All right.

I'd like to start the health committee on the board of supervisors for Monday, February 23rd.

Supervisor Cam, present Supervisor Miley.

Instructions.

For in-person participation, the meeting site is open to the public.

If you'd like to speak on an item, fill out a speaker's card in the back of the room and hand it to the clerk for remote participation.

Follow the teleconferencing guidelines posted at www.acgov.org and use the raise your hand function.

Thank you.

So we're gonna take public comment first.

So on non-agendized items.

So any public comment on David Canna.

We just stand or approach the podium.

Okay.

Can I hear me?

David.

Good morning, Supervisor Cam, Rosa Miley, everyone here.

Um my name is David Shanner.

I am the CEO at an organization called The Better Way.

We serve kids and families throughout the area.

I'm here today as president of the Alameda County Behavioral Health Collaborate, though.

We're grateful for the collaboration we've had with Alameda County leadership and supervisory board.

Um we are here today to again state our strong concern about the impact of the way that Prop 1 is being implemented and the transition from MHS to PHSA.

We've um made clear our concerns about this, the impact on roughly 15,000 clients who are gonna lose critical services, and also a need for some urgent mitigation for that risk.

We're gonna lose about 27 million dollars in funding in our collaborative alone.

That's not counting all of the similar agencies throughout Alameda County, and we're gonna lose a lot of jobs that are currently held by people with lived experience who are going to be now both without livelihood and also without key services that are being removed without a direct immediate plan to fill those in.

Um our biggest ask today is for a hearing.

We would urgently request to schedule a hearing to discuss this in more depth.

We've had some very um fruitful and helpful and appreciated conversations with a number of you and we want to keep that ball rolling.

We're we're every day that we add up the calculus of what's coming.

Um we are losing some sleep.

We know there's other many urgent matters on the county's agenda right now and things that are big, so we appreciate your attention and we would love the chance to dig into this in an immediate and ongoing way.

All of you, some of our colleagues are in the room today from the collaborative and also hopefully calling in.

So you might hear from others of us today, but I just wanted to introduce that general topic.

Thank you for having us here.

Teresa Becker.

My name is Chris Becker.

I'm a licensed marriage and family therapist, and I work at Highland Hospital and the outpatient behavior program.

I'm here just to give you some information because on Wednesday there'll be a balance and hearing.

Highland Hospital is planning to, Alameda Health System is planning to close the two behavioral health programs that they have at Fairmont and at Highland, and these programs are first of all funded by Medicare.

Um, only clients with Medicare can have them, which means that people basically have to be disabled or old like me.

Um, the programs serve people with serious mental illness.

So what I did is I just made a little printout of something from the VA and um also do the program brochure.

So other programs serve those who receive brief treatment after a mental health crisis and continue their treatment with individual therapy and psychiatric health.

However, Highland and Fairmont programs serve those who need a consistent support to be stable.

The program is really amazing.

Clients are picked up in a van, lunch, snacks, brought home.

This is important because transportation is often an issue for people with serious mental illness.

The thing that blows my mind is that we have interpreters who will sit with people in a group if they're not fluent in English and they'll quietly translate to them so that they can actually get treatment, and that is something that just doesn't happen anywhere, and I've worked in a large code places.

Um many of the clients have been in the program for years.

These are people with serious mental illness disability.

The program structures their lives and offers a sense of community, which is deeply important.

And some of them even talk about just being working.

You're on the line, you have two minutes.

Good morning, supervisors.

My name is Jamie Campos.

I'm a CEO of Horizon Services.

I'm here today about the elimination of our Lambda Youth Program.

So this is a contract serving LGBTQ youth aged uh 12 to 24 years old.

So we received a notification of termination effective July 1st due to the BHSA transition.

And as you know, the major uh county behavioral health uh budget shortfalls.

Uh the program exists because the county's own community planning process identified that 45% of LGBTQ youth seriously consider uh suicide.

Uh and Alameda County families uh told us that they needed uh this very kind of service, so providing counseling, uh safe spaces and crisis support.

Uh so this this program uh which will uh soon be closed uh delivers 60 hours a week of services in an individual and group therapy uh type of setting, along with some suicide prevention.

Uh and it's one of only two programs funded to serve this population uh countywide.

Uh but the BHSA cuts are having uh greater cascading effects on other parts of the network.

Uh so Horizon is an addiction treatment provider as well.

So certain programs uh like our Cherry Hill programs on the Fairmont campus, uh providing sobering and detox services, which we've operated since 2008, are running on really outdated funding levels.

Uh and the county funders have acknowledged that they can't adequately resource these contracts right now because of the broader budget imbalances uh due to BHSA reform.

Uh so providers really are at a breaking point, and um we're asking for the board to consider some bridge funding this next fiscal year and to work with the collaborative on some additional steps.

Thank you.

Caller, you're on the line.

You have two minutes.

Yes, caller.

Oh, sorry.

Uh hi, my name is Lynn Rivas.

I'm the executive director for the California Association of Mental Health Peer Run Organizations.

Um, you have three peer organizations in Alameda County.

Um, Black Men Speak, Peers, and the Peer Wellness Collective.

Uh, they all received cuts, uh, but two of the organizations in particular, Peers and the Peer Wellness Collective, received dramatic cuts.

In fact, the Peer Wellness Collective received 100% of cuts.

Um, we anticipated cuts.

This has been happening across uh the state because of proposition one.

However, the severity of the cuts uh was really a shock, and it's really a problem.

The peer wellness collective has been in this county for more than 30 years.

Peers has been here more than 20 years.

Um, they provide a very important service of recovery, and in fact, because they're peer-run organizations, they're the ones who provide the training for the recovery model.

You can't have peers in the county without peer-run organizations.

Um, the viability of both of these organizations is a risk.

Uh, they may not survive these cuts, and we're hoping that you can prioritize, as you have for many, many years, prioritize uh these very important services.

Caller, you're on the line.

You have two minutes.

Narges.

Unmute your microphone.

Got it.

Hi, good morning, everyone.

Thank you so much for the opportunity to speak today.

Narja Stillen, executive director of crisis support services of Alameda County here.

And I also wanted to comment on the impact of the Prop One transition on the broader behavioral health system and give an example of what that impact looks like here at Crisis Support Services of Alameda County.

Some of the programs that we will be closing down at the end of this fiscal year include our hospital follow-up program, which currently works with individuals who are being released from John George and other psychiatric facilities.

The follow-up program works with them on stabilization and figuring out their next steps so they can be connected to ongoing care since the 30 days following hospitalization are the highest risk period.

Another program that we will be closing is our survivors of suicide attempt support group.

This group is designed for people who've had a prior attempt in order for reducing the isolation and stigma connected to that.

So I want us to be aware that when we talk about prevention being cut, and I obviously believe that prevention is worth it all day, every day, but when we talk about prevention being cut, some of the services that our communities losing access to are actually at the highest level of acuity.

And considering the fact that in the last year, our crisis line has increased a 40% increase in call volume, losing these services, we know for a fact is gonna have a bigger and long-term impact on the community.

And not having places to send folks who are in need of care is only going to push people into the crisis part of the continuum.

Thank you so much for considering that as you make your decisions.

Sarah, unmute your mic.

Thank you.

I have unmuted it.

Um my name is Sarah Markser.

I live in district three.

Um I work at Peers Engaging in envisioning and engaging in recovery services.

