, and Denver counties. Funding Sources: Restricted State Funds


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 246,946 300,300 - (300,300) (100.00%)FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 246,946 $ 300,300 $ - (300,300)$ (100.00%)


EXPENDITURES:WAGES $ 86,154 $ 118,808 $ - (118,808) (100.00%)BENEFITS 30,154 41,583 - (41,583) (100.00%)

Total Personnel $ 116,308 $ 160,391 $ - (160,391)$ (100.00%)CONTRACTS / SERVICES 36,050 11,016 - (11,016) (100.00%)TRAVEL 86 4,611 - (4,611) (100.00%)SUPPLIES 36,636 43,685 - (43,685) (100.00%)OPERATING 7,243 11,800 - (11,800) (100.00%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 196,323 $ 231,503 $ - (231,503)$ (100.00%)


TOTAL DIVISION EXPENDITURES $ 196,323 $ 231,503 $ - (231,503)$ (100.00%)

INDIRECT ALLOCATION $ 52,932 $ 68,797 $ - (68,797)$ (100.00%)GENERAL FUND USE - - - - 0.00%



COMMUNITY HEALTH PROMOTION-CCPD WORKSITE WELLNESS (332) Increase / (Decrease)


80

Mental Health Promotion and Suicide Prevention TCHD will serve as a convener and backbone to collective work where appropriate, uniting efforts across sectors to implement the TCHD-area Mental Health Promotion Framework and the TCHD-area Suicide Prevention Framework. Staff will assess and communicate community needs, gaps, and solutions; share data, trends, and evidence-based practices; and lead identification of barriers and implementation of effective strategies. A priority will be placed on reducing stigma; increasing access to and utilization of services; and building capacity within other sectors, including school districts. Throughout implementation, community members will influence the work and strategies will aim to reduce inequities. Funding Source(s): General Funds


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00%

z MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 15,336 $ 89,543 $ 115,797 26,254$ 29.32% CONTRACTS / SERVICES 90,430 31,113 7,100 (24,013) (77.18%)TRAVEL - - 500 500 0.00% SUPPLIES - - - - 0.00% OPERATING - - 7,563 7,563 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







COMMUNITY HEALTH PROMOTION-MENTAL HEALTH PROGRAM (358) Increase / (Decrease)


81



82

Nursing Division


83



84

NURSING DIVISION

Division: 4 NURSING DIVISIONFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 1,909,750 2,728,053 2,756,810 28,757 1.05% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS 242,304 489,991 429,309 (60,682) (12.38%)FEES 270,827 463,513 464,788 1,275 0.28% STATE CONTRACTS 5,401,545 5,953,247 4,722,011 (1,231,236) (20.68%)FEDERAL PASS THRU FUNDS 2,480,770 4,586,127 $ 3,255,022 (1,331,105) (29.02%)OTHER GRANTS / CONTRACTS 158,078 117,664 83,216 (34,448) (29.28%)OTHER REVENUE 674 - - - 0.00% FUND BALANCE USE - 73,755 - (73,755) (100.00%)IN-KIND REVENUE 726,465 1,136,000 1,136,000 - 0.00%

TOTAL DIVISION REVENUE $ 11,190,411 $ 15,548,350 $ 12,847,156 (2,701,194)$ (17.37%)


EXPENDITURES:WAGES $ 7,582,635 $ 10,905,020 $ 9,909,368 (995,652) (9.13%)BENEFITS 2,670,288 3,758,158 3,521,577 (236,581) (6.30%)

Total Personnel $ 10,252,922 $ 14,663,178 $ 13,430,945 (1,232,233)$ (8.40%)CONTRACTS / SERVICES 589,959 1,701,369 551,150 (1,150,219) (67.61%)TRAVEL 72,172 280,000 243,303 (36,697) (13.11%)SUPPLIES 421,938 939,178 650,885 (288,293) (30.70%)OPERATING 218,014 253,416 307,815 54,399 21.47% OTHER COSTS 7,695 29,093 9,441 (19,652) (67.55%)EQUIPMENT (Non-Capital) 149,229 4,000 16,830 12,830 320.75%

TOTAL DIRECT EXPENSES $ 11,711,929 $ 17,870,234 $ 15,210,369 (2,659,865)$ (14.88%)

CAPITAL & LEASEHOLD IMPROVEMENTS $ 51,438 $ - $ - -$ 0.00% IN-KIND EXPENSE 726,465 1,136,000 1,136,000 - 0.00%

TOTAL DIVISION EXPENDITURES $ 12,489,832 $ 19,006,234 $ 16,346,369 (2,659,865)$ (13.99%)

INDIRECT ALLOCATION $ 1,636,926 $ 1,869,921 $ 1,988,362 118,441$ 6.33% GENERAL FUND USE 4,894,518 5,327,805 5,487,575 159,770 3.00%

TOTAL AGENCY NET $ 1,958,171 $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




85


86

Division Operations This core leadership team is responsible for oversight, planning, implementation, and evaluation of all nursing activities and programs. This division operations team is also responsible for financial oversight, data collection and management, grant and contract management, and program evaluation. This team also assists with quality assurance and improvement processes. Funding Source(s): Required General Funds

Division: 4 NURSING - DIVISION OPERATIONS (490)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - 73,755 - (73,755) (100.00%)IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ - $ 73,755 $ - (73,755)$ (100.00%)



Total Personnel $ 919,802 $ 1,063,855 $ 1,105,062 41,207$ 3.87% CONTRACTS / SERVICES 6,809 88,755 15,000 (73,755) (83.10%)TRAVEL 2,197 13,000 12,759 (241) (1.85%)SUPPLIES 11,754 17,700 17,700 - 0.00% OPERATING 67,566 93,271 121,275 28,004 30.02% OTHER COSTS 6,569 7,641 7,641 - 0.00% EQUIPMENT (Non-Capital) 1,690 - - - 0.00%

TOTAL DIRECT EXPENSES $ 1,016,386 $ 1,284,222 $ 1,279,437 (4,785)$ (0.37%)


TOTAL DIVISION EXPENDITURES $ 1,016,386 $ 1,284,222 $ 1,279,437 (4,785)$ (0.37%)






87

Arapahoe County Senior Dental Program The Senior Dental program provides preventative, some restorative, and maintenance dental services to income-eligible seniors residing in Arapahoe County. Qualifying adults over 55 can receive care on a sliding fee scale with the majority of funding provided by Arapahoe County. Routine dental care improves the quality of life, general health, and well-being for senior citizens. Funding Source(s): Fees, Restricted County Funds, Restricted State Funds, Medicaid Reimbursement

Division: 4 NURSING - ARAPAHOE COUNTY SENIOR DENTAL (495)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 304,294 311,943 311,943 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS 13,953 30,000 30,000 - 0.00% FEES 70,953 101,513 101,509 (4) (0.00%)STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 68,000 - 3,000 3,000 0.00% OTHER REVENUE 674 - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 334,958 $ 336,476 $ 348,452 11,976$ 3.56% CONTRACTS / SERVICES 28,135 45,435 42,935 (2,500) (5.50%)TRAVEL 261 895 1,133 238 26.59% SUPPLIES 15,562 38,533 28,672 (9,861) (25.59%)OPERATING 5,017 1,000 1,000 - 0.00% OTHER COSTS 87 - - - 0.00% EQUIPMENT (Non-Capital) 54,653 - 3,000 3,000 0.00%


CAPITAL & LEASEHOLD IMPROVEMENTS $ 35,313 $ - $ - -$ 0.00% IN-KIND EXPENSE - - - - 0.00%







88

Nurse Home Visiting Program – Adams County Nurse Support Contract Programs This program is a longstanding contract with the Adams County Human Services Department (ACHSD). ACHSD recognizes that public health nursing intervention can result in improved pregnancy outcomes, parenting knowledge, and enhanced self-sufficiency for families receiving benefits or involved with child welfare. Funding Source(s): Restricted County Funds.

Division: 4 NURSING - ADAMS COUNTY NURSE SUPPORT CONTRACT PROGRAMS (420, 428)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 501,366 913,222 939,092 25,870 2.83% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 456,397 $ 867,488 $ 847,457 (20,031)$ (2.31%)CONTRACTS / SERVICES 62 23 2,200 2,177 9465.22% TRAVEL 7,839 21,035 21,914 879 4.18% SUPPLIES 6,051 5,073 7,450 2,377 46.86% OPERATING 5,231 10,707 10,282 (425) (3.97%)OTHER COSTS 203 - - - 0.00% EQUIPMENT (Non-Capital) 1,690 - 5,070 5,070 0.00%




INDIRECT ALLOCATION $ 23,483 $ 46,051 $ 44,719 (1,332)$ (2.89%)GENERAL FUND USE - 37,155 - (37,155) (100.00%)





89

Nurse Home Visiting Program – Arapahoe County Nurse Support Contract Programs The Arapahoe County Department of Human Services (ACDHS) recognizes that public health nursing intervention can result in improved pregnancy outcomes, parenting knowledge, and enhanced family self-sufficiency. The County also provides funds for public health nurses to work with child and adult welfare units, to provide professional assessments, and to act as liaison for families referred to human services. Funding Source(s): Restricted County Funds

Division: 4 NURSING - ARAPAHOE COUNTY NURSE SUPPORT CONTRACT PROGRAMS (424, 426)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 942,048 1,282,556 1,288,341 5,785 0.45% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 942,048 $ 1,282,556 $ 1,288,341 5,785$ 0.45%



Total Personnel $ 822,418 $ 1,152,527 $ 1,159,678 7,151$ 0.62% CONTRACTS / SERVICES 3,346 1,039 5,636 4,597 442.44% TRAVEL 7,966 28,976 25,070 (3,906) (13.48%)SUPPLIES 3,129 23,464 12,908 (10,556) (44.99%)OPERATING 12,844 15,476 16,440 964 6.23% OTHER COSTS 369 - 500 500 0.00% EQUIPMENT (Non-Capital) 3,617 - 6,760 6,760 0.00%









90

Nurse Home Visiting Program – Douglas County Mothers First Program This program is the result of a new contract with the Douglas County Department of Human Services (DCDHS) to provide public health nursing intervention resulting in supporting and helping families stay together, prevention of out-of-home placements, reduction of unintended pregnancies, and provisioning of prenatal education and psychosocial support for pregnant women and their families Funding Source(s): Restricted County Funds

Division: 4 NURSING - DOUGLAS MOTHERS FIRST PROGRAM (427)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 85,676 143,967 141,069 (2,898) (2.01%)FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 54,953 $ 99,101 $ 95,603 (3,498) (3.53%)BENEFITS 23,278 34,685 34,848 163 0.47%

Total Personnel $ 78,231 $ 133,786 $ 130,451 (3,335)$ (2.49%)CONTRACTS / SERVICES 160 - 200 200 0.00% TRAVEL 940 1,499 2,000 501 33.42% SUPPLIES 570 1,000 500 (500) (50.00%)OPERATING 490 826 1,200 374 45.28% OTHER COSTS 136 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 4,026 $ 6,856 $ 6,718 (138)$ (2.01%)GENERAL FUND USE - - - - 0.00%





91

Child Fatality Prevention Review The Child Fatality Prevention Review program works with community partners, law enforcement and county officials in all three counties to facilitate case reviews of all preventable child deaths. The goal of each county review team is to improve the health and safety of children by examining individual fatalities, exploring fatality trends and documenting population-based recommendations. Funding Source(s): Restricted State Funds, Required General Funds

Division: 4 NURSING - CHILD FATALITY PREVENTION REVIEW (425)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 58,250 64,000 55,700 (8,300) (12.97%)FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 46,351 $ 48,052 $ 47,921 (131) (0.27%)BENEFITS 16,223 16,818 17,467 649 3.86%

Total Personnel $ 62,574 $ 64,870 $ 65,388 518$ 0.80% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 88 814 704 (110) (13.51%)SUPPLIES 271 400 400 - 0.00% OPERATING 395 900 550 (350) (38.89%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 19,587 $ - $ - -$ 0.00% GENERAL FUND USE 7,553 2,984 11,342 8,358 280.09%





92

Nurse Home Visiting Program – Nurse Family Partnership The Nurse Family Partnership is a research-based primary prevention nursing case management program targeting first time, low-income women. The program begins home visits during the client’s pregnancy. The mom and baby receive home visits weekly or bi-monthly until the child’s second birthday. The goal of the program is to improve pregnancy outcomes, enhance family interactions, expand parenting skills, and increase parental self-sufficiency. Another long-term goal of the program is to limit the time that families receive entitlement family support or welfare programs. Funding Source(s): Restricted Federal Funds, Restricted State Funds, Medicaid Reimbursement

Division: 4 NURSING - NURSE FAMILY PARTNERSHIP (455, 457)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS 5,970 17,806 17,806 - 0.00% FEES (0) - - - 0.00% STATE CONTRACTS 2,852,148 3,185,906 3,373,311 187,405 5.88% FEDERAL PASS THRU FUNDS 753,872 916,801 969,116 52,315 5.71% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 2,762,526 $ 3,137,204 $ 3,249,187 111,983$ 3.57% CONTRACTS / SERVICES 54,991 51,698 107,573 55,875 108.08% TRAVEL 18,949 108,058 91,725 (16,333) (15.12%)SUPPLIES 34,229 55,724 59,425 3,701 6.64% OPERATING 44,318 38,940 83,197 44,257 113.65% OTHER COSTS 134 800 800 - 0.00% EQUIPMENT (Non-Capital) 57,430 4,000 2,000 (2,000) (50.00%)





TOTAL AGENCY NET $ (904) $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




93

Public Health Nursing Clinical Education TCHD’s Public Health Nursing Clinical Education Program is primarily responsible for providing a wide variety of clinical education to nursing students and assisting in the coordination of professional development for division staff. This program leads student placements for contracted schools of nursing, provides latent tuberculosis case management to referred clients, coordinates ancillary nursing student placements, and participates on internal work groups including the Disease Intervention Field Team and the Public Health Incident Management Team. Funding Sources: Restricted Contracts, Required General Funds

Division: 4 NURSING - PUBLIC HEALTH NURSING CLINICAL EDUCATION (411, 415)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 2,100 2,100 2,100 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 35,614 65,664 54,216 (11,448) (17.43%)OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 34,583 $ 64,143 $ 52,847 (11,296)$ (17.61%)CONTRACTS / SERVICES 285,811 285,811 285,811 - 0.00% TRAVEL 86 420 266 (154) (36.67%)SUPPLIES - 273 275 2 0.73% OPERATING 944 828 828 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE 286,592 283,711 283,711 - 0.00%





94

Disease Prevention and Clinical Services Program – Harm Reduction and HIV Prevention Program This program focuses on the prevention and education of Human Immunodeficiency Virus (HIV), Hepatitis C Virus, and sexually transmitted illnesses (STI). Providers in this program focus on individual screening, community education, and outreach to individuals affected by these infections. Linkage to care services are provided for individuals who have been newly diagnosed or have fallen out of HIV care. The Aurora Syringe Access Services provide sterile syringes, safe injection supplies, wound care education, and Naloxone for individuals that use intravenous drugs who are at risk for HIV and Hepatitis C infection and overdose death. Funding Source(s): Restricted Federal Funds, Restricted State Funds, Required General Funds

Division: 4 NURSING - HARM REDUCTION AND HIV PREVENTION PROGRAM (469)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS 248,471 277,618 193,000 (84,618) (30.48%)FEDERAL PASS THRU FUNDS 317,780 487,073 600,184 113,111 23.22% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 388,118 $ 559,751 $ 586,725 26,974$ 4.82% CONTRACTS / SERVICES 31,608 27,951 1,440 (26,511) (94.85%)TRAVEL 5,739 13,969 8,127 (5,842) (41.82%)SUPPLIES 29,800 18,105 20,583 2,478 13.69% OPERATING 5,599 10,832 9,542 (1,290) (11.91%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









