2021 Original Adopted Budget - El Paso County Public Health

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EL PASO COUNTY PUBLIC HEALTH

2021 Original Adopted Budget

National Public Health Network Agencies

Centers for Disease Control and

Prevention (CDC)

Colorado Department of Public Health

and Environment

National Public Health Network

El Paso County Public Health

D istinguishedB udget P resentation

A w ard

G O V E R N M E N T FIN A N C E O FFIC E R S A S S O C IA TIO N

January 1, 2020

For the Fiscal Year Beginning

PRESENTED TO

El Paso County Public Health

Executive Director

Colorado

2021 Adopted Budget El Paso County

Public Health & Environmental Services Colorado

Prepared for: The El Paso County Board of Health and Residents of El Paso County, Colorado

Dr. James Terbush, President Longinos Gonzalez, EPC Commissioner Victoria Broerman, Vice President Samuel Gieck, Fountain City Councilman

Cami Bremer, EPC Commissioner Doris Ralston Dr. Robert Bux, M.D Kari Kilroy

Yolanda Avila, Colorado Springs City Councilmember

With the Cooperation of the 2021 Board of County Commissioners: Stan VanderWerf, District 3, Chair

Cami Bremer, District 5, Vice-Chair Carrie Geitner, District 2, Commissioner

Longinos Gonzalez Jr., District 4, Commissioner Holly Williams., District 1, Commissioner

Public Health Leadership Team: Susan Wheelan, Public Health Director DeAnn Ryberg, Deputy Director Brenda Heimbach, Health Services Division Director Kyle Unland, Community Health Promotion Division Director Vacant, Environmental Health Services Division Director Dr. Robin Johnson, Medical Director Dr. Leon Kelly, Deputy Medical Director Michelle Hewitt, Public Health Information Officer Lisa Powell, Emergency Preparedness and Response Program Manager Stephen Goodwin, Chief Data Scientific Strategist Carolyn Gery, Development Officer

Prepared by: Sherri Cassidy, CPFO, Chief Financial Officer

Nikki Simmons, CPA, CPFO, County Controller Lori Cleaton, CPFO, County Budget Manager

Shanna Smith, Lead Budget Analyst Nora Todd, Budget Analyst

Cheryl Smith, Budget Analyst

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Table of Contents

BUDGET MESSAGE ........................................................................................................................................... 7

I. INTRODUCTION SECTION .................................................................................................................... 11

2021 BOARD OF HEALTH MEMBERS .......................................................................................................... 12

James Terbush, M.D., M.P.H., Board of Health President .................................................................................. 12

Victoria Broerman, Board of Health Vice President ............................................................................................ 12

Cami Bremer, El Paso County Commissioner ...................................................................................................... 12

Doris Ralston, M.P.A., C.H.E.S, Colorado Springs Osteopathic Foundation Executive Director & CEO ........ 13

Kari Kilroy .............................................................................................................................................................. 13

Longinos Gonzalez, Jr., El Paso County Commissioner ...................................................................................... 13

Robert C. Bux, M.D. ............................................................................................................................................... 14

Sam Gieck, Fountain City Councilmember ........................................................................................................... 14

Yolanda Avila, Colorado Springs City Councilmember ........................................................................................ 14

ORGANIZATIONAL CHART .......................................................................................................................... 15

OVERVIEW ....................................................................................................................................................... 16

GOALS AND STRATEGIES 2018-2022 ........................................................................................................... 26

2021 BUDGET DEVELOPMENT AND PROCESS.......................................................................................... 32

BASIS OF ACCOUNTING AND BUDGETING ............................................................................................... 33

DEBT & CAPITAL PROJECTS ........................................................................................................................... 33

HEALTH PROGRAMS AND SERVICES OVERVIEW.................................................................................. 34

STAFFING ......................................................................................................................................................... 43

II. ORIGINAL ADOPTED BUDGET SECTION .......................................................................................... 44

HISTORICAL BUDGET REVIEW .................................................................................................................. 45

CURRENT FINANCIAL STATUS ................................................................................................................... 48

PROJECTED FINANCIAL STATUS ............................................................................................................... 49

CHANGES FROM PRELIMINARY TO ADOPTED BUDGET ...................................................................... 50

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2021 ORIGINAL ADOPTED BUDGET SUMMARY ....................................................................................... 51

BUDGETARY STRATEGIES -FIVE YEAR FINANCIAL ROAD MAP ........................................................ 52

2021 ORIGINAL ADOPTED BUDGET REVENUES ...................................................................................... 53

2021 ORIGINAL ADOPTED BUDGET EXPENDITURES ............................................................................. 54

RESOLUTION ................................................................................................................................................... 55

III. FINANCIAL SECTION ........................................................................................................................ 57

PUBLIC HEALTH DIRECTOR ....................................................................................................................... 58

EL PASO COUNTY PUBLIC HEALTH - FUND 95 ........................................................................................ 59

BUDGET SUMMARY BY PROGRAM ............................................................................................................ 61

ADMINISTRATION .............................................................................................................................................. 62

PURPOSE STATEMENT ...................................................................................................................................... 62

OVERVIEW ........................................................................................................................................................... 62

PROGRAMS ........................................................................................................................................................... 62

OBJECTIVES ........................................................................................................................................................ 62

PERFORMANCE MEASURES AND OPERATING INDICATORS ................................................................. 63

HEALTH SERVICES ........................................................................................................................................ 74

PURPOSE STATEMENT ...................................................................................................................................... 74

OVERVIEW ........................................................................................................................................................... 74

PROGRAMS ........................................................................................................................................................... 74

OBJECTIVES ........................................................................................................................................................ 74

PERFORMANCE MEASURES AND OPERATING INDICATORS ................................................................. 75

COMMUNITY HEALTH PROMOTION ......................................................................................................... 88

PURPOSE STATEMENT ...................................................................................................................................... 88

OVERVIEW ........................................................................................................................................................... 88

PROGRAMS ........................................................................................................................................................... 88

OBJECTIVES ........................................................................................................................................................ 88

PERFORMANCE MEASURES AND OPERATING INDICATORS ................................................................. 89

ENVIRONMENTAL HEALTH ....................................................................................................................... 104

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PURPOSE STATEMENT .................................................................................................................................... 104

OVERVIEW ......................................................................................................................................................... 104

PROGRAMS ......................................................................................................................................................... 104

OBJECTIVES ...................................................................................................................................................... 105

PERFORMANCE MEASURES AND OPERATING INDICATORS ............................................................... 106

OFFICE OF EMERGENCY PREPAREDNESS ............................................................................................. 111

PURPOSE STATEMENT .................................................................................................................................... 111

OVERVIEW ......................................................................................................................................................... 111

OBJECTIVES ...................................................................................................................................................... 111

MANDATES/STATE STATUTES REQUIRED ............................................................................................. 117

FUND BALANCE POLICY ............................................................................................................................. 118

IV. DEMOGRAPHIC & STATISTICAL SECTION ................................................................................ 122

GLOSSARY ..................................................................................................................................................... 126

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BUDGET MESSAGE January 8, 2021

Dear Board of Health, Board of County Commissioners, and El Paso County Residents: Our charge in the development of the 2021 El Paso County Public Health (EPCPH) budget was twofold – actively address the urgent and emerging needs of El Paso County during a time marked by significant challenges, while looking ahead at long-term needs to continue to support the health and well-being of our community. As the COVID-19 crisis continues to unfold, we are keeping our strategy concentrated on our central mission to promote and protect public health and environmental quality across El Paso County through people, prevention and partnerships while developing longer-term solutions that will help us recover, rebuild and reimagine the future of our County. The 2021 EPCPH budget, developed in close collaboration with El Paso County Budget Office, reflects our commitment to these objectives. At the beginning of 2020, we set out to implement the agency’s key priorities for the year driven by goals set forth in our Strategic Plan and Community Health Improve Plan (CHIP), and to continue our foundational services and activities for the coming year, but by February our plans pivoted as El Paso County assumed its statutory role as lead agency in the COVID-19 response. At the start of the response effort, EPCPH grappled with numerous external challenges. In addition to contending with the novel virus, there were a multitude of factors impeding the response effort including the absence of a statewide and federal unified plan, and insufficient public health capacity. Yet, despite these issues, EPCPH continued to thread the needle successfully due to existing partnerships and infrastructure put in place prior to the pandemic that were made possible by El Paso County Board of County Commissioners’ and EPCPH Board of Health’s unanimous approval in 2018 of a budget that included projected increases resulting in additional monetary support starting 2019 through 2023. This five-year phased funding roadmap was the first time since 2012 that El Paso County increased its core funding amount to EPCPH enhancing, among several objectives, the agency’s ability to address emergent community needs. This foresight in budgetary planning placed the agency in a position of strength in the early stages of the COVID-19 response, prior to the provision of Coronavirus Aid, Relief, and Economic Security (CARES) Act funding. The County’s investment in 2019 was instrumental in our ability to respond swiftly upon the onset of the crisis in early 2020, particularly with regard to the establishment of the agency’s data infrastructure to inform critical decision-making across multiple entities in the County involved in the response effort, as well as longstanding partnerships and new collaborations made possible through the strategic allocation of resources to address critical community needs. Between 2010 and 2019, El Paso County experienced 15.8% population increase. With significant growth expected to continue over the several years, the need was identified to expand Public Health’s capacity to collect, analyze and disseminate data to harness the power of data for informed, proactive community decision-making. With this objective the agency established a new Office of Data and Analytics in 2019 designed to lead strategic agency and community efforts that are upstream, using data, evidence-based best practices, and innovative approaches to create efficiencies and further community health improvement measurements. In 2020, this office was instrumental in launching an innovative COVID-19 data dashboard, a critical component of our agency’s response to the pandemic, which greatly expanded access to data for public

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and community partners. Data visualizations and information regarding disease incidence and prevalence with interactive features has made it easier for users to visualize and breakdown complex data to better understand disease spread within the community and inform mitigation efforts. Amid a constantly shifting landscape, the Public Health Data and Analytics COVID-19 dashboard is understood by the community to be a place to find reliable, trustworthy and immediate information and has quickly solidified EPCPH as the leading local data expert with the purpose of establishing a central repository to provide transparent, accurate, and timely information. The information is presented and explained through multiple conduits, public forums, city council meetings and in the media. Challenges exist in keeping pace with the demand for information and the incoming stream of data. So it is a budgetary imperative during 2021 and beyond to continue to build out our data infrastructure and acquire tools for data management necessary to sustain a high level of resolution in providing details and the granular level of data necessary to examine the specific impact of not only COVID-19 but other health conditions that we are statutorily obligated to track, the social determinants of health, and Public Health interventions to address these issues. The opening of a new El Paso County Public Health building located in the Southeast region of the county -- an area hit hardest by the pandemic -- is a working example of how data analytics fueled a vital, Public 3.0 endeavor. Data related to social determinants of health and health disparities in the area informed a collaborative effort between the City of Fountain, multiple agencies, and EPCPH to develop a proposal to open a new, innovative public health space. The new El Paso County Public Health South opened in December 2020 and is providing multiple services to the community. It is designed as a central location where multiple partnering agencies provide support for food insecurity, access to behavioral health services and a Women’s Infant and Children’s (WIC) program and health services including vaccinations for the flu and COVID-19. The site provides emergency response and recovery staff and efforts such as COVID-19 parking lot, drive through testing to meet the increased need of the community. The issue of unemployment and associated disparities related to poverty is further exacerbated by the current pandemic. Once the first cases of COVID-19 were detected in March 2020, EPCPH realized cross-sector collaboration would be critical to develop an orchestrated and actionable plan designed to meet the health needs of community residents. At this time, it also became apparent to the business sector that a collaborative approach would be critical to response, relief, and recovery. Launched in April of 2020, the COVID-19 Regional Recovery Council (RRC) was formed as a collaborative effort between the El Paso County Public Health and the Colorado Springs Chamber & Economic Development team. The Council represents multiple sectors including economic development, county and municipal government, tourism, marketing, public health, workforce, higher education, non-profit and philanthropy and community development. This multi-sector effort is an innovative collaboration between public health and commerce and represents the collective understanding about the co-dependent relationship between public health and economic health. EPCPH has continued to be keenly focused on how to balance the needs of public health with what is required to sustain the local economy during this crisis and beyond. In close collaboration with the local Chamber of Commerce, Economic Development, multiple businesses, and County and City entities, EPCPH has maintained a focus on supporting this collaboration through dedicating the time and staff needed to mitigate COVID-

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19 disease spread in the community. These efforts include robust risk communication, education, testing and containment measures, technical support, data resources, assistance to businesses and organizations in interpreting swiftly changing public health orders and guidance, and the orchestration of the COVID-19 vaccination campaign for the region. One result of this collaborative effort was the drafting of a multi-pronged variance designed to help businesses across several sectors reopen as safely and quickly as possible in accordance with statewide (stay at home) health orders. EPCPH leadership equipped businesses with resources empowering them to continue operations while promoting the safety of employees and customers. Because of these steady efforts, sales tax revenues for both the City of Colorado Springs and El Paso County are beginning to recover sooner than expected. This emphasizes the positive impact attributed to the collaborative work of El Paso County, including all municipalities, with the business and medical communities that ultimately supported the economy in opening faster, while still protecting the health of the community. To address sustainability, we anticipate the group will continue to serve the community post-COVID-19. The focus in the future will remain on ensuring public and economic health through continuing to connect and refine disaster preparedness plans to enhance resiliency and recovery for the next natural or man-made disaster that affects the Pikes Peak community. Disasters have occurred in almost every community in America at some point, leaving in their wake a need to rebuild, reconnect and, sometimes, restructure. The COVID-19 pandemic is no different, apart from the duration of time it is impacting our lives. With no official pandemic end date, anxiety and fear have an opportunity to take root in our community in a deep and unique way. We recognized early in our local response to the pandemic the need for access to tools to help the community address concerns and doubts, and to build up our strength and ability to cope. GRIT (Greater Resilience Intervention Team/Information Tookit) was developed at the local onset of COVID-19 by Dr. Charles Benight, Dr. Josef Ruzek, and Nicole Weis of University of Colorado, Colorado Springs to help community members support each other during these uncertain times. It was designed to train and support volunteers -- people who have no formal mental health training -- to become coaches who boost resilience and support people through the pandemic. El Paso County is no stranger to disasters, with man-made and natural disasters having come through our community in the last 10 years. Each disaster has brought support from local and national levels, mostly through FEMA funding. This funding has existed for many years and has been allocated based on research by SAMSHA. The core principle is to go into a community affected by disaster and provide emergency aid for physical, medical, and mental health needs. The problem begins when the threat of the disaster is over and the funds leave the community, which in many cases is only after a few months. For mental health professionals and community agencies who support those with mental illness, this is devastating, as most mental health distress comes much later. Based on the roles we hold in Public Health, we know that COVID-19 would require a different level of response, and one that would last for years to come. The El Paso County Method was born when representatives of EPCPH leadership initiated connections with Dr. Charles Benight and many community members and the National Alliance on Mental Illness (NAMI) and AspenPointe (a local mental and behavioral health organization) to brainstorm ways our community could come together to respond to COVID-19 in both the short- and long-term. After hearing from other community leaders about the GRIT program referenced above, they connected with the National Institute for Human Resilience to see if GRIT could be part of a community solution. The basic premise of the El Paso County Method is simple: Core community agencies support each other’s ongoing work, and build a stronger mental health safety net, by collaborating on efforts to increase the number of GRIT coaches in our community. Then GRIT coaches’ partner with NAMI volunteers to continue to support community members throughout

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times of great uncertainty, creating a network of people who are trained and committed to helping each other. Those coaches and volunteers create a pipeline into both no-cost NAMI services and to AspenPointe for higher levels of care (including care in the FEMA-funded Crisis Counseling Program, while it is in place.) Through this system, AspenPointe can stretch FEMA funds today and create a network of connections and a support framework for the longer term, when NAMI volunteers and GRIT coaches will carry on the education, support, and training that the El Paso County Method collaboration began. The method maximizes the time and funding that FEMA provides to build community partnerships; trains members how to be more resilient by becoming GRIT coaches or NAMI volunteers; utilizes the social networks of both individuals and community agencies; and starts building resilience and support locally. Behavioral health issues were emerging in crisis levels well before we were dealing with COVID-19 in 2020 and the budget priorities we established last year were intended to continue the agency’s efforts to develop a framework for behavioral health system improvement and strengthen the mental health treatment continuum in El Paso County. The El Paso County Method has been a great collaboration which complements and builds on these efforts to address and create solutions that are sustainable more effectively. The establishment these and other partnerships too many to mention here demonstrates how quickly the creation of coalitions can provide opportunities in the midst of a crisis. While many sources cite the importance of multi-sector partnerships in attaining the goals of the Public Health 3.0 model, it is clear how this need is heightened during a disaster relief effort. The Public Health 3.0 model emphasizes the imperative for local health departments to actively engage both the public and private sectors in order to support healthy, equitable, and resilient communities. During times of stability, strategic partnerships expand the capacity of the health agency through shared funding opportunities which allows for integrating multiple revenue sources. In 2020, EPCPH was tested in profoundly remarkable ways. Yet, the energy, commitment, focus and adaptability of our Public Health team and our community partners during the COVID-19 crisis has enabled us to develop the exemplary and replicable outcomes we’ve been able to achieve thus far. So while, at the time of this letter, the COVID-19 incidence, hospitalizations, and deaths decline in El Paso County, the vaccine is rolled out, schools are returning to in-person learning, and it appears for our fortunate  community at least, the worst is behind us, much work is left to be done. The 2021 budget is a reflection of the priorities and needs we have identified as our community moves toward recovery, renewal, and re-focus on the fundamentals of our mission. It is with great appreciation to all who participated in the development of our 2021 budget, Board of County Commissioners, Board of Health, all support staff and especially to the staff of the El Paso County Financial Services Department Budget Division, that I submit the 2021 budget and look forward to the year ahead with a strong vision for the future. Sincerely

Susan Wheelan, MBA Public Health Director, El Paso County Public Health

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I. INTRODUCTION SECTION

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2021 BOARD OF HEALTH MEMBERS

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Cami Bremer was appointed to the Board of Health in 2019. Ms. Bremer brings broad experience in government and media relations as well as health care and non-profit management to her role as a Board member. She has served as Regional Director for the American Heart Association, Provider & Community Relations Manager for Penrose Cancer Center, Director of Governmental Affairs for the Chamber of Commerce, and Communications Specialist for the City of Colorado Springs. Ms. Bremer attended the University of Georgia where she earned her Bachelors of Journalism in Public Relations. After moving to Colorado in 2002, she continued her education with an MBA in Marketing from UCCS.

Victoria Broerman was appointed to the Board of Health in 2011. She is a registered nurse with more than 26 years of experience in patient care and governmental affairs. Ms. Broerman is an active member of the Colorado Springs Chamber of Commerce, past board member of the State of Colorado Board of Nursing, and a volunteer at Marian House Soup Kitchen.

James Terbush, M.D., M.P.H., Board of Health President Captain Terbush USN, served as Command Surgeon to North American Aerospace Defense Command (NORAD) and U.S. Northern Command (USNORTHCOM) from 2006-2009. In this role, he served as the Medical Advisor to the Commander and was responsible for the integration of Department of Defense medical assets internally and with other agencies in support of military response to civilian disasters combating terrorism and protecting Americans. From 2009-2011, Dr. Terbush served as the Fleet Surgeon for Commander, U.S. Naval Forces Southern Command. He was deployed forward to Port au Prince in response to the devastating earthquake disaster in Haiti, integrating DOD medical capabilities into the overall International response. Dr.Terbush’s final assignment before retiring from military service in 2014, was with the Science and Technology Directorate at NORAD and USNORTHCOM where he served as the lead for medical innovations.

In more than 30 years of Government service Dr. Terbush was the physician to U.S. personnel in more than 80 countries. He is published in scientific journals on; Influenza and Air Travel, Mass Fatalities Management and Public Health Consequences of a Cyber Attack. He is also an advisor to the National Academy of Sciences Institute of Medicine Forum on Disaster and Public health and is the Past President of the American Academy of Disaster Medicine. Dr. Terbush received his M.D. from the University of Colorado and a Master’s in Public Health from the University of California, Los Angeles.

Victoria Broerman, Board of Health Vice President

Cami Bremer, El Paso County Commissioner

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Kari Kilroy is the Office Supervisor/Executive Assistant to the CEO and Board of Directors at UCHealth Memorial, with nearly 20 years of nonprofit and public sector experience. She was appointed to the Board of Health in 2012, and elected Board of Health President from 2014-2018. Kari has served other community organizations, including the El Paso County Citizen Budget Oversight Committee and the City of Manitou Springs Parking Authority Board. She is the current Chair of the Communications Committee for the Association of Healthcare Administrative Professionals, which publishes an award-winning newsletter. Kari has a Bachelor’s degree in Philosophy from UCCS and a Master’s degree in Health Communication from Emerson College/Tufts University School of Medicine in Boston. She is also a graduate of the UCCS College of Business “Leadership Development for Emerging Healthcare Leaders” Program.

Doris Ralston, M.P.A., C.H.E.S, Colorado Springs Osteopathic Foundation Executive Director & CEO Doris Ralston works as executive director of the Colorado Springs Osteopathic Foundation. She holds a Master of Public Administration degree from UCCS and a bachelor’s degree in community health education from East Carolina University. Gov. John Hickenlooper appointed Ralston to the Commission on Family Medicine, representing Congressional District 5, where she is serving her second term.With Ralston at the helm, the Osteopathic Foundation was named the outstanding grant-making organization for 2012 by the Center for Nonprofit Excellence’s Partners in Philanthropy. She was also awarded the John H. Drabing Award for “extraordinary dedication and support” in 2010 and the National Award for Excellence in Financial Development, awarded by the Congress of Lung Association staff at its national meeting. Ms. Ralston continues to volunteer for the American Heart Association.

Longinos Gonzalez, Jr. was appointed to the Board of Health in 2016. A retired military officer, Mr. Gonzalez served 20 years in the U.S. Air Force as an intelligence officer and retired as a Lt Colonel in 2012. In addition to a political science degree from the Academy, Longinos has a master’s degree in science education and was a teacher with Harrison School District 2 prior to his election. Longinos is the county representative on the Fountain Creek Watershed Flood Control, Board of Health, and Housing Authority. He also serves on numerous other boards and committees- including the Pikes Peak Rural Transportation Authority, Community Development Advisory Board, and City/County Drainage Board.

