1/11/23 Board Meeting

001Thanks for waiting just a couple of minutes while we got some of our stuff situated here. Uh so we'll go ahead and um well we don't really have to we'll call the meeting to order. Um so tonight we are discussing the school-based healthc care um center. There's currently one at Central High School and there's the proposed one at um the new Grand Junction High School. So with this meeting we um since it's been a few years since the pre well the previous board had this conversation um wanted to have this board be brought up to speed with those conversations and be able to ask questions. um bring the community along in this discussion. Um obviously prior to this board, there's obviously been a lot of things that have happened locally and nationally. Um so it's

002just I think prudent to come back and have this conversation. Uh you know, pros and cons. So that's the purpose of tonight. Um, I know we have some information that we've uh brought together um from the previous uh intake or excuse me um needs analysis that was done uh prior 2017 2018 and is that when okay in 2018 yeah and so we'll bring all that information together. So um there's not going to be any public comment tonight. That does not mean that if uh you need to catch one of us afterwards or send an email with any other thoughts or or questions that anybody has, please do. There will be public comment at the business meeting next Tuesday. Uh so if you want to uh you know formulate anything, I know we've received a handful

003of emails uh today and so I do have some of those questions that were proposed in some of the emails that we received that we could look at addressing. And so really this is for the the public to just listen to the board um you know hashing out this conversation. And so instead of our I know our board meetings go long we opted that we would offer a special meeting to discuss this particular uh topic with each other and uh obviously have the community here as well. So if any particular um I don't know if we want to start looking back um maybe we should just look back at what was presented in uh with the needs analysis um from our last conversation at our workshop. Um it was proposed that we potentially have Marilac

004or the community do another needs analysis but then after further thought we're not sure whether that's a good use of time and money. Um because really the needs analysis is there for the students that is that's already been done and they did all the focus groups and all that information. We may end up just replicating information we already have. Really what this is about is bringing the community along to see what the community feels around having the health clinic in Grand Junction High School. And I think also clarifying questions or concerns um you know whether for or against that that we've had expressed to us from the community. So um so we we're going to hash through some of those tonight. Um I encourage every board member to please um please express this. This is

005I want this to be a good healthy discussion um between all of us and you know kind of what we're hearing from people and uh bring up different you know questions or thoughts and so I just want to engage the entire board um in in the discussion. So uh do you want to oh you have some stuff up okay if this is what the board wants us to go through this is I I sent this to everybody in December. It's the presentation that was given. It looks like it was actually January 2019. So, the folks that were giving the presentation at the time, some of our staff members are they're retired and so they're not around uh anymore. So, we can go through all the slides if you want and um review it um or

006whatever the board would prefer. You think that's good? Okay. I think let's look at this information um making sure that all board members are, you know, again on the same page with the same information. We can stop at any point if board members want to, you know, ask a question. Um, I know Maril is here if they need to ask qu or answer any questions. And we also have um facilities here because if we're looking at making the change of what's on the plan um so you know that the board could understand or get some information on what that may look like. So we do have some people here that could potentially answer some other questions for us as well. So um I will try to recreate the presentation from uh like four years ago.

007But this gives us all kind of a baseline grounding and so so we have defined terms so when someone says something we can all know that's what that means instead of just making some assumptions. So I I think to go through that is this is good. So this first slide is really just a definition of what a schoolbased health center is. Um so schoolbased health center is a health care facility located inside a school or on school grounds staffed by multi multiddisciplinary team of medical and behavioral health providers sometimes dental professionals health educators and health insurance enrollment specials specialists uh and the purpose is to improve health and education outcomes. Um so who is served? Students who have barriers or challenges to accessing care um or is limited um services are designed to uh identify

008problems early, provide continuity of care and improve academic participation. Um and also just kind of a side note, I know there was some questions from the board about um whether or not the the current one we have at Central serves the community and it's that is not open to the community. So the one at Central High School is just for the students at the school and I believe if we were to move forward with the one at um Junction it would just be for students within the building. So there those are not open to the community. I think there are some schoolbased health actually I know there's some schoolbased health centers uh in other places that are open to the community but ours currently isn't. Um, so this slide, it was a difference. Well, the

009logo is covering it up, but there was a difference between um what a schoolbased health center can do and what a school nurse um can do. So, I won't read all those, but you can see them there uh on the screen. Okay, I'll go. You go if I move on. Okay. Um, so the outcomes um for schoolbased health centers, increased immunization rates, uh decrease use of emergency rooms, uh improved screening and identification of students at risk for depression and or anxiety. Uh improved screening and early intervention to address risky substance uh use. Decrease teen pregnancy. Improved identification and screening of overweight/obese students. uh and improved educational outcomes for better school performance, grade promotion, and high school completion. Uh those would be the goals for having the schoolbased health center. Um so back when there was

010a committee that was put together in I believe 2018, um these were the members that were on that committee. So or committee so it was some D-51 staff and then representatives from um different uh entities throughout the community. So you can see the names there. Um so the objectives of the need needs assessment that was done um and my understanding is this the needs assessment took um I can't remember it was four to five months um to complete uh and I this presentation will go through kind of the what they did during that needs assessment but um the goals were to understand the health care needs of students uh in the target areas of Mesa County Valley School District 51, assess the potential utilization of a school-based health center and and understand existing community resources

011including healthcare facilities that serve low-income children and youth and identify barriers to to students receiving services. Um so they had um student parent and staff surveys were conducted and it looks like they had about um 1300 respondents to that. There were also focus groups that were conducted uh 55 participants in six different focus groups. uh community partner interviews with four different organizations and then they used existing uh data for health and so socioeconomic uh indicators and then you can see the target population over here to the side. Um the analysis focused on students enrolled at central Grand Junction High School and their feeder middle schools. Um the CHI the Colorado Health Institute uh found that both high schools met key indicators uh that project the need for a school-based health center. Those were health outcomes,

012access and utilization of care, health insurance coverage and youth risk factors. Um, so you can see the uh respondents by stakeholder group, student survey respondents representative of the district student population and race and ethnicity and gender. Spanish speaking parents, male parents, central high school parents um, and central high school parents are under reppresented in the survey. Um, so mental health was the most critical student health concern. The top five student health concerns. Um, for students, you can see them on the screen. Feeling worried or stressed, feeling sad, eating and weight issues, suicide or wanting to hurt themselves, alcohol or drug use. Uh, for parents, feeling worried or stress, violence and bullying, feeling sad, not enough exercise and eating and weight issues. And then for staff it was anxiety and stress, alcohol or drug use, problems

013at home, coming to school hungry, um, and eating and weight issues. Top five health complaints or chronic conditions that affect students attendance and academic achievement. Um, so emotional issues were the number one. Uh, sore throat, colds, fever, earachches, and coughing. Uh, behavior issues, stomach aches, and headaches. Um so health insurance coverage for the county. So um at that time D51 ranked 80th out of 178 school districts for percentage of school age children in poverty. Um the percentage of school age children living in poverty in district 51 is higher than the statewide average. Mesa County has a higher percentage of uninsured children uh than the state. I believe that's supposed to say. Uh the percentage of children enrolled in Medicaid is higher than the statewide average. And the percentage of children eligible for um CHIP plus

