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HomeMy WebLinkAboutagenda.council.joint.20141202 CITY COUNCIL & JOINT WORK SESSION December 02, 2014 4:00 PM, City Council Chambers MEETING AGENDA I. Health and Human Service Trend Discussion II. Board of Public Health IGA 1 AGENDA ITEM SUMMARY WORK SESSION DATE: December 2, 2014 AGENDA ITEM TITLE: Joint City/County Health and Human Services Presentation STAFF RESPONSIBLE: Mitzi Ledingham and the POD network ISSUE STATEMENT: The Pitkin County Health and Human Services (HHS) network, known as “the POD”, consists of a dedicated group of nonprofit agencies who meet regularly to share information and collaborate on initiatives and issues of common concern in the health and human services arena. Today the POD will present an overview of the trends in service provision that agencies are currently experiencing. BACKGROUND: For a number of years, the POD has met with City of Aspen and Pitkin County elected officials during budget season to review grant requests and provide information on common issues and trends in the provision of services to City of Aspen and Pitkin County residents and workers. No meeting was held in 2013 as the City was exploring options related to funding HHS agencies. The City Council has as one of its 2014-2015 top ten goals to complete a review of HHS funding, identifying the purpose of the city’s involvement in funding, how it will participate in the effort, and the amount and source of the city contribution. Both the City and County have allocated non-profit funding in their 2015 budgets. The purpose of today’s meeting is for POD members to provide information about emerging trends that will affect future community needs to inform the City’s deliberations on its HHS funding goal and future deliberations of the Healthy Community Fund Grant Review Committee. No budget decisions will be made at today’s meeting. Today’s POD presentation is based on the Lifelong Aspenite chapter of the 2012 Aspen Area Community Plan, to help our citizens achieve a higher quality of life through the four organizing principles of Self-Reliance, Public Safety, Health and Well-Being, and Education and Lifelong Learning. Agency representatives will describe how the human services programs supported by Pitkin County and the City of Aspen work together to provide a safety net of support and services for our residents and workers. Attachment A contains the details of the presentation. Attachment B contains additional agency specific data, the HCF 2013 Report Cards. These 2013 year-end summaries highlight many of the outcomes and achievements of the non-profit agencies who are Healthy Community Fund grantees. P1 I. 2 LINK TO STRATEGIC PLAN: Livable and Supportive Community KEY DISCUSSION ITEMS: Review/discuss current trends affecting individuals, families, adults and non-profits in our community. BUDGETARY IMPACT: none at this time. RECOMMENDED BOCC ACTION: None at this time, informational only. ATTACHMENTS: A. HHS Presentation B. 2013 Healthy Community Fund Report Cards P2 I. 1    ATTACHMENT A    Presentation to the Aspen City Council and   Board of County Commissioners   From Area Non‐Profit Organizations    December 2, 2014    INTRODUCTION  Marty Ames – Pitkin County Senior Services    SELF‐RELIANCE  Dana Peterson – Mountain Valley Developmental Services    I.1. Ensure that affordable, accessible high‐quality childcare is available for all families who need it.  (Community Goal)  Rocky Mountain Early Childhood Council and Kids First Early Childhood Network and other childcare  programs throughout the valley have this as a goal and are supportive and working to achieve this goal.     I.2. Encourage businesses to adopt family‐friendly employment policies.  (Collaborative Initiative)   Government and big business lead the work in this area.   Difficult given the cost of health insurance in the valley – especially in Garfield County   Personal Time Off (PTO) policies.   Flexible work schedules.   Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement  Accounts  (HRAs) increasing in popularity   Colorado Employer Benefit Trust (CEBT) clinics in Glenwood and Rifle   Other benefits   If ½ of income is going to rent, what do businesses do?    I.3. Promote self‐sufficiency and self‐reliance through coordinated, comprehensive and sustainable  programs. (Collaborative Initiative, Work Program for Health and Human Services)  Pitkin County Health and Human Services (HHS):   In 2012, HHS had 148 Public Assistance cases.  As of September 30, 2014 there are 1,100 people  on Medicaid.  More people are eligible for health care coverage, but they have to go to Basalt,  Glenwood, Grand Junction or Rifle to get access to care.   LEAP (low income energy assistance program) numbers are down, but Energy Outreach  Colorado numbers are up.  Catholic Charities:   Catholic Charities is seeing a decrease in dental requests due to Medicaid coverage.   Overall numbers for emergency assistance through Catholic Charities is back to 2008‐2009  numbers (down by 14% or more).   Wage Theft is a problem where employers are taking advantage of those who desperately need  jobs and then do not pay them in a timely or accurate manner.        P3 I. 2    Mountain Valley Developmental Services (MVDS):   Twenty‐three new Supported Living Services slots have become available off the MVDS waiting  list, thus increasing self‐sufficiency and sustainable services for these families and individuals.   Early Intervention services are effectively reducing developmental delay or risk of delay thereby  drastically decreasing the need for additional services after age three.  Only 43% of children  continue needing specialized services once they start school.    Pitkin County Employee Assistance Fund:    Seventeen (17) residents have been assisted with rent payments totaling $15,724 by July 30th,  2014, compared to twenty‐six (26) residents receiving a total of $21,202 by this same time in  2013.  However, Aspen SkiCo Human Resources is reporting a difficult time for seasonal  employees to find affordable housing over the winter due to rental shortages and high costs.   We also supplement what we can provide through accessing resources of our many partners,  e.g. Catholic Charities, which was recently able to assist a resident with $880 towards a new  apartment rental; Pitkin HHS also works with Salvation Army, Aspen Community Foundation,  and others, and this year, Rocky Mountain Human Services, based in Grand Junction with a new  satellite office in Carbondale, for financial help for veterans throughout the region.  Roaring Fork School Districts:   Roaring Fork School District graduation rates declined slightly between 2012 and 2013.  Pitkin  County’s increased slightly.  State graduation rates were up.     Drug and Alcohol issues at the high schools: one school has had 17 students suspended up to  this point. Distribution of marijuana is happening at all of the high schools.   Increased pregnancies at the high schools over the past couple of years.   Increased homeless students and families (all schools); primarily families doubling up due to  economic hardship.   High number of students with eating disorders at the high schools.   Increasing numbers of newly immigrated Latino population which takes more effort around  welcoming them to the school district and informing the parents of the education system. A lot  of them are very behind in school (grade levels). Seeing trauma with this population‐‐lashing out  at teachers and truancy issues.    Mental health needs in the high schools have increased to the point where two of three high  schools have mental health therapists in the schools.  The third is working toward having one as  well.    I.4. Expand the opportunity for safe and healthy housing for those in need, including older adults,  people with disabilities and low‐income populations. (Work Program for HHS)  Habitat for Humanity Roaring Fork Valley   Habitat has partnered with 17 local families in need to construct affordable homes, but has  struggled to build houses up valley due to the lack of available land and high real estate  development costs.    The need for Category 1 affordable housing in Aspen/Pitkin County is high. There are very few  Category 1 rental units and virtually no Category 1 homes.    The Aspen Pitkin County Housing Authority (APCHA) has donated a parcel of land on which to  build a Habitat duplex in Aspen. The current sentiment of the Aspen City Council seems to  support the creation of home ownership opportunities for these lower income residents, and  Council has asked the City Manager's office to work with Habitat to develop a plan to remove  development hurdles.   P4 I. 3     The Basalt Town Council has sold Habitat a lot for a single‐family home in the Eagle County  portion of the town. Habitat has developed a feasible financial pro forma for the project and  anticipates breaking ground in the spring of 2015. Basalt is looking at a range of affordable  housing projects to partner on with Habitat.    School District Observations:   School Districts continue to see people floating into town – no jobs, no place to live, nothing  planned.  Hypothesize that this has something to do with marijuana legalization.  This summer  saw a dramatic rise in this move‐in population.   Rents have skyrocketed with landlords being unwilling to rent to families unless there is a  bedroom for each child.  Aspen Homeless Shelter:    The Roaring Fork Valley community is experiencing a notably large number of residents with  extreme emotional distress. In some cases, these residents resort to suicide. The Aspen  Homeless Shelter is aware that difficult economic times may cause otherwise resilient  individuals to become highly stressed, lose their foothold in the community, and become  homeless. In response, the Aspen Homeless Shelter is emphasizing personalized case  management that identifies an individualized path forward for these individuals so that they  may regain control over their lives and reestablish themselves in the community.  Mountain Valley Developmental Services (MVDS):   MVDS provides individuals with intellectual and developmental disabilities ages 18‐years or  older with a place to live, supports for daily living, recreational opportunities, medical and  emotional resources, and training in areas which promote independence and self‐sufficiency.  MVDS offers residential facilities for 24‐hour assistance, community access support, life skills  training, and occupational opportunities for community based work.   MVDS has housing available for the first time in years for adults with disabilities and room to  take individuals off the waiting list if they are interested.  Catholic Charities:   Catholic Charities continues to receive 3‐5 requests per day for rent assistance, and a growing  trend is the number of requests from people who have moved here because “it looks like a nice  place to live.” These people have no income, no job and nowhere to live.    I.5. Ensure that all community members have access to all public assistance programs for which they  qualify. (Work Program for HHS)   Roaring Fork School District (RFSD): placed a liaison in each school district in order to engage  more parents.   Trend in the valley – supporting children and school‐ aged kids (almost to the detriment of other  adult‐based programming).   A light downward trend in 2014 for community health in both Garfield and Pitkin Counties.   Aspen Homeless Shelter (AHS) serves the chronically homeless who choose not to pay rent –  who are actively choosing not to comply.   Catholic Charities: providing more programming for people to help with self‐reliance – providing  the assistance to try to teach them how not to return to poverty and assessing those who do  return to determine how to support them.   