Cirque Meadows by Adam Johnson




The Larimer County Board of Health (BOH) convened its regular meeting at 7:00 PM at the Larimer County Department of Health and Environment (LCDHE), 1525 Blue Spruce Drive, Fort Collins, CO.


           MEMBERS PRESENT:           N. Mark Richards, M.D., M.P.H.

                                                            Lee Thielen, M.P.A.

                                                            Steve Yurash


      Executive Secretary:               Adrienne LeBailly, M.D., M.P.H.

Commissioner Liaison:             Steve Johnson

Staff:                                         Marie Macpherson, Paula Lady


Guests:                                      Nisha Alden, Boulder County

                                                  Communicable Disease Division Manager,

                                                 Jeff Zayach, Boulder County Public Health Director

                                                 Jeff Basinger, NCAP   

                                                 Chris Grado, NCAP

                                                 Jennifer Jason, NCAP


1.   Call to order T he Board of Health meeting was called to order at 7:00 PM.


2.   Approval of August 24, 2011 meeting minutes - minutes of the August 24, 2011 meeting were unanimously approved.


3.   Presentation by Boulder County Public Health on the Boulder Works program – Nisha Alden, Communicable Disease Division Manager, and Jeff Zayach, Public Health Director.  Jeff Basinger, NCAP.    Ms. Alden presented the syringe exchange program (SEP) offered through the Boulder County Public Health Department.  She described the history of the program which has been in existence for over 20 years and the importance of collaboration with public safety law enforcement.  She reviewed the client-centered  services they offer and the outcomes as a result of the program.  Harm reduction is the basic principal for having a SEP.  Boulder Works sees a variety of people at different stages of drug use and addiction.  One of the goals of the Works program is to keep people safe by supplying antiseptic pads and sterile needles and syringes to injection drug users in their program.  An important benefit to the community is keeping used syringes off the streets.  The police department’s In Boulder and Longmont have reported reduction of syringes in alleyways and near Boulder Creek.  The Boulder Works program also saves money by preventing and reducing transmission of diseases, such as HIV, Hepatitis B and Hepatitis C.  One positive HIV case will cost approximately  $600,000 in health care of a lifetime, assuming that a person lives about 24 years after infection.  Each year the diagnosis is delayed, the costs increase.  This program allows earlier testing of HIV and other blood-borne disease, as testing  is offered when clients come in for exchanges.

 Jeff Zayach shared with the group a summary of 17 reviews showing crime reduction with SEPs.  Boulder Works was the third SEP in the country.  They have been able to keep this program running with the support of law enforcement and the district attorney.  The program has an outreach worker that will meet with clients anywhere, not just in the office.  The program is housed within their Communicable Disease Division.  In addition to working with Boulder’s HIV program offering free HIV, hepatitis B and C testing, they work with their immunization program to offer needed vaccines.  They have three fixed sites for the SEP; one in Longmont, one at their 24-hour addiction recovery center, and one at their North Broadway site.  The outreach worker  will meet clients anywhere for syringe exchange and also provides HIV testing and counseling.  Group education and individual counseling is offered.   


The budget for the Boulder Works program is $25,900, not including  staffing.  Supplies are the biggest cost.  Their client population is about 200 unique individuals that they serve directly; it is estimated they indirectly serve about 500 clients.  Staff of the program include: one full time program coordinator, one full time outreach worker and a half time HIV/Hepatitis C counselor.  Front desk staff is trained to receive clients and help with a syringe exchange if needed. 


The program serves clients ranging from 15 – 68 years of age with 40 being the mean age. 12% are homeless; 60% have been to a drug treatment program; 20% report wanting a referral to a drug treatment program.  Data are collected on an annual basis.  The data collected here are from 2009.  Primary drug use reported by clients: 45% meth; 35% heroin and opiates; 7% cocaine; and 13% use multiple drugs.  


Surveys are done annually with clients. Syringe exchange logs report how many people the exchange includes and if there interest in testing, counseling and treatment, or vaccination.  The outreach worker completes a form collecting similar information for each encounter, including the site of the encounter.  The Works program increases safety for the community as well as the drug user. Boulder Public Health offers their own drug treatment services, while NCAP provides referrals to community drug treatment programs.  NCAP has a strong referral network. 