014uh is double the state average. Le uh leaving an estimated 2,243 children who are eligible but not enrolled. See the statistics on there for the C or the county versus the state. Access to care. So most parents and students report that they um youth have seen a doctor and dentist in the past year. Um more than a quarter of parents and students report that they have seen a mental health therapist in the past year. Um and you can see here 6% of parents reported that their children does their child does not have health insurance. 17% have Medicaid uh and 9% have um CHIP plus and then 40% of parents believe there are not enough places to get health care. And then you can see the um percentage reporting student access to care up there in

015the top right corner. Um I won't go through all those. Um percent of parents avoiding slashdelaying care due to barriers. So the barrier lack of time um and then the percent of surveyed parents avoiding delaying child healthcare. So 32% um mentioned lack of time. 33% mentioned cost and 10% me mentioned uh transportation. Um and then this uh these were questions around um for students view the students use of a schoolbased health center. So um how many of them would actually use it um the parent view for student use of the schoolbased health center and then staff support for it. Um so you can see the percentages there. It looks like the last one didn't have the percentages on it, but um the the staff one uh was the larger one was I think it is

016a good idea and I'm supportive. Um and then you can see for parents um for definitely use 24% 32% said probably use. Um and then 28% neutral and then 7% probably not and 9% definitely not. And then for students, um, uh, 11% said they would definitely use it, 23% said they probably would, 36% were neutral or don't know, and then 20% said they probably wouldn't, and then 10% said that they would not use it, definitely would not use it. Schoolbased health center use and support. Um, so you can see with the answers here, um, these are, um, I believe these were questions around whether or not they would access the schoolbased health center for these services. And I'm going to actually look back because I think Marilc maybe is that what those questions were. It

017was whether or not they would actually utilize these. Okay. Yeah. So you can see that on there. Do we have something like this for what was actually used? So I have um two documents that I can think of right now. One is um it shows over the last three years the amount of the services that were utilized at the central clinic. So, we can pull that up if if need. And then um we also have one that's a little bit more detailed um that breaks down within those categories like what were those services that students utilized. So, I can pull that up if the board. Do y'all want me to pause and pull that up now? No, sorry. You can finish and then pull that up. Okay. Write that down. So, okay. Um common questions

018and concern concerns for operations. It was around staffing uh quality and experience, location, where and transportation hours, operating hours, non-school days and hours, and then services. Um what services are being offered, coordination with outside providers, and then cost for parent um involvement, communication, parent knowing child was seen or being present. Uh confidentiality, child receiving care without parent knowledge, understanding who has access to medical records, and creating space where kids can receive services confidential uh confidentially. Um and then for funding uh the cost to operate how it will be funded, not wanting education dollars shifted to healthare and then sustainability uh closed if not funded long-term options to fund long term. So those were some of the um questions and concerns that came out of those um surveys and then the meetings I think were the

019focus groups. Recommendations from the group was that community input indicates ample support to pursue a schoolbased health center in the district. mental health and substance use are a clear priority area. Um to develop a communication plan to reach stakeholders and then schoolbased health center operational policies and procedures can address feedback from staff, students, and parents and address potential concerns. Um so again, this was back in 2018. These were the recommendations that were made. And that's the last slide on that one. So let me pull up um unless anybody has questions about this one before I close it. to go back. So, um I can try to answer these the best I can. So, so staffing, yeah, maybe Maril might want to help chime in if I mess this up, but staffing is all um they're

020they're the folks that work within the schoolbased health center at Central currently are not uh D51 staff. their staff um staffed by Merillac and um that's funded through um Mirillac. So we're not actually spending um D-51 funds on that um location. Obviously at this point we have a central high school um schoolbased health center. I think um based on the the documents that I've shared that we found and then also just you know conversations that have happened over the years that the um assumption was was that the next location would be Grand Junction High School. Uh my understanding is that actually Grand Junction High School was identified as the number one for need, but at the time um there was a concern about putting um money into the infrastructure of that building knowing that it

021needed to be rebuilt at some point. So Central uh became the the target. Um so um operating hours is during school hours. Um and again, it's not open to um it's not open to the public. Um I don't have the exact hours. So, um, Mayor Lac could possibly provide that for us. Um, and then we do have a list of services. I can pull that slide up, um, and go through all the services. Um, there. Um, like I said, cost, uh, all the equipment at Central High School, um, the staffing, everything is done by, uh, Mirillac. Um, I think the only thing that we provide would possibly be custodial when they're cleaning the whole building. Um, but I could even be wrong about that. And then um and then obviously if it's part of the

022building there's some energy costs but um that's pretty minimal compared to the rest of the building. Um so communication parent knowing child was seen or being present. We have another slide that I can bring up that talks about uh legally um what services that um parents have to be notified about and then what services that that's not required over a certain age. So we can pull that slide up because if I try to remember it by heart I'll butcher it. Um uh and that goes into the confidentiality one as well. Um I kind of mentioned cost to operate um that there's grant funds that are paying for this through Merillac. Um and then sustainability. The the central one's been open. This is the third year I believe it's been open at central. So any other

023questions about this presentation before I close it out? Okay. Let me pull up I think to answer your questions Dr. Schulties. I'll try to find the um the slide for um where the the service is being offered uh currently. So this was um a document that was shared last time. Um and so I'll pull this up and try to make it as visible as possible. I can think I can zoom in down here. It's fun when you extend your display and you can't see what you're doing. There we go. So these were provided um last board meeting but these these are the past three years the um the main services that were being provided at central high schools. So you can see uh in each uh year's column you have two columns one is the

024number of users that utilize that service and then the number of visits is the next is next to it. So the first year um you can see medical 290 users and there were 613 visits. Behavioral health 140 users with 441 visits and then dental 36 users with 41 u visits. And then you can see that going on through um the years. So year three you can see it's just through December of this year. That's one semester's worth of visits at Central High School. Um and then We have medical break what's beh you know what I'm saying I think that's this one let me try to pull it up as well um so you look at that sorry so this was also provided to us um and I will try to zoom in oh um so

025this was a breakdown of visits, diagnosis recorded in services by program area from August 2020 to December. So when you talk about behavioral health, this is the reasons for students visiting for behavioral health. Um depression screenings being number one, stress, anxiety, depression, trauma, uh tobacco, grief, self harm, addiction, and eating disorders. And then you asked about medical Oh gosh, you asked about medical in particular. I just messed that up. Well, it was just break down. Oh, there it is. Um so this these numbers are from the beginning of opening. Yes. So those are the medical visits. Um the main one being nutrition and physical activity counseling, BMI, common cold or virus issues. Um and then blood pressure management, sports physicals, STI testing, reproductive health education, immunization counseling, injuries, and so on so forth. Um so

026back to the Oh, and then you can see dental down here too. So 75 dental for dental screenings, 11 for tooth and jaw pain, and then one for injection. Um so back to this one. those my if I'm reading this right those numbers are broken down in the other one I just showed um and you can see here just some other statistics so less than 1% of the visits are for reproductive health visits um and then 36 to 40% are for behavioral health visits uh they did a breakdown of um for the payer um for the visits and then here's a list of top diagnoses that were um uh that they've been seen for. So, depression, anxiety, stress at home, anger, social anxiety, relationship problems, family discord, uh PTSD, OCD, acute stress, panic attacks, substance

