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Emily Peterman:
Good afternoon, everyone. We’re going to go ahead and get started, and just want to welcome everyone. This is our first and last concurrent session of the day. So thanks for joining us. Yeah, so we’re here today to talk about strengthening local health capacity and really hear some stories of impact from the infrastructure grant. So we’ll be in here spending the next 75 minutes together. But before that, I want to introduce myself. My name is Emily Peterman. I’m part of the PHIG national partner team, where I serve as the Senior Director for evaluation at the Association for State and Territorial Health Officials. I’ve been in this role, kind of with this organization, for almost nine years, which is wild. Cannot believe that, but I can confidently say the best part of this job has been and continues to be hearing these stories from all of you, really on the ground doing awesome public health work.

So excited to continue with that tradition today, and really excited too just to bring these two panelists along to introduce this work. So before that, I do want to introduce them. Sorry about that. Just really quickly, our first speaker is coming to us from the great state of Indiana. The Indiana Department of Health, Olivia will be talking about strengthening local health departments through regional collaboration, and the impact of CDC funding via the public health infrastructure grant.

Olivia has worked for the Indiana Department of Health since 2023, when she joined the department as a grant evaluator for PHIG. She received her Bachelor’s and Master’s of Public Health from the University of Evansville in Evansville, Indiana, in 2021 and 2022, respectively. And she’s also a facilitator of the PHIG peer evaluator group. So if anyone’s in that group, you might have heard her earlier today, helping facilitate part of that meeting, but she’s currently obtaining her Certificate of Public Health from the National Board of Public Health examiners. Olivia is from Valsparro, Indiana, and now lives in Indianapolis. If you are familiar with Indiana geography, which I was not until chatting with Olivia, that means she has lived in the south, the central, and the northern part of the state. So Hoosier through and through, and we’re excited to have her with us today.

Our second speaker is Dr Todd Nicholson, and he is joining us from the Southern Nevada Health District. We’ll talk, be talking with him about the impact of the public health infrastructure grant in Southern Nevada. So also, since May 2023, Todd has been working on PHIG and is serving as the workforce director, the program manager, and the primary investigator for the program. He holds a doctorate in education, leadership, and learning, with a focus in healthcare administration and leadership from Aspen University, previously serving as a Senior Public Health Preparedness planner and Hospital Preparedness Program liaison for the Southern Nevada Health District for eight years.

Dr Nicholson has also served for over 30 years in all branches of the US Army, including the Army Medical Department and over five years as a Department of the Army civilian, primarily as a medical plans and operations officer in the Army Medical Service Corps. Todd holds a master’s degree in legal studies and history and a bachelor’s in social science, as well as being a graduate of the United States Army Command and General Staff College, the United States Army Combined Arms and Services Staff School, the Armed Service Staff School, and the United States Army Medical Department, Officer Advanced and Officer Basic courses. That’s a mouthful.

Todd is also happily married to Tammy, and has seven children and seven grandchildren, so please welcome or join me in welcoming them to our session this afternoon. Up here, you can see what we’re going to do. We’re just going to run through these presentations, and then at the very end, open it up for Q and A, so if you have a question, write it down. We’ll have some facilitated discussion at the very, very end. But without further ado, Olivia, can I welcome you up to the podium?

Olivia Ault:
Good afternoon. It’s nice to see some of you again. I recognize some of you from earlier this morning when you were going through the peer evaluator network. So nice to see you. I will be talking this afternoon about our regional teams, how we decided to approach some of our A1 funding with our locals, and some of the successes we’ve had with that. So I’ll go ahead and get right into it to begin. Obviously, Indiana, we have received a lot of funding from the CDC, and we know what we had to do was allocate about 40% of it to our workforce and work with them to support local health departments. So part of this, we had already been doing an evaluation of our local health departments, just kind of looking and seeing, what do they actually need from IDOH, what’s going to make them most effective, what’s going to work with them?

I’ll give you some background on the makeup of Indiana local health departments. So we have 95 LHDs, and we serve about 6.9 million Hoosiers. So we have, as part of that, we saw with our evaluation that we have less than the average number of employees for our local health departments, so about 4.1 per 100,000 Hoosiers, below the average. We needed to somehow increase that make it easier for us to reach out to them. So we decided to break our state up into these three regions based on pre-existing, basically disaster preparedness districts, just for ease of dividing it up.

And as we created these districts, we were asking our locals, what do you need from us? What would be the best use of these funds? They said they didn’t actually want to take these funds and hire people themselves, because some of them, especially our rural departments, would just be sitting on that for a while. It’s really hard to get people to want to move out into the really rural Indiana and be a data analyst. Not necessarily going to be enticing.

So we created these regional teams that are going to have, like our data analysts, public health nurses, school health liaisons, health services directors, we have communication specialists, we have a staff attorney, all positions that will help serve the locals, but that they don’t necessarily need to have on staff all the time. They just need someone to go to when they have a problem. Who do we get in contact with at IDOH? And that is their specific person. So that’s the background. That’s how we divided it up. Some of them, as I said, are shared among all the teams, so like our communication specialist and our lawyer, we can’t afford to have three lawyers, even with all this funding. So they are shared, but most of them are one for each region.

So, as part of the survey that we did, we are continuing to evaluate them, making sure that these teams are doing what we said they were going to do. Our locals are receiving the support that we said they were going to receive. So we created surveys to go out to them. We’ve had them go out twice now. We’ll be scaling it down to once a year, so that we’re not overwhelming them. And we geared the questions to focus on some demographic questions. You know, who’s filling them out, what’s your role within the agency, within your local health department? But we wanted to keep that kind of thing in the background. We wanted people to just focus on being clear with us. Did not use that to identify anyone, really, so we could go from there.

So like I said, we had two surveys, one out in May 2024, and October 2024. We were building the team, still at that point, especially in May. So some of them had only been some of our team members had only been in there since March. So we had some lower responses at that point because people just didn’t have the familiarity with the teams. They weren’t sure exactly what they were doing with them, what services they were going to be offering. But then in October, they had been familiar with them for a while. There were already some impacts of having these people be in their corner, be able to go out to them. We had most people; we had 100% response weight in our southern region. We’re really close on the rest of them. Most people submitted one or two, most LHDs. Some of them did submit six each time. They were really, really active in wanting to share their feedback. So that was really good to see.