Kari Kilroy

Longinos Gonzalez, Jr., El Paso County Commissioner

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Dr. Robert Bux was appointed to the Board of Health in 2011. Dr. Bux is a board certified Pathologist in Anatomical, Clinical and Forensic Pathology, with more than 25 years of experience as Medical Examiner. From 1971-2002 Dr. Bux served as a Major in the United States Army Reserve Medical Corp. He is a member of the American Medical Association, the National Association of Medical Examiners, and the American Academy of Forensic Sciences. Dr. Bux has served as a member of the Medical Advisory Board, International Forensic Program of Physicians for Human Rights since 2006 and has served on the Colorado Bureau of Investigation Cold Case multidisciplinary team since 2010. Dr. Bux was appointed by the Board of County Commissioners to the Office of El Paso County Coroner in January of 2006. He was elected to his first four year term in November 2006 and elected to a second term in November of 2010.

Sam Gieck was appointed to the Board of Health in 2018. He is a retired fireman who spent 26 years working for the Colorado Springs Fire Department. He also spent five years with Thompson’s Investigations as a field investigator for welfare fraud, and 13 years with Widefield School District 3. He is currently serving as a City Councilman for the City of Fountain Ward 3. He has been a City Council member for the past four years, and is currently on a second four-year term.

Robert C. Bux, M.D.

Sam Gieck, Fountain City Councilmember

Yolanda Avila, Colorado Springs City Councilmember Yolanda Avila was appointed to the Board of Health in 2019. Ms. Avila’s family has lived in Colorado Springs since 1958. Ms. Avila graduated from Colorado College in 1985 with a BA in International Political Economy. In 1990 Ms. Avila began work as a criminal defense investigator in Orange County, CA. She also worked as a field supervisor and mentor to local university students. In 1998, Ms. Avila was diagnosed with Retinitis Pigmentosa, a degenerative eye disease that has a prognosis of blindness. When Ms. Avila retired in 2011, she returned to Colorado Springs to be near her now 96-year-old mother.

Ms. Avila is passionate about infrastructure and has championed several causes in District 4 by improving transit accessibility, fixing bus routes and frequency. Ms. Avila is a resident leader of the Southeast RISE Coalition, which receives and disseminates information and sponsors activities for projects in Southeast. As part of these efforts, there have been façade improvements in two Southeast shopping centers and a $1M grant from the Colorado Health Foundation for the Southeast hub. She also served as the Black/Latino Leadership Coalition President.

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ORGANIZATIONAL CHART

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OVERVIEW Profile of the Government

El Paso County, incorporated in 1861 and located in the central part of Colorado, is one of the top growth areas in both the state and the country. The 2021 population projections from the Colorado Department of Local Affairs have El Paso County’s population estimated at 748,981. El Paso County is the second most populous county in the state and occupies 2,158 square miles. El Paso County Public Health (EPCPH) serves all residents of El Paso County with 158 full-time equivalent (FTE) employees. In 2020, an additional temporary 24 FTE employees plus numerous part-time and contracted employees, were added to respond to the COVID-19 pandemic. These employees are funded through COVID-19 response grants.

EPCPH is governed by a nine-member Board of Health, whose members are appointed by the El Paso County Board of County Commissioners for five-year terms. The Board of Health governs the agency through the establishment of policy, approval of budgets, and appointment of the public health director.

Mission

Our mission is to promote and protect public health and environmental quality across El Paso County through people, prevention, and partnerships. Our public health agency serves all residents and visitors of El Paso County, which includes the cities of Colorado Springs and Manitou Springs, and the towns of Calhan, Fountain, Green Mountain Falls, Monument, Palmer Lake, and Ramah . Public Health is defined by the Institute of Medicine as “fulfilling society’s interest in assuring conditions in which people can be healthy.” Programs are targeted toward the general population and specific high-risk groups to aid in making healthy choices, and to provide interventions to prevent the spread of disease.

Vision

Our vision is for all El Paso County residents to live in thriving communities where every person has the opportunity to achieve optimal health.

Local economy

Major industries located within El Paso County’s boundaries, or in proximity, include several military bases and their supporting operations, semiconductor companies, automobile dealers, large retailers, as well as several financial institutions, religious organizations, and insurance companies.

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Mandates/State Statutes

Public health is defined in statute as the prevention of injury, disease, and premature mortality; the promotion of health in the community; and the response to public health and environmental health needs and emergencies and is accomplished through the 10 essential public health services.

Colorado Public Health Act Title 25, Article 1 of Colorado Revised Statutes

• Assessment, Planning, and Communication • Communicable Disease Prevention, Investigation, and Control • Emergency Preparedness and Response • Environmental Health • Prevention and Population Health Promotion • Vital Records and Statistics (Birth and Death Certificates) • Administration and Governance

The 10 Essential Services of Public Health

• Provides a framework for public health to protect and promote the health of all people in all communities through a lens of health equity

• Promotes policies, systems, and services that enable optimal health and seeks to remove obstacles and systemic and structural barriers

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El Paso County Strategic Plan Collaboration, Goal and Objectives

Our agency is part of the County’s five-year strategic plan, specifically Goal #5: Strive to ensure a safe, secure, resilient, and healthy community:

• Enhance EPCPH involvement in the transportation, land use, and environmental planning processes

• Expand carbon monoxide and radon awareness, outreach, and detection • Develop a public outreach campaign to provide information on outdoor air pollution, source of

pollutants, and corrective actions

Quarterly we report to the Board of County Commissioners our objectives and the progress. EPCPH objectives to accomplish the goal include:

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• Implement a “Communities That Care” model to assess and implement prevention strategies to reduce youth substance abuse

• Convene community partners to implement strategies to reduce teen suicide • Continue to actively support the El Paso County Community Health Improvement Plan • Support community efforts to combat substance abuse • Reduce foodborne illness through increased food worker education and expanding compliance

efforts of food safety standards at retail food establishments • Continue to work collaboratively with other stakeholders, via the Groundwater Quality Study

Committee, to study and protect groundwater quality and identify emerging issues through periodic monitoring, sharing data among stakeholders

• Participate in efforts to prevent water contamination and if warranted, support mitigation efforts with community stakeholders

• Test the public health pandemic disease response plan, including points of distribution and update plan as warranted. This became a reality in 2020 and the plans were put into action.

COVID-19 Response

In late December 2019, EPCPH began monitoring the novel coronavirus that emerged in Wuhan, China. Local public health agencies are statutorily charged with leading their community’s response during a pandemic and by February 14, 2020, EPCPH activated its Incident Command System and on March 5, 2020, El Paso County saw its first case of COVID-19. On March 14, the El Paso County Board of County Commissioners declared a local state of emergency. Each step of the way, EPCPH has been proactive, taking swift action to keep the public and partners informed, as well as taking the necessary steps to protect the well-being of the community by balancing health and economic vitality.

Facing a global pandemic of a magnitude never faced in our lifetimes, 2020 was challenging in many ways. EPCPH focused mainly on emergency response, from bringing together key community leaders, legal expertise, law enforcement, school districts, hospital systems, and business and economic communities; providing education and resources to individuals, families, schools, and businesses to minimize the spread of COVID-19; connecting people to critical support services in the community; and managing the herculean feats of testing, case investigation, contact tracing and vaccination efforts, all while continuing continuity of many essential Public Health services for our community when they are needed most. This work has made a difference and will continue to be a critical component of our community’s resilience and ability to recover from this crisis in the year ahead.

The pandemic and ensuing agency response caused a rapid shift in culture for EPCPH staff. We had to transition from working in-office to teleworking on March 17 and find innovative ways to continue to provide essential services to the public. Many of our programs were prepared to do this and implemented their existing continuity of operations plans (COOPs). These plans allowed for many services to continue through virtual meetings, over the phone, and through email and mail. Less than a quarter of EPCPH’s

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staff remain working in office to keep essential functions going, such as the Public Health Laboratory, who continue to ensure the El Paso County community has safe drinking water; Operations, who continue to staff our front desk and provide needed logistical cross-agency support; Vital Records, who continue to provide birth and death records; and some Women, Infants and Children (WIC) staff who need to be present to see high risk clients, issue breast pumps and provide first-time clients with their debit cards.

Programs were assessed and those that provide services that are also available from other community organizations, such as Family Planning and Immunizations, were closed so their staff could be reassigned to COVID response roles, specifically in long-term care facilities and communicable disease. Other programs drastically reduced or shifted their “normal” services so they could also provide direct support to the response. At one point, over two-thirds of EPCPH staff were assigned to a COVID response role and many will continue to be into 2021. Each division’s role in the COVID response is described in this book. Program closures, along with closures of local restaurants and other business establishments, will result in lost revenue that EPCPH typically sees from license fees and insurance payments.

In addition to the transition to teleworking and reprioritization of services, EPCPH staff have also had to face a shift in work-life balance. Other than the occasional after-hours event, our agency’s operating hours were Monday – Friday from 7:30am-4:30pm. As the COVID response is necessary 24 hours per day, seven days per week, staff are having to work different hours, on-call shifts, and a hefty amount of overtime. EPCPH hired more staff in 2020, however local public health agencies, including ours, are already understaffed and the changing dynamics, response demands and steady increase in cases have not provided any reprieve.

Thankfully in 2019, EPCPH leadership had the foresight to request additional funding from El Paso County to address ongoing and emerging critical needs. The Board of County Commissioners and EPCPH Board of Health unanimously approved a budget that included projected increases resulting in additional monetary support from 2019 through 2023. The funding supported the hiring of 10 new staff positions to address the needs of our growing population, and these positions were some of the first staff to be redeployed to the COVID-19 response in March.

The hiring of these staff also allowed for the implementation of the Office of Public Health Data and Analytics in 2019. This Office expanded EPCPH’s capacity to collect, analyze and disseminate data and solidifies our agency as the leading local data expert. Throughout the COVID-19 response, this Office has created a central repository to provide the most accurate, credible, and timely information by establishing a public data dashboard that is updated daily. The dashboard and Data and Analytics staff have been key in providing resources used by community leaders and the public throughout the pandemic.

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Though EPCPH does have some emergency reserve funding set aside, it was not prepared for what 2020 brought and the accompanying strain on finances and resources. To assist with the extensive COVID-19 response and recovery efforts during this time, EPCPH is grateful to have received Coronavirus Aid, Relief, and Economic Security (CARES) Act funding from both the state of Colorado and El Paso County. The state provided $652,970, which was used to cover staff salaries, including overtime pay, from March through early May. El Paso County provided $4.4 million in CARES funding that was used for personnel costs and supplies, increased communication efforts and mental health and resiliency efforts.

Four million in personnel costs include the multitude of staff hours spent on the COVID response, as well as hiring 24 FTEs and five part time staff in positions such as Environmental Health Specialists, Public Health Nurses, Disease Intervention Specialists, Project Managers, Epidemiologists, and a School Liaison. Over 30 contracted staff were also hired through a partnership with the Pikes Peak Workforce Center and Goodwill Staffing, and many had lost work in other roles due to layoffs caused by the pandemic. Contracted staff work in roles such as case investigations (contact tracing), data entry and administrative support. Though CARES funding must be expended by the end of 2020 and under the current legislation cannot be carried into 2021, EPCPH knows that the COVID response is not going to follow that same timeline. The 2021 budget includes keeping these staff for at least the first six months of 2021, and hopefully longer. Recovery from the pandemic is going to take years and additional staff are going to remain critical to continue to support public health infrastructure.

Two hundred thousand dollars in CARES Act funds were also spent on increased communication efforts. Considering how rapidly evolving the pandemic has been, and the sheer amount of negative and incorrect information circulating, having accurate and readily available information is paramount. In our modern world, people are relying on nontraditional media platforms such as social media and websites for their information. Having professional services to assist with graphic design and content creation allowed EPCPH to create and disseminate information that was approachable, easy to understand, and would impart a sense of positivity and trust, all essential during this time. Communication materials and posts were created in and translated to Spanish, as El Paso County has a high population of Spanish-speaking residents. These funds also supported the COVID-19 Dashboard that was added to EPCPH’s website to provide the most accurate and timely information regarding COVID-19 cases, outbreak information and hospital capacity.

Another $200,000 was utilized for staff and community mental health, wellness, and resiliency efforts. EPCPH staff were now working 24 hours a day/seven days a week and experiencing negativity and distrust from the public, as well as intense situations they have never faced before, such as residents of long term care facilities in their oversight dying from COVID-19. Realizing that staff needed support services to deal with stress and trauma, EPCPH reached out early to get help from one of the world’s most highly regarded experts on trauma, secondary trauma, and building community resilience and the University at Colorado, Colorado Springs (UCCS) National Resilience Institute.

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UCCS and EPCPH also collaborated with the National Alliance for Mental Illness to launch the Greater Resilience Intervention Team (GRIT) resiliency training website to benefit El Paso County and the state of Colorado. Through the UCCS National Resilience Institute, GRIT, the Greater Resilience Information Toolkit training, are free resources with information and supportive video content that empower individuals and communities to expand their capacity to build resilience, a person’s ability to cope with traumatic events. The COVID-19 response and recovery is going to be a long-haul effort and expertise and focused attention is critical for our staff and the broader community. We also utilized our communication contractors to further mental health and resiliency promotion and resources to the broader community through a coordinated effort. Addressing the stress and trauma of this major lifetime event in a timely manner will prevent other problems from surfacing, such as ongoing trauma and other behavioral health consequences.

In addition to CARES Act funding, El Paso County provided EPCPH with an additional $4 million to support the purchase of a COVID-19 response and recovery building in southeastern El Paso County, an area that already faces drastic health disparities made worse by the current pandemic. These inequities include lack of access to care, lack of adequate public transportation, being further away from services offered in other areas of the County, and high rates of unemployment. Having a larger presence in this area will bring more services to the community, including low barrier COVID-19 testing; services to assist with economic recovery; behavioral health services to support the community during the pandemic and recovery phases, and after; Public Health services so County residents who live in or near the area will not have to travel far; space for points of dispensing (PODs) for the COVID-19 vaccine; and ample storage for POD equipment and other emergency preparedness items. All of these services will assist the community with much needed services in the long recovery process from the effects of COVID-19.

Also, EPCPH currently leases a small building in Fountain Valley as a satellite WIC office. This location serves over 4,000 clients. WIC funding is anticipated to be cut due to across the board funding cuts we are seeing caused by the COVID-19 pandemic. Not having to pay rent would be a tremendous relief to this program’s budget and ensure we could continue to serve these clients and enroll new clients who need WIC benefits, assisting with the increase of food insecurity this area is facing due to lost income caused by layoffs from the pandemic.

EPCPH also received a 30-month grant from the Colorado Department of Public Health and Environment (CDPHE), originated from the Centers for Disease Control and Prevention, for slightly over $5.1 million, called the Epidemiology and Laboratory Capacity (ELC) Grant. The ELC Grant provides funding for the enhanced detection, response, surveillance, and prevention of COVID-19. It is intended to continue to support the continued need for contact tracers, epidemiologists, and disease intervention specialists, as well as COVID testing and laboratory support.

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In addition to the ELC Grant, EPCPH also applied for and received two Protect Our Neighbors (PON) grants from CDPHE - $50,000 for planning and $150,000 for implementation. The $150,000 grant was also met with a match from EPCPH and community partners for $150,000. EPCPH contributed $68,000 in CARES funding, plus in-kind personnel and other supply costs. The PON grants were utilized between October and December 2020 to survey Spanish-speaking residents in the most disparate regions of our County to assess the impacts of COVID-19 on basic needs, COVID prevention practices, access to social supports and preferred methods of communication. The information was then analyzed and funds were distributed to community partners to address identified needs, such as mortgage, rent and utility assistance, food insecurities, resource distribution, transportation, COVID testing, outreach, and Spanish radio and social media ads.

EPCPH utilized CARES and PON funding as best it could in 2020, to set the stage for continuous COVID-19 response efforts. However, this funding cannot be carried over into 2021 and knowing the pandemic will not end on December 31, 2020, EPCPH has requested additional monies from its general and reserve funds to be utilized in 2021, mainly to keep current infrastructure through staffing. EPCPH will plan, coordinate and lead multiple points of dispensing (PODs) to vaccinate the entire El Paso County community; this requires a large number of staff and many programs may need to cease services for a time so staff can be reallocated to assist with POD efforts.

Financial recovery from the pandemic is also a concern and could take several years to fully mitigate all secondary effects. As mentioned, since EPCPH is statutorily charged with leading the community’s response to the pandemic, we had to close multiple services beginning in March to allocate staff to the COVID response. These services are still closed or operating in very limited capacity today. This, along with state public health orders resulting in the closing and/or limited capacities of many businesses, is causing a drastic decrease in the typical revenues that EPCPH sees and will carry into 2021.

Other 2021 Budgetary Highlights

As stated, EPCPH had to prioritize the COVID-19 response in 2020. Consequently, many of the previously planned goals, objectives and projects had to be put aside. However, there is a notable achievement that was still accomplished during this time. After an over two-year process, we were notified that we achieved Reaccreditation status through the Public Health Accreditation Board (PHAB). This status is recognition of our agency meeting very rigorous and specific sets of standards and measures set by PHAB that are recognized as leading best practices in public health. We were the first local public health agency in Colorado to be accredited in 2013, and are the first agency to be reaccredited in the state.

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Long-term Strategic Planning and Critical Needs Update

To address ongoing and emerging critical needs, in 2019 the Board of Health unanimously approved a budget that includes projected increases to result in additional support through 2023. The additional funding supported the hiring of up to 10 additional staff positions and creation of the Office of Public Health Data and Analytics. As mentioned, these staff positions were some of the first to be activated in the COVID-19 response, and the new Office has been an essential resource throughout the pandemic. The positions also align with the agency’s five-year strategic plan, which aims to build a strong public health workforce and leadership pipeline, develop and strengthen strategic partnerships, solidify core funding, position the agency to be even more nimble and proactive with timely and locally-relevant data, and enhance the agency's foundational infrastructure. This funding is critical to maintain EPCPH’s high-performing staff and its mandated core services while allowing the agency to address emerging community needs.

The 2019 Critical Needs request accomplished the following and will set this agency on a path to continue to serve the growing population as well as meeting the needs of prevention and protection:

• 2019 Critical Needs funding phased over five years

• Continued support for meeting the increasing demand for public health protections and services

• Increased safety by addressing emerging health issues

• Allow the Board of Health to address unmet needs

• Continued support by Board of Health to utilize savings during the phase-in of county support

• No new Critical Needs funding requested for 2020 and using savings to fund one-time 27th pay period

• During the phase-in process the budget strategy included hiring an additional 10 full-time equivalent (FTE) employees in the identified areas of need. Filling the funding gap each year with one time use of available fund balance above the targeted reserve established in the fund balance policy

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2018-2022 Public Health Strategic Plan Goal Areas:

• Workforce development • Technology, informatics and data analysis • Communication • Community partnerships • Funding for agency and community partners • Community Health Improvement Plan 2018-2022:

1. Mental health and substance abuse 2. Healthy eating and active living

• Health equity

2021 Budget Development, Base Budget and Critical Needs

Over the course of the year, EPCPH has worked closely with the County budget office to develop the 2021 budget and continue an effective strategy on how to most efficiently implement the five-year phased funding road map. In developing the EPCPH budget, we observed the following critical realities:

• El Paso County’s population has increased from 599,060 in 2008 to an estimated 748,981 in 2021; this is a total increase of 149,921 people, or growth of 25%

• Health departments serving populations of 500,000 to 999,999 have an average of 269 full-time employees; in 2020, we had 158 full-time equivalent employees, not including the temporary, fund-limited 24 FTEs we hired to assist with the COVID-19 response

• Increasing demand for services across all areas • Capacity to respond to emerging issues such as deployment of personnel in response to the

COVID-19 pandemic • Many grants are time limited; reoccurring funding remains flat • 74% of revenue is restricted (grants, contracts, fees) • State funding for core services has remained flat for almost a decade – EPCPH continues to

advocate for state funding for El Paso County • CARES Act funding to assist with COVID-19 response and recovery efforts must be used by

December 31, 2020; however, the pandemic will not end on that date, and may become worse before it gets better

• Twenty-four CARES-funded full-time staff, five part time staff and numerous contracted staff that were hired specifically for the COVID response and recovery need to remain on board, despite their funding stream ending. Some, but not all, of these staff expenses can be covered by the ELC grant. Funding for the others, plus numerous supplies and services still necessary for the response, will be funded from EPCPH’s fund balance and possibly emergency reserves in 2021.

• Program closures and closures of local businesses will result in lost revenue from insurance payments and fees that EPCPH typically sees in 2020, 2021 and possibly beyond.

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The COVID-19 pandemic has further highlighted the fact that our agency needs to focus on building infrastructure and obtaining additional funding. The severely increased workload and demands of the pandemic continue to exceed staff capacity. While we are thankful for the CARES Act funding received in 2020, it was time-limited and will not be able to be used in 2021. The staff hired with the funding are critical to continuing to protect the community and respond to the pandemic; while we have some funding we can use from fund balance to support these staff in 2021, that will become time-limited as well. The approval of the COVID-19 vaccine is cause for hope and future reprieve, but EPCPH will need to continue to support the community’s long road to recovery from the primary and secondary effects created by the pandemic.

You will see in this budget document, charts and graphs, the five-year financial roadmap, and the final presentation document provided to the Board of Health when requesting adoption of the budget. The five-year financial roadmap demonstrates the funding plan and impact to fund balance.

Great appreciation is given to the El Paso County Board of Commissioners and the El Paso County Board of Health for their collaboration and support of the leadership and staff charged with implementation of these efforts.

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GOALS AND STRATEGIES 2018-2022

The goals selected for each strategic plan topic area represent broad achievements EPCPH plans to reach by the end of 2022. The goals are expressed at a high-level in order to capture all possible forward movement across the agency and within specific programs. The strategies selected represent the most important ways in which EPCPH can focus its agency and programmatic objectives to meet each goal. Specific objectives will be articulated each year and set forth in an annual work plan. The annual work plan guides the daily work of programs and staff to assure that work is aligned with the strategic plan, there is process for measuring progress, and that Quality Improvement (QI) opportunities are identified. Annual work plans for 2018-2022 will be based on these goals and strategies.