95

Disease Prevention and Clinical Services Program – Immunization and Clinical Outbreak Response This program provides immunizations to individual of all ages to protect them from vaccine-preventable diseases. Immunizations are available every weekday and one Saturday per month. Clinics are held in TCHD offices and at community-based sites around the three-county region and appointments are coordinated through our Patient Services Call Center. The immunization program targets persons who are uninsured or underinsured. There is no residency or income requirement; although a $22 administration fee is requested for each immunization, nobody is turned away for inability to pay. Funding Source(s): Restricted Federal Funds, Restricted State Funds, Required General Funds, Medicaid Reimbursement, Patient Fees, Patient Donations, Private Insurance Billing

Division: 4 NURSING - IMMUNIZATION AND CLINICAL OUTBREAK RESPONSE (460, 461)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS 122,133 175,000 190,000 15,000 8.57% FEES 116,055 175,000 175,000 - 0.00% STATE CONTRACTS 689,836 2,045,679 600,000 (1,445,679) (70.67%)FEDERAL PASS THRU FUNDS 693,401 1,846,914 572,323 (1,274,591) (69.01%)OTHER GRANTS / CONTRACTS (43,606) - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE 673,345 1,040,000 1,040,000 - 0.00%



EXPENDITURES:WAGES $ 947,585 $ 2,637,726 $ 1,502,759 (1,134,967) (43.03%)BENEFITS 332,754 913,638 543,671 (369,967) (40.49%)

Total Personnel $ 1,280,338 $ 3,551,364 $ 2,046,430 (1,504,934)$ (42.38%)CONTRACTS / SERVICES 106,150 1,090,579 6,500 (1,084,079) (99.40%)TRAVEL 11,810 43,026 37,848 (5,178) (12.03%)SUPPLIES 162,885 351,124 199,133 (151,991) (43.29%)OPERATING 35,229 33,997 22,200 (11,797) (34.70%)OTHER COSTS - 20,452 300 (20,152) (98.53%)EQUIPMENT (Non-Capital) 17,977 - - - 0.00%


CAPITAL & LEASEHOLD IMPROVEMENTS $ 16,125 $ - $ - -$ 0.00% IN-KIND EXPENSE 673,345 1,040,000 1,040,000 - 0.00%


INDIRECT ALLOCATION $ 328,929 $ 324,107 $ 393,311 69,204$ 21.35% GENERAL FUND USE 1,116,360 1,172,056 1,168,399 (3,657) (0.31%)





96

Access to Healthcare Program – Health Enrollment Team The Health Enrollment (HE) Team works to improve access for children and pregnant women enrolled in Health First Colorado, Colorado’s Medicaid Program, and Child Health Plan Plus (CHP+). The HE program directly aligns with TCHD’s strategic goal to increase interactions with the health care delivery system. Funding Source(s): Restricted Federal Funds, Restricted State Funds, Required General Funds, Medicaid Reimbursement Access to Healthcare Program – Regional Health Connectors The goal of the Regional Health Connectors (RHC) Program is to improve health in communities by connecting the systems that keep communities healthy- including primary care, public health, social services and other community resources. The RHC program supports TCHD’s strategic goals by interacting directly with primary care providers and with clinical Quality Improvement teams. Funding Source(s): Required General Funds


97

Division: 4 NURSING - HEALTH ENROLLMENT TEAM AND REGIONAL HEALTH CONNECTIONS (440-999,450, 451)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 5 - - - 0.00% STATE CONTRACTS 579,817 - - - 0.00% FEDERAL PASS THRU FUNDS 283,610 637,577 613,399 (24,178) (3.79%)OTHER GRANTS / CONTRACTS 99,300 52,000 26,000 (26,000) (50.00%)OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:

WAGES $ 614,544 $ 733,484 $ 777,247 43,763 5.97% BENEFITS 217,573 256,635 283,307 26,672 10.39%

Total Personnel $ 832,117 $ 990,119 $ 1,060,554 70,435$ 7.11% CONTRACTS / SERVICES 19,579 17,178 17,040 (138) (0.80%)TRAVEL - 12,408 12,650 242 1.95% SUPPLIES 3,638 1,739 1,744 5 0.29% OPERATING 12,787 15,589 11,557 (4,032) (25.86%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) 10,862 - - - 0.00%




INDIRECT ALLOCATION $ 129,415 $ 149,713 $ 155,906 6,193$ 4.14% GENERAL FUND USE 395,441 497,169 620,052 122,883 24.72%





98

Disease Prevention and Clinical Services Program – Sexual Health The goal of this program is to provide sexual health services and prevent unintended pregnancies. The Sexual Health program sees women and men and targets at-risk populations, including those who are under-served, low-income and adolescents. The program offers reproductive health exams, contraceptive counseling and supplies, cervical cancer screening, pregnancy testing, HIV testing and sexually transmitted infection (STI) testing and treatment. The program also offers pre-conception counseling for clients planning a pregnancy. Annually this program also helps to educate thousands of high school students within our community about sexual health. Funding Source(s): Restricted Federal Funds, Restricted State Funds, Required General Funds, Medicaid Reimbursement, Patient Fees, Patient Donation

Division: 4 NURSING - SEXUAL HEALTH (477)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 74,265 74,265 74,265 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS 100,248 267,185 191,503 (75,682) (28.33%)FEES 83,814 187,000 188,279 1,279 0.68% STATE CONTRACTS 705,491 380,044 500,000 119,956 31.56% FEDERAL PASS THRU FUNDS 432,107 697,762 500,000 (197,762) (28.34%)OTHER GRANTS / CONTRACTS (1,231) - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE 53,120 96,000 96,000 - 0.00%

TOTAL DIVISION REVENUE $ 1,447,815 $ 1,702,256 $ 1,550,047 (152,209)$ (8.94%)


EXPENDITURES:WAGES $ 1,563,631 $ 2,061,545 $ 2,056,323 (5,222) (0.25%)BENEFITS 542,619 680,050 722,391 42,341 6.23%

Total Personnel $ 2,106,251 $ 2,741,595 $ 2,778,714 37,119$ 1.35% CONTRACTS / SERVICES 30,811 92,900 66,815 (26,085) (28.08%)TRAVEL 11,808 35,900 29,107 (6,793) (18.92%)SUPPLIES 149,519 426,043 302,095 (123,948) (29.09%)OPERATING 23,568 31,050 29,744 (1,306) (4.21%)OTHER COSTS 199 200 200 - 0.00% EQUIPMENT (Non-Capital) 1,310 - - - 0.00%

TOTAL DIRECT EXPENSES $ 2,323,466 $ 3,327,688 $ 3,206,675 (121,013)$ (3.64%)

CAPITAL & LEASEHOLD IMPROVEMENTS $ - $ - $ - -$ 0.00% IN-KIND EXPENSE 53,120 96,000 96,000 - 0.00%

TOTAL DIVISION EXPENDITURES $ 2,376,586 $ 3,423,688 $ 3,302,675 (121,013)$ (3.53%)

INDIRECT ALLOCATION $ 268,448 $ 402,831 $ 372,006 (30,825)$ (7.65%)GENERAL FUND USE 2,048,353 2,124,263 2,124,634 371 0.02%





99

Emergency Preparedness, Response, and Communicable Disease Surveillance Division


100



101

EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICABLE DISEASE SURVEILLANCE DIVISION

Division: 5 EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCEFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 28,500 - 15,872,428 15,872,428 0.00% FEDERAL FUNDS - 201,520 201,520 - 0.00% MEDICAID FUNDS - - - - 0.00% FEES (4,720) - - - 0.00% STATE CONTRACTS 4,720 - - - 0.00% FEDERAL PASS THRU FUNDS 13,886,432 1,596,755 $ 1,650,264 53,509 3.35% OTHER GRANTS / CONTRACTS - 19,000,000 - (19,000,000) (100.00%)OTHER REVENUE 4,720 - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 5,713,153 $ 1,285,879 $ 1,296,252 10,373 0.81% BENEFITS 1,994,588 446,225 468,489 22,264 4.99%

Total Personnel $ 7,707,741 $ 1,732,104 $ 1,764,741 32,637$ 1.88% CONTRACTS / SERVICES 5,723,894 7,236,673 6,409,976 (826,697) (11.42%)TRAVEL 14,131 17,206 45,912 28,706 166.84% SUPPLIES 129,951 3,474,811 3,089,610 (385,201) (11.09%)OPERATING 480,696 1,147,525 1,041,139 (106,386) (9.27%)OTHER COSTS 1,624 876 2,376 1,500 171.23% EQUIPMENT (Non-Capital) 6,460 1,735,920 1,536,508 (199,412) (11.49%)




INDIRECT ALLOCATION $ 682,347 $ 6,084,415 $ 4,544,675 (1,539,740)$ (25.31%)GENERAL FUND USE 588,619 631,255 710,725 79,470 12.59%





102


103

Public Health Emergency Preparedness (PHEP) Program This federally funded program from the Centers for Disease Control and Prevention (CDC) promotes local preparedness for natural (i.e., wild fires, floods, disease outbreaks) and human-made (i.e., bioterrorism, radiological) disasters and emergencies through planning, training, and exercises with a wide variety of local partners and TCHD as a whole. These efforts also link to collaborative preparedness efforts between federal, state, and local agencies as well as local emergency management and health and medical partners throughout the North Central Region of Colorado. TCHD works to improve its capacity for early identification of disease outbreaks, rapid delivery of prophylaxis, and communication among first responders, health and medical partners, and public health agencies. This program integrates disease surveillance through the Colorado Electronic Disease Reporting System (CEDRS), 24/7 response capacity, and communication via the Health Alert Network (HAN). Emergency Preparedness and Response assessment includes risk analysis and sharing of expertise, situational awareness and information with both internal and external partners as well as the public before, during and after an incident. Efforts also include the development of plans (including the public health emergency operations plan, continuity of operations, crisis and emergency risk communication, and medical countermeasures and dispensing) and agreements in preparation for and response to incident. Finally, assurance of emergency preparedness and response is accomplished through training, education, public messaging, exercising, and capacity building events/activities. Each year, TCHD participates in numerous drills and exercises on topics such as medical countermeasures and dispensing, command/coordination/incident management, first responder drills, redundant communication, and other identified areas to improve training, planning and response capacity. Funding Source(s): Restricted Federal Funds


104

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 28,500 - 15,872,428 15,872,428 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 12,921,964 926,841 927,767 926 0.10% OTHER GRANTS / CONTRACTS - 19,000,000 - (19,000,000) (100.00%)OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 5,143,403 $ 480,168 $ 471,146 (9,022) (1.88%)BENEFITS 1,794,448 166,070 169,655 3,585 2.16%

Total Personnel $ 6,937,851 $ 646,238 $ 640,801 (5,437)$ (0.84%)CONTRACTS / SERVICES 5,588,024 7,082,344 6,260,648 (821,696) (11.60%)TRAVEL 8,382 5,000 9,328 4,328 86.56% SUPPLIES 119,630 3,458,045 3,071,520 (386,525) (11.18%)OPERATING 253,900 1,095,585 982,915 (112,670) (10.28%)OTHER COSTS 1,045 376 376 - 0.00% EQUIPMENT (Non-Capital) 6,460 1,735,920 1,536,508 (199,412) (11.49%)




INDIRECT ALLOCATION $ 528,237 $ 5,903,333 $ 4,298,099 (1,605,234)$ (27.19%)GENERAL FUND USE - - - - 0.00%



Increase / (Decrease)EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - PUBLIC HEALTH EMERGENCY PREPAREDNESS (PHEP) PROGRAM (520)


105

Syndromic Surveillance Program The Syndromic Surveillance program is aligned with the Centers for Disease Control and Prevention (CDC) National Syndromic Surveillance Program that tracks health problems as they evolve and provides public health officials with data, information, and tools needed to better prepare for and coordinate responses to safeguard and improve the health of the American people. Mandated in the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, the CDC Syndromic Surveillance program was launched in 2003 to establish an integrated national public health surveillance system for early detection and rapid assessment of potential bioterrorism-related illness. Syndromic Surveillance serves to protect the health of the American people by providing timely insight into the health of communities, regions, and the nation by offering a variety of features to improve data collection, standardization, storage, analysis, and collaboration. The key components of the Syndromic Surveillance program include: building health monitoring infrastructure and workforce capacity where needed at the state, local, tribal, and territorial levels; facilitating the interchange of information that can be used to coordinate responses and monitor health-related outcomes routinely and during an event; expanding the utility of Syndromic Surveillance data to multi-use (and all-hazard) beyond early event detection and to contribute information for public health situational awareness, routine public health practice and improved health outcomes and public health; improving the ability to detect emergency health-related threats by supporting the enhancement of systems to signal alerts for potential problems; increasing local and state jurisdictions participation in Syndromic Surveillance; and advancing science and technology. Funding Source(s): Restricted Federal Funds, Required General Funds


106

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:




EXPENDITURES:WAGES $ 58,316 $ 42,077 $ 39,644 (2,433) (5.78%)BENEFITS 20,411 14,727 14,450 (277) (1.88%)

Total Personnel $ 78,727 $ 56,804 $ 54,094 (2,710)$ (4.77%)CONTRACTS / SERVICES 116,877 97,296 88,121 (9,175) (9.43%)TRAVEL 373 930 3,427 2,497 268.49% SUPPLIES 24 - - - 0.00% OPERATING 194,436 576 576 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%





TOTAL AGENCY NET $ (87) $ - $ - $ - 0.00% (Revenue minus Expenses & Allocations)


Increase / (Decrease)EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - NATIONAL SYNDROMIC SURVEILLANCE PROGRAM (NSSP) (550)


107

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - 201,520 201,520 - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 86,771 - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 53,611 $ 102,692 $ 107,996 5,304$ 5.16% CONTRACTS / SERVICES - 34,134 18,951 (15,183) (44.48%)TRAVEL - 3,056 7,186 4,130 135.14% SUPPLIES 48 2,700 2,700 - 0.00% OPERATING 12,251 16,789 16,568 (221) (1.32%)OTHER COSTS 362 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - SYNDROMIC SURVEILLANCE SUICIDE PREVENTION (551)



108

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 62,846 $ 92,115 $ 99,125 7,010$ 7.61% CONTRACTS / SERVICES 10,576 11,899 1,756 (10,143) (85.24%)TRAVEL 388 2,550 4,931 2,381 93.37% SUPPLIES 16 2,423 650 (1,773) (73.17%)OPERATING 9,991 7,480 5,480 (2,000) (26.74%)OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - OVERDOSE DATA TO ACTION (552)



109

Cities Readiness Initiative (CRI) Program The CDC’s Cities Readiness Initiative (CRI) is a federally funded program designed to enhance preparedness in the nation’s largest cities and metropolitan statistical areas where more than 50% of the U.S. population resides related to medical countermeasures and dispensing. Using CRI funding, state and large metropolitan public health departments develop, test, and maintain plans to quickly receive and distribute life-saving medicine and medical supplies from the nation's Strategic National Stockpile (SNS) to local communities following a large-scale public health emergency. Initially, the CRI planning scenario was based on a response to a large-scale anthrax attack; however, through continued analysis and lessons learned, it became apparent that CRI jurisdictions must be prepared to respond to other public health emergencies. The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 emphasized an all-hazards approach to public health preparedness planning, thereby expanding the scope of the CRI planning to include natural and man-made public health threats. The Emergency Preparedness and Response program has developed plans for receipt, storage, and distribution of large quantities of medicine and medical supplies to protect the public in the event of a public health emergency. Funding Source(s): Restricted Federal Funds