Senior Care Navigation provided individual assistance to 58 seniors in 2013 to navigate systems,  plan and create a safe environment to meet their needs.  P5 I. 4     POD, monthly meetings of Health & Human Service (HHS) groups who serve clients in Pitkin  County, where program information is shared and issues are discussed.   Mid‐Valley Collaborative‐ quarterly meetings of HHS groups who serve clients between Old  Snowmass and Carbondale (including Fryingpan and Crystal River Valleys)   Coalition of Emergency Assistance Providers (CEAP)‐Pitkin, Eagle and Garfield‐ includes all  emergency providers‐ County Economic Services, Salvation Army, Catholic Charities, River  Center, the faith community, law enforcement, American Red Cross, nonprofits providing  frontline assistance.   Cradle to Career‐ Aspen Community Foundation initiative, bringing together everyone who  works with youth, birth through 18, to align with goals and services ensuring educational  success, readying youth for college or career.   West Mountain Regional Health Alliance (WMRHA) ‐ health care providers throughout Eagle,  Pitkin and Garfield counties who meet quarterly to ensure affordable, quality and accessible  health care.   Coordinated Community Response Team (CCRT) – First responders in Aspen and Pitkin County  meet to ensure coordinated response to crises.    Aging Well Community Planning Initiative (AWCPI)‐ Finalized in November 2014, this effort  engaged community members in a comprehensive process to ensure that Pitkin County is a  place where residents can access services and activities throughout all stages of life.    FACET (Family and Child Engagement Team) South‐ meets monthly to work with referred  families and children to ensure that all of their needs are met.   Early Childhood Council‐ State lead coordinator leads the group of childhood providers (birth to  5) from Pitkin, Eagle and Garfield and Lake counties‐ includes schools and providers.   Western Colorado Community Health Care Worker, Promatora Coalition‐ Eagle, Garfield and  Pitkin Counties working with the State to receive funding in order to staff Community Health  Workers/Patient Navigators in each county.     PUBLIC SAFETY  Lori Mueller – YouthZone     I.1 Ensure a safe community.  Non‐profits provide a variety of services which lead to a safe community.  Domestic violence education  for teens and adults, drug abuse prevention and referral services, homeless services and rent assistance,  child protection services, sexual abuse treatment and referral services, pro bono legal services,  restorative justice, services for at‐risk teens and child advocates.      II.2 Ensure a safety net exists for Aspen Area residents, visitors and workers who may be at risk.   RESPONSE: Provides Services for Survivors of Domestic Violence:   Agency offering more health classes & support groups at schools and businesses   Agency coordinating Community Response Team   Emergency services for domestic violence victims    River Bridge Regional Center: Prevention and Treatment of Child Abuse:   Increase in number of parent workshops on child sexual abuse prevention, from 0 in 2012 to 8 in  2014‐ all free to public  Catholic Charities: Provides support services for the poor:   Receives 3‐5 requests a day for rent assistance in the tri‐county region  P6 I. 5    Court Appointed Special Advocates: Advocates in juvenile court for abused and neglected children:   2 Dependency and Neglect cases filed in Pitkin County affecting 5 children   3 children in Pitkin County placed in out of home care in 2012 (State Judicial)  Aspen Hope Center: Provides suicide intervention and prevention services:   Pitkin county’s suicide rate is twice as high as other counties in Colorado and three times the  national average    II.3 Reduce juvenile and adult crime.  Youth Zone – Provides services to youth and their families involved in the juvenile justice system:   90% of youth do not reoffend while at YouthZone    Assault and Petty Theft charges have gone down by 50% over the past 2 years   Alcohol and Harassment charges have both doubled    Marijuana charges have remained stable  Valley Partnership for Drug Prevention: Promotes drug prevention and education for youth:   The youth of our community uses marijuana at twice the national average   Pitkin County Department of Human Services:   In 2008 there were 58 child welfare referrals; in 2013 there were 166.   80% of child welfare  referrals were due to domestic violence    HEALTH & WELL‐BEING  Lindsay Lofaro – The Buddy Program    III.1 Promote community‐wide collaboration to address health and social service needs throughout  the community and in association with new development.  Health & Human Service non‐profits work together in a multitude of ways and on a multitude of topics to  ensure quality programming for clients.    Current collaborative efforts include:   POD‐ monthly meetings of Health & Human Service (HHS) groups who serve clients (residents  and workers) in Pitkin County   Mid‐Valley Collaborative‐ quarterly meetings of HHS groups who serve clients between Old  Snowmass and Carbondale (including Fryingpan and Crystal River Valleys)   Coalition of Emergency Assistance Providers (CEAP)‐Pitkin, Eagle and Garfield emergency  providers including County Economic Services, Salvation Army, Catholic Charities and others as  listed above.   Cradle to Career‐“ a collective impact effort that builds youth success from Aspen to Parachute  by serving the needs of over 22,000 children ages 0‐18, ensuring that children are ready for  kindergarten and graduate from high school ready for college and career.”   West Mountain Regional Health Alliance (WMRHA) ‐ health care providers throughout Eagle,  Pitkin and Garfield meet quarterly to ensure affordable, quality and accessible health care.    Coordinated Community Response Team (CCRT) – the CCRT Coordinator serves to enhance the  domestic violence response of core community responders, and  participates in developing  and/or enhancing the law enforcement, criminal justice, and advocacy response to victims in the  community. The purpose and goal of this team is to improve the criminal justice process in order  to provide victim safety and offender accountability.   P7 I. 6     Aging Well Community Planning Initiative (AWCPI)‐  Finalized in November 2014, engaged  community members in a comprehensive process to ensure Pitkin County is a place where  residents can access services and activities through all stages of life.    FACET (Family and Child Engagement Team) South‐ meets monthly to work with referred  families and children to ensure that all of their needs are met.   The Rocky Mountain Early Childhood Council‐ a coalition of community members and agencies  working together to support families and advance the health, mental health, and early care &  learning systems in Eagle, Garfield, Lake, and Pitkin counties.   Western Colorado Community Health Care Worker, Promatora Coalition‐ Eagle, Garfield and  Pitkin Counties working with the State to receive funding in order to staff Community Health  Workers/Patient Navigators in each county.     III.2.Ensure that a comprehensive health care system exists and that the community is aware of the  system.  Nonprofits work continuously to ensure that the community is aware of the available healthcare options  and promote these options to their constituents.     III.3. Ensure that residents have access to primary care.  There continues to be a lack of doctors and dentists who take Medicaid and Medicare in Pitkin County.  This creates barriers for those with Medicaid or Medicare, or for those who are uninsured to receive care.   Pitkin County Health & Human Services:   Individuals who have signed up for Medicaid have expanded 155% from Sept 2013‐June 2014 in  Pitkin County.    Investing heavily in Mountain Family Health Centers to serve population in Basalt.  Mountain Family Health Center in Basalt:   Saw 688 individuals with Medicaid or Medicare in February 2014 and saw 2,995 individuals in  September with Medicaid or Medicare.  Pitkin County Public Health:   Community Health Assessment to the State has been submitted (this happens every 5 years).  Top Pitkin County priorities include:  Access to care, Mental Health Services, Seniors and Aging  services, Radon awareness and reduction.   Pitkin County Seniors:   Population group over age 60 is the fastest growing segment of county population, currently  21% of total. This trend continues for 25 years.   Population growth over age 80 is almost 3 times faster. The 400 individuals now in this group  will grow to 1400 in 25 years. This group has the greatest need for services.    72% of seniors who responded to the 2012 Community Assessment Survey of Older Adults  (CASOA) reported they are likely to remain here throughout their lives, so Medicare providers  are crucial.    III.4. Ensure that residents of all ages and abilities have access to a comprehensive mental health and  substance abuse system that addresses acute and chronic mental health needs.   Many organizations are working with clients who have mental health needs and there seems to be a  trend that mental health needs are more complicated and complex than ever. Organizations are working  together to help clients navigate where to get services and are also looking at coordinating care amongst  agencies. Many youth and family organizations offer mental health services.     P8 I. 7      Aspen Hope Center:   Continuing to work collaboratively with many agencies to ensure services for clients.   32% increase in welfare checks in 2014 (from 2013).   75% of work is crisis work.   Summer of 2014 saw a higher volume of clients than ever before.  Windwalkers‐ Equine Assisted Learning and Therapy Center:   Work with veterans has increased through the Horses for Heroes Program.  Mind Springs Health and Aspen Detox:   Mind Springs Health‐ Aspen saw an increase of unduplicated client counts by 30% from 2013‐ 2014.   The average wait from first contact to first appointment was three days.   There were 130 detox admissions in FY 2014, with 63% of those participating in follow up  treatment following detox.   Crisis contacts increased by 28% in the Fiscal year 2014.    III.5. Ensure that all residents have access to a comprehensive dental program.   As aforementioned, the lack of dentists who accept Medicare or Medicaid in Aspen and Pitkin County  creates gaps for all of our clients seeking this care.     Aspen to Parachute Dental Alliance:   2nd largest school sealant program in the State geographically.    Pitkin County has no dentists who currently take Medicaid.   Pitkin County Medicare clients, uninsured and under‐insured individuals have to go to Rifle (or  beyond) to Mountain Family Health Center for dental care.  Pitkin County Seniors:   ‘Smiles for Seniors’ screening and cleaning offered at affordable rate (Medicare doesn't cover);  additional financial assistance for low‐income seniors.    III.6. Promote healthy family functioning.   An abundance of coordination and collaboration is happening up and down the Roaring Fork and  Colorado River Valleys to ensure healthy family functioning. Health and Human Services agencies are  committed to preventive services as well as serving everyone in our communities so that workers and  residents in Aspen and Pitkin County can thrive and help drive the economic engine in our region.     Family Visitor Programs:   Nurse Family Partnership Program (first time moms, single moms, young moms) referrals have  doubled since 2013.    Total number of births are down from Aspen to Parachute 2009 (164) to 2013 (123).    Number of births to foreign‐born women is down from Aspen to Parachute.  