So we were able to take this kind of survey. We were asking them questions like, How often are you working with your regional teams? Do you have anything that isn’t working? Do you have success stories? What are you able to do that you weren’t able to do prior to this and sent it out, had only a total of 27 questions to try to keep it from being too overwhelming for them, because we all know sometimes we get a lot of surveys, and people don’t want to answer the surveys, especially if this is the fifth one that they’ve seen from the state already. So, trying to be mindful of that. So yeah, we’ve had a really good response. From that so far, and I guess I’ll be doing it again soon.

Now, kind of sharing some of what we’ve seen so far, we’ve had a lot of really positive responses. 82% of local centers, extremely easy. To get support or resources from their teams on a scale of one to five. I asked people, How successful were they at providing customer service? And the average was about a 4.6 rating. So that was really positive to see, especially with it being kind of early in the game for this, so they’re getting a lot of positive responses. A quote from one of the survey recipients said, In the beginning, I did not feel like the need for regional teams was there, or, should I say, I didn’t totally understand what the purpose was. But now I’m very happy they exist, and I find some comfort in knowing where to go for advice and answers to questions.

So we’re seeing that it is providing support that wasn’t previously there. They’re saying that they’re feeling more connected to IDOH than they were previously because they have these connections, which is going to be huge on how we’re able to implement new things. If people know who to go to, what’s expected of them, I think we all know sometimes state reporting can get a little down in the mud, and people don’t know what’s needed from them, what’s expected. And having someone to go to, like our staff attorney, and be like, Okay, what does this legal was this legally mean for us? What do we actually need to do with this if they want to roll out a new program, they can go to our communication specialist and say, how do we utilize our social media platforms to get the word out that we’re doing a vaccine clinic, stuff like that, that they weren’t seeing before, and where like our my quote just came from. We had free space for the LHDs to share that information with us.

I did meet with our three regional directors and our local Health Services Commissioner after the surveys to kind of go over the results so that we could give that feedback to their teams. Because again, we wanted this city to be something that the locals felt was positively impacting them. We wanted them to see the results of the survey and action so that any tweaks that needed to be made, we made in as close to real time as possible. We have had to kind of adjust some of the positions since our first idea, first iteration, and we’ve been able to kind of swap stuff out, tweak it so that fits a little bit better to the needs that we’re seeing, especially as you know, funding cuts come into place, we’re not seeing the same amount of support that we did at the state level that we had previously, or at the federal level.

So we’re, we’re taking those results and making adjustments in real time. So yeah, that’s the survey that we did to kind of see what was needed with them, what could be most effective for them. Now we can move on to some of the more fun success stories that we’ve seen. This is from a public-facing tracker that we have for some of the KPIs that we’re managing; we have about 30 or so that we’re tracking across the state. Can see at the top, this was in December of 2023, and then to June of 2025, we’re seeing a lot more green than we were at the beginning, and that’s because we were able to implement the lead testing or lead case management that was happening, so they were able to work with their teams on getting that up and going.

Hopefully, in the near future, this entire state will be green for this one, at least in particular. So like I said, we’ve seen an increase from a 64 to 93% due to the technical assistance. We also have seen the increase of LHDs working with local and state partners to address gaps and barriers in how services go from 51 to 63, and it’s tracking, like I said, about 23 core services on our local website. So if any of you are interested, you can go through and see everything that we’re working on. It’s updated about every six months. Here’s some more results as our linkage to clinical care going up to 82% from about 60 again, a lot more green because of the support that we’ve been able to utilize in the last two and a half, three years now, with PHIG funding, so we were able, we’re responding to cases in less than 24 hours, and talk about A2 briefly.

We had A2 funds that we used to buy lead testing kits for preschools, for daycares, and we’ve been able to test out 300 kids so far, continuing that as we can, but that was a huge increase from what we’re able to do previously, and that leads back into this. So we’re able to. Use funds from across PHIG to see these successes come up, and again, it’s something that we weren’t seeing before moving on to our results. A little bit more this shift from direct funds going directly to the locals to fund these programs, to fund these positions into this regional team collaborative approach exemplifies the transformative impact of PHIG on Public Health Administration. We’ve been able to use state staff resources effectively and enhance the capacity of our LHGs while promoting sustainable partnerships, which will hopefully continue to evolve to face public health challenges.

Another quote from one of our LHDs, they said, “I’ve been with this LHD for over 11 years, and the past year, with the connection from the regional team, I’ve been more engaged, informed, and active in expanding the health department services, ideas, goals, and connection to our community.” So they’ve seen this transformation happen very recently, something that they’ve been waiting to see, as another quote, “IDOH, support has never been this accessible before. Despite any challenges or hiccups, I can’t imagine being able to complete all of our activities without them.” So we were seeing this have real life impact very quickly. We’re tracking all this, hoping to continue to get funds, hopefully from the federal level.

I’ll talk briefly about what we’re doing at our state level as well, seeing if we can get some support after PHIG ends to do this by ourselves, or at least a version of this by ourselves. So we are, like I said, working on what comes after PHIG in 2027. In 2023, Indiana launched Health First Indiana, which is a new public health initiative that is investing millions of dollars into improving public health throughout the state. Indiana has typically ranked in the bottom half of the states or in the country for public health outcomes. We just haven’t invested in it previously the way that it should be.

So the timing of HFI with fig has been really beneficial for us, because we’re able to fund our regional teams with PHIG dollars, funding those salaries, but then we’re having state money that’s going towards these initiatives that previously weren’t happening. So we’re vibrating this. We’re seeing what can happen. We’re making the most out of every dollar. The goal is that when HFI comes back around, our next budget year is, I believe in 2027 we just passed our budget for the next few years to be able to go back to our state legislatures and say we’ve done all of this with HFI, with PHIG, we can continue to see these improvements, see these goals continue to be met, but we need, we need support from our state, our state level, to be able to meet those goals. So we’ll see what happens.