027uh dependency, eating disorders, vaping and nicotine, sports physicals, and then um acute cough, sore throat, headache, COVID screening, concussion, colden virus, routine screening, STI. Um and the top it looks like top diagnosis matches the 2018 needs assessment findings from student and parent staff comments. So if you look at that as if That's true. And is there so when you see these is there any customer satisfaction? other than checking off this and that hard. So I can't answer that unless unless that leads me to a question I actually have um under the memorandum of understanding um under item 13 and this is the the one we have with central. So this is um this is under Yeah, the obligations. Oh, further agreements of the parties. Number 13 says the parties agree to design and annually and

028annually execute an evaluation of the school-based health clinic processes students health status and student health needs. It says both parties will identify, collect, analyze, and share data necessary to perform the agreed upon evaluation. evaluation results will be used to improve the SBHC's efficiency, effectiveness, utiliz utilization, and financing in order to increase students access to primary healthcare. So, I was just wondering since we've had it open if we have that. Yeah, if you don't mind because I'm not a part of that. So, the question is has did we create a uh and did we design and annually execute an evaluation of the process student health status, student health needs? So I guess what's the what does the evaluation process look like for the current services at Central High School? Well, and this is an obligation to

029both parties. So I'm just wondering where we hold on to this at the district level too. If you could come to the microphone to you're all welcome to or they can send you up by yourself. We appreciate it. Thank you. Part of it um is that we um have a advisory a community it's called a community advisory committee or council that meets three to four times a year and it has school representatives on it Marilac representative the health department is on it a private pediatrician so there's other folks that are on it and um so that agenda includes reviewing kind of a dashboard kind of like what you're doing what services users what utilization data anything that's coming up then that's usually discussed there any you know suggestions that they may make from the committee

030or the council standpoint and then um the principal at central last year did a survey a youth survey and one of the questions on their youth survey included questions around the schoolbased health center. So, he has all of that data and he did present that at one of the council meetings and talked about it, what the results, what the students were saying about it. Um, having that available to them, the benefits, um, the use of it, things like that. So, he has that survey. He said at that time his plan was to do an annual survey. Can I ask who in the district is responsible for upholding our portion of that part of the agreement? you know, making sure that district that we're participating in that. Well, it sounds like the principal is a part

031of that advisory committee. So, so going back to if you look under the obligations of the district under the memorandum of understanding number four says it's to designate the school principal as the leaison between the school personnel um and SBHL excuse me SBHC personnel in planning and problem solving issues around issues concerning the SBHC. the principal will assist medical sponsor in and medical sponsor is referring to who's running the clinic in developing an annual budget um for the operations and to include a value of inind support from the district but I don't know if that's also implying that the principal is then the one responsible for collecting that data um I think in addition to student data are we also collecting data from the parents via a survey of what they I And that's really

032kind of what I'm wondering is what what our parents are feeling as far as and and what value they're they're seeing with with the clinic um with their students getting that healthcare. So um is your understanding well is your understanding only that um it was a student survey that the principal conducted? That's my understanding. Okay. Also on um on the advisory committee I do have one question. Um yeah under further agreements of the parties um it says this is under number one. So the parties will jointly sponsor a community advisory committee made up of representatives of each party to this memorandum of understanding representatives of the community at large and um the schoolbased health users parents and students. So, do you also have parents and students on that? There is a parent and and a

033student. Okay. Thank you. And I can get more clarity on the other question. Get back to the board. Yeah. So, I think we're going to need um if we can get the survey from Lance on what that information was and then if we could get and then just clarify whether that was students only. Um, and I think moving forward, I'd like to also have parental input or or parents to be surveyed on that as well. Um, just while we're thinking of it. So, the other one that So, do you I can go off of this and because the other question that was raised was around services and parental consent. So, I can go to that one unless y'all there's other questions about this document before I pull it down. Um, so let me find that

034one real quick. My there was a uh presentation that was given actually to this board um about a year ago. And so let me pull that one up because I know it had a slide in there that talked about um here it is. Um there we go. Um so this was the presentation that was given to the board uh last March and there is a slide in here that mentions um had a breakdown of there it is. So this um is under Colorado state law miners are able to consent to several types of medical treatment. And then you can see on the left column the types of treatment and then um at what age um is there consent. So I'll leave that there. There were questions about that. Um do I have it right though

035that students um that there has to be a parental consent for students to use the clinic? Okay. So, just I just want to repeat that for anybody who might be listening. Um, so it is in the registration packet for students when they pick it up for parents to consent to the student accessing the health clinic. So, okay. And they're sent directly from docysine to parents. Okay. If you don't have that just They engage. Sure. So to be clear to student access the clinic there's either verbal or written consent by the parent. Right. So the clinic the clinic per my understanding is I mean because state law is going to trump any policy or procedure that we would have because this is law. So if it's if if a student doesn't have to have parental permission

036to access that service, they could they could go to any clinic, not just the clinic that's in the high school. They could they they could take a bus and go to any clinic and access those services without parental knowledge or consent. Is that that's the as the law as I understand it. Okay. Okay. So there could be a registration process. Dr. Dr. Hill, were you able to get the other information that I had requested? That was that other one that I just showed. Okay. Because for some reason, I'm not I can't pull it up. That's this one. So, it's got the breakdown. So, I had um requested from our last workshop. I had reached out to Marillac um to see kind of the exhaustive list of services um or or that what they're required to

037do per their grant funding. um and wanted to kind of specifically see some of that. So, they were very gracious to um put that information together and get it over to us. So, um I know it's sometimes I don't mind powerpoints, but sometimes I like seeing the documents themselves with the information in it to be able to read and understand what um that information is. So, that's what this information is. It's in the other problem. No, I I had emailed to ask what was specifically in the grant language of what you're required to provide. So I think you provided Yes, you provide Yeah, thank you. That's that's what I was looking for. is all that. Okay, remember this one was in one of the presentations services required by CD uh PHE and high schoolbased health

038center. So those are that was in that other presentation. Yeah. So I think one question we could so reproduction, health, education and services. Um what what is encompassed under that or is is that detailed more in the the information that was given to us? I think some of our parents I mean I'm guessing this could potentially be STDs. um uh maybe birth control. Um I don't I don't know what what falls underneath that category. I mean that's been one of the the points that I think parents were had some questions on. And then also I think vaccinations was the other one. Do we have a on that? I'm not an expert on uh well or if somebody if you guys don't have it if you could email it to us a list of what is

039under reproductive health education and services. Thank you. And I and did the previous one say that that was less than 1% of the medical services provided. Thank you for pointing out it's less than 1% of the medical services provided is reproductive. That was on this one um right up here. more than just group together. So what is included in the 1% Okay. Thank you. Right. Because a student could come in and talk they might have a sore throat. um then want to talk about something reproductive health-wise and yeah I understand in medical field you guys have to record everything that you are having that discussion with and so so but then they do delineate out if a particular exam service or medication is administered so thank you for um delineating out that information ask me

