1. A Successful Regional Health Department in Colorado Richard L. Vogt, M.D. Executive Director CCI Conference, June 10, 2009

2. Composition Tri-County Health Department (TCHD) serves Adams, Arapahoe and Douglas Counties We serve 1¼ million residents, ¼ of Colorado’s population Our Board of Health has three appointed representatives from each county, for a total of nine members

3. History TCHD was formed in 1948 to include Adams, Arapahoe and Jefferson Counties

4. History In 1958, Jefferson County formed its own Health Department, so TCHD served only two counties until 1966 In 1966, Douglas County decided to join TCHD after they received mutual aid in response to the South Platte River floods

5. Approach as a Regional Health Department Delicate balance functioning as one health department serving the needs of three diverse counties TCHD needs to keep consistent approaches for all of our three counties However, each county has special needs and interests that also need to be addressed

6. Regional Health Department Provide core services to all three of our counties Provide some individualized services for each of our counties

7. Core Services Offered to Each County Nursing –Adult and child immunizations –Family planning –Women’s cancer screenings –Maternal child health programs –Access to care programs –HIV/AIDS, sexually-transmitted disease and TB outreach programs –Chronic disease prevention

8. Core Services Environmental Health –Restaurant inspection program –Child care inspection program –Pool/spa inspection program –Onsite-wastewater program –Hazardous chemicals in schools –Land use reviews –Vector control

9. Core Services Nutrition –WIC program –Community nutrition –Early childhood obesity and prevention –Dietetic internship –Breast-feeding support program

10. Core Services Epidemiology, Planning and Communication –Infectious disease investigation –Outbreak control –Public information –Tobacco prevention –Statewide older adult fall prevention program –Health planning –Geographic Information Systems (GIS)

11. Core Services Emergency Preparedness –Developed emergency response plans in coordination with external and internal partners –Coordinated agency responses to public health emergencies –Coordinated the strategic national stockpile and mass prophylaxis –Developed agency continuing operation plans (COOP)

12. Core Support Services Administration –Purchasing –Payroll –Human resources –Information technology –Facility management

13. Individual County Interests and Programs

14. Adams County Major interest in protective measures with oversight of landfills and the Rocky Mountain Arsenal cleanup project Developed an innovative mutual agreement with Adams County Human Services to provide selected nursing services for human service clients using Temporary Assistance for Needy Families (TANF) funds Household hazardous waste disposal

15. Arapahoe County Largest populated county in our jurisdiction We have special funding to help provide dental services for Arapahoe County senior citizens Developing a similar program with social services again using TANF funds Arapahoe County has shown a special interest in outbreaks of illness that require planning –West Nile Virus –H1N1 influenza infections

16. Douglas County Has a special interest in water –Quantity –Quality TCHD conducted a special study of the quality of well water in homes that have septic systems, finding little contamination in households with submitted samples Household hazardous waste disposal

17. Three-County Agreement In 1988, all three sets of County Commissioners entered into an agreement to provide the same level of county per capita funding The advantage is that there is a common contribution for all of the three counties A disadvantage is that we are funded at a level that the most financially challenged county can afford each year We also have individual contracts for county-specific activities

18. Benefits of Regional Health Department Provide more uniform services across counties Provide enough depth to shift resources depending upon the public health need Can provide a significant nursing workforce for public health activities in the area Able to undertake large campaigns –In 1992, administered IG to 15,000 residents –In 1993, coordinated activities for the Pope’s visit –In 2009, administered 1,300 doses of IG and hepatitis A vaccine

19. Benefits Receive financial support from three counties which enables us to have professionals and programs that would otherwise be unavailable We have economies of scale with one office of administrative services for three counties

20. Challenges A presence in each of our three counties Staff liaison in an office located in each county Attendance at each of the many county functions –Volunteer appreciation receptions –Ground-breaking and dedication ceremonies –Presentations of our proposed budget to each county

21. Challenges Campaign with Commissioners over the years with the theme that “TCHD is your local health department” Lack of recognition as a “department” similar to those housed within the county structure Lack of awareness by county residents that TCHD is their county health department

22. Challenges Some difficulty in managing 11 offices in our jurisdiction –Four full service offices –Two partial service offices –Four WIC offices –One administrative office Currently have an “office director” for each office

23. Challenges Arrange for courier services between offices Negotiate multiple leases for properties not supported by counties Strive to be “equal and fair” to employees in 11 different offices Strive to provide uniform services between the different offices

24. Space Challenge At present, each county provides at least one office for TCHD free-of-charge However, one county has provided all of our office space at no charge TCHD contracted with a consulting firm to evaluate the current county space support The results will be presented to our three sets of County Commissioners

25. Douglas County Study In 2003, Douglas County formed a committee to review the possibility of forming their own LHD At that time, Colorado Statutes allowed this to happen, giving 12 months notice to the LHD TCHD convinced Douglas County of the worth of our agency to provide services to residents In the end, Douglas County decided to stay with TCHD because of “economies of scale” and demonstration of vision and strong leadership

26. Activities Undertaken a campaign to be included in all written county reports that list county departments Attempted to attend all county functions recognizing county departments Attempted to send a TCHD staff representative for regular county management meetings

27. Summary There are many advantages to establishing a regional health department However, the process is not without challenges At present, each of our three counties feel that we are providing cost-effective, high- quality public health services to our residents and are attentive to individual county needs

28. Thank you!