Workforce development Goal 1: Strengthen EPCPH’s workforce to improve public health and environmental quality Strategy 1: Provide trainings that develop and strengthen public health core competencies Strategy 2: Develop career pathways for existing staff to move into leadership positions

Strategy 3: Improve organizational capacity to support our workforce Strategy 4: Provide technology tools and trainings to improve skills and create organizational efficiencies

Technology, informatics, data analysis Goal 1: Strengthen EPCPH’s capabilities to collect, analyze, share, and use data to make timely and information-driven decisions

Strategy 1: Develop and maintain collaborative relationships with key stakeholders to share relevant data Strategy 2: Improve internal capabilities to collect and provide data for community health assessments Strategy 3: Expand internal resources for data collection, storage, and analysis Strategy 4: Regularly disseminate important and emerging health information to community partners

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Communication Goal 1: Strengthen EPCPH’s capabilities to provide information on public health issues and public health functions to external partners

Strategy 1: Provide opportunities for media relations training, maintain relationships with media partners, and seek new partnerships with diverse media outlets Strategy 2: Increase use of digital media to promote public health messages and enhance health marketing materials Strategy 3: Expand the agency’s participation in an annual health marketing schedule for a planned approach to develop and implement health promotion activities

Strategy 4: Identify opportunities to promote key agency accomplishments within the community

Goal 2: Strengthen EPCPH’s internal communication capabilities Strategy 1: Increase cross-program collaboration and communication to improve internal and external customer service Strategy 2: Increase knowledge and understanding of EPCPH’s brand guidelines to raise brand awareness of public health in the community Strategy 3: Increase staff use and awareness of internal staff website for information sharing, operational updates, staff accomplishments, and awareness of agency activities

Community partnerships Goal 1: Develop and maintain strong relationships with key community partners to support public health or assure the provision of health care services Strategy 1: Develop and strengthen relationships with elected officials and other policymakers

Strategy 2: Expand EPCPH staff participation on key community collaborations, coalitions, committees, or other work groups that can influence health outcomes and policy, including those that address the social determinants of health Strategy 3: Expand participation from non-traditional partners on EPCPH-led coalitions, collaborations, or committees to create bi-directional relationships

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Funding for the agency and community partners Goal 1: Increase funding for EPCPH from diverse sources to support core public health services, programmatic services, and innovative strategies Strategy 1: Increase EPCPH’s ability to bill insurances for direct services Strategy 2: Build relationships with state agencies that provide funding for public health activities and funding Strategy 3: Build relationships with state and local elected officials to support public health activities and funding Strategy 4: Build relationships with key foundation partners, academic institutions, and business leaders to support public health activities and funding

Goal 2: Provide technical support for funding to key community partners Strategy 1: Increase grant training opportunities for partner agencies Strategy 2: Maintain support for partner agencies that need fundraising or grant writing assistance

CHIP 2018-2022 Goal 1: Decrease incidence of poor mental health and substance use and misuse Strategy 1: Reduce stigma for behavioral health conditions Strategy 2: Increase evidence-based mental health school programs Strategy 3: Increase mental health screening & treatment for depression and anxiety Strategy 4: Increase social connectedness Goal 2: Reverse the upward trend of population living at an unhealthy body weight

Strategy 1: Reduce household food insecurity Strategy 2: Increase access to a variety of healthy foods encouraged by the dietary guidelines

Strategy 3: Increase access to safe places for physical activity Strategy 4: Increase the number of youths that get 150 minutes of vigorous physical activity per week

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Health equity Goal 1: Increase public awareness of health equity issues, its systemic causes, and opportunities to foster heath equity Strategy 1: Increase community awareness of root causes of health equity and evidence-based solutions that address health equity Strategy 2: Increase community awareness of health indicator data as stratified to highlight health equity issues by population Goal 2: Remove barriers to healthcare and community resources to improve health outcomes among health disparate populations Strategy 1: Increase EPCPH service locations in geographic areas with high need for service

Strategy 2: Increase EPCPH’s use of remote access, online, and telehealth services to reduce transportation and time barriers

Plan implementation, evaluation, and quality improvement

EPCPH uses a program assessment tool (PAT) created in 2015 to standardize information gathering from each EPCPH program and service area. The information gathered in the PAT is used to create the annual agency work plan, which is an appendix to the strategic plan. The PAT asks programs to provide information about its goals and objectives, population served, intended outcomes, evaluation processes, funding sources, communications needs or plans, community partners, workforce development needs or plans, and quality improvement ideas. The PAT seeks to gather information from existing work plans that programs have created in response to grants and contracts, or in the case of programs’ funding by fees or general funds, from existing logic models and internal plans.

The PAT was revised to align with the 2018-2022 strategic plan goals and strategies (Appendix B). PAT information is gathered every December and programmatic and agency-wide objectives are added to the goals and strategies framework to create the annual work plan. Objectives are specific, measurable, actionable, realistic, and time- bound, or SMART. The work plan is reviewed and approved by SPHIT and the Leadership Team. The work plan is posted to EPCPH’s intranet so that all staff can easily access the plan and understand how daily work helps EPCPH meet its short and long-term goals.

Evaluation

The work plan is updated quarterly to determine progress and notes are reflected for each objective. At the close of each year, the fully updated work plan is reviewed and a percentage of completed objectives is calculated to determine how the agency is meeting its objectives. EPCPH seeks to meet 90 percent of annual work plan objectives. Where objectives are not met, the work plan describes the barriers to achievement and if future work will continue in the objective area.

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Quality improvement (QI) opportunities

EPCPH’s QI team quarterly reviews progress on the annual work plan to look for potential QI projects or identify places where programs are at risk for not meeting their objectives. QI team members are assigned as liaisons to each program. QI liaisons contact their assigned programs quarterly to request updates on work plan objectives. The liaison works with program manager to identify opportunities for QI projects that can help achieve objectives, or QI projects that can assist with improvements in other program areas.

Once potential projects are identified, EPCPH’s QI liaison will provide technical assistance for the QI project. Technical assistance refers to building human and organizational capacity using the principles of collaboration and adaptability in order to create accountability and targeted, outcome-oriented results. All members of the QI team receive thorough training in QI, Plan-Do-Study-Act, lean processes, and A3 Practical Problem Solving. Completed projects are then communicated with all EPCPH staff through storyboards and other reports to stakeholders and reflected in the annual work plan.

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2021 BUDGET DEVELOPMENT AND PROCESS

2021 PUBLIC HEALTH BUDGET PREPARATION CALENDAR

The following calendar is an early estimate of the timelines to prepare the budget and meet statutory deadlines with final approval by the Board of Health. It will also follow the calendar set by Financial Services for coordination of approvals through the Board of County Commissioners. All dates are subject to change as necessary and this document will be updated regularly when there is a change.

January 1, 2020 Budget Year begins Monthly Financial Review with Executive Director Monthly Financial Report to Board of Health

June 24, 2020 Present to BoH 2019 Audit/Comprehensive Annual Financial Report

June 30, 2020 Begin PH Budget Planning, FTE updates and count General additions, deletions, overall strategy discussions

August 7, 2020 FTE Worksheet due back to budget

August 2020 Budget Training and Prep for new managers & staff

August 17, 2020 Preliminary PH Budget Work Papers from Budget to PH Managers

September 1, 2020 Preliminary Program budgets due back to Budget

Week of Sept. 14 Preliminary Budget review with PH Leadership

October 28, 2020 2021 Preliminary Balanced Budget to Board of Health December 16, 2020 2021 PH Budget to Board of Health – (Original Adopted Budget)

Resolution to Adopt and Appropriate the 2021 Budget FISCAL YEAR

The El Paso County Public Health and Environmental Services fiscal year is a calendar year (January 1 – December 31) as required by Colorado Statute CRS 29-1-103(1).

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BASIS OF ACCOUNTING AND BUDGETING

The modified accrual basis of accounting is used for all governmental fund types. Revenues are recognized in the accounting period in which they become available and measurable. Property tax, when applicable, is reported as a receivable and deferred revenue when the levy is certified, and as a revenue when due for collection in the subsequent year.

The budget is prepared using Generally Accepted Accounting Principles (GAAP) for all funds except that the budget also includes proceeds from long-term financing and capital grants as revenue; expenditures include capital outlays and bond payments. Depreciation on property and equipment are excluded from the budget. On January 1, 2002, the Governmental Accounting Standards Board (GASB) Statement 34 became effective for El Paso County and requires governments to prepare their statements in a format that will enhance the comprehension and usefulness of the financial reports. Governments also need to report capital assets with consideration of depreciation, including infrastructure assets and historical treasures.

Adjustments to the Original Adopted Budget may occur throughout the calendar year and shortly into the subsequent calendar year to account for revenues received in excess of the budget and to authorize expenditure of additional funds. Whenever El Paso County Public Health Department receives unanticipated revenues or revenues not assured at the time of the adoption of the budget and those revenues need to be expended, a supplemental budget appropriation shall be enacted to authorize the expenditure of these unanticipated funds. The budgetary level of control resides with the El Paso County Board of Health who approves all budgetary changes.

DEBT & CAPITAL PROJECTS

El Paso County Public Health Department does not have any debt, as defined by Colorado statutes. Public Health does not manage any capital projects and as they provide health programs and services to the citizens of El Paso County, personnel and operating are a large majority of the expenditures.

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HEALTH PROGRAMS AND SERVICES OVERVIEW

Funding

The majority of El Paso County Public Health’s (EPCPH) 2021 annual revenues, 42.83 percent, will come from program-specific grants and 14.88 percent comes from a specific COVID-19 response grant (the Epidemiology and Laboratory Capacity, or ELC, grant) that is time-limited through the end of 2022. Program specific grants are mainly funded through the Colorado Department of Public Health and Environment (CDPHE),and include the Women, Infants and Children (WIC) program; Immunization program; Family Planning program; Nurse Family Partnership programs; Vital Records; Emergency Preparedness and Response programs; Communicable Disease and Tuberculosis programs; the Tobacco Education and Prevention Partnership; Maternal Child Health programs; and Environmental Health programs. Funding for these programs has been regularly renewed but the amounts can change at any time based on the amount of federal funding CDPHE receives for each program and is never guaranteed. EPCPH also receives grant funding through other programs that require a competitive application process. These programs include Communities That Care, a five year grant that runs from July 2016 to June 2021 and funding from the El Pomar Foundation that supports the Resilient, Inspired, Strong and Engaged Coalition who is implementing grass roots efforts to better the communities in southeast Colorado Springs, an area that faces significantly more health disparities than other areas in the county. In addition to grant funding, slightly over sixteen percent of EPCPH’s 2021 budget is anticipated to come from licenses, fees, and permits, mainly for birth and death records, water testing and other laboratory services, retail food establishment, body art and child care center license fees, and air quality and onsite wastewater treatment system permit fees. However, due to the pandemic and the effect it had on the 2020 revenue from these sources, this number may be less. The status of restrictions caused by the pandemic and effects they have on local business and the general population is fluid and hard to predict. El Paso County provides 21.33 percent of Public Health’s total funding, and the State of Colorado provides 4.61 percent in per-capita funding to the total budget. This funding is used for general agency operational expenses and to fund programs that do not currently receive grant funding, such as the Office of Public Health Data and Analytics; Teen Suicide Prevention; Public Health Planning; Development, Communications and Administration. EPCPH did receive an additional $4.4 million of CARES (Coronavirus Aid, Relief and Economic Security) Act funding and $4 million in general funding from El Paso County in 2020 to support COVID-19 response efforts; the CARES Act funding had to be expended by the end of 2020 and the general funds were used to purchase a building to provide COVID-19 testing, vaccines and public health services. The overall projected revenue for EPCPH in 2021 is $20.8 million. As with any service-related agency, the majority of EPCPH’s funding in 2021 will go to personnel expenses (73 %). Facilities and maintenance expenses make up slightly over 10%, and contracted services, especially related to the COVID-19 response, make up around 5%. The remaining allocation of the budget will go toward supplies, travel, operating equipment, advertising and communication expenses, insurance, legal services and state required fees. EPCPH’s projected expenditures for 2021 are $21.6 million. The overage is largely due to the continued need to support COVID-19 response activities and EPCPH may need to draw funds from its emergency reserves.

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History

County and state per capita funding are allocated to EPCPH to ensure the conditions in which people can be healthy, and address issues that affect the health and well-being of individuals, families, communities, populations and societies. Grant and contract funding are acquired to further EPCPH’s mission and restricted, by the grantors, for specific uses detailed in the grant or contract. As noted above, a significant portion of EPCPH revenues comes from grants and other contracts. Grant services include research, development, community-level health interventions and planning. EPCPH writes and submits numerous grant applications to federal, state, local, and private funders to ensure the county has the necessary funding to investigate, plan and problem- solve current, emergent and urgent health issues and crises. Additional funding that was approved by El Paso County in 2019 resulted in the hiring of 10 critical needs positions; these were among the first employees who were reassigned into the COVID response roles when the pandemic came to El Paso County.   EPCPH was re-accredited through the Public Health Accreditation Board (PHAB) in 2020. Accreditation activities included completing and advancing several agency plans: Community Health Assessment, Community Health Improvement Plan, Workforce Development, Quality Improvement, Continuity of Operations, and a Strategic Plan. Additionally, PHAB requires the gathering and submission of large volumes of documentation for required standards and measures and an annual report. Achievement of reaccreditation demonstrates accountability, leadership, and success in following national public health evidence-based practices.   On October 30, EPCPH closed on the new Public Health South building located in southeastern El Paso County. Currently, Women, Infants and Children (WIC) is the only present program operational at the new building. The occupancy is used for the high volume, community-based Fountain COVID-19 testing site. Additionally, the building has been prepared for other potential programs such as Immunizations, for the distribution of COVID-19 and other vaccines; Communities That Care, to lead community efforts to reduce youth substance use; and Nurse Family Partnership and Maternal Child Health, to assist families with young children and link them to needed resources. This new building provides many opportunities that support Public Health infrastructure in an area of the county that was facing multiple health disparities made worse by the pandemic.

COVID-19 Response In 2020, the majority of Public Health’s staff was reassigned and deployed to the COVID-19 response. As the lead agency in response, we engaged community partners and leveraged staff in specific roles through continuity of operations plans. To leverage so many staff, we also had to close some services and shift normal agency priorities. In late 2019, EPCPH accomplished the building of the new Office of Data and Analytics and in 2020, the data team quickly developed and launched an interactive data dashboard for COVID-19 cases. This platform enhances transparency by increasing access to timely and accurate data. With the county’s local declaration of emergency in March 2020, Public Health was able to leverage volunteers from Medical Reserve Corps to strengthen response efforts. In addition, local Community Emergency Response Team (CERT) volunteers have provided well over 600 hours of time in staffing call centers and responding to questions from the community. Lastly, the University of Colorado, Colorado

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Springs College of Nursing, leveraged 425 student hours and 138 faculty hours toward case investigation and recovery interviews.

Programs/Services Administration

EPCPH’s Administration serves all EPCPH staff and is headed by the Public Health Director and Deputy Director. The office is responsible for strategic planning, workforce development, ensuring continuity of day to day administrative business and adherence and enforcement of policies and procedures. This office also manages all operational aspects of EPCPH, and serves as liaison to El Paso County IT, HR, Finance and Procurement offices. Operations is a sub-division of Administration and is responsible for day to day operational aspects of the agency, acting as liaison to County Facilities and IT, in and out processing of new staff, fleet vehicle management, and staffing the EPCPH information desk. The Office of Communication (OoC) serves as an in-house marketing, public relations, and advertising department, providing numerous services to support EPCPH in fulfilling its overall agency, division, and program goals. The OoC serves both internal and external customers, to include the broader El Paso County community. Their role is to provide accurate, timely and credible information on a wide array of public health issues to the public, community partners, stakeholders, staff, and any other relevant parties. Communication materials include: social marketing; advertising campaigns; publication development and support; writing/editorial services; design/layout; web content management; social media strategy and content development; event coordination, support, and community outreach; media relations and public relations; media training; emergency/risk communication and issues management; strategic communication planning; video and photography. The Development Office researches and applies for grant and other funding opportunities, liaises with other County agencies and community stakeholders to form meaningful collaborations, and leads strategic initiatives that support the entire agency. The Vital Records Program provides certified copies of birth certificates and death certificates for the State of Colorado, which meet stringent state and federal requirements for recording of these vital statistics. Funding source: Birth and death certificate fees (statewide). COVID-19 Response: EPCPH’s Director has led the Policy Group, a collaboration of emergency management, city and county leadership, and business community support throughout the pandemic. EPCPH’s Deputy Director has been serving as Director of the Emergency Coordination Center (ECC). Both roles are ensuring a coordinated county-wide response to the pandemic. The Administration Division provided logistical support throughout the pandemic by transitioning staff from working in-office to teleworking, coordinating the hire process of additional staff and contractors to assist with the response, and activate current staff in Incident Command System/Emergency Coordination Center roles. Additionally, the OoC leads the Joint Information Center (JIC), convening partners from County, City, health care, and many others to ensure dissemination of accurate, timely and credible information regarding the pandemic.

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Health Services

Health Services provides laboratory and clinical services to vulnerable and high-risk populations to prevent diseases in varied age and population groups. The Family Planning program provides reproductive health services to women and men, including evidence-based interventions. Women who are pregnant are provided area resource information and medical care referrals. Women and men have access to reproductive and preventive health services based on gender and age. Providers are responsible for reporting sexually transmitted diseases (STDs) to the Colorado Department of Public Health and Environment. The Family Planning program refers clients needing more specialized services, such as HIV, to community providers. Funding sources: Federal and State grants, client fees, Medicaid, private insurance The Immunization Program provides parent education and immunizations for children who are uninsured/underinsured, Medicaid eligible, insured, or Alaskan Native or Native American. These activities are coordinated through the Vaccine for Children (VFC) program in El Paso County. The Immunization Program also supports school immunization audits and helps health care providers maintain proper immunization practices. The Immunizations program worked closely with El Paso County Public Health Disease Prevention division and community providers to address the Hepatitis A outbreak in El Paso County, providing 6,891 Hepatitis A vaccines between October 2018 through December 31, 2019. In addition, the clinic provides recommended adult vaccinations for individuals with Medicaid and most forms of insurance, on a fee-for-service basis. The Immunizations program also provides counseling, education and vaccinations for international travelers who require immunizations prior to departing on business, recreation or mission trips. This clinic offers immunizations not easily obtained from primary care providers in El Paso County and helps ensure that international travelers do not return with an infectious disease and introduce it into the community. Funding sources: State funding, grants, private insurance, Medicaid, and client fees The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is an evidence-based program resulting in improved birth outcomes, fewer infant deaths, and reduced health care costs. Registered Dieticians and Health Educators provide supplemental food benefits as well as child development and nutrition education to qualifying women and their children. WIC also provides breastfeeding counseling and depression screening to pregnant and postpartum women. WIC maintains a caseload of more than 12,800 clients per month in El Paso County. WIC offices are located in Fountain and Colorado Springs. Funding source: Grants The Nurse-Family Partnership (NFP) is an evidence-based, nationally recognized nurse in-home visitation program that helps improve the health, well-being and self-sufficiency of low-income, first-time parents and their children. Nurses begin home visits with women during pregnancy and continue until their child is two-years old. Pregnancy outcomes are improved by helping women engage in good preventive health practices—including consistent access to prenatal care, improved diet and decreased use or elimination of cigarettes, alcohol and illegal substances. This program provides parents with the tools and resources to support their children’s health and development. Families improve their economic self-

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sufficiency by learning to establish long-term goals, continue their education, and secure employment. Funding sources: Medicaid fees and grants COVID-19 Response: The El Paso County Public Health Family Planning and Immunization clinics were closed from mid-March through August and are currently only partially open to the public.  WIC and NFP have been providing services via technology versus in-person since mid-March.  All Immunizations clinic staff and some Family Planning clinic staff have been assigned full time to the COVID response since mid-March.  As a result, the programs have not been able to reach the goals that were set prior to the onset of this global pandemic. We anticipate ongoing COVID activities including leading our community in the vaccine distribution and will not resume normal functioning for the foreseeable future.

Community Health Promotion Community Health Promotion works to prevent diseases, improve health and enhance human potential through evidence-based interventions throughout the general population in El Paso County. This division also initiates strategic partnerships in the community to provide information and prevention activities for all age groups, including bullying prevention, youth suicide prevention and youth substance use prevention. The Child Health Promotion and Youth Advocacy Programs (Maternal Child Health; Youth Suicide Prevention, Child Fatality Review Team, and Youth Substance Use Prevention/Communities That Care) address a wide range of health issues affecting children and youth in El Paso County, with an emphasis on improving health and safety initiatives, along with child abuse prevention and advocacy. Program activities include participation in a variety of community committees focused on the health and well-being of children and youth. This effort includes health education on important issues such as child abuse prevention, positive parenting and child development, trauma-responsive environments, health and safety topics, and health advocacy within the community. Youth advocacy activities include convening work groups of partner agencies and community members to prevent youth suicide and substance use, as well as promoting resiliency and community connectedness for elementary- age children. Communities That Care addresses risk and protective factors to impact youth substance use, poor mental health, and violence. Funding source: Local and State funding sources

HCP, a care coordination program for children and youth with special health care needs focuses on supporting and improving the health, development and well-being of children from birth to 21 years of age who have, or are at increased risk for having, a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children and youth generally. HCP is a division of the Maternal Child Health program. The HCP care coordination team assures that families have access to integrated, family- centered, culturally competent, and community-based programs and services. These services are provided free of charge to families and there are no diagnostic or income-based criteria to qualify for these services. Program activities include information and referrals to community services, assistance with accessing early intervention and specialty care services, development of an individualized plan of care, support for families in advocating for their child, and consultation and capacity building with community partners. In

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2019, HCP received 297 referrals, provided in-depth care coordination to 114 families, and provided information or referrals to 240 individuals or agencies. Funding source: Title V MCH block grant and local funding. The Tobacco Education Prevention Partnership (TEPP) focuses on policy level tobacco prevention intended to help adults and youth quit tobacco, prevent youth from starting tobacco, and decrease exposure to secondhand smoke. TEPP’s target populations are youth, young adults, low socioeconomic status and other health disparate populations. TEPP utilizes many different community partners to accomplish the following:

• Strengthen tobacco-free school policies and promote youth involvement in prevention efforts; • Assist workplaces, housing properties, local governments and more to enact tobacco-free policies that protect the public from the harmful effects of smoking and secondhand smoke; • Educate the community on tobacco-related topics including prevention, new products, and resources to help people quit tobacco; • Train health care providers to provide counseling and community resources that help people quit tobacco.

