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HUGO — While kids meander among the stacks at the Hugo Public Library, 5-year-old Letty Nuffer sits cross-legged at a table concentrating on her language skills using a borrowed laptop computer that displays a fun video to show her how to pronounce consonant blends.

Thanks to a pilot project in telehealth, Letty can access therapy for her speech delay without a four-hour round trip to Denver for an in-person appointment. By checking out an equipment kit designed to facilitate a wide range of health care consultations, Letty’s mom, Kali Nuffer, can connect directly with her therapist as well as to specially designed video lessons.

The library, already an almost daily destination for Nuffer’s family, now has become the conduit for virtual doctor’s appointments for all four of her kids — just one more service that the facility offers beyond the traditional resources for residents on the Eastern Plains. Kristin Allen, the library’s director, says this year’s addition of telehealth has started to become, well, contagious.

“I’ve had several people recently call and say, ‘How can I do this? How can I get one of those kits?’” she says. “Just come down and get a library card. That’s all you need.” 

For many Coloradans, today’s library card unlocks a lot more than books or even an ever-expanding array of digital material available from 113 public library jurisdictions across the state — and that’s particularly significant for relatively far-flung rural communities whose smaller systems account for nearly 75% of the total.

The way libraries serve the public has evolved significantly over the last several years — a trend that only accelerated during the COVID pandemic, says State Librarian Nicolle Davies. She notes that libraries “leaned into technology” for the entire range of patrons, whether that involved teaching grandparents how to use video chat apps, preparing job seekers for a 21st-century workforce or helping kids advance their digital literacy.

“For years, we were really freaked out that everybody identifies us as just books, but we’re so much more,” Davies says. “And the reality is we’ve been in the (digital) space long enough now that we’re comfortable saying, ‘Yeah, we are still about books and we’re about all these other things as well.’ So it’s very surprising when people visit libraries today and find out what we’re doing and what we have, because the perception still can be outdated and antiquated.”

The pandemic necessitated a number of innovations that worked around COVID restrictions, and many of those remain. Davies, who lives in Douglas County, recalls checking out a meat-smoking kit from her local library that came complete with recipes and seasonings. She also checked out an outdoor version of the block-stacking game Jenga for the family to play.

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“There were just so many ways that the library got really creative on how to provide services to people during the pandemic,” she says.

The pandemic also elevated the role of libraries when it came to digital resources like ebooks, audiobooks, streaming movies and music, notes Sherri Baca, executive director of the Pueblo City-County Library District. She said her district reallocated its 2020 budget to pump up funding to digital vendors, embracing the “library at home” concept that meant buying fewer hard-copy books in order to meet the needs of homebound patrons with digital offerings.

“Readers are reading, but the formats are a little different, which is great,” Baca says. “I think that that’s what libraries are supposed to do, move with the times and be very relevant to our users, and get them what they need when they need it.”

That credo has provided scaffolding for public libraries’ ongoing evolution, a transformation forged in times of a devastating virus and deafening political noise — both challenging factors as library workers face burnout on one hand and, on the other, an invigorating reimagining of their role. Pushing back against the headwinds of censorship, libraries have sought to serve as patches in the social safety net, channels closing the distance between patrons and health care, and myriad other functions — while still navigating the shifting demands for information and entertainment in all its digital and analog forms.

Digital content use was escalating even before the pandemic, and COVID ratcheted the demand even higher. But for the Denver Public Library, there’s still high interest not only in bound books, but also older media formats such as CDs and DVDs, which remain popular among those who may not have access to the latest streaming technology.

“We think that’s an equity issue,” says Michelle Jeske, the city librarian and executive director of the Denver Public Library. “A lot of people still don’t have high-speed internet access or may not have great devices for downloading ebooks or streaming videos. Some people might still have a VCR or a Blu-ray player, so we’re still seeing use of those formats. And that’s why we’re continuing to buy or support that part of our collection.”

The specter of censorship

In any format, library collections nationwide have become the target of challenges — some from individuals, others orchestrated by politically motivated groups that have brought issues surrounding intellectual freedom prominently into the public discourse.

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Colorado isn’t without its conflicts, but has been far less affected than many other states. Still, lawmakers in the last legislative session passed a measure designed to reinforce the policies and procedures Colorado’s public libraries employ not only to acquire and use materials, but to deal with challenges to their content. 

James LaRue, executive director of the Garfield County Public Library District, has dealt with more than a thousand such challenges over a career in library management that includes stints as director of the Douglas County libraries as well as with the American Library Association’s Office for Intellectual Freedom. His book “On Censorship” explores the motives behind the challenges, which have come from across the political spectrum, and the dangers of book banning.

“It has gone from the one or two people that get upset by running across something in a library to being more centrally coordinated,” he says, noting that nationally many of the recent objections stemmed from both isolation during the pandemic that pulled some down conspiracy rabbit holes and political strategy aimed at motivating conservatives for the 2022 midterm elections — most often by objecting to books with LGBTQ content. 

Poll after poll says this is a deeply unpopular view, that 70% of either party is opposed to censorship. But why do they keep at it? Because it seems to work. It gets people riled up, and as always in America we are both obsessed with and repelled by sex.

— James LaRue, executive director of the Garfield County Public Library District

“Poll after poll says this is a deeply unpopular view, that 70% of either party is opposed to censorship,” LaRue says. “But why do they keep at it? Because it seems to work. It gets people riled up, and as always in America we are both obsessed with and repelled by sex.”

Although he notes that other states have experienced more frequent challenges, and have seen legislative efforts aimed at even criminalizing anyone who provides access to certain materials, about five states have passed what he calls “anti-censorship legislation.”

“Colorado,” he adds, “is a much happier environment.”

In particular, he notes the new state law’s emphasis on the “request for reconsideration” that challenges must go through that effectively slows the process and prevents knee-jerk reactions. The new law requires that library boards establish a written policy for reconsideration, and lists specific standards that, among several other things, require they consider the perspectives of marginalized groups.

Davies, the state librarian, says that the rancor that spills over from book challenges now appears to have gotten personal. For years, she recalls, surveys on the most trusted professions in America found librarians ranked near the top, along with firefighters. But in the last few years she has been troubled to hear the integrity of her peers disparaged, even if the spitefulness seems less prevalent in Colorado.

“We’re all librarians at the end of the day,” she says, “and so when institutions like the American Library Association are getting challenged, and everybody’s lumping our profession into having this agenda of grooming children and being pedophiles, it’s just been something I never thought I would have seen in this work.” 

The Pueblo district has had a request for reconsideration policy in effect for more than 10 years, and the passage of the new law required them to simply tweak the timeline for how often an item could be reconsidered, Baca says — from once in a 12-month period to once every two years, the most frequent allowed by the law.

Although she welcomes the attention to the issue of censorship, she estimates that in the nine years she’s been with the library system it has received only one or two requests per year for material to be reconsidered.

In Denver, Jeske estimates she sees “zero to one challenge a year — knock on wood.” Even before the new state law, DPL changed its policy to only allow Denver residents to challenge materials to block organized national challenges.

Providing a social safety net

The pandemic proved challenging in many ways, and its aftermath revealed all sorts of societal issues that had always been present but suddenly were exacerbated. Think homelessness, mental health issues and substance abuse, among others. And libraries, particularly in population centers, found themselves nudged to become more engaged when it comes to connecting those in need with social services.

“That’s nothing new, especially for the Denver Public Library being in this urban setting,” Jeske says. “I think the pandemic demonstrated to us and the community how vital we are as a public space and a place of access — for learning, for knowledge, for technology and connection to the world.”

Not to mention for clean water and a restroom.

Since 2015, the Denver Public Library has had at least one social worker on staff to serve that population. That lone hire nine years ago “seemed like a win,” Jeske says, but soon it became clear that one wouldn’t be enough. Now there’s a Community Resources team of at least 10 people, some of them “peer navigators,” people whose experience mirrors those they’re serving.

The team’s training has spilled over to the entire frontline staff so they’re better equipped to handle issues like security, de-escalation, mental health and first aid.

“We’re one of the pioneers in that space,” Jeske says.

Increasing concern over drug abuse at libraries surfaced early last year with a string of suburban Denver library closures over possible contamination from methamphetamine fumes. (There were no reports of patrons affected by exposure.) Contamination became an issue at one branch in the Pueblo district that required action to remediate exposure to the public, Baca says — though fortuitously, the branch was already scheduled to close for renovations. 

But just as libraries have adapted to community needs, they’ve also had to adopt safety measures. In Pueblo, that means installing environmental sensors in the restrooms that monitor the air in real time to detect potential hazards and immediately notify staff.

“A lot of preventative kinds of stuff,” Baca says, “and just being really active in making sure people understand what the library rules are.”

Pueblo’s library system saw another vehicle for meeting the community’s needs. Although most of the district’s facilities are clustered in the city, Baca launched the telehealth pilot in 2,000-population Colorado City, about a half-hour south of the city limits. Kits similar to the ones used in Hugo and elsewhere are available, with the added feature of a hot spot that can provide patrons mobile internet access in an area where service can be lacking — thanks in part to grant money from the Federal Communications Commission during the pandemic.