We’re going to keep continuing to move on these goals and see what we can do with them. But it’s been incredibly successful so far in what we’ve been able to achieve. So I’ll be talking a little bit more about this tomorrow as well, for our promising practices. If you want to hear this again, or if you have any other questions about it, I think I might have talked a little bit fast. But yeah, it’s been a really big change for us; it’s something that, again, Indiana hasn’t seen before. I’m hoping that we can continue to build off of it, regardless of what PHIG looks like in the next few years. So thank you.

Todd Nicolson:
Standing ovation already, and I’m just walking up. Hey, does this thing work? Hey, look at that. Cool. That means I’m not tied down to the podium, which is one of the things that I hate. So, good afternoon, everybody. My name is Todd Nicolson. I am the workforce director, program manager, and the premier investigator for the public health infrastructure grant in Southern Nevada. Southern Nevada is Clark County, Nevada, which houses Las Vegas. And everybody knows where Las Vegas is.

The funny thing about Las Vegas is the strip’s not in Las Vegas. The strip is in unincorporated Clark County. I only say that because when people are reminded of the mass shooting we had there in 2017, they always want to know why didn’t Las Vegas respond? Because it wasn’t in their jurisdiction. That’s why the yellow fire trucks came and not the red ones. So that’s just a little bit of a number there. I’m going to talk a little bit. Differently. We’re kind of, I’ve been finding out that a lot of you guys belong to either the county or the city. Southern Nevada Health District belongs to neither.

We are a standalone independent jurisdiction that services Clark County, and the 73% of the population are 2.3 million people that live there, you couple in 40 to 50 million visitors a year, and you can kind of see the impact that we have across the state. Out of the 17 counties, there are only about three that are really populated: Carson City, Reno, and Las Vegas. The other 14 are pretty much rolling frontier. And if you drive 20 miles outside of Las Vegas, you’ll be in rural and frontier Nevada. There’s my plug for the CDC. The opinions are my own, solely my own. Drop Off slides. Okay, you guys are too young to remember your hand dropping off. I got it. So he was like the Prime Minister of the of Russia for like, two days and passed away.

So if I don’t have to stand here, can you hear me? 30 years in the Army pretty much taught me how to project one voice. So I’m pretty sure that I don’t need a podium for a microphone. This is my agenda. This is what I’ll be talking about. I’m not going to read it to you because we’re all educated public health officials. I will tell you that five years ago, on Thursday, my son had a bad motorcycle accident, and I was finishing my doctorate. In fact, I had five days out from my doctoral defense, and I’ve been growing this thing on my face because I want to try it. So my friends, when they retired from the army, said, Hey, so Pat, didn’t I throw a big mustache? So I was trying. This is just kind of a, you know, wait and see me. I said we would go in September. September sounds good. My voice is married to you for your hair.

And then my son said, Oh, come on, Dad, you gotta go through no shade. Don’t ever. Then he had his accident, ended up in shock trauma in Austin, Texas, and did a great job. He’s still with us. They’re not really sure if they want to walk again, because his spinal cord wasn’t severed; it was pinched. So he’d been working really hard at rehab and getting heavy, and he got married and all those wonderful things. But about a year and a half ago, I said, Well, you’re literally sitting on your butt. Let’s do something. We got him into his MPH. He’s working on his mph, so we’re very proud of that.

One of the things that we always talk about with the PHIG grant is how we look compared to our population, where we’re at, we have 8000 square miles, which is about the size of New Jersey. I’ve been to New Jersey once I’ve been to Bayonne. I hope that’s not indicative. I already talked about being incorporated. That’s our census. Okay, everybody serves tourism is down by about 11%, about 50 million people. That 11% is not a big thing for us, but this is the demographics of Clark County. This is how we look as a whole, as an organizational group that we serve. You can see we have a large Hispanic population, African American, black, others, Asians, and whites. But when there are two or more, they identify as two or more different.

Emily Peterman:
Online, people can’t hear you with that mic.

Todd Nicolson:
Online people, all right, I apologize to the online people, but as we take a look at this, and then we compare it to our demographics at the Southern Nevada Health District. We’re a pretty good representation of the community that we serve, which I think is important as we take a look for our successes to the public health infrastructure grant and as we show Congress what we’re doing with their money, they say you got to look like your community, and We pretty much do with some minor exceptions, but we’ll see as we get to the school district that’s a little more skewed. But if they’re like me and have a bunch of kids who then have a bunch of kids that have a bunch of kids, you’ll see some demographic changes. But this is how we serve our community.

What I really like to talk about is the programs that we’re doing using our A1 strategy, workforce, money, and our A2 strategy, foundational capabilities, money, because I think those are really where we’re making the inroads into our community. Now this is an A1 program with human resources. My slides are actually in the app. One set of the slides that I found in the app. The majority of PHIG is found in personnel and human services for us, HR, it’s all of our salaries and our fringe, and all of those programs. But our HR does our organizational vital signs study.

We’ve been doing it for three years, taking a look at our satisfaction within the organization and how leadership gets involved. I will tell you. I took the organizational vital stands in 2023, probably a month before I took this position, and then ran to Chicago. I took the position on Thursday, ran to Chicago on Sunday for a Monday meeting. I was sitting out there in the audience, and we were talking about the five. I’d never heard about the five, so I’m looking from the back, going, what five are they talking about? I couldn’t see any signs or anything. So about 10 o’clock, when my brain kicked in from Las Vegas, it was like, Oh, they’re talking about the public health infrastructure, virtual engagement platform. So I didn’t feel as stupid, but I felt pretty stupid for a while. Our vital signs, our organizational vital signs, of the OVS is also going to be a longitudinal study for our targeted Evaluation Program.

We’re going to see where we are versus where we end up in five years, and we’ll produce a white paper for the CDC that’s part of our deliverables. And I hate statistics, because you know, you can take numbers and make them lie. One of the key points is that you have to remember that, in 2023, we had 809 staff. In 2024, we had 750 staff. And now in 2025, we’re at 880 staff. So when you start saying, well, 63% of these took it, 63% of what, but that’s what we’re taking a look at. But every year, our numbers have kind of crept up. So that’s a good thing. When we talk about sustainability, we have trained some of our HR staff to go ahead and learn how to do the emotional intelligence analytics for any of our surveys.