040if I us have those say this year 436 users what percent22 what percent of users You see what I'm getting? Well, no. I'm I'm just as a as a Well, what whatever requires there are some things that that don't require parent permissions. There there's some things there you said do. So, that's off the table. We know they do, but the ones Yeah. Out of the whole picture of of users, how many what percentage makes up they they didn't have parent permission? US. Okay. only because it answers a question that we get inundated with and um like the 1% that that's so basically anything on the state anything on that chart that a child can see of you know someone without parent permission we just need those broken out by what services the clinic is providing

041and what percentage of that is falls under that category I'm sorry on the medical side. Okay. Okay. On the medical side, 99% have permission. No health services shall be provided to the child under 18 by the medical sponsor subcontracting organization without prior written consent of medical services. Only to get context of as that comes up. So we can answer with facts and not just what we think or what we hear somebody says. But also we can rest assured that no health services are being provided without parental consent. No medical service is being Yeah. Unless except in the case of an an emergency, a life-threatening emergency. I I I think it's just to have a better understanding of this. How widespread is it? I I think there's a notion among some that it's just I could

042go in and get anything done and well no but that's what people believe right and we we want to I want to dispel if if if it is can be dispelled what what actually is happening so we have facts over perception or what people think because I don't know what what that is okay so one question I have you're and you guys are probably probably not going to be able to answer it, but and I and I'm trying to figure out how to um find out more information on this. The school-based health clinics in other states um some are some are going more way further than I'm comfortable as as a parent and I know some of that is coming down from legislation um from those states. So, you know, we're we're in this board

043role for a period of time and obviously we've all even inherited problems and decisions that have been made from previous boards. And so I'm the way I'm trying to approach this is not only thinking of what's going to happen the next three or four years, but what ramifications, you know, good or bad, um, are there in, you know, 10 or 20 years down the road? Because I think we all know that there can be things that are presented at a certain day and age that you're saying that you're like, "This is good. I I agree with these things. But then legislation changes, governors change, state house changes, state senates change, and then the rules start to change. And now all of a sudden, like I said, I think last time at the workshop is once

044the toothpaste is out of the tube, you really can't it's hard to get it back in. And so I I really want to think long term what what happens if things change in the state of Colorado to you know the further I guess undermining of parental rights with their kids. I mean for instance in California I'm just going to say it. They can get gender affirming care. And I'm not saying that I'm for or against it. What I'm saying is the parent needs to be involved in the discussion. Doesn't matter what my personal belief is around it. The role of the school board is to make sure that we are team members with parents, students, and our staff. And so parents are getting frustrated because they feel like their decision-making processes or the just the

045decisions they want to make for their kids are then getting undermined because a student may have a thought about wanting to change their gender. Can I just say really quickly, California law requires parent or guardian consent per for gender affirming care for minors. They cannot do that without um parental consent. Right. Well, that's great. That that's helpful. I just want to make sure that we are not getting ourselves into the situations where we hear some of these other clinics, you know, coming about doing things like that. So, and I need to get some more information because I've have on good authority students getting that without parental consent. I think that's more probably more of a staff administration issue probably in some of those districts rather than it being the state law. So, just to um

046in agreement with with what you said, I'm not so concerned about what the rules are today, but I am concerned about where the rules may go and it may not even be 10 years down the road. It could be next year. It could be very it could move quickly. And so, that that's also a hesitation that I have with having another entity inside our school. I just, you know, I I just I want the board to express whatever concerns or thoughts they have, but I just, you know, and I'm and I'm still sifting through all this information and this data, but I'm I'm looking at this being I'm playing the long game here on what this could look like down the road, you know, for our students and for our parents and our community. Um,

047I think there's a lot of good things that come from it and then there's just other things that I I need to get sorted out. um around that and looking at is there possibilities for helping more of our students with mental health needs rather than there being one clinic in one school. Um, you know, is there ways that I I'm more concerned or really concerned that children at our middle school level and even our upper elementary, like fourth and fifth grade levels that are disregulated and they're, you know, what help are we able to give them before they get to high school so they know how to function and work through behavior and mental health issues? I I I I would like to just see if there's a way that this conversation could become bigger

048to help more of our students with the areas that are that are highly impacted. Um, you know, because I we know that the mental and behavioral health is is a huge concern just from what we hear from our teachers um and and and from what we hear from students as well and we obviously see it in the numbers with with the clinic. And so I just wonder if there's if we need to think bigger rather than just one clinic in one school. Is there a way that is something that that's maybe more mobile that could help you know students and their families? Um I'd like to start uh Will and I um well I sit on the behavioral health um committee that the county puts on and you know Mindr Springs is on a good

049track. They're working through some good things with new leadership and then uh Director Jones is going to start going with me. But I just wonder if there's a way that we could just start looking at other opportunities to help, you know, help our students and families. So, I'm just putting that more out there. As we were looking as we were um a couple of meetings ago, Patty came in and did a presentation, you know, regarding what kind of staff we have to handle those kinds of issues. And it seemed pretty light to me. And we know that these problems don't start in high school. And we know that there are issues with our middle school students. And I I agree. I think maybe something broader where we could move it around and go to wherever

050the need is the greatest. I think this was an idea that that hatched based on what what all was going on at the time, but maybe there is a way to, like you say, think broader, think bigger, and um make it more accessible for those that that want to use those services. I think that that's a great idea and I think we should definitely explore that. But I also don't see that as a reason to not move forward with this really great opportunity to serve, you know, over a thousand or 2,000 students in their medical and behavioral health and dental needs each year. Again, you know, I know that the assessment was done in 2018, but I don't think anybody in this room thinks that needs have decreased since 2018. Um yeah, you know, it's

051and I think great points. Um and if you we go back even to 18 is, you know, what is the end goal for the district? What why a clinic? Why why do we do the things we do, right? Why do we provide busing? Why do we provide uh lunches for kids? Why do we do a lot of the things we do? to have certain outcome and that is academic success. um you know all all those things with that and that's was the target of of the clinic at central and proposed at junction and it's what what is the old saying good is the enemy of great or something like that is if if there's you don't want to miss opportunities to help recognizing there may be other better ways to do it but if you

052wait till you have the test, you'll just never get anything done and those services won't ever be rendered for kids or community. So, it's it's that balancing act of looking outside the box like you said. Are there are there other avenues, other delivery systems to address this, not just through the district, but through the county and the city or cooperatively, but in the meantime, there are the fires raging at our schools, right? middle, we talked about middle schools and maybe upper elementary and what are some uh strategies? What are some resources we have that that could meet those needs? And so, you know, our decision I look at the meeting purpose of tonight is okay, what is it that we're trying to decide upon? and and it seems like we're trying to find what are

053the resources that are available to our students to have good outcomes personally and and success in their learning and success as being young people and um and what is the most effective way of doing that and you know a couple years ago the clinic was that I don't think it was viewed as an end all that's going to fix everything but it's a step in the right direction so I'd hate to see us um get lost in weeds and look what what's going to what can we do to continue that momentum and yet not just say that it's all done and this is how it's going to be because I think you're right there's there's other things we can look at and and how do we maximize you know the concern how do how do

054we address the concerns people have about no no one's out to undermine parents it's never the goal here like you know by the way we want to undermine parent permission that's no No one ever does that. It happens, I guess, right? But that's not the goal. So, how do we how do we minimize that or eliminate that and still provide the services that are needed? You know, there can be a win-win all across the board. And so, that's we have to look. Does that make sense? When junction we agreed to build junction, was this brought up in Oh, be before that was ever on the bond. the the the plan at that time was after the presentations was the the recognition that this is a a a useful tool to help our students at at