Jeff Basinger from NCAP acknowledged what a difference a SEP makes in a county where there is a local program.  In the last five years NCAP has provided outreach, assistance, and bleach kits to injection drug users.  NCAP has had 957 encounters with active injection drug users in this time period.  190 unique clients have so far accessed services in 2011 through NCAP.  Having NCAP as a SEP would reduce potential controversy compared to having the county health department being the exchange site.  NCAP is looking to fund this within their existing program. Mr. Basinger said in just one week in the “Drop to stop” campaign in 2009, six thousand syringes were returned to them. 


Ms. Thielen asked what the role of BOH would be if we end up in agreement with NCAP.  Mr. Zayach’s reply was to ensure the program is run as expected, in compliance with state statutes.  An annual report is required to be submitted to the State. NCAP, the district attorney, law enforcement, and other stakeholders would all need to be involved in the conversation before a decision on a SEP could be made by the Board of Health.


4.   2011-Revised and 2012-Proposed Budget – Questions and clarifications - Marie Macpherson, - Dr. LeBailly Ms. Macpherson distributed the Letter of Budget Transmittal as well as the department’s budget documents. The numbers are very similar to the draft budget that was presented in August. The summary page shows the variance from one year to the next in the major categories. The total 2012 proposed budget is slightly less (0.43% less) than the 2011 revised budget. Marie informed the Board that certain grant-funded programs, such as the WIC Program, were experiencing budget reductions and FTE losses. This year is the first full year that tobacco funding has been gone and we have no tobacco prevention program.  So far the department has not reduced staff in our core public health services even though we experienced a loss of county funding. If reductions must be made in 2012, it cannot be done without reducing service levels; staff workloads are at capacity now. We are unsure how much our budget will be reduced going further this year from State and/or Federal sources.  The fund balance usage for 2012 is projected to be over $400,000. While we may not use that much of our reserves, based on our track record, we can’t use that much fund balance on an ongoing basis.  As we look at forward, 2013 is when we likely will have to look at more reductions. The Department will bring to the Board information from our internal process as well as what we learn from the Public Health Improvement planning process to assist with decisions when the time comes.  Mr. Yurash said that it would be helpful to have a list of which programs are most vulnerable and if there are other community partners that might do the service.  A handout was distributed showing pie charts of the how both county funds and our total budget are allocated to the 5 major service areas.


5.   Update on Community Health Assessment and County Health Improvement Planning process – Dr. LeBailly distributed a handout of Powerpoint slides describing the Community Health Assessment (CHA) and Public Health Improvement Planning (PHIP) process.  The Community Health Assessment will use data from many sources that have already been collected, and will identify data gaps that may need to be addressed in the future.  We are trying to partner with area non-profit hospitals to help them meet new IRS requirements for documenting “community benefit,” since these hospitals will need to do Community Health Needs Assessments every 3 year under the new law and we don’t want to duplicate efforts. 

The State’s top ten public health priorities are listed on page four of the handout titled “Colorado’s Winnable Battles”.  Our County Public Health Improvement Plan is not supposed to be a plan for the department but for all persons in the geographic boundaries of Larimer County, and will focus on a few priorities selected by the larger stakeholder group.  Dr. LeBailly referred to the National Prevention Strategy document as a potential template for presenting information on important health issues in the county.  We would like to create a website to be able to share information with the public. She mentioned the  “Health Matters in San Francisco” website as an example.  


6.   Director's Report – Director's Report – Dr. LeBailly mentioned that the Nurse Family Partnership, as well as several other health and prevention programs will be moved at the state level from the Health Department to the Human Services Department.  This will require statutory changes by the legislature.  A number of local public health agencies are concerned about the process and impacts of such a change. 

Dr. LeBailly shared with the BOH a letter from “Invest in Kids” asking that the Maternal, Infant and Early Childhood Home and Visiting Program (MIECHVP) in the health care reform legistlation be maintained.  They would like to know if the Larimer County Board of Health is willing to sign this letter of support.  Ms. Thielen pointed out that the BOH has not prioritized home visitation over a number of other public health priorities that may be part of the federal budget, and therefore cannot sign this letter, although they might have been able to support one that sought to maintain funding for public health prevention services more generally.

7.   Next meeting, Thursday, November 17th, 2011.   Dr. LeBailly asked the BOH if it was okay to move the November meeting from November 10th to November 17th.    This was approved. Next meeting will be November 17th at 7:00 pm. 

8.    Adjourn - meeting was adjourned at 9:20 pm.  




_______________________________           _______________________________________________

Paula Lady, Recording Secretary                    Adrienne LeBailly, MD, Executive Secretary

Background Image: Cirque Meadows by Adam Johnson. All rights reserved.