Pueblo recently received a $250,000 Mellon Foundation grant for a project aimed at collecting digital archives to preserve the local culture and history of areas that may not have the wherewithal to host the material themselves. As the regional hub for this effort, the Pueblo library will be reaching out to communities across southern Colorado to solicit audio, video or photo files that can be uploaded to help maintain the historical record.

She holds out both projects as evidence of the evolving state of public libraries as they match resources with pressing local concerns.

“So it goes back to the social supports,” Baca says. “Where are the gaps? Can the library be relevant?”

Digital literacy, broadband and health

Kieran Hixon suspected something was up when he took part in Gov. Jared Polis’ broadband initiative and learned that rural areas use telehealth at far lower rates than urban centers. The trend seemed counterintuitive, given the scarcity of medical services in rural areas.

A subsequent partnership with the state Office of eHealth Innovation explored melding telehealth services with libraries that, especially in small towns, are considered anchor institutions when it comes to broadband. And it turns out that one of the hurdles to implementing telehealth in those communities is digital literacy. 

Hixon, the rural and small library consultant within the state department of education, saw the gaps and immediately knew libraries could be relevant by combining their core mission — namely literacy, including the digital kind — and their unique ability to provide access to broadband in far-flung locations. He started calling around to small libraries to ask what they thought and found that while some were already hearing about patrons’ health concerns, they didn’t have the resources to assist them. 

“I called this one librarian and she says, ‘People are coming in, and I just don’t know how to help them. And I could sure use help to do it better,’” Hixon says. “I was like, OK, we’re onto something.”  

In partnership with Ashley Heathfield, a telehealth project manager at the Office of eHealth Innovation, Hixon combed data to find the counties with the worst health outcomes that were farthest from medical services. Then they targeted libraries in those counties and sent out an email to see who was interested.

Eventually 17 library jurisdictions, encompassing 24 buildings, signed on to the pilot project, which has been running for less than a year. Early findings include greater use of the in-library spaces than the kits. 

But in Hugo, director Allen began a “soft launch” last spring, and then started spreading the word. Two portable kits have been the most popular, with Allen scanning a barcode just as she would a book to check them out. Patrons normally have 24 to 48 hours to use the kits, though Allen remains flexible. She also fitted a mobile desk that patrons can roll into the library’s board room to use for in-library telehealth appointments with privacy.

Each kit contains a laptop computer with features like headphones with individual volume controls for the hard of hearing and large-print keyboards for the vision impaired, and an ergonomic mouse. It also includes a ring light, scale, blood pressure monitor (including cuff sizes from child to extra large adult), pulse oximeter and forehead thermometer. The kit includes a wireless hot spot to provide an internet connection to a health care provider.

Getting people to realize that libraries are available for more than just books is changing a thought process.

— Kristin Allen, Hugo Public Library director

Allen estimates that the portable kits get checked out five or six times a month, a gradual increase as the area’s “very traditional” population becomes familiar with telehealth as an option and gets used to the idea that their library can be a resource to pursue it.

“Getting people to realize that libraries are available for more than just books is changing a thought process,” Allen says. “They still get surprised when you say, ‘Oh, yeah, you can come in and make copies.’ And then you throw in being able to check out a telehealth kit, and they’re like, ‘A what?’ It’s just a whole new thing for a lot of people to wrap their heads around.”

Librarians going … and coming 

As libraries have undergone mind-bending changes, there’s been some evidence of burnout among librarians even as another generation has embraced the job for new reasons.

Davies, the state librarian, says she’s seen signs of burnout particularly among those frontline staff who deal directly with the public. She also notes what appears to be a mass retirement among those in library leadership roles, though it’s unclear whether that’s a response to librarians coming under attack over issues of content, the overarching lack of civility from the public or just demographics naturally thinning the ranks.

“Regardless of why it’s happening,” she says, “it is happening.” 

But she adds that a lot of younger people have been attracted to librarianship, prompting a spike within some programs as students seek advanced degrees in library and information science, because the shifting role of libraries has in some ways recast the profession as social justice work.

“It’s an equalizer in a community,” Davies says. “It serves everybody.” 

Allen, 44, first worked as an auto insurance claims adjuster in California, but about 14 years ago migrated to Colorado when her company moved its call center to Colorado Springs. She eventually moved to Limon after her husband took a job at the correctional facility outside of town.

With a degree in early childhood education, Allen did day care in her home. She often took her own kids to the Limon Memorial Library for story time with library director Lucille Reimer.

Describing herself as “one of those odd introverts that likes people,” Allen soon found that at the library she was completely in her element, and that comfort zone fed an innate desire to help people. It wasn’t long before Reimer, who needed some extra help, offered her a part-time job. So a few days each week, Allen learned that being a librarian involved a lot more than checking out books.

“It’s a service that you’re providing a community,” she says. “And it just spoke to my heart.”

After about a year, the position overseeing the Hugo library opened up. Reimer urged her understudy to apply. Allen hesitated — she didn’t have that much experience. But Reimer convinced her to take a shot, and she got the job.

It’s part-time, like many library jobs in rural areas, but that meant Allen could continue helping Reimer on a morning schedule in Limon before heading over to run the Hugo library in the afternoon. Now, Reimer is retiring and passing the reins in Limon to Katie Zipperer, who has been directing the library’s bookmobile, another crucial tool for serving the 2,500 square miles of Lincoln County.

“We try to do everything we can together,” says Allen, who’s in her third year directing the Hugo library. “So when we make flyers, when we do programs, it’s always the three of us working together. So it’s been great to share resources.”

When she attended CALCON, the annual gathering of library staffers from all over the state, Allen saw the world opening up. She knew she wanted even her tiny facility to be about much more than books, and suddenly she learned that bigger (and better funded) libraries were doing all sorts of things to serve their populations.

“It just opened my eyes,” she says. “When I saw what other, bigger city libraries were doing, I thought, ‘We can do that.’ I was like a blank sheet when I got here.”

While Hugo’s size and budget might be limiting, Allen’s imagination was not. She noticed the array of “tool kits” that other libraries offered — materials for crafts, sewing machines, yoga, even memory resources for Alzheimer’s patients. She went to her board and told them that Hugo wasn’t keeping up. The library could do more.

So she started small, packaging various school materials in backpacks that students could check out. After those started gaining popularity, Allen moved to providing copying services and printing services that could produce brochures, flyers and posters. Word started filtering through town that the library could offer some extras like binding and laminating, printing and faxing — Allen even started providing a notary service.

With the Lincoln County Courthouse nearby, services like those proved particularly popular.

“We’re trying to do small things,” Allen says. “We don’t have tons of room but we can add on services to make things easier for people.”

When it comes to the future, Davies figures that Colorado is “just scratching the surface” in terms of creative ways that libraries can serve their patrons.  

“Ten years ago, we didn’t have a library of things where you can check out tools and you can check out cake pans, and you can check out VR headsets or GoPro cameras,” Davies says. “Whether you’re checking out gardening tools because you live in an apartment, but you have a gardening box, you don’t need to own these things. But how cool is it that you can check it out from the library?”

Facing millions of dollars in fines, dozens of violations, legions of complaints from homeowners as well as local governments, oil and gas operator Prospect Energy on Wednesday had its right to do business in Colorado canceled.

The Energy and Carbon Management Commission endorsed a settlement agreement between the commission staff and the Highlands Ranch-based company. Prospect Energy also has an agreement with Larimer County and Fort Collins to clean up sites.

As part of the agreement, $1.7 million in ECMC fines will be waived, with what funds the company has going toward securing and cleaning up its sites. Prospect Energy was fined for illegal flaring, spills and failing to do well-integrity tests.

Prospect Energy’s 59 wells will end up in the ECMC Orphan Well program and will eventually be plugged and abandoned by the state.

Under the agreement, Prospect Energy’s owner, Ward Giltner, must obtain commission approval before owning or operating any future oil and gas properties in Colorado. Giltner did not reply to email and telephone requests for comments.

The company, however, still faces $337,000 in fines from the state Air Pollution Control Division for air emission violations. In 2022, the division ordered one of Prospect Energy’s sites closed until dangerous emissions could be curbed.

“This is an exceptional and rare course of action,” APCD director Michael Ogletree said at the time. “This is a unique situation that calls for extraordinary measures to ensure we are protecting public welfare.”

Division inspectors found emissions of volatile organic chemicals and hydrogen sulfide, which smells like rotten eggs, on repeated visits to the company’s Krause facility tank battery.

“These issues have been going on for more than four years,” said Matt Lafferty, Larimer County principal planner. “The county and the city filed a formal complaint to push the ECMC.”

Prospect Energy operates mainly low-producing wells — 49 in Larimer County and 10 in Fort Collins — and several tank batteries for collecting produced water and oil. The wells date as far back as 1928.

“We have an old, outdated oil field that has seen the end of its life, and I am sure it is hard for owners to let go because they still make a little money,” Lafferty said.