110

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 260,910 253,537 306,120 52,583 20.74% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 182,084 $ 172,125 $ 188,813 16,688$ 9.70% CONTRACTS / SERVICES - 1,000 8,000 7,000 700.00% TRAVEL 2,656 3,090 6,200 3,110 100.65% SUPPLIES 8,425 7,143 10,240 3,097 43.36% OPERATING 5,661 9,945 14,000 4,055 40.77% OTHER COSTS 216 500 2,000 1,500 300.00% EQUIPMENT (Non-Capital) - - - - 0.00%







Increase / (Decrease)EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - CITIES READINESS INITITATIVE (CRI) (530)


111

Communicable Disease The Communicable Disease program works to protect the public by preventing the spread of infectious diseases. Communicable disease epidemiologists conduct ongoing epidemiologic surveillance to identify new and emerging infectious disease trends and outbreaks. They conduct day-to-day investigation of vaccine-preventable diseases such as pertussis and measles, enteric diseases such as E.coli and salmonella, and zoonotic diseases such as rabies and plague. They are trained in rapid response to disease outbreaks, working to identify the causative agent and putting control measures into place to prevent the spread of disease. Funding Source(s): Restricted Federal Grant Funds, Restricted State Grant Funds, Required General Funds

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 306,411 $ 471,413 $ 471,373 (40)$ (0.01%)CONTRACTS / SERVICES 2,231 10,000 32,500 22,500 225.00% TRAVEL 830 580 12,340 11,760 2027.59% SUPPLIES 48 - - - 0.00% OPERATING 3,287 5,450 9,900 4,450 81.65% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







Increase / (Decrease)EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - COMMUNICABLE DISEASE (510)


112

Administration The general program provides support for the EPRCDS division and leadership. This program also includes the Safety and Security Program, which is dedicated to developing, coordinating, and consistently applying standard workplace safety and security efforts to improve both the culture of safety and staff capabilities related to safety throughout the TCHD organization to support both staff and the communities served by TCHD. Funding Source(s): Required General Funds

Division: 5

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES (4,720) - - - 0.00% STATE CONTRACTS 4,720 - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE 4,720 - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 4,720 $ - $ - -$ 0.00%



Total Personnel $ 86,210 $ 190,717 $ 202,539 11,822$ 6.20% CONTRACTS / SERVICES 6,186 - - - 0.00% TRAVEL 1,501 2,000 2,500 500 25.00% SUPPLIES 1,760 4,500 4,500 - 0.00% OPERATING 1,172 11,700 11,700 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







Increase / (Decrease)EMERGENCY PREPARENESS, RESPONSE, and COMMUNICABLE DISEASE SURVEILLANCE - ADMINISTRATION (590)


113



114

Environmental Health Division


115



116

ENVIRONMENTAL HEALTH DIVISION

Division: 6 ENVIRONMENTAL HEALTHFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 62,292 130,000 110,000 (20,000) (15.38%)FEDERAL FUNDS 116,582 206,161 218,923 12,762 6.19% MEDICAID FUNDS - - - - 0.00% FEES 43,917 3,018,250 2,800,175 (218,075) (7.23%)STATE CONTRACTS 7,914 56,899 64,200 7,301 12.83% FEDERAL PASS THRU FUNDS 25,274 31,937 224,456 192,519 602.81% OTHER GRANTS / CONTRACTS 419,999 257,402 272,288 14,886 5.78% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 675,978 $ 3,700,649 $ 3,690,042 (10,607)$ (0.29%)


EXPENDITURES:WAGES $ 2,093,364 $ 4,703,084 $ 4,910,233 207,149 4.40% BENEFITS 745,756 1,624,187 1,757,417 133,230 8.20%

Total Personnel $ 2,839,120 $ 6,327,271 $ 6,667,650 340,379$ 5.38% CONTRACTS / SERVICES 102,771 240,160 244,177 4,017 1.67% TRAVEL 22,985 106,582 139,561 32,979 30.94% SUPPLIES 61,247 63,175 48,131 (15,044) (23.81%)OPERATING 144,124 145,457 186,846 41,389 28.45% OTHER COSTS 19,920 16,210 20,600 4,390 27.08% EQUIPMENT (Non-Capital) 15,106 (5,508) 3,500 9,008 (163.54%)


CAPITAL & LEASEHOLD IMPROVEMENTS $ - $ - $ 125,000 125,000$ 0.00% IN-KIND EXPENSE - - - - 0.00%


INDIRECT ALLOCATION $ 148,122 $ 268,592 $ 289,400 20,808$ 7.75% GENERAL FUND USE 3,033,734 3,461,290 4,034,824 573,534 16.57%





117


118

Division Administration and Informatics Budgeted activities include the core leadership team, which is responsible for planning, implementation, management, and evaluation of all environmental health activities and programs. This division’s support program is also responsible for financial oversight, data collection and management, grant and contract management, Environmental Health Informatics activities, and some support staff services. Expenditures such as capital equipment, staff training, support staff services, and some local travel may be budgeted under this program to capture expected costs; however, during the course of the year, expenses are applied to the programs that actually incur the costs. Funding Source(s): Required General Funds

Division: 6 ENVIRONMENTAL HEALTH - ADMINISTRATION (690, 695)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 720 - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 720 $ - $ - -$ 0.00%



Total Personnel $ 652,486 $ 1,241,137 $ 1,296,373 55,236$ 4.45% CONTRACTS / SERVICES 7,107 2,000 59,500 57,500 2875.00% TRAVEL 2,164 - 17,050 17,050 0.00% SUPPLIES 27,069 36,793 25,393 (11,400) (30.98%)OPERATING 71,207 76,641 115,986 39,345 51.34% OTHER COSTS 17,540 15,000 19,500 4,500 30.00% EQUIPMENT (Non-Capital) - - 3,500 3,500 0.00%









119

Child Care Program The goal of the Child Care program is to prevent the spread of infectious disease in childcare facilities and other public residential settings. Local health departments work with the Colorado Department of Human Services (CDHS) as well as the Colorado Department of Public Health and Environment (CDPHE) to assess and provide assistance to child care operators and staff as mandated by C.R.S. §25-1.5-101(1)h. The following services are conducted for CDHS licensed facilities: annual or biennial on-site inspections; investigation of complaints; review and approval of plans for newly constructed or remodeled childcare facilities; and education. Funding Source(s): Fees, Required General Funds

Division: 6 ENVIRONMENTAL HEALTH - CHILD CARE (640)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 60 151,250 130,000 (21,250) (14.05%)STATE CONTRACTS - - 11,250 11,250 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 60 $ 151,250 $ 141,250 (10,000)$ (6.61%)



Total Personnel $ 36,646 $ 258,177 $ 276,381 18,204$ 7.05% CONTRACTS / SERVICES 15,679 - - - 0.00% TRAVEL 379 7,300 7,300 - 0.00% SUPPLIES 186 600 950 350 58.33% OPERATING 1,096 1,000 1,350 350 35.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









120

Food Protection Program The goal of the Food Protection program is to prevent the occurrence of foodborne illness from food prepared in licensed retail food establishments. This program is required by the Food Protection Act (C.R.S. §25-4-1601) and authority is granted to local health departments to administer the program and collect license fees. The following services are conducted for licensed facilities: risk-based inspections; investigation of complaints; review and approval of plans for new or remodeled facilities; opening inspections and approval of licenses; food safety education for restaurant operators; enforcement actions against facilities that continue to fail to meet safe food handling requirements; and assessment of damage to retail food establishments due to disasters, such as fire or flood, to ensure the maintenance of a safe food supply. All food service inspectors go through a formal “standardization” process every three years to ensure a uniform inspection approach. Continuing education is required to ensure a trained and competent workforce. This program is working to improve food safety through collaboration with state and local partners in food program data standardization efforts in support of Goal 8 of the TCHD Strategic Plan. Funding Source(s): Fees (set in statute), Required General Funds


121

Division: 6 ENVIRONMENTAL HEALTH - FOOD PROTECTION PROGRAM (630)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES (375) 1,967,000 1,964,500 (2,500) (0.13%)STATE CONTRACTS - 33,750 33,750 - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 22,708 - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 22,333 $ 2,000,750 $ 1,998,250 (2,500)$ (0.12%)


EXPENDITURES:WAGES $ 780,347 $ 2,049,828 $ 2,122,996 73,168 3.57% BENEFITS 300,244 716,183 766,426 50,243 7.02%

Total Personnel $ 1,080,590 $ 2,766,011 $ 2,889,422 123,411$ 4.46% CONTRACTS / SERVICES 2,933 15,500 19,500 4,000 25.81% TRAVEL 6,257 55,546 60,000 4,454 8.02% SUPPLIES 2,776 3,500 4,500 1,000 28.57% OPERATING 25,999 21,554 24,000 2,446 11.35% OTHER COSTS 1,888 1,100 1,100 - 0.00% EQUIPMENT (Non-Capital) 15,106 - - - 0.00%




INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE 639,466 862,461 1,000,272 137,811 15.98%

TOTAL AGENCY NET $ (473,750) $ - $ (0) $ (0) 0.00% (Revenue minus Expenses & Allocations)




122

General Environmental Health Services The General Environmental Health Services category includes crosscutting Disease Prevention program activities and a combination of various division programs due to their relatively small budgets. Programs included are: Animal Control; Body Art; Air Pollution; and Marijuana Infused Product Manufacturer. The following services are conducted: education on the risk of contracting rabies from domestic and wildlife animals; investigation of disease outbreaks and food-borne illness complaints; annual inspections of marijuana infused product manufacturer; annual inspection of body art facilities; and work on regional air quality issues, including climate change. Additionally, TCHD's Institutions and Public Accommodations Program includes activities concerning mobile home parks, private housing, penal institutions, and public accommodations. These program components are addressed on a complaint basis only. Funding Source(s): Fees, Contracts (restricted funds), Required General Funds

Division: 6 ENVIRONMENTAL HEALTH - GENERAL (610, 617, 620, 643, 692)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 44,213 - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 2,255 33,125 35,075 1,950 5.89% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 24,724 25,337 - (25,337) (100.00%)OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 85,546 $ 93,889 $ 88,681 (5,208) (5.55%)BENEFITS 29,941 32,861 32,324 (537) (1.63%)

Total Personnel $ 115,487 $ 126,750 $ 121,005 (5,745)$ (4.53%)CONTRACTS / SERVICES 7,051 3,000 2,000 (1,000) (33.33%)TRAVEL 792 3,824 3,300 (524) (13.70%)SUPPLIES 4,620 50 500 450 900.00% OPERATING 13,678 3,000 - (3,000) (100.00%)OTHER COSTS 175 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 11,168 $ 99 $ - (99)$ (100.00%)GENERAL FUND USE 138,663 78,261 91,730 13,469 17.21%





123

Industrial Hygiene Program The goal of the Industrial Hygiene program is to reduce indoor air pollution effects/events, workplace health and safety hazards, and workplace injuries and illnesses. Hazards in the workplace have been well documented, which led to the creation of the federal Occupational Safety and Health Act (OSHA) in 1970. According to the Environmental Protection Agency (EPA), indoor air pollution is one of the top five health hazards facing the general population. Major sources of indoor air pollution include combustion sources (i.e., wood and tobacco products), lead, asbestos, outdoor sources (e.g., radon), mold, and various chemicals. The following services are conducted: investigation of complaints or inquiries; assistance in eliminating workplace health and safety hazards; follow up investigation for homes with children and high lead levels; and radon education and testing. Funding Source(s): Fees, Grants, Required General Funds, Restricted Grant Funds

Division: 6 ENVIRONMENTAL HEALTH - INDUSTRIAL HYGENE (622, 627)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - 5,600 5,600 - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS 550 6,600 6,050 (550) (8.33%)OTHER GRANTS / CONTRACTS - 5,000 5,000 - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 550 $ 17,200 $ 16,650 (550)$ (3.20%)



Total Personnel $ 40,336 $ 73,473 $ 81,794 8,321$ 11.33% CONTRACTS / SERVICES 1,570 4,000 - (4,000) (100.00%)TRAVEL 739 3,599 2,750 (849) (23.59%)SUPPLIES 17,326 2,030 2,577 547 26.95% OPERATING 5,658 3,275 3,275 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









124

Land Use Program The goal of the Land Use program is to incorporate sound environmental health principles in planning and development activities to create healthy living environments. Since chronic diseases and obesity are associated with inactivity (i.e., heart disease, stroke, and diabetes) and now rank among the nation’s greatest public health risks, we promote “healthy eating, active living” policies and community designs. Land Use reviews address both regulatory requirements and recommendations. The following services are conducted: provide health-related comments on development applications; provide recommendations for incorporating environmental health policies into master planning efforts, codes and regulations; participate in key state programs and regional planning activities; collaborate with other entities; and provide education. Funding Source(s): Fees, Grants, Required General Funds

Division: 6 ENVIRONMENTAL HEALTH - LAND USE (650)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - 100,000 100,000 - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 30,500 246,160 35,000 (211,160) (85.78%)STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - 218,406 218,406 0.00% OTHER GRANTS / CONTRACTS 254,442 - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 308,987 $ 589,814 $ 628,693 38,879$ 6.59% CONTRACTS / SERVICES 36,151 44,660 59,000 14,340 32.11% TRAVEL (101) 3,160 9,400 6,240 197.47% SUPPLIES 2,125 6,150 460 (5,690) (92.52%)OPERATING 5,791 10,565 11,540 975 9.23% OTHER COSTS 68 25 - (25) (100.00%)EQUIPMENT (Non-Capital) - - - - 0.00%









125

Rocky Mountain Arsenal (RMA) Program The goal of the RMA program is to protect the community from short and long-term environmental risks associated with the RMA’s previous waste disposal activities and during ongoing operations and maintenance of the site. Off-post groundwater quality is monitored to verify there is no risk to the public through consumption of private well water and to verify that RMA cleanup efforts continue to be effective. On-post remediation oversight is provided consistent with the provisions of the Certificate of Designation issued by Adams County on September 29, 1997, and specific agreements TCHD has with Adams County and with the Department of the Army. The following services are conducted: sample and analyze water from selected private wells in the RMA off-post study area for contaminants; oversight of completed on-site waste disposal areas, caps and covers; act as liaison with affected communities in Adams County concerning RMA related issues and the responsible parties (U.S. Army and Shell Oil Co.); and provide oversight of RMA remediation and monitoring activities. Funding Source(s): Contract (restricted funds)

Division: 6 ENVIRONMENTAL HEALTH - ROCKY MOUNTAIN ARSENAL (683)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS 116,582 206,161 218,923 12,762 6.19% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 73,897 $ 135,355 $ 141,963 6,608$ 4.88% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 769 1,872 1,700 (172) (9.19%)SUPPLIES 1,444 8,336 7,300 (1,036) (12.43%)OPERATING 5,234 11,896 12,540 644 5.41% OTHER COSTS 105 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 25,192 $ 48,702 $ 55,420 6,718$ 13.79% GENERAL FUND USE - - 0 0 0.00%