So if PHIG were to go away, we’re able to sustain this program and take a look at things now. The new boss is not a big fan of big organizational surveys, so we’re going to start looking at minor what they call mini surveys, or pull surveys in the future to help us with this for engagement, one of the things that I personally didn’t like as an employee for eight years was I never saw the leadership unless I ran into them in the hall walking to the bathroom or to the Board of Health. They never came out of the office. But they are we also weren’t recognizing our employees as well. For the first time, I got a snappy for my 10-year service award.

Once I found out that I was funding that program, I donated to it. No ethics problem here, but we have a process where, monthly, the supervisors and managers can nominate an employee to go before a board. It’s all very unbiased, and they choose some winners, and then quarterly, we do the same thing for our supervisors and managers. At the end, besides getting a snappy and a small reward, they get to come before the board of health, the board of health that month, and they get to have their picture taken with the board. We’re also very proud of our employee referral program. However, we’ve had to readjust some money there, because, much like my colleagues in the room, we’re kind of on a hiring freeze, and I don’t want that money to sit there because Todd’s not giving back a bunch of money. Todd’s spending every dime, and if Todd needs to set up his own account. You know Venmo me.

We also do academic affairs. We’re an academic health department. She makes sure that we keep up our credentialing. She works for our intern program, which we have a small stipend for four years for that program to bring them in, and we can give them a little bit of money, please help with gas, and they’ll be there for it, kind of depends. They have a semester longer; they have a short term.

And then we do a thing called Health District after dark, where we take, and we coordinate an event. Brain Health is public health was one of them. Gun Violence is a public health issue; we invite members of the community if we have it, and we’re trying to reach out to the whole community. And even UNLV is on the border with our underserved community in Las Vegas. If I want my underserved population to come to this to get this education and listen to these experts. I don’t expect them to pay for parking at the college. So we’ll, we’ll make sure that we cover the parking when they come in.

And then when we partner with UNLV, the School of Public Health, they’ll bring like, refreshments and things. So it’s a great, big collaboration with UNLV there in Las Vegas. Cross Connection training program. These two gentlemen, we had one, are the guys that go out when we have a crisis, like Legionnaires’ disease, Legionella. I call it Legionnaire’s disease, as it was in the 70s when it first happened. You know, we have a personal connection to that in my family, but we provided an opportunity for one of our people to go out to the University of Southern California and go through this program.

It helps them to go to the hotels and the motels, and they’ve done very little with health care, because that’s not really their primary focus. But now he can go out and help them identify where their potable, non-potable water supplies may be crossing over and contaminating, and leaving some of these, he’s better trained to help assess plumbing systems, identify his cross-connection hazards, and then collaborate more effectively with facilities engineers. And if anybody saw in New York, they just had a big Legionella outbreak, and I think they had three deaths at last call.

This guy is one of the people who goes out and takes a look at what’s going on, and here’s the impact on the community. But this is the big one. We have two people to cover, 150,000 rooms, 37 major hotels on the strip, and that’s not including all the mom and pop and little hotels, like the Tropicana, that’s not on the strip or some of the other ones, but that’s 150,000 rooms. That’s a lot of real estate for two guys. So we increased our capacity with this young man. He’s a really good young fellow named Siege Castile. And Siege just recently got married, but he’s doing great stuff with us. Condenal syphilis, one of the nurses said, and it’s on the next slide; one death is too many.

Now, before the PHIG, we had a backlog of pregnant females who had syphilis from their partners who were carriers that just weren’t being seen or referred to care. Through this program, we were able to fund a nurse case manager who took the backlog down to zero. There’s nobody on the waiting list. Six, the interesting thing about this program is that you may come in, we may identify we may send it to the lab. We may confirm that you have congenital syphilis. And if we refer you, you may not go. I mean, 64 of 96 clients have gone. What are we doing with the other 28? What are they doing? And we don’t want to do that. That was in 2024, and only 20 of 28 have been referred this year. Have gone to their referrals.

But the fact that we have a program like this now is better for the community, and we’re starting to see the impact across Southern Nevada. And here it is. One death from congenital syphilis is one too many. We’re working on some other things with this team, but they really work hard, and they’re also going to start working with our I believe they’re going to be involved in our street and field medicine team. Now we have a bit of a, and I’m not sure the politically correct term, I think, on the House population. I think back in the day, it was the forgotten man in the 30s, when we had the depression, we had some unique modifiers for these people, which is unfortunate.

We have a very large homeless population of veterans as well. And I will tell you, being a veteran, some of those guys, they want to be on the street, and there’s nothing. And we have a good Veterans Program. We can get them housing and things like that. They don’t want to come off the street. But the case manager has been going out and providing education to our hospitals, our EDs, and into the community. So that’s a very big program that we’ve had a great impact on.

Safe Routes to School. It’s a program that we’ve been doing for a while. We’ve been working with the Clark County School District, CCSD, for 15 years on Safe Routes to School. We have the fifth-largest school district in the nation, according to the Department of Education, before everything went bad there with federal funding, but it encourages them to be able to walk safely or ride their bikes to school. Now, a couple of years ago, we had problems with people getting hit in the school zone. Well, if it’s six o’clock in the morning, you’re going to school, and you’re wearing all black, and somebody’s racing a little bit through the school zone, and adults do it too. So it’s not just the kids.

The possibility of getting run over is pretty high, but it’s also an effort to increase their physical fitness. We’re also doing some body mass index BMI data research on this as well, but over the last three years, we’ve been able to assist this program by providing PHIG funds for them to basically help administer the program. Now, I don’t know about everybody here, but if somebody’s offering free money, I’m taking it. I’m going to get it on my board of health agenda. I’m going to present it. I’m going to take it. We’ve had some challenges, but overall we’re working with 296,000 kids in our school. This is the demographics. So you can see that we have high Hispanic, Latino, followed by white, and then black, multiracial, Asian, Hawaiian, Pacific Islanders, and then American Indian Alaska Natives.

When I first got to Vegas 10 years ago, I kept driving by this place called Ninth Island Jujitsu. It’s a martial arts place, and I was like, why is it called Ninth Island? Well, there are eight islands in the Hawaiian Island chain, and the ninth Island is Las Vegas, because we have a heavy Hawaiian and Pacific Islander community. And we just opened our first Zippys. And if you’re from there, you know that that’s a local place to get local cuisine, so you couldn’t get in for the first three months because everybody else was there.

