At a June 18 work session of the Archuleta County Board of County Commissioners (BoCC), the board heard an update on public health from Archuleta County Public Health Department (ACPHD) Executive Director Ashley Wilson.
Wilson began by explaining that the department will be reaching six months of existence at the beginning of July and that staff are currently working on compiling data about the first six months.
She added they are also finalizing contracts for the upcoming fiscal year with the state for the department.
The amount of money coming from contracts has fluctuated, she stated, with some programs receiving more funding and some receiving less.
Wilson added that having these contracts will allow the ACPHD to be better prepared for the county budgeting process in the fall since the department will have exact costs for the contracts.
Next, she provided data on the numbers of services that the ACPHD has performed in its first six months, including providing 84 birth certificate and 50 death certificate copies; investigating one tuberculosis case, one hepatitis A case, one pertussis case, 21 animal bites, one prairie dog die-off potentially connected to plague, and one bat with a potential risk for rabies; and serving a caseload of 286 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clients.
Wilson noted that there have not been 84 births and 50 deaths in the county and that people often order multiple copies of certificates.
WIC
She also pointed out the WIC caseload has increased by 42 clients since the transition from San Juan Basin Public Health (SJBPH).
Commissioner Ronnie Maez asked if Wilson believes that the increase in the WIC caseload is due to the program being “more local” and more accessible to clients.
Wilson commented that the program has always been located at the ACPHD’s current location, but that the ACPHD has done more targeted outreach through local organizations to attract clients compared to SJBPH.
She added that the ACPHD has a different marketing strategy focused on outreach through local organizations compared to SJBPH, which focused on distributing fliers and radio advertisements.
Wilson added that WIC staff member Inez Lobato is working with a variety of Spanish-speaking clients across Archuleta and La Plata counties.
That, she explained, is part of a mutual agreement with La Plata County where the La Plata County Public Health Department (LPCPHD) provides supervision and assistance with high-risk nutritional issues associated with WIC clients in exchange for Lobato assisting with Spanish-speaking clients.
Wilson explained that the ACPHD encourages staff to take the initiative to find and apply for grants, and that Lobato secured an approximately $6,000 grant to support breastfeeding initiatives in the community in addition to a grant from Nourish Colorado providing “10 shares of fresh fruits and vegetables” which she is distributing to WIC clients.
She stated that Lobato had 62 families who were interested and that she provides shares to 10 families a week through the grant.
Wilson indicated that the breastfeeding grant will allow the ACPHD to purchase a tent and associated equipment to provide a private location for breastfeeding that could be located at community events during the summer.
Health insurance
She explained that Health Navigator Karen Evans reports that there has been a 90 percent increase in clients since the transition from SJBPH, with Evans reaching 88 clients for health insurance enrollment support or health insurance literacy.
Wilson stated that the ACPHD applied to be a designated enrollment center for Connect for Health Colorado and was awarded $5,000 to provide the program, eliminating the need to partner with La Plata County on it.
She added that Evans also provides care coordination assistance, providing additional support for complex health care.
She stated that the ACPHD will begin offering cancer screening through the Women’s Wellness Connection program and that Evans will also provide care coordination for those who may be diagnosed with cancer through this program.
Wilson indicated that, beginning in July 2025, care coordination services will be billable to Medicare and Medicaid, meaning that some of Evans’ work could be billed to those services.
Clinic
Wilson stated that the clinic has seen increased usage recently and that the ACPHD has been doing additional vaccination clinics, including clinics at the public schools, the Pagosa Senior Center, Pine Ridge Rehabilitation and Healthcare Center, and in Arboles.
Wilson explained that ACPHD staff visit Arboles one Wednesday a month, including the ACPHD nurse and other staff, with the potential for additional outreach events as needs arise.
Medina commented that Arboles residents are “very excited” about having ACPHD services in the community.
Wilson stated that the clinic has provided sexual health services to 10 community members, including sexually transmitted infection testing, education and prevention services.
She added that the ACPHD has also distributed 65 boxes of Narcan to community members and locations in the community, including bars and the Archuleta County Department of Human Services.
She indicated that one of clinic nurses is currently completing the sexual assault nurse examiner’s course, which will allow the ACPHD to provide sexual assault exams if necessary.
Wilson stated that, from her previous work with Rise Above Violence, there were many instances where sexual assault victims had to be transported as far as Farmington, N.M., to receive an examination.
Commissioner Warren Brown commented that he was involved in bringing a similar service to another community.
He noted that having such examinations available in the community is highly valuable both in allowing victims to move forward from the assault and for prosecution of sexual assault.
“Good job,” Brown said.
Wilson added that many victims may not want to go to the emergency room due to the “level of trauma,” and the ACPHD can offer a more private and quiet setting for such examinations.
She also stated, in response to a question from Brown, that the ACPHD already has the necessary equipment for such examinations.
Wilson indicated that, as part of providing the cancer screenings for Women’s Wellness Connection, the department is working on hiring a nurse practitioner, physician’s assistant or doctor to perform the examinations.
She added that she is hoping to learn through this process if there may be individuals with similar credentials who would be willing to work for the ACPHD clinic a day a week, which would allow a significant expansion in the services the clinic could offer.
Medina asked Wilson if she has access to the list of people with medical credentials who applied to serve on the Board of Health since they might be willing to assist the ACPHD in this role.
Wilson replied that she does have the contact information for these individuals and “it’s always worth asking,” although she noted that at least one individual who applied to serve on the board has since taken a more time-consuming position.