Still, the passage in 2019 of Senate Bill 181, which made protection of public health, safety and welfare as well as the environment the priority in regulating oil and gas operations, has put pressure on small operators and low-producing fields, Lafferty said.

For example, Lafferty said, in 2020 the state adopted rules severely limiting flaring, the practice of burning off gas from oil and gas wells, and it created another violation for Prospect Energy.

“Once that ball started rolling on Prospect Energy, it was clear it didn’t have the resources,” Lafferty said. “Everyone is starting to take action. The snowball got pretty big.”

“This isn’t an oil and gas thing,” Lafferty said “It is a health and safety issue.”

Andrew Klooster, the Colorado field advocate for the environmental group Earthworks, first documented emissions from Prospect Energy, using an infrared FLIR camera, in 2021. Klooster said exasperated residents had contacted his group.

“People were complaining of odors, headaches, nausea,” Klooster said. “Krause tanks had holes in them because they were so old and decrepit,” he said, adding that even when they were replaced, emissions from hatches continued.

“An operator that was not interested in complying”

Klooster said over the years he has made 29 visits to Prospect Energy facilities finding repeated violations, with a big point of concern the Fort Collins Meyer tank battery, where in recent years the Hearthfire development — with homes going for $1 million or more — has been built.

“The refrain the county has been hearing from us and the community is that this was an operator that was not interested in complying with the air quality regulations,” Klooster said.

Meanwhile, ECMC inspectors were also logging a string of problems and began issuing violation notices in 2020. The company racked up 14 penalties adding up to $1.7 million.

Prospect Energy provided the ECMC staff with financial documents showing that it could not pay the fines, Caitlin Stafford, a senior assistant attorney general representing ECMC staff, told the commission.

Commissioner Trisha Oeth said she was “unhappy” with the company completely avoiding paying a fine. Stafford said it is the “hope the operator puts whatever remaining money they have to put the last bit of compliance.”

“It’s not the best outcome,” ECMC Chairman Jeff Robbins said, “but the only likely outcome.”

Prospect Energy still faces the air pollution fines. Under an agreement with the state air pollution division, the company was going to pay in installments, but failed to pay starting in March, according to Zachary Aedo, an agency spokesperson.

“On Tuesday, Aug. 13, the Colorado Attorney General’s Office filed a lawsuit on behalf of the division seeking compliance from Prospect Energy and its manager Ward Giltner with the terms of the enforcement agreement,” Aedo said in an email.

Under the terms of a separate agreement reached with Larimer County and Fort Collins, Prospect Energy will shut in all its wells and then hire an independent inspector, approved by the local governments, to check that none are leaking.

Any leaking wells will be repaired within 21 days. In addition, the company will remediate a flowline spill in the Country Club Reserve neighborhood east of the Fort Collins Meyer tank battery, and remove the surface equipment there and from the Krause facility to the north within 90 days.

Lafferty said that Prospect Energy hopes to recoup some money by selling off the equipment. He also said that the county’s inspector will participate in the third-party inspection of the shut-in wells.

“It has been a saga,” Klooster said. “Prospect gets out of paying some fines, but for the residents it is worth it for the peace of mind it will bring.”

More than 35 people have been referred for rabies post-exposure treatment following last week’s announcement about a rabid puppy at a rescue adoption event. But Colorado has so far identified no human cases as a result of the event, as state health officials continue to plead with those who were at the event to come forward for screening.

Rabies is almost universally fatal once symptoms appear, making this perhaps the most urgent public health response in Colorado since the early days of the COVID pandemic. The disease can be prevented after exposure if those exposed are treated before symptoms occur.

A spokeswoman for the Colorado Department of Public Health and Environment said Wednesday that the state has assessed more than 115 people to determine if they had contact with the puppy that could have spread the rabies virus to them. The more than 35 people referred for what is known as post-exposure prophylaxis came from that group.

More are expected to be screened as public health workers continue to interview people.

“I don’t want people to either minimize the risk or say ‘I didn’t have that much contact’ or ‘I probably wasn’t exposed,’” said Dr. Michelle Barron, the senior medical director of infection prevention and control for UCHealth and an expert in infectious diseases. “We want the public to get a formal assessment so (public health officials) can ask those questions.”

The head of the rescue group that organized the adoption event posted on Facebook this week, and told 9News in an interview, that another dog from the infected puppy’s litter subsequently tested positive for rabies after being euthanized. State health officials confirmed the second positive test Wednesday evening but also said the negative tests for the remaining 10 puppies in the litter did not rule out the possibility that they, too, were infected.

This is because the test is conducted only on brain tissue, which, if positive, indicates the animal was both infected and infectious. Because rabies develops slowly, it is possible other puppies were also infected but that the infection hadn’t yet reached the brain — meaning they weren’t able to spread the virus when they were euthanized but they could have later become infectious.

“CDPHE is doing everything possible to protect people and other animals from rabies,” agency spokeswoman Kristin Richmann wrote in an email.

People who attended the adoption event should contact CDPHE for screening. They can call the agency’s hotline at 303-692-2700 during business hours or 303-370-9395 after hours and on weekends and holidays. Or they can email cdphe_zoonoses@state.co.us.

A 20-day delay

The puppy, a shepherd mix, was part of a litter brought from Texas to Colorado and made available for adoption at an event July 20 at Moms and Mutts Colorado Rescue for Pregnant and Nursing Dogs on West Oxford Avenue in Sheridan. The puppy was one of 12 in the litter, which was called the “July Shepherd Mix” litter or the “Celebrity Kids” litter at the event.

CDPHE spokeswoman Gabi Johnston said the puppy arrived in Colorado on July 16. It began showing symptoms of rabies July 29, became seriously ill and was euthanized. A veterinarian submitted a sample for rabies testing, which came back positive Aug. 7. CDPHE notified the public Aug. 9.

That delay between when people were potentially exposed at the adoption event and when they were notified is not ideal because the post-exposure treatment should be started as soon as possible.

But it is crucial people receive the prophylaxis treatment any time before they begin showing symptoms of infection. Once people begin exhibiting symptoms, especially ones related to the virus’ attack on the brain, then rabies almost always kills — save for a handful of cases worldwide.

A wait of week — or years 

Rabies has an irregular incubation period, depending on the type of exposure and the location of infection. A scratch on the hand from an infected animal, for instance, may take longer to show symptoms than a bite on the neck. The typical incubation period in humans is anywhere from three to 10 weeks, but it can be as short as a week or as long as several years.

Post-exposure treatment consists of a large dose of rabies-fighting antibodies as well as a four-shot course of rabies vaccination given over a period of two weeks. The idea is to amass an immune-system army to fight the virus before it can gain a foothold.

On Facebook, the rescue that ran the adoption event said it has worked closely with the state on the response but also said the state “created a panic” that has caused families to back out of other adoptions and has severely damaged the rescue’s finances.

Barron, the UCHealth doctor, said the state is being appropriately cautious.

She said it’s possible the puppy had a lower level of infectiousness at the adoption event, since it wasn’t showing symptoms there. But she said that’s not certain, which is why public health officials are urging people to be screened and, if appropriate, start treatment.

“If this was not a uniformly fatal disease, we would play by different rules,” Barron said. “But it’s so high-risk that if we’re wrong about what information you’re giving us, you could die.”

“Devastated” adopters

Johnston, the CDPHE spokeswoman, said the puppy — and likely the rest of its litter — is believed to have had contact with a rabid skunk in Texas. CDPHE said last week that the owners of the puppy and the veterinarian who examined the dog were both bitten. They are among those referred for treatment.

Meanwhile, all of the other puppies from the litter have been surrendered to animal control, where they were euthanized because they had contact with the infected dog and, possibly, the rabid skunk. The puppies were unvaccinated against rabies at the time of the exposure in Texas.

In most states, puppies receive their first rabies vaccination after they are 3 months old, followed by booster shots in subsequent years. Colorado requires dogs 3 months and older that are being imported into the state to have a proof of up-to-date vaccination. 

“The people who adopted the other puppies were understandably devastated when they learned their puppies were exposed to rabies for a prolonged period of time,” Johnston wrote in an email.

The state has also requested immediate vaccination and quarantine of additional animals from the rescue, saying they had potential exposure to the infected puppy. Because their possible exposure was significantly less than that of the puppy’s littermates, though, the state has not ordered the animals be euthanized.

Homelessness in Denver increased by 12% in the past year, but for only the second time in recent history, the number of people living outside has decreased, according to the results of an annual count released Wednesday. 

The number of people living in shelters, transitional housing, tents and on the streets of Denver climbed to 6,539 from 5,818 the previous year. In the seven-county metro area, homelessness rose 10% to 9,977 people. 

In Denver, the good news is that there are fewer people sleeping in tents and on the streets after a massive effort to move people indoors. 

Denver Mayor Mike Johnston, who campaigned on a promise to house 1,000 people by the end of his first year in office, said the drop in unsheltered homelessness in the city was among the largest in the nation, in line with Houston and better than Seattle, Chicago, Washington, D.C., and Atlanta.