We have the achievement level program. It’s a framework that encourages people and schools to do this program more. We’ve increased that by 30% again. I don’t like statistics like that, but of our 53 total schools, you know, we increased by 30%; our baseline schools were 40. After that, we have reached what they call the achievement level, one or gold. I believe it is bronze, silver, gold, and 11 have reached the platinum. I don’t administer a lot of these. What I do is they come to me, they say, I want to spend money. Do you think I could? And one of the things they said three years ago is for this grant, it’s, how do I get to yes?

So I’m the guy who looks at the program, looks at what you’re trying to do, and I figure out a way to get us to Yes. So that’s really my job here, and making sure that we put in our applications for the NCC. Who’s all got that done? Yeah, we did ours before we came out, because I don’t want to run back and have to do it on Monday. So if you haven’t done it yet, I’m sorry. I’m really sorry. And all my whole grants team changed over this year, and I’ve had six accountants in three years. So you can imagine some of the challenges we’re having with understanding the program.

The beauty shop barbershop initiative. It’s really getting us out into those communities where people talk. How many times have we ever heard that? You know, JFK told everything to his barber. We’ve even got shows called barber shop where they’re all talking in the barber shop. So this is a great opportunity for us to go out into those places where everybody’s congregating and have these discussions started in 2017 with one barber shop. We’ve grown to 13 barber shops and five beauty shops. We’re having a big event there.

I think next Saturday we’re going to be at I had to look at the poster twice because it says we’re going to be at blade masters, a guy who studies martial arts. I’m a blade master. Sword guy. Now it’s a barber shop. They’re called blade masters. But it’s also a faith Health Initiative, where we get out. We talk to these guys about disease, disease, diabetes, self-maintenance, education, and we talk about the fact that with every heartbeat is life, where we heal. I think that’s the way they pronounce it. We heal. We get out to food-based pantries as well.

It’s the client’s experience from behind the chair. We’ll set up initially, and they’ll come in, and we’ll ask them if they’d like to participate. We’ll give them some educational material, and it works out pretty well. The one thing that I would like to say is, and I’m kind of in agreement with the boss. He says, we’re not doing any longitudinal studies on these people about how we’re changing their lives, and we need to get better at that, because we can only think that we’re going to do better if we understand the impact on the community. And these are our volunteers, or trained volunteers and partners, Etta, Etta, Etta, and that’s not a mistake.

Chapter of the Chi Eta Phi Nursing Society, Nevada State. They weren’t the College of Southern Nevada. They’ve changed their name. Then we have the Southern Nevada black Nursing Association, the Nevada Faith and Health Coalition, community health workers, and our Lake Community volunteers. I always walk over to where we are right outside our building. We have a little Pizza Hut right next to them. They have a barber shop. And I always want to walk in there and see what we’re doing, if we’re doing anything, because it’s right there in the parking lot.

It’s a non-traditional setting. You don’t have to go anywhere. We’re going to come to you. You know, you’re sitting there, you’re getting a haircut, maybe you’re getting a trim, and we’re going to be there talking to you. And it builds trust. It provides you with an opportunity to get a blood pressure screening. I will tell you that right after I got to Afghanistan, I had to be treated for high blood pressure for a couple of weeks. I don’t know why.

Culturally appropriate site. It’s the pillar of the African American community. A lot of people go to the barber shop, and then, of course, it’s an effective peer-based management system. So we can get out to the people in the barber shops, give them the message. And you know, it’s funny, when you talk to one person, you talk to another person, then you talk to another person. I worry about a lot of this stuff because my youngest is mixed race. He’s half African American, half white. So he and I, he was spent two weeks with me, and I said, these are the things I worry about for you that I don’t understand, as well as you know his mother does.

So we have those conversations. We have conversations about, but that’s one of them. These are some of the numbers that we’ve shown between 2024 and 2025. This program was just briefed to our Board of Health about getting out into the community. And of course, you know, people in political office like to see numbers. So there are our numbers of participants that have been screened, 795, number of events, 155, and so on. So our average age at the barbershop is 38, and the average age at the salons is 46.

Purchase, we use some of the PHIG to provide published educational material to the people when they come out to the event. We were providing ride cards for the bus. If they couldn’t get there, we would have a way for them to get there because we wanted to be there. We also do diabetes prevention and self-management materials, training, and education for the teams that come out here. So this is a wonderful impact on our community, I think, as a whole.

This one seems to be my favorite. I’ve done a couple of things on the Double Up Food Bucks program. It’s one of those that you can see the actual impact on the community from afar. In my eyes, it’s a fruit and vegetable nutrition supplemental program that works with the sub Supplemental Nutrition Assistance Program snap. It would not be confused with the snappy. Research indicates that people who have access to nutrition incentive programs have improved health outcomes. So when my son was coming out, I said, What do you what’s your list of things that you can or can’t have because he’s got some food allergies? Said, well, I need this, I need this, and I need some apples and bananas. So guess what he didn’t eat? It’s my house, the apples, and the bananas. So I have apples and bananas to eat when I get home.

We’ve been operating for over 10 years in Southern Nevada, and we can be your partner. But over the last three years, with PHIG and A1, we’ve been able to provide over $400,000 in assistance to the program. So we’re getting out there and doing better things, and together, we can as a local nonprofit through the GUS Schumacher Nutrition Incentive Program, or the GUSnip. I didn’t know what GUSnip was until I got prepared to do these slides, but we just don’t go out and do this.

We work with the Southern Nevada food council to make sure that we’re. Doing an assessment of the landscape and where the most need is. It identifies locations where there’s limited access to nutritional value. In fact, one of our locations sits in the middle of an area that, without them to do this program, is six square miles for anybody to go get fruit, fresh fruits and vegetables, and then to double that up through this program. So I think we’re making an impact. And we use the assessment by priority zip codes. If you’ve ever taken a look at any of your data for your electrical uses, where you have most of your durable medical equipment out in the community, you’ll see those priority zip codes. So that’s how they make those assessments.