And I um want to emphasize today, I appreciate the opportunity to make this comment that um because our county's three peer one organizations funded through uh MHSA historically are all in danger of closing our services.

Um I work at peers because the peer community has been a source of hope and help for my family when we found little hope elsewhere.

I have lived experience as a parent with many of the life-saving services in the child, youth, and adult systems of care in our county, and um they're all crucial.

Um, and peer one programs do something that not served with us, which is to provide living proof that recovery is possible.

And for people with major mental health challenges, stigma means that places to belong and to contribute, which all humans need, uh are few and far between.

And peer one organizations build communities where that's possible.

Our county cannot afford to lose them.

Um at Peers, we employ about uh 30 uh folks, all of whom have lived experience, um, and many of whom really um rely on our our programs and the ability to participate in them as as staff uh for their own mental health.

Um and we can't afford to lose them.

Thank you very much for considering these comments.

Caller, you're on the line, you have two minutes.

Peer wellness.

Good morning, everyone.

My name is Katrina Talou.

I'm the executive director of the Peer Wellness Collective.

Um, this is a you know a real sad day for us in the Peer community.

Um, the Peer Wellness Collective started out as the Alameda County Network of Mental Health Clients in 1988.

And so we've been providing peer services in a capacity when there was nothing, and we've watched the community grow.

And for us to be hit with such a devastating cut is going to have a huge ripple effect on our community.

Um, currently, our organization, um we have 25 individuals that work for our organization that are all individuals of lived experience.

Our organization is peer-run.

Every position, including our board, are individuals that lived experience that have advocated endlessly to support and continue the consumer voice.

And with this proposition one, it completely wipes out with one proposition all of the work that we've done over the last 25 years to create an environment that supports recovery based on the need and the desire of the individual.

And with this happening, there will be no open doors.

We've built so much over time and to have it gone overnight, and individuals in power not seeing the impact is a crime within itself.

We think we see a crisis now in our community.

We are in for a roller coaster ride because there will be no open doors, very similar to what happened years ago when the state hospitals release individuals into the community and there were no services there.

We are going to be approaching that time.

We deplore all of you to be considerate and advocacy around these cuts and make sure that we preserve our community.

Thank you for your time.

We have no other speakers for public comment.

Oh, quiet, but these are for item two.

This is just public comment.

I think that batch, if you might, um, these are for yeah, these are for the public comment.

Yeah, I'm sorry about that.

Uh Giovanni Iglesias.

Thank you.

Good morning, Supervisor Tam Supervisor Miley.

I'm Giovanni Glesias.

I'm the chief operating officer at Bay Area Community Services.

I have been serving this community as a behavioral health provider for over 20 years, and I'm speaking as both a constituent and um and a provider.

And I am here to express my concerns about the BHSA cuts.

Um, BAX uh is one of several organizations that is facing severe cuts.

Um, approximately 15,000 people will be losing, not um transferring their services, but completely losing their services.

BAX alone is slated to lose four thousand or diminished services for 4,000 clients across all jurisdictions uh in this county.

We operate in every single district in this county, and we are looking at a shortfall to number of community-based service teams, a number of wellness centers, and a number of other programs uh that uh impact people in their homes on the streets and in various settings.

Uh I'm glad to see that we're talking about the OBN settlement funds today.

Um BAX has been a provider that's been uh heavily involved in that.

Our teams like Sage and the wellness centers, which you'll hear about today, have been instrumental in providing Narcan to the community, and they are slated to close.

They will no longer be providing.

So when you look at the section that says challenges for the OPS settlement funds, please uh add these cuts to uh the uh that uh prevailing issue.

Um, and we are asking for a formal hearing of these cuts, a formal transition plan, and a uh and a longer off-ramp to support these vital programs that will no longer be in existence with the addition of the cuts to AHS.

Uh, we're looking at a complete collapse of the behavioral health uh crisis system and the support services that would otherwise mitigate those services.

Thank you.

I yield my time.

Marcos Gonzalez.

Hello, Marcos Gonzalez, uh, associate director at BACS.

Um, we currently have four wellness centers in Alameda County, and those serve individuals that are unhoused at risk of homelessness, um, that have behavioral health concerns.

They are a hub for individuals.

No door is uh the incorrect door when we come there, so anything that anybody needs in the community, they come there.

It is instrumental to those communities.

And these cuts will eliminate them.

Not only do we have individuals there from the communities, but we also staff individuals with lived experience.

We are a huge supporter.

I'm a great advocate and appeared myself, started at the wellness centers, wouldn't have made it here without them.

But these cuts will impact that.

And that's already going to put a strain on the resources that we have that already don't exist.

So we are hoping that these cuts don't happen because those individuals will have nowhere to go.

And for them, the sense of community is probably the biggest piece that is meaningful to them.

So thank you.

Thank you very much, Claire.

Good morning, supervisors and health committee.

My name is Shemima Abdullah.

I am a program manager with Bay Area Community Service, our SAGE program here in Alameda County.

I want to thank you for the opportunity to be able to speak on those POP three as well as the impact that Prop One and how it'll be detrimental to lives that we that we impact every day.

Programs like Sage serve some of the most vulnerable residents in Alameda County with living experience experience with severe mental health and also unhoused and uninhoused, struggling with maintaining their lives every day.

With the impact of Prop One, weekly wellness checks, supporting clients with attending psychiatrical and therapy appointments, assisting with social security disability, Narcan support, coordinating care, health care services, reducing psychiatric hospitalizations, providing appropriate community care and based services, ensuring clients receive the appropriate level of care with the right time instead of cycling through crisis services.

The Sage currently program provides almost approximately 300 supports to clients yearly.

For many of our clients, stage is their only bridge to health care services and income support.

The impact of these cuts will forward forward program, excuse me.

If these cuts move forward, programs like Sage will be forced to eliminate services, not only impacting the current lives of others, they also impact our staff.

I always say one thing we don't want to make our staff an example.

We don't want our staff to be an example of everything that we're working hard for.

With support from this support, clients are able to maintain their appointments, be able to sufficiently maintain their income, they're able to maintain their housing as well as maintain their mental health support services.

These individuals who are already struggling with navigating complex systems removing support will push them back into emergency rooms, institutional care, Prop One's cuts not only save money, but the shift of cost of hospitals, emergency rooms, and departments, and law enforcement.

But more importantly, sorry, more importantly, they take away the hope and stability from people who are dependent on these services.

I ask that the board and I implore you guys to make a decision that Prop One does not get, does not cut funding or services from our Alameda County services.

Thank you.

Good morning.

Thank you so much, honorable supervisors, and thank you, departmental staff.

I do too want to make the opioid settlement link, which we're in full support of.

So I also want to make the link to the Alameda Health System major cuts that are also cutting critical behavioral health services.

And so we are at a moment in time in history that we have not seen before, worse than the 2008 recession, worse than back in the 80s, I believe strongly.

My name is Jamie Almanza.

I work for Bay Area Community Services as its CEO for the last 16 years.

And the room here alone, just from four VAX employees, we have over 40 years working at VAX alone.

I've worked in Alameda County for 30 years with the same populations.

To get very specific with VACs, we're going to be closing 600 individuals, single adults living with severe and persistent mental illness, co-occurring active substance use disorders, physical health uh challenges, and who over 80% are unhoused when we receive them.