There were 1,273 people sleeping outside in Denver on the January night volunteers and outreach workers conducted the count, down from 1,423 a year prior. 

And as of Wednesday, there are 117 tents in the city, down from 242 when the “point-in-time” count was taken, the mayor’s office said. The city has cleared 17 encampments and closed 350 blocks of downtown to camping under the mayor’s homelessness initiative. Critics have accused the city of offering people temporary shelter instead of more permanent options. 

“We have always believed that homelessness is a solvable problem, and now we have the data to prove it,” Johnston said in a triumphant news release. “Denverites should be proud to live in a city that responds to homelessness with compassion.”

Not counted in the survey: the 4,300 new migrants from mainly South America who were sleeping in city-funded shelters on the night of the count. 

The Metro Denver Homeless Initiative, which organizes the annual count required by the U.S. Department of Housing and Urban Development, said that leaving migrants out of the count was the best way to determine “the most accurate information of those experiencing homelessness on a single night.” 

The number of people living in shelters in Denver grew by 20% throughout the year, however.

In the seven-county area, the number of people sleeping outside increased by 5.6%, to 2,919. The number of chronically homeless — people who have not had a home for at least a year — rose by 16% and the number of homeless families grew by nearly 50%, to 3,136 from 2,101.

Volunteers spread across the metro area, throughout Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties, from sundown Jan. 22 to sundown Jan. 23, tallying and interviewing people in shelters and outside. 

Johnston said the data shows the city needs to work harder at preventing homelessness in the first place, as well as expanding family shelter and permanent housing options. The Denver City Council is scheduled to vote next week on whether to ask voters to approve a sales tax to generate $100 million annually for affordable housing. The Affordable Denver Fund would pay for 44,000 units of affordable housing over the next 10 years, the mayor said.

PUEBLO — Urban farmer Perdita Butler was ready to harvest her bok choy and fresh, crunchy kohlrabi outside her 1940s stucco home in Pueblo. It was early spring, and the nymph grasshoppers were already munching her crops, forcing her to cover her beds with protective gauze nets. She carefully peeled back the nets to reveal blue potatoes, golden beets, dinosaur kale and other vegetables erupting from the soil.

“What I love about farming is there’s always something new to learn,” Butler said, looking at the snap peas taking off on one side of the garden.

Later this summer, she’ll sell these vegetables and others she’s growing at a new farmers market on Pueblo’s East Side neighborhood—a community without a grocery store since the Safeway in the area closed seven years ago. Butler hopes to build community and improve nutrition in the neighborhood by selling fresh, affordable produce grown five miles away on her microfarm Quarter Acre and a Mule.

Federal, state and local programs that incentivize buying produce at farmers markets, including those in Pueblo, make them affordable to some low-income families and older adults in Colorado. In addition to increasing participants’ access to fresh fruit and vegetables, these programs support small farmers like Butler and boost local economies, especially during the summer and fall harvest cycles.

Three programs specifically help low-income older adults and women and their children in Colorado: Colorado Women, Infants, and Children (WIC) Farmers’ Market Nutrition Program, Boulder County WIC Farmers Market Program, and the Colorado Nutrition Incentive Program.

“It’s a win-win. You’re feeding people. You’re supporting farmers,” said Daysi Sweaney, director of healthy food incentives at Nourish, a nonprofit that helps implement and run some of these programs.

Consumers and growers have participated in farmers market programs in Colorado over the past five years, but barriers such as funding cuts and limited time, transportation and money remain challenges.

Farmers market programs

According to the nonprofit Feeding America, Pueblo is among 10 counties with the highest rates of food insecurity in the state. Still, efforts to help families afford local produce are growing in the area. At the other Pueblo Farmers Market location, in downtown Mineral Palace Park, redemption of incentives for fruit and vegetables by low-income families increased significantly from $9,000 in 2020 when it began accepting them to $25,000 last year.

Growth of the federal Supplemental Nutrition Assistance Program (SNAP) and Double Up Food Bucks—a grant-funded program available in some states like Colorado that gives SNAP participants double the amount to spend on fruit and vegetables—and the WIC Farmers’ Market Nutrition Program has contributed to the increased use, said Marci Cochran, market director for the Pueblo Farmers Market.

“The WIC Farmers’ Market Nutrition Program is explosive in Pueblo,” Cochran said of the program.

Funded by the U.S. Department of Agriculture, the Colorado Department of Public Health and Environment program gives $30 annually in coupons for each participating family member to spend at 22 participating farmers markets (down from 24 last year) statewide before Oct. 31. For example, a pregnant or new mom and her two children over six months of age would have $90 to spend during the season, an increase of roughly 8% from their annual WIC budget of approximately $1,092 for fruit and vegetables.

Angelika Sunie, 25, of Pueblo, who has two children ages 1 and 4, has used the WIC Farmers’ Market Nutrition Program for the past two seasons.

“It really helped stretch my benefits,” said Sunie, who also uses SNAP and Double Up Food Bucks.

Sunie bought green beans, Pueblo chiles and Palisade peaches at the farmers market. She made a peach crisp and a simple syrup out of peaches for tea.

She said it helped her bring healthier foods into her home during the summer. Sunie added that she would have spent twice the amount allocated if it had been available.

When she was pregnant with her son in 2022, Sunie said eating more nutritious foods from the farmers market helped her pregnancy. However, she does not qualify for the program now that she has started a new job at UCHealth.

Sweaney said WIC families’ spending at farmers markets is highest along the Front Range corridor stretching from Pueblo to Greeley, but the redemption rate statewide is relatively low.

According to CDPHE data, the use of the coupons has risen from 17% in 2021 to 23% in 2023. (The program was first piloted in 2020.) Emily Bash, a nutrition and physical activity specialist at CDPHE, said she hopes to increase the rate this year by mailing coupons earlier, using text reminders and offering handouts in multiple languages.

Bash and her colleagues also received a $350,000 USDA grant to move from paper coupons to a digital system. It’s easy to lose paper coupons or forget to bring them to a farmers market, Bash said, and buyers can’t get change if their purchase is less than the coupon amount. She said these digital systems are already successful in Nebraska, New Mexico and Washington.

Nourish’s budget to help run programs like these was drastically cut this year by federal WIC funding. Sweaney said there is always fear that money for extra initiatives like these will dry up.

Sweaney and Bash noted that transportation is also a barrier for program participants. According to 2023 CDPHE data, families who live farther away from a farmers market were less likely to use coupons than those who lived in the same zip code as a farmers market.

Cochran said that proximity is why the Pueblo Eastside Farmers Market could be a game changer for residents. “We have a Dollar General and a Dollar Tree and a convenience store, but there is no real food access.”

Local solutions

Meanwhile, county governments like Boulder have created their own solutions. Making local produce affordable and accessible is the focus of a 7-year-old program that provides a punch card worth $80 for Boulder County WIC families and $160 for City of Boulder WIC families per month to spend at farmers markets, helping to supplement the federal money they receive.

Zhuldyz Tokbulatova, 32, a stay-at-home mom, bikes with her 3-year-old son in a bike trailer to the Boulder Farmers Market on Wednesdays and Saturdays to participate in the program. On one Saturday in June, she bought fava beans, tomatoes and cucumbers. Cherries were in season, along with her son’s favorite fruit, aprium, a mix between an apricot and plum.

“He’s a picky eater. He doesn’t eat everything. But he likes to come with me to the farmers market, and he likes to shop there,” Tokbulatova said. “He talks to the vendors and helps pick out vegetables.” His first solid food as an infant was squash from the market.

Tokbulatova, who has participated in the program for four years, said she would not be able to afford to shop at the farmers market without the program. The family’s income is low, and they are careful about their spending.

“It’s very important for me to be able to provide local, fresh produce,” she said. Tokbulatova did not grow up eating many vegetables in her native Kazakhstan, but the program allows her to make more salads or add extra vegetables to staples like beef stew. “It fulfills me as a mother.”

More than 1,000 Boulder County families bought $296,000 worth of farmers market produce from April to November last year—more than double the $116,000 spent by WIC families statewide. It is entirely locally funded by the county’s sustainability tax, the City of Boulder’s Health Equity Fund and the City of Longmont’s Human Services Fund. To overcome transportation challenges, volunteers deliver farmers market produce to families’ homes.

In Garfield County, the local WIC agency used extra funds at the end of the 2023 season to purchase produce from Early Morning Orchard in Palisade, then gave it away for free to 130 families who came in for height and weight measurements as part of WIC wellness checks in Rifle and Glenwood Springs. The hope is for this to become an annual tradition in Garfield County, said Christine Dolan, nutrition programs manager for Garfield County Public Health.

Community-supported agriculture

The Colorado Nutrition Incentive Program connects some of these families directly to produce from local growers — no farmers market required. Community-supported agriculture, or CSA, shares — which run through the summer months — provide weekly boxes of freshly harvested fruit and vegetables to Colorado WIC families and older adults.