The Buddy Program:   Working with increased number of youth who are from single parent families (40% of all clients).   Served 21 youth and families through our counseling fund (referrals to outside therapists) in  2013.   56% of the families served report earning under $50,000 a year.  Youth/Zone FACET (Family and Child Engagement Team) South‐    19 families have participated in this process, 52% from Pitkin County, 48% from Eagle County.   P9 I. 8      In addition to the organizations listed here, many other organizations are working to ensure healthy  family functioning and have been mentioned in other parts of this presentation. They include, but are not  limited to:   Roaring Fork Family Resource Centers, Alpine Legal Services, Mountain Valley  Developmental Services, RESPONSE, River Bridge Regional Center, Valley Life for All, and others.     EDUCATION & LIFELONG LEARNING  Dana Peterson – Mountain Valley Developmental Services    IV. Ensure all residents have access to local education opportunities. (Community Goal, Collaborative  Initiative)  Go2Work – Colorado Mountain College (CMC) Programming:   Using Colorado Department of Labor statistics to find out what jobs are trending and then works  to place people in those fields.   Working with CMC to increase opportunities for seniors to be employed.   Valley Life for All:   10% of all US students have Individual Education Plans (IEPs).  1 in 54 children will be diagnosed  with autism.   Offers Leadership Classes so families can learn to advocate for their children.   Works with Self‐Advocates (people with disabilities) so they can learn to advocate for  themselves.  Mountain Valley Developmental Services:   Interfaces with the transition program at school districts as well as with Board of Cooperative  Educational Services (BOCES) for adults with disabilities to ensure appropriate placement and  vocational training, recreational activities and residential supports for those aging out of the  school system.  Senior Services:   Senior Services provides education on a wide range of topics with community partners,  including individual technology training so seniors can learn to access information and systems  on their own.    75% of the 600+ seniors who utilized senior center programs in 2013 were residents or visitors  of Aspen.  English in Action:   English In Action serves 225‐275 immigrants annually with the help of 150+ volunteer tutors, but  still has a waiting list of 100 individuals who would like a volunteer tutor (with no advertising on  our part).  Denver University Graduate School of Social Work, Western Colorado Master of Social Work (MSW)  Program:   Based in Glenwood Springs, the Western Colorado Masters in Social Work (MSW) Program  allows students from the Roaring Fork Valley and beyond to earn an MSW degree in their local  community.    Social workers are uniquely prepared to address the health and wellness needs of individuals,  families, and communities.    The first cohort of 22 students are currently in their second year of study and will graduate in  May, 2015.    Other organizations offer parenting classes and other learning opportunities:  P10 I. 9     YouthZone, Family Resource Centers of the Roaring Fork Valley, RESPONSE, Aspen Hope Center,  Valley Settlement Project (Manaus Fund), River Bridge Regional Center….and many more!    CONCLUSION  Lindsay Lofaro – The Buddy Program    Thank you for inviting us to present today.  We hope that our hard work and dedication to providing  great services is evident to you, as we certainly believe it makes a difference to those we serve and to our  communities.    P11 I. 1 ATTACHMENT B 2013 Healthy Community Fund: Spotlights This document outlines 2013 year-end health and human services (HHS) data (spotlights) as submitted to Pitkin County HHS via a year-end report. HHS agencies fall within the following four goal areas: Goal 1: Family and Youth Well-Being; Goal 2: Physical Health; Goal 3: Mental Health; and Goal 4: Well-being of Seniors. In each section, agencies are identified in the table entitled “Benefits To Our Community” and then individual data for each agency is outlined below. Goal 1: Family and Youth Well Being- $435,000 Promoting the social, emotional & economic well-being of families and youth. Program Agencies - Benefits To Our Community Alpine Legal Services Legal services for low-income clients. The Buddy Program Youth mentoring programs, support services. Catholic Charities Emergency assistance program. Family Visitor Programs Support and education for pregnant women and new parents. The Manaus Fund-The Valley Settlement Project Connect low income families who work in Pitkin County to available resources to improve school readiness and school achievement and family economic stability. Mountain Valley Developmental Services Vocational & residential programs for the developmentally disabled. Roaring Fork Family Resource Centers School-based services to connect with families and improve student health and academic achievement. RESPONSE Support for survivors of domestic violence and sexual assault. River Bridge Regional Center, formally Childhelp River Bridge Child advocacy center dedicated to the prevention, assessment, treatment, and investigation of child abuse. YouthZone Alternative sentencing options for youth in the juvenile justice system. Alpine Legal Services - http://www.alpinelegalservices.org 2013 Fund Amount: $20,000 “...to ensure access to justice by providing and coordinating quality legal services that protect and advance fundamental legal rights.” • 775 served who live or work in Pitkin County; 40% of overall clients served. • ALS provided more than 3,200 attorney hours on approximately 400 cases in 2013 - equates to a value of more than $480,000 in free legal services annually. • More than 2,200 people contacted ALS seeking legal information for issues such as tenant rights, evictions, debts, small claims actions, custody, divorce, civil rights, employment, and public benefits. • More than 75 attorneys volunteering their time in ALS’s Pro Bono Program. P12 I. 2 • ALS offered 30 legal education seminars in the valley, serving 175 participants. • Ripple effect of services helps stabilize individuals and families, helps them secure safety, go back to work, and generally participate in society. • Civil legal aid ensures justice for all Americans, regardless of their income. This insurance of fairness in our judicial system is critical to maintaining a functioning and fair society. The Buddy Program - http://www.buddyprogram.org ... strengthens our community by guiding and inspiring youth through mentoring...increasing self-esteem, capacity to make healthy decisions, interest and attitude toward school and ability to have healthy relationships...” 2013 Fund Amount: $30,000 • Total number of youth served in 2013: 638 - 118 adult Big Buddies, with increase going forward to 56 new adult recruits for 2014. • 2012-2013 youth programs pre and post survey results show parameters of self-esteem, healthy decision-making, interest and attitude toward school, and ability to have healthy relationships were maintained or improved. • Assistant Director Lindsay Lofaro first recipient of Helen Kalin Klanderud Leadership Award. Catholic Charities - http://www.ccdenver.org/western-slope-emergency-assistance “We serve the needy of Eagle, Garfield and Pitkin Counties” 2013 Fund Amount: $15,000 • Families with young children • Single mothers • The disabled • Veterans and seniors • Individuals and those battling financial hardship • Providing financial assistance with: • Eviction prevention • Utilities shut-off prevention • Medical prescriptions • Dental emergencies • Transportation assistance • The Emergency Assistance Program served 711 households in 2013 - 74 in Pitkin County (with the probability of even more working, but not living in Pitkin County). • A stabilized household benefits the greater community. Families can focus on jobs, helping their children in school, finding a job, better their education, avoid the trauma of eviction, help landlords avoid expense and time of evictions, and provide continuity and stability for schools and employers. Family Visitor Programs - http://www.familyvisitor.org “...to promote healthy families by providing education, advocacy and support services that strengthen and empower families, foster the optimum development of children, and prevent child abuse and neglect.” 2013 Fund Amount: $70,000 • Colorado Bright Beginnings: focus on early brain development, early literacy, discipline. • Partners for a Healthy Baby: prenatal, post-partum, visits to age 1; Universal and evidence based curricula. • Nurse Family Partnership: for 1st time mothers. Visits begin in 1st trimester and continue until 2 years old - limited to 100 low-income families; funded by State of Colorado. • Healthy Families America: for parents who have experienced adverse childhood experiences. • Teen Parent: until graduation from high school; also enrolled in Partners for a Healthy Baby, Nurse Family or Healthy Families America. • 834 families served, including 291 clients who live or work in Pitkin County - 34% of total. P13 I. 3 The Manaus Fund-Valley Settlement Project – www: themanausfund.org “engaging communities to achieve social justice” • Neighborhood navigator makes contact in each person’s home, visits families prior to the child’s first day of school to promote and deepen the relationship between staff and family. • Parent mentors provide approximately 10,000 hours of volunteer time in classrooms in RE1 school district. • Of the families reporting jobs, 98% work in Pitkin County. • Program is focused on improving the school readiness of low income children prior to kindergarten through mobile preschool, improving the health of young families in the RE I school district, and improving elementary school achievement in two target schools. Mountain Valley Developmental Services - http://www.mtnvalley.org/ “...to encourage and support individuals with developmental disabilities, enhance their ability to live, learn, and work in an independent and inclusive manner, and to educate the community about their contributions and capabilities.” 2013 Fund Amount: $70,000 • 517 unduplicated children and families served by Mountain Valley Developmental Services in 2013; approximately 28 individuals live in Pitkin County - approximately 20% served by MVDS in Garfield and Eagle County work in Pitkin County. • MVDS provides individuals 21 years or order a place to live, supports for daily living, recreation opportunities, medical and emotional resources, and training areas, which promote independence and self-sufficiency. • The number of individuals served with employment opportunities is the second highest in the state, with the highest rate of pay for these working individuals. • Provide a Children’s Program serving children 0-3 demonstrating delays of 25% or more, or diagnosed with disabilities. Therapists go into family homes, working to assure children are meeting developmental milestones. Of the 293 children served in 2013, only 43% needed ongoing services in the school system; 57% were functioning at or near developmental age after receiving services. Roaring Fork Family Resource Centers - http://www.rffrc.com/ “ ...works with families to make sure that children have access to doctors, dentists, ophthalmologists, counselors, warm clothes, a safe home, and activities that build their self esteem.” 2013 Fund Amount: $40,000 • The FRC facilitates three direct service programs: Student Health and Well-being, Parent Education, and Health Promotion; the FRC is a public/private partnership that supplements the existing education system. • Increasing numbers of families seeking help with urgent or emergent needs—medical, food, housing, utilities, etc., and have responded to changing demographics in the schools by ensuring that all of their centers have at least one fully bilingual Resource Coordinator. • 818 unduplicated students were directly served, 22% or 181 indicated the head of household was employed in Pitkin County. 