They started with one market, and then they expanded to two, and this year, they expanded to a third market, which I think is really great. And then we’re looking at the budget, the way it looks, we’ll have to decrease some of their money next year, but we will still. We’ve made some concessions in other areas, so that when we put in the NCC, we made sure that this program has a little bit of money to help with the programmatic end. And there are the objectives of effectively leveraging resources to expand the Double Up Food Buck implementation sites, strategies to increase program uptake and utilization, and then identify locations that are suitable, along with seeking additional funds and resources that don’t always come from the health department.

Some of the strategies they’ve used are they used to do $5 and $10 coupons as a separate model. They’d give them a coupon. So what they’re doing now is going to a smaller amounts of $5 $1 to become eligible for the program, and they’re working with their point of sales representatives to actually print the coupon, the Double Up Food bug program coupon on the back of their receipt, much like when you print out your thing from Smith’s for two items and it’s got a coupon on the back. We’re working. They’re working to do that here as well.

Oh, those are my references. If you want to check my math, it’s probably wrong. I was not a math major. I took the statistics by itself when I was in my doctorate, because I don’t like statistics. I’ve already said that same thing. I told my son, take statistics by itself. You’ll have some challenges. And with that, there’s my information again. My slides are on the app I saw on their day. And that’s some of the other things that that’s how to get a hold of me. I also have to have the old number for the appointment line, so I get all the calls for Aetna with people looking to get a new appointment as a new patient in Southern Nevada, so I field all of those questions as well. So, with that, I’ll turn it back over to Emily.

Emily Peterman:
Well, thank you again. Todd and Olivia, great presentations, and really, just awesome to hear about the work that’s happening in your jurisdictions. We do want to open up for discussion. So Kendra is going to be running a mic around the room if there are any comments, questions, reflection on what we’ve already talked about today. I’m going to pause and see where we want to start.

Larissa (Audience Member):
Hi, I’m Larissa from Harris County in Texas. I have one question for each of you, so I’m sorry I can’t remember either of your names right now from Indiana. Olivia and Todd. Okay, thank you, Olivia. Can you tell me again about the composition of the regional teams? I know you, I know you touched on it, but I would love to hear more about that.

Olivia Ault:
So I don’t know if people online will hear if I don’t come up, but yeah, our regional teams, we have about 10 members. So we have our regional directors, data analysts, communication specialists, staff attorney, MCH specialist, disease intervention specialists, a school health liaison, and core and quality service providers. I might be forgetting one person, but I don’t think I am. So yeah, we have this pretty extensive team.

We are talking potentially about maybe combining some roles, maybe downsizing, maybe seeing what can go to LHDs, just as we’re trying to make the best use of PHIG. Funds, especially in our last 28 months or so of the grant, just yeah, kind of getting talking to LHDs of what that could potentially look like in the future, of what they take on now that they’ve had HFI funding, now that they’ve seen what they’re capable of doing, kind of going from there.

Larissa (Audience Member):
Yeah, that’s really helpful. Really diverse. Do you have an idea of like, which were, which of those roles were the highest utilized? Like, what were they most interested in, or was it pretty even distribution across the team?

Olivia Ault:
So I know, like our regional directors, they are, like, the first point of contact for pretty much anything. Health service directors, as well. Staff Attorney, I think, is probably one of our lower utilized one, which makes sense. Typically, you know, it should be fairly clear cut on, like, what legal ramifications are. Don’t need to use them as much. But that was one of the things in our first survey, which was how often you utilize them, and kind of seeing recent growth from there, like, you know, it seems like our communication specialist wasn’t being used a lot. Is it because they were hired later, or do you just not know how to use them? And kind of going with that.

Larissa (Audience Member):
so awesome. Thank you. Okay, Todd, my question for you is about the food box. So one, if you could just explain the coupon amounts, 10, five, one, if you could explain it didn’t make sense to me. Like, are you saying, like, if someone got $2 worth of qualifying stuff by lowering the amounts they could get, they could actually get to utilize the program and get, like, $1 buck.

Todd Nicolson:
So, initially was $10 of qualifying to get access to the program. We’re allowing it to lower denominations of $5 and one dollars, so more people have access to the program through lowering the denominations, we found out that, you know, when you’re in that type of a market, underserved, underutilized, they need a lower amount to become qualified to make sure they’re getting, you know, the nutritional food to sustain.

Larissa (Audience Member):
And how did you figure out that you needed to do that?

Todd Nicolson:
Well, I’m, I think I qualified this by saying I don’t run into these programs, but I’m pretty sure that with the programmatic person at together, we can and our chronic disease prevention health promotions team, they were able to look at the data of who was using this, and, you know, figuring out the Why, what? Why aren’t they using it? And they determined that it, you know, the prices were too high that, you know, some of these people are coming in, you know, I can remember back in college, you know, five bucks was big deal, and I might not be able to get any, you know, for the three small kids I had at the time, I might not be able to get anything that would qualify that way. So, yeah, yeah.

Emily Peterman:
Any other questions in the room? Kendra over here. I’m just running around with these mics. I think.

Rochelle Whitaker (Audience Member):
Hi, my name is Rochelle Whitaker. I’m from Wake County in North Carolina, and I had some questions for Olivia about the response rate. You said that you got a pretty good response rate from the surveys that you provided to the area. What was your response rate? Do you remember?

Olivia Ault:
We had 116 for the first one and 142 for our second, and out of those, we have 95 LHDs. So like I said, our southern region had 100% response rate, and then their northern and central regions were like 85 to 90 also, like I said, there’s one that kind of skewed that a little bit because they responded six times. So with my next survey, going to try to encourage them to get that down to one or two; they just seem to really like surveys in that one county.

Rochelle Whitaker (Audience Member):
Okay? And with the survey that you provided, are you doing that on an annual basis, or are you kind of switching that up?

Olivia Ault:
Sorry, I didn’t go into that as much as I should have. So what we did the first time was we did it in about May of 2024, it was open for a month, and that was the trains had been in existence for nine months to six months at that point, as we were gradually hiring people. So, kind of the initial feedback is this: Are we starting this off on the right foot? Are we doing what we said we were going to do?