055Central Junction and you know from a personal angle I thought why how are our kids at Fruda or or Palisade any different they have those needs too but it was a good starting point that was the highest temperature at that point that needed to be addressed but yeah I think the the plan um the previous board was this this this would be um a useful resource for our kids at junction. That's that was four years ago. And to your point, it's we don't we got to look long term and just because four years ago that was determined maybe maybe it isn't today. And we it'd be interesting to hear more from the central community, not just the student survey, but parent survey and getting outcomes that everybody had hoped for. We know how many are

056getting services, but are are we getting the outcomes we want to? Are people feeling it's good reflective point to see is this really working the way we wanted it to work and if not how do we fix it or do we scrap it or do we say this is this is continuing. I think it needs constant evaluation of as president heights mentioned in in the me memorandum of understanding is that was supposed to be built in and for various reasons is not there but that all makes I think personally I think the communication just could be better between all parties I think that it tends to get lost with with certain things and you know, there's an understanding that that our you are getting, you know, abortions at the school and we're not telling the

057parents or they're getting, you know, AB or C, but if we don't have that continued open dialogue that parents don't understand what's going on, we don't know what's going on. And it's kind of like, you know, then we're being sneaky. We're trying to sneak this in. So, I think that the communication is a lot better between all parties that it definitely could help relieve a lot of that stress, a lot of that tension. and we also let the parents know that they're still, you know, they're still this their children are still in charge, but we just need to figure out a better way of doing that in my opinion. No, don't disagree with that at all. So anyway, so I think the questions, we've thrown some questions out that I think we still need answers

058to to help decide what what the future will look like at junction or not. I think that um so the the clinic at Junction is not open to the public, correct? The the clinic at Central is not open to the public, just students and staff. Correct. Okay. So, um Okay. So that leads to I think facilities and FCI is um if if the board or whatever if if the if it changes from the clinic what is what is that going to look like costwise with that space that it's almost 1500 square feet. Um, so there's been I don't know I and maybe I've mis misheard, but if we don't move forward with it being a clinic, um, what does that look like as far as expense or what? Do you have a question? No, go

059for it. Can one of you guys come up and I know I don't think it's volunteered. I think they're volunttoled to come up. I just want to I just can I right before I just that just reminded me of a question that I had like just the framing of this to get to that question. So this has been a this is a fascinating conversation. I love hearing about what all we've done and what has been done. And again it sounds like there's you know 500 to a thousand medical service appointments provided 500 to a,000 mental health service appointments you know dozens of dental appointments. I guess in my mind and and again there's no medical services rendered without parental consent in except for in the case of an extreme emergency like I I can't get

060I I can't wrap my head around all of that and getting to to no clinic, you know? I I can't sort why how that would even be on the table right now. Well, I think it's going to end up being a board decision. So, I don't know which way the board would vote. So I what I'm trying to do is just make sure that the board has all the information possible because one little thing may yeah may influence the other. So um you know I I think it would be foolish of us to just say it's okay to move forward with without having have brought the community along in the conversation especially with other things that we know we're going to have to ask the community for. So, I just I just since since a

061lot has happened and people are now kind of re-engaging, I think it's time to bring a lot of people and a lot of people are interested in the school district to bring them along in this conversation. So, I don't know what the board will want to decide. So, that's why I just want to put everything on the table, so to speak. I think we're talking about two different things here with FCI and and the contract. We're we're looking at we have space that was built into the budget for this project that was voted on and passed and and that that space at the time of the bond election was visioned to be a clinic. Now now three years from now, five years from now, boards may decide or schools may decide we want to be

062a bike bike shop or whatever it may be, right? But we want to make sure that to honor what was initially approved or clinic that that the infrastructure is there for that or whatever we want it to be down the road. That's that's at least where I'm coming from that we haven't taken the space away for whatever we use it for and that the infrastructure is there for a if if we as a board vote to have a clinic or we vote to have whatever we may have in that space. And I think we can that makes sense. Yeah. And I think we can rest assured that the space is available. It we've we've earmarked the space. Um we have we had a discussion this last week. Uh the the drop dead date is really

063March 1st. Um timeline. Does that sound right? Yeah. March 1st. We just need to know um so we can pour concrete and get everything else done in that space that we need to um to to to talk to the um question of what do we do with the space if it's not a health clinic? Um there's been some other things that have been thrown out, habedasherie, um uh some kind of an area that that people can come to to get services for clothing, that kind of a thing. Um but right now the space has been earmarked for the clinic. I mean it's that's what it shows on the drawings right now. Um I think that was so is that correct? Yeah, the current space is a big box basically. So that's what's currently in the

064uh contract if you will and then the CL if you add the clinic that would be added cost um to the project. So that wasn't figured in the cost to begin with. It's an add it was an add all. Yeah. Could you just just for our community, could you could somebody just explain what the ad alternate or add is? Yeah. So, um uh things like the clinic were were easy things to price and put on a we might do it later list. Okay. And so we uh we put it on an add alternate list which we price it up. we have a full cost for it and then we identify things like that that we can add at any point through the project um you know you know with minimal impact to us and so

065that's why we put it on that list so that so that this decision could be you know made you know so by March 1st you need to know is be a clinic or not a clinic let's say hypothetically it's not a clinic then five years from now whatever may come around they want it to be a but I'm suggesting would it be easy to transfer that or would it be pretty easy yeah no pretty easy because we we are stubbing in the plumbing the underground plumbing uh so that if it ever turns into a clinic it'd be some pretty easy concrete cuts and put the plumbing where you need it and add walls and uh divide the space up into whatever you need. So it's it's it sounds like the space can be o over

066the decades that building's going to be in place. We'll have flexibility to be used. Yeah. Whatever the infrastructure will be in place to do whatever we need to in the space. I will add though that there obviously is a cost to renovating a space. So whatever that is um health clinic or classroom or whatever it is, there's a cost associated with that. So the cost isn't specific to the health clinic. It would be no matter what we make. Doesn't matter. Right now it's just a box. It's just a box, right? Yeah. So there's no extra money being spent um you know to make it a box or to make it you know it won't cost anymore to make it a clinic if the decision is made in a timely fashion. There will be no there's

067no premium to that added. So this decision being made now has has no impact costwise. It's just it's just a straight one for one. That's what it cost. Perfect. That was I think that was one of the questions I had was you know are are we making a significant change. Um I think there's questions whether it was original plan or add alter. So I I do appreciate the clarification um as far as that goes. And then um yeah, and then kind of just knowing if if this ends up becoming a board vote or decision, you know, what time frame does the board have to kind of make make those decisions um concerning that? Mark, do you remember what the cost was on the adult list? I knew you were going to ask. I knew I

068should for the equip for the furnishings for the finishings and furnishing was 240. 240. That sounds right. That sounds right. Yeah. I didn't dare. Yeah, but even our with Central put um Mirlac in charge of that. So, while it was aspirational to have it in there, I think makes sense that it's that it was an adult and that it's not right. So, we want to make sure we got the design correct, right? You don't want to build it and not, you know, fit the needs if that's what it ends up. So, I said we're in a very good spot right now. So I mean, so that leads to another question I'm going to have and maybe other parents have is I mean that's almost 1500 square feet in inside of a school that we're very