We also are going to be uh losing all of our wellness centers, which were started in 1969 and have served thousands and thousands and thousands of clients.

When we close the doors to the wellness centers permanently, 35 individuals unduplicated per year will not have services.

Many of our services uh for our community-based care bill MediCal.

So the county is going to lose 50 cents on the dollars on the dollar for the federal match, which in effect we're losing double.

We're losing the MHSA allocation that is being severely cut, but we're also losing the leverage of 50 cents on the dollar for Medi-Cal for many of our services.

As you've heard, we provide psychiatric and nursing care in the field.

We're in the encampments all day long.

We're getting people connected to coordinated entry, and more importantly, we're housing so many of them at a very rapid pace.

80% of our clients identify as African American, 80% of our staff identify as people of color and with lived expertise, including myself.

And I think just wrapping it up, we are going to see Santa Rita become the new mental health biggest institution.

If we don't put a very major pause to this, we are going to see what I believe will be lines around the block accessing John George's PES.

And again, AHS is going through a lot of hardship right now.

We cannot be the community that we espouse to have others uh role model by turning our biggest uh our jail into our biggest mental health agency.

So I compel the board of supervisors to enact a special session immediately.

We only have a few months to go.

We have issued over 150 layoff notices again to put mostly people with lived experience.

Um we will be issuing another 50 layoff notices, and so we need to do something right now, and the time is today.

This is as catastrophic as any natural disaster when it means how many lives we anticipate will be lost.

So thank you very much.

And I also should have mentioned I am part of the Alameda County behavioral health collaborative.

Thank you very much.

No additional speakers for public comment.

Okay, so I want to thank uh the speakers.

Yeah, we have aware of this.

I know we've had uh conversations about this at the CPAG meeting as well, and I know the um directors of our behavioral health department at the agency are being with folks.

So um I'll make sure that supervision had my schedule of a hearing on this at this committee next month, so we can kind of see where we are and where we might be able to go in terms of trying to alleviate some of the problems that are foreseen.

So that's that's our that's our commitment.

I know uh we've got to kind of put all this in the context of the budget that's coming up for the county for the new fiscal year, but we'll all be hearing on this, and we'll have our staff continue to be folks too.

Okay, alrighty.

So let's um yes, Chair Miley.

Uh just uh comment.

So uh Chair Miley said we are aware of these issues.

We back in October, um, our board had allocated um about four million dollars in measured W money to in anticipation of um the cuts in prevention and early intervention.

Uh our staff, our department heads are going through all of the um the programs that were affected to see what can be more efficiently backfilled and having a concerted uh conversation through a hearing with all of you.

I think would help inform them in terms of prioritizing, but we also need to get some input on where some efficiencies can be made at that hearing.

So appreciate your time today.

Great.

Okay.

So thank you.

Um, yeah, so let's uh go to our first informational item overdose and poison prevention program update.

Good morning, supervisors.

I'm Dr.

Kathleen Clannen from Alameda County Health.

I'm here with Dr.

Tribble and other colleagues for uh periodic update for you on uh efforts um around the drug overdose and poisoning crisis in our county.

Uh I'm gonna say that um that there are some hopeful news as part of this.

Um at the same time that uh that we are are holding the the challenges of continuing to make progress.

Um but there are investments that that you all you have authorized and have been funded with external funding for prevention for treatment and for rescue, NARCAN and other forms of rescue when necessary that are and we have seen progress in our county in terms of the number of our residents who we are using uh to drug overdose and poisoning.

Uh we have two presentations for you this morning.

First, uh my colleague uh Dr.

Mr.

Joel Ravier, um, we'll be presenting uh some of the numbers, in particular focusing in on both on what we're seeing in terms of progress but on the populations that the residents of the county uh who are remain the most impacted.

And then moving into uh some efforts that are being made in field-based programs to keep people safe and connect them into the larger resources we have for addiction treatment and support.

Um, those are funded with uh federal funding from CDC for the uh grant called the overdose to action data to action grant, and then there'll be a second presentation by behavioral health colleagues on work that they are doing and specifically that is funded through the opioid 70 dollars.

So I'm gonna turn it over to Mr.

Add.

Thank you, Dr.

Clannon.

Oh, okay.

So we have an agenda.

I'm going to uh welcome Supervisor Miley, Supervisor Tam.

It is great to be speaking with you.

Um I am going to, as Dr.

Clannon mentioned, review some of our trends in overdose uh data and mortality.

I'm gonna focus on a few key health disparities, uh, and then I'm going to highlight some of our uh most prominent interventions.

You know, we have a lot of representation from other community organizations and health care providers in the room, and this uh presentation here will not focus on the work, excellent work that's happening uh by community providers and other health providers.

This is focused on the county's efforts to identify overdose trends and a lot of the county-led um uh interventions in preventing overdose death.

And we will wrap up by focusing on a couple of known challenges and our priorities as we come forward.

Next slide.

Uh and I'm gonna just start at the beginning to say that you know, while we are speaking today with you about uh overdose, overdose trends, and interventions.

Um, we have been working to make this information more available to the public, uh and that includes a new website to make the same overdose data uh available to those who access the Alameda County website.

So this is hosted by our friends at public health, and uh credit to the uh community assessment planning and evaluation team that has put this website together and recognition to our behavioral health colleagues as well.

We've worked closely with behavioral health on uh supplying data and resources to their new website as well, so it includes both the substance use continuum of care resources as well as some other community resources that other parts of the county funds and supports.

Next slide.

You know, this is a graph that shows trends in overdose deaths in our county over the last 19 years.

And we can see that overdose deaths have actually peaked in 2023.

And over the last two years, we have seen a significant and sustained decrease in overdose deaths.

And this data indicates that our investments in treatment and harm reduction and overdose reversal and prevention, that these interventions are working.

And we should celebrate, we should celebrate our accomplishments, we should learn from the interventions that work, and we should focus on systemic and known barriers for accessing treatment.

This is actually a little bit challenging of a presentation to make because on one hand we have successes that we want to celebrate, and on the other hand, overdose deaths are still a public health crisis and are still a huge cause of mortality.

And as we move actually to the next slide, we can see that despite the changes that we've seen and our interventions, overdose deaths are still the leading cause of death, single leading cause of death for adults under 55.

And so I have a little bit of a dilemma in our presentation, and this is going to be maybe a theme in talking about overdose and some of our prevention activities, which is there are components to celebrate and to highlight, and there's sort of a clear-eyed look at the public health crisis that still exists, that these problems are not solved despite improvements.

When we look at the next slide, this is one of two slides focusing on health disparities.

And we've actually worked with our data science colleagues to extend the way that we look at this data back 20 years.

About a 300% increase.

And we see this not only in race and ethnicity, but we also see it in their next slide when we look at people who are currently or recently homeless.

Based on the work from the homeless mortality report that our health care for the homeless department, health care for the homeless team has produced over the last three years.

In this last year, 50% of all overdose deaths are among people who are currently or recently homeless.

That is up from 44% the year before and 38% the year before.

It is the single highest disparity with a nearly 4,300 percent higher rate of overdose death among people who are currently recently homeless compared with uh our housed neighbors.

And part of our challenge is understanding what our key touch points are for accessing people or for people to access resources and treatment.

And so I'm highlighting two today.

And again, this is within our county ecosystem.

We're going to look at EMS, our ambulance providers, and Santa Rita jail.