Accomplishments in 2019 included educating nearly 4,000 community members regarding electronic cigarettes or vapes including students and faculty in seven school districts. This team also collaborated with Colorado Springs Housing Authority (CSHA) to conduct a survey of residents living in multi-unit housing which revealed a smoking prevalence of 30% (this figure is twice the national average). Approximately 83% of residents reported a desire to quit. Two Board of Health resolutions were passed in 2019. The first declared vaping a public health crisis and the second declared support for evidence- based practices to protect and prevent vaping among youth. Funding source: Local and State funding sources Public Health Planning: The Healthy Environment Planner and Public Health Planner work with internal and external stakeholders on a variety of strategic initiatives and partnerships. In 2020, the planning team worked with Colorado Springs Food Rescue to complete the final phase of a Food Systems Assessment for El Paso County, completed a Community Services Block Grant Needs Assessment report, provided project management support for Community Navigation, worked on successful Public Health Accreditation Board (PHAB) re-accreditation efforts for the agency, made numerous presentations to community partners on the equity impacts of COVID-19 (with Health Equity Planner). The Healthy Community Collaborative (HCC) convened in January 2020 and began mapping out relationships/list of boards and committees to ensure EPCPH representation and voice is involved in strategic partnerships. Managed QI team and program assessments, workplan/goal setting. In 2020, a MCH Health Equity Planner position was created with a focus on assessing and reducing maternal and child health disparities to include maternal and infant mortality, pregnancy-related complications, pre-term delivery and low birth weight, Adverse Childhood Experiences and trauma, mental health and substance abuse, lack of access to high-quality health care, economic insecurity, discrimination, and environmental and structural factors. Healthy Communities and Community Mobilization El Pomar awarded El Paso County Public Health a $350,000 grant spread over 7 years, from 2017-2024. This funding allows us to continue to support community leaders through the Resilient, Inspired, Strong, Engaged (RISE) Coalition. Highlights include partnerships with the Trust for Public Land and the City of Colorado Springs for the Panorama Park renovation, which is the largest park renovation in city’s history,

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with already $9 million dollars secured for improvements. RISE Coalition partners have reported leveraging more than $8 million in funding for the Southeast Colorado Springs Community since initial funding by El Pomar in 2016. Funding: Grant and local funding COVID-19 Response: Due to the pandemic, Community Health Promotion Division staff have been reassigned to help in response efforts.

Environmental Health Division

Environmental Health works to assure the safety of retail food, body art establishments, public swimming pools and spas, childcare facilities, schools, air quality, waste tire generators and haulers, drinking water and Onsite Wastewater Treatment Systems to prevent disease in those settings.

The Body Art Program conducts inspections, investigates complaints, and provides enforcement of local public health regulations at body art establishments and temporary events. El Paso County has more than 75 licensed body art establishments. Funding source: License fees

The Onsite Wastewater Treatment Systems (OWTS) program works to ensure that wastewater systems provide adequate treatment of wastewater rather than simply disposing of wastewater. The program protects public health and the environment by preventing human exposure to sewage and works to prevent the contamination of groundwater. The program accomplishes this by ensuring proper placement, design, installation, and maintenance of OWTS. We focus on regulation of OWTS associated with both commercial and residential facilities that are not serviced by a municipal wastewater system. There are a nearly 33,000 operating OWTS in El Paso County, more than any other county in the state of Colorado. EPCPH issues approximately 600 (OWTS) permits and reviews about 1,000 transfer of title inspections per year. Funding sources: Permits and license fees

The Food Safety Program helps prevent foodborne illness in El Paso County's retail food establishments through regulatory and educational efforts. As of 2019, El Paso County has 2,735 licensed establishments or vendors that provide food to the public—including restaurants, caterers, grocery stores, convenience stores, school kitchens, and mobile vehicle vendors. EPCPH’s Environmental Health specialists routinely inspect facilities to assure compliance with food safety regulations and educate food handlers, investigate consumer complaints, and assist with foodborne outbreak investigations. In addition, EPCPH issues retail food establishment licenses and conducts thorough reviews of plans for new and remodeled facilities. Food safety classes are offered in English and Spanish languages. Funding sources: Local per capita, license fees

The Child Care Program works to protect children and staff from infectious diseases, including foodborne illness, by inspecting childcare facilities, providing education about proper handwashing, best practices, cleaning, sanitization, disinfection, and food handling. El Paso County has more than 370 licensed childcare facilities. Environmental Health Specialists inspect childcare facilities to assure compliance with the Colorado Regulations Governing Health and Sanitation of Child Care Facilities. Staff also

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investigate consumer complaints, assist with illness investigations and conduct thorough reviews of plans for new and remodeled facilities. Funding sources: Inspection fees

The Public Swimming Pool Program assures proper pool and spa maintenance and operation to prevent waterborne disease. Environmental Health Specialists routinely inspect public swimming pools and spas to assure compliance with Colorado's Safe Swimming Pool and Mineral Baths Regulations. El Paso County has 282 public swimming pools and spa facilities. Funding source: Inspection fees

The Air Quality Program actively responds to air quality complaints for odor and opacity. Environmental Health Specialists review control plans and applications and issue open burn and construction activity permits in El Paso County to protect public health and the natural environment. Funding sources: Contract and permit fees

The School Safety program works to educate schools about the proper handling and storage of hazardous materials and equipment in high risk areas through on-site inspections and self-evaluations. There are more than 55 middle and high schools in El Paso County that have high risk areas. The Environmental Health Specialists ensure compliance with the Rules and Regulations Governing Schools in the State of Colorado through the high-risk inspections, self-evaluations and complaint investigations on the low risk areas. Funding source: EH general funding

The Waste Tire program assures that tires from a variety of vehicles that are deemed as waste are properly stored, disposed of, or transported for an end-use by inspecting Waste Tire Generators and Haulers. Environmental Health Specialists inspect generators and haulers to ensure compliance with Section 10 of the Regulations Pertaining to Solid Waste Sites and Facilities. El Paso County has 300 waste tire facilities. Funding source: Grant funded

COVID-19 Response: Environmental Health staff have provided technical guidance, and consultation on state public health orders and guidelines related to COVID this year. The team has fielded over 9,000 inquiries from mid-March through September this year, compared to a typical call volume of 1,900 last year. The retail food program is actively engaging with business and retail food partners to proactively plan and identify innovative solutions to expand outdoor dining in the winter months. The childcares and schools program worked closely with Communicable Disease department to address exposures in centers and schools to decrease further potential spread. There were many facilities closed in March 2020, but the programs and services were still able to work with our regulated partners. In August 2020, certain programs resumed including virtual childcare inspections, regular body art inspections, plan reviews for childcare and body art facilities, as well as responding to outdoor air quality complaints. During the response efforts, it is important to note that the OWTS program was not impacted by COVID. In fact, we have seen an increase in permits and transfer of title applications during this period compared to 2019. Additionally, the water recreation team remained engaged with public pools and spas to provide education and ensure proper chemical treatment of pools remaining in use.

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Emergency Preparedness and Response

The Emergency Preparedness Program assures that EPCPH is prepared for, and capable of responding to, naturally occurring disasters (wildfires, floods, earthquakes, blizzards, etc.), intentional acts of terrorism, pandemics, and other public health emergencies in collaboration with community partners. The program promotes preparedness and educates the community on emerging health threats, such as a flu pandemic; serves as regional coordinators, trainers and epidemiologist for a five-county region within Colorado; and provides expanded reference laboratory capacity for the Pikes Peak region. The Emergency Preparedness and Response team was able to hire one additional staff member in late 2019. This critical workforce position will allow for focus on El Paso County-specific planning, training and exercises. Funding source: Grants The Laboratory provides testing services for EPCPH’s programs and clinics. This public health laboratory performs drinking water potability testing for private well owners of El Paso County, as well as public water systems required to meet Colorado Primary Drinking Water Regulations. As a member of the Laboratory Response Network (LRN), the EPCPH lab works closely with the Colorado Department of Public Health and Environment Laboratory to incorporate procedures for the detection of potentially threatening microbiological agents. This Laboratory is inspected by CDPHE and is approved under the Clinical Laboratory Improvement Amendments. Funding source: Local per capita COVID-19 Response: The Emergency Preparedness and Response (EPR) program had a major role the response efforts in the COVID-19 pandemic. In late December 2019, Public Health began monitoring COVID-19. On February 14, 2020, Public Health activated Incident Command. By March 5, 2020, Public Health and the Pikes Peak Regional Office of Emergency Management initiated a Unified Command structure. Each step of the way, Public Health and partners have been proactive, taking swift action to keep our community and partners informed and take the necessary steps to protect the well-being of our community – balancing health and economic vitality. We have continued to expand and refine our testing strategy to increase access and reduce barriers to COVID-19 tests. The community-based drive through testing locations are a few of the ways Public Health continues to explore ways to expand testing to other parts of the county. El Paso County Public Health is committed to the following highest priority objectives:

1. To continuously improve case and contact tracing efforts using sampling and surveys 2. To maintain and expand capacity for COVID-19 testing across the county, focusing on shortening time for results 3. Plan and implement a robust vaccine distribution plan in a phased approach, prioritizing essential personnel and people at highest risk of life-threatening infection. 4. Continuing efforts to prevent and control COVID-19 in congregate settings. 5. Communicating with key stakeholders, elected officials, and the public in a timely transparent manner throughout the response. 6. Accurately collect, interpret and share data related to COVID in our community

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STAFFING

Department FTE additions totaled 22 (temporary FTEs): The changes are as follows:

• ELC Grant Funding to provide additional support for the COVID-19 pandemic added 12 temporary

FTEs

• Emergency Preparedness added 11 temporary FTEs to assist in the additional workload for the COVID-19

pandemic

• Workload adjustments made throughout the departments decreased FTE (1)

Department/Division/Office2018

Authorized 2018 Adj +/-2019

Authorized 2019 Adj +/-2020

Authorized 2020 Adj +/-2021

AuthorizedAdministration Director's Office 5.00 1.00 6.00 (1.00) 5.00 2.50 7.50 Development & Strategic Initiative 2.97 0.73 3.70 3.80 7.50 (3.60) 3.90 Healthy Places - - - - - - Southeast Colorado Springs Initiative 0.50 (0.25) 0.25 0.75 1.00 1.00 Colorado Opioid & Substance Use 0.03 (0.03) - - - - Vital Stats 5.00 - 5.00 (1.00) 4.00 4.00 Office of Communication 2.50 - 2.50 1.20 3.70 0.05 3.75 Operations 3.00 1.00 4.00 - 4.00 0.50 4.50 Health Services - - - - - - Immunizations 6.30 3.30 9.60 - 9.60 9.60 International Travel Clinic 2.70 (2.70) - - - - Health Services Division Administration 2.00 1.00 3.00 - 3.00 (1.00) 2.00 Co-Responder - - - - - - Nurse Family Partnership Program 10.00 - 10.00 - 10.00 10.00 Healthy Children & families 2.00 (1.00) 1.00 (1.00) - - WIC 36.80 2.70 39.50 (2.05) 37.45 0.05 37.50 WIC Breastfeeding peer Counseling 0.20 0.05 0.25 0.30 0.55 (0.05) 0.50 Southeast WIC Outreach 0.50 (0.50) - - - - Family Planning 6.00 0.40 6.40 1.00 7.40 7.40 Disease & Health Promotion - - - - - - Communicable Disease 5.30 0.30 5.60 (1.50) 4.10 1.00 5.10 Tuberculosis Program 3.40 1.00 4.40 (0.50) 3.90 (1.00) 2.90 Tobacco Education Prevention &Cessation 5.55 (0.20) 5.35 (0.20) 5.15 (0.35) 4.80 Establishing Peer Tobacco Cessation - 1.20 1.20 0.30 1.50 (0.10) 1.40 MCH - Child/Adolescent Program 2.70 - 2.70 1.00 3.70 (1.00) 2.70 HCP - Care Coordination 2.55 (0.25) 2.30 - 2.30 1.00 3.30 Foster Child Care Coordination 0.75 (0.75) - - - - DHP Administration 2.50 - 2.50 (0.50) 2.00 1.00 3.00 Youth Suicide Prevention 1.00 - 1.00 - 1.00 1.00 EPC Funds to Youth Suicide Prevention 1.00 - 1.00 - 1.00 1.00 Communities That Care 2.25 - 2.25 (0.10) 2.15 2.15 Environmental Health Services - - - - - - Child Care Inspections 25.50 2.00 27.50 0.50 28.00 28.00 Laboratory 5.00 - 5.00 (1.00) 4.00 4.00 Environmental Health Services - - - - - Office of Emergency Preparedness - - - - - - Emergency Preparedness 4.16 1.00 5.16 - 5.16 0.14 5.30 Emergency Response - - - - - - Cities Readiness Initiative 0.84 - 0.84 - 0.84 (0.14) 0.70 ELC Grant 12.00 12.00 Emergency Preparedness-CARES 11.00 11.00 TOTAL FTE's 148 10 158 0 158 22 180

FULL-TIME EQUIVALENT POSITIONS (FTE'S)

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II. ORIGINAL ADOPTED BUDGET SECTION

45

HISTORICAL BUDGET REVIEW

Total Revenue vs. Population Growth

State & Local Support Revenue vs. Population Growth

46

HISTORICAL BUDGET REVIEW

Number of Full-Time Equivalent Public Health Employees

Citizens Served Per Public Health Employee

47

HISTORICAL BUDGET REVIEW

Population Growth and Public Health Employees

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CURRENT FINANCIAL STATUS

Total Operational Reserves – Historical Change and Forecast

Operational Reserves 2019 Fund Balance Details

• Restricted TABOR Reserve $ 339,679 • Unassigned Fund Balance $4,445,520 • Unassigned as a percent of 2019 Collected Revenue 26%

The Fund Balance Policy minimum range is 18% to 21% of the Prior Year

Collected Revenue which is a fund balance of $3.1-3.6M

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PROJECTED FINANCIAL STATUS

2019 2020

Actual Budgeted Revenue

El Paso County 3,831,061$ 7,992,775$ State LPHA Funding 964,579$ 1,156,343$ Other Intergovernmental Revenue 25,000$ 25,000$ Federal Reimbursements/CARES -$ 4,400,000$ Revenues from Program Specific Grants 8,472,047$ 9,257,488$ Revenues from Licenses, Fees, and Permit 3,583,633$ 3,712,147$ Revenue from Interest Income 83,123$ 50,000$ Revenue from Miscellaneous 24,515$ 21,600$

Total Revenues 16,983,957$ 26,615,353$

ExpendituresPersonnel Expense 12,399,676$ 18,965,477$ Operating 4,748,073$ 6,797,410$ Capital Expense -$ 2,461,724$

Total Expenditures 17,147,749$ 28,224,611$

Net Change in Fund Balance (163,792)$ (1,609,258)$

Fund Balance - Beginning of Year 4,609,312$ 4,445,520$ Est Fund Balance - End of Year 4,445,520$ 2,836,263$

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CHANGES FROM PRELIMINARY TO ADOPTED BUDGET

Changes since the Preliminary Public Health Budget:

Revenue Estimates – No Change

• Board of County Commissioners approved salary allocation • Funded $201,374 additional County Core Support for a 2% salary, FICA and Retirement

allocation to Public Health

Expenditure Estimates – Increased $106,486

• Personnel Costs - $149,495 – based on allocation from Board of County Commissioners

• Operating – reduced by $43,008 due to decrease in facility common area maintenance costs

Planned Use of Fund Balance – No change

• Strategy remains to fund Critical Need positions above county support as phased in over next five years

• Total budgeted use of Fund Balance is $868,565

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2021 ORIGINAL ADOPTED BUDGET SUMMARY

2021Original Adopted

BudgetRevenue

El Paso County 4,444,149$ State LPHA Funding 960,796$ Other Intergovernmental Revenue 15,000$ Federal Reimbursements/CARES -$ Revenues from Program Specific Grants 12,024,775$ Revenues from Licenses, Fees, and Permits 3,379,744$ Revenue from Interest Income -$ Revenue from Miscellaneous 13,620$

Total Revenues 20,838,084$

ExpendituresPersonnel Expense 15,837,749$ Operating 5,868,900$ Capital Expense -$

Total Expenditures 21,706,648$

Net Change in Fund Balance (868,565)$

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BUDGETARY STRATEGIES -FIVE YEAR FINANCIAL ROAD MAP

Approved/proposed additional County core support

• Phasing in of Financial Roadmap funding - $1 Million phased in over a five-year time

period – 2019-2023 • $200,000 awarded in 2019 – on-going funding to phase in full implementation of support • No request for additional on-going funding in 2020 - preliminary budget included the 10

additional full-time employees and all supportive needs • $250,000 approved in 2021 El Paso County Adopted Budget for on-going funding • Also approved in 2021 - $201,374 on-going core funding for Investment in Human

Capital

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2021 ORIGINAL ADOPTED BUDGET REVENUES

54

2021 ORIGINAL ADOPTED BUDGET EXPENDITURES

55

RESOLUTION

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2019 2020 2021 2021 Changes sincere Actual

Estmated Budget

Preliminary Balanced Budget

Original Adopted Budget

Preliminary Balanced Budget

RevenueEl Paso County 3,831,061$ 7,992,775$ 4,444,149$ 4,444,149$ -$ State LPHA Funding 964,579$ 1,156,343$ 960,796$ 960,796$ -$ Other Intergovernmental Revenue 25,000$ 25,000$ 15,000$ 15,000$ -$ Federal Reimbursements/CARES -$ 4,400,000$ -$ -$ -$ Revenues from Program Specific Grants 8,472,047$ 9,257,488$ 12,024,775$ 12,024,775$ -$ Revenues from Licenses, Fees, and Permits 3,583,633$ 3,712,147$ 3,379,744$ 3,379,744$ -$ Revenue from Interest Income 83,123$ 50,000$ -$ -$ -$ Revenue from Miscellaneous 24,515$ 21,600$ 13,620$ 13,620$ -$

Total Revenues 16,983,957$ 26,615,353$ 20,838,084$ 20,838,084$ -$

ExpendituresPersonnel Expense 12,399,676$ 18,965,477$ 15,688,254$ 15,837,749$ 149,494$ Operating 4,748,073$ 6,797,410$ 5,911,908$ 5,868,900$ (43,008)$ Capital Expense -$ 2,461,724$ -$ -$ -$

Total Expenditures 17,147,749$ 28,224,611$ 21,600,162$ 21,706,648$ 106,486$

Net Change in Fund Balance (163,792)$ (1,609,258)$ (762,078)$ (868,565)$

Fund Balance - Beginning of Year 4,609,312$ 4,445,520$ 2,836,263$ 2,836,263$ Fund Balance - End of Year 4,445,520$ 2,836,263$ 2,074,184$ 1,967,698$

Attachment B

El Paso County Public Health2021 Original Adopted Budget Summary

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III. FINANCIAL SECTION

58

PUBLIC HEALTH DIRECTOR

Susan Wheelan, Public Health Director Public Health Leadership Team:

Susan Wheelan, Public Health Director

DeAnn Ryberg, Deputy Director, Disease Prevention & Health Promotion Division Director

Brenda Heimbach, Health Services Division Director

Kyle Unland, Community Health Promotion Division Director

Vacant, Environmental Health Services Division Director

Dr. Robin Johnson, Medical Director

Dr. Leon Kelly, Deputy Medical Director

Michelle Hewitt, Public Health Information Officer

Lisa Powell, Emergency Preparedness and Response Program Manager

Stephen Goodwin, Chief Data Scientific Strategist

Carolyn Gery, Development Officer

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EL PASO COUNTY PUBLIC HEALTH - FUND 95

EPC Public Health reporting consists of one single fund, Fund 95. Fund 95 is comprised of five divisions. Within each division are multiple related programs. The programs’ function determines which division it falls into. The Finance section provides a Division summary and Individual summaries of each of the programs that make up Fund 95. The programs within Fund 95 are funded by State, County, Federal funds, and related fees.

With a dedicated staff, each of these programs supports the foundation, strength, and growth of Public Health, while also reaching out to support the public and individuals who are experiencing trying times or need assistance.

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Fund 95 fund balance is anticipated to decrease by approximately -31%. This is due to spending into fund balance in 2021 of approximately $868,565 for additional expenditures related to COVID-19 response.

Revenues by Division 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Administration Division 3,308,450 3,712,446 3,654,525 7,754,750 3,455,163

Health Services Division 6,505,371 6,680,563 6,944,798 6,944,798 6,837,710

Health Promotion Division 3,111,131 3,010,875 3,126,317 3,026,092 3,014,270

Environmental Health Division 2,736,061 2,788,042 2,933,695 2,933,695 2,917,695

Office of Emergency Preparedness 700,815 792,032 903,048 5,956,018 4,613,246

Total Revenues 16,361,828$ 16,983,957$ 17,562,383$ 26,615,353$ 20,838,084$

Personnel by Division 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Administration Division 1,486,717 1,471,500 1,046,051 1,046,051 517,969

Health Services Division 5,157,812 5,509,873 6,322,079 6,322,079 6,241,889

Health Promotion Division 2,318,697 2,361,011 2,829,451 2,829,451 3,027,228

Environmental Health Division 2,368,101 2,441,310 2,750,417 2,750,417 2,811,839

Office of Emergency Preparedness 516,944 615,982 753,935 6,017,479 3,238,824 Total Personnel 11,848,270$ 12,399,676$ 13,701,933$ 18,965,477$ 15,837,749$

Operating by Division 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Administration Division 2,165,694 2,656,034 3,004,552 3,004,552 2,499,814

Health Services Division 1,382,899 1,104,363 884,582 884,582 952,376

Health Promotion Division 564,213 403,255 432,923 432,923 368,494

Environmental Health Division 520,884 416,673 417,088 417,088 433,638

Office of Emergency Preparedness 142,978 167,748 230,563 2,058,265 1,614,578 Total Operating 4,776,668$ 4,748,073$ 4,969,708$ 6,797,410$ 5,868,900$

Capital by Division 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OABAdministration Division 214,817 - - - -

Health Services Division - - - - -

Health Promotion Division - - - - -

Environmental Health Division - - - - -

Office of Emergency Preparedness - - - 2,461,724 -

Total Capital 214,817$ -$ -$ 2,461,724$ -$ Total Expenditures 16,839,756$ 17,147,749$ 18,671,641$ 28,224,611$ 21,706,649$

Change in Fund Balance (477,928)$ (163,792)$ (1,109,258)$ (1,609,258)$ (868,565)$

Fund Balance - Beginning of Year 5,087,240$ 4,609,312$ 4,445,520$ 4,445,520$ 2,836,262$

Fund Balance - End of Year 4,609,312$ 4,445,520$ 3,336,262$ 2,836,262$ 1,967,697$

CAPITAL BY DIVISION

BUDGET SUMMARY

FUND 95 DIVISION SUMMARY

REVENUES BY DIVISION

PERSONNEL BY DIVISION

OPERATING BY DIVISION

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BUDGET SUMMARY BY PROGRAM

Program Number Department/Division/Office Revenue Expenditures Administration

5310001 Director's Office 1,392,041 930,299 5310006 Development & Strategic Initiative 600,000 447,041 5310007 Healthy Places - - 5310009 Southeast Colorado Springs Initiative 62,000 61,354 5310012 Colorado Opioid & Substance Use - - 5322018 Vital Stats 851,694 834,200 5364086 Office of Communication 270,000 403,018 5364087 Operations 279,428 341,871

Total 3,455,163 3,017,783 Health Services

5321008 Immunizations 965,347 1,025,441 5321010 International Travel Clinic - - 5330022 Health Services Division Administration 288,372 268,192 5330023 Co-Responder - - 5332028 Nurse Family Partnership Program 1,292,005 1,295,111 5333030 Healthy Children & families - - 5334032 WIC 3,439,615 3,695,694 5334033 WIC Breastfeeding peer Counseling 129,515 131,576 5335034 Southeast WIC Outreach - - 5336035 Family Planning 722,856 778,251

Total 6,837,710 7,194,265 Disease & Health Promotion

5321005 Communicable Disease 408,000 454,027 5321007 Tuberculosis Program 338,075 277,729 5324024 Tobacco Education Prevention &Cessation 739,084 717,939 5324125 Establishing Peer Tobacco Cessation 196,956 192,904 5331029 MCH - Child/Adolescent Program 283,420 342,840 5331030 HCP - Care Coordination 425,852 411,741 5331031 Foster Child Care Coordination - - 5342051 DHP Administration 150,000 482,986 5343052 Youth Suicide Prevention 92,461 131,723 5343154 EPC Funds to Youth Suicide Prevention 91,660 92,598 5344053 Communities That Care 288,762 291,235

Total 3,014,270 3,395,722 Environmental Health Services

5326020 Laboratory 459,900 467,864 5351073 Environmental Health Services 2,457,795 2,777,613

Total 2,917,695 3,245,477 Office of Emergency Preparedness

5366091 Emergency Preparedness 1,359,902 1,275,413 5366098 Emergency Response 35,000 - 5366100 Cities Readiness Initiative 117,915 106,197 5366097 ELC Grant 3,100,429 2,249,988 5366099 Emergency Preparedness-CARES - 1,221,804 5366101 Building Expenses-EPCPH South - -

Total 4,613,246 4,853,402

Fund 95 Total 20,838,084 21,706,649

2021 Division Budget Summary by Program

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ADMINISTRATION

PURPOSE STATEMENT Provide cross-agency leadership and internal support to all staff and programs of El Paso County Public Health, and provide external communication, support and services to El Paso County residents, community partners and stakeholders.