126

Solid and Hazardous Waste Program The goal of this program is to control the impacts of solid and hazardous wastes on human health and the environment. Local health departments are authorized by Colorado law to assist in compliance activities for solid waste sites. TCHD performs oversight of solid waste disposal sites to ensure that these facilities are properly constructed and operated to protect public health and the environment. The following services are conducted: investigate solid and hazardous waste complaints; monitor construction activities at hazardous waste disposal sites; monitor construction and operational activities at non-hazardous waste disposal sites; participate on the technical advisory committees for designated Superfund sites; serve as a community liaison to responsible parties and regulatory agencies for hazardous waste sites; respond to spills and emergencies involving hazardous materials to support local fire and law enforcement agencies 24/7; provide household chemical waste collection and education programs; inspection of waste tire generators; and perform methamphetamine lab cleanup oversight. Funding Source(s): Fees, Contracts (restricted funds), Donations, Required General Funds


127

Division: 6 ENVIRONMENTAL HEALTH - SOLID & HAZARDOUS WASTE (668, 669, 677, 678, 679, 680, 686, 687)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 17,321 65,064 63,000 (2,064) (3.17%)STATE CONTRACTS - - 12,000 12,000 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS 142,849 252,402 267,288 14,886 5.90% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 148,145 $ 287,008 $ 313,309 26,301$ 9.16% CONTRACTS / SERVICES 22,745 163,000 92,177 (70,823) (43.45%)TRAVEL 1,321 7,433 6,172 (1,261) (16.96%)SUPPLIES 950 2,516 2,536 20 0.79% OPERATING 4,336 8,976 6,895 (2,082) (23.19%)OTHER COSTS 70 - - - 0.00% EQUIPMENT (Non-Capital) - (5,508) - 5,508 (100.00%)




INDIRECT ALLOCATION $ 10,499 $ 24,040 $ 29,628 5,588$ 23.24% GENERAL FUND USE 181,234 169,999 108,429 (61,570) (36.22%)

TOTAL AGENCY NET $ 153,338 $ - $ 0 $ 0 0.00% (Revenue minus Expenses & Allocations)




128

Vector Surveillance Program The goal of the Vector Surveillance program is to reduce exposure and transmission of vector-borne diseases to the public. Vectorborne diseases have been recognized as potentially having fatal consequences. Diseases such as Arboviral Encephalitis (e.g., West Nile virus), plague, Hantavirus, and Colorado tick fever are endemic in the TCHD area. Because outbreaks of vector-borne diseases are not predictable, ongoing surveillance of mosquito breeding sites is conducted. Monitoring for the presence of Western Equine Encephalitis, St. Louis Encephalitis, and West Nile virus (WNV) is accomplished through horse, mosquito, and human surveillance and mosquito testing. Prairie dog mapping and die-off investigations are conducted to determine local black-tail prairie dog colony locations and the presence of plague. The following services are conducted: surveillance for arboviruses in the environment; participation in the Regional Encephalitis Monitoring program; routine mosquito light trapping and mosquito identification; collection and transport of animal specimens to the CDPHE laboratory for testing; education to the public; prairie dog colony complaint die-off investigation; hantavirus environmental investigations; and flea collection and submission to the Centers for Disease Control and Prevention (CDC). Funding Source(s): Required General Funds


129

Division: 6 ENVIRONMENTAL HEALTH - VECTOR SURVEILLANCE PROGRAMS (613, 614)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 58,215 $ 63,116 $ 80,385 17,269$ 27.36% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 2,751 699 4,730 4,031 576.68% SUPPLIES 1,114 1,200 1,765 565 47.08% OPERATING 1,352 600 1,145 545 90.83% OTHER COSTS 75 85 - (85) (100.00%)EQUIPMENT (Non-Capital) - - - - 0.00%









130

Water Program The Water Program includes water quality, onsite wastewater treatment systems (OWTS), and recreational water (pools, spray pads, spas, and beaches). The goal of this program is to prevent disease transmission introduced into ground, surface, or recreational waters. The Water program addresses all aspects of water supplies including, but not limited to, drinking water, private well water, reclaimed water, gray water, and storm water. The following services are conducted:

• Responding to citizen complaints or concerns • Providing guidance/support to contamination incidents • Participating in key watershed and stakeholder meetings • Inspection of bio-solids land application sites.

The OWTS program assures that wastewater from homes and businesses not served by a public sewer is adequately treated to prevent contamination of surface and groundwater. The following services are conducted:

• Permit and inspect all new and repair OWTS • Issue use permits after inspections are completed on existing systems by qualified

wastewater professionals • Investigate malfunctioning systems • Consult with planning departments, homeowners, engineers, and installers • Train and license OWTS contractors and cleaners

Recreational water features at aquatic venues and swim beaches have long been recognized as an efficient medium for the transmission of communicable diseases and are also subject to a variety of accidents/injuries. The following services are conducted:

• Bi-annual inspections of all public and semi-public swimming pools, spray pads, and spas • Complaint investigations • Plan reviews and opening inspections of newly constructed or remodeled pools, spray pads

and spas Funding Source(s): Fees, Contracts, Required General Funds (s): Restricted Grant Funds


131

Division: 6 ENVIRONMENTAL HEALTH - WATER PROGRAM (645, 653, 656, 657, 658)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 18,079 30,000 10,000 (20,000) (66.67%)FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES (6,564) 550,051 567,000 16,949 3.08% STATE CONTRACTS 7,914 23,149 7,200 (15,949) (68.90%)FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%




Total Personnel $ 324,330 $ 786,430 $ 838,325 51,895$ 6.60% CONTRACTS / SERVICES 9,535 8,000 12,000 4,000 50.00% TRAVEL 7,914 23,149 27,159 4,010 17.32% SUPPLIES 3,637 2,000 2,150 150 7.50% OPERATING 9,774 7,950 10,115 2,165 27.23% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%




INDIRECT ALLOCATION $ 460 $ 1,834 $ 4,512 2,678$ 146.02% GENERAL FUND USE 282,936 226,163 310,061 83,898 37.10%





132

Human Resources Division


133



134

HUMAN RESOURCES DIVISION

Human Resources Human Resources manages a variety of employee-centered programs with a commitment to refine services and processes to meet the ever-changing employee and Agency needs. Services provided by Human Resources include recruitment, on-boarding and orientation, benefits and retirement, compensation, compliance (Policy/Procedure/FMLA/ADA/Leaves of Absence), employee relations, employee performance management, employee recognition programs, worker’s compensation. Human Resources’ staff take pride in providing a confidential, honest and objective approach in functions. The team strives to be proactive, responsive and a knowledgeable sounding board, providing a strong array of HR practices to TCHD employees. Funding Source(s): General Funds

Division: 7 HUMAN RESOURCESFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:



FTE's 5.50 5.50 5.50 0.00 0.00% Benefits as a Percentage of Wages -270.08% 545.14% 640.99%

EXPENDITURES:WAGES $ 348,506 $ (221,289) $ (294,650) (73,361) 33.15% BENEFITS (941,235) (1,206,343) (1,888,690) (682,347) 56.56%

Total Personnel $ (592,728) $ (1,427,632) $ (2,183,340) (755,708)$ 52.93% CONTRACTS / SERVICES 101,075 75,500 79,500 4,000 5.30% TRAVEL 366 1,615 - 3,238 1,623 100.50% SUPPLIES 3,949 7,782 11,538 3,756 48.27% OPERATING 132,689 143,013 145,846 2,833 1.98% OTHER COSTS 319 4,373 10,650 6,277 143.54% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ (354,331) $ (1,195,349) $ (1,932,568) (737,219)$ 61.67%


TOTAL DIVISION EXPENDITURES $ (354,331) $ (1,195,349) $ (1,932,568) (737,219)$ 61.67%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE (443,899) (706,231) (1,932,568) (1,226,337) 173.65%

TOTAL AGENCY NET $ (89,568) $ 489,118 $ - $ (489,118) (100.00%)(Revenue minus Expenses & Allocations)




135

Employee Wellness Employee Wellness initiatives have long been associated with improving health and morale of employees, increasing productivity, decreasing absenteeism, and helping to control employer healthcare costs. TCHD’s employee program focuses on supporting employees to improve eating habits, adopt a more active lifestyle and maintain mental wellness. It is well documented that modifying behaviors in these areas can help lower one’s risk for developing chronic conditions, including diabetes and heart disease. Family-friendly policies are also a focus of TCHD’s internal program. These include flexible work schedules, infant-at-work, lactation-support, and healthy meeting policies. Funding Sources: General Funds

Division: 7 HUMAN RESOURCES - EMPLOYEE WELLNESS (710)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 39,762 $ 100,904 $ 106,083 5,179$ 5.13% CONTRACTS / SERVICES 280 500 500 - 0.00% TRAVEL 366 1,615 1,559 (56) (3.47%)SUPPLIES 273 3,700 4,800 1,100 29.73% OPERATING 1,416 4,000 5,500 1,500 37.50% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









136

Division: 7 HUMAN RESOURCES - HUMAN RESOURCES (720,790)

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:



FTE's 4.50 4.50 4.50 0.00 0.00% Benefits as a Percentage of Wages -298.24% 416.34% 514.78%

EXPENDITURES:WAGES $ 319,053 $ (296,033) $ (372,395) (76,362) 25.80% BENEFITS (951,544) (1,232,503) (1,917,028) (684,525) 55.54%

Total Personnel $ (632,491) $ (1,528,536) $ (2,289,423) (760,887)$ 49.78% CONTRACTS / SERVICES 100,795 75,000 79,000 4,000 5.33% TRAVEL - - 1,679 1,679 0.00% SUPPLIES 3,675 4,082 6,738 2,656 65.07% OPERATING 131,272 139,013 140,346 1,333 0.96% OTHER COSTS 319 4,373 10,650 6,277 143.54% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ (396,429) $ (1,306,068) $ (2,051,010) (744,942)$ 57.04%


TOTAL DIVISION EXPENDITURES $ (396,429) $ (1,306,068) $ (2,051,010) (744,942)$ 57.04%

INDIRECT ALLOCATION $ - $ - $ - -$ 0.00% GENERAL FUND USE (553,861) (816,950) (2,051,010) (1,234,060) 151.06%

TOTAL AGENCY NET $ (157,432) $ 489,118 $ - $ (489,118) (100.00%)(Revenue minus Expenses & Allocations)




137



138

Administration and Finance Division


139



140

ADMINISTRATION AND FINANCE DIVISION

Division: 8 ADMINISTRATION and FINANCEFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ 10,956,329 $ 11,141,313 $ 11,298,723 157,410 1.41% COUNTY - PROJECT SPECIFIC 80 - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 1,801,520 1,700,000 1,700,000 - 0.00% STATE CONTRACTS 1,916,010 1,882,445 1,882,445 - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE 34,993 48,075 48,075 - 0.00% FUND BALANCE USE - 1,951,000 1,500,000 (451,000) (23.12%)IN-KIND REVENUE 428,162 428,162 428,162 - 0.00%




Total Personnel $ 2,422,604 $ 2,248,003 $ 2,369,344 121,341$ 5.40% CONTRACTS / SERVICES 481,301 6,087,690 915,279 (5,172,411) (84.97%)TRAVEL 6,017 11,542 - 11,542 - 0.00% SUPPLIES 91,003 107,952 111,853 3,901 3.61% OPERATING 2,869,875 2,989,649 2,994,934 5,285 0.18% OTHER COSTS 19,006 14,200 14,200 - 0.00% EQUIPMENT (Non-Capital) 453,687 2,379,162 - (2,379,162) (100.00%)


CAPITAL & LEASEHOLD IMPROVEMENTS $ 25,525 $ 1,951,000 $ 3,752,779 1,801,779$ 92.35% IN-KIND EXPENSE 428,162 428,162 428,162 - 0.00%


INDIRECT ALLOCATION $ (4,352,678) $ (10,281,912) $ (8,655,358) 1,626,554$ (15.82%)GENERAL FUND USE (13,366,377) (14,083,827) (14,914,669) (830,842) 5.90%

TOTAL AGENCY NET $ (673,786) $ (2,868,280) $ - $ 2,868,280 (100.00%)(Revenue minus Expenses & Allocations)




141

Finance and Operations The Administration and Finance Division is dedicated to the people and the purpose of Tri-County Health Department. We maintain effective management of Tri-County Health Department’s (TCHD) financial activity and provide support services to all of the organization’s divisions and programs. The role of Administration and Finance (A&F) is to oversee all financial aspects for the organization including coordinating financial activity to ensure that we conduct business in accordance with Board of Health and TCHD policy and procedures and within all guidelines of Generally Accepted Accounting Principles. This division is responsible for the oversight and management of all financial activities including:

• Budget development, planning and management • Financial Analysis, Forecasting and Reporting • Annual Financial Statement preparation • Annual External Audit • Accounts payable • Accounts receivable • Contracts management • Grants management • Internal control policies and procedures • Payroll processing and compliance • Cash and Investment management • Financial compliance with laws, regulations and policies

Funding Source(s): General Funds Facilities Operations Facilities, warehouse, distribution, and purchasing operations provide efficient and timely support to TCHD staff in the following areas:

• Purchasing (P-card, small purchases) • Vaccine storage • Warehouse operations and delivery service • Remodel, repair, and maintenance services • Motorized and non-motorized vehicle maintenance • Strategic planning services related to office locations and space to optimize needs of the

communities we serve Funding Source(s): General Funds


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Division: 8 ADMINISTRATION and FINANCE - FINANCE AND OPERATIONS (810, 820, 840, 860, 870, 890, 895, 899)FY2020ACTUAL

FY2021REVISED FY2022 Proposed $

%REVENUE:

COUNTY $ 10,956,329 $ 11,141,313 $ 11,298,723 157,410 1.41% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 316,051 350,000 350,000 - 0.00% STATE CONTRACTS 1,916,010 1,882,445 1,882,445 - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE 34,993 48,075 48,075 - 0.00% FUND BALANCE USE - 1,951,000 1,500,000 (451,000) (23.12%)IN-KIND REVENUE 428,162 428,162 428,162 - 0.00%




Total Personnel $ 2,083,297 $ 1,674,391 $ 1,770,761 96,370$ 5.76% CONTRACTS / SERVICES 367,954 6,060,440 888,029 (5,172,411) (85.35%)TRAVEL 3,246 11,542 11,542 - 0.00% SUPPLIES 58,564 67,052 69,453 2,401 3.58% OPERATING 2,503,270 2,671,077 2,672,077 1,000 0.04% OTHER COSTS 10,229 3,000 3,000 - 0.00% EQUIPMENT (Non-Capital) 453,687 2,379,162 - (2,379,162) (100.00%)


CAPITAL & LEASEHOLD IMPROVEMENTS $ 25,525 $ 1,951,000 $ 3,752,779 1,801,779$ 92.35% IN-KIND EXPENSE 428,162 428,162 428,162 - 0.00%


INDIRECT ALLOCATION $ (4,595,957) $ (10,582,407) $ (8,999,946) 1,582,461$ (14.95%)GENERAL FUND USE (13,366,377) (14,083,827) (14,914,669) (830,842) 5.90%

TOTAL AGENCY NET $ (1,052,811) $ (2,946,251) $ (3,122) $ 2,943,129 (99.89%)(Revenue minus Expenses & Allocations)




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Vital Records TCHD is authorized by the State of Colorado to issue birth and death certificates through its Vital Records offices located in Greenwood Village, Commerce City and Castle Rock. Our award winning Vital Records Program is able to issue birth or death certificates for the State of Colorado regardless of the county of birth or death. Certificates can be issued through a wide variety of ordering methods such as in-person, online, by mail or electronically. Vital Records is a self-funded program through fees collected from services provided. Excess revenue from the Vital Records program is used to assist programs and services that are not fully funded. Funding Source(s): Fees