For the past three years, Highwater Farm in Silt has provided CSA shares to WIC families in Garfield County. Families visit the 3-acre farm weekly to select harvested produce, with an option to walk into the fields and pick things like cherry tomatoes, snap peas, herbs and flowers. Alternatively, Highwater Farm delivers shares to pickup spots in Glenwood Springs and Carbondale, where families receive a curated share of produce.

Highwater Farm Manager Rebecca Gourlay said CSAs are a relatively new concept for some families along Colorado’s Western Slope. She includes familiar vegetables like lettuce, onions, garlic, beans and peppers in the boxes.

But it’s also an opportunity to introduce families to new vegetables like arugula or mustard greens. These are explained in a weekly newsletter in English and Spanish that includes new recipes. The farm has a part-time bilingual outreach coordinator who talks to families during pickups.

“She helps us connect with our Latino community in a more meaningful way,” Gourlay said.

Without subsidies, it’s difficult for low-income families to afford CSAs, Gourley said, because a person has to pay upfront in the winter for produce provided throughout the summer and fall seasons.

Despite successful partnerships like those at Highwater, overall funding for the CSA program in Colorado dipped to $320,000 in 2024, down from $1.2 million in 2023. Since the program’s inception in 2019, it has relied on state, federal and philanthropic funding. This year, its grant did not allow Nourish to pay farmers 100% upfront for the summer’s produce, and some small farmers, already operating on thin margins, could no longer afford to participate, Sweaney said. Fewer than 30 farmers signed up this year, compared with 115 last year.

Becca Jablonski, co-director of the Food Systems Institute at Colorado State University, worries about farmers relying on subsidies and venues that may not exist in the future. While more data points are needed to fully understand how nutrition incentive programs benefit farmers’ overall bottom lines compared to alternatives, Jablonski said the programs could make rural farmers markets more attractive to farmers if they significantly increase the overall amount of money spent. (Cochran, with the Pueblo Farmers Market, said that nutrition incentive programs kept the market afloat during the COVID-19 pandemic.)

Jablonski’s research has shown that incentive programs benefit local economies in states like California and Colorado.

“For every $1 invested in a healthy food incentive program, we can expect to see up to $3 in economic activity generated,” she and her co-authors wrote. In Colorado, conservative estimates for scaling these programs statewide would create 92 jobs, $4.3 million in labor income, and an economic contribution of $19.8 million, based on data from 2018 and 2019.

At the state level, there is some stability for these programs next year. In June, the Colorado legislature created the Healthy Food Incentives Program—a bill allocating $500,0000 for fiscal year 2024-25 to support Nourish’s work, including CSA produce boxes for low-income families.

But Sweaney said the appropriation is insufficient to meet the box demand. Nourish plans to work with the state legislature’s Joint Budget Committee to secure more state funds and advocate for more federal funding for local food systems and food access in the upcoming U.S. Farm Bill.

Building community through food

On a Saturday morning in May, farmer Brett Mills of Sweet Valley Farm drove 45 minutes to sell plant starters for heirloom tomatoes as part of an early-season pop-up event at the Pueblo Farmers Market. Whatever he didn’t sell, he planned to donate to community gardens.

“We want to be helpful to people growing their own food in the community,” Mills said.

Community is something that advocates like Butler and Cochran say nutrition incentive programs can help build as part of broader efforts to create local food systems for families and growers. Eastside Farmers Market is the next step of a community redevelopment project in Pueblo that will eventually include a grocery store at the site of the former, now-abandoned Spann Elementary School.

Bringing fresh, local produce to Pueblo’s East Side at a farmers market is a first, said Monique Marez, a food systems practitioner who grew up in Pueblo and ran the Pueblo Food Project for three years. However, other treasures exist at the farmers market besides fruit and vegetables.

“The goal is to open up a conversation about how the community is doing,” Marez said.

The market is also an opportunity for families and children to connect with farmers and learn how food grows. “You never know when you might meet the next generation of farmers,” Cochran said.

Back at her urban farm, with railroad tracks several feet away and the Wet Mountains in view, Butler talked with reverence about a sweet pepper variety that she couldn’t wait to taste. She was eager to sell basil, beans, cilantro, tomatoes and 20 other types of fruit and vegetables at Eastside Farmers Market.

Butler said she fully supports nutrition incentive programs, but the idea is more significant than improving access to local produce. It encompasses nutrition, empowerment and agency, community and relationship building.

“The farmers market is the hub—the start, the seed,” Butler said.

Freelance reporter Kate Ruder wrote this story for The Colorado Trust, a philanthropic foundation that works on health equity issues statewide and also funds a reporting position at The Colorado Sun. It appeared at coloradotrust.org on July, 29, 2024, and can be read in Spanish at collective.coloradotrust.org/es. 

A puppy at an adoption event in the south Denver metro area last month has tested positive for rabies, and now state health officials are racing to find anyone who attended the event so that they can be screened for the almost-always fatal disease.

The puppy was part of a litter of 12 at a July 20 event hosted by Moms and Mutts Colorado Rescue for Pregnant and Nursing Dogs, also known as MAMCO. The event took place at the rescue’s shelter at 2721 W. Oxford Ave. in Sheridan. The address is sometimes also listed as in Englewood.

The puppy, along with its littermates, came from Texas and was unvaccinated for rabies at the time of exposure. At the event, the puppy’s litter was known as the “July Shepherd Mix” litter and may have also been referred to as the “Celebrity Kids” litter.

The puppy subsequently tested positive for rabies and was euthanized — there is no approved treatment for rabies in animals and euthanization is required to confirm the disease’s presence. The puppy’s littermates will likely also have to be euthanized because they, too, were unvaccinated and placing them in a strict, secure quarantine away from people and other animals is not possible.

Officials with the Colorado Department of Public Health and Environment are working to track down 17 people who had close contact with the rabies-positive puppy, including shelter pup foster families, shelter staff and veterinarian staff, to provide them with what is known as post-exposure prophylaxis for rabies.

But public health officials are concerned people who attended the adoption event may have also been exposed to rabies and are trying to reach them.

Rabies is spread most often through the saliva of an infected animal — bites, commonly, but also through licking or scratches. It can lie dormant in the body for weeks or even months before symptoms begin to show. Once symptoms appear, rabies is almost universally fatal. This makes early screening and treatment, which can stop the disease after exposure, critical.

What to do if you attended the event

People who attended the adoption event should contact CDPHE for screening. They can call the agency’s hotline at 303-692-2700 during business hours or 303-370-9395 after hours and on weekends and holidays. Or they can email cdphe_zoonoses@state.co.us.

CDPHE staff will determine whether attendees need post-exposure treatment.

How rabies is treated

Rabies post-exposure treatment consists of two components to try to kill the rabies virus before it can gain a foothold and cause damage.

The first is a shot of what is known as immunoglobulin or immune globulin — readymade antibodies that immediately go to work fighting the virus in the body. The second is a course of rabies vaccination, which can boost your immune system to carry on the fight. A full course of vaccination consists of four shots, given immediately and then three, seven and 14 days later.

While it is commonly believed that rabies vaccination shots are given in the stomach and are painful, shots today are given in the arm and are no more painful than any other vaccination.

When started as soon as possible, rabies post-exposure treatment is almost always effective at preventing the disease.

Local governments commonly require pets such as dogs and cats to be vaccinated against rabies in Colorado. Animals that came into contact with the infected puppy’s litter may need a booster dose of vaccine, though.

No human cases in nine decades

The rabies virus attacks the brain and early symptoms can be flu-like. As the disease progresses, though, it can cause anxiety, agitation, hallucinations, fear of water and over-salivation, among other nightmarish symptoms.

Nationwide, about 60,000 people each year receive treatment for potential exposure. In Colorado, the state typically finds around 50 cases of rabies in wild animals each year — skunks and bats are common carriers. The state hasn’t had a rabies case in a dog since 2020.

There hasn’t been a human case of rabies in Colorado since 1931.

BERTHOUD — Parents everywhere hear the call of the wild, especially in the summer months, and one of the most common refrains is, “Can we go to the park?”

For many parents it might be a relief, a chance to shoo them out of the house like a miller moth. Yes! Go to the park! But for Lauren Bowling, that refrain is anything but a chance to unwind. It means work. It means nearly two hours in the car. It means a whole afternoon. 

Lauren and her husband, Richard, have twin boys they call walking miracles. Miles and Mack had twin-to-twin transfusion syndrome and were week-to-week starting about 12 weeks into her pregnancy, Lauren said, until they were delivered by emergency cesarean section at 28 weeks. The babies scrapped and survived, and the boys are now age 7. Mack is as able-bodied as they come and Miles has no cognitive problems, which gives the Bowlings oodles of gratitude. It really could have been much worse.

But Miles has cerebral palsy and uses a wheelchair to get around. This means not every park will work, including all the available playgrounds in Berthoud, where he lives with his parents, Mack and an older brother, Braxton.

This will change by next spring and possibly a lot sooner, thanks to the Berthoud Adaptive Park Project. The park will be Berthoud’s first inclusive playground of any kind, but this one will be one of the most inclusive in northern Colorado, with a surface he can roll on and swings, monkey bars and a merry-go-round, all adapted so Miles can have fun, too. Berthoud broke ground on the park on May 29. 