Then the next one we had in the fall, so a couple of months later, and it was more. We’ve been in existence for about a year at this point, and some of them are still a little bit newer. What are you starting to be able to do? Like, what projects are you starting to plan for? What are we seeing that you’re able to do that these teams are now, these teams are, like, more firmly in existence. You know what they are. You know who’s available.

Rochelle Whitaker (Audience Member):
Okay, so you mentioned, as people are coming in, did you make it a part of your onboarding process to survey people, or did you assess the entire area that first time in May?

Olivia Ault:
So we sent to all the 95 LHDs for the first time in May. We had worked with the regional teams and told them, like, Hey, this is going to come. We want to talk to the locals and make sure that this is happening as we said. So that kind of holds them accountable, too. Of course, make sure that you’re doing the services that you’re supposed to be providing.

Rochelle Whitaker (Audience Member):
Okay, and based on the questions that you asked in the survey, I know you said you had 27 questions. Did you all? How did you link? Did you implement activities based on the results you got from that survey? And is that where you got your metrics from? Because I know you talked about the lead response rate and the clinical care, were those questions reflected in the survey, or did you go based on the feedback they had?

Olivia Ault:
So the like the lead and like the clinical care, those are the KPIs that we’re measuring. So, yeah, we are kind of linking it off, you know, are there programs that you are planning to do that you had wanted to do previously, that you were able to do? And the lead stuff was, like, an example of what we wanted to be doing more of that kind of thing. So we can see, like in the real world, the KPIs are showing that LHDs are able to tell us kind of what they’re planning to do in the survey, and we like some free response in there. Does that help answer your question?

Rochelle Whitaker (Audience Member):
Yes, I think that was all of them. Thank you. I did have one more question. I’m sorry for Todd, your organizational vital signs here is that something that you all do on a on an annual basis?

Todd Nicolson:
During PHIG, yes, yeah, we’re doing it with an organization called Six Seconds, and they have a way that we can customize the questions, but we work with them. They provide the platform. We send a link out, and then everybody can click on the link. It takes less than 15 minutes. If you’re in a bad mood, it takes less than five, but that’s how we’ve been doing it. That’s why, when I mentioned the two trainers that we’ve had go through to learn how to do all this and the analytical background to it, they all went through six seconds. So we’re looking for the long term.

Rochelle Whitaker (Audience Member):
Awesome. And you mentioned it was a 63% response rate for the vital records for the last year.

Todd Nicolson:
So last year, I had this data, I didn’t put it in the presentation because, as I said, numbers can be skewed. While we’ve gone up in respondent rates. I think last year was 78%, and the first year was 61% you have to look at our hiring numbers. Is why I gave them to you, 8097, 50, and 880. We show a trend up in the percentages of people who have responded, but we also have either had more or fewer people on staff at the time, so that skews those statistical numbers. But this past year was probably the best we’ve had, and we’ve actually hit some benchmarks that we can do with the focus groups, and our teams can now go in, ask the right questions, and start putting together an action plan so we can address those as an organization.

Rochelle Whitaker (Audience Member):
And can you expand a little bit on the emotional intelligence component that you talked about, like either a survey or assessment style around emotional intelligence?

Todd Nicolson:
So part of the organizational vital signs is based on the emotional intelligence of our leaders, managers, and supervisors, and how the employees view them for that. So the emotional intelligence piece is the best basis for our team to do their analytics. In the future, we will continue to use six seconds, as long as we still have support, financial support, to do that. But we’re looking in the long term. So the HR training team can look at this. They’re all being certified, so they could do it at the local level without, you know, spending 12 or $15,000 on a third party.

Emily Peterman:
Thank you. Any other questions in the room right over here? We’ve got one. There we go.

Audience Member #1:
Thanks. Thanks so much. This is for both of you. I think you both kind of touched on the sustainability piece and thinking about the future. Is there anything in particular that you’ve been collecting or thinking about collecting that you think really will be important in the future of discussing the impact with like folks outside your PHIG team?

Olivia Ault:
We’ve been focusing a lot on, like, quick wins, so that we can go back to like, our state legislatures and talk to our legislators and talk to them about, like, you know. We’re seeing in your district that we’re seeing a decrease in. I’ll just keep going back to a lot like, we’re seeing more kids get tested for this. We’re able to respond to it a lot sooner. We’re going to see healthier outcomes and stuff like that, because we know that’s what they like. They don’t necessarily want a whole long, thick report. They want quick and fast, easy to digest.

So that’s kind of what we’re trying to do. That’s one of the things with the survey, as I’m as we do it, I’m trying to compile it so that we can tell the story of what we’re seeing in these outcomes. We’re seeing these impacts. The dashboard that I showed you with the KPIs being able to show that, like, hey, it’s getting a lot more green since we’ve had this funding. If you say that you want Indiana to be a place where everyone learns, lives, grows, works, plays, like, that’s how you’re going to get people to come and stay and live there. So that’s kind of how we’re trying to approach it.

Todd Nicolson:
We knew the same thing with the quick wins, except we sent it to the CDC because, you know, we are a direct recipient in Southern Nevada. But for the first time in our history, our legislature actually started to identify funds in the governor’s budget for public health. The first year we received out of the $15 million, I think Southern Nevada received about $10 million to enact programs in public health. And now, this past session, public health funding has been a line item. So they’re starting to recognize, much like my colleagues in Indiana, that, you know, public health just doesn’t happen. I mean, a bunch of people don’t just show up when there’s no funding and do this work. So they’re taking a real look at it. I think from what I’m hearing, the reporting is a bit laborious.

And, you know, much like Olivia just said, I don’t think that anybody wants to read a long, drawn-out report on, you know, what this money is doing? They want the quick upfront. This is what I can hang my hat on, you know? I mean, I don’t hear many politicians going out and say I did 75,000 words of the, you know, they touch on the big things. You know, vector. Vector is a big one, things like that. So that’s how we’re addressing it. We are starting to see some public health money coming from the state, which I think is a good sign that, you know, people start to understand the role that we all play.

Larissa (Audience Member):
Okay, thought I was done, but then I have another one. So, how are you guys? Oh, who cares? I don’t listen to the rules. So, about for so for both of you, about these quick wins, the team that I work with, we do a lot of data analytics and evaluation for PHIG and just other county programs. And some of our reports are really long and drawn out. And I’m often thinking, I’m like, is anyone reading these? You know? So, this thing about quick Rin wins is really resonating with me. How are you guys communicating your quick wins? Like, is this like, you know that your legislators are monitoring your social media, so you’re blasting it. There are these, like, notes or memos, or, you know?