And our EMS providers administer over 2,000 doses of naloxone in the field.

And only about 2% of those make it into some form of treatment.

Either starting medication assisted treatment or another form of treatment.

You know, we looked at some data based on EMS runs and, or I should, when I say we our EMS department has been looking at data focused on EMS runs and looking at mortality, and have identified that 30% of all overdose deaths had an ambulance transfer within 60 days of their death, 60 days prior to their death.

So EMS is a high touch point for patients who are dying of overdose.

Some decedents have received dozens of ambulance transfers.

And the ability for EMS to become a more active source of referral and entry into treatment is something that I know our EMS colleagues are working on.

The other one that we'll look at is around Santa Rita jail.

And actually, as we move to, there's a few points on this slide just around it being a second highest provider of MAT in the county, and knowing that we have high rates of diagnosed and reported substance use disorder among people who are incarcerated.

But I'll move to our next slide.

Because this is both a high touch point and it's also a place where we want to really recognize some of the drastic improvements that have been made.

And I feel a little conflicted even presenting this now because of our colleagues that are talking about the changes to MHSA and BHA BHSA under Prop 1, where the jail becomes increasingly the last safety net of providing health services for patients.

And the reality when we look at Santa Rita jail right now is that they are already the second highest provider of MATs in our county.

That's medications for addiction treatment.

Second only to our Highland Hospital's bridge clinic.

It's a critical entry point for people accessing treatment, especially for people who are homeless or experiencing homelessness.

And there is, there's been a tremendous and important investment from the behavioral health department.

And I want to just recognize not just behavioral health, but the Sheriff's Office, Well Path, and many others that have contributed to improving and increasing the amount and types of medications that are available to people who are incarcerated.

And one of the successes is that we have a very robust set of medications to treat people and more people that are getting treatment while they're incarcerated.

About half of the people who are screened report substance use disorder, and about half of those are in treatment.

Now, substance use disorder includes methamphetamine and amphetamine use.

We're focusing just on treating opioid use with these medications, and so we're gonna see a higher number of people that are reporting substance use that are not receiving medications to treat opioid use.

However, the increase in medications from opioid settlement funds and from behavioral health, especially the long acting injectable forms of bufinorphine, the sublicates, the brixotties, is profound in its ability to increase people's access to treatment.

Now we know that there's gaps, which is that linkage to ongoing treatment post release is very difficult.

And we are having a very difficult time ensuring that patients have a warm handoff to treatment, despite some of the excellent efforts that Wellpath, HEPPAC, and others are doing at the jail.

We also know that there are not enough funds to cover the amount and the types of medications for treating opioid use disorder at the jail.

And it presents a dilemma in terms of how to sustain the level of medications for treating uh substance use disorder that we currently have.

And limited access to some of the same innovative long acting injectable forms of buprenorphine that are available in the jail outside in the community.

We know that that is still limited.

I'm gonna move to talk also about another intervention that I want to highlight, another uh success, which is which is focused on public access naloxone.

Um, our county receives from the state and distributes over 50,000 doses of naloxone per year.

Our program has been working closely with both the behavioral health department, again, a use of opioid settlement funds, and collaborating with the public health department with the Office of HIV prevention and some of their existing harm reduction work around developing and expanding a network of public access to all comes.

These are free boxes where people can access 24 hours a day, naloxone in public locations.

They are mapped and available and expanding.

There are over 50 currently.

This has been done in regional coordination with our neighboring counties.

So all of our neighboring counties are not only in close coordination with us, but the boxes look the same.

They have the same types of information.

It is a seamless experience, whether you are traveling up to Richmond or down south to Milpitas or crossing the bridge.

And we are working with uh BART for uh additional regional access across the five Bay Area counties that BART travels through.

We have two more highlighted interventions that I want to cover quickly.

The next one is around substance use navigators and substance use navigation.

Substance use navigators are a type of community health worker that specifically focuses on resources and navigating treatment options for patients with substance use disorder.

This is a strong intervention.

This is a strong active intervention for increasing the initiation and retention for MAT for patients.

You know, we have been investigating how this intervention can be most impactful, and we have seen how impactful it is, especially in clinical settings in emergency departments and where health care is being provided.

And we are still investigating how this can be useful in other settings, including street health and with housing and other community organizations.

There's two other pieces, which is just that there is an effort led by the county to support a regional coherence in terms of the professional cohort of substance use navigators, that is regular gatherings, trainings, and support of breaking down barriers between navigators and other parts of the health system, and anticipated upcoming changes to Medicaid billing under Cal AIM that will allow health organizations to be able to use enhanced care management to pay for substance use navigators or help pay for substance use navigators.

And the interesting part that we are finding as a county agency is that the data that we've collected from about 500 samples so far indicates that our county's drug supply is relatively unadulterated.

And so a lot of concern which is well founded is that synthetic opioid synthetic opioids like fentanyl are in all parts of the drug supply.

And what we are seeing based on the data that we've collected so far is that the rise in polydrug overdose the rise in overdose that involves methamphetamine, fentanyl, heroin, cocaine, alcohol is actually seems to be driven by changes in consumption patterns or consumption habits rather than changes in the drug supply.

As we transition away from some of our activities and interventions, I want to highlight some of the known challenges that we are anticipating in this next year and beyond.

And these extend or maybe highlight or um build upon some of the changes that we're hearing from our advocates around Prop one which is that you know MediCal funds the majority of MAT in our county.

And the upcoming changes to Medi-Cal eligibility will mean that people who then lose medical will have a much harder time accessing treatment.

And those same Medi-Cal related losses are going to impact organizations and make it much more difficult for them to serve people with substance use disorders.

So it's like a one-two punch from Prop one to HR1 and that's on top of policies and executive orders from this current administration that is threatening and making the continuity of any federally funded programs that involve harm reduction or substance use disorder much more difficult.

And with that we still have things that we want to focus our attention on where we see the most promise and priorities I just want to thank and recognize this board including the health committee for a long history of supporting innovative harm reduction programs, homeless services, low barrier health I think ongoing support for known and proven harm reduction and treatment interventions despite federal pressure is essential for us.

We know that our priorities are improving connections to treatment especially at some of the highest touch points that we have mentioned that includes EMS includes our county jail it includes hospitals and it includes how to improve or improving how substance use disorder treatment is accessed by people experiencing homelessness.

We know that that is the overwhelming burden of disease is born by of overdose death or by people who are currently in recent health.

Again it's a pleasure to be able to present on not just the trends and the data but on some of the interventions that our county is supporting.

The last time that we presented you all had questions for us that I hope that we try to address in this presentation, we're happy to address additional questions you may have after our behavioral colleagues speak.

So thank you so much, and I appreciate you questions either now or we can do it after being relevant, so whatever works for you all.

I can just ask one question now and then, but you're right.

Most of my questions are after we talk about the planning and implementation update.

Um, so I appreciate a very thorough presentation on where um the data is right now when it comes to um overdose.

The issues that I'm trying to sort through has to do with the funding of um the map programs at Santa Rita jail because it is like you said, the second highest provider of um medication for addictions.

Um my understanding is that when you're at Santa Rita jail uh for any length of time, your access to Medicail is ceases, right?

That's correct.

And how um how can we offset some of that with the opioid settlement funding?

Very good question about how opioid settlement funding can better offset the cost of medications in the jail.

And I would feel a little disingenuous speaking on this in in place of my uh behavioral health uh colleagues over here.