30 households reported residences within Pitkin County. RESPONSE - http://responsehelps.org “...to support, educate and empower victims of domestic violence and sexual assault.” 2013 Fund Amount: $35,000 • 209 new unduplicated clients, for a total of 561; 876 total contacts made in 2013; 54% were from Pitkin County (13% Eagle, 18% Garfield, 18% from other locations outside of service area or State) • Crisis line received 145 contacts; provided 6 nights of emergency housing (6 women; 4 children). • Conducted 31 community education and awareness activities in 2013 - attendance of more than 259; 19 presentations provided Aspen High School, Aspen Middle School, Basalt Middle School, and Carbondale Community School about cyber-bullying, sexual- bullying, teen dating violence awareness and healthy relationships. Services include: • 24-hour help line and crisis intervention • Emergency shot-term shelter • Court advocacy • Safety planning P14 I. 4 • Medical advocacy - accompaniment to doctor, hospital, or Sexual Assault Nurse Examiner exam • Counseling • Support groups - English and Spanish • Information and referral • Information and assistance regarding applications for Victim’s Compensation • Immigration and human trafficking support services • Garden of Hope Sanctuary for survivors and visitors • Resource library • RESPONSE is the only program in Pitkin County (and Western Eagle County) providing free services dedicated to victims and survivors of domestic violence and sexual assault. • Programs augment existing emergency services provided by law enforcement, child protection, Mind Springs Health, Aspen Valley Hospital, private counselors, and physicians. , River Bridge Regional Center – www.riverbridgerc.org …”where silence ends and healing begins” • RBRC provides hope and healing to neglected and abused children and their families through treatment, advocacy, and investigation services. • Seven (7) child abuse victims were served reporting residence in Pitkin County, as well as another four (4) victims in Basalt and El Jebel served by Pitkin county agencies –represents 7% of total served by the agency in 2013. • Program provides victim advocacy, medical exams, mental health consultations, and case review services for the multidisciplinary team (MDT) serving children and families in the valley. YouthZone - http://www.youthzone.com ... providing opportunities for youth to be responsible, contributing members of their families and society...to enhance the quality of life in our communities through prevention, support, parent education and direct services.” 2013 Fund Amount: $45,000 • Case management with youth referred by Pitkin District and County Courts and other referral sources, community service, Girls Circle, Restorative Justice, counseling, Parent Consultations, and one-on-one parent coaching. • Collaborated with other groups to begin the Family and Community Engagement Team, a service to provide families with comprehensive assessments and access to services. • 121 clients served in Pitkin County: 106 youth, 15 adults (parents or guardians). 79 of the 106 were referred by the juvenile justice system and 27 referred by schools, parents, or other sources - 9.7% of total YouthZone clients reside or work in Pitkin County. • Total number of clients served in 2013 from Aspen to Parachute was 1169. • Services affect the community at large because of the economic, social, moral, and safety impacts. • Court system and incarceration cost per child cost $50,000 per year - with a high rate of recidivism, estimated to cost 2.6 - 5.3 million dollars within the criminal system; 2013 outcome data show 89% of clients do not reoffend. • YouthZone costs per child are generally $1,100 per youth for 3-6 months of services; YouthZone data show statistically significant improvement in measures of substance abuse, delinquency and aggression, self-depreciation, optimism and problem solving, and school and community involvement. • Providing better parenting support and skills, families are stronger during potential crisis, fewer resources are used, and greater contributions to our community are realized. Goal 2: Physical Health- $516,000 Promoting the physical well-being of individuals. Program Agencies - Benefits To Our Community Aspen Cancer Survivor Center Cancer rehabilitation including cardiopulmonary stress testing, personal training instruction, exercise programs, mental health counseling, and coaching. Aspen Community Church Direct assistance in the form of food vouchers, bus vouchers, limited medical, prescription and utilities to Pitkin County residents in need. P15 I. 5 Aspen Homeless Shelter Warm place to stay in winter, helping access resources to meet needs, and assisting in the transition to stability and self-reliance. Aspen to Parachute Dental Health Alliance Family Visitor Programs acting as fiscal agent for this collaborative; to continue the work of the Oral Health Education Program and work to develop a model to provide affordable dental treatment for the region. Community Health Services Affordable public health services. Hospice of the Valley Operational support for the care of dying patients, the provision of home health services and expanded grief and bereavement services for families. Mountain Family Health Centers Primary care for the medically under-served and uninsured. The Neighborhood Clinic at Woody Creek Primary care for the medically under-served and uninsured; medical home for residents of the Woody Creek Community Planned Parenthood Affordable reproductive care. Roaring Fork School Health Centers Preventive and primary health care, behavioral health services and education to the students of the Basalt Schools. Sopris Therapy Services Rehabilitation services for uninsured, under-insured, and limited income children and adults living or working in Aspen/Pitkin County with special needs who require services not met by other programs. WindWalkers Equine Assisted learning and Therapy Center Funding will provide therapeutic horseback riding opportunities for riders with intellectual and physical disabilities or social, emotional, educational and behavioral challenges. Aspen Cancer Survivor Center for Health and Well-Being - www.aspencancer.org “...assisting cancer survivors answer the “Now What?” once treatment has ended; issues such as physical, nutritional, mental health, cancer related fatigue, loss of mobility, and returning to work.” 2013 Fund Amount: $5,000 • 38 cancer survivors (Aspen Valley and Valley View Hospitals, Shaw Regional Cancer Center, and the community) received free consultation and assessment, 18 resided in Pitkin County. • Cardiopulmonary stress testing, personal training instruction, exercise programs, mental health counseling, and coaching. • Ongoing work in Aspen resulted in peer-reviewed research publications, national presentations, and outreach with cancer survival groups such as the City of Hope Cancer Center, Cancer Fit, and the Simms Mann Cancer Center in California. • Treated cancer survivors return to work earlier and remain independent longer, resulting in decreased financial burden on the local economy and health care system. The Aspen Community Church - http://www.aspencommunitychurch.com “...participates in emergency care for those in need as a partner with other county agencies.” 2013 Fund Amount: $2,500 • Fulfilled 101 requests for assistance, 76 of which were individuals. 90% of clients served were Pitkin County residents. • Limited interim assistance - food vouchers, bus vouchers, limited medical, prescription and utilities encourages individuals to continue looking for work, reducing future dependence on public assistance. Aspen Homeless Shelter - http://www.aspenvalleyfoundation.org/aspenhomelessshelter.php “...to help those Aspen residents who have fallen on hard times.. address the root causes of homelessness...” 2013 Fund Amount: $22,500 • 3 main programs: Day Center (10:00 AM - 8:30 PM), Evening/Dinner Program (6:00 PM, hot nutritious meal), and Overnight Shelter (9:00 PM-7:00 AM; classrooms converted to rooms - bedding provided and gift certificates for free hot breakfast provided for McDonalds Restaurant); thanks to the generosity of St. Mary’s Church on Main Street in Aspen. • 3,726 dinners served in 2013. P16 I. 6 • 1,912 nights of shelter to 63 individuals provided in winter of 2012-2013. • 112 individuals provided shelter during the day. • 119 unduplicated individuals served in 2013, 89% from Pitkin County - translated to hours: up to 20.5 hours per day, or total client service hours calculated to 95,812 for 2013. • No deaths due to exposure, access to services of Pitkin County Health and Human Services building, alternative to streets, library, stairwells, etc.; reduces public interactions from public intoxication, loitering, panhandling, etc.. • Supports and works with 9th Judicial District Drug Court, Behavioural Wellness Program; referrals to mental health providers. The Aspen to Parachute Dental Health Alliance - http://www.mygreatteeth.org “...to create a comprehensive dental system that promotes education, prevention and improved access for residents from Aspen to Parachute.” 2013 Fund Amount: $20,000 • 1,964 unique individuals served; 20% Pitkin County in 2013. • 1,182 2nd grade to 7th grade students received screenings, cleanings, sealants, flouride varnishes, treatment referals, and oral health education - 42% of total school populations in 12 schools from Aspen to Parachute in 2013. • US Surgeon General declared America’s high prevalence of dental disease a “silent epidemic”, and that oral helath is integral to general health. • APDHA provides: • an improved dental public health • increased awareness about the importance of oral health • access to oral health care for high risk populations • decrease in cost to community members for furture dental care • Colorado Health Institute Report (12/17/2013) estimates that 240 Pitkin County Medicaid adult enrollees will seek dental care providers - that number is expected to quadruple to more than 1,000 by 2016. Currently, Pitkin County does not have any private practice dentists who accept Medicaid. APDHA is working with Mountain Family Health Centers to create a dental clinic in Basalt. Community Health Services - http://aspencommunityhealth.org/ “To optimize the health and well-being of the people of the Roaring Fork Valley through the promotion of healthy lifestyles and the delivery of accessible preventive public health programs.” 2013 Fund Amount: $320,000 10 Essential Public Health Services: • Monitor health status to identify community health problems. • Diagnosis and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Mobilize community partnerships to identify and solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care • when otherwise unavailable. • Assure a competent public and personal health care workforce. • Evaluate effectiveness, accessibility and quality of personal and population-based health services. • Research for new insights and innovative solutions to health problems. • 2,326 unique individuals served in direct service programs; 63% resided in Pitkin County, including prenatal care, family planning services, and adult, travel and child immunizations. • The prenatal program this year in partnership with All Valley Women’s Care with services to Eagle County women. The program is the only alternative for Medicaid eligible women in the two county region. • Health care reform brought 5 private insurance companies to CHS as in-network providers in 2013 - with the implementation of the Affordable Health Care Act, CHS expects to see an increase in the number of insured clents, including Medicad. Services will remain low cost for the uninsured residents of the Roaring Fork Valley. P17 I. 7 HomeCare and Hospice of the Valley - http://www.hchotv.org “To provide compassionate and dignified palliative and end of life care to patients and their families.” 