OVERVIEW El Paso County Public Health’s Administration Division consists of multiple offices that provide support of day to day administrative and operational functions to all staff. Cross-agency leadership is provided by the Director and Deputy Director. This division also provides internal and external communication; seeks funding and coordinates all grants and contracts; monitors and analyzes local health data while developing and implementing effective policies and strategies to address issues in partnership with community stakeholders; and issues birth and death records for Colorado residents.

PROGRAMS Administration

Operations Office of Communication

Development Office Vital Records

OBJECTIVES

• Provide leadership and administrative support to all staff, including workforce development • Provide administrative support for the El Paso County Board of Health • Ensure continuity of day to day administrative business and adherence to and enforcement of

agency and County policies and procedures • Support operational aspects of the agency • Serve as liaison between staff and El Paso County IT, HR, Finance, Procurement and Facilities

63

• Seek new funding sources and apply for grants and other funding opportunities • Coordinate and monitor grants, contracts and other business agreements • Serve as an in-house marketing, public relations and advertising department for all programs • Provide accurate, timely and credible information to the public, community partners stakeholders,

staff and other relevant parties on a wide array of public health issues • Collect and analyze local health data • Monitor the status of current and emergent health-related issues and develop and implement

effective policies and strategies to address these issues in partnership with community stakeholders

• Issue birth and death records for all vital events occurring in Colorado

COVID-19 Response Objectives • Provide leadership to El Paso County in relation to the COVID-19 response and recovery efforts • Coordinate the hiring of additional staff and contractors to assist with the COVID-19 response • Activate current staff in Incident Command System/Emergency Coordination Center roles to

assist with the COVID-19 response • Provide logistical support in transition staff from working in-office to teleworking • Lead the Joint Information Center efforts to ensure accurate and timely dissemination of

information regarding COVID-19 • Coordinate the purchase and logistics of a COVID-19 response building in an area of the County

with high need for public health and COVID-19 response services

PERFORMANCE MEASURES AND OPERATING INDICATORS COVID-19 greatly impacted the Administration Division’s performance measures for 2020, as indicated after each objective below. As will be common with all divisions, priorities had to shift to focus on the COVID-19 response and recovery efforts. As we know the efforts will need to continue into 2021, we are not focusing on setting new performance measures at this time.

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.1: Provide trainings that develop and strengthen public health core competencies

Strategy Objective Department Measure 2021

Target

Increase public health visibility with external partners through the provision of informational presentations and

growth of internship program

Admin - Leadership team

By December 31, 2020, EPCPH will identify 4 strategic partners to receive

education about public health and increase the knowledge and value placed on public health

involvement with external collaborations

EPCPH will pursue non-traditional partnerships and

collaborations.

Update: EPCPH has provided numerous presentations to community leaders and groups around the COVID response. Unfortunately, we have had to pause our internship program as we do not have capacity to onboard, train or supervise them.

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.2: Develop career pathways for existing staff to move into leadership position1

Strategy Objective Department Measure 2021

Target

64

Utilize community resources (e.g. Pikes Peak Community

College) to develop and build leadership skills among staff

Admin-Admin

Leads are provided continuous education

related to leadership as a method of succession planning

LT will work with the workforce development

committee to identify at least 2 leadership develop

trainings for EPCPH team leads

Update: Planned trainings at EPCPH were unfortunately not executed in 2020. However, there were multiple staff who were placed in supervisory COVID-19 response roles who were not former supervisors. EPCPH did work with El Paso County HR to implement a

mini-leadership series through Employer’s Council to provide them with some training and support for their new roles.

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.3: Improve organizational capacity to support our workforce

Strategy Objective Department Measure 2021

Target Develop a workforce development committee that seeks

out and promotes free and low-cost training and educational opportunities and

promotes awareness of these opportunities to staff.

Admin-Admin By December 31, 2020, EPCPH will establish

a workforce development committee

EPCPH will track number of staff participating in

professional development

This goal was not met as most workforce development opportunities for staff, including formation of the committee, were put on hold due to the COVID response. However, EPCPH recognizes the need for workforce development and employee support, especially with the rapid transition from

working in-office to teleworking and associated culture shift, and is actively hiring for a Workforce Development Specialist. GOAL 2- Technology, informatics, data analysis - Strengthen EPCPH's capabilities to collect, analyze, share, and use data to make timely and information-driven

Strategy 2.2: Improve internal capabilities to collect and provide data for community health assessments

Strategy Objective Department Measure 2021

Target

Decrease the burden on staff to provide Department level reporting data and information, while increasing the Departments ability to provide key

data and information that supports core services and operations.

Admin - Development and

Strategic Initiatives

By December 31, 2020, DSIO in collaboration with county IT will have at least two EPCPH systems that

are interoperable for data reporting purposes

By December 31, 2020, the data office will pull data and generate a progress report for at least two

data systems. Update: The Office of Public Health Data and Analytics was formally established, and while this specific goal was not met, the Office has been vital in analyzing

and providing data related to COVID cases and trends.

GOAL 2- Technology, informatics, data analysis - Strengthen EPCPH's capabilities to collect, analyze, share, and use data to make timely and information-driven Strategy 2.4: Regularly disseminate important and emerging health information to community partners

Strategy Objective Department Measure 2021

Target

Connecting regularly with board of Health and increasing awareness and proactive messaging around timely and emerging

Public Health issues

Admin-Admin

Content and Quality of Board of Health reports provide meaningful and timely information to

Board of Health members.

By December 31, 2020, Admin will conduct an assessment of

the content and quality of Board of Health Reports and provide

recommendations for improvement.

Through intentionality around legislative engagement, EPCPH will develop meaningful data informed communications with key

partners that represents the public health community voice.

Admin-Admin

By June 30, 2020, EPCPH will have engaged in the 2020 legislative process as it relates to Public

Health involved bills.

EPCPH will track public health related bills during and outside

of legislative sessions.

Update: These goals were not met; however, the strategy objectives were still achieved in relation to the COVID response.

GOAL 3A - Communication - Strengthen EPCPH's capabilities to provide information on public health issues and public health functions to external partners Strategy 3A.1: Provide opportunities for media relations training, maintain relationships with media partners, and seek new partnerships with diverse

media outlets

Strategy Objective Department Measure 2021

Target

Improve EPCPH's capabilities to respond to media inquiries.

Admin - Communications

- # of people who provide media interviews -# of staff that go through media training At least 30 staff complete media

training.

GOAL 3A - Communication - Strengthen EPCPH's capabilities to provide information on public health issues and public health functions to external Strategy 3A.2: Increase use of digital media to promote public health messages and enhance health marketing materials

2021

65

Strategy Objective Department Measure Target

Improve website accessibility and compliance with ADA standards.

Admin - Communications year-over-year 508 compliance

improvement

Increased accessibility score by 10% in 2020

Increase video content in health marketing and social media content

Admin - Communications

Increase the number of people who engage with

video content as compared to static content.

Increased number of EPCPH video posts

GOAL 3A - Communication - Strengthen EPCPH's capabilities to provide information on public health issues and public health functions to external Strategy 3A.4: Identify opportunities to promote key agency accomplishments within the community

Strategy Objective Department Measure 2021

Target

EPCPH will submit for a County Innovation Award annually

Admin-Admin

The quality improvement team will document QI activities and accomplishment systematically

throughout the year

At minimum these accomplishments will be highlighted during public health week.

By December 31, 2020 the Employee Recognition Committee

will identify at least three opportunities to highlight

accomplishments

GOAL 3B - Communication - Strengthen EPCPH's internal communication capabilities Strategy 3B.1: Provide opportunities for media relations training, maintain relationships with media partners, and seek new partnerships with diverse media outlets

Strategy Objective Department Measure 2021 Target

Develop stronger proactive relationships with media to facilitate coverage of Public Health topics and achievements

Admin - Communications

Increase number of media strategy meetings

Conduct at least 6 media strategy meetings with relevant media

sources.

GOAL 3B - Communication - Strengthen EPCPH's internal communication capabilities□ Strategy 3B.2: Increase knowledge and understanding of EPCPH's brand guidelines to raise brand awareness of public health in the community

Strategy Objective Department Measure 2021 Target

Increase the internal EPCPH, knowledge, related to the utilization of EPCPH brand

Admin - Communications

All communications are appropriately branded according to guidelines

100%

GOAL 3B - Communication - Strengthen EPCPH's internal communication capabilities□ Strategy 3B.3: Increase staff use and awareness of internal staff website for information sharing, operational updates, staff accomplishments, and awareness of agency

Strategy Objective Department Measure 2021 Target

Increase utilization of Intranet Admin - Communications

Number of times that the intranet is locked out Reduced number of times that the intranet is locked out

GOAL 4 - Community Partnerships: Develop and maintain strong relationships with key community partners to support public health or assure the provision of

Strategy 4C: Expand participation from non-traditional partners on EPCPH-led coalitions, collaborations, or committees to create bi-directional relationships.

Strategy Objective Department Measure 2021

Target

Develop a Behavioral Health Strategic Plan for EPCPH

Admin - DSIO

Development of a Behavioral Health Strategic Plan and identification of funding source(s) to

execute plan

By December 31, 2020 the DSIO office has developed comprehensive Behavioral Health Strategic plan that

includes a BH continuum of care.

Update: This goal was achieved with the help of a consulting agency, Health Management Associates. HMA also helped us draft a Behavioral Health Disaster Plan specifically related to COVID response and recovery efforts in the County.

GOAL 5A- Funding for agency and community partners: Increase funding for EPCPH from diverse sources to support core public health services, programmatic

Strategy 5A.2: Build relationships with state agencies that provide funding for public health activities and funding

Strategy Objective Department Measure 2021

Target

66

Increase CDPHE grants to EPCPH that support programs and services

Admin - Development and

Strategic Initiatives

Increase the number of state funded grants

EPCPH submits applications

Grow state funding by

$150,000 by December 31, 2020.

Update: We received COVID-related funding from CDPHE through a CARES grant and an Epidemiology and Laboratory Capacity grant. However, these are term limited and EPCPH will continue to advocate for additional funding from CDPHE.

GOAL 5A- Funding for agency and community partners: Increase funding for EPCPH from diverse sources to support core public health services, programmatic

Strategy 5A.4: Build relationships with key foundations partners, academic institutions and business leaders to support public health activities and funding

Strategy Objective Department Measure 2021

Target

Increase federal and foundation grant funding to EPCPH that supports programs and services

Admin - Development and

Strategic Initiatives

Increase the number of federal or foundation

grant applications submitted by EPCPH

Grow funding by $150,000 by

December 31, 2020.

Update: EPCPH did not receive any additional federal or foundational funding in 2020 that was unrelated to the COVID response. A new Development Officer was hired late 2020 and will focus on these efforts going forward.

GOAL 6A - CHIP 2018-2022: Decrease incidence of poor mental health and substance use and misuse Strategy 6A.2: Increase evidence-based mental health school programs

Strategy Objective Department Measure 2021

Target

Develop a Strategic Plan for addressing behavioral health in El Paso County

Admin -

Development and Strategic Initiatives

By June 30, 2020, the Development and

Strategic Initiatives Office will have developed a strategic plan for addressing behavioral health

services in El Paso County.

By December 31, 2020 EL Paso County will have established a

proof of concept for a continuum of care for justice involved

individuals entering and leaving the county jail.

GOAL 7A - Health Equity: Increase public awareness of health equity issues, its systemic causes, and opportunities to foster health equity Strategy 7A.1: Increase community awareness of root causes of health equity and evidence-based solutions that address health equity

Strategy Objective Department Measure 2021

Target

Provide health equity training to all EPCPH staff annually and include a health equity 101 training in orientation process for new

staff.

Admin - Development and

Strategic Initiatives

EPCPH staff receive training on health equity at

least annually.

By June 30, 2020, DSIO has developed or found a healthy

equity training for staff.

Update: This goal was not met due to the COVID response. However, once EPCPH hires its Workforce Development Specialist, this will be one of their duties.

2018 Actual

2019 Actual

2020 Estimated

2020 Actuals as of 12.04.2020 2021 Estimated

Vital Records-Birth Certificates issued 21,783 21,592 21,691 17,043 17,384Vital Records- Death Certificates issued 35,975 36,664 36,268 37,325 38,086Number of Facility Work Requests 176 223 288 60 150

Operating Indicators

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 1,758,405 2,000,277 1,666,870 5,767,095 2,218,469

State LPHA Funding 477,063 397,167 518,547 518,547 323,000

Licenses, Fees and Permits 860,097 879,095 855,613 855,613 846,193

Program Specific Grants 146,334 342,948 558,395 558,395 67,381

Interest Income 62,277 83,123 50,000 50,000 -

Other Misc 4,274 9,836 5,100 5,100 120

Total Revenues 3,308,450$ 3,712,446$ 3,654,525$ 7,754,750$ 3,455,163$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,207,013 1,357,439 1,726,444 1,726,444 1,659,353

Personnel Benefits 689,938 792,692 689,875 689,875 655,013

Personnel Reimbursement Indirect (1,245,235) (1,353,428) (2,103,047) (2,103,047) (2,553,067)

CIPS - EBMS 83,483 100,733 102,243 102,243 104,328

CIPS - Budget/AFS 398,390 400,153 436,450 436,450 451,726

CIPS - Health Department 353,129 173,912 194,086 194,086 200,616

Operating 2,655,543 3,031,288 3,371,478 3,371,478 3,272,253

Operating Reimbursment Indirect (489,849) (375,254) (366,926) (366,926) (772,438)

Capital Outlay 214,817 - - - - Total Expenditures 3,867,229$ 4,127,534$ 4,050,603$ 4,050,603$ 3,017,783$

2018 2019 2020 2020 Revised 2021

Total FTE Count 21 21 25 (0.35) 24.65TOTAL FTEs 21 21 25 (0.35) 24.65

BUDGET SUMMARY

ADMINISTRATION DIVISION SUMMARY

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

68

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 1,277,200 1,200,177 617,442 4,717,667 1,169,041

State LPHA Funding 410,232 327,099 223,000 223,000 223,000

Program Specific Grants - - - - -

Interest Income 62,277 83,123 50,000 50,000 -

Other Misc 4,272 3,998 5,000 5,000 -

Total Revenues 1,753,981$ 1,614,397$ 895,442$ 4,995,667$ 1,392,041$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 349,166 411,580 502,898 502,898 637,137

Personnel Benefits 338,665 410,436 163,872 163,872 222,091

Personnel Reimbursement Indirect (1,032,302) (1,353,428) (2,103,047) (2,103,047) (2,553,067)

CIPS - EBMS 83,483 100,733 102,243 102,243 104,328

CIPS - Budget/AFS 398,390 400,153 436,450 436,450 451,726

Operating 2,066,529 2,356,713 2,260,677 2,260,677 2,840,514

Operating Reimbursment Indirect (400,582) (375,254) (366,926) (366,926) (772,437)

Capital Outlay 214,817 - - - - Total Expenditures 2,018,165$ 1,950,933$ 996,167$ 996,167$ 930,292$

2018 2019 2020 2020 Revised 2021

Total FTE Count 5 6 5 2.50 7.50TOTAL FTEs 5 6 5 2.50 7.50

BUDGET SUMMARY

DIRECTOR'S OFFICE

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

69

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 223,078 300,000 500,000 500,000 500,000

State LPHA Funding 66,830 60,000 100,000 100,000 100,000

Program Specific Grants 61,795 67,872 10,000 10,000 -

Total Revenues 351,703$ 432,872$ 610,000$ 610,000$ 600,000$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 262,260 284,053 555,884 555,884 275,897

Personnel Benefits 103,393 110,351 212,402 212,402 106,173

Personnel Reimbursement Indirect (12,319) - - - -

Operating 107,498 86,921 61,360 61,360 64,971

Operating Reimbursment Indirect (4,738) - - - - Total Expenditures 456,093$ 481,325$ 829,646$ 829,646$ 447,041$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 4 8 (4.1) 3.9TOTAL FTEs 3 4 8 (4.1) 3.9

BUDGET SUMMARY

DEVELOPMENT & STRATEGIC INITIATIVE

FTE INFORMATION

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

70

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants - 207,534 452,575 452,575 -

Total Revenues -$ 207,534$ 452,575$ 452,575$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Operating - 207,534 452,575 452,575 - Total Expenditures -$ 207,534$ 452,575$ 452,575$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count - - - - - TOTAL FTEs - - - - -

BUDGET SUMMARY

HEALTHY PLACES

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

EXPENDITURES

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants 47,603 60,862 90,000 90,000 62,000

Total Revenues 47,603$ 60,862$ 90,000$ 90,000$ 62,000$

Expenditures by Category 2017 Actual 2018 Actual 2019 OAB 2019 Revised 2020 OAB

Personnel 20,466 29,922 39,940 39,940 39,230

Personnel Benefits 10,090 15,239 22,567 22,567 21,927

Operating 19,852 15,701 8,183 8,183 197 Total Expenditures 50,408$ 60,862$ 70,690$ 70,690$ 61,354$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 1 1 1 TOTAL FTEs 1 1 1 - 1

BUDGET SUMMARY

SOUTHEAST COLORADO SPRINGS INITIATIVE

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

71

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

State LPHA Funding - 10,068 195,547 195,547 -

Program Specific Grants 31,395 - - - -

Total Revenues 31,395$ 10,068$ 195,547$ 195,547$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,680 - - - -

Personnel Benefits 1,454 - - - -

CIPS - Health Department 5,803 - - - -

Operating 11,479 5,020 195,547 195,547 - Total Expenditures 20,416$ 5,020$ 195,547$ 195,547$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count - - - - - TOTAL FTEs - - - - -

BUDGET SUMMARY

COLORADO OPIOID & SUBSTANCE USE

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

72

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Licenses, Fees and Permits 860,097 879,095 855,613 855,613 846,194

Program Specific Grants 5,540 6,680 5,820 5,820 5,380

Other Misc 2 1 100 100 120

Total Revenues 865,639$ 885,776$ 861,533$ 861,533$ 851,694$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 225,673 196,005 204,532 204,532 199,174

Personnel Benefits 100,306 96,922 97,803 97,803 94,809

CIPS - Health Department 347,326 173,912 194,086 194,086 200,616

Operating 408,241 337,087 367,468 367,468 339,601 Total Expenditures 1,081,545$ 803,925$ 863,889$ 863,889$ 834,200$

2018 2019 2020 2020 Revised 2021

Total FTE Count 5 5 5 (1) 4 TOTAL FTEs 5 5 5 (1) 4

BUDGET SUMMARY

VITAL STATS

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

73

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 90,343 250,100 270,000 270,000 270,000 Total Revenues 90,343$ 250,100$ 270,000$ 270,000$ 270,000$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 166,912 170,593 239,521 239,521 283,032

Personnel Benefits 60,997 70,468 98,941 98,941 103,209

Personnel Reimbursement Indirect (129,671) - - - -

Operating 24,941 12,219 15,480 15,480 16,777

Operating Reimbursment Indirect (57,242) - - - - Total Expenditures 65,937$ 253,280$ 353,942$ 353,942$ 403,018$

2018 2019 2020 2020 Revised 2021

Total FTE Count - Fleet 3 3 4 (0.3) 3.7Total FTE Count 3 3 4 (0.3) 3.7

BUDGET SUMMARY

OFFICE OF COMMUNICATION

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

EXPENDITURES

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 167,784 250,000 279,428 279,428 279,428

Total Revenues 167,784$ 250,838$ 279,428$ 279,428$ 279,428$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 164,758 175,623 183,669 183,669 224,883

Personnel Benefits 75,033 89,275 94,290 94,290 106,799

Personnel Reimbursement Indirect (70,943) - - - -

Operating 17,004 10,092 10,188 10,188 10,189

Operating Reimbursment Indirect (27,286) - - - - Total Expenditures 158,566$ 274,991$ 288,147$ 288,147$ 341,871$

2018 2019 2020 2020 Revised 2021

Total FTE Count - Fleet 3 4 4 0.50 4.50Total FTE Count 3 4 4 0.50 4.50

EXPENDITURES

BUDGET SUMMARY

OPERATIONS

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

74

HEALTH SERVICES

PURPOSE STATEMENT Provide laboratory and clinical services to vulnerable and high-risk populations to prevent diseases in varied age and population groups.