So I'm not to have to keep your question, but to just recognize Dr.

Triple.

Thank you, Supervisor Tam for the question.

Um, that is exactly what our department looked to do because there is um uh Catelyn does provide 90 days of coordination at the time of discharge, but for everyone that comes in since the county has now pivoted, everyone is assessed and evaluated.

We're working to make sure that regardless of their medical status specifically it will end.

Um, we're able to provide support and services, so these are free in charge, uh free of medical confines, and we're also leveraging any existing dollars that we have, whether general fund 1992 or 91 or 2001 realignment.

So we're just putting it all together on the back end as far as treatment, and so that's um exactly how we did it.

So the first go-round I believe was five million dollars with the initial investment, and um we saw high utilization, which is positive.

Uh so we've had to increase the funds in terms of the allocations there, but technically it's pure opioid settlement so that it doesn't draw down any issue with Medi-Cal, lockouts, or anyone else.

Um, are we running into issues with adequacy going forward?

We are because there is such a great use as uh the my colleague mentioned.

Um there continues to be the need.

Uh, one of the things the logistical piece was that uh there were medications being used, but we felt that the other medications that I believe was referenced, would be more qualitatively impactful.

So those things have been successful, and to some degree that we've been able to get individuals interested in it.

The long-acting injectables and everything, it's wonderful, but it's come to the cost.

So, what we've looked at is our spin rate for the other pharmacy, and the good thing is our pharmacy director is fantastic with budgeting and work, so we've been able to uh stave off some shortfalls that we could have, but essentially it's pink for those medications.

So uh at some point though, uh, based on the revenues that come in from opioid, we'll be at a funding crisis for lack of a better word, but that's what we use.

Thank you.

Appreciate that.

Thank you.

Good item two.

Good morning.

I did not uh say who I was uh to start.

So good morning, both supervisor and uh chair Miley.

Um, Dr.

Karen Tribble, the behavioral health director, and I really appreciate context provided by our colleagues in terms of what's happening.

Um, I should also, I would be remiss if not acknowledged as you all have done, the significant impacts that we're having from Prop One.

We've heard from our providers, we really appreciate the opportunity for hearing, and we'll continue to partner with them because uh there's so much uh impacting as again, one uh prop one, and um everything else that seems to be a full following.

So we really appreciate that opportunity to do that.

Our presentation today, and I have to uh also acknowledge literally what's going on in the world.

Um, I'm going to be presenting on behalf of my deputy director James Wagner.

He is out of the country now and in fact, in fact, uh impacted, you say, but by the cancellations of flights.

So I will be hearing is uh gate based on what's happening in the world.

So again, quite a bit happening.

Um, so next slide, please.

So my goal is to provide you kind of an update and some of your questions aligned with some of the updates we'd like to provide and give us a little more context.

Uh next slide, please.

So thank you.

So, as you know, uh this stems from the federal nation.

Um, and in 21 and 22 nation nationwide settlements were reached.

That is actually the time where our department began the planning early on and to make sure that we had a smooth path forward to utilize those funds as they were released.

As you may be aware, these funds are coming between 6 to 18 years, depending on when the actual settlement is reached for the pharmacy.

So it also requires a lot of stacking and pre-planning because the revenue dollars may not be available in year two in the same amount as they will be in year 16, for example, and I'll talk a little bit about that.

Uh, next slide.

And California, there were uh priority areas that were established.

Um, what they were very clear on is they intended opioid settlement dollars to expand the SUD treatment infrastructure for counties.

They wanted, as I kind of described before, counties to match as many funds as they possibly can, i.e., if there was a provider or service or something that was created and funded by uh opioid settlement, their goal was that the counties would also leverage existing dollars if they possibly could.

And as you have heard, in terms of the data that we're seeing across communities of color, particularly in our African American community, the goal of California was also to address those needs of people of color and the vulnerable populations.

And although it is a sad rubric, we are hopeful at least your investment and support for the African American Wellness Hub, for example, can help what this county is seeing in terms of demographics and impacts, and also they also uplifted in interventions to prevent drug addiction and vulnerable youth.

And so when you hear about some of the dollars that are actually being quickly moved to the community, you'll hear more about those different types of programs.

Next slide.

Local planning in Alameda County is impacted by a structure, and so essentially 85% of the opioid dollars have to be used to mitigate opioid remediation strategies, obviously.

There's 15% for California subdivision funds for past opioid expenses such as attorneys' fees and such.

So again, the state receives those funds so that we can continue to move forward to pay those attorneys and such.

And if you do not use it, very much like Prop one, ironically, it you can, or if it's not encumbered with an active attention to use within five years of receipt or seven years for capital fundings, it can't be returned to the state.

So proud to say Alamed County will not do that.

We've never had a problem, and we won't based on our funding and the way that we strategize going forward.

Next slide.

Oh, thank you.

In terms of Alameda County's local allocation allocation, so initially we thought we would receive 46 million dollars for 18 years.

Now we're approximately at 80 million dollars.

And so those are new settlements.

It does not mean because the settlement is reached that a pharmacy can't contest that in court, but for the most part, those funds are distributed pretty much at that clockwork.

Um the settlement varies in payments from two to eighteen years, and again, I'll show you what that looks like uh locally with a brief update.

And as I mentioned before, we received a significant amount of payments uh from the federal government through the state initially, but we obviously those were tight trade down because we did note that some pharmacies opted to pay most upfront and others uh over the years, and I'll show we'll show that in a moment.

Finally, we decided uh locally, in terms of planning and implementation, that it would be important to make sure that we're tracking because again it's required, but we're auditing every use, where the dollars go, how they're assigned, whether they can be used, because again, we have to do a settlement back to the state of California to make sure that we're compliant.

We've provided a few presentations to your board in terms of our update and our plan strategies, both initially and going forward, and we'll continue to do that.

So, in terms of where we are, next slide.

So this will really focus on specific activities that have been happening these past few years.

So as you can see, we reported to your board initially.

I believe at this time it was the full board with updates to your health committee around a strategic framework.

What we opted to do is to break it down in the areas that you've mentioned.

We thought it was very important to model it in the way of MHSA.

Again, this was pre-proposition one passage, but we found that getting community and provider input was going to be critically important.

So we focused on that, mirroring the board alignment with priorities that you have established or that the county endorses, as well as we wanted to make sure we planned for every single district as much as we could.

We knew that we would uh we have historically not always looked at every district in terms of individualization and if it's continuous.

So that was our intention to have some intentionality around where the services are rendered and how they are going across the board.

The other piece that we looked at is the long-term sustainability.

Because the funds are not long-term, they are finite.

We also wanted to make sure that the services we provide at some point could be picked up by other funding sources or that we could leverage as much opportunity as we possibly can.

Now, of course, as my colleague mentioned, that was pre-HR-1.

We're in a very complex time now.

But nevertheless, our goal was to look at how the projects could be sustained on a long term basis.

And then finally, we looked at integrating what's needed across the system, including what's uh best and necessary at our agency within our agency, across the boards for our CBOs, and implementing.

In total, we had about 300 community participants in this process that weighed in to some degree.

And the next slide shows in terms of what it yielded.

One of the concrete structures we developed was an opioid settlement funds advisory council, and we thought it was important to have a uh accountability-based group that would monitor the department and also give us feedback along the way should there be changes to the structure or need in the county.