069much changing up how that school is going to run because our teachers there don't actually have dedicated classrooms. So then if you know question I have is um what you know what if all of a sudden we we need space in that school for educators or something else that comes up but then we don't have it because I mean again this is all in theory and I know there's other schools that run this way but I it just makes me think do you just wait because you don't know whether what you need that space for which I know we may not have that luxury. Um but it just these are the questions that then kind of end up popping up in my mind because Junction's going to run very differently than we've ever had be

070like any other school before. So I mean I know it'll be maybe like a college campus where you know you're going to different classrooms but I don't know these they're just concerns or questions that I have on kind of operations too. So that sounds like it's a like a was the building designed properly question. Well, no, I just I just wonder, you know, since our I believe there, if I remember how the plans look, there will be spaces for teachers to basically land. They can do sit down, do planning or have spaces where the teachers will be at, but because they don't have dedicated classrooms where they'll be having you know, all their items set up like it's, you know, their space. I just wonder, you know, would the school need about 1500 square feet

071for something that is unforeseeable to us? I I don't even know what what issues could arise. So, Andrea, that question did come up. They posed that question at an OIC meeting at a couple of the meetings and the principal there indicated that they could definitely use the space was I believe an exact quote. We could we could definitely use the space. Okay. So, you know, we can we can dig into that a little bit more if we need to or or whatnot. I guess I just, you know, I just want to know what what the options are and what and maybe what other people are, you know, seeing it through, you know, people who are going to be in that building, you know, day in and day out and maybe what constraints they already feel

072that they have. So, I I would love that feedback. um of what what they they might foresee being a challenge with it changing up. So, you know, I just do I do want to make sure that we're I don't want to drag her feet on it because we do need to be able to make decisions moving forward that would not end up costing, you know, the district, you know, just just in response to that is the original and I'm just going back to the previous board when when the original design came out and this is my recollection and ask previous board members, but that space was not in the original design and all the you know there were a lot of meetings about how the building should be designed and laid out and space needed

073for this this and that right and and so that gets back to K's question about you know are we looking was the original design not done properly this space was added was an add-on purposefully we went back and said you know the priests were desired to have that face earmarked for a clinic and that was added then on to the ask of the community uh in the bond election. So you know from where I sit I I kind of look again things have changed but that was the intent of that add-on and the extra dollars that we added on to the ask of the community was for that clinic. So did we add total space to the building the size of the footprint yes got larger Just to add the clinic, it wasn't an interior

074moving around. No, we actually made the building larger to accommodate to make sure we could accommodate a clinic. Yes. Okay. Was a clinic specified in the bond language or it was just it's it wasn't specified in the bond language. we've lived that the may have been the intention but it was not in the bond language. So therefore it's not a requirement. We have we have decision makers. I mean I would say that you know yeah I mean it's not like the stairwell was in the bond language you know like specific build specific rooms would not and to the point Angelar listen as as a building principle that you can always have more space right so if if if we as a board decide or five years from now decide or 10 years you know want

075to change anything in a building and the use of it that space can be used for something different right and and uh because you're you're you can always have more space. The reason the space was finally determined what it was, I remember we had to cut out, I remember, tens of thousands of square feet from the original design of that building because of cost and we wanted to have it under a certain dot and that that transmitted into cutting square footage, right? From the original aspirational goal, what we wanted the building to be like. Well, my point is is that it doesn't surprise me a building principal say, "Yeah, I can always use that space." Anyone use that space. Um our our our decision isn't based on what a particular principal feels they could use

076that space. It's to determine do we feel a clinic a health clinic will benefit the needs of our students. Whatever space is used, right? If you bring in a modular or whatever you want to bring in that that it's you're designed to help our students perform better in their school and be successful. Um, so does that make sense? You know, I'm not arguing any point one way or the other. I'm just I think the space is there. That's kind of what we want to make sure that it's there for whatever it's used for. Just to clean up on the square foot space for clarity and as there was a target square foot space that square footage through design, it happens a lot. It just grows and then it was reduced back to the target square

077foot space. So, was originally planned. Square footage is what we have. So, I thought on the plan it said like it was like 1,400. I mean, I I literally the plan that we were sent whatever's on there is just it's under just under 1500 square feet. What's the I think it was 249. 242 249 I think but I remember it started out close to 270 when we first started it was at about 270 Eddie do you remember that pardon me it was 259 I think and we we ended up being we ended up with a target that that through design it grew and then we got it back to where the target was. So, so from the very beginning we're right. Yeah. To me, what was what we wanted to ask right just for for

078better. Thank you. And Mariah does confirm that that space was added specifically for the health club. Yeah. I guess I I guess my only concern is and I voted for Grand Junction High School and I think a I think establishing a clinic in a high school is different than saying we're going to have stairwells in a high school. I mean I understand that we don't you don't tell the voters every little thing but something like I mean we had lots of discussions around a balcony. We've had lots of discussions around gyms. We have a lot of discussion around this auxiliary gym that we decided to keep, which that'll be another discussion down the road. I think it I think it it bothers me actually that if we did not make that clear to the voters.

079I mean that that is that is just kind of why I'm advocating so much to bring the community along in the decision now because I don't want it to look like they got hoodwinkedked by by the district. I feel like we're doing a really good job this board and our staff and admin to create a lot more trust that has been eroded away for lots of various reasons, right? It's just been contentious the last couple of years for everyone. and everyone's lives have been turned upside down and I just don't want there to I don't want to take all that trust and erode it away because they think well it was just in there and that's just what we did because it frustrates me to think that a clinic was proposed but I don't know

080how clear it was to the public. I mean I I did not know about that when I voted for it. So, I mean, and I'm not casting blame on anybody or what or or and and and my responsibility was probably to ask the board at the time more questions. But that's what I'm just saying. It's a clinic is different than a lot of other things when we're asking parents, you know, send your kids to school and trust them with us with what we're doing. And I just I just want to make sure that we are still moving forward with with that healing that we need in our community with the trust between our community and and you know the district. So that's just I I I just feel a lot of responsibility around that. Absolutely.