OVERVIEW The Health Services Division provides direct clinical services and evidence-based programs that give individuals and families the resources and skills to live the healthiest lives possible. Health services programs primarily serve low-income, uninsured and underinsured populations. Programs include WIC (Women, Infants and Children), Nurse-Family Partnership (NFP), Immunizations, and preventative services such as cervical, breast, and reproductive screenings.

PROGRAMS Immunizations

Women, Infants and Children Nurse-Family Partnership

Family Planning

OBJECTIVES ● Provide vaccines to both insured and uninsured members of the community (children and adults) ● Support school immunization audits and help health care providers maintain proper immunization

practices ● Provide counseling, education and vaccinations for international travelers who require

immunizations prior to departing on business, recreation or mission trips ● Provide supplemental food benefits as well as child development and nutrition education to

qualifying women and their children

75

● Provide breastfeeding counseling and lactation support to pregnant and postpartum women ● Provide in-home nurse visits to help improve the health, well-being and self-sufficiency of low-

income, first-time parents and their children ● Improve pregnancy outcomes by helping women engage in good preventive health practices,

including consistent access to prenatal care, improved diet, and decreased use or elimination of cigarettes, alcohol and illegal substances

● Provide parents with the tools and resources to support their children’s health and development ● Provide reproductive health services to women and men, including evidence-based interventions ● Report sexually transmitted infections (STIs) to the Colorado Department of Public Health and

Environment ● Refer clients needing more specialized services (e.g., pregnant women, individuals with HIV) to

community providers

PERFORMANCE MEASURES AND OPERATING INDICATORS COVID-19 greatly impacted the Health Services Division’s performance measures for 2020. As will be common with all divisions, priorities had to shift to focus on the COVID-19 response and recovery efforts. As we know the efforts will need to continue into 2021, we are not focusing on setting new performance measures at this time.

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.4: Provide technology tools and trainings to improve skills and create organizational efficiencies

Strategy Objective Department Measure 2021

Target Establish policies and procedures that maximize time and efficiency to enable NFP to fulfill its commitment to focus on clients during their home visits.

Health Services - NFP

Reduced charting time during home visits.

Reduced charting time during home visits.

GOAL 5A- Funding for agency and community partners: Increase funding for EPCPH from diverse sources to support core public health services, Strategy 5A.1: Increase EPCPH's ability to bill insurances for direct services

Strategy Objective Department Measure 2021

Target To provide exemplary reproductive health services to all members of the community by providing high quality, efficient, confidential services and flexible scheduling to meet or exceed the state specified qualifying visit goal on an annual basis.

Health Services - Family Planning

Qualifying Visits Completed

Year-over-year improvement in state

specified qualifying visit goals

Increase the redemption rates of 5 WIC-allowable food categories (legumes, fish, whole grains, breakfast cereal and yogurt) purchased by El Paso County WIC participants utilizing the October 2019 Percent of Food Redeemed report by 2% by September 30, 2020.

Health Services - Women, Infant and

Children

Increase the redemption rates of 5 WIC allowable

food categories

2% increase

76

OPERATING INDICATORS 2017 Actual 2018 Actual 2019 Actual 2020 Actual 2021 Estimated

Average Women, Infants, and Children (WIC) Monthly Caseload 13,285 13,476 12,790 12,731 13,000

WIC Clients Served 23,250 25,000 25,000 24,247 25,000

WIC Food Vouchers Used in the Community $8,354,145 $8,407,508 $7,907,715 $6,745,643 $8,000,000

STD Tests Performed 5,703 4,658 4,693 1,217 1,500

Immunizations Provided 11,641 8,961 12,115 2,374 4,000

Number of Reproductive Health Clinic Visits 3,005 2,283 2,915 1,011 1,200

Nurse-Family Partnership (NFP) Home Visits 2,502 2,683 3,000 3,292 2,500

Contraceptive Implant (non IUD)(insertion and/or removal) - estimation 45 76 140 59 65

Cryosurgery (external genitalia) - estimation 52 60 30 11 15

Depo-Provera Injection - estimation 740 700 600 116 130

IUD (insertion and/or removal) - estimation 125 145 75 44 47 PAP Smears - estimation 650 600 175 58 65

Number of PHQ-2s (depression/frequency screens) performed by WIC unknown 1,745 2,487 N/A N/A

Total clients referred from WIC based on PHQ-2s unknown 94 125 N/A N/A Number of PHQ-9s (multi-dimensional depression screens) performed by NFP 293 263 249 323 300 Number of clients referred from NPF based on PHQ-9s 423 745 546 92 90

77

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 139,348 358,969 481,872 481,872 481,872

State LPHA Funding 122,505 205,411 300,000 300,000 300,000

Licenses, Fees and Permits 657,713 763,066 864,984 864,984 537,000

Program Specific Grants 5,571,746 5,344,932 5,282,942 5,282,942 5,506,839

Contributions & Donations 12,979 6,183 15,000 15,000 12,000

Other Misc 1,080 2,003 - - -

Total Revenues 6,505,371$ 6,680,563$ 6,944,798$ 6,944,798$ 6,837,711$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 3,272,072 3,295,826 3,465,995 3,465,995 3,509,207

Personnel Benefits 1,381,871 1,537,255 1,642,429 1,642,429 1,602,259

Personnel Reimbursement Indirect (208,198) - - - -

CIPS - EBMS - - - - -

CIPS - Budget/AFS - - - - -

CIPS - Health Department 712,067 676,791 1,213,655 1,213,655 1,130,423

Operating 1,413,277 1,104,363 884,582 884,582 952,378

Operating Reimbursment Indirect (30,378) - - - -

Capital Outlay - - - - - Total Expenditures 6,540,711$ 6,614,236$ 7,206,661$ 7,206,661$ 7,194,267$

2018 2019 2020 2020 Revised 2021

Total FTE Count 67 70 70 (3) 67 TOTAL FTEs 67 70 70 (3) 67

BUDGET SUMMARY

HEALTH SERVICES DIVISION SUMMARY

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

78

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

State LPHA Funding 7,092 - - - -

Licenses, Fees and Permits 64,773 555,442 625,000 625,000 298,000

Program Specific Grants 423,186 429,741 397,102 397,102 667,347

Total Revenues 495,051$ 985,183$ 1,022,102$ 1,022,102$ 965,347$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 289,833 454,186 493,622 493,622 483,704

Personnel Benefits 126,694 219,053 235,189 235,189 228,500

Operating 97,463 353,955 400,927 400,927 313,237 Total Expenditures 513,991$ 1,027,194$ 1,129,738$ 1,129,738$ 1,025,441$

2018 2019 2020 2020 Revised 2021

Total FTE Count 6 10 10 (0.4) 9.6TOTAL FTEs 6 10 10 (0.4) 9.6

EXPENDITURES

BUDGET SUMMARY

IMMUNIZATIONS

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

79

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 22,031 - - - -

Licenses, Fees and Permits 430,298 - - - -

Other Misc 1,080 - - - -

Total Revenues 453,409$ -$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 84,584 - - - -

Personnel Benefits 37,485 - - - -

Operating 212,362 15 - - - Total Expenditures 334,430$ 15$ -$ -$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 - - - - TOTAL FTEs 3 - - - -

EXPENDITURES

BUDGET SUMMARY

INTERNATIONAL TRAVEL CLINIC

REVENUES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

80

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 3,473 216,370 288,372 288,372 288,372

Total Revenues 3,473$ 216,370$ 288,372$ 288,372$ 288,372$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 151,671 165,015 202,489 202,489 198,323

Personnel Benefits 51,155 63,195 81,616 81,616 64,004

Personnel Reimbursement Indirect (208,198) - - - -

Operating 25,035 11,073 8,365 8,365 5,865

Operating Reimbursment Indirect (30,378) - - - - Total Expenditures (10,714)$ 239,283$ 292,470$ 292,470$ 268,192$

2018 2019 2020 2020 Revised 2021

Total FTE Count 2 3 3 3 TOTAL FTEs 2 3 3 - 3

EXPENDITURES

BUDGET SUMMARY

HEALTH SERVICES DIVISON ADMINISTRATION

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

81

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants 116,317 - - - -

Total Revenues 116,317$ -$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 6,982 - - - -

Personnel Benefits 2,356 - - - -

Operating 105,703 - - - - Total Expenditures 115,041$ -$ -$ -$ -$

2018 2029 2020 2020 Revised 2021

Total FTE Count - - - - - TOTAL FTEs - - - - -

EXPENDITURES

BUDGET SUMMARY

CO-RESPONDER

REVENUES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

82

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Licenses, Fees and Permits 2,676 4,465 4,984 4,984 4,000

Program Specific Grants 1,123,059 1,127,072 1,250,490 1,250,490 1,288,005

Other Misc - 300 - - -

Total Revenues 1,125,736$ 1,131,838$ 1,255,474$ 1,255,474$ 1,292,005$

Expenditures by Category 2018 Actual 2019Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 540,629 547,376 659,899 659,899 646,137

Personnel Benefits 210,769 231,662 269,519 269,519 261,936

CIPS - Health Department 193,744 172,918 199,400 199,400 210,007

Operating 178,211 175,137 140,914 140,914 177,031 Total Expenditures 1,123,353$ 1,127,092$ 1,269,732$ 1,269,732$ 1,295,111$

2018 2019 2020 2020 Revised 2021

Total FTE Count 10 10 10 10 TOTAL FTEs 10 10 10 - 10

EXPENDITURES

BUDGET SUMMARY

NURSE FAMILY PARTNERSHIP PROGRAM

REVENUES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

83

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants 193,510 45,310 - - -

Total Revenues 193,510$ 45,310$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 115,763 27,445 - - -

Personnel Benefits 43,619 13,313 - - -

CIPS - Health Department 12,716 3,226 - - -

Operating 21,475 3,883 - - - Total Expenditures 193,573$ 47,867$ -$ -$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count 2 1 - - - TOTAL FTEs 2 1 - - -

EXPENDITURES

BUDGET SUMMARY

HEALTHY CHILDREN & FAMILIES

REVENUES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

84

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

State LPHA Funding 66,205 160,000 300,000 300,000 300,000

Program Specific Grants 3,290,662 3,081,114 3,212,805 3,212,805 3,139,615

Total Revenues 3,356,867$ 3,242,814$ 3,512,805$ 3,512,805$ 3,439,615$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,680,507 1,607,540 1,605,364 1,605,364 1,644,418

Personnel Benefits 765,355 835,153 858,007 858,007 847,331

CIPS - Health Department 496,579 482,564 981,900 981,900 888,773

Operating 495,667 348,674 172,338 172,338 315,172 Total Expenditures 3,438,108$ 3,273,932$ 3,617,609$ 3,617,609$ 3,695,694$

2018 2019 2020 2020 Revised 2021

Total FTE Count 37 40 37 0.45 37.45TOTAL FTEs 37 40 37 0.45 37.45

BUDGET SUMMARY

WIC

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

85

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 18,500 18,500 18,500

Program Specific Grants 59,249 113,460 96,015 96,015 111,015

Total Revenues 59,249$ 113,460$ 114,515$ 114,515$ 129,515$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 36,167 69,063 65,023 65,023 70,605

Personnel Benefits 6,463 13,259 16,148 16,148 15,249

CIPS - Health Department 9,028 18,084 32,355 32,355 31,643

Operating 9,006 12,605 7,354 7,354 14,079 Total Expenditures 60,663$ 113,011$ 120,880$ 120,880$ 131,576$

2018 2019 2020 2020 Revised 2021

Total FTE Count - - 1 (0.45) 0.55TOTAL FTEs - - 1 (0.45) 0.55

BUDGET SUMMARY

WIC BREAST FEEDING PEER COUNSELING

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

86

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants 60,936 31,438 - - -

Total Revenues 60,936$ 31,438$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 18,428 9,463 - - -

Personnel Benefits 9,579 4,862 - - -

Operating 29,881 17,113 - - - Total Expenditures 57,888$ 31,438$ -$ -$ -$

2018 2019 202 2020 Revised 2021

Total FTE Count - 1 - - - TOTAL FTEs - 1 - - -

BUDGET SUMMARY

SOUTHEAST WIC OUTREACH

REVENUES

EXPENDITURES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

87

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 113,844 142,599 175,000 175,000 175,000

State LPHA Funding 49,208 45,411 - - -

Licenses, Fees and Permits 159,965 203,159 235,000 235,000 235,000

Program Specific Grants 304,827 516,797 326,530 326,530 300,856

Contributions & Donations 12,979 6,183 15,000 15,000 12,000

Total Revenues 640,824$ 914,151$ 751,530$ 751,530$ 722,856$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 344,858 415,739 439,598 439,598 466,020

Personnel Benefits 128,396 156,758 181,950 181,950 185,237

Operating 238,474 181,907 154,684 154,684 126,994 Total Expenditures 711,728$ 754,404$ 776,232$ 776,232$ 778,251$

2018 2019 2020 2020 Revised 2021

Total FTE Count 6 6 7 0.4 7.4TOTAL FTEs 6 6 7 0.4 7.4

BUDGET SUMMARY

FAMILY PLANNING

REVENUES

EXPENDITURES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

88

COMMUNITY HEALTH PROMOTION

PURPOSE STATEMENT The purpose of the Community Health Promotion Division is to promote the development of community Systems, partnerships, and upstream public health prevention actions to reduce chronic diseases and improve the population’s health over the lifespan.

OVERVIEW To achieve the division’s purpose, staff utilize data, evaluation, planning, and partnerships to collectively collaborate on best practice strategies and activities. Programs work with community members, policy makers, and coalitions to promote upstream public health prevention efforts. These collective efforts will increase access to healthy foods, physical activity opportunities, smoke-free environments, health care, support systems, housing, schools, and communities.

PROGRAMS Community Health Planning

Healthy Environment Planning Tobacco Education and Prevention Partnership

Maternal Child Health Youth Substance Use Prevention/Communities That Care

Youth Suicide Prevention and Child Fatality Review Team

OBJECTIVES • Develop systems in the division to increase collaboration, effective communication, and

continuous quality improvement • Identify resources and funding to help communities within the county address issue that prevent

healthy aging • Promote healthy child and youth behaviors and development to improve lifelong health outcomes

89

• Collaborate with community members to support youth initiatives focused on prevention, policy, and system changes

• Increase tobacco/smoke free multi-unit housing availability • Decrease vaping and smoking within the county • Support the emotional, behavioral and physical well-being of children and youth with special

healthcare needs • Take collective action in support of youth mental health and bullying and suicide prevention • Prevent youth substance use and abuse; violence; and poor mental health outcomes • Provide public health consultation and education for health care providers and to the public • Build and maintain relationships with school districts in El Paso County.

PERFORMANCE MEASURES AND OPERATING INDICATORS COVID-19 greatly impacted the Community Health Promotion’s performance measures for 2020. As will be common with all divisions, priorities had to shift to focus on the COVID-19 response and recovery efforts. As we know the efforts will need to continue into 2021, we are not focusing on setting new performance measures at this time.

90

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality

Strategy 1.1: Provide trainings that develop and strengthen public health core competencies Strategy Objective Department Measure 2021

Target Select a core group of Community Health Promotion (CHP)

staff to participate in a statewide Social Determinants of Health Training.

CHP Begin training in November 2021 By December 31,

2021 staff will have begun

SDOH training. GOAL 2- Technology, informatics, data analysis - Strengthen EPCPH's capabilities to collect, analyze, share, and use data to make timely and information-

Strategy 2.3: Expand internal resources for data collection, storage, and analysis

Strategy Objective Department Measure 2021

Target Establish greater visibility and accountability for Youth

Suicide Prevention Workgroup efforts by implementing a data dashboard to track Community Action Plan outcomes

and creating opportunities for greater alignment and capacity building between Workgroup members.

CHP/YSPP By the end of 2020, a data dashboard development process will be started.

December 31, 2021

Strategy 2.4: Regularly disseminate important and emerging health information to community partners

Strategy Objective Department Measure 2021

Target Through education and outreach, advance the

implementation of community-oriented public health tobacco control, prevention, and education work in El Paso County

by adhering to evidence-based prevention practices.

CHP/TEPP Disseminate tobacco use prevention, cessation and health information within the

County.

December 31, 2021

GOAL 4 - Community Partnerships: Develop and maintain strong relationships with key community partners to support public health or assure the

Strategy 4.2: Expand EPCPH staff participation on key community collaborations, coalitions, committees, or other work groups that can influence health

outcomes and policy, including those that address the social determinants of health

Strategy Objective Department Measure 2021

Target Increased support in the Fountain Valley for community spaces

for youth, access to quality childcare early in life, and the Kid Power program.

CHP/CTC Increased stakeholder support, in the

Fountain Valley region, for community spaces for youth, access to quality

childcare early in life, and Kid Power programs.

December 31, 2021

Proactively engage in the promotion and recruitment of El Paso County Schools for the Healthy Kids Colorado Survey

CHP

Develop strategy and messaging timelines for recruiting school districts.

Develop communication slides that

emphasize the importance of Healthy Kids Colorado Survey and why robust participation in El Paso County is

important.

December 31, 2021

Raise awareness and promote collaboration in the community (DHS, schools, early child-care centers, hospitals, physician

offices) to ensure that all children and families receive the care they need to thrive.

CHP/MCH Increase awareness and collaborations. December 31, 2021

Strategy 4.3: Expand participation from non-traditional partners on EPCPH-led coalitions, collaborations, or committees to create bi-directional relationships SMART Objectives Office of Primary

2021

91

Strategy Objective Department Measure Target

Establish procedures and communication strategies to engage 40 community partners in Child Fatality Review

Team prevention recommend

CHP/Youth Health and

Development

Begin process to established procedures and communication strategies

December 31, 2021

OPERATING INDICATORS

2017 Actual 2019 Actual 2020 Actual

2021 Estimated

Number of Colorado Quitline Calls 1,678 1,550 1,239 1,250 Maternal Child Health HCP - Number of Families Provided with Care Coordination

83 114 106 160

Maternal Child Health HCP - Referrals Received 241 297 274 275

92

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 909,976 876,865 1,195,033 1,094,808 1,094,808

State LPHA Funding 114,034 109,000 50,000 50,000 50,000

Licenses, Fees and Permits 12,784 4,511 1,500 1,500 2,500

Program Specific Grants 2,074,337 2,017,675 1,879,784 1,879,784 1,866,962

Other Misc - 2,824 - - -

Total Revenues 3,111,131$ 3,010,875$ 3,126,317$ 3,026,092$ 3,014,270$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,483,654 1,404,232 1,636,279 1,636,279 1,803,257

Personnel Benefits 571,516 602,326 697,245 697,245 721,739

Personnel Reimbursement Indirect (62,804) - - - -

CIPS - Health Department 326,332 354,454 495,927 495,927 502,232

Operating 587,957 403,255 432,923 432,923 368,490

Operating Reimbursment Indirect (23,744) - - - - Total Expenditures 2,882,910$ 2,764,266$ 3,262,374$ 3,262,374$ 3,395,718$

2018 2019 2020 2020 Revised 2021

Total FTE Count 27 28 27 0.35 27.35TOTAL FTEs 27 28 27 0.35 27.35

BUDGET SUMMARY

DISEASE & HEALTH PROMOTION DIVISION SUMMARY

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

93

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 494,967 400,000 358,000 358,000 358,000

State LPHA Funding 48,858 50,000 50,000 50,000 50,000

Total Revenues 543,825$ 450,000$ 408,000$ 408,000$ 408,000$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 250,688 266,958 247,894 247,894 290,613

Personnel Benefits 95,828 114,823 106,688 106,688 127,046

Operating 67,743 40,925 68,553 68,553 36,368 Total Expenditures 414,259$ 422,705$ 423,135$ 423,135$ 454,027$

2018 2019 2020 2020 Revised 2021

Total FTE Count 5 6 4 1.1 5.1TOTAL FTEs 5 6 4 1.1 5.1

BUDGET SUMMARY

COMMUNICABLE DISEASE

REVENUES

EXPENDITURES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

94

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 149,211 159,000 348,000 247,775 247,775

State LPHA Funding 38,176 - - - -

Licenses, Fees and Permits 12,784 4,511 1,500 1,500 2,500

Program Specific Grants 124,386 118,115 100,000 100,000 87,800

Other Misc - - - - -

Total Revenues 324,556$ 281,625$ 449,500$ 349,275$ 338,075$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 144,356 162,626 231,449 231,449 182,614

Personnel Benefits 61,624 77,168 100,750 100,750 75,161

Operating 56,033 22,891 31,708 31,708 19,954 Total Expenditures 262,014$ 262,685$ 363,907$ 363,907$ 277,729$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 4 4 (0.1) 3.9TOTAL FTEs 3 4 4 (0.1) 3.9

BUDGET SUMMARY

TUBERCULOSIS PROGRAM

REVENUES

EXPENDITURES

FTE INFORMATION

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

95

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 20,000 20,000 20,000

Program Specific Grants 793,949 679,050 719,084 719,084 719,084

Total Revenues 793,949$ 679,050$ 739,084$ 739,084$ 739,084$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 301,386 272,605 290,063 290,063 269,284

Personnel Benefits 122,433 123,285 130,421 130,421 118,861

CIPS - Health Department 146,744 137,543 170,187 170,187 172,656

Operating 247,488 146,782 165,998 165,998 157,138 Total Expenditures 818,050$ 680,215$ 756,669$ 756,669$ 717,939$

2018 2019 2020 2020 Revised 2021

Total FTE Count 6 5 5 0.15 5.15TOTAL FTEs 6 5 5 0.15 5.15

BUDGET SUMMARY

TOBACCO EDUCATION PEVENTION & CESSATION

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

96

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 6,500 6,500 6,500

Program Specific Grants 57,599 183,468 190,457 190,457 190,456

Total Revenues 57,599$ 183,468$ 196,957$ 196,957$ 196,956$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 25,158 83,092 84,222 84,222 80,699

Personnel Benefits 10,745 37,161 37,942 37,942 35,029

CIPS - Health Department 10,646 37,162 46,107 46,107 46,391

Operating 11,050 26,285 36,954 36,954 30,785 Total Expenditures 57,598$ 183,699$ 205,225$ 205,225$ 192,904$

2018 2019 2020 2020 Revised 2021

Total FTE Count - 1 2 (0.5) 1.5TOTAL FTEs - 1 2 (0.5) 1.5

BUDGET SUMMARY

ESTABLISHING PEER TOBACCO CESSATION

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

97

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 57,000 57,000 57,000

Program Specific Grants 282,609 313,953 298,537 298,537 226,420

Total Revenues 282,609$ 313,953$ 355,537$ 355,537$ 283,420$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 131,423 131,056 207,308 207,308 164,228