Todd Nicolson:
So, my project officer at the CDC actually sent me a format on how to do these quick wins. So we put them together, and we get a lot of them from progress reports that we receive, you know, semiannually and annually. So we go out, and we start looking for these things, or they’ll do a report to the Board of Health on the heart disease, the Combating heart disease in the African American community. That was just to our Board of Health last month, so I borrowed their slides, and that’s how we communicate a lot of the programs we’re doing in public health now, through our Board of Health. We have two physicians, and they’ve been doing this for a long time. We have several other elected officials who have been doing this for a long time. The chair is very knowledgeable in public health and has been instrumental in helping us write some regulations that we send out to the people, and I’ll get it wrong, but the people who set the pool standards, you know.

Because during the summertime in Vegas, believe it or not, the bit, one of the biggest complaints I get is, why did you guys shut down my pool? Well, somebody drowned because their hair got caught in the wrong vent. That’s why you know things like that. But our Board of Health is pretty involved now. We have not, I have not presented on PHIG to them. They haven’t requested it. So all my stuff goes into the PHIVE, you know, those five guys from Chicago, and I know that they’re being read at the CDC. And for me, you know, when they start putting together their congressional testimonies, those are really the guys I want to see it at the local level. If they start asking us to send them stuff so they can kind of start mirroring it, I’m all over it.

Olivia Ault:
I will say we are also, like, obviously reporting to our project officer, like, what our quick wins are and everything, so she can compile her reports and report back to her leadership. But usually for mine, it’s been fairly informal so far when we had our surveys, and, as I said, I met with, like, our regional directors and the commissioner that oversees them. I did put together, like, a slide deck of, like, here are the highlights, customer service, like, I said, was rated pretty high. We’re seeing, like, some blurbs, like, what projects of that they said they’ve been able to do that they weren’t doing previously. So that’s kind of how we’re doing it so far.

I’m keeping, like, a running list of what we’ve been doing as I’m talking with people, though, like in the department of saying, like, hey, PHIG did this. Like, we weren’t able to do that before, like, I just got word that we completed all this testing or whatever, and making sure it makes its way back to the commissioner, to our head, so if, if and when, like, we need to all create a report and put that all together. I know, like, she’s going to talk to the Governor or something like that, I’m happy to put that together. But, yeah, ours are fairly informal at the moment.

Todd Nicolson:
The one thing I didn’t mention about the fashion statement, if you see me without it, in the next two years, he took his first class, great. That’s the indicator.

Emily Peterman:
I think we’ll have another PHIG convening in two years, so we’ll get to see that. I think we had one more question over here. We met our question quota on this side, so this, I think, will be our last one. Take it away.

Dominic (Audience Member):
And this question should be brief. This is for you. Todd, hi. My name is Dominic. I’m with the St Louis County Department of Health here in town. My question was about the employee referral program. You kind of touched on it, but I wanted to see if you could go a little more in-depth about how it was running, or what all it entails?

Todd Nicolson:
Having been stationed at Scott Air Force Base for three years, my wife is a St Louis girl. Yeah, I’m happy to do that. So we put into our PHIG grant certain amounts of money for referrals. I think it’s 500, but don’t quote me, but we have an amount. So if we’re trying to fill a position and we get a qualified candidate from an employee, then we will reward them if we hire that person on. When I kind of glossed over it was because, you know, we’re on a hiring freeze, and I’ve got that money sitting there. So I said, Hey, we can’t give this money for employee referrals, but we can shift it to employee recognition, which means more people get, you know, recognized for the quality work that they’re doing in Southern Nevada. So I hope that answered the question.

Dominic (Audience Member):
No, it does. I know, with us, we were awarded our fig funds from the state of Missouri, so we have tried to do something similar to an employee recognition program, but have had issues just at the county level with different things, and then at the state level. So I was just curious. But you did mention that, with you all being a direct recipient, that might make it a little easier.

Todd Nicolson:
And I think that that’s one of the things that I find most interesting about our organization, is that we are kind of independent, and I don’t necessarily answer the state on some of the grants, cooperative grants, like HPP, App CRI, you know, they come as a pass-through. You know, we had to do those reports we had, you know, they would. They’re only supposed to take 18% but, but they’re the health department for the rest of the county, so they’re going to take another 17. You know, I won’t say they were stealing money, but they were doing some creative accounting.

So I fully understand what you’re saying. And one of the things is, because we do this internally, and I go directly to my district health officer. I see them every month, and we talk about programs and things like that; we’re able to set up something. And it was also identified in one of the early OVS, is that we did, is that we didn’t have a strong employee recognition, I’ll say a strong Employee Recognition Program. So that was one of the things we were really striving to get on the books. Was a way to do a quality recognition of our people. Our team likes snappy. Everybody seems to like snappy. You know, it gives you a variety of gifts. So, yeah, that’s kind of

Dominic (Audience Member):
Cool. Thank you.

Emily Peterman:
Well, thank you again, Todd and Olivia, for your thoughtful presentations, answering these questions, and guiding the discussion. Folks who have joined us virtually. Thanks for being here. I do have a couple of announcements before y’all run out. So bear with me. We got three ones. Please make sure you join us. We’re gonna have a welcome reception right after this out here. I believe we’re on the fourth floor, so it should be right out here. There’s gonna be poster sessions. Check out the posters. The author should be out there for conversation. But one of our sponsors, Inductive Health, is sponsoring that. So there will be some beverages, some snacks, and just lots of opportunity for networking. So join us out there.

And my last announcement is that there will be breakfast tomorrow morning, 8 am sharp. You want to get there in time, because there will be some other sponsor discussions during breakfast as well, but that will be more of a plated breakfast that will be in the ballroom. So thanks again for being here, joining us for the last session of the day. Excited to spend another two days together. As I said, I’m an evaluator, and heard the good, the bad, and the ugly. So thank you for the good day, and looking forward to spending the next couple of days with you. Thanks