And so that was formed in March 6, about two years ago, 2024, and community leaders, county leaders, uh, your board, your staff members also participate, experts within the county, and these are across the agency as well.

So they represent a variety of stakeholders, but again, within our public health and health care domain.

Uh what we found is that they looked at some of the initial and continuing community stakeholder feedback, they gave updates to the department.

So, in the middle of during the times, the interim where we provided your board with feedback.

We also got feedback from the council, and it meets several times a year, and so it's very structured.

It's it's um we track information and updates, and at the very end of the day, we made sure that it's not necessarily a governing body, but it's one to give advice, feedback, or guidance again represented by county and also your your leadership or in staff.

Next slide, please.

So, as was mentioned, um, one of the things that came up in terms of need and outcomes obviously was the what was going on in Santa Rita jail.

So we made that a priority to make sure since there weren't many people there, the impacts and the outcomes we perceive were not good.

So that is when we allocated significant dollars to expand MAT at the jail.

We also worked with Wellpath, as has been said already, who historically was providing uh MAT, but we saw that they were probably more efficient and costly, though, and appropriate clinically appropriate drugs.

So again, that's where we we uh provided the support, paid for it, and shifted the approach, and we've had some very very promising results.

Um we've also um uh recovery residents and residental treatment ban expansion.

Some of the examples just last week at some of the opening of one of our CBO providers, we were able to use some dollars for capital.

As you know, BCHIP was very uh successful in our county.

About 177 million dollars of BCIC funding, but there still were gaps, and so because the opioid settlement allowed for that, we also infused opioid settlement dollars where we could and where the regulation would allow that actually helped us to construct and expand SUD treatment bids.

And very pleased to have those opened.

Um they're not in the room, but I'll acknowledge uh just most recently uh La Familia and Moscine.

We also decided pretty early on.

Um, frankly, I thought we wanted it besides working with our our partners who have a wealth of information and expertise, we wanted to pivot and have it's not they're not really many grants because they really are impactful.

Dr.

Kelly will speak to what those are, but we wanted to make sure we find a swift way to get things out into the community to actually start these services, knowing that the county procurement process may be complex.

We wanted to make sure that their pilot opportunities and made the decision to mirror that is as far as innovations.

As Image previously had an innovation component.

I mentioned before, we developed CAT as a result of that.

We use the same type of approach and model to get innovative strategies in the community.

We've also done, I believe some of them are being erupted, so you might see them.

Um, public campaign outreach teams are now being funded with our county partners and CBO partners and free distribution of the nylop zone stand boxes, which has been previously mentioned.

Um, we wanted to on the next slide just give for an accountability cross-reference here.

And I recognize the font is small.

I have no glasses, so I'm gonna try to do what I can't from memory.

Um, in terms of as you see on the left, that's the stakeholder feedback.

So that is what we got from the community, family members, people who lived experience.

We got from our CBOs, hospitals, and others, those 300 stakeholders that I mentioned before on the left-hand side talked about what they thought it would be important for the county invest in.

And so for us, again, for a measure of accountability, we track that feedback and we also work to develop responsive strategies and projects that directly correspond there.

So that's what this crosswalk is for.

So on the right hand side, those are the actual activities that the county for our department implemented with our partners with our county, or with uh some of the activities that we've described earlier.

So as you can see, there's a very clear uh consistency with what the community, what our input came to be, and what we did.

Next slide, please.

In terms of an update, um, this is very complex overview.

But at the end of the day, as I mentioned, this and I think our colleagues have said this is a very precarious time with funding and where we are.

But total we have about 80 million dollars.

What we have received to date is about 31.7 million, and that is I'll show it in that later slide based on the influx of dollars that we get once it goes through the process again.

Once a pharmacy maybe has exhausted their uh the legal term escapes me, their challenge to the findings of the settlement.

Uh, we receive those dollars, and again, that's the breakdown.

Local 25 million and subdivision is about 6.7.

So that's the fees essentially that we pay back to the state and such for their uh administration and allocation of it.

This fiscal year, we're uh projecting to spend about 18.7 million, and which will leave us about 13 million.

And again, it depends on when we get the money in terms of when we can spend it, and it isn't all at the same time.

And if you look at the next slide, that's a clear example of that.

So as you can see, not necessarily for any reason other than a particular provider, but as you can see in the light purple, I believe Walmart, for example, was uh very proactive and paid all of their settlement dollars all at once.

So that's where you can see fiscal year 204 and in between 25.

So you see a huge increase because a number of pharmacies opted to pay initially, and then as you can see over time, and these are where the projections come in, year 31, fiscal year 32, and beyond, that's where the allocations diminish.

So part of our job is to make sure when the opioid and the grants you see have sustained funding for the life of the projects, and or if we want to sustain them for longer term, the amount we'll have available to us will be obviously diminished, but we're able to look at outcomes, and again, Dr.

Kelly will speak, Dr.

Bowers will speak a little bit to that.

So we're tying what's working, we'll look at outcomes, the data, and look to see how we can reinvest.

Should we be able to?

If you look at the next slide, this is just again another transparent allocation and a breakdown of the activities.

So this directly relates to the projects we funded as of and when the funding and expenditures hit to date.

So as you can see, there is some variation, and if you can see our MAT activities, we have spread out approximately the one million dollars or total of about five or so uh to MAT at the jail.

Uh we are seeing a high utilization, obviously, and there's continued need, which I believe has been spoken to.

So we're looking to see how to go beyond 2728 in terms of that.

But again, as you look down, here is exactly a breakdown of when the activity started and the funding to date and projected going to 2627 and 2728.

Uh next slide, please.

So one of the things I've mentioned that we're very proud of are the opioid settlement mini grants, and we have uh Dr.

Kelly Bowers who will speak to that.

And as a brief introduction, we timed an RFP to make sure that we could administer and push these dollars out to the community.

So we're extremely pleased that Three Valleys were one that they have a high a very high oiled machine.

I don't know, high oil machine probably is not the best words, particularly, but they are very well versed at providing uh community-based services in terms of dollars and administering them.

And so with that, I would refer to Dr.

Kelly.

I have to apologize, my voice is a little husky today, so maybe it's more pleasing.

So I'm really pleased to be here.

I want to thank Alameda Academy for our health department for being such incredible partners, and I also would like to thank our honorable supervisors Tam and Miley for having us here today.

I'm representing Tree Valleys Community Foundation.

So we'll start with the slide next.

And so basically, we were we were engaged in this process through a competitive RP in order to make sure, as Dr.

Dribble said that funds could get inly and quickly out of me.

So we did engage in research and we poured over the listing session feedback and tried to make a competitive application process that would engage a large variety of stakeholders into the process.

And with that, we were able to successfully deploy 5.5 million dollars out into the community and through the region in order to address the opioid crisis.

So we are still in the midst of it, but as Dr.

Tibble said, the outcomes will be something that you'll be very pleased with.

Next slide, please.

So key to this process was the promotion of innovation, and it doesn't mean that there weren't evidence-based and research-based practices employed, but it does mean that people were asked to the applicants were asked to look and possibly apply in the way or a different population or even across into different parts of the community.

So it's a different approach, some creative ways to to approach the crisis, and people really stepped up for that.

So in the first round was three million dollars that was deployed, and then the second round was 2.5 million.

And we didn't go through a second application process because in the first round, there were so many incredible applications that came in.