Personnel Benefits 53,650 61,497 93,518 93,518 69,002

CIPS - Health Department 52,171 63,592 119,909 119,909 82,449

Operating 44,940 57,779 28,127 28,127 27,161 Total Expenditures 282,183$ 313,924$ 448,862$ 448,862$ 342,840$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 3 4 (1.3) 2.7TOTAL FTEs 3 3 4 (1.3) 2.7

BUDGET SUMMARY

MATERNAL & CHILD HEALTH (MCH) - CHILD ADOLESCENT PROGRAM

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

98

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OABEPC Funds to Public Health - - 37,000 37,000 37,000

Program Specific Grants 320,680 321,503 316,735 316,735 388,852

Total Revenues 320,680$ 321,503$ 353,735$ 353,735$ 425,852$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OABPersonnel 153,425 153,847 171,253 171,253 197,130

Personnel Benefits 58,361 56,574 62,461 62,461 83,732

CIPS - Health Department 58,001 63,815 93,158 93,158 99,019

Operating 50,894 47,398 34,532 34,532 31,860

Total Expenditures 320,680$ 321,634$ 361,404$ 361,404$ 411,741$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 2 2 1.3 3.3TOTAL FTEs 3 2 2 1.3 3.3

BUDGET SUMMARY

CHILDREN & YOUTH WITH SPECIAL HEALTH CARE NEEDS PROGRAM (HCP) - CARE COORDINATION

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

99

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 265,798 297,478 150,000 150,000 150,000

State LPHA Funding 27,000 59,000 - - -

Total Revenues 292,798$ 356,478$ 150,000$ 150,000$ 150,000$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 214,427 80,378 148,152 148,152 361,754

Personnel Benefits 65,050 24,034 56,628 56,628 106,089

Personnel Reimbursement Indirect (62,804) - - - -

Operating 26,463 10,643 12,593 12,593 15,143

Operating Reimbursement Indirect (23,744) - - - - Total Expenditures 219,392$ 115,055$ 217,373$ 217,373$ 482,986$

2018 2019 2020 2020 Revised 2021

Total FTE Count 3 3 2 1 3 TOTAL FTEs 3 3 2 1 3

BUDGET SUMMARY

DISEASE PREVENTION & HEALTH PROMOTION - ADMINISTRATION

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

EXPENDITURES

100

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Program Specific Grants 39,829 - - - -

Total Revenues 39,829$ -$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 20,210 - - - -

Personnel Benefits 8,468 - - - -

CIPS - Health Department 7,361 - - - -

Operating 3,731 - - - - Total Expenditures 39,771$ -$ -$ -$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 - - - - TOTAL FTEs 1 - - - -

EXPENDITURES

BUDGET SUMMARY

FOSTER CHILD CARE COORDINATION

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

101

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - 10,615 92,461 92,461 92,461

Program Specific Grants 97,727 54,498 - - -

Total Revenues 97,727$ 65,113$ 92,461$ 92,461$ 92,461$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 62,286 64,492 64,864 64,864 63,711

Personnel Benefits 23,449 26,087 26,764 26,764 26,042

CIPS - Health Department 6,389 3,885 - - 31,678

Operating 8,841 4,240 3,524 3,524 10,292 Total Expenditures 100,966$ 98,705$ 95,152$ 95,152$ 131,723$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 1 1 - 1 TOTAL FTEs 1 1 1 - 1

BUDGET SUMMARY

YOUTH SUICIDE PREVENTION

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

EXPENDITURES

102

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - 9,772 91,660 91,660 91,660

Program Specific Grants 81,363 81,363 - - -

Total Revenues 81,363$ 91,135$ 91,660$ 91,660$ 91,660$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 61,274 62,536 64,383 64,383 63,238

Personnel Benefits 23,612 26,207 26,682 26,682 25,962

Operating 2,614 3,896 3,292 3,292 3,398 Total Expenditures 87,501$ 92,639$ 94,357$ 94,357$ 92,598$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 1 1 - 1 TOTAL FTEs 1 1 1 - 1

BUDGET SUMMARY

EPC FUNDS TO YOUTH SUICIDE PREVENTION

REVENUES

FTE INFORMATION

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

103

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 34,412 34,412 34,412

Program Specific Grants 276,196 265,726 254,971 254,971 254,350

Total Revenues 276,196$ 268,550$ 289,383$ 289,383$ 288,762$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 118,811 126,642 126,691 126,691 129,986

Personnel Benefits 48,295 55,490 55,391 55,391 54,815

CIPS - Health Department 45,019 48,457 66,566 66,566 70,039

Operating 68,161 42,418 47,642 47,642 36,395 Total Expenditures 280,287$ 273,006$ 296,290$ 296,290$ 291,235$

2018 2019 2020 2020 Revised 2021

Total FTE Count 2 2 2 0.15 2.15TOTAL FTEs 2 2 2 0.15 2.15

EXPENDITURES

BUDGET SUMMARY

COMMUNITIES THAT CARE

REVENUES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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ENVIRONMENTAL HEALTH

PURPOSE STATEMENT Work to assure safe environments using science-based risk assessments, policy development, inspections, consultation, education, and enforcement of regulations designed to protect the food we eat, the water we drink, the air we breathe and the places where we live, play, and work.

OVERVIEW The Environmental Health Division is critical to the development of a healthy, economically vibrant and safe community. As part of their regulatory oversight, they focus on sanitary practices and working with industries to prevent disease and reduce the risk of environmental health hazards. This is accomplished through plan reviews, inspections, and responding to citizen complaints of retail food establishments, on-site wastewater systems, land use planning, body art facilities, child care facilities, public pools, spas, public and private drinking water testing, proper waste tire generator inspections, and school safety investigations.

PROGRAMS Retail Food

Establishment Inspections On-site Wastewater Treatment Systems Inspections

Land Use and Planning Body Art Facility Inspections

Air Quality Complaint Investigations Child Care Facility Inspections

Public Pools and Spas Inspections Public and Private Drinking Waters Testing

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Waste Tire Generator/Disposal Inspections School Safety Inspections

OBJECTIVES

● Educate on safe food handling practices in retail food establishments to prevent foodborne illness ● Prevent disease through education and regulatory enforcement ● Assure safe body art practices through licensing and enforcement of local public health

regulations ● Ensure proper treatment of wastewater to prevent ground water contamination ● Prevent the spread of infectious diseases, including foodborne illness, in children and staff and

educate on hazards by inspecting childcare facilities and schools, providing education about proper hand washing, sanitization, food handling and proper handling/storage of toxic and hazardous materials.

● Prevent waterborne illness through education and inspection of public swimming pools and spas ● Protect air quality by responding to complaints and issuing construction activity and open burn

permits. ● Ensure proper disposal of waste tires through inspecting waste tire generators and haulers.

COVID-19 Objectives:

• Educate and assist retail food establishments to successfully navigate the COVID-19 requirements listed in the Public Health Orders that apply to restaurants, grocery stores, convenience stores, bars and taverns.

• Provide customer service to the community through Environmental Health Specialists staffing the COVID-19 Call Line to address their concerns, q1uedstions and complaints.

• Assist childcares and schools in navigating best practices, cleaning, and disinfection through educating the COVID-19 requirements and recommendations that apply, a well a responding to exposure scenarios.

• Gain compliance of the public health orders through education and partnering with businesses.

PERFORMANCE MEASURES AND OPERATING INDICATORS

COVID-19 greatly impacted the Environmental Health Division’s performance measures for 2020. As will be common with all Divisions, priorities had to shift to focus on the COVID-19 response and recovery efforts. As we know the efforts will need to continue into 2021, we are not focusing on setting new performance measures at this time.

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PERFORMANCE MEASURES AND OPERATING INDICATORS

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.1: Provide trainings that develop and strengthen n public health core competencies

Strategy Objective Department Measure 2021

Target Regular presence at the Regional Building Department to facilitate and coordinate Environmental Health components of the plan review process for regulated facilities (including but not limited to food safety, child care, pool, and body art).

Environmental

Health

Increased quality and efficiency for plan receipt and

EPCPH sign-off

Year-over-year improvement in efficiency times

GOAL 1 - Workforce Development: Strengthen EPCPH's workforce to improve public health and environmental quality Strategy 1.2: Develop career pathways for existing staff to move into leadership positions

Strategy Objective Department Measure 2021

Target

Increase the number of Environmental Health forms and records available digitally, which improves accessibility and availability of forms and records to field staff and improves transparency for customers requesting service.

Environmental

Health

Number of processes that have moved from paper to

electronic formats in 2020.

50% of forms and records are available

digitally.

GOAL 2- Technology, informatics, data analysis - Strengthen EPCPH's capabilities to collect, analyze, share, and use data to make timely and Strategy 2.1: Develop and maintain collaborative relationships with key stake holders to share relevant data

Strategy Objective Department Measure 2021

Target

Identify opportunities for stakeholder engagement around Environmental Health issues.

Environmental

Health

Environmental Health has identified two environmental health issues and worked with

stakeholders to develop and implement a solution.

Identification and development of at least

2 evidence-based stakeholder priorities.

GOAL 2- Technology, informatics, data analysis - Strengthen EPCPH's capabilities to collect, analyze, share, and use data to make timely and Strategy 2.2: Improve internal capabilities s to collect and provide data for community health assessment

Strategy Objective Department Measure 2021

Target

Poise EPCPH to respond to emerging environmental health issues (e.g. environmental justice, PFOS/PFAS, air quality, etc.)

Environmental Health

Environmental Health staff improve foundational program knowledge and selectively become involved

with stakeholder groups, participation in council of governments, and participation in state rule making. Activities may include opportunities related to air

quality (e.g. kiss and go school drop off programs; decentralization of workforce; decreasing commute

time, etc.).

Increased data to support evidence-based

policy decisions

GOAL 5A- Funding for agency and community partners: Increase funding for EPCPH from diverse sources to support core public health services, Strategy 5A.3: Build relationships with state and local elected officials to support public health activities and funding

Strategy Objective Department Measure 2021

Target Evaluate, review and assess fee schedules to ensure that actual cost are covered to the extent allowable by law.

Environmental

Health

Environmental Health (EH) reviews and proposes a revised fee schedule to El Paso County Public Health

Board of Health based on stakeholder input.

By December 31, 2020, EH will have

presented proposed fee schedule update to the

BOH

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2017 Actual 2018 Actual 2019 Actual 2020 Estimated

Number of Retail Food Establishment Plan Reviews 123 175 135 145

Number of Food Workers Who Completed Food Safety Education Classes 963 983 1,288 1,300

Number of Retail Food Establishment Inspections 5,792 5,894 4,322 5,000

Number of Microbiology Private Well Water Tests 2,908 2,704 2,931 3,200

Number of On-site Wastewater Permits Issued 597 606 590 605

Number of Microbiology tests for Public Water Systems 4,120 4,212 4,159 4,300

Number of Tests in the Pretrial Services Program (average by month) 168/month 294/month 586/month 700/month

Number of Air Quality Permits issued* 140 120 148* (does not include complaints) 110 (AQ construction permits); 40 AQ open

burn permits; 45 complaints

Number of School Safety Inspections** 63 40 9 20

Number of Child Care Inspections*** 255 241 265 288

2019 NEW process: High risk field consults (HRFC) 45 50

Number of Public Pool Inspections 431 406 308 290 + follow up inspections

Number of Body Art Establishment Inspections**** 116 102 100 (includes pre-ops and followups) 117 (not including temporary event pre-ops)

OPERATING INDICATORS

* For Number of Air Quality Permits Issued, 2017 data for "permits" INCLUDED unique complaints,

which are separate from permits; 2018 data is unclear. 120 is not the total for permits plus complaints. There were 111 PERMITS and 43 complaints.

2019 Data: AQ Construction Activity Permits: 110; AQ Open Burn Permits: 38 = Total permits 148 and 39 complaints.

The separation is important as issuing permits takes a small amount of time in comparison to investigating complaints, which could take months or even years.

** A process changed in this program in 2019. The numbers shown for 2017 and 2018 included complaints with inspection totals.

The 2019 numbers and 2020 estimates are for inspections only, no complaints.

*** 2017/2018 data included regular inspections, pre-op inspections, followup inspections, room changes,

AND complaints and Foodborne Illness/communicable disease investigations. These activities are not all inspections.

**** 2017/2018 data included regular, pre-op, followups, AND complaints. Complaints should be separate.

Temp events may have been included in 2018 but both temp events and complaints were 8 or 9; data is unclear.

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 503,075 525,587 579,000 579,000 569,000

State LPHA Funding 235,122 253,000 277,796 277,796 277,796

Licenses, Fees and Permits 1,923,663 1,940,331 1,991,550 1,991,550 1,994,050

Program Specific Grants 74,202 69,124 85,349 85,349 75,349

Other Misc 2,779 16,602 11,000 11,000 1,500

Total Revenues 2,738,840$ 2,804,643$ 2,944,695$ 2,944,695$ 2,917,695$

Expenditures by Category 2018 Actual 2019\ Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,669,350 1,693,057 1,924,040 1,924,040 1,990,494

Personnel Benefits 668,915 748,254 826,377 826,377 821,345

Operating 520,884 416,673 417,088 417,088 433,639 Total Expenditures 2,888,984$ 2,857,984$ 3,167,505$ 3,167,505$ 3,245,478$

2018 2019 2020 2020 Revised 2021

Total FTE Count 31 33 33 (1) 32 TOTAL FTEs 31 33 33 (1) 32

BUDGET SUMMARY

ENVIRONMENTAL HEALTH DIVISION SUMMARY

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 56,488 54,000 54,000 54,000 54,000

State LPHA Funding 92,326 54,000 77,000 77,000 77,000

Licenses, Fees and Permits 351,217 310,785 315,400 315,400 313,900

Other Misc 396 13,806 9,500 9,500 15,000

Total Revenues 500,426$ 432,591$ 455,900$ 455,900$ 459,900$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 252,865 249,533 259,812 259,812 251,244

Personnel Benefits 106,225 108,439 105,198 105,198 101,719

Operating 174,886 114,919 105,036 105,036 114,901 Total Expenditures 533,976$ 472,891$ 470,046$ 470,046$ 467,864$

2018 2019 2020 2020 Revised 2021

Total FTE Count 5 5 5 (1) 4 TOTAL FTEs 5 5 5 (1) 4

BUDGET SUMMARY

LABORATORY

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health 446,587 471,587 525,000 525,000 515,000

State LPHA Funding 142,796 199,000 200,796 200,796 200,796

Licenses, Fees and Permits 1,569,667 1,612,944 1,665,150 1,665,150 1,665,150

Program Specific Grants 74,202 69,124 85,349 85,349 75,349

Other Misc 2,383 2,796 1,500 1,500 1,500

Total Revenues 2,235,635$ 2,355,450$ 2,477,795$ 2,477,795$ 2,457,795$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 1,416,484 1,443,523 1,664,228 1,664,228 1,739,250

Personnel Benefits 562,689 639,815 721,179 721,179 719,626

Operating 345,998 301,754 312,052 312,052 318,737 Total Expenditures 2,355,008$ 2,385,093$ 2,697,459$ 2,697,459$ 2,777,613$

2018 2019 2020 2020 Revised 2021

Total FTE Count 26 28 28 28 TOTAL FTEs 26 28 28 - 28

BUDGET SUMMARY

ENVIRONMENTAL HEALTH SERVICES

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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OFFICE OF EMERGENCY PREPAREDNESS

PURPOSE STATEMENT Strengthen the local public health system’s capability to prepare, respond, and recover from threats and emergencies impacting the health of the public.

OVERVIEW The Emergency Preparedness Program assures that El Paso County Public Health is prepared for, and capable of responding to, naturally occurring disasters (wildfires, floods, earthquakes, blizzards, etc.), intentional acts of terrorism, pandemics and other public health emergencies in collaboration with community partners. The program promotes preparedness and educates the community on emerging health threats, such as the COVID-19 pandemic; serves as regional coordinators, trainers, and epidemiologist for a five-county region within Colorado; and provides expanded reference laboratory capacity for the Pikes Peak region.

OBJECTIVES ● Provide emergency preparedness planning, training, exercises and epidemiology to a five-county

region in Colorado (El Paso, Park, Lake, Chaffee and Teller) ● Routinely plan, prepare and organize tabletop and full-scale functional exercises with response

partners ● Collaborate with state, local and community partners to develop plans that account for all

constituents in their jurisdictions ● Collaborate with the South-Central Healthcare Coalition, with members representing hospitals,

offices of emergency managements, emergency medical services, behavioral health, and public health with a purpose to effectively respond to incidents that have a public health and medical

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impact ● Respond to pandemics, acts of terrorism, and other emergencies that threaten the public’s health ● Routinely respond to local and multi-state or multi-jurisdictional disease outbreaks

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - 13,000 95,000 95,000 95,000

State LPHA Funding - - 10,000 10,000 10,000

Program Specific Grants 699,545 778,732 798,048 798,048 4,508,246

Other Misc 1,270 300 - - -

Total Revenues 700,815$ 792,032$ 903,048$ 903,048$ 4,613,246$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 305,728 330,268 393,292 5,163,610 1,790,068

Personnel Benefits 116,343 137,442 161,264 604,490 728,958

CIPS - Health Department 94,873 148,272 199,379 199,379 719,797

Operating 142,978 167,748 230,563 519,989 1,614,581 Total Expenditures 659,921$ 783,730$ 984,498$ 6,487,468$ 4,853,404$

2018 2019 20290 2020 Revised 2021

Total FTE Count 5 6 6 23 29 TOTAL FTEs 5 6 6 23 29

BUDGET SUMMARY

OFFICE OF EMERGENCY PREPAREDNESS

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - 13,000 60,000 60,000 70,000

Program Specific Grants 588,855 619,778 615,761 615,761 1,289,902

Total Revenues 589,715$ 633,079$ 675,761$ 675,761$ 1,359,902$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 257,287 276,589 336,414 336,414 348,645

Personnel Benefits 97,450 115,328 138,382 138,382 139,865

CIPS - Health Department 78,463 139,145 169,231 169,231 306,722

Operating 121,598 83,135 109,231 109,231 480,181 Total Expenditures 554,798$ 614,197$ 753,258$ 753,258$ 1,275,413$

2018 2019 2020 2020 Revised 2021

Total FTE Count 4 5 5 0.30 5.30TOTAL FTEs 4 5 5 0.30 5.30

BUDGET SUMMARY

EMERGENCY PREPAREDNESS

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 25,000 25,000 25,000

State LPHA Funding - - 10,000 10,000 10,000

Program Specific Grants - 43,906 64,371 64,371 -

Total Revenues -$ 43,906$ 99,371$ 99,371$ 35,000$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Operating - 48,747 97,050 97,050 - Total Expenditures -$ 48,747$ 97,050$ 97,050$ -$

2018 2019 2020 2020 Revised 2021

Total FTE Count - - - - - TOTAL FTEs - - - - -

BUDGET SUMMARY

EMERGENCY RESPONSE

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - - - 3,100,429

EPC Funds to Public Health - - - - -

Program Specific Grants - - - - -

Total Revenues 410$ -$ -$ -$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel - - - - 633,541

Personnel Benefits - - - - 290,481

CIPS - Health Department - - - - 387,536

Operating - - - - 938,428 Total Expenditures -$ -$ -$ -$ 2,249,986$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 1 1 11 12 TOTAL FTEs 1 1 1 11 12

BUDGET SUMMARY

EPIDEMIOLOGY & LABORATORY CAPACITY (ELC) GRANT

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - 10,000 10,000 -

Program Specific Grants 110,690 115,047 117,916 117,916 117,915

Total Revenues 111,100$ 115,047$ 127,916$ 127,916$ 117,915$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel 48,441 53,679 56,878 56,878 48,325

Personnel Benefits 18,893 22,114 22,882 22,882 18,854

CIPS - Health Department 16,410 9,127 30,148 30,148 25,539

Operating 21,379 35,866 24,282 24,282 13,479 Total Expenditures 105,124$ 120,786$ 134,190$ 134,190$ 106,197$

2018 2019 2020 2020 Revised 2021

Total FTE Count 1 1 1 (0.30) 0.70TOTAL FTEs 1 1 1 (0.30) 0.70

BUDGET SUMMARY

CITIES READINESS INITIATIVE

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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Revenues by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

EPC Funds to Public Health - - - 4,400,000 -

EPC Funds to Public Health - - - - -

Program Specific Grants - - - 652,970 -

Total Revenues 410$ -$ -$ 652,970$ -$

Expenditures by Category 2018 Actual 2019 Actual 2020 OAB 2020 Revised 2021 OAB

Personnel - - - 4,770,318 759,557

Personnel Benefits - - - 443,226 279,754

CIPS - Health Department - - - - -

Operating - - - 289,426 182,493 Total Expenditures -$ -$ -$ 5,502,970$ 1,221,804$

2018 2019 2020 2020 Revised 2021

Total FTE Count - - - 11 11 TOTAL FTEs - - - 11 11

BUDGET SUMMARY

Emergency Response-COVID

REVENUES

EXPENDITURES

FULL TIME EMPLOYEE POSITIONS (FTEs) SUMMARY

FTE INFORMATION

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MANDATES/STATE STATUTES REQUIRED

Public Health is governed by C.R.S. 25-1-520, which requires that each county establish and maintain a county public health agency

Required duties of all public health agencies:

• Complete a community health assessment • Create a county public health plan (every five years) • Advise local board of health on public policy issues necessary to protect public health and

environment

Provide or arrange for the provision of quality, core public health services:

• Assessment, planning and communication • Vital records and statistics (birth and death certificates) • Communicable disease prevention, investigation, and control • Prevention and population health promotion • Emergency preparedness and response • Environmental health

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FUND BALANCE POLICY August 24, 2016

Adopted Per Resolution 2016-04

FUND BALANCE POLICY

BACKGROUND Governmental Accounting Standards Board (GASB) released “Fund Balance Reporting and Governmental Fund Type Definitions” (GASB Statement No. 54). The objective of GASB Statement No. 54 is to enhance the usefulness of fund balance information for every user of governmental financial statements. This includes rating agencies, taxpayers, elected officials, and the media. The goal of GASB Statement No. 54 is to be consistent across all governments on how fund balances are reported. GASB Statement No. 54 addresses two items of governmental reporting: fund types and fund balances. What is a “Fund Type”?

• Fund Type – One of 11 classifications into which all individual funds can be categorized. El Paso County Public Health is a Component Unit of El Paso County which has always reported our Governmental Fund Types in compliance with GASB and our current fund type reporting structure is consistent and in compliance with GASB Statement No. 54. Thus, we are not required to do anything additional to address the fund type section of this GASB. What is a “Fund Balance”?