Division: 8 ADMINISTRATION and FINANCE - VITAL RECORDS (880)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC 80 - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES 1,485,469 1,350,000 1,350,000 - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - - - - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ 1,485,549 $ 1,350,000 $ 1,350,000 -$ 0.00%



Total Personnel $ 339,308 $ 573,612 $ 598,583 24,971$ 4.35% CONTRACTS / SERVICES 113,348 27,250 27,250 - 0.00% TRAVEL 2,771 - - - - 0.00% SUPPLIES 32,438 40,900 42,400 1,500 3.67% OPERATING 366,604 318,572 322,857 4,285 1.35% OTHER COSTS 8,777 11,200 11,200 - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%

TOTAL DIRECT EXPENSES $ 863,246 $ 971,534 $ 1,002,290 30,756$ 3.17%


TOTAL DIVISION EXPENDITURES $ 863,246 $ 971,534 $ 1,002,290 30,756$ 3.17%


TOTAL AGENCY NET $ 379,025 $ 77,971 $ 3,122 $ (74,849) (96.00%)(Revenue minus Expenses & Allocations)




144



145

Planning and Information Management Division


146



147

PLANNING AND INFORMATION MANAGEMENT DIVISION

Division: 9 PLANNING and INFORMATION MANAGEMENTFY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - $ - - 0.00% OTHER GRANTS / CONTRACTS 4,852 7,400 7,400 - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%



EXPENDITURES:WAGES $ 891,928 $ 1,351,018 $ 1,499,766 148,748 11.01% BENEFITS 318,798 469,126 542,776 73,650 15.70%

Total Personnel $ 1,210,726 $ 1,820,144 $ 2,042,543 222,399$ 12.22% CONTRACTS / SERVICES 48,549 58,350 58,350 - 0.00% TRAVEL 2,623 - 750 - - (750) (100.00%)SUPPLIES 4,138 3,500 3,500 - 0.00% OPERATING 701,334 696,749 704,149 7,400 1.06% OTHER COSTS 465 - - - 0.00% EQUIPMENT (Non-Capital) 190,762 110,000 110,000 - 0.00%


CAPITAL & LEASEHOLD IMPROVEMENTS $ 73,959 $ - $ 595,000 595,000$ 0.00% IN-KIND EXPENSE - - - - 0.00%


INDIRECT ALLOCATION $ 1,185 $ - $ - -$ 0.00% GENERAL FUND USE 2,718,076 2,682,093 3,506,142 824,049 30.72%





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Health Data and Geographic Information Systems (GIS) This multi-disciplinary team continues to increase informatics and data analytic capacity at TCHD, including supporting work around the COVID-19 Response and Priority Area 2: Goal A (Enhance technology and information systems) in the 2019-2024 Strategic Plan. Staff within this program developed a data system, in house, for tracking COVID-19 cases and their contacts and developed a series of data dashboards for the public and our stakeholders to support decision-making. Staff apply epidemiological and statistical methods and advanced technology to understand the distribution and determinants of health and disease in the TCHD jurisdiction to help guide decision making and prioritization in TCHD’s efforts to improve population health. The data analytic team has developed a large series of interactive data dashboards and story maps to help illustrate the occurrence of disease, injury, and risk and protective factors in our three county jurisdiction. Staff in this program also support the work of community health assessments, strategic planning, public health improvement planning, maintaining TCHD’s public health accreditation, and measuring impact through a performance management system that include multiple quality improvement methods. Funding Source(s): Required General Funds


149


FY2021REVISED

FY2022 Proposed $

%REVENUE:

COUNTY $ - $ - $ - - 0.00% COUNTY - PROJECT SPECIFIC - - - - 0.00% FEDERAL FUNDS - - - - 0.00% MEDICAID FUNDS - - - - 0.00% FEES - - - - 0.00% STATE CONTRACTS - - - - 0.00% FEDERAL PASS THRU FUNDS - - - - 0.00% OTHER GRANTS / CONTRACTS - 7,400 7,400 - 0.00% OTHER REVENUE - - - - 0.00% FUND BALANCE USE - - - - 0.00% IN-KIND REVENUE - - - - 0.00%

TOTAL DIVISION REVENUE $ - $ 7,400 $ 7,400 -$ 0.00%



Total Personnel $ 236,680 $ 421,174 $ 456,434 35,260$ 8.37% CONTRACTS / SERVICES (2,600) 250 250 - 0.00% TRAVEL 16 - - - 0.00% SUPPLIES - - - - 0.00% OPERATING 13,473 20,399 27,799 7,400 36.28% OTHER COSTS 166 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%







Increase / (Decrease)PLANNING and INFORMATION MANAGEMENT - Health Data and Geographic Information

Systems (GIS) (930)


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Division Administration The leadership and support team is responsible for planning, implementation, management, and evaluation of all PIM activities and programs, including development, implementation, and monitoring of TCHD’s Strategic Plan and Public Health Improvement Plan This also includes Performance Management and Quality Improvement, which are part of Priority Area 2: Goal C in the TCHD Strategic Plan as well as a key factor in maintaining Public Health Accreditation and monitoring agency-wide performance. This team has also become the technical experts around organizational change management, also called out in Priority Area 2: Goal C in the Strategic Plan. The Public Health Planning Initiatives Coordinator, Performance Management Coordinator, and Informatics Project Manager are included in this group. All staff in this program were activated in the COVID-19 response as well. Funding Source(s): Required General Funds

Division: 9 PLANNING and INFORMATION MANAGEMENT - Division Administration (990)

FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 287,018 $ 497,010 $ 553,598 56,588$ 11.39% CONTRACTS / SERVICES 45 5,200 5,200 - 0.00% TRAVEL 96 - - - 0.00% SUPPLIES 1,112 1,000 1,000 - 0.00% OPERATING 4,111 11,000 11,000 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









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Information Technology Program The Information Technology (IT) program has worked through the strategies of Priority Area 2: Goal A aligning with the new TCHD Strategic Plan. IT is designed to provide a self-supporting, reliable, and secure computer operating architecture and environment at TCHD. The IT program supports both full and part-time TCHD employees by administering account information, assisting with application software issues, and solving technical problems using an efficient Help Desk system. IT configures, implements, maintains, monitors, and administers a wide variety of network and communication services such as: voice over IP (VoIP) systems, server equipment, personal computers, and associated peripheral hardware. Additionally, IT maintains computer equipment inventories, administers cellular phones, and ensures software license compliance. The IT team also provides and operates a reliable, robust, and secure infrastructure to support mission-critical applications software for electronic health records system, accounting system (financial, payroll, procurement, and reporting services), E-mail services, environmental health system, and Women, Infants and Children (WIC) support. Finally, they monitor, maintain, and administer IT security, Internet connectivity, and the Wide Area Network infrastructure that connects all TCHD locations to our central computing resources, including a disaster recovery site/plan. IT was instrumental in implementing innovations around the COVID-19 response that allowed TCHD staff to work remotely, to support various technical aspects of the response, and in ensuring the provision of core public health services in these challenging times. Funding Source(s): Required General Funds


152

Division: 9 PLANNING and INFORMATION MANAGEMENT - Information Technology (950)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 641,435 $ 676,933 $ 795,950 119,017$ 17.58% CONTRACTS / SERVICES 51,104 52,900 52,900 - 0.00% TRAVEL 2,393 - - - 0.00% SUPPLIES 3,026 2,200 2,200 - 0.00% OPERATING 682,604 662,925 662,925 - 0.00% OTHER COSTS - - - - 0.00% EQUIPMENT (Non-Capital) 189,576 110,000 110,000 - 0.00%


CAPITAL & LEASEHOLD IMPROVEMENTS $ 73,959 $ - $ 545,000 545,000$ 0.00% IN-KIND EXPENSE - - - - 0.00%







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Medical Epidemiology Our Medical Epidemiologist consults with programs throughout TCHD seeking expertise in epidemiologic analyses, knowledge on the clinical aspects of disease, or medical interpretation of data. Additionally, this position also oversees development and implementation of epidemiology-based studies for the department on a wide variety of public health topics. Our Medical Epidemiologist has been a critical resource to staff throughout the COVID-19 response by providing specific infectious disease medical expertise across a multitude of topics. Funding Source(s): Required General Funds

Division: 9 PLANNING and INFORMATION MANAGEMENT - Medical Epidemiology (910)FY2020ACTUAL

FY2021REVISED

FY2022 Proposed $

%REVENUE:





Total Personnel $ 41,768 $ 225,027 $ 236,561 11,534$ 5.13% CONTRACTS / SERVICES - - - - 0.00% TRAVEL 110 750 - (750) (100.00%)SUPPLIES - 300 300 - 0.00% OPERATING 1,146 2,425 2,425 - 0.00% OTHER COSTS 299 - - - 0.00% EQUIPMENT (Non-Capital) - - - - 0.00%









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Glossary


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GLOSSARY ACDHS Arapahoe County Department of Human Services – provides public assistance

to the citizens of Arapahoe County. ACHSD Adams County Department of Human Services – provides public assistance to

the citizens of Adams County. ADA Americans with Disabilities Act – a 1990 federal civil rights law that prohibits

discrimination and guarantees that people with disabilities have the same opportunities as everyone else to enjoy employment opportunities, to purchase goods and services, and to participate in State and local government programs and services.

AHC Accountable Health Communities – this model addresses a critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization.

BOCC Board of County Commissioners – the decision-making board for a county. BOH Board of Health – the policy-making body for Tri-County Health Department

that is comprised of nine members: three each from Adams, Arapahoe and Douglas Counties.

CARES Coronavirus Aid, Relief, and Economic Security Act – committed over $2 trillion in economic relief to protect the American people from the public health and economic impacts of COVID-19. Tri-County has received CARES funding from our three counties and CDPHE.

CCPD Cancer, Cardiovascular and Chronic Pulmonary Disease Grants Program – was created in 2005 to fund competitive grants to provide a cohesive approach to cancer, cardiovascular disease, and chronic pulmonary disease prevention, early detection, and treatment in Colorado.

CDC Center for Disease Control and Prevention - the leading national public health institute of the United States under the Department of Health and Human Services.

CDHS Colorado Department of Human Services - the principal department of the Colorado state government that operates Colorado's social services.

CDPHE Colorado Department of Public Health and Environment - the principal department of the Colorado state government responsible for public health and environmental regulation.

CEDRS Colorado Electronic Disease Reporting System – a CDPHE system for laboratories, health care providers, or public health staff who need to report a case of illness.

CFR Code of Federal Regulations – collection of administrative laws governing federal regulatory agency practice and procedures.

CHA Community Health Assessment – a systematic examination of the health status indicators for a given population that is used to identify key problems and


157

assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community’s health needs and identified issues.

CMMI Center for Medicare and Medicaid Innovation – develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act.

CRS Colorado Revised Statute – the laws passed by the Colorado Legislature, which are collected, edited and printed each year by the Office of Legislative Legal Services.

DCDHS Douglas County Department of Human Services – provides public assistance to the citizens of Arapahoe County.

DRCOG Denver Regional Council of Governments – representatives of the Denver metro area counties, cities and towns working together to ensure the region remains a great place to live, work and play.

DSME Diabetes Self-Management Education – the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards.

EHR Electronic Health Records – computer system that collects patient information, schedules appointments, and facilitates billing.

ELC Epidemiology and Laboratory Capacity – a CDC agreement that awards annual funding to state, local, and territorial health departments to: improve laboratory capacity to support vector-borne disease surveillance; improve completeness and timeliness of vector-borne disease surveillance reporting; increase availability of timely and accurate information on vector-borne disease risk and prevention; and identify faster and more completely vector-borne disease outbreaks.

EPA Environmental Protection Agency – established in 1970 to consolidate in one agency a variety of federal research, monitoring, standard-setting and enforcement activities to ensure environmental protection.

Expenditure The payment of cash for the purpose of acquiring an asset or service. FY Fiscal Year- a period that a company or government uses for accounting

purposes and preparing financial statements. For TCHD, this is also the calendar year, although the fiscal year doesn’t have to follow the calendar year. The State of Colorado’s fiscal year runs from July 1 to June 30.

FMLA Family Medical Leave Act - a 1993 federal labor law that provides certain employees up to 12 weeks of unpaid, job-protected leave per year.

Fund Balance The excess of the assets and deferred outflows of resources of a fund over its liabilities and deferred inflows of resources.

GASB Governmental Accounting Standards Board – the source of generally accepted accounting principles used by state and local governments in the United States.

HRSN Health-Related Social Needs, such as food insecurity, housing instability, and lack of transportation, are associated with worse health outcomes, and are increasingly the focus of health-related social needs interventions within healthcare.


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MCPN Metro Community Provider Network – works with the community to provide excellent, culturally-sensitive health services to meet the needs of each individual.

NACCHO National Association of County and City Health Officials – works to improve the public's health while adhering to a set of core values: equity, excellence, participation, respect, integrity, leadership, science & innovation.

NDPP National Diabetes Prevention Program – a partnership of public and private organizations working to prevent or delay type 2 diabetes. Partners make it easier for people at risk for type 2 diabetes to participate in evidence-based lifestyle change programs to reduce their risk of type 2 diabetes.

NENS Non-English, Non-Spanish – assists patients through the use of linguistically and culturally responsive multilingual care navigation, by ensuring NENS children and adults screened and referred for specialty care and services are able to access that care, and connecting NENS child and adult patients without a medical home.

OMB Office of Management and Budget – oversees the performance of federal agencies, and administers the federal budget.

OSHA Occupational Safety and Health Act – a 1970 federal law enacted to reduce workplace hazards and implement safety and health programs for both employers and their employees.

OWTS Onsite Wastewater Treatment Systems – a broad term referring to any system for the collection, storage, treatment, neutralization, or stabilization of sewage that occurs on the property

P-Card Procurement Card – a type of Commercial Card, similar to a consumer credit card, that allows businesses to make electronic payments for a variety of business expenses (e.g., goods and services).

PHAB Public Health Accreditation Board – a nonprofit organization dedicated to improving and protecting the health of the public by advancing and transforming the quality and performance of state, local, tribal, and territorial public health departments.

PHIP Public Health Improvement Plan – a long-term, systematic effort to address public health problems based on the results of community health assessment activities and the community health improvement process.

QI Quality Improvement – a systematic, formal approach to the analysis of practice performance and efforts to improve performance.

Revenue Sources of income financing governmental operations. RFP Request for Proposal – a formal process to obtain pricing and details for

services. RFQ Request for Quote – a formal process to obtain pricing for specific products or

supplies. SAMSHA Substance Abuse and Mental Health Services Administration - the agency

within the U.S. Department of Health and Human Services leading public health efforts to advance behavioral health and reduce the impact of substance abuse and mental illness on America's communities.


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SDOH Social Determinants of Health – conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SNS Strategic National Stockpile – the national repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other critical medical equipment and supplies.

STI Sexually Transmitted Illnesses – an infection transmitted through sexual contact, caused by bacteria, viruses, or parasites.

Strategic Plan The document used to communicate organizational goals, the actions needed to achieve those goals and all of the other critical elements developed during development of the plan.

TCHD Tri-County Health Department. TCOPP Tri-County Overdose Prevention Partnership – a community-based partnership

of public and private partners serving the Counties of Adams, Arapahoe, and Douglas, Colorado, with two main priorities: 1. Prevent opioid overdose deaths in our counties. 2. Increase awareness and education about factors leading to and preventing opioid overdose deaths.