2013 Fund Amount: $50,000 • 699 home health patients, 91 in Pitkin County (13%) • 167 hospice patients agency wide, 10 in Pitkin County (6%) • Offer grief and bereavement services to the entire community (Basalt and Edwards locations); 2 monthly grief support groups in Pitkin County and a 10-week Grief Recovery Method program. • Provide pediatric home-based services; many of the complex technology dependent children would need to live near cities or big hospitals if it were not for HV. • Developing a new program known as Transitions Care to accommodate residents with chronic diseases will reduce hospital visits and will have significant benefits to patients. Mountain Family Health Centers/Basalt Clinic - http://www.mountainfamily.org/our-clinics/basalt-co “To provide high quality, integrated primary, behavioral, and dental health care in the communities we serve, with special consideration for the medically under-served, regardless of ability to pay.” 2013 Fund Amount: $40,000 • 1,352 patients served in 2013; more than 90% live in Pitkin County (10% live Eagle County). • 52% of Basalt MFHC patients are uninsured, 70% have family incomes under 200% of Federal Poverty level, as detailed by the Colorado Trust/Colorado Health Institute’s 2012 report. • Advent of health care reform, Medicaid expansion, and the Connect for Health Colorado helped MFAC uninsured patients access affordable health insurance. MFAC helped patients get affordable health insurance via a partnership with Pitkin, Eagle, and Garfield Counties by hiring additional outreach and enrollment staff. The Neighborhood Clinic (TNC) at Woody Creek Community Center - www.theneighborhoodclinic.org/ “A Health & Wellness Program at the Woody Creek Community Center” 2013 Fund Amount: $15,000 • 280 patients were provided with referrals, treatment, subsidized physical therapy, free flu shots, and at-cost blood work at a cost of approximately $120 per patient • TNC made a concerted effort this year to help residents sign up for health insurance through Connect for Health Colorado. • TNC initiated “Open Doctor’s Hours” to members of their community and the greater Roaring Fork Valley, as well as “Mini Health Fairs”, as well as a “Senior Health Day” in collaboration with Pitkin County Senior Services. Planned Parenthood of the Rocky Mountains - Glenwood Springs Health Center - www.plannedparenthood.org/health-center/centerDetails.asp?f=2172 “...committed to ensuring quality health care, education, and information for all individuals... commonsense solutions designed to protect women’s health and safety and the basic human rights of us all.” 2013 Fund Amount: $7,500 • Glenwood Springs Health Center provided 236 Pitkin County residents with health care services - 9% of the total patients served at the center in 2013. PPRM did not track information regarding Pitkin County employment of its patients. • Funding from the Healthy Community Fund ensures that the Glenwood Springs Health Center is able to offer affordable prices and a sliding fee scale (those living below 150% of federally defined poverty level). The Glenwood Springs Health Center offers:  Family planning education, birth control supplies, and emergency contraception.  Annual gynecological examinations, including clinical breast and pelvic exams.  Cancer screenings for women, including Pap tests, breast exams, colposcopies, cryrotherapy, and referrals for mammograms.  Human papillomavaris (HPV) vaccinations.  Pregnancy testing and referrals adoption, abortion, and prenatal care.  Mid-life and menopause services including hormone replacement therapy, education, and referrals for osteoporosis screenings. P18 I. 8  Diagnosis and treatment of sexually transmitted infections (STIs).  HIV testing with results available within 12 minutes, referrals.  Abortion pill services.  Testing and treatment for urinary tract and vaginal infections.  Men’s services, including testicular cancer screenings and self-exam information.  Screenings for basic health care problems, including hypertension, diabetes, and anemia.  Ultrasounds for gestational sizing.  In response to the Affordable Health Care Act, health center staff provide education, encouragement, direction to resources, including PPRM brochures that detail provisions of the act that impact them. Roaring Fork School Health Centers - https://www.facebook.com/RFSHC “Providing accessible and affordable preventive and primary health care, behavioral health services and education to the students of the Basalt Schools.” 2013 Fund Amount: $15,000  400 unduplicated students/users served; 81 unduplicated students/clients live in Pitkin County - or 20% of total in 2013.  School-based health centers support public health at large by delivering targeted services to school children - especially the wellness needs of uninsured, underinsured, and the under-served youth of the Basalt School community.  Healthy students are more willing and able to learn  Healthy Community Fund helped support: • Primary and acute care • Management of chronic illness • Preventative health exams • Immunization clinics • Nutritional counseling • Mental health case management, screening, and counseling services • Oral health screening • Health education • Medicaid/CHP Outreach Services • Medical referrals to specialist or community organizations • Continuing collaborations with Roaring Fork Family Resource Center, Colorado West Regional Health - Aspen to Parachute Dental Health Alliance, and Aspen Hope Center. Sopris Therapy Services - http://www.sopristherapyservices.org “To Empower Children and Adults with Disabilities and Daily Challenges to Reach Their Full Potential through Equine Assisted Therapies.” 2013 Fund Amount: $9,000 • 172 clients served - 121 living or working in Pitkin County (70%). • 98% of patients who have “leveled out” in other programs have shown dramatic improvements - fewer surgeries and hospital visits. • Continuum of health care services - education, prevention, intervention, and outreach programs, regardless of ability to pay. • At-risk youth provided mental health and substance abuse counseling; support for victims of domestic violence; services for developmental disabilities and physical challenges. • Community benefits by having healthier, more self-sufficient members. • Variety of physical, social, and educational activities for seniors. WindWalkers - http://www.windwalkerstrc.org “...to provide a variety of equine assisted therapies to aid in the development and growth of those with challenges, be they physical, neurological, emotional, behavioral or psychological.” 2013 Fund Amount: $9,000 • 84 unduplicated people who live or work in Pitkin County; 30% of total clients served. • Individuals with Muscular Dystrophy, Cerebral Palsy, brain injuries, spinal cord injuries, Down Syndrome, learning disabilities, Attention Deficit Disorder, and Autism find positive treatment. P19 I. 9 • Therapeutic riding provides improvements in balance, muscle strength, gait, posture, symmetry, joint mobility, sensory processing, and motor planning. • Bonding with horses forms responsibility, newfound freedom of movement and skill. • Builds understanding, care for oneself and others, independence, and increased aptitude for learning and focus, Goal 3: Mental Health & Substance Abuse Prevention- 237,100 Promoting the psychological well-being of individuals; providing treatment and prevention of substance abuse. Program Agencies - Benefits To Our Community The Aspen Hope Center A project of the Aspen Valley Medical Foundation - crisis intervention and community education on suicide prevention, for people living and working in Pitkin County. Colorado West Regional Mental Health - Aspen Detox Center - replaces most services provided by the Right Door; dba Mind Springs Health Aspen Detoxification and case management. Colorado West Regional Mental Health - Aspen Counseling Center; dba Mind Springs Health Aspen Mental health services - counseling, emergency services, and substance abuse Colorado West Psychiatric Hospital; dba West Springs Hospital Funding for operations at the Grand Junction Psychiatric Hospital benefitting Pitkin County residents in need of inpatient mental health care. Valley Partnership for Drug Prevention Wellness program in schools for prevention of alcohol, drug and tobacco use; drug awareness campaign through local media. Your Friends for Life Direct case management and support services for cancer patients and their families. Aspen Hope Center - www.aspenhopecenter.org “...to extend a beacon of hope to those in emotional crisis and offer a continuum of comprehensive care while steadfastly working to decrease the stigma of mental illness through expert clinical care, public education, community collaboration, and outreach. 2013 Fund Amount: $18,000 • 733 unduplicated individuals served in 2013; estimated 25% lived in Pitkin County. • Prevalence of suicide within the Roaring Fork Valley is higher than the greater U.S. • Virtual Intensive Outpatient Program is successful - increases the connectedness and tightens the safety net for affected individuals, family, and community. • Collaborations within the Roaring Fork Valley are formal - e.g. contracts with Aspen Valley Hospital and Valley View Hospitals, Roaring Fork Neurology, Roaring Fork Health Systems) and informal -referrals to and by private physicians and other community organizations. • Outreach and education reduce stigma - help create informed awareness and care. • Suicide awareness training starting in 8th grade in Aspen, Basalt, and Roaring Fork schools. Colorado West Regional Mental Health/Aspen Detox Center - http://www.mindspringshealth.org/treatment/locations/aspen “...to provide access to quality mental health and substance abuse services, enhancing recovery and resilience in individuals, families, and communities.” 2013 Fund Amount: $30,000 (additional $85,600 provided from Pitkin County General Fund) • 611 unduplicated individuals served, 2751 services provided in 2013; 80% were Pitkin County residents. • Services provide increased resilience and ability to engage in mental health and substance abuse programs - reducing community costs for law enforcement, hospitalization, and jail. • Increased community safety and well-being. • Colorado West Regional Mental Health data indicate a 72.6% success rate in use reduction.” P20 I. 10 Colorado West Regional Mental Health/Aspen Counseling Center - http://www.mindspringshealth.org/treatment/locations/aspen “...to provide access to quality mental health and substance abuse services, enhancing recovery and resilience in individuals, families, and communities.” 