She explained that the ACPHD is currently exploring options for expanding clinic services, including a potential program that would partner with small businesses to provide some basic medical services for their uninsured employees.
The ACPHD is currently circulating a small business survey to assess interest in such a program, Wilson indicated.
Emergency
preparedness
She stated that the department is making progress on emergency preparedness, including staff attending additional training, working on interagency collaboration and updating emergency plans to fit the community and structure of ACPHD.
Community outreach
Staff are working on building connections with local schools and the Town of Pagosa Springs Parks and Recreation Department for the tobacco cessation program, Wilson explained, and expect to do outreach events at the schools and other locations in the fall.
She added that the department has also surveyed local tobacco sellers to ensure they are complying with advertising standards, particularly in terms of advertising to youth, as part of the program.
SafeCare
Wilson stated that the department is currently interviewing for its SafeCare position, which has received 10 applications, including multiple from “highly qualified” individuals.
She added that the state grant administrator for the program expressed that the ACPHD had more referrals for the program than expected and that the program should “start to kick off” once the position for it is hired.
Nurse Family Partnership
The ACPHD, which offers Nurse Family Partnership services through a partnership with La Plata County, currently has more clients than LPCPHD, and staff from LPCPHD who administer the program are currently in Pagosa Springs “almost two full days a week” to provide services, Wilson indicated.
She added that the ACPHD offers Nurse Family Partnership office space and space to potentially meet with clients at its offices.
Air quality
The ACPHD has two funding sources for air-quality work, Wilson explained, including a National Association of City and County Health Officials grant that focused on community outreach around Air Quality Awareness Week in May.
That effort included social media and radio advertisements, as well as five local agencies flying air-quality flags during the week, she noted.
She stated that the U.S. Forest Service office requested to keep its flags due to positive community feedback and is continuing to partner with the ACPHD to provide air-quality information.
Another air-quality-related grant for the ACPHD is through the U.S. Environmental Protection Agency, Wilson explained.
She stated that this grant has been on hold due to the issues with providing services in La Plata County but that the grant is now likely to move forward since the La Plata County portion of the grant will transfer to a nonprofit who will administer that portion of the grant.
Environmental health and food safety
Wilson then covered the ACPHD’s environmental health and food safety efforts, which include issuing 104 retail food licenses, eight child care food licenses and eight school food licenses.
She stated that Environmental Health Specialist Angelica Leslie has completed 32 restaurant inspections so far and has until the end of the year to inspect each licensed food establishment at least once.
Wilson added that Leslie has performed nine reinspections, which indicate that an establishment had issues with its first inspection and required an additional inspection.
She stated that no food establishments have failed an inspection.
Leslie is working on getting the ACPHD through the National Standardized Retail Food Regulatory Program, Wilson explained, with the ACPHD receiving a small grant to assess its readiness and Leslie now working on ensuring that the department meets the standards necessary to operate under this program.
Wilson stated that Leslie is also completing the training process to become a trainer and proctor for ServSafe and for the state food safety training.
She commented that ServSafe is particularly important since the new food model code that will be published next spring will require that food establishments have someone who is ServSafe-certified on site at all times, raising the importance of offering this training locally.
Medina asked what the pricing would be for such training.
Wilson explained that the ACPHD has to see the new pricing on books that must be provided to each person who takes the training before it can set pricing.
Medina commented that local businesses have often had to bring in a trainer to train their staff and that having the service available locally would be valuable.
Wilson stated that the ACPHD would likely provide on-site training for larger establishments, such as The Springs Resort.
Health and safety is “No. 1,” Medina commented, adding that there were previously more limited checks on food safety and that, with the establishment of the ACPHD, “businesses are starting to see them more.”
She stated that the ACPHD could impose these regulations in a way that business would view the department as a “helping hand.”
She added that the department needs to focus on building positive relationships with businesses in the community since many of them are not used to the food safety regulations being consistently enforced.
“There are quite a few businesses that are not happy, but I just remind them that the health and safety of what you’re serving is a paramount, not only for the community, but for their livelihood, for the continuation of their business,” Medina said.
Wilson noted that the food safety regulations are state-mandated and that the department focuses on a coaching-first approach to reduce the likelihood of needing to be “punitive,” although she noted that the department has this ability.
“If people can see us more as … An inspection is not meant to be punitive, it is meant to help you so that we can come back if we need and we can offer support in any ways that we need to, train staff if we need to,” Wilson said. “So, those are all things that are part of what we hope to do. So, as long as they are willing to work with us, then that is going to tell me that is what we continue to have. If they choose not to work with us or are more resistant in other ways, then that becomes another issue because we actually don’t have a lot of … There is no leeway when it comes to the code set by the state and what is required for a permit.
“And, I would encourage anyone who has complaints or problems, if they feel like they can’t talk to Angelica herself about whatever their concerns are, I am always available to try to help people walk that road and manage what they need to.”
Medina commented that Leslie is “amazing” and that she has heard from business that she is “very approachable.”
‘Kudos’
Brown congratulated Wilson on the first six months of the ACPHD, adding, “It sounds like, it looks like the intent of bringing the health department local is doing just what we wanted it to do and that is providing better service to our community. Way to stay on track. Lot of work. Kudos to you and your staff.”
Wilson thanked Brown and concluded by stating that the department has obtained approval to bill Medicare and Medicaid and has received its first payments from both, which she commented is a “pretty big feat.”
josh@pagosasun.com