There were definitely more that deserved to be funded and still are.

And these were coming from all parts of our county.

So we were very pleased with our outreach because we social media, we use the networks, we use the counties networks, we used all of the newspapers, media, even radio, TV, to make sure that the word got out so that people who were interested in community-based organizations have the opportunity.

Slide.

So just to kind of go over who was eligible for the application, this might be a little bit of a recap for you.

You might be familiar already, but 501c3 nonprofits were eligible, or if they were fiscally sponsored.

So groups like Punks with Lunch were fiscally sponsored and they were able to participate.

And also cities, we did find out through the process that that was allowed, cities and other agencies.

So Caster Valley Unified and City of Fremont actually ended up being grantees.

These applications we encouraged also, in addition to innovation, we could encourage collaboration, and that was because that is actually a goal, and it also helps with sustainability in the long term.

And the high impact abatement activities were definitely priorities.

And so we've heard those before about it bearing repeating early prevention innovative things, reducing harm.

So all of the applications had to directly benefit and serve Alameda County.

So they actually could have come from outside of the area as long as services and the funding stayed here.

Next slide, please.

So when we looked at the targeted outreach, we felt that we did do a great job with it.

And I can tell you that since then our outreach has gone even in a different direction than we had anticipated.

There are other counties now looking to the example that Alameda County has set up.

And they are wanting to look at the innovative way that you have approached the mini grant process and deployed those funds.

And so I think that's a great complement to what you're doing.

And we've actually might even be working with a different county in order to do something very similar.

So let's just go over what the application entailed.

It was creativity and innovation, collaboration, and it had to be feasible because they're getting the funds for about a year, a year to 14 months.

It had to be sustainable beyond the grant.

It doesn't mean that every component was, but hopefully that investment was going to yield benefits beyond that time.

So demonstrate impact, and that'll be the exciting part that we'll get to share as we close up the first round of grants, we'll be able to share the impact in different ways and a certain focus on those priority populations.

And we looked to organizations, and it wasn't about size, but we wanted to look at their leadership capacity and that they had organizational effectiveness and had demonstrated that confidence-inspiring leadership and reflective representation.

People with lived experience needed to be engaged in the process so that we knew that it was genuine.

And the awards range from 50,000 to 250,000 if they were a solo organization, but if they were collaborative, which many were they were eligible for up to 300,000.

And as Dr.

Triple said, they were called many grants from the start, but to many of these organizations, especially some of the smaller community-based, it was a huge complex of fund.

So it really was a major grant in many many ways, but we'll stick with the term that was applied.

Um so next slide, please.

We already know.

Um so there were 41 applications received, and 22 ended up being funded.

So we had 12 in the first round, 10 in the second, and that was about half of the request.

But just to give you that scope, 10 million dollars in requests means there's such a need, as we heard earlier from community-based organizations and from all the speakers, the need far exceeds even what was available, even though this was a generous influence.

And the particular grants that we awarded range from 62,000 to the 300,000 next century.

So the high impact abatement activities, substance use disorder treatment, diversion from the justice system.

We've heard a lot about Santa Vita Jail, and there are a lot of the partnership projects engaged with them, preventing addiction among youth.

My background was in schools, and so I have to say I wasn't on the committee that chose, but I definitely was pleased to see so many youth focused programs because we know that we can touch that population and that generation, then maybe we won't be dealing with some of the problems that we are seeing of the um adults.

Naloxone was key, and again, naloxone might not sound so innovative because we know that's been around, but the way it was deployed, the way that it was made more accessible, all of those things were and the way the training was provided to different populations with different languages, all of those things are different creative ways to get the stands, and then harm reduction was key, and other and we have all the mathematicians look and say, well, that doesn't add up to the same amount.

That's because many of the projects um covered more than one of the high impact areas.

Next slide, please.

And overall, there were several countywide projects funded, and that was I think something that was an added bonus because we love to see that people were branching out beyond where they were based, and many of them are cross um across areas.

So one a particular one I'm thinking of is the town that's based in Oakland.

It was a junior journalism program, it was youth-based about getting the youth voice out there in order to promote and advertise um the dangers as well as some of the resources for opioid um for addressing the opioid crisis, and that was local youngsters from Oakland partnering with the Pleasanton Weekly way across the county, and so um with amazing results.

So we did touch on all of the areas we when the committee met and evaluated the projects.

They didn't they didn't choose by that area, but they but it ended up being that it was a nice regional spread.

Next slide, please.

And so this slide really is is very similar, just shows that um shows what it looks like because you sometimes people forget the diversity and the the breadth and depth of our county that you covered.

Next slide, please.

And of course, the target priority populations had to be addressed, and unhoused clearly rose to the top, as well as vulnerable at-risk youth, black men, other communities, color, and justice involved.

And again, these numbers will not quite add up because several cross-mortal area, next slide.

So I know since we are working within the supervisoral districts that many of our supervisors were curious about how that was distributed through their areas, and so you can definitely feel very confident and proud of the fact that um that the projects did hit and cover populations in every single area of our next slide, please.

And so um did just a pretty quick recap of which organizations were funded and how much funding they received, and sometimes it was because they didn't ask for the whole amount, they asked for what they needed.

Some we didn't quite fund at the highest level that they wanted it, so they were allowed to adjust their budget, but that was so that we could have more depth and breadth.

But some of the um projects that you'll read about and hear about um were just pretty incredible because what we've seen firsthand is behind all the data, there's that human element and human story, and some of the projects maybe it wasn't as large of a population, maybe the reach wasn't as high in quantity, but the quality of the kind of touch that happened for people has been really impactful.

And so, what we're getting ready to do in this next uh three months of the first round, which will be the first 12, is we're collating and bringing in data statistics, but also the human element, the anecdotes, the stories on the central video we have, which will carry out for testimonials, so you'll be able to hear.

There's some people measure impacts in terms of dollars out.

That is certainly the first part, but the real impact is that human element of where this funds went and what kind of impact we're making to apply in the lives of while they're here.

So we're just very proud and appreciative of a partner with you, and the only thing I can tell you is that I wish more of the community-based organizations were able to tell you in person.

I don't hopefully, at Thanksgiving time that we pay for the funding and so thank you.

Because they are very great, there's not a half of all of them, who lives in the spikes in the channel.

So as Dr.

Bowers mentioned, the work is not done.

As you heard in terms of the data, there's certainly more impact to be made that we are committed to doing.

So our goal is to continue to integrate the feedback we get from our CBO partners.

We even heard some strategic support and suggestions from our public comment.

So we're noting all of that to determine how we can make sure that's continued to align with our community impact, the feedback, the county priorities, vision 2036.

And our goal is to really provide an update with you regarding the metrics.

So not only to see the impact, but what it actually did, what the dollars actually did, results-based accountability as mentioned, there may be a lot of opportunity for qualitative because we're trying to cover all of our bases as well as aggregate the number of people served and supported.

And at this point, given where we are with our funding and the projections, we're going to continue to fund our as I mentioned before, we are committed.

We will not let any dollar uh return to the state, unless given our coffers, it is going to be spent.

Um, but the amount is less flexible, but nevertheless, we're going to be looking at outcomes and to see whether there's a pivot or there is an additional expertise that can be targeted based on the settlement needs.

Um, and with that, that concludes our presentation.

Thank you.

So I'll start with supervisor.