2013 Fund Amount: $126,000 • 947 unduplicated clients; 70% from Pitkin County in 2013. • Providing outpatient counseling, case management, psychiatric/medication evaluations, and 24-hour emergency on-call services. • Individual, child, couples, family, group therapy, and Employee Assistance counseling and consultation to help with anxiety, depression, substance abuse, and relationship difficulties. • Suicide in Pitkin County is twice as high as rest of Colorado and three times the national average. • Services available to people of all ages, and all fees available on a sliding scale - to $0. • Mind Springs Health was first in Colorado for Symptom Improvement in 2013. • Benefits include: • Increased resilience and ability to engage in mental health and substance abuse services, reducing community costs in law enforcement, hospital, and jail. • Increased mental recovery, improving community safety, as well as costs to medical providers and law enforcement. • Increased community health and well being. Colorado West Psychiatric Hospital - https://www.mindspringshealth.org/treatment/west-springs-hospital/ “To build stability in individuals as soon as possible through a comprehensive, personalized, cost-effective treatment plan for support and services on a outpatient basis. Our guiding principles are to treat all with respect, manners, kindness and professionalism.” 2013 Fund Amount: $30,000 • Only psychiatric hospital between Denver and Salt Lake City (Grand Junction location), caring for adults, adolescents, and children in crisis who need 24-hour care and supervision. • Ensure patient personal safety and understanding of their role in resilience and recovery. • Care of individuals requiring inpatient and supervision care benefits the community by keeping these individuals off the street, out of jail, or out of emergency rooms, keeping the community safer. • 23 patients served were residents or work in Pitkin County in 2013; 11% of total served. • Seeing more patients in critical need of inpatient care; planning for expansion of hospital beds. • Anticipate offering specialized areas/programming for adolescent and geriatric patients. • Expecting to see changes and impacts from the Affordable Health Care Act in 2014. • Reduced average patient length of stay by 20%. • Patients educated to increase understanding of their own illness, importance of medication compliance, and risks of any side effects, resulting in faster recovery. Valley Partnership for Drug Prevention - http://valleypartnershipaspen.org “...to promote the prevention of alcohol, tobacco, and illegal drug use in youth by providing resources, education, and leadership to schools, family, and community.” 2013 Fund Amount: $38,100 • Substance abuse is consistently cited as the biggest health issue in our community. VPDP devotes 100% of its time and resources to prevention. • 100% of Aspen Middle and Aspen High School students participated in the VPDP’s health and wellness educational outreach, as well as drug, alcohol, and tobacco prevention curriculum and programming during 2013. • 94% of students reported positive or very positive outcomes from participating in VPDP’s programs. • 16,000 community members reached via media campaigns from Aspen to Parachute. • 90% of students surveyed disagree with the statement, “It’s cool to get drunk.” That percentage has been increasing each year for the last 5 years. • Extensive use of surveys and data analysis allows VPDP to use The Social Norms Approach - when perceived use goes down, real use follows suit. • Gap between real use and perceived use is the "sweet spot" of prevention; VPDP fulfills this by gathering and using extensive data to help lower substance abuse use and abuse rates. P21 I. 11 Your Friends for Life - http://yourfriendsforlife.org 2013 Fund Amount: $5,000 “...to provide non-medical support, to nurture and encourage cancer patients, caregivers and their family members during diagnosis, treatment and recovery from all types of cancer...” • 100 individuals served in 2013; 32% work in Pitkin County. • Support reduces emergency room client visits, allowing hospital staff more attention for true emergency care. • Increase in lower income and low or under-insured clients. • The program provides phone coverage support 24/7 for families needing help. • No clients with cancer needing support have ever been turned away. • The program’s success lies in the generosity of volunteers who work hard to provide meals, cleaning, and other forms of support for cancer patients. Goal 4: Well-Being of Seniors- $378,195 Social, emotional, economic and physical well-being of seniors. Program Agency - Benefits To Our Community Pitkin County Senior Services - http://www.aspenpitkin.com/Departments/Senior-Services ... to facilitate quality of life and independence for individuals over 60...” 2013 Fund Amount: $378,195 • 875 unduplicated seniors served in 2013; 75% were from Pitkin County. • Providing exercise and wellness classes, lunches three days per week, bike, snowshoe, cross country, and alpine ski outings, community events, overnight trips, transportation, after-lunch entertainment and educational programs, support groups, referrals for many types of assistance, and computer services. • Families, neighbors, law enforcement, and health and human service providers see their concerns addressed by the Care Management Program - helping community seniors navigate options to ensure a safe and independent environment. • Pitkin County’s Senior Transportation Program is relied upon for transportation to the senior center, medical appointments, grocery stores, therapy appointments, classes, and community events. • In 2013, this program provided 4,104 senior van rides, 223 supplemental transportation rides by taxis, and 4,058 trips by volunteer drivers for the Home Delivered Meals program, as well as 33 other volunteer trips. • Trips to the mid-valley are now offered to allow seniors increased access to health care at the new Mountain Family Health Clinic while trips to Glenwood, Silverthorne, or Grand Junction are offered once a month. • Senior Center nutrition program provided 3x weekly nutritious meals for seniors at any income level. 100% of meals were reviewed by a state certified nutritionist to ensure that they met OAA guidelines. 10,523 meals were served with an average of 71 meals provided per day. This includes 2,494 meal deliveries that were made to homebound seniors. • 100% of surveyed clients reported that they felt safer and healthier. P22 I. AGENDA ITEM SUMMARY WORK SESSION DATE: December 2, 2104 AGENDA ITEM TITLE: Joint City of Aspen/Pitkin County Discussion on the Proposed Intergovernmental Agreement for Provision of Public and Environmental Health Services STAFF RESPONSIBLE: Liz Stark, CJ Oliver, Nan Sundeen ISSUE STATEMENT: Today the Aspen City Council and Pitkin Board of County Commissioners will review a draft Intergovernmental Agreement for provision of public and environmental health services in Pitkin County. BACKGROUND: At the September 17th, 2013 joint City Council/County Commissioners meeting, elected officials from both jurisdictions directed staff to pursue the idea of discontinuing the City of Aspen Board of Health and establishing the Pitkin County Board of County Commissioners as the sole Board of Health in Pitkin County. Staff from both jurisdictions, including City/County attorneys, City/County environmental health directors, Pitkin Health and Human Services Director, Pitkin Community Development Director, and the Pitkin County Public Health Director have worked together to negotiate the terms of such an agreement and now have a unified document to present. Below is some background regarding the decision to merge the Boards of Health. Public Health Act Requirements The Colorado Public Health Act – SB 08-194 required Boards of County Commissioners (or municipalities) to establish a county public health agency or participate in a district public health agency by July 1, 2009. The Public Health Act also required that within 90 days of establishing a Public Health Agency, a local board of health would be established. Such boards are required to adhere to the following: • Consist of at least five commissioner-appointed members so that no business or professional group, or governmental entity shall constitute a majority of the board • Counties of less than 100,000 people can have a three member board-and the county commissioners may serve as the board of health or as a member of the board • Home-rule counties will abide by their charters in respect to the establishment of a local board of health • Jurisdiction shall include county or counties within a district and all municipalities therein unless a municipal public health agency is established. P23 II. Current Structure in Pitkin County and City of Aspen In May 2009, Pitkin County Board of County Commissioners, by resolution, identified the Board of Health as the Public Health Agency and identified the BOCC as the Board of Health. Shortly thereafter, the Pitkin Board of Health named Liz Stark as the Public Health Director. Concurrently the City of Aspen identified the City Council as the Public Health Agency and the Board of Health. They named Lee Cassin as their Public Health Director. After Lee Cassin retired CJ Oliver was appointed to that position. There are only two municipalities in Colorado who acted on the option to establish themselves as a Board of Health (Aspen and Denver.) Staff Review and Possible Solutions City of Aspen, Community Health Services, Inc. (CHS) and Pitkin County staff met in June, 2013, and concluded that the current structure for Public and Environmental Health in Pitkin County is redundant, inefficient and confusing. Below are the Pros of merging the two Boards of Health include: • Simplification of direction/oversight of public and environmental health services in Pitkin County • It is the State of Colorado’s (Colorado Department of Public Health and Environment) preference that we have one Board of Health • It would clarify the lines of accountability/responsibility for public and environmental health • In a crisis it will speed up response to have one Board of Health • Timing is good with the Community Health Assessment and Performance Improvement Plans completed and submitted • It would align us better with the Public Health Act • We could potentially bring more community expertise to the Board of Health Because the opportunities of combining our Boards of Health far out- weigh the challenges, City of Aspen, CHS and Pitkin County staff unanimously recommended that the City of Aspen discontinue its Board of Health, Public Health Agency and Public Health Director in favor of establishing one expanded Board of Health, one Public Health Agency and one Public Health Director in Pitkin County. While there are some merits to establishing a totally separate Board of Health (from the Board of County Commissioners) it was unanimously concluded that because we already contract public health services to a separate private non-profit organization with its own Board of Directors, it would be more efficient to use the Board of County Commissioners or the Board of County Commissioners plus two additional representative (one from City of Aspen and one from Town of Snowmass Village) for a unified Board of Health. Today the Aspen City Council and Pitkin County Board of County Commissioners are asked to review a draft Intergovernmental Agreement for the provision of public and environmental health services in Pitkin County. Once the Intergovernmental Agreement is approved, Pitkin County will take formal action to expand its Board of Health to include a representative from the City of Aspen and a representative from the Town of Snowmass Village. P24 II. LINK TO STRATEGIC PLAN: Livable and Supportive Community- Self Sufficient Individuals and Families Prosperous Economy – Affordable and quality health care options KEY DISCUSSION ITEMS: 1. Review the draft Intergovernmental Agreement for Provision of Public and Environmental Services in Pitkin County BUDGETARY IMPACT: None at this time RECOMMENDED BOCC ACTION: 1. Review, approve and direct staff to set for formal action, the draft Intergovernmental Agreement for Provision of Public and Environmental Services in Pitkin County ATTACHMENTS: ATTACHMENT A: Draft Intergovernmental Agreement for Provision of Public and Environmental Health Services P25 II. (Attachment A) INTERGOVERNMENTAL AGREEMENT For Provision of Public and Environmental Health Services THIS INTERGOVERNMENTAL AGREEMENT (the “Agreement”) is made this ______ day of ____________________, 2014 by and between Pitkin County, Colorado, a Colorado home rule county whose address is 530 East Main Street, Aspen, Colorado, 81611, ("Pitkin”), the Pitkin County Board of Health (“BOH”), and the City of Aspen, a Colorado Home Rule Municipality, whose address is 130 S. Galena Street, Aspen, Colorado, 81611 (“Aspen”). RECITALS 1. This Agreement is entered into pursuant to, inter alia, C.R.S. §§ 29-1-201, et seq., and Article XIV, Section 18 of the Colorado Constitution and C.R.S. §25-1- 506(2)(a)(I) . 