081So, and I think moving forward, if if this rendition of the board of education were to move into doing um another building or anything that that's that large a commitment and investment from our community that I would want those kinds of things very much specified at the risk of maybe not getting a bond passed, but to be very specific with the community and and transparent with I do want to add that the board did pass a resolution about this as well. So like it was it was very I mean with part of the bond language where it comes down to the vote this will said this we we can never communicate enough and obviously if if one person didn't understand it then we didn't communicate that enough but when we did when when the clinic

082and again this is my recollection of everything when we had the clinic at central it was it was clear it was board discussion public discussion that that the intent would be junction would be the next to have that now in the bond that that wasn't you know that wasn't communicated as well as it could have been as maybe other things should have been communicated too but you're right as we are today right that's history you're absolutely right whatever we do it we don't want to set up anybody for failure the school the staff me the district the future boards um want people and again understand not everyone's going to buy into whatever we do if we have one or not have one but to be very thorough and transparent about, you know, if we do

083have it or don't have it. It's what what what our reasoning and logic is behind that decision. Dr. Jones, did you have Thank you, Clint. Thank you, Mark. Thanks. And you're I know it's you guys are ran by grants, right? It's funded by grants. It's how you run how you run the Maryland clinic, right? And billing. Yeah, there's quite a lot of Medicaid billing. So then my question would be is it just for I mean is it is there a way to open it up for families and students or just I mean is it just student based I think a lot of that I mean a lot of the frustration is I mean it's great from August to June but what happens in July when school's out and and these students go home you know

084if they're not seniors they're sophomores freshman what happens then then you're stuck you know trying to find healthare or if it goes deeper than just if it's a mental mental health uh issue, you know, if it's just the son, but we don't know if he's having his health issue because he's having problems at home. So, why not be able to extend those to the families at home to be able to go in and get counseling in the home or have him come to the school and have a center. I mean, I would be more apt to be more comfortable if we opened it up to the families and it's not just 8 to five or a 9 to4 or whatever it is type of thing. I just didn't know if that was the way it

085was set up that designed that way or if it was a possibility to open it up to That makes it more difficult for you. I think I think we all I think we also need to consider school safety and the idea that we've got this thing locked down for a reason with with not letting the public come in and use the the school facility and not just have access to it. Um, I think we have to be really mindful about allow I I understand totally what you're saying and I I I agree when we're looking at behavioral stuff. How often do we really need to see more than just the the student? We need to see family members with them or or family me members in addition. Um, but if we're allowing the public to

086just come in and use that as a separate kind of facility, that would um I would piggyback that on my suggestion that we maybe put a clinic very very close in close proximity to a school but not inside the school and and sort of uh muddy up those waters between what is school and what is the clinic. Yeah, we had gotten a few emails around uh parental concern that that they thought the clinics were open to the public and how were how were people getting into the school and the school still staying safe which that is not happening. We we don't have public access to the and now what kind of if we allow people access from the outside to come in now what kind of safety do we have between people gain gaining access

087from the outside into that space and their again having access into the internal part of the school that I think would be right those would need pretty interesting logistics to get through to make sure that the inside of our that our school can remain safe and can be hardened if necessary. So Mark and Eddie would that be and again we're talking step 300 more time step one but is is that something with the outside exit you know just like we do in our main building there is you know entrance way and a security vestibule and people check out who they are. Is that would that still be a possibility if if that's how everybody decides to go to make expand the the reach? Can that be done? Was that thought of as as a jun

088a junction? Can you do an exterior entrance that would be secure to the clinic? Was that considered in the design? Thanks. So, just so people at home, it's not currently in the design. Uh, it could be to obviously make it more robust um to be secure for I think what our requirements are for security. Then we're going to have to have security on the other end. Exactly. So, um, I kind of want to just recap because I think we have some action items, right? Some things that I know the board needs follow-up information on. Um, so I Marilax's going to get us some uh some more addition information um on some of those reproductive services, kind of what the the list of those are. Um, we wanted uh we wanted to know too what I'm

089sorry. Did somebody keep a list? I should have read Well, this is what I wrote down. I wrote down um the survey results from the principal that were given students and then it sounds like possibly if there wasn't a parent survey that the board might request that, but if we don't have that data right now, then that'd be something we'd have to get. So, but at least the data that the principal um received and then I think there was a question around um like district level oversight um of the what's going on at the clinic. So, I can get clarification on that. But then I think there was a question for Mirac specifically around um the reproductive health. Yes. And then um Mr. Levenson had asked for the delineation of the services that are provided

090that do not require parental consent. um just kind of what percentage that looked like um because then obviously everything else requires parental consent. I think that information would be helpful board. Is there any other questions or thoughts comments that Well, I don't know if I even if I have my thoughts clear on this, but what is it that each of us need to know to help make the decision? Because again, you know, we're we're getting we're getting uh influenced by others that that we need to vote yay or nay on that, you know, clinic or no clinic. What what is it that um we we each need to to learn about that can help solidify the decision and the rationale behind that decision. Does that make sense? Yeah. I know for me I need to

091go back and find where I found information uh for instance in California where parents were not being um or parents were not giving their consent and I need to find out for whether that was um a district or administrative issue because again what I'm saying is I want to get out ahead of something and think of a long-term game because if it's something that does move forward then what do we need to do as a district to ensure that that doesn't happen here. Um, so I I will do some investigating on my I need that I need that comfort level of knowing that we're always keeping the parent informed um on what our obligations are per state law. So, and if those laws were to change, what does that look like? So, you know, I

092guess for me, you know, I brought up some is is that for lack of another term, that customer satisfaction information, you know, with all the interventions that have been done, have have they borne the fruit we had hoped they would with student performance, student wellness, those kinds of attendance, you know, just the things the outcomes that were the best hopes at the time at Central. I'm picking on Central. I know there's other data places, you know, other schools that have, but in our district, you know, have have those outcomes been reached? Um, that that would be one. Um, yeah. Yeah, that's that's good information. So, I think you can we can get data on satisfaction from the services. I'm not sure you're going to be able to pinpoint data that says because a schoolbased health

093center went in there in 2020, especially through everything that's happened in the last couple years that attendance was changed or that academic performance has changed. Like I'm just putting that out there. I don't think we're going to be able to get you that. We can probably get or we can get the feedback from Lance's survey that ideally would be I don't know what those questions were, but it would be asking the families at the school or the students at the school in this case. Did they feel like that the services met their needs? We could get that, but you're not going to get data that says and I'm not. The other thing that occurred to me is, you know, get I'm I'm looking at what are the issues. I I think as as I've listened

094to all all of our board and and many in the community, I think there's consensus that there are needs out there and probably even greater than the needs that were there four years ago. So if if we go with that and and maybe not everybody feels that way, but I sense that we we have a baseline that we agree with that that none of us are saying that we don't want to provide a service. We're questioning maybe is this the most effective and efficient and service that we can provide with some of the caveats that are frustrating for people. the parent permission thing perhaps or the cost which we have minimal costs with and I know but to to explore what what would be some other options one one came up I know we have

095to follow the state law I guess but are there I mean Tammy's not here but are there are there ways around that to still provide I hate to throw out everything because of one thing that may not sit well with people right you hate to throw out everything baby with the bath water when you know most of it's working or is effective and are there goarounds to get for example I'm not saying this is a major one the the parent permission thing right that that to to get a service that we can I can I just sure parent permission is required for every medical service and there's not that's that's period there's some behavioral health services that they're figuring out what is what hasn't had. Is that AC? That's accurate. Yeah, we've got to also

096think about, you know, Andrea uses the analogy putting the tooth toothpaste back in the tube today. They're doing that, but will not only will they have to, but will they be able to? It's in our memorandum of understanding. So, we can put that in a memorandum of understanding, and that's going to trump if state law changes. That's a great question. I'm not a lawyer. Yeah. But that can be part of our, you know, and we can put in our memorandum of understanding is that like if things change in a way that invalidates the memorandum of needs to be revisited. Andrea and I had a meeting with I think all of you guys were there a few several months ago. I think I think it was warm. Um, and you had mentioned that, correct me where