“The monkey bars are built so kids in wheelchairs can pull themselves through,” Lauren said. “Miles will be able to play on monkey bars with other boys.”

Berthoud launched the park thanks to the Bowlings, who raised money for it with a ridiculously successful lemonade stand (this year’s annual event raised more than $13,000, for a total of $53,000 over four years) and the help of Can’d Aid, a Longmont nonprofit launched in 2013 by craft-brew-in-a-can pioneer Dale Katechis. It also took some haranguing, the kind parents of disabled children learn to do as their offspring grow up enough to explore the outside world and realize some things aren’t the same for them.

Haranguing, even a few years ago, was how inclusive parks were built. Now parks departments realize that an adaptive park doesn’t mean building a ramp so kids can sit in their wheelchair while other kids run by them. Denver, in fact, tries to be inclusive with every new park. 

“Now people are realizing that accessible is not inclusive,” said Juliet Dawkins, who started LuBird’s Light Foundation with Jason, her husband, for their daughter, Lucia, after her nickname. “Even if you have a smooth surface, a wheel-able surface, if you don’t have a piece of equipment for them to play on, what’s the point?”

Most of Colorado’s larger cities have at least one inclusive park, and the movement is trickling down to towns such as Berthoud, with a population of 12,000. 

Yet parents still need to show up, speak up and make sure they are heard, Bowling said, despite emphasizing in her speech at the groundbreaking that she couldn’t have done it without the help of many others. She had to help push community fundraising for the park toward its $1.6 million goal, after all. 

“There were times I got intimidated by our grand goal, and anytime that happened, someone in the community reached out and would reinvigorate me,” Bowling said. “But I don’t think it would have happened without me pushing. It feels gross to say that, because so many helped lift me, but no, I don’t.” 

Where you belong (really)

This year’s theme of the National Recreation and Park Association is “Where You Belong.” That’s intentional, said Kara Kish, director of parks and recreation for the city of Loveland.

“A lot don’t feel they do belong,” Kish said. “But in the last five years, universal access has been the new standard. The primary drive is the commitment to be in service to everyone.” 

Cities across the country, including Loveland, Denver and many others, have revamped their recreation departments to not only offer programs specifically for those in disabled communities but adjust any class or sport to make it accessible if someone requests it. 

Parks are a harder commitment, but they are working on it. Loveland’s spent the past decade, Kish said, to make all its parks compliant with the American for Disabilities Act.

ADA standards, however, aren’t always fun, and that’s why parks departments are looking beyond them. Loveland broke ground April 22 on the 160-acre Willow Bend Natural Area and Universal Access Playground, which will feature the city’s first universally accessible playground — 12 acres. Loveland hopes it will be ready by spring. 

“Universal access goes beyond physical limitations,” said Bryan Harding, Loveland’s parks and recreation planning manager. “It runs the whole gamut. We won’t have everything for everybody but we will have something for everyone.” 

The park will feature play equipment designed to be used with other people, with a concrete slide, for instance, that’s extra wide and doesn’t cause static that can knock out pacemakers and bother those with hearing difficulties, as well as bathrooms with oversized stalls and adult changing tables. There will be tools for sensory play as well, which can be soothing for those with autism and other similar issues. There’s even charging stations for mobility devices such as electric wheelchairs. 

Concrete slides are a new concept, but it’s likely able-bodied kids will like them better as well, Harding said, since they don’t get nearly as hot as metal or plastic slides. Inclusive swings and merry-go-rounds are still loved and used regularly by everyone as well. 

“Inherently when you improve upon something,” Harding said, “it serves everyone better.” 

“We want people to be together”

Denver Parks and Recreation now considers whether a park is universally accessible and inclusive instead of buying a piece of equipment and calling it good. 

“It’s a conversation we are going to have every time a park is in the planning stage,” said Owen Wells, the district park planning supervisor for Denver Parks and Recreation. “We’ve had a lot of conversations with families and advocacy groups. They’ve helped us understand what makes parks inclusive. We’ve been learning over time.” 

Sometimes parks departments were the opposite of inclusive even when they meant well. Buying a single piece of adaptive equipment can be anything but inclusive.

“The idea is we want people to be together,” Wells said. “It doesn’t meet that goal if a kid is playing on a piece of equipment in a section of the park by himself.”

Parks and recreation departments and the equipment providers that serve them nationwide are doing their best to learn, Wells said. Denver’s focused on inclusive playgrounds for a bit now — Wells said it’s been a focus since he started working for Denver four years ago, and it was before he got there — and it’s now so commonplace that even towns such as Berthoud do their best. 

“I think we are in a moment where the industry is evolving a little bit,” Wells said. 

There are also limitations, Wells said. Some of Denver’s 175 parks were built during World War I and aren’t easy to retrofit, as accessible equipment can be much larger. Cost can also be an issue, although that may depend on the cities, as some said the equipment they found was a lot more expensive. Wells agreed that adaptive equipment costs more but also said fitting the equipment in older parks was a bigger constraint. 

“Is it backbreaking? No,” Wells said of the cost.

The fight continues

Yet with all the thinking on a citywide level about inclusive parks, there are still people fighting for more of them. Sarah Spiller, a physical therapist for Academy School District No. 20 in Colorado Springs, has a hard time recommending a park for her families in Colorado Springs. 

“Our closest one that’s accessible in our area is 30 minutes away,” Spiller said. 

There are three inclusive parks in Colorado Springs, she said, including Panorama Park, which she calls “wonderful.” But from the school district where she works, it’s 35 minutes away. 

Colorado Springs wants to work with her, she said, but said it is hamstrung by tens of millions of dollars in deferred maintenance on its parks. Many parks were built in the early 1990s, she said. But the city told her that if she could raise money for it, the city would match her contribution. 

She’s also spoken with an HOA that might be willing to donate money for a neighborhood park if they could use the grounds for free for events like Easter egg hunts. Maybe parks companies would donate a piece of adaptive equipment. 

“I need to create an organization and meet again with parks and rec,” Spiller said. “We will see.”

Spiller’s push is the kind of initiative that LuBird oundation wants to see, even if Dawkins does agree that parks and recreation departments are taking a lot more initiative on inclusive parks. 

“Whenever there’s a new park, generally cities will present plans to the public, and there are questions like, ‘Do you want a regular swing or a support swing?’,” Dawkins said. “Parents should advocate for that.”

There are certain pieces that LuBird pushes for nearly every time a new park gets built, such as surface merry-go-rounds and supportive swings, things that Dawkins calls “a slam dunk.” 

“It’ll be awhile before every park is inclusive every time,” Dawkins said. “But at the minimum, you can have those pieces and add more from there.” 

The park in Berthoud won’t be ready for kids until late fall, and it’s possible the rubber surface won’t be ready until the spring. They are planning a grand opening for Memorial Day. 

Bowling sees the park less as a way for her to avoid driving long distances as a real chance for Miles to be a typical boy whenever he wants. He can ask his mother if he can go to the park, and Bowling, finally, will be able to shoo him out the door. 

“He’ll be able to roll out the garage door and go down the block and play safely with his friends,” Bowling said. “That’s something I wish for every child.”

Larimer County’s community mental health center has abruptly laid off 75 employees, causing a gap in care for some of the most vulnerable patients and increasing concerns about how far the fallout will spread after a seismic shift in Medicaid funding. 

Connor Grogan had 35 clients at SummitStone Health Partners in Fort Collins when he was told at a mandatory meeting last week that he was among those losing their jobs because of a budget crisis. He had to turn in his phone and laptop on the spot, with no opportunity to say goodbye to his patients. 

“It was unethical the way that it was handled,” said Grogan, who had counseled children, families and adults at the center for more than two years. “At the very least, I feel like it is not trauma-informed, which is something that SummitStone had been preaching about for quite some time.”

The community mental health center, one of 18 statewide, is the latest to lay off employees in the wake of hundreds of thousands of Coloradans losing Medicaid coverage after the end of the pandemic public health emergency and a massive change in the way the state Medicaid division reimburses behavioral health providers. 

Mind Springs, the safety-net mental health center for several counties in northwestern Colorado, laid off 49 people, 13% of its administrative staff, this summer. Centennial Mental Health, which serves 10 counties in the northeastern corner of the state, laid off three of its five top executives in June. And Jefferson Center for Mental Health, which serves Jefferson, Clear Creek and Gilpin counties, is dealing with a $5 million shortfall on a $89 million budget, a deficit so large that plans for a merger with Denver’s mental health center, Wellpower, were called off in June. 

SummitStone had to cut $14 million to break even on its $80 million budget. About $9 million of those cuts came from staff reductions. 

“I’m going to be OK,” said Grogan, who is likely to find a job because he speaks Spanish and is a male therapist. “The piece that hurts the most is that I had zero closure with my clients. I lost yearslong relationships in an instant. I couldn’t even say goodbye. 

“I’m devastated for the most vulnerable humans in our community that were getting better. I worry about suicides rising in our community. I worry about overdoses rising in our community.”