2. The Public Health Revitalization Act, Senate Bill 08-194, now codified at C.R.S. §§25-1-501 et seq. (the “Public Health Act”), revised and restructured the public health statutes of the State of Colorado. In compliance with the Public Health Act, Pitkin, acting as the Public Health Agency/ BOH, created the Pitkin Public Health Agency and established the BOH, appointed a Public Health Director and entered into contracts with the State of Colorado for provision of public health and consumer protection services. 3. The Public Health Agency/ BOH contracts with Community Health Services, Inc., (“CHS”), a Colorado non-profit organization, to provide Public Health Services to its citizens and CHS has the ability, capacity and expertise necessary to provide the Public Health Services in compliance with the rules and regulations governing these Public Health Services. 4. Pursuant to the Public Health Act, Aspen created an Aspen Public Health Agency, established its municipal board of health, appointed a Public Health Director, and entered into contracts with the State of Colorado for provision of consumer protection services. 5. Despite the existence of the two separate boards of health and public health directors, staff for Pitkin and Aspen have informally collaborated since the formation of the separate public health agencies to allow the Pitkin County Public Health Agency to provide some of the services and fulfill some of the obligations that would otherwise have been within the purview of the Aspen Public Health Agency, including those services performed by CHS. 6. Both Aspen and Pitkin operate separate environmental health departments and desire to continue those departments’ operations, even though the public health agencies have similar functions. The State of Colorado has requested that Pitkin and Aspen combine their Consumer Protection contracts for the ease of managing one 1 P26 II. contract for the State. Aspen and Pitkin wish to maintain separate control of all obligations and duties relating to Environmental Health and Sustainability in their respective jurisdictions, including; a) planning, directing and supervising environmental and environmental health programs, b) administering, supervising or selecting personnel for resources to carry out the environmental health programs; c) administering monies allocated to environmental health programs, d) administering and enforcing laws pertaining to air pollution, solid and hazardous waste and water quality, and operating its consumer protection services with funding from the State. 7. Pitkin and Aspen now wish to merge their boards of health and public health agencies to secure and support the provision of public health services to citizens in Aspen and Pitkin. Under the Public Health Act public health services include: A. The assessment of health status and health risks and the development of policies to protect and promote health and assurance of the 10 essential public health services; B. To the extent authorized, administering and enforcing laws pertaining to public health,; vital statistics’ and orders, rules and standards of the state board; C. Advising the local board of health on public policy issues necessary to protect; D. Providing and arranging for the provision of quality, core public health services as defined by the Colorado Board of Health 8. Colo. Rev. Stat. §29-1-201 et seq provides that governments may cooperate with one another to provide any function, service or facility lawfully authorized to each, by contract specifying the purposes, powers, rights, obligations, and responsibilities, financial and otherwise, of the contracting parties. 9. The parties acknowledge that funding for critical health services in Pitkin County is vital and are willing to enter into an agreement to preserve these services without fully resolving future funding at this time. 10. The Pitkin County Public Health Agency/BOH wishes to oversee the administration and provision of the public health services on behalf of Pitkin and Aspen because it allows for the opportunity to achieve efficiencies and economies of scale and avoids duplication or redundancy of public health services and statutory obligations within Pitkin County. 11. Aspen and Pitkin desire to set forth the terms and conditions upon which they will merge their Public Health Agencies and otherwise provide public and environmental health services. NOW, THEREFORE, for and in consideration of the mutual promises and agreements of the parties and other good and valuable consideration, the adequacy and sufficiency of which is hereby acknowledged, the parties agree as follows: 2 P27 II. 1. The City eliminates its Public Health Agency, Board of Health and the position of Public Health Director, effective as of the effective date of this Public and Environmental Health IGA. 2. BOH hereby declares an expansion of two additional positions of its membership to the BOH. The BOH agrees that one position shall be filled by a City appointment and one position will be filled by a Town of Snowmass Village appointment. The remaining five positions will be filled by Pitkin. The Aspen and Town of Snowmass Village appointments may be an elected official or not, at the sole discretion of each municipality. 3. The term of each such member of the BOH shall be: a. Pursuant to C.R.S. 25-1-508 et seq., the Pitkin County – Board of County Commissioners- Board of Health members’ initial terms shall be staggered and set to expire based on their individual terms in office. b. After the initial terms, full-term appointments shall be for five years pursuant to C.R.S. 25-1-508 et seq c. City of Aspen representative – full term appointment shall be for five years. d. Town of Snowmass Village representative – full term appointment shall be for five years. 4. Aspen has full discretion to maintain its City Environmental Health and Sustainability Department which services and programs within the City of Aspen. Those services shall include but are not limited to consumer protection and all relevant contracts with the Colorado Department of Public Health and Environment (CDPHE), indoor and outdoor air quality and associated monitoring activities, waste reduction and resource management, environmental sustainability, and the regulation of facilities distributing marijuana infused products. Additional Environmental Health and Sustainability programs may be developed and implemented in Aspen at the direction of City Council and the City Manager. 5. Pitkin has full discretion to maintain its Environmental Health Department to provide Environmental Health services and programs in unincorporated Pitkin County, outside of the City of Aspen. 6. CDPHE will issue a single annual contract for Consumer Protection services to Pitkin. Pitkin will allocate a portion of the funds to City of Aspen as determined by the state standards and formula for funding. Pitkin then will be responsible to assure that the Aspen Environmental Health and Sustainability Department receives its portion of the Consumer Protection contract dollars. Both Aspen and Pitkin agree to this with the understanding that Pitkin and the Pitkin Public Health Agency will allocate in full the amount due to Aspen Environmental Health and Sustainability for their portion of the program. 7. BOH will continue to contract with Community Health Services for the provision of Public Health Services other than the environmental health services which Pitkin and Aspen will continue to separately provide. 3 P28 II. 8. Nothing in this agreement shall be construed as delegating to the Pitkin County Public Health Agency any power or authority held by either Aspen or Pitkin as set forth in their respective home rule charters, state statutes, or otherwise, even if such powers and authority are granted to the Public Health Agency, except as provided herein. 9. This Agreement may be modified only by written agreement approved by Aspen and Pitkin, acting separately; provided that Aspen, acting alone, has the authority to withdraw this voluntary merger and reestablish its separate public health agency as contemplated in Title 25 of the Colorado Revised Statutes. 10. Pitkin County Public Health Agency’s/BOH Obligations and Authority. The Pitkin County Public Health Agency/BOH, agrees that it will assure the provision and administration of all of the Public Health services, except as provided in this Agreement in compliance with all applicable laws, rules and regulations. The parties agree that: A. BOH will meet a minimum of quarterly with Community Health Services to provide direction on current and long range public health issues and strategies. In addition, the BOH will annually review and recommend adoption to the BOCC the CHS budget and work plan. B. BOH will comply with and execute all Public Health Revitalization Act obligations on behalf of Aspen and Pitkin. C. Pitkin Treasurer shall be responsible for the “master contract” with the State for setting up a separate Public Health Fund, depositing all state revenues and reporting to the state, and depositing all appropriations D. After consultation between the Pitkin Public Health Director and the BOH, the Pitkin Public Health Director will have sole discretion to determine the means by which Public Health services will be implemented and provide the services and supervision to CHS staff-person(s). E. The BOH will provide oversight and support necessary to ensure proper provision of the Public Health services including on-going financial support. Pitkin will continue to provide in-kind rent, access to IT support, and administrative support from Pitkin Health and Human Services staff. F. The BOH, through its Public Health Director and service providers, will ensure the provision of core public health services including but not limited to the following actions: a. Assessment, Planning and Communication b. Vital Records and statistics c. Communicable Disease Prevention, Investigation and Control d. Prevention and Population Health Promotion e. Emergency Preparedness and Response f. Environmental Health g. Administration and Governance 4 P29 II. 11. Aspen’s Obligations and Authority: Aspen, through its Environmental Health and Sustainability department, will cooperate with CHS to facilitate the provision of public health services to its citizens. Aspen will: A. Continue to set environmental health and sustainability priorities and spending for such services in Aspen, staff City environmental health for purposes of consumer protection and other services, enforce environmental policies and programs within Aspen; B. Continue to participate in public health incident management groups that have a county wide impact for public and environmental health; C. Continue to participate in public and environmental health meetings for the purpose of streamlining services, sharing resources and seeking efficiencies. 12. Financial Compensation to Community Health Services from Aspen: For 2014 Aspen will contribute to Community Health Services for the provision of public health services to all Aspen residents pursuant to this Agreement the 2014 grant amount to Community Health Services, $61,000. Any future contribution, for succeeding budget cycles is dependent upon Council approval subject to budgetary appropriations. 