Tri-County Health Department Syringe Access Services Update

A COMMUNITY-BASED PREVENTION AND INTERVENTION PROGRAMPresenter: Lauren Mitchell, ND, RN

Nurse Manager, Harm Reduction and HIV Prevention

Board of Health MeetingSeptember 9, 2021

Quick Overview: Syringe Access Programs (SAP) Providing Community Harm Reduction

• Data collected nationally and internationally has shown that syringe access programs are an effective method of HIV and Hepatitis C (HCV) prevention. Along with decreasing the prevalence of HIV and HCV in communities, syringe access programs have shown to increase risk reduction practices among participants and increase referral and access to other needed services (i.e. substance use treatment, mental health care, health care access, health insurance, etc.).

• SAP provide testing for HIV/HCV. Testing is prevention!• SAP reduce syringe sharing among people who inject drugs (PWID), decreasing rates of

HIV and HCV transmission.• SAP provide life saving Naloxone education and provision, helping to address a portion

of the opioid overdose epidemic.• SAP increase safe disposal of used syringes, protecting police officers and the public

from accidental exposure to blood-borne diseases.

Drug Overdose Epidemic Headlines

• “Fatal drug overdoses surged 59% in Colorado last year as overall deaths rose during the pandemic,” (Denver Post, March 2021).

• “Fentanyl has invaded Denver,” city’s chief medical examiner says. Statewide, overdose deaths involving fentanyl more than doubled, rising 111% to 452 deaths last year. (The Colorado Sun, Feb 2021).

• “Drug overdose epidemic worsened during COVID pandemic. The nation’s COVID pandemic made the nation’s drug overdose epidemic worse. Reports showing increases in drug overdose mortality and other concerns relating to access to evidence-based care for substance use disorders…and harm reduction services.”(American Medical Association Issue brief June 1, 2021).

2013 2014 2015 2016 2017 2018 2019 2020

Adams 17.9 20.1 17.5 18.5 22.65 20.6 17.3 26.33

Arapahoe 15.9 16.1 16.3 13.7 14.4 17.0 16.1 21.58

Douglas 8.9 6.5 6.6 10 9 7.7 9.2 13.36

Colorado 15.93 16.28 16.16 16.48 18.04 16.5 17.8 24.8

0

5

10

15

20

25

30

2013 2014 2015 2016 2017 2018 2019 2020

Drug Overdose Deaths Rates 2013-2020

Adams Arapahoe Douglas Colorado

Rate

s of A

ll O

verd

ose

Deat

hs p

er 1

00,0

00

Data as of: 7/22/2021Source: CDPHE, Vital Records Program

0

2

4

6

8

10

12

14

16

18

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Rate

s of O

pioid

Over

dose

Dea

ths

per 1

00,0

00

Year and County


Opioid Overdose Death Rates 2001-2020

Source: CDPHE, Vital Records Program*Missing data are suppressed rates due to a small number of events

Data as of: 7/22/2021

0

1

2

3

4

5

6

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Rate

s of H

eroin

Ove

rdos

e De

aths

per

100,

000

Year and County


Source: CDPHE, Vital Records Program*Missing data are suppressed rates due to a small number of events

Heroin Overdose Deaths Rates2001-2020

Data as of:

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

2013 2014 2015 2016 2017 2018 2019 2020

Rate

s of F

enta

nyl O

verd

ose D

eath

s per

100,

000

Year and County

Fentanyl Overdose Death Rates2013-2020

Adams Arapahoe Douglas

Source: CDPHE, Vital Records*Missing data are suppressed rates due to a small number of events

Data as of: 7/22/2021

TCHD Overdose Deaths 2019-2020

TCHD Syringe Access Services Efforts (2021)

= Frequent SAS Outreach Locations

New HIV Diagnoses

2016 2017 2018 2019 2020 Q2 2021*Total 8 11 11 8 7 2

New HIV Diagnoses, Douglas County, 2016-Q2 2021*

2016 2017 2018 2019 2020 Q2 2021*Total 65 57 62 72 55 16

New HIV Diagnoses, Arapahoe County, 2016-Q2 2021*

2016 2017 2018 2019 2020 Q2 2021*Total 43 66 58 53 32 22

New HIV Diagnoses, Adams County, 2016-Q2 2021*

Preliminary data and subject to change *1/1/2021-6/30/2021

TCHD Syringe Access Services (SAS)

These services are part of the bigger program called:Harm Reduction and HIV Prevention Program

•One fixed site and street outreach service delivery model in Adams County and Arapahoe County•Multiple community collaborations•Model Practice Award: National Association of City & County Health Organizations (NACCHO) 2018•SAS small team of 7 consists of:Harm Reduction Health Educators, HIV Prevention Specialists, HIV Linkage to Care Nurse, Program Supervisor and Program Manager

TCHD Syringe Access Services Provided

-Education on safe injection practice, overdose prevention, wound care, and other health problems related to injection drug use

-HIV and HCV testing, education and linkage to care-Provision of sterile equipment, wound care kits and naloxone-Education, referral, navigation, and case management for range of services

• Substance use treatment• Mental health services• PrEP for HIV prevention• Medicaid enrollment, housing, etc. • Family planning and immunizations• Wound care, medical care/treatment

TCHD Syringe Access Services Results 10/5/16-12/31/2018 2019 2020 2021 (Q1-Q2)

# Enrolled participants in SAS (unduplicated)

176 292 210 120

# Interactions with participants of SAS

1369 1112 1009 462

# Syringes Dispensed 89,347 77,645 85,574 50,005

# Syringes Returned(% return rate)

77,347 (86.56%) 68,403 (88.09%) 80,300 (93.83%) 47,173 (94.33%)

# Naloxone Kits Provided to SAS participants

463 191 201 143

# Self-Reported Reversals(% reversal rate)LIVES SAVED!

64 (13.82%) 24 (12.56%) 23 (11.44%) 12 (8.39%)

Community Naloxone Training and Provision

202018 individuals• Young People in Recovery• Almost Home Brighton• Valiant Living

202186 individuals (Q1-Q2)• Motel employees at 10 different motels in Arapahoe and Adams Counties• Arapahoe County Resident Reentry Program• Volunteers of America

Looking Back

• October 2016 BOH approval was given to provide syringe access services in Arapahoe County• Fixed site and mobile outreach

• Dec. 10, 2019 BOH approval was given for Adams County SAS expansion• Jan. 1, 2020 beginning SAS in Adams County • March 2020 COVID-19 hit- closure of SAS fixed site, but outreach continued in Adams

and Arapahoe Counties• March 2020-Dec. 2020 SAS continued outreach work 4-5 days a week during COVID-19

great public health work took place during this time!• May 2021- SAS fixed site opened back up

Looking Ahead

• Continue with the important mobile and fixed site SAS work• Increase HIV testing on mobile outreach with SAS participants• Start mobile outreach work in other Arapahoe County areas such as Englewood• Increase syringe disposal box locations in Adams and Arapahoe Counties

May 2021 installed one at MLK Library Application initiated for installation at TCHD Englewood office location (September 2021)

• Open a fixed site in Adams County• If future funding allows, purchase van to cover other outreach locations and areas,

providing HIV/Hep C testing “on-site” as well as potential other services

Thank You For Your Continued Support!

August 2021 Health and Food PHIP Overview

The following update includes Health and Food PHIP:

• Vision and Goals • Data Overview • Recent Accomplishments • Adjustments during COVID • Key Partners • Future Plans for 2021-2022

Vision and Goals

In a healthy community, all residents can access safe, nutritious, affordable and culturally relevant food and are able to practice healthy eating habits. The goals of the Health and Food Priority area are to:

1) Increase access to safe, nutritious, affordable and culturally relevant food, especially in communities with limited resources and communities of color

2) Promote food security and healthy eating habits through messaging, education, advocacy and policy development

Data

The following data points are key population health measures that the Health and Food Workgroup identified to impact through outlined objectives of the work plan. Food insecurity rates have increased from 2018 to 2020 across all three counties. High rates of food insecurity are especially concerning in vulnerable populations of children, pregnant women and seniors.

Figure 1. Overall rates of food insecurity in Adams, Arapahoe, and Douglas Counties

Figure 2. Food insecurity among vulnerable populations in Adams, Arapahoe, and Douglas Counties in 2019.

The Health and Food Workgroup has also been working closely with TCHD’s Planning and Information Management team to create a story board on Health and Food to share programming, client stories, program level data and contacts of the work. This will be updated on a regular basis to reflect new data and new programming/efforts within TCHD and our Health and Food Plan.

The story board will also highlight topic area population health metrics and program work across Adams, Arapahoe and Douglas counties to address the Health and Food PHIP goals. In the photo to right is a draft of the story board and a map to highlight food insecurity and chronic diseases such as diabetes, heart disease, obesity rates.

The Health and Food Story Board is under development right and will be released late summer/early fall followed by other PHIP priority areas.

Recent Accomplishments from Year 2 Work Plan

Goal 1: Increase access to safe, nutritious, affordable and culturally relevant food, especially in communities with limited resources and communities of color Objective 1: By the end of 2021, provide technical assistance and capacity building support to 10 organizations, agencies, and community leaders implementing community-based food projects, food assistance, and/or food systems environment or policy changes in two focus areas in the TCHD jurisdiction. From July 2020 through June 2021, the TCHD Food in Communities (FIC) team has provided technical assistance to over 20 organizations, institutions, and public agencies implementing community-based food projects, food assistance, and/or food systems environment or policy changes. This has included trainings with participation from multiple partners, as well as individual technical assistance. Group trainings have included racial equity training, foundations in data equity, and municipal food policy training (see below for more details). Individual technical assistance included grant writing support, subject matter research and presentations, meeting facilitation, strategic thought partnership, participation on community advisory groups, and other technical assistance.

In 2021, the TCHD FIC team hosted a Municipal Food Policy Training with representatives from the Adams County government and seven municipal governments. The training delved into how municipal and county policies can be used as tools to increase access to healthy, affordable, and culturally important food. The national-level facilitator also met with each jurisdiction to offer relevant local food policy case studies with respect to current and forthcoming planning and policy processes in each jurisdiction.

Additionally, in 2020 and 2021, the TCHD FIC team has not only supported community partners with implementation funding from FIC’s Cancer, Cardiovascular, and Chronic Pulmonary Disease grants program (CCPD) budget from CDPHE but also engaged other funders and leveraged over $645,000 from public and private sources for community partners to implement strategies in Adams County and Aurora. The TCHD Food Systems Coordinator participates in Workgroups 2 and 3 of the Colorado Blueprint to End Hunger: Community Access and Engagement. Objective 2: Increase access to locally grown produce to Adams County community members by December 31, 2020

Farmer’s Markets: From July through October 2020, the Healthy Farmers Markets operated during COVID-19 to provide food assistance to the communities in and around Thornton. COVID CARES Act funding through the City of Thornton was able to provide a $25 produce voucher for Thornton residents who receive WIC, SNAP or who were over the age of 55. To establish equitable opportunities, funding through the American Heart Association (AHA) was able to match the value of this voucher to provide the same incentive for non-Thornton residents in the same three qualifying areas. With support of TCHD's PIM division, ArcGIS Survey123 was used to survey market participants to determine their produce voucher eligibility as well as how they heard about us, their zip code of residence and other food programs that they participate in. These data were highlighted in a farmers market data dashboard

https://tchdgis.maps.arcgis.com/apps/opsdashboard/index.html#/4d111f70071a48b7a3a35ff0ceb1a8f1

to monitor geographic reach and marketing engagement strategies in real-time throughout the market season. Overall, participants purchased a total of $54,991 in fresh produce. AHA created a Healthy Farmers Market video to highlight the efforts of the partner organizations to increase food access in these areas to use for future marketing, to solicit funding/sponsorships and to share with interested partners. This video was submitted to NACCHO after receiving a 2021 Model Practice award to be presented during NACCHO's award ceremony. The 2021 season began in July 2021 with funding to provide a $5 voucher for WIC, SNAP and older adults over 60 through Thornton Assistance Funds (TAF) for Thornton residents and through AHA for non-Thornton residents.

Community Gardens: In May 2020, we continued with two WIC community gardens to provide access to freshly grown produce and nutrition education to WIC clients who participated. The 27J Community Garden in Brighton, produced 384 pounds of produce, the Amazing Meadows Community Garden in Thornton produced 281 pounds, and 434 pounds of produce were donated to local food pantries.

Community Supported Agriculture (CSA): The CSA pilot program started in August of 2020. Nourish has been able to provide funds for four seasons which provides food box deliveries for an average of 51 families per season. This model differs from a traditional CSA program by delivering directly to the homes of WIC families that are served out of the North Broadway office. All partners, which includes Nourish, East Denver Food Hub, and Bondadosa, are looking for sustainable funding so that the program can be expanded to additional clinics in TCHD jurisdiction.

Objective 3 &4: Increase WIC caseload by 2% through enrollment and retention efforts and SNAP participation by 3% by December 31, 2021

The Special Supplemental Nutrition Program for Women, Infants and Children provides nutritious foods, nutrition education, breastfeeding education and support and referrals to medical and community providers. Unfortunately not all who are eligible participate in the WIC Program. Updated enrollment data has not been released since the date below and waiting on new data from USDA. Table 1. Percent Eligible Enrolled participants in the WIC and SNAP Programs.

0%

10%

20%

30%

40%

50%

60%

70%

80%


2017 Eligbile Enrolled by County

2017 Eligible Enrolled WIC 2017 Eligible Enrolled SNAP

https://www.youtube.com/watch?v=fGAPPMHWMmc&t=1s

With federal waivers in place, WIC continued to provide the majority of appointments via telehealth with options for clients to come into the clinic to pick up their WIC EBT card and/or breast pump. Through the American Rescue Plan Act, this summer (June – September) WIC also increased its Cash Value Benefit (CVB) to $35 per month for children and women to purchase more fruits and vegetables (compared to either $9 or $11/month). Across the nation, changes in children’s WIC participation during the pandemic varies widely by state, ranging from a 22% decrease to a 25% increase. Child participation in WIC in Colorado has remained relatively stable (1% decrease since pandemic). Trends from 2019 – 2021 can be seen below for TCHD WIC Program.

Figure 3. WIC participation in Colorado by month for years 2019-2021 To help with enrollment efforts, TCHD WIC Program is participating in the WIC Central Referral Pilot with CDPHE to help increase the number of enrollments from referrals entered through PEAK and the on-line referral system. The pilot includes process of engagement (frequency and timing) and testing a two-way texting platform. The pilot has been extended into a second year to continue to evaluate and develop a plan for statewide implementation on follow-up of referrals through the on-line platforms. This is funded through the Colorado Health Foundation. TCHD WIC also received funding from Colorado Access Community Innovation Program (CIP) to improve our telehealth services while working remote. During the beginning of the pandemic, staff were calling clients from their personal phones and by blocking their number. The CIP grant allowed the program to purchase the Vonage platform for all staff to make calls and text clients from their computer. Additionally both iPhones and Zoom licenses were also purchased for each WIC clinic to securely receive proofs via text and provide educational opportunities on-line with zoom. TCHD continues its partnership with DRCOG Accountable Health Communities. WIC participants who are also on Medicaid are provided a referral to Community Resource Navigators who then screen

further for other social determinants of health: food, housing/living situation need, safety, transportation and utilities. If they have a positive screen to any area they are provided additional community resources. If they have a positive screen and have also been to the emergency department two or more times in the last two months they will also receive navigation to resource needs. Below are charts on number of individuals screened and their identified needs. The Community Resource Navigators have receive an average of 142 referrals per month with highest of 213 in March. As you can see in Figure 4, Food and Housing are the highest identified needs by those screened. Figure 4. Resource Needs Identified of those Screened The Supplemental Nutrition Assistant Program (SNAP) or food stamps, provides nutrition benefits to supplement the food budget of families so that they can purchase healthy food move and move towards self-sufficiency. In figure 5 below, it shows the annual client county by county from 2016 – 2020 for Adams, Arapahoe and Douglas. Increases in participation were seen across all counties from 2019 – 2020.