• Fund Balance – A subset of assets and liabilities deemed relevant for purposes of assessing near-term liquidity (similar to working capital). Fund balance includes Non-spendable, Restricted, and Unrestricted.

GASB 54 required El Paso County to establish a fund balance policy for fiscal year 2011. The desired outcome of this directive is to have in place a plan to maintain a satisfactory level of unrestricted fund balance reserves (which includes committed, assigned, and unassigned funds) to insure a continued strong financial position within the County. This policy was established December 20, 2011. After implementing this policy over the last four years, Budget Administration found that the way it was written did not meet El Paso County’s needs and has therefore adopted a revised policy effective December 17, 2015. El Paso County Public Health has not adopted a formal policy for the maintenance of fund balance nor its use of restricted and unrestricted (committed, assigned, unassigned) fund balance. Informally, the Board

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has maintained a targeted level of reserves to be 21% of annual budgeted expenses intended to cover unforeseeable fluctuation in income and/or expenditures. With a newly adopted fund balance policy by the County it is now an opportune time to review the policy of the Board of Health (BoH) and formalize the guidelines to be compatible with El Paso County policy while holding to the specific needs of Public Health. PURPOSE OF THIS POLICY To establish a policy to maintain a satisfactory level of the Public Health Fund unrestricted fund balance reserves to insure a continued strong financial position. The Government Finance Officers Association (GFOA) recommends a fund balance policy to include the following:

1. Desired minimum level of unrestricted fund balance.

2. Describe the specific circumstances in which the resources accumulated for contingencies may be spent.

3. In the event the unrestricted fund balance must be used, how the Board of Health would replenish the fund balance and over what time frame the replenishment would occur.

BASIS FOR FUND BALANCE GFOA states the “only (accounting) fund typically having a fund balance policy is the General Fund.” This is because all core revenues flow through the General Fund. Thus, the General Fund supports or provides funding as needed to cover shortfalls in the other funds. This basis of accounting is consistent with how El Paso County Public Health operates. Since Public Health has only one fund it is the primary operating fund and it accounts for all financial resources of the entity. The revenues associated with the activity within the Public Health Fund are included as a basis for fund balance percentage calculation. Further, GASB 54 states the Fund Balance Policy will focus on the Fund category containing Committed, Assigned, and Unassigned fund balances in our Comprehensive Annual Financial Report.

RECOMMENDATIONS FOR DETERMINING BASIS

1. The basis of the fund balance reserve shall be unrestricted revenues for the fund as Public Health expenditures are very stable. The volatility lies in revenues.

2. The fund balance reserve plus the Restricted Tabor Reserve will result in a reserve amount

recommended by the Government Finance Officers Association (GFOA) of approximately 16.67% the equivalent of 2 months of Revenues or Expenditures. El Paso County Public Health’s desired level is 18% to 21% of revenues.

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3. That an adequate level of reserve be maintained for cash flow purposes. 4. That a sufficient level of reserves be maintained to carry El Paso County Public Health through

low economic periods or fluctuations in anticipated annual revenues.

5. That an adequate level of reserves will be available due to unexpected needs. UNRESTRICTED FUND BALANCE MINIMUM REQUIREMENTS The Board of Health has established:

1. The appropriate minimum level of unrestricted fund balance to be maintained is the range of 18% to 21% of unrestricted revenues.

2. The unrestricted fund balance may be used in the following circumstances: a. Revenues received are at least 4% less than budgeted due to economic conditions

impacting the local funding from El Paso County b. Federally declared natural disasters within the County c. Declared emergencies, such as a disease epidemic, natural disaster, or bioterrorism

event d. Elimination or significant reduction of core revenue streams, such as:

i. State Per Capita revenue ii. Core Public Health Services

1. Assessment, Planning and Communication 2. Environmental Health 3. Vital Stats 4. Communicable Disease Prevention 5. PH Emergency Preparedness and Response

3. BoH determined emergency of one-time cost

4. Fund balance will be used in the order of: unassigned, assigned, and committed

5. The unrestricted fund balance will be replenished using the following methods:

a. Adjust the financial projection so that spending is adjusted down (or economic recovery predicted) and desired levels of unrestricted fund balance are replenished.

b. Natural disaster use is replenished when anticipated reimbursement will be received from state/federal government.

c. Fund balance will be replenished in the order of: committed, assigned, and unassigned.

6. The unrestricted fund balance will be replenished using the following timeline: a. The amount that needs to be replenished will be adjusted in the financial projection to be

brought to the minimum required level over a maximum of five budget years. 7. The highest level of decision-making authority to establish, modify and rescind commitments

is the Board of Health by Resolution.

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8. The officials authorized to assign Board of Health approved amounts for specific purposes are the Public Health Executive Director and Budget Officer.

RESPONSIBILITIES

• Administration & Financial Services shall be responsible for the preparation and notification to the BoH, the status of unrestricted fund balance reserves on an annual basis, noting any exceptions to the levels as defined in the policy.

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IV. DEMOGRAPHIC & STATISTICAL SECTION

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Median Household Income (in 2019 dollars) $68,779

Median Value of Owner –Occupied Housing Units 2015-2019 $275,000

Households 2015-2019 257,507

High School Graduate or Higher, percent of age 25+ 2015-2019 94.8%

Bachelor’s Degree or Higher, percent of age 25+ 2015-2019 38.5%

Total Employer Establishments 2018 17,882

Total Employment 2018 246,115

Mean Travel Time to Work (minutes) age 16+ 2015-2019 23.7

Source: United States Census Bureau

El Paso County Demographic and Economic Indicators

Area Name 2013 2014 2015 2016 2017 2018 2019COLORADO STATE 5,272,942 5,352,866 5,454,707 5,542,951 5,616,567 5,694,311 5,763,976EL PASO 656,763 663,957 675,663 689,577 701,544 714,398 722,493Calhan 806 805 809 820 826 831 832Colorado Springs 439,133 443,167 450,505 459,791 466,280 473,928 477,975Fountain 28,002 28,443 28,925 29,511 29,961 30,618 30,928Grn Mtn. Falls (Part) 814 817 821 839 843 864 908Manitou Springs 5,223 5,209 5,238 5,290 5,326 5,448 5,459Monument 5,933 6,009 6,125 6,266 6,840 6,997 7,582Palmer Lake 2,557 2,588 2,636 2,695 2,727 2,793 2,893Ramah 126 126 127 128 129 130 131Unincorp. Area 174,169 176,793 180,477 184,237 188,612 192,789 195,813

Source: Colorado Department of Local Affairs

El Paso County and Municipalities Population 2013-2019

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PLACETotal

PopulationHousehold Population

Total Housing

Units

Occupied Housing

Units

Vacant Housing

UnitsCalhan 832 832 353 331 22Colorado Springs 477,975 467,555 195,393 191,904 3,489 Fountain 30,928 30,928 10,666 10,439 227Green Mtn. Falls (Part) 880 856 600 429 171 Manitou Springs 5,459 5,426 2,910 2,740 170Monument 7,582 7,582 2,457 2,443 14 Palmer Lake 2,893 2,890 1,227 1,142 85Ramah 131 131 69 60 9 Unincorp. Area 195,813 185,269 65,354 64,359 995

Source: Colorado Department of Local Affairs

El Paso County - Municipalities 2019

Race 2018 2019 2020American Indian non Hispanic 8,500 8,661 8,816 Asian non Hispanic 31,401 32,722 34,038 Black non Hispanic 46,782 47,810 48,805 Hispanic 122,997 127,326 131,657 White non Hispanic 504,715 509,585 514,040

Total 714,395 726,104 737,356

Source: Colorado Department of Local Affairs

El Paso County Demographics

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SubjectHouseholds

EstimateFamilies Estimate

Married-couple families Estimate

Nonfamily households Estimate

Total 257,507 175,552 137,813 81,955

Less than $10,000 4.5% 2.9% 0.9% 9.3%

$10,000 to $14,999 3.3% 1.6% 0.7% 7.1%

$15,000 to $24,999 7.4% 4.6% 2.7% 14.1%

$25,000 to $34,999 8.1% 6.0% 4.4% 13.1%

$35,000 to $49,999 12.0% 10.5% 9.0% 15.7%

$50,000 to $74,999 18.9% 19.4% 18.8% 18.8%

$75,000 to $99,999 14.3% 15.9% 17.1% 9.7%

$100,000 to $149,999 17.4% 20.7% 24.1% 8.6%

$150,000 to $199,999 7.4% 9.6% 11.7% 2.0%

$200,000 or more 6.6% 8.7% 10.6% 1.7%

Median income (dollars)

68,779 81,957 94,347 40,508

Source: U.S. Census Bureau, 2014-2018 American Community Survey 5-Year Estimates

El Paso County 2015-2019 Median Household Income

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GLOSSARY A

Accounting Period: A period at the end of which and for which financial statements are prepared (typically a month or a year).

Accrual Basis: The basis of accounting under which revenues are recorded when earned and expenditures are recorded as soon as they result in liabilities for benefits received, notwithstanding that the receipt of revenue or the payment of the expenditure may take place, in whole or in part, in another accounting period.

Accrual: An accounting method that reports income when earned and expenses when incurred.

Activity: A specific service performed by one or more units of government.

Actual - Actual refers to the expenditures and/or revenues that are actually realized; as opposed to those that are forecasted or budgeted.

Ad Valorem: According to value.

Adopted Budget: Refers to the budget amounts originally approved by the Board of County Commissioners at the beginning of the budget year and the budget document, which consolidates all beginning‐of‐the‐year operating appropriations.

Agency: A governmental or quasi‐governmental unit which provides services to residents of the county but is not part of the county government, per se. An agency may be linked to county government by an intergovernmental agreement or may be formed pursuant to an intergovernmental agreement.

Agenda Item (BoCC) – Any item scheduled to be reviewed/approved by the BoCC at a scheduled meeting.

Allocations: A part of a lump‐sum appropriation which is designated for expenditure by specific organization units and/or for special purposes, activities, or objects.

Amended Budget: Budget which includes changes to the Adopted Budget that are approved by the Board of County Commissioners and transfers within the authority of management.

Appropriated Reserves: The amount of fund balance used to supplement revenues required to fund appropriated expenditures.

Appropriated Budget: The expenditure authority created by the Appropriation Ordinance and related estimated revenues. The Appropriated Budget would include all reserves, transfers, allocations, and other legally authorized legislative changes.

Appropriation: The legal authorization granted by the Board of County Commissioners which allows the departments, offices and agencies of the county to make expenditures and to incur obligations for specific purposes. An appropriation is usually limited in amount and as to the time when it may be expended.

Appropriation Resolution: The appropriation resolution is the means whereby the Board of County Commissioners enacts the appropriation, making it legal. The act of adopting the budget does not include legal authority to spend. In order to spend an appropriation resolution must also be approved outlining the expenditures proposed in the adopted budget.

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Asset: A resource owned or controlled by the county, which has monetary value. An asset is either current or fixed. A current asset is typically consumed within one year, such as cash, accounts receivable, and inventories. A fixed asset provides benefit for more than one year, such as equipment, buildings, and open space properties.

Audit: A methodical examination conducted by a private accounting firm, of the utilization of the county’s resources. An audit tests the accounting system to determine the extent to which internal accounting controls are both available and being used. The audit concludes with a written report of findings called the Auditor’s Opinion.

Authorized Position: A position (job, FTE) authorized by the Board of County Commissioners as part of the annual adopted budget.

B

Balanced Budget: A budget where current operating expenditures do not exceed current operating revenues plus unreserved and available fund balance for each individual fund subject to appropriation. Per state statute, the county is required to adopt a balanced budget each year.

Base Budget: An estimate of funding to continue existing programs at current levels of service prepared by each department or office during the budget development process.

Basis of Accounting: A term used to refer to when revenues, expenditures, and transfers (and the related assets and liabilities) are recognized in the accounts and reported in the financial statements.

Benchmarking: Comparing desired performance and results against a relative standard.

Board of County Commissioners (BoCC): the board is composed of a five‐member group of publicly elected officials. They are the main policy makers and financial stewards of the county.

Board of Health (BOH): the board is composed of an eight‐member publicly elected group, and they are the main policy makers and financial stewards of the county

Budget: An annual policy document, financial plan, operations guide, and communications device, containing estimated revenues and expenditures. The budget, once adopted by the Board of County Commissioners, is the legal basis for expenditures in the budget year.

Budget Calendar: A timetable showing when particular tasks must be completed in order for the Board of County Commissioners to adopt the annual budget before the beginning of the next fiscal year.

Budget Development Process: The annual cycle in which the county prepares the annual budget for adoption.

Budget Message: Written overview of the budget addressed to the Board of County Commissioners. The budget message contains an explanation of principal budget items, significant changes from the previous fiscal year, summaries of major issues impacting the budget, and challenges facing the county.

Budgetary Basis: The basis of accounting used to estimate financing sources and uses in the budget. This generally takes one of three forms: generally accepted accounting principles (GAAP), cash, or modified accrual.

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Budgetary Control: The control or management of a government in accordance with an approved budget to monitor and control expenditures within the limitations of approved appropriations and available revenues.

C

Capital Expenditures: Expenditures resulting in the acquisition of or addition to the county’s fixed asset inventory.

Capital Lease: An agreement that conveys the right to use property, plant, or equipment, usually for a stated period of time.

Capital Outlay: Those purchases of $5,000 or more, which become a new fixed asset of the county.

Capital Project: A major capital construction project, such as those related to buildings, drainage, streets, trails, etc., included in the CIP or Road & Bridge Fund. Capital projects tend to have significant costs and have useful lives of many years.

Committed Fund Balance: Amount that can be used for specific purposes determined by formal action of the Board of County Commissioners. Commitments may be established, modified, or rescinded, only through resolutions approved by the BoCC.

Contingency: A possible future event or condition arising from causes unknown or at present indeterminable.

Charges for Services Expenditures: Charges for services include various contracted services (professional consulting, auditing, advertising, legal, and printing, security, delivery, vehicle repair and maintenance, and building rental).

Charges for Services Revenue: A revenue category comprised of revenue generated from services the county provides to residents and other entities. Services that are charged for include motor vehicle registrations, document recording, and insurance, Sheriff Academy, County Fair, Coroner Autopsies, and District Attorney Services.

Children and Youth with Special Health Care Needs Program (HCP): This is a program designed to help care for children with special needs from birth to 21 years if age

Colorado Local Government Budget Law: In preparing an annual budget, all Colorado counties must follow the provisions of Title 29, Article 1, Part 1 of the Colorado Revised Statutes, which defines the legal requirements for budget format, content, and cover; budget hearing and adoption; appropriation resolution/ordinance; filing the budget; and changing the budget.

Cost Center: A responsibility center within the government organization.

D

Department: An organizational unit within the county government that is under the direction of non‐elected county management staff.

Department of Disease and Health Promotion (DHP):

Designated Fund Balance (Reserves): Portions of fund balance that are set aside for a specific purpose and which are, therefore, not available for general appropriation (except for that specific purpose).

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E

Elected Official: An official elected by El Paso County voters to manage an elected county office.

El Paso County (EPC): Is one of 64 counties in the state of Colorado.

Emergency: An emergency is defined as 1) an act of God, 2) public enemy, or 3) something which could not have been reasonably foreseen at the time of the adoption in the budget. For the purpose of TABOR, this is further restricted to exclude economic conditions, or revenue shortfalls.

Encumbrance: Obligations in the form of purchase orders, contracts or salary commitments which are chargeable to an appropriation and for which a part of the appropriation is reserved. They cease to be encumbrances when paid or when the actual liability is set up.

Expenditure: A decrease in net financial resources due to payments made by the county for goods or services, such as personnel, supplies, and equipment.

F

Fiscal Year: A period of any 12 consecutive months to which the budget applies. El Paso County's fiscal year is January 1 through December 31.

Full Time Equivalent (FTE): Numeric equivalent of one person occupying one employment position for one year (equivalent of 2,080 hours or 52 forty‐hour weeks).

Full Time Employee (FTE): In EPC, only Full Time benefit eligible positions are considered FTE’s. No part-time or temporary are part of this count.

Fund: An independent fiscal and accounting entity with a self‐balancing set of accounts recording cash and/or other resources together with all related liabilities, obligations, reserves and equities, which are segregated for the purpose of carrying on specific activities or attaining certain objectives in accordance with special regulations, restrictions or limitations.

Fund Balance: The excess of assets over liabilities. Fund balance is accumulated when revenues exceed expenditures and is decreased when revenues are less than expenditures.

Fund Type: Any one of seven categories into which all funds are classified in governmental accounting. The seven fund types are general, special revenue, debt service, capital projects, enterprise, internal service, and trust and agency.

G

General Fund: A fund used to account for all transactions of a governmental unit which are not accounted for in another fund. The General Fund is used to account for the ordinary operations of a governmental unit which are financed from taxes and other general revenues.

Generally Accepted Accounting Principles (GAAP): Uniform minimum standards and guidelines for financial accounting and reporting. GAAP encompasses the conventions, rules, and procedures necessary to define accepted accounting practice at a particular time.

Governmental Accounting Standards Board (GASB): Is the source of generally accepted accounting principles (GAAP) used by state and local governments in the United States.

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Government Finance Officers Association (GFOA): Professional association of state, provincial and local finance officers in the United States and Canada.

Governmental Funds: Funds generally used to account for tax‐supported activities. Examples of governmental funds are the General Fund and Capital Projects Fund.

Governmental Services Expenditures: Governmental services include grants made to other institutions, economic incentives, and sales tax share back payments to cities.

Grant: A contribution of assets (usually cash) by one government unit or other organization to another. The contribution is usually made to aid in the support of a specific function (for example, education), but it is sometimes also for general purposes.

H

I

Inflation: As defined by Colorado TABOR, it is the percentage change in the Denver/Boulder Bureau of Labor Statistics’ consumer price index for all items, all urban consumers, or its successor index.

Intergovernmental Agreement (IGA): A signed agreement between two or more governmental units, and approved by their governing bodies, that provides for the exchange of goods or services between the governments.

Intergovernmental Revenue: A revenue category comprised of intergovernmental and grant funds received from federal and state governments and other jurisdictions for designated purposes.

Intergovernmental Expenditures: Grants, entitlements and cost reimbursements from the county to other local governments, entities, authorities, or organizations.

J

K

L

Level of Service: Used generally to define existing or current services, programs, activities and/or facilities provided by a government to its citizens. Level of service in any given department or office may be increased, decreased, or remain constant, depending upon needs, alternatives, productivity, and available resources. To continue a given level of service into future years assumes that objectives, goals, quantity and quality of the service will remain unchanged.

Liability: A debt or other legal obligation arising out of a transaction in the past which must be liquidated, renewed, or refunded at some future date.

M

Mandated Services: Services that the state or federal governments require the county to perform for which no revenue or partial revenue is provided to the county.

Maternal & Child Health (MCH): Is a program to improve health and well-being in the MCH population this includes; Early Childhood Obesity, Bulling and Youth Suicide.

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Memorandum of Understanding (MOU): Bilateral or multilateral agreement between two or more parties.

Miscellaneous Revenue: A revenue category comprised of items that do not easily fit into one of the other defined revenue categories. Miscellaneous revenue includes insurance recovery of losses, bank charges, contributions and donations, rents received for use of county buildings, telecom reimbursements, gain/loss on sale of investments, and proceeds from sale of assets.

N

Nonspendable Fund Balance: Amounts that cannot be spent either because they are in nonspendable from or because they are legally or contractually required to be maintained intact.

O

Object Account: As used in expenditure classification, this term applies to the article purchased or the service obtained (as distinguished from the results obtained from expenditures).

Office: Offices are generally managed by elected county officials.

Operating Budget: Budget that accounts for the costs of carrying on activities that do not meet the criteria for capitalization.

Operating Capital: Vehicle, equipment or furniture costing more than $5,000 with a life of more than one year.

Other Financing Sources: Financial resource increases not typically classified as revenues in compliance with GAAP to avoid the distortion of revenue trends, but are other resources used to fund government purchases and services. Resources such as the issuance of debt, lease proceeds, interfund transfers, and proceeds from the sale of assets, insurance proceeds and payments on demand bonds reported as fund liabilities are coded to a separate area of the financial statements.

Other Financing Uses: Financial outlays not typically classified as expenditures for GAAP purposes, but represent decreases in current financial resources to fund certain activities such as issuance discounts on long‐term debt, refunding transactions, interfund transfers and the reclassification so demand bonds as a fund liability. These transactions are reported on a separate area of the financial statements to avoid distorting expenditure trends.

P

Personnel Expenditures: One of six major categories of expenditures used in the El Paso County budgetary system. Personnel expenditures include all salaries and benefit costs for full‐ time, part‐time, and temporary employees of the county.

Program: Specific (or like group) activities or organizational units directed at attaining specific purposes or objectives.

Program Based Budget: A budget wherein expenditures are based primarily on programs of work and secondarily on character and object.

Proposed Budget: A budget recommended by the Financial and Administrative Officer (the Budget Officer) to the Board of County Commissioners.

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Public Hearing: A meeting to which El Paso County residents are invited for purposes of providing input and comments.

Q

R

Reimbursement: Cash or other assets received as a repayment of the cost of work or services performed or of other expenditures made for or on behalf of another governmental unit or department or for an individual, firm or corporation.

Requested Budget: A budget submitted by each department or office which identifies needs or desires for the following year.

Reserves: An unappropriated source of funding that can be utilized to meet unexpected budgetary needs.

Resolution: A special or temporary order of the Board of County Commissioners usually requiring more legal formality than an ordinance or statute.

Restricted Fund Balance: Amounts constrained to specific purposes by their providers (such as grantors, bondholders, and higher levels of government), through constitutional provisions, or by enabling legislation.

Revenue: An item or source of income, such as income from taxes, fees, grants, and interest earnings.

S

T

Transfers: 1) Interfund transfers: are internal transactions only and do not represent actual outflow from the county. They represent one fund sending cash to another fund. Interfund transfers done without regard to repayment or an equivalent exchange of value. 2) Interdepartmental Transfers: are transfers between departments. If within the same fund, they are intrafund transfers and eliminated for financial reporting, but not budgetary reporting.

U

Unassigned Fund Balance: Amounts that are available for any purpose; these amounts are reported only in the General Fund.

Unincorporated El Paso County: Those portions of the county that are not part of any incorporated municipality.

Unrestricted Fund Balance: Total of committed, assigned, and unassigned balances.

V

W

Women, Children and Infants (WIC): Is a Special Supplemental Nutrition Program for Women, Children and Infants, within an approved service area.

X

Y

Z