13. Reporting to and Reimbursement. Pursuant to the individual contracts with CDPHE, each entity shall be wholly responsible for reporting public health expenses to CDPHE and be responsible for meeting any and all financial accounting guidelines and requirements for state reimbursement of public health programs. 14. Termination of Agreement. The Parties reserve the right to terminate this agreement with or without cause upon 90 days prior written notice provided. Should either Party default in the performance of its obligations under this Agreement, the other Party may terminate this Agreement upon 60 days prior written notice provided in accordance with ¶ 19, below. Aspen may withdraw its voluntary merger as stated in ¶ 9 above. 15. Independent Contractor Status. The Parties to this Agreement intend that the relationship between them is that of independent contractor. Aspen, and any agent, employee, or servant of Aspen shall not be deemed to be an employee, agent, or servant of Pitkin. A. Pitkin is not required to offer this service exclusively to Aspen under this Agreement. Pitkin may choose to work for other entities during the term of this Agreement, provided that the basic services and deliverable products required under this Agreement are submitted in the manner and on the schedule defined within this agreement. 5 P30 II. B. Pitkin warrants that the performance of Pitkin’s obligations under this Agreement, and all work its contractors produce, will conform to all applicable industry standards of care, skill and diligence. C. Pitkin shall not attempt to oversee or supervise the work or actions of any Aspen employee, servant or agent in the course of completing work under this Agreement. D. Pitkin and any agent, employee or servant of Pitkin is not entitled to any Workman’s Compensation benefits through Aspen and is responsible for payment of any federal, state FICA and other income taxes. 16. Non-Assignable. This agreement is not assignable by either party. 17. Integrated Agreement. This Agreement may be changed or modified only in writing by an agreement approved by the respective Boards of the Parties and signed by authorized officers of each Party. This Agreement constitutes the entire Agreement between the parties and all other promises and agreements relating to the subject of this Agreement, whether oral or written, are merged herein. 18. Severability. Should any one or more sections or provisions of this Agreement be judicially adjudged invalid or unenforceable, such judgment shall not affect, impair, or invalidate the remaining provisions of this Agreement, the intention being that the various sections and provisions hereof are severable. 19. Notices. Any notice required or permitted under this Agreement shall be in writing with effective date of delivery the date sent and shall be hand-delivered, emailed or sent by registered or certified regular mail, postage pre-paid to the addresses of the parties as follows. Each party by notice sent pursuant to this paragraph may change the address to which future notices should be sent. Notice to Aspen: CJ Oliver City of Aspen Environmental Health 130 S. Galena St Aspen, CO 81611 Cj.oliver@cityofaspen.com Notice to Pitkin County: Nan Sundeen 0405 Castle Creek Road, Suite 8 Aspen, Colorado 81611 Nan.sundeen@pitkincounty.com With copy to: John Ely Pitkin County Attorney 530 E. Main St., Suite 302 Aspen, CO 81611 6 P31 II. John.ely@pitkincounty.com 20. Immunity. The Parties agree and understand that both parties are relying on and do not waive, by any provisions of this Agreement, the monetary limitations or terms or any other rights, immunities, and protections provided by the Colorado Governmental Immunity Act, C.R.S. 24-10-101, et seq., as from time to time amended or otherwise available to the parties or any of their officers, agents, or employees. 21. Currently Budgeted Expenditures. The Parties acknowledge and agree that any payments provided for hereunder or requirements for future appropriations shall refer only to currently budgeted expenditures of the Parties. The Parties’ obligations under this Agreement are subject to each individual Party’s annual right to budget and appropriate the sums necessary to provide the services set forth herein. No provision of this Agreement shall be construed or interpreted as creating a multiple fiscal year direct or indirect debt or other financial obligation of either or both Parties within the meaning of any constitutional or statutory debt limitation. This Agreement shall not be construed to pledge or create a lien on any class or source of either Parties’ bonds or any obligations payable from any class or source of each individual Party’s money. 22. Binding Effect. The rights and obligations of the Parties under this Agreement shall be binding upon and shall inure to the benefit of the parties and their respective successors and assigns. 23. Choice of Law and Venue. This Agreement shall be construed according to the laws of the State of Colorado, and venue for any action shall be in the District Courts of Pitkin County, Colorado. Each Party to this Agreement shall have standing to bring an action to enforce the terms of this Agreement in District Court, limited to an action for specific performance and injunctive relief. 24. Method for Resolving Disputes and Service. In the event of a dispute between the Parties concerning performance of either Party’s obligations under this Agreement, the dispute shall first be referred to the Public Health Director. In the event that these individuals are unable to reach agreement regarding the dispute, they shall refer it to the respective Managers of each Party. Should the Managers fail to resolve the dispute, this Agreement may be terminated pursuant to ¶ 14. 25. Term. This Agreement shall automatically renew for succeeding January 1 to December 31 and ongoing one-year periods. 26. Pitkin County BOCC Approval. The foregoing Agreement is approved by the Board of County Commissioners of Pitkin County, Colorado at its regular meeting held on the _____ day of , 2014. Resolution# ________________________. 7 P32 II. 27. City of Aspen Approval. The foregoing Agreement is approved by the City of Aspen at its regular meeting held on the _____ day of , 2014. Resolution # ____________________________. 28. BOH approval. The foregoing Agreement is approved by the BOH at its regular meeting held on the _____ day of , 2014. Resolution # ____________________________. In Witness whereof, the parties hereto have caused this agreement to be executed as of the day and year first above written. BOARD OF COUNTY COMMISSIONERS APPROVED AS TO FORM OF PITKIN COUNTY, COLORADO By:_______________________ ______________________ Robert A. Ittner, Jr., Chairman John Ely, County Attorney _______________________ Jon Peacock, County Manager CITY OF ASPEN, COLORADO APPROVED AS TO FORM By:______________________ ______________________ Steve Skadron, Mayor City Attorney ________________________ Steve Barwick, City Manager PITKIN COUNTY BOARD OF HEALTH By:________________________________ 8 P33 II. Page 1 of 2 MEMORANDUM TO: Mayor and City Council FROM: CJ Oliver, Director of Environmental Health & Sustainability THRU: Randy Ready, Assistant City Manager DATE OF MEMO: 11/24/14 MEETING DATE: 12/2/2014 RE: IGA to Combine Public Health Structure REQUEST OF COUNCIL: Staff is requesting that Council review and approve an IGA to combine public health structures with Pitkin County to form a single Board of Health (BOH). PREVIOUS COUNCIL ACTION: At a September 17 th , 2013 joint work session, City Council and the BOCC directed staff to pursue the idea of combining public health structures for the City of Aspen and Pitkin County. The concept was generated by public health staff from both agencies and presented at the joint meeting. BACKGROUND: Please see the Background section of the Agenda Item Summary that follows for accurate detailed background information on this issue. DISCUSSION: The County memo lists the advantages of combining public health structures, and City staff concurs with this list. There are numerous benefits to this proposal which relate to efficiency of operation and decision making, better alignment with the requirements and preferences set forth in the Public Health Revitalization Act, and the assignment of appropriate duties to the most knowledgeable staff regarding specific topic matters. There are also potential drawbacks which staff has carefully considered and addressed through the attached IGA. The first consideration relates to concerns about loss of appropriate control over programs and projects for each of the involved agencies including City of Aspen Environmental Health, Pitkin County Environmental Health, and Community Health Services. This item is addressed in the IGA with assurances that each agency will develop and implement its own programs, budgets, priorities, staffing, etc. under the direction of each jurisdiction’s management and elected boards as is done currently. Under the proposed structure, the City and County maintain separate Environmental Health Departments. P34 II. Page 2 of 2 Cost is another consideration which has been addressed in the IGA with any future budgetary requests of the City of Aspen requiring Council approval. There are no financial obligations included in the combining of public health structure, and no inherent reason that a combined BOH structure would be more expensive for the City than the current structure. In fact, there will be some City staff efficiencies in not having to prepare memoranda and presentations for separate BOH meetings. Moving forward under the combined structure, any City contributions to the public agency would require council approval. A third potential area for concern is the communication of public health information to City Council without Council-specific BOH update meetings. City of Aspen Environmental Health staff will attend quarterly countywide BOH meetings in addition to an appointed City of Aspen representative on the Board of Health. When appropriate, staff can update Council at a work session on relevant public health topics in addition to the updates provided by the appointed BOH member during board updates of regular council meetings. It is staff’s recommendation that the appointed member from the City of Aspen be an elected official, as the remaining members of the BOH will be members of the BOCC and a member of the Town of Snowmass Village Council. Staff from public and environmental health as well as a medical officer will attend meetings to provide technical expertise to the BOH. FINANCIAL/BUDGET IMPACTS: There are no direct financial impacts from combining the public health structures of the City of Aspen and Pitkin County, except that staff will seek to maximize efficiencies. The IGA specifies that any future budgetary contributions by the City require Council approval and there are no specified financial obligations from the City of Aspen beyond the $61,000 grant to Community Health Services for 2014 that has already been approved. RECOMMENDED ACTION: City staff recommends that Council approve the attached IGA to combine public health structures with Pitkin County. Additionally, staff recommends that the City Council appoint a member of the Council to represent the City on the combined Board of Health. ALTERNATIVES: Council could choose to not approve the IGA to combine public health structures with Pitkin County and continue to have the City of Aspen maintain a separate Board of Health and Public Health Agency. CITY MANAGER COMMENTS: P35 II.