Figure 5. SNAP Annual Client County by County

020406080

100

Resource Needs Identified

Living Situation Need Utility Need

Food Need Safety

Transportation Need

2019-2020 2020-2021

In 2020, TCHD began a partnership with Hunger Free Colorado to be a SNAP PEA or Partners Engaging in Application Assistance. The goal was to complete dual enrollment of WIC participants into SNAP and increase the number of WIC families who were enrolled in both programs. WIC staff completing appointments with participants identify those who are not enrolled in SNAP and make a referral to one of our Food Resource Navigators (FRN) and scheduled during their WIC appointment. This is a successful model as participants are getting a referral from a trusted resource and our FRNs are also trained WIC staff. The FRNs not only help with the application process, but will upload documents and check on status

and needed proofs to ensure success in their application. In Year 1 (2019 -2020), TCHD exceeded their goal of 636 applications and helped to complete 776 applications. In Year 2 of this grant (2020-2021), the Nutrition Division has recently expanded its food access efforts to address food insecurity in Adams County and hired two Food Access Navigators to help increase access to federal nutrition programs as well as local resources. Starting fall of 2020, outreach events took place to reach families, seniors, and college students at local events and food pantries. In partnership with Adams County Human Services, the Food Access Navigators are able to complete Supplemental Nutrition Assistance Program (SNAP) applications and provide a county interview all in one day. This style of outreach is especially helpful for those experiencing homelessness, those who may not have a phone, or may not be able to travel to the Human Services Office. TCHD also increased the number of outreach sites to help with SNAP application process. New sites include local food pantries, farmers market, and a community college. In addition, programs within TCHD are now referring clients to the SNAP program. These programs include NFP, Harm Reduction & HIV Prevention Program and the Diabetes Education Program. The goal for Year 2 is to help complete 1,200 applications. Social media presence on Facebook and Instagram to increase WIC and SNAP participation has increased this past year by posting program information through weekly posts, videos, highlights, and stories. New

video reels have reached an average of 1,000 people per video and program social media following has increased. Staff are also participating in the Blueprint to End Hunger Workgroup 4: Increase Enrollment in SNAP and WIC where work is happening to align enrollment of Medicaid Members into both programs. Objective 5: Expand access to quality nutrition for underserved or vulnerable children in the Summer Food Service Program.

With waivers in place this past summer, TCHD’s focus was to provide education and promotion of SFSP lunch/meal pick up options for families during the summer and school year. Opportunities were shared via social media and e-mail notifications to WIC families. The School Health Liaison continues to participate in the Blueprint to End Hunger Workgroup 5 Maximizing Childhood Nutrition to learn of strategies and to connect TCHD programming and education efforts.

Goal 2: Promote food security and healthy eating habits through messaging, education, advocacy and policy development

Objective 1: Develop a web-based platform with data, program information and stories to highlight data related to food insecurity, food safety and related health outcomes.

Members of the Planning and Information Management division assisted the Health and Food Workgroup to create this platform. The purpose of the “storyboards” is to provide up-to-date data, program information, client stories and contacts to our board, elected officials and partners.

A sample of the upcoming story board was listed under the data section.

Objective 2: Complete comments and sign on letters to support food security efforts at local, state and national levels.

The Food Systems Coordinator worked with the Policy and Public Affairs Officer to draft an online form for TCHD staff to submit requests for TCHD to engage in policy activities. The Policy and Public Affairs Officer implemented the form and is now tracking policy requests and activities through the form. During the last state legislative session, the CDC Public Health Associate also helped to track bills that staff and the agency were interested in. Below is a chart of number of bills TCHD engaged on and passed in each of the PHIP areas.

Table 2. Health-related bills in the Colorado General Assembly, 2021

Total Bills in this area Total Passed Total TCHD engaged on

PHIP Priority Area Senate House Senate House Senate House

Access to Care 28 27 25 21 2 0

Mental Health 4 17 4 17 1 0

Health and Food 1 1 1 1 0 1

Health and Housing 6 17 6 15 0 0

Federal Bills TCHD supported in 2021:

• Hunger Free Colorado letter sign-on, requests to include “Healthy School Meals for All” in the upcoming infrastructure bill, letter sign-on, 06/09/2021

• NWA letter sign-on, support Wise Investment in Our Children (WIC) Act, letter sign-on, 03/04/2021

Objective 3: Expand access to quality nutrition for underserved or vulnerable children in the Early Child Care and Education System

The Office of Early Childhood’s Preschool Development Grant, Quality Nutrition in Early Care and Education (ECE) Strategy workgroup convenes regularly with TCHD representation. The goal of this workgroup is to expand access to quality nutrition to underserved or vulnerable children in the ECE system. Components of this work include data sharing and outreach strategies. In 2020, data sharing was strengthened to better analyze utilization of the Child and Adult Care Food Program (CACFP) by ECE programs and a childcare homes outreach brochure was created and distributed. Future activities will include the publishing of a statewide Geographic Information System map reporting CACFP utilization and expanding outreach with both childcare homes and centers. Notably, the pandemic related federal waivers to allow flexibilities with child nutrition programs including CACFP are greatly assisting with outreach and participation. TCHD utilizes a childcare newsletter and training sessions to distribute updates and education. Additionally, we collect information from providers utilizing a Healthy Eating and Active Living self-assessment. This document has been used regionally for years and it is currently being pilot-tested along with an accompanying toolkit that will soon be published for statewide use. The assessment allows programs to identify strengths and growth areas to assist with local level action planning regarding policies, systems, and environments.

Objective 4: Establish organizational (e.g., schools, worksites) and municipal policies to promote healthy food consumption.

Child Care Providers: During the past year, nine childcare providers completed the annual re-assessment process to update their Breastfeeding Friendly Childcare Provider Certification. Five providers made enhancements to lactation spaces (e.g., added a refrigerator or chair) and one provider added a new lactation space. Private and Government Employers/Worksites: Fifty-seven organizations (private and government employers) completed an annual healthy food and beverage (HFB) organizational assessment tool. Seven organizations adopted a HFB policy. The policies will be applied in 46 new sites. At the beginning of July, there are 19 organizations in the drafting/pre-approval phase of HFB policy development. Last year, fifteen organizations (private and government employers) completed a breastfeeding friendly (BFF) assessment. Six organizations adopted lactation policies and were designated as BFF Employers. Between these 6 organizations, a total of 32 new lactation spaces were created. At the beginning of July, there are 31 organizations in drafting/pre-approval phase of lactation policy development. Schools and Municipalities:

https://docs.google.com/document/d/1M7l9CEuSMFYNXx0g4dlscJhj0rPaQFPAkX4Cj_tLZbE/edit

https://docs.google.com/forms/d/e/1FAIpQLSdryNEHHpltRSFqNde8dP0Np4SVx7W39fZgT_O2chcimO36hQ/viewform

Other activities outlined in this objective related to providing technical assistance and support to schools and municipalities on healthy food and beverage policy and practices has been delayed due to COVID response efforts by these organizations and key TCHD staff. The second reading on the Healthy Kids' Meal Drinks ordinance in Aurora was delayed multiple times during the pandemic and ultimately postponed indefinitely in June 2021 due to insufficient political will including the council sponsor withdrawing support. The healthy beverage team is now regrouping and completing a readiness assessment to determine which other municipality(ies) could support a healthy kids meal drink ordinance. Adjustments during COVID:

Many programs and projects made adjustments to their Health and Food work to best serve community members during the pandemic. A key measure that ensured programs could continue, were flexibilities granted in federal programs through waivers. Federal waivers have been in place for WIC, SNAP, and Child Nutrition Programs (CACFP, NSLP and SFSP) during the public health emergency to improve access and utilization while keeping our staff and clients safe. All key flexibilities and waivers during the pandemic can be found here for al nutrition programs: https://www.fns.usda.gov/american-rescue-plan.

WIC Waivers: Physical Presence Waiver: Allows participants to enroll or re-enroll in WIC without visiting a clinic in person and postpone certain medical tests. Remote Benefit Issuance Waiver: Allows WIC agencies to issue benefits remotely so participants don’t have to pick up their WIC benefits in person. SNAP Waivers: SNAP Interview: SNAP applicants waived from being required to participate in a 60-90 minute interview in addition to applying to receive SNAP benefits via written application. SNAP to Success ABAWD Waiver: Currently, able-bodied adults without dependents (ABAWD) are waived from being required to produce actively seeking work in order to receive SNAP benefits

Child Nutrition Programs:

Meal Times Waiver: Allows meals be served to kids outside traditional times to maximize flexibility for meal pick-up. Non-congregate Feeding Waiver: Allows meals to be served in non-group settings to support social distancing Parent/Guardian Meal Pick-Up Waiver: Allows parents/guardians to pick-up meals and bring them home to their children. Seamless Summer Option (SSO) and Summer Food Service Operations: Allows SFSP and Seamless Summer Option operations through June 30, 2021. Pandemic EBT (P-EBT) P-EBT provides households with eligible children with funds to help purchase food. This benefit has been distributed because children missed essential meals while child care centers and schools were closed or on reduced hours due to COVID-19. P-EBT was originally launched in Spring 2020 as a one-time benefit and was extended to the 2020-21 school year by USDA.

https://www.fns.usda.gov/american-rescue-plan

https://www.fns.usda.gov/cn/covid-19-meal-times-nationwide-waiver

https://www.fns.usda.gov/cn/covid-19-non-congregate-feeding-nationwide-waiver

https://www.fns.usda.gov/cn/covid-19-parents-and-guardians-waiver

https://www.fns.usda.gov/disaster/pandemic/covid-19/cn-extension-SFSP-SSO

Through SNAP Under Six P-EBT, families with children under the age of 6 (who receive SNAP) can receive up to $942 in total for October 2020 to May 2021 benefits. Community Service Branch and Connecting to Food COVID-impacted individuals and families are referred to the CSB Branch to be connected to resources so they can safely isolate and/or quarantine. The Branch partners with other areas of the TCHD COVID-19 response and connects individuals to food, financial assistance, access to health care, and other resources. The branch has helped community members who have been experiencing food insecurity, and connect them with a free food delivery and food banks, the case managers have also done an excellent job informing and referring to organizations/community partners that can help them apply for public benefits WIC, SNAP, Pandemic EBT, etc., and delivery options if needed (Walmart/amazon for EBT). Key partners in food delivery and distribution in our communities were SECOR Cares, Benefits in Action, Project Angel Heart, Early Childhood Partnership of Adams County. Our community partners contracted to provide linguistically and culturally appropriate navigation support to cases and contacts with limited English proficiency sometimes use additional sources such as local ethnic restaurants and markets to accommodate dietary needs and preferences - as well as support small businesses in their communities.

August 1, 2020 – July 29, 2021 Data: Total Referrals received by CSB: 3,278 Number of referrals received by language: Spanish: 669 English: 2,816 Other: 135 Food and essential item delivery needs identified: 1,280 Food and essential item delivery needs provided, 1,232 The numbers do not take into account the food resources provided by our community partners who support cases and clients with limited English proficiency. They do amazing work with our food referrals!

Key Partners in Heath and Food

The Health and Work Group partners with many state and local organizations and coalitions to increase access to food and to promote healthy food and beverage consumption. Below is a list, not all inclusive, of our key partners in various sectors:

American Heart Association Amigos de México Anythink Libraries Aurora Economic Opportunity Center Aurora Interfaith Community Services Children’s Health Clinic City and County Governments Colorado Blueprint to End Hunger Colorado Breastfeeding Coalition Colorado Farmers Market Association Colorado Food Cluster

Colorado Department of Education and other Health Education Institutions Cultivando CDPHE Colorado Food Cluster Colorado Refugee Connect Colorado School of Public Health DRCOG

Hermanas de Color Hunger Free Colorado Hunger Free WIC Coalition Local Chambers of Commerce Maiker Housing Partners Mosaic Church of Aurora Nourish Colorado Project Protect Food Systems Regional Local Public Health Agency Partners

Rocky Mountain Welcome Center Salud Senior Hub Sprout City Farms The Fax Partnership Thrive Church Village Exchange Center We Don’t Waste

Future Planning

The Health and Food Workgroup recently did an internal assessment to determine where our work is occurring within the food system (Agricultural Production, Processing, Distribution, Access, Consumption and Resource Recovery) and where food-related work is implemented within TCHD’s jurisdictions. The infographic below shows programs that support each part of the food system as well as key strategies of the work being done (see Figure 5). The following table details where specific services, programs and projects are implemented with respect to county, municipal and specific community geographies (see Table 3). Please note this will continue change as our response to COVID changes and funding opportunities and partnerships arise. As we plan for our work through December 31, 2022, we will continue to expand and strengthen our work from the first two years:

• Sustain TCHD’s strong work in federal nutrition programs, local food access and partnerships with community based organizations

• Strengthen local, state and federal food assistance programs and food and agricultural systems through technical assistance and subject matter expertise on state and federal legislative bills and rulemaking processes

• Strengthen communications and messaging related to education, awareness and advocacy

Figure 6. TCHD’s PHIP Health and Food work in relation to the segments of the food system

Table 3. Geographically Where Health and Food Work is Being Implemented

Across All Counties • WIC Program • SNAP Outreach • Diabetes Education • HEAL in Childcare • Dietetic Interns

(supervised practice experience)

• School Wellness • WIC Breastfeeding

Support

• Breastfeeding Friendly (BFF) regional grant

• Colorado Breastfeeding Coalition work

• Workplace Wellness Initiative (includes both HFB and BFF work)

• Regional Healthy Beverage Partnership work - toolkits, messaging, planning a Summit for summer/fall

• Food in Communities Advocacy & Policy Change

• DRCOG Accountable Health Communities

• Community Service Branch – COVID19 Response

• Nurse Family Partnership

Adams County Arapahoe County Douglas County • WIC Gardens • WIC CSA Boxes • WIC Central Referral

Project

• WIC colocations (Stride and Child Health Clinic)

Specific community or municipality SW ADAMS COUNTY communities

• Food in Communities SW Adams County (Westminster, Thornton, Federal Heights, Commerce City)

• Healthy Farmer's Markets –Thornton

• Drive-Thru Boxes - Commerce City

AURORA • Food in Communities –

NW Aurora & E Colfax • Aurora Healthy Kids Meal

Ordinance/ Healthy Kids' Meal Beverages

• WIC colocations in Aurora

Health and Food PHIP PrioritySeptember 9 BOH UpdateJill Bonczynski, Director of NutritionCaitlin Matthews, Food Systems CoordinatorLilia Chavez Bernal, Adams County Food Security Specialist

• Lead: Jill Bonczynski• Executive Co-Sponsors: Jill Bonczynski and Brian Hlavacek• Workgroup Members:

Community Health Promotion: Sam Decker, Heidi Fritz, Amanda Gersabeck, Michele Haugh, Kathy StaatsEnvironmental Health: Caitlin Matthews, Courtney Tomlin EPRCDS: Matt NewmanExecutive Team: Mellissa SagerNursing: Meghan Prentiss, Greta MaceyNutrition: Lilia Chavez Bernal, Judy Fowler, Michelle Harris, Allie LaMonica, Melanie Morrison, Heidi Williams

Health and Food Overview

Vision

In a healthy community, all residents can access safe, nutritious, affordable and culturally relevant food and are able to practice healthy eating habits.