Most of the employees who lost their jobs did not work directly with clients and instead were in other departments, including technology, SummitStone CEO Michael Allen said. The 75 jobs were about 10% of the workforce at SummitStone, which has locations in Fort Collins, Loveland and Estes Park. Executives took a 5% cut in pay. 

The first budget problem for the center was that thousands of Coloradans were dropped from Medicaid insurance at the end of the three-year federal public health emergency put in place at the start of the COVID pandemic. In the past year, the percentage of SummitStone clients without insurance rose to 25%, up from 17%.

On top of that, landmark legislation that brought sweeping changes to Colorado’s mental health system — including how mental health providers get paid — went into effect July 1. 

First effects of monumental change 

The Behavioral Health Act, passed in 2022, was intended to break up the monopoly of Colorado’s mental health centers, opening them up to competition with private behavioral health agencies. 

For years, the centers operated under no-bid contracts with the Colorado Department of Health Care Policy and Financing, which includes the Medicaid government insurance program for people with low incomes. The centers received $437 million in tax dollars per year and were required to treat people in their regions. 

Under the new structure, mental health centers don’t get a lump sum. They must bill the state Medicaid program for every service they provide, per person — a reimbursement for an individual therapy appointment, another for a group therapy session, another for a housing consultation. 

Mental health centers warned lawmakers that communities, especially in rural areas, could end up with fewer services under the new payment structure. They worry providers will offer only services that make money, leaving out help with housing and employment. 

This summer, it seems the effects of the monumental change in policy are beginning to take shape. Mental health experts are wondering if the current structure is beginning to break apart, and they hope the new one that forms in its place will end up more robust and capable of serving more people.

Still, the process is painful. 

The three community mental health centers that have had layoffs “likely won’t be the only ones,” said Kara Johnson-Hufford, CEO of the Colorado Behavioral Healthcare Council, the association for mental health centers. 

“Folks have scraped their reserves,” she said. “They are not filling open positions.” 

Not all community mental health centers are struggling, but some have been hit harder by the drop-off in Medicaid rolls, Johnson-Hufford said. In some communities, Medicaid enrollment has shrunk by 35%-60%, she said. 

Colorado had 1.8 million people enrolled in Medicaid during the pandemic, a historic 30% of the state’s population and up from a pre-pandemic 21%. Medicaid enrollment is now down to about 22% after the federal rules were lifted last year. 

Mental health centers tried to budget for the Medicaid cliff, but they were basing their plans on state projections that were not accurate for every region. That drop-off hit at the same time as the payment structure overhaul. And the new bill-per-service structure does not account for the uninsured, Johnson-Hufford said. 

“Significant reform is hard,” she said. “Bring more providers into the safety net, absolutely.” But, she added, Colorado policymakers need to make sure the system’s funding and structure can support mental health providers who want to serve their communities. 

The changes have amounted to the “perfect storm,” Johnson-Hufford said.

“Not all of this is impacting all of our providers in the same way,” she said. “And it’s not just any one thing.”

Mind Springs, which serves Mesa and seven other counties, spent $1.9 million last fiscal year on treatment for people without insurance, CEO John Sheehan said. Services are already taking a hit — the mental health center had to drop its men’s program when it laid off 49 people this summer. 

The new per-service payment structure, at a time when the number of uninsured is rising, “doesn’t make a lot of sense,” he said. 

“And so far it hasn’t done anything but destabilize the system,” Sheehan said. “The provider network is fragile and has been made more fragile. When you lose them, you can’t get them back.”

It’s hardly surprising that safety-net mental health centers are feeling the loss of Medicaid coverage for 600,000 Coloradans in the span of about a year, said Vincent Atchity, president and CEO of Mental Health Colorado.

“It’s an earthquake that takes a segment out of a highway,” he said. “It’s a crisis for sure.” 

Atchity, who advocated for payment reform and more transparency in public spending on community mental health centers, said it’s likely there is “some seismic shifting that occurs when a system is flipping itself as much as this.” 

But it’s unclear this early on in the transformation why some mental health centers are “complaining vociferously” about the new payment system while “others are shrugging their shoulders.”

“I’d love to get to the bottom of what is actually happening,” he said.

Employees got no severance, clients got no goodbye

SummitStone’s CEO summed up the payment reform bluntly: “The pie didn’t get any bigger but the number of folks accessing the slices of pie did get bigger.” 

Allen expects SummitStone will lose 5%-10% of its clients because “our reputation in the community has taken a hit” when so many people lost their jobs and many clients lost their therapists without notice.

“These are hard things,” Allen said. “It’s a hard conversation to tell the community that we are in an opioid crisis and we are in a loneliness crisis and the largest behavioral health provider in the area is laying off 10% of its staff. That doesn’t make sense.” 

Laid-off employees were invited to mandatory meetings in small groups and were told they could not return to their desks or contact their clients, that they would get no severance pay and that their health insurance would last until the end of the month, according to several former workers who spoke to The Colorado Sun. 

It’s a hard conversation to tell the community that we are in an opioid crisis and we are in a loneliness crisis and the largest behavioral health provider in the area is laying off 10% of its staff.

— Michael Allen, CEO of SummitStone

The CEO said the mental health center operated with a deficit as long as it could and that he tried to avoid layoffs by scrapping plans to renovate buildings, cutting travel and catering budgets and staff incentives. But in June, when the center got its rates and contracts for the upcoming fiscal year that started July 1, it was obvious that there was no way to break even without “dramatic” cuts in staff, Allen said.

“This was a last resort,” he said. “Nobody wanted to do this.” 

The center partners with several other Larimer County agencies to provide mental health services and Allen said he is hopeful that those agencies can afford to pay the full salaries of those workers. The partners included Sunrise Community Health, a medical health center that integrates mental health care, and Outreach Fort Collins, a nonprofit that has a mobile mental health response team for people living outside. 

“It all hurts. It’s all terrible. My heart aches,” Allen said. But, he added, SummitStone had to make the cuts in order to continue “to be here for our community.” 

SummitStone has a contract with Larimer County to provide behavioral health care at the Acute Care Center at Longview Campus, which was not affected by the layoffs, county staff said.

As for client care, Allen said clients typically have a care team — including a case manager and a peer specialist with personal experience dealing with behavioral health issues — that will help them through the transition. 

Former employees, however, accused Allen of not being honest with them about the budget crisis and said the layoffs came as a huge shock. Some said they have complained to state agencies, including the Department of Regulatory Agencies, about the way clients were “abandoned” because of the layoffs. 

“We were all shocked by what was happening,” said Katie Rapson-Stecula, a supervisor who also provided therapy for a handful of clients. “Nobody discussed continuity of care for clients. There was no plan that we were able to be a part of as their providers. There were no warm handoffs. There wasn’t even a conversation to say goodbye.”

Rapson-Stecula said she couldn’t stop thinking about one of her clients who has a long history of suicide attempts. “It’s not how we are supposed to treat our clients in any way,” she said. “It’s unethical.”

When Dr. Matthew Daley began his term on a previously little-known advisory committee with the U.S. Centers for Disease Control and Prevention, he knew he had a bigger task before him than he had expected.

Daley is a pediatrician with Kaiser Permanente in Denver, but he also does research through KP’s Institute for Health Research. Daley’s work primarily focuses on vaccines — their safety and patients’ hesitancy to get them — and it had long been a goal of his to serve on that obscure committee, known as the Advisory Committee on Immunization Practices, or ACIP.

But while Daley waited for his chance, the COVID-19 pandemic swept into the nation. By the time Daley took his seat in January 2021, ACIP had become one of the most closely watched medical bodies in the country, responsible for reviewing safety and efficacy data on COVID vaccines and making recommendations about whether and how they should be given.

Daley’s term ended in June, and we recently caught up with him to talk about his experience. The following conversation has been condensed and lightly edited for clarity.

The Colorado Sun: How are you feeling now that your term has ended? Happy? Relieved?

Matthew Daley: I’m really going to miss it, so I’m kind of sad, frankly. It was such an incredible experience. It was so much more work than anybody anticipated, so now I can put back all that energy into my day job, which is being a pediatric health services researcher and a pediatrician. Certainly I’m excited to get back to the rest of my day job, but I’m going to miss it because it was such an interesting experience.

Sun: You joined the committee at such a tumultuous time for the nation’s health systems. Why did this volunteer job appeal to you?

Daley: I was really grateful to have an opportunity to serve. Often, we have the energy, we have the expertise, but we don’t always have the opportunity. If you remember early in the pandemic, we were under lockdown, everything was shut down. And kids could get quite sick from COVID, but it was just a whole lot less common versus adults. So as a practicing pediatrician, the first couple months of the pandemic were pretty quiet for us. It felt so odd to be a doctor in a public health crisis who was not very busy. So I really was grateful for the opportunity to serve in this very unusual and unprecedented circumstance.

Sun: There was, of course, a lot of public attention on your work, and there was also speculation about political pressure on institutions like ACIP. How did that feel from the inside?