097I may be paraphrasing a little bit too much, that under the conditions of your grant and I believe state law that we really couldn't pick and choose which services you would offer. It had to be everything that was in that in the grant language or under or or maybe it was also CDPHE that was the the maybe the health the state health department about what they required a school-based Mhm. So, no, no, no, no, no. Okay, go ahead. I I didn't mean to interrupt you. So, that just brings another um question of mine that that I brought it up at the last meeting, but I'm going to do it again tonight. Um I'm a big proponent of choice, whether it's parental choice, uh choice in healthcare, choice in services. And so with the referring, we're

098it sort of feels like we're putting all of our eggs into one basket. Um, I don't know how it all came to be that that it's Marilac as an organization. Um, but in those referrals, I I like the idea of giving parents and students a choice in saying you could go here or you could go here for these kinds of services. I think when it comes down to to health care services, I like the idea that that people have choice. So again, if we were to do a referral process or something like that, I think we'd have to get really specific about how that would happen. K, what were you going to did? You have an example that you were going to share? What What did that look like? Fore strong. So you don't deny

099the service. You're you're saying we we can't again a hypothetical we can't provide that here but you can get it. I would be curious. for things like that. If we're starting to, you know, do allocart services, I would want to understand um, you know, does that do we have any information about that specifically impacting teen pregnancy rates if they, you know, don't have those services on site or whatever? just do it in the mics so that it's for the public. Just quickly, you talked about choice and yes, that's important to us, too. And and the whole model of school-based health centers is not to take away um care by their primary care physician or somewhere where they're already established. That's not the point of it. It the point is to be able to um almost

100like be a an arm or a support of that. And that's why we had physicians and pediatricians on our planning committee so that that was understood and it was part of the FAQ that I think is even still posted, you know, on the um schools healthy schools website that we we help coordinate the care. So if you came in or your child came in had something acute right then that we could take care of, it's not to say we're going to take over your care now forever. we're going to say follow up with your primary care physician or if it's a chronic condition, follow up with your chronic care or with your primary care uh physician. It's helpful for those families that don't have access to care, uninsured families, maybe have never had a medical

101home or a dental home, that we can be an option for them. So, it's it's there for them if they want to make it their medical home, but it's not to replace their primary care physician. It's to be a an arm, an extension, a support of that. Thank you. Dr. Hill, could you bring up the slide again? It's cutting off on mine of just what is the minor consent at what age? So because um the questions I have around this is you know you've got outpatient mental health services um and I know so the minor can consent to that they want care for that also for if they're a victim of sexual abuse um and then substance abuse disorder. I know it kind of cuts Yeah. And then Yeah. So I guess my question is

102is you know and I appreciate Dr. ulties making sure we're staying clear on what parents are getting consent on. But I mean, if there's I just I get concerned, you know, are can you only tell the parent if the minor tells you that if they're having a mental health issue, if they don't want the parent to be told or substance abuse? Because I guess then I wonder are the families getting engaged in helping the student through this crisis? I mean I understand some families are why kids have the crisis but what what is happening if like you know being a parent I would want to be able to come in and help support my child if there was this issue and granted that you know being a a mother of teenagers they don't always want

103to tell you everything. So, I appreciate that they have friends or other people they can talk to, but but then it just concerns me from the parent standpoint like how then are we how can the parent then support their child? So, am I can the only a parent know that a child access that if the child gives the health care provider permission to disclose it to the parents? Okay, that would I mean that's my understanding is that you right that's that's for any healthcare provider. That's not just Marilac. I'm I appreciate you guys answering our questions and I don't I don't want people to think we're just I'm picking on Marilac, but I'm I just want an understanding of the Colorado law. So, the So, the parent may give a general uh sign a a

104general consent form saying, "Yeah, if my kid needs to do whatever at the healthcare clinic, that's fine." But if you know, if the if the parent is thinking, well, they would use it for maybe the the sports physical or or one of those things, but really the student ends up using it for one of the other things. The parent would not know that they came in. Thank you. The students right to decide whether or not the parent would be brought into the conversation. Got it. Right. Right. Right. You you have to adhere to the law and and just for those who might not have heard, Marilax says that they very strongly encourage the students to speak to their families about it. But again, by law. So, you know, I don't agree with the law. I'm

105just going to say personally as a parent, I don't like it. Um but you know it it is the law. So um that does kind of tie the hands of physicians. Um obviously puts you know the school district we we don't control that part of it nor does Marilac control that part of it. So I think it's just a matter of how do we navigate through some of these things to make sure that as far as it's up to us we we do keep parents at the center of that. And I do appreciate that you guys are advocating and telling telling students to do that. Um if any if any of these require medication though to treat an infection, those can be administered then to the student if it's like a sexually transmitted infection. Okay.

106You don't dispense of those. Okay. Okay. Okay. But that that is one I think just for clarity a student can get a medication without parental consent because it falls under this minor consent. Okay. Right. Right. What I'm what I just want to clarify is that some of these do actually require a medical treatment like a a medication. Okay. Right. I'm not saying whether you know We're not saying that all medical services require parental consent because there are these that are minor consent and a medication or a treatment could accompany whatever that need or whatever needs to be done for the student. Correct. Okay. You don't stock them. You don't dispense them. write the the the script for them and the student then goes and seeks out attaining. Yeah. Right. Just like when I go to

107my doctor. Yeah. Exactly. Yep. No. Understood. I just want to I just am trying to bring clarity. Um I know a lot of well at least before becoming a school board member it was a lot of um understanding from the parental view that the school board doesn't have any say in this because this is state law when it's you know when it comes to this age with your the children. So, I just Well, right. No, because the law the law will always I mean, my understanding is the law is always going to trump um a policy, a procedure, or anou. And we can ask Tammy that, but it's the law. So, I don't see how you could I would like her to answer that for everybody. I did talk to her about that and I

108believe you're correct. Okay. Well, yeah, but I would like Tammy. I'm not an attorney, but we'll I'd like Tammy to just give that answer. board. Was there any other um items on our list that we wanted to investigate? So, okay. Well, personally, I have some things I want to look at. Obviously, we'll then see what we can get from the principal. Marilac will get us a couple different uh data or data points and then um uh if I guess if board if you think of anything else, we can email those so that we can get the information. And uh so is the plan next meeting or is that too tight? I don't know because our next meeting is Tuesday. We have a pretty packed agenda with our business meeting. Um so potentially yeah the work

109session um if if needs be or if we have to do something before that. If we're able to get the information for the meeting on Tuesday, we could see if it wouldn't take long to present that to make sure that uh the board can have that information. So, if we have it, I'd say we could probably add that. We have time to I don't know that we're take Yeah, I wouldn't say unless the board is ready. I wouldn't if if this is looking like it needs to be a vote. I don't know. I don't know that I'd feel personally ready by Tuesday to make a a vote on it. So, I want to make sure everybody feels like they've had time to digest the information um before doing any kind of vote. So, it could

110be discussion items on Tuesday, but no vote. We could get the information say by the the end of the month and we can have vote following in February because you're right. You want to sit on that information and see if that prompts new questions. Yeah. Well, we want adequate time for our our community to reach out as well. Correct. Any other? All right. Well, thank you everybody. Uh thank you for Marilac and our other staff that came out in FCI to answer our questions. Thank you community members for uh coming if you need to catch any of us afterwards if you want to any questions or you're welcome to um email us as well um as we're taking in all that feedback um during this time. Thank you everyone.