Health and Food: Vision and Goals

Goals

1. Increase access to safe, nutritious, affordable and culturally relevant food, especially in communities with limited resources and communities of color.

2. Promote food security and healthy eating habits through messaging, education, advocacy and policy development

Severity of Food Insecurity Over Time, 2009-2021, Colorado

Source: Hunger Free Colorado

Food Insecurity in Adams, Arapahoe, & Douglas

DURING COVID-19 PANDEMIC (as of April 2021)• 33% of Coloradans are food insecure• Higher food insecurity rates for people of color,

people with disabilities, and households with children

Food Insecurity in Colorado

For more information: https://www.hungerfreecolorado.org/covid-hunger-survey/

− 44% of households with children struggling to have regular access to nutritional foods

− 43% of Latinx and people of color, compared to 29% of white, non-Latinx people− 1 in 5 adults in CO (20%) reported having to cut back or skip meals because there

wasn’t enough money to buy food.

• Community food resources have seen a 2-10 times increase in demand for services

https://www.hungerfreecolorado.org/covid-hunger-survey/

PRE-COVID• Two main federal programs: the

Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

• Not all those who are eligible for these benefits are enrolled in these programs

• Overall, Colorado ranks 43rd in SNAP enrollment and 48th in WIC enrollment

Federal Nutrition Program Participation in Adams, Arapahoe, & Douglas

0%

10%

20%

30%

40%

50%

60%

70%

80%


2017 Eligbile Enrolled by County

2017 Eligible Enrolled WIC 2017 Eligible Enrolled SNAP

Sources: CDPHE WIC Percent Eligible Enrolled Reports; Hunger Free Colorado Food Stamps Impact Report 2019

Health & Food Storyboard

Public Health Improvement Plan (PHIP) Website (Storyboard)• Highlight topic area population health metrics and program work to

address the PHIP goals.

• As a PHIP priority area, Food Security will have a section of the storyboard

• Data describing issues around Food Security across the three counties

• Programs addressing Food Security will be highlighted with a program description and performance metrics to gauge how the programs are addressing this topic

Community perspectives on food access during the pandemic

What we’ve heard from community members and partner organizations…

What has worked well: Food pantries open to all with drive-thru and

curbside pick-up Delivery to homes by trusted organizations Simple intake processes Dependable/reliable scheduling and location Updating information on websites, texts,

referrals, etc. Cross-sector partnerships Federal waivers for CACFP, WIC/SNAP, and

Grab and Go school meals Federal stimulus benefits related to food

assistance Farm to food pantry

What is still needed: Funding to sustain programs and

operations Fresh and culturally important foods Food for people experiencing

homelessness Ongoing updates when operations

change Translation/interpretation at food

pantries Volunteer and staff capacity Linkages with local businesses for

culturally important foods Expanded policies for food delivery

• Increase participation in SNAP, WIC, School Meals and Summer Food Service Program

• Expand access to quality nutrition in Early Care and Education System

• Increase access to fresh and locally grown produce

• Support partners in implementing community-based food projects and food systems, environment, and/or policy changes

• Support organizational and municipal policies to promote healthy food consumption

Health & Food Focus Areas

Image from Johns Hopkins University https://www.foodspan.org/

https://www.foodspan.org/

The “landscape” of TCHD’s Health & Food work

Geography of the work:• Federal- and state-funded programs dominate work

implemented across all three counties

• Work in specific communities funded through local- and state-level grants

How the work relates to the food system:

• TCHD’s niche in the food system is in access and consumption• Some expansion of work to include distribution strategies

during the pandemic• Partnerships through Food in Communities extends TCHD’s

reach in the food system

Almost 100% of TCHD’s Health & Food work is grant-based, which has limitations in terms of innovation and responsiveness.

• Fresh Food Access− Farmer’s Markets− CSA Produce Boxes

• Federal Nutrition Programs− SNAP & WIC Outreach− SNAP Team Coordination

• Community Partnerships− Presentations− Hunger Free Colorado WIC

Coalition

• Communications− Content and Social Media

Adams County Food Security Specialist

• Sustain TCHD’s strong work in federal nutrition programs, local food access and partnerships with community based organizations

• Strengthen local, state and federal food assistance programs and food and agricultural systems through technical assistance and subject matter expertise to state and federal legislative bills and rulemaking processes

• Strengthen communications and messaging related to education, awareness and advocacy

• Will utilize updated Community Health Assessment and Community Engagement efforts to refine and update plan

Future and Emerging Focus Areas

Image from Johns Hopkins University https://www.foodspan.org/

https://www.foodspan.org/

Questions?Contact Us:

Jill Bonczynski: [email protected] Chavez Bernal: [email protected] Matthews: [email protected]

mailto:[email protected]



Tri-County Health Department Board of Health

Executive Director’s Report September 9, 2021

1. AWARDS/RECOGNITION: Tri-County Health Department Recognized as Statewide Leader in Workplace Health and Safety Contacts: Jessica Gomez, Health and Wellness Specialist, [email protected] and Michele Haugh, Workplace Prevention and Equity Lead, [email protected] Health Links™ has announced that Tri-County Health Department (TCHD) has been named a finalist for the following annual, statewide awards. Kudos to all TCHD staff who contribute to these ongoing efforts and who have demonstrated vision, innovation, and commitment to advancing workplace health, safety, and well-being both internally and externally throughout a very challenging year.

• TCHD has been named a finalist for the Integration Award The Integration Award is given to one organization that excels at integrating workplace health and safety – the key to achieving Total Worker Health®—an integrated approach to promote the health, safety, and well-being of all workers.

• TCHD has been named a finalist for the Family-Friendly Workplace Award The Family-Friendly Workplace Award recognizes one organization that excels in supporting employees as caregivers in all stages of life.

• Michele Haugh has been named a finalist for the Director’s Award The Director’s Award is given to one individual who demonstrates leadership in Total Worker Health.

Final recipients will be announced October 28, 2021.

2. TCHD PROGRAMS: Announcing New, Upstream Title V Priorities for Serving Children, Youth, and Families Contact: Alix Hopkins, Maternal and Child Health Program Manager, [email protected] The mission of the TCHD Title V Maternal and Child Health (MCH) program is to ensure equitable access to opportunities, services, and supports necessary for the health and well-being of all children, youth and families, according to their needs. We are excited to announce that, beginning October 1, TCHD’s new Title V Block Grant work plans will focus directly on a) reducing racial inequities, b) increasing economic mobility, c) improving access to supports, and d) increasing social and emotional well-being. This change follows a data-driven planning process that began October 2020. These four new priorities will guide efforts, align resources, and ensure outcomes at both the local and regional levels, positively impacting the lives of




Executive Director’s Report Board of Health September 9, 2021

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women, children and youth, including those with special health care needs, and their families. Future Executive Director reports will highlight the related objectives and targeted strategies. New Class of Dietetic Interns Contact: Michelle Harris, Nutrition Manager, Dietetic Internship, [email protected] TCHD’s Dietetic Internship Program welcomed the new class of six dietetic interns on August 16, 2021. The interns have traveled to TCHD from California, Massachusetts, New Jersey, Texas and Colorado. So far, the interns have had the opportunity to meet many TCHD staff members, learn about nutrition and community health promotion programs, and dive into our public health/ community nutrition rotation. The dietetic interns will complete at least 1200 hours of supervised practice in public health, school, hospital and research settings by June of 2022, which will then allow them to sit for a credentialing exam to become a future Registered Dietitian Nutritionist.

Left to Right: Kara Bowie, University of Massachusetts; Elizabeth ‘Rosie’ Newton, Simmons University; Claire Benoist, University of California-Davis; Lena Grimaldi, University of Pittsburgh & Montclair State University; Sarah Saulsbury, Cornell University & University of Northern Colorado; Sarah Shannon, University of North Florida & Metro State University-Denver.



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Update on Employee Turnover Contact: Mame Fuhrman, Director of Human Resources, [email protected] It has been all over the news that the nation is facing a turnover tsunami in many organizations. Public Health agencies have been hit particularly hard in the last couple of years. TCHD has been lucky. In 2020, our turnover rate was 12.7%. Many of our employees were activated and almost all employees supported the COVID-19 response in some capacity. However, 2021 is not looking as good. Year-to-date, our employee turnover rate is 16.3%. Exit interview data indicate the following reasons staff leave TCHD. The top four are the most frequent reasons provided:

• Other position or promotional opportunity (many in new industries) • Relocation (usually to be closer to family with a lower cost of living) • Retirement • Stay at home with family • Burnout due to COVID-19 response • Travel • Back to school

Many employees cited secondary and other contributing factors for their departure as well. TCHD is working to decrease turnover by fully understanding the reasons employees leave, addressing their personal and professional needs, prioritizing their wellbeing, and providing them with flexible benefit options and improved transparency. Additionally, we are planning 4% salary increase in January 2022 for all employees. We are hopeful these efforts will improve employee retention rates by the end of the year. Update on New Financial System Implementation Contact: Monique Didier, Administration and Finance Director, [email protected], and Mame Fuhrman, Human Resources Director, [email protected] The project team is continuing to make strides with the financial systems implementation. The team is currently working with Tyler Implementation Consultants to design the new system. The current phase of the implementation is process design and training for the functional leads. The next phase of training will include the other members of the project team. We are currently on track to go live in January 2022! Nursing Division Moves Forward with Request for Proposal Process in Anticipation of Upgrading to a New Electronic Health Record System Contact: Melissa Spencer, Associate Director of Nursing Operations, [email protected] TCHD has retained the services of BerryDunn to assist with assessing our current software systems and business processes in order to identify future software needs. The project’s focus is to assess current processes, define future-state requirements, and plan for the replacement of our current legacy Netsmart software application. BerryDunn has extensive experience working with agencies similar to ours in assessing software system needs.






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The preliminary stages of the project are underway. The TCHD Project Team within the Nursing Division has provided existing documentation to BerryDunn in an effort to educate them on the current software system environment at TCHD. Congruently, project team meetings, including representatives from TCHD and BerryDunn, have commenced. A web survey has been disseminated to all stakeholders aimed at collecting information to understand the challenges in the current environment, and all employees, agency-wide, were encouraged to participate in the survey. The feedback collected from the survey will be reviewed during our working project team meetings. In order to facilitate successful project communications, BerryDunn will be coordinating with us to schedule meetings, meet project deadlines, and help ensure that all input is included throughout this project. The internal project team structure can be found above, and a high-level project timeline is outlined below.

3. PUBLIC HEALTH ISSUES: Childhood Vaccination Coverage Rate: 2020-21 School and Licensed Childcare Data Contact: Karen Miller, Nurse Manager, [email protected] Colorado Board of Health rule 6 CCR 1009-2 requires most schools and licensed childcare facilities to report aggregate immunization and exemption data to the Colorado Department of Public Health and Environment (CDPHE) on an annual basis. On Monday, August 23, 2021, data for the 2020-21 school year was published and shows a slight decrease in both school and child care vaccination rates compared to the 2019-20 school year. In addition, a slight decrease in the number of schools and child cares who reported data was noted. Although a disappointment, this decrease was expected given that Colorado had seen a decline in routine vaccinations administered to children and teens during the initial months of the COVID-19 pandemic. The newly published data can be viewed for each school and district, can be compared to previous school years, and can be sorted by vaccine type. Overall, 3,577 (87.76%) of Colorado


https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=7698&,fileName=6%20CCR%201009-2

https://cdphe.colorado.gov/school-and-child-care-immunization-data


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schools and licensed child care facilities reported data for the 2020-21 school year, compared to 3,685 (91.26%) who reported data during the 2019-20 school year. Of the schools who reported data, 94.17% report compliance with the school immunization law, by either having an up-to-date or in-progress immunization record on file for each student, or by having an exemption on file. This was a slight decrease from the 95.04% compliance rate the previous school year. The tables below are a snapshot of the past three school years compliance rates broken down by schools (grades 1-12), kindergarten, and child care/preschool, and compares statewide data with TCHD jurisdictional data.

2020-21 School Year School Compliance Rate

Kindergarten Compliance Rate

Child Care/Preschool

Compliance Rate Statewide data 94.17% 92.22% 95% TCHD Jurisdiction 94.69% 93.63% 92.70% Adams County 96.04% 94.97% 97.86% Arapahoe County 91.91% 91.42% 95.36% Douglas County 96.87% 95.02% 85.42%

2019-20 School Year School Compliance

Rate Kindergarten

Compliance Rate Child

Care/Preschool Compliance Rate

Statewide data 94.97% 93.70% 95.49% TCHD Jurisdiction 95.66% 94.64% 95.94% Adams County 98.35 97.91% 98.36% Arapahoe County 92.51% 91.07% 95.19% Douglas County 97.36 96.18% 94.90%

2018-19 School Year School Compliance

Rate Kindergarten

Compliance Rate Child

Care/Preschool Compliance Rate

Statewide data 92.51% 88.42% 94.58% TCHD Jurisdiction 93.05% 89.28% 95.61% Adams County 97.89% 96.12% 96.51% Arapahoe County 89.08% 86.24% 95.03% Douglas County 93.87% 85.92% 95.62%

There is still much attention on Colorado’s kindergarten measles, mumps and rubella (MMR) vaccination rates. The 2020-21 data shows 90.47% of kindergarteners fully vaccinated against MMR, and 0.3% in process. This is a slight decrease from the 2019-20 school year data at 91.09% fully vaccinated, 0.44% in process. In response to this newly published data, and in line with Immunization Program core services grant deliverables, TCHD’s Immunization Program will utilize this data to inform schools,


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childcare facilities, parents, and the community about these rates. Additionally, we will work to increase the number of schools reporting data through proactive outreach to non-reporters to address barriers and provide guidance and education. We will also analyze schools and childcare facilities that report rates under a defined percentage, follow up with schools reporting the highest exemption and non-compliance rates, and offer additional support such as community presentations, parent communications, and connection to vaccination services. Lastly, the Program anticipates the results of SB-163, School Entry Immunization, to positively impact school immunization rates for the current school year. Beginning July 1, 2021, for the 2021-22 school year, all students seeking a non-medical exemption must follow the new exemption process by either completing an online immunization education module or by submitting a certificate of nonmedical exemption with a signature from an immunizing provider. The reporting portal for the 2021-22 data will open October 1, 2021 and close on January 15, 2022. September is National Preparedness Month Contact: Michele Askenazi, Director of Emergency Preparedness, Response, and Communicable Disease Surveillance, [email protected] September is National Preparedness Month, a nationwide effort to encourage individuals and communities to plan and prepare for emergencies. The national theme this year is Prepare to Protect. As we have seen over the last couple of years, taking the time to ready yourselves and those you care for is an important step in assuring that you are ready to face any disaster. TCHD is committed to increasing the preparedness and resiliency of our staff and the communities we serve, especially this year as we continue to respond to and recover from the impacts of the COVID-19 pandemic. TCHD’s Emergency Preparedness and Response program staff are sharing information through our annual Preparedness Month email from the EPRCDS Division Director; through TCHD’s employee newsletter, The Triangle; and via social media to provide tips and tricks and to encourage everyone to be prepared. Additionally, we refer staff to helpful preparedness materials updated each year on TCHD’s Preparedness Month website – useful information for everyone!

https://www.dcphrapps.dphe.state.co.us/storyline360/story.html

https://cdphe.colorado.gov/School-child-care-data-reporting


https://www.ready.gov/september

http://www.tchd.org/623/National-Preparedness-Month

Documents

Board of Health