Daley: The ACIP was allowed to independently follow its process for decision-making. We were aware of these different power centers, but I was never getting late-night calls from any of those groups saying, “This is what we need you to do,” or, “This is the decision we need you to make.” We adhered to our process, the process served us well, and we had independence to make vaccine policy decision-making. And so that was very encouraging to find because I think there was always suspicion out there that somebody had their finger on the scale. But really, the ACIP had a process, followed it and was independent.

Sun: But there was still some pretty intense criticism from parts of the public. Did that ever become uncomfortable?

Daley: Our emails are up on the ACIP website, and people could easily find our emails. So we would get emails from the public. And some of those were pretty negative. Some of those were pretty positive, you know, just thanks for the work that you’re doing. And sometimes it was a high volume, but what was interesting there was that it was sort of copied and pasted. So you get a bunch of emails, but it was verbatim from another email that you’d get. So it seemed like a small number of people who had an organized campaign. But, given the circumstances, it was totally understandable and just fine.

Sun: How did you incorporate that feedback?

Daley: I think it was helpful to hear what people were worried about. And to the extent I could, I would try to address that in the public meetings. I remember a meeting where there were some public commenters who were really worried about COVID vaccine side effects. And I remember saying, “We hear how great your concerns are about COVID vaccine side effects. We do factor that into our decision-making.” We know that no vaccine is 100% safe or effective. And then here’s what data we have about safety. We have good safety surveillance systems in the U.S. The safety monitoring was some of the most intensive — probably the most intensive — safety monitoring ever in the history of modern science in terms of how many eyes were on safety. And so I was reassured by that.

Sun: There were so many consequential decisions during your time on ACIP, in terms of recommending use of COVID vaccines and really being one of the final checks before vaccines started going into arms. Are there any decisions you regret now?

Daley: I don’t have decisions that I wish I could have had back. But I think one thing that I as a pediatrician would have appreciated is if there had been vaccines available for kids sooner. That’s out of our hands because we can’t approve something until the vaccine manufacturer has submitted their data to the FDA (Food and Drug Administration), and the FDA has made a decision about it. And I think the burden (of disease) was so great in older adults that we lost sight of the fact that there were still, in absolute terms, some significant burden in pediatrics. More kids were dying from COVID than were dying from flu. It’s because the relative burden on kids was so much less than the burden on adults that there was so much more focus on adults and getting those individuals vaccinated.

Sun: COVID, obviously, drew the most attention during your time on the committee, but was there anything else that happened that didn’t receive as much public attention as you thought it deserved?

Daley: There’s a product called nirsevimab, and what nirsevimab is is it’s a long-acting monoclonal antibody that prevents RSV (respiratory syncytial virus) in infants. So that is not technically a vaccine because it’s an antibody and a vaccine is different. But it was being used in a very vaccine kind of way. And and so there was this debate about whether the ACIP should consider it and should vote on its use. As a practicing pediatrician, I’ve admitted more babies with RSV to the hospital than anything else I’ve seen in my 25 years of practice. It’s really common, and it can be really severe. And then here we’re given this opportunity to prevent a lot of that illness including hospitalizations and ICU admissions and deaths from RSV. I remember at a meeting where I sort of realized that if we handled it very differently, we’re probably not going to achieve the public health goals that we wanted and not achieve the disease prevention that we wanted.

Sun: So this is an injection that provides protection against RSV, but it doesn’t do it in the same way as a vaccine would by creating an immune response within your body to produce your own antibodies — it takes a shortcut by just giving you the antibodies to start. And the debate was whether to treat it like a vaccine?

Daley:  It’s being used very vaccine-like, meaning it’s being given to everyone for prevention. And so I just remember saying we’ve achieved a lot in the national immunization program. And we have all of these systems in place to achieve high coverage for routine childhood vaccination. And because of that, we have prevented a tremendous amount of disease. And we have the same opportunity with nirsevimab, but we need to use all of our processes, all of our systems, to achieve the same thing with nirsevimab that we’ve achieved with infant vaccines. And after that, ACIP considered it.

Sun: What happened as a result?

Daley: Coverage was really high in the fall. This product is incredibly successful at preventing RSV hospitalizations in kids. There’s also an RSV vaccine for pregnant women that prevents their babies from getting RSV. And the combination of the two prevented just a huge amount of disease this last season. It sort of goes against the argument that there’s so much hesitancy out there that any new product is viewed with great skepticism because probably as many as 50% of infants in the U.S. in this past respiratory season, either they got nirsevimab or their mom got the RSV vaccine during pregnancy.

Sun: You mentioned hesitancy, which is a research specialty of yours. How do you view vaccine hesitancy, post-pandemic, and how do you address it now that vaccines have become a much more polarizing topic?

Daley: It’s a challenge that’s going to stay with us, I think, forever. I think we’ll always have some degree of hesitancy. When I look at hesitancy in pediatrics, I start with the principle that parents want what’s best for their kid. So I try as hard as I can not to get judgmental when parents make a different decision than what I recommend. They want what’s best for their kid. Then in the context of COVID vaccines, that’s a little different because people are making decisions for themselves and not for their kids. But it’s the same thing they want. They don’t want to get COVID, but they’re worried about the safety of COVID vaccines and they’re worried about maybe there’s some things that we don’t know about vaccines. So I understand that. But I think if we have transparency, integrity, public airing of the data, that helps. And then I think what also helps is to continue to study vaccine safety and study what people are really worried about.

Sun: When your term ended on ACIP did you get a parting gift?

Daley: No, I mean not really. What happened is that we had a three-day meeting, and on that Friday, they took a few moments to make comments about each of us and then they gave us a few minutes to make a comment. There were four of us who started right around Jan. 1, 2021. We had the most meetings that anybody ever had in the history of the ACIP. So they said thank you for your service. And that meant a lot.

Sun: OK, but not even a cake?

Daley: We didn’t have a cake. We had a lot of work to do.

The art is hung. The toilets flush. The X-ray machines are (finally) assembled.

On Saturday, barring any last-minute hiccups, Intermountain Health’s Lutheran Medical Center in Wheat Ridge will shut down its current location and move 3 miles west to a brand new, $680 million campus. It’s the first major hospital relocation in Colorado in years, and the new facility showcases how the COVID-19 pandemic has forced health systems to rethink what a hospital must be able to do.

Take, for instance, the patient rooms. There’s 226 of them, and each one comes with a nifty sliding supply cabinet that nurses can pull out to restock from the hallway.

This means nurses won’t need to disturb patients as often. But the feature serves another purpose. If the patient inside the room has a contagious bug, it keeps staff from having to load up on protective gear just to refill the tissue boxes.

Here’s another COVID-inspired design choice, taken from a pandemic when hospitals often worried about running out of capacity: Every patient room can be converted into a critical care room if needed.

“An outcome of the pandemic is we need the flexibility to take care of really sick patients everywhere,” said Casey Bogenschutz, the executive who is overseeing Saturday’s move.

Orchestrating the move

Bogenschutz is Lutheran Medical Center’s director of strategic initiatives, but that title severely undersells both the strategy and initiative the job requires.

At 6 a.m. on Saturday, the current location — at West 38th Avenue and Wadsworth Boulevard, where it has stood in some form since 1905 — will stop accepting new patients. The new hospital, which is just off Interstate 70 near the interchange with Colorado 58 in a development known as Clear Creek Crossing, will begin accepting patients.

Then the dance begins.

Starting at 8 a.m., a fleet of about 20 ambulances will begin running loops transporting patients already in the hospital to the new campus. The hospital is expecting to move about 180 patients, in a precisely timed choreography, one patient moving every eight to 10 minutes.

“We will have a down-to-the-minute plan for each patient,” Bogenschutz said.

On a recent day, Bogenschutz led The Sun on a tour of the new hospital, weaving through a maze of corridors and rooms, some with signage still TBD. Outside each room hung a list, attached with blue painter’s tape, of all the items needing to be placed inside. Bed, check. Toilet paper, check.

There were large televisions and “digital whiteboards” — screens with information for both patients and staff — to be connected. Bathrooms in the patient rooms were built as prefabricated pods at a factory in Phoenix, then shipped to Colorado on a truck and lifted by crane into place.

The operating rooms were just days away from intensive cleaning to render them sterile and ready for surgery.

Why build a new hospital?

In addition to COVID, the facility has been designed with other modern afflictions in mind. Doors connect all the rooms for trauma patients, allowing a doctor treating people from a mass-casualty incident such as a mass shooting to move quickly from patient to patient.

Bogenschutz said the new hospital has been organized for efficiency. MRI and CT scanners are positioned nearby the patients who will need them. The room numbering is orderly and intuitive, allowing a nurse to know exactly where they are in the hospital at any time. There’s an organized flow as patients move from one treatment area to the next — no more long walks or elevator rides to connect commonly used areas.

This, Bogenschutz said, is the best argument for building a new hospital, instead of simply renovating the old one.

“It doesn’t have the adjacencies that are required in the industry,” she said of the current hospital. “You make it work, but when you upgrade you can build things the way you want them.”