Yeah, but then I'll answer the questions.

Thank you, Chair Miley, and thank you very much for that presentation.

I'm glad to see that we are going from 46 million to 80 million.

The question I had, um, if you look at your graph on page 15, slide 15.

I am thinking that you have a high level of expenditures in the beginning, and and your uh revenue is not all that predictable or even available.

How do you manage between trying to um deal with the fact that the funding might come later on toward the end of the settlement period?

That is a wonderful question.

I think each of the projects uh I'll start first with the mini grants as Dr.

Bowers mentioned.

We'll be looking at impact, and uh the good thing is this came through a county process, so to some degree it's it's open to us to pilfer the ideas.

So, what we've done is looked at ways in which the system or even a provider or community-based organization can be enhanced or augmented to actually do some of the work and the learnings.

Um, at the end of the day, uh, it is going to be very complex and it has been.

So, what we've done is also looked at each round.

There's two rounds, there are some dollars remaining.

We're trying to be very conservative because at the end of the day, we anticipate the initial dollars, but what it looks like is there'll be massive opportunity, a lot of um target intervention is what you're seeing now, and at the same time, we're absorbing, we're also looking at more sustainable for the programs.

So the next couple of years, actually a few years to 3031 will be the most complex, but the spike that you've seen again is relative to some one-time funds or capital.

We've got a little bit of that, um, but it is absolutely going to be complicated.

So I are thankfully we look at our budget expenditures uh all the time to make sure we're in um in compliance.

So far, we're okay.

Okay.

Um my next question had more to do with some of the issues that I'm hearing mainly from the community.

Um and it has to do with the CAP program, and uh I think Joel mentioned that the EMS program is the critical touch point for the overdose patients, and I know um there's varying levels of availability of clinicians, for example, when it comes to alternative response units with our EMS programs.

Can some of the funding from the settlement be used to help support the CAT program?

I'm thinking mainly in Oakland, for example, because I think they're thinking that they might have to segue from macro to a full blown cat program.

But good point.

So it does have a home.

The one and we've also already taken over City of Berkeley's uh CAT uh opportunities, and now it's dispatched there.

So Oakland does have CAT, I hate to say CAT capacity across all of our county there is a CAT um response rate.

I think what on the BHSS EHSA side, what we had hoped to do is increase by two additional vehicles based on funding.

We will have to cap that for now until and if funding looks available, but we're able to hope steady.

Um could opioid settlement funds be used around that as long as it targets actually the requirements that I mentioned before.

Um given where the intersection is with people with lived experience, it could also theoretically align with some of that work.

Um our goal though would be to look at um to what degree long-term sustainability in your question can be achieved.

So if there's any concern that it would be a one time, we would look at connecting um Oakland, for example, with the existing programs with existing work that's happening to see whether they can access it, and then we'll be looking at the metrics to determine whether it would be something that the county could potentially expand in, including in in Oakland.

So there's there's a lot of what ifs.

Um that's a very indirect answer to say it is possible, uh, but it would only be related to opioid abatement.

So it would limit the scope, for example, of macro is mostly targeting individuals with uh that are homeless that are challenged with some mental health needs.

So it would be a little complex, but there are certainly ways to connect them with the existing programs now.

Yeah, but yeah, sometimes when you're responding to a call, you have a co-occurrence between some mental health and potential issues with uh substance use, right?

And so you you can't kind of demarcate that without some clinicians making that assessment.

That's true.

So the good thing is now that MHSA has transitioned if there is a positive thing, uh thing is DHSA does allow the use of funds for people with substance use.

Okay, I would just say the this is highly restrictive and categorical because uh you really would have to demonstrate that the person did have and it's an opioid abatement activity, so it's really uh somewhat risky to utilize a program that may be seeing everyone, but it is still possible.

So, what we'll be looking at again.

Right now, we're only we're right in the middle of our planned experience expenses.

What we anticipate again, unfortunately with HR1, we may see a dip in even what we planned to program, because programs may not just be able to do that, they may not be able to reach as many individuals as they thought, but we could reevaluate to see whether there is uh an opportunity, but it really would be very restrictive.

Whereas CAT can see anyone, anyone insurance doesn't matter, whether it's mild to matter, it doesn't matter.

They transport people anywhere they need to go, so it maybe it's not a substitute issue, maybe they had it on board, maybe it's not opioid.

So it's it's a it's so um broad, it would be a finite amount of the activity that the cat program that would do that could be you know fundable if we were able to, but you raise a really good question, so we'll we're gonna continue to look and see.

Thank you.

Okay, so I've got a few questions.

So let me see here, so thanks for the presentations.

I'm trying to understand.

So overdose deaths to look at the first three peaked in 2023.

It started going up in 2018.

Was that what was that?

Do we have a sense of the cause of that?

Was that because of the homeless crisis?

What what caused that that rise?

Do we know?

I believe there's some data that she mentioned off the 30 years.

Do we go up?

Okay.

Well, I'm about to give a complicated I don't know.

Do you want to kill that?

Fentanyl.

No, that's so that you know 2017 is when is when fentanyl in large and you know, uh many people had access to it, and and we we saw we've seen if you look at the numbers broken out by the primary drug that that killed people, it's fentanyl and fentanyl.

Okay.

Questions are always really hard to answer from these kind of data.

It's really talking to the people is how you find out the whys, but um, there's still certainly a lot of fentanyl around.

People I think are more accustomed to it, and it you know, using it in less risky ways, maybe uh also these declines have been seen nationwide and in our area.

Some of that is probably our emergence from the terrible impact of the pandemic on people's mental health, um, and the econom and economic health.

So some of that is contributing those big social forces.

Um so you know, those kind of factors, but uh it but um this this decline is real, that's a real thing, and uh the you know the challenge of how do we keep doing what you know what we know is working.

Did which did that did that help?

Yes, and then with the disparity between uh other ethnic groups and African Americans, what do we attribute that to?

Is it once again because of the homeless crisis?

Probably multifactorial, right?

And and again, the major issues of you know, structural racism, impact on on people's economic health, etc.

But the the linkage between homelessness and addiction, and in particular, you know, overdose as a as a as an aspect of addiction, that tight linkage between homelessness means that uh if you're in particular an African American single man, uh you know, without tight family connections, that you're you're you're right in the crosshairs of a bunch of uh factors that put you in high risk, okay.

Um, that's just another question.

Just to try to get clarity.

So the overdose, overdose deaths, uh it's a public health crisis, it's the leading cause of those 18 to 55.

A lot of the homeless are seniors, so I'm trying to understand that.

Is there any response?

Uh I'd say a little bit that has to do with the way these numbers are looking because it's looking at the leading cause, as seniors do you know, do die of overdoses, but they also die of heart problems and liver problems and other things that don't affect the younger population as much because they take decades to show up.

So it's when we talk about the number one cause, that's why it pops in the in the young folks.

So it so it's losing more years of healthy life, um, but uh but overdose definitely happens in senior folks, okay.

Okay.

And does does kill them.

Okay.

Um with the I'm still on the first presentation with the but I hope I might blend over to the second, but um with the key touch points in Alameda County, EMS and Santa Rita jail.

I'm trying to understand based on Dr.

Treble's presentation and this.

Oh, are we waiting to see results?

What I didn't get a sense of the results, the numbers.

I can step in to say that.

In terms of uh the jail, I can say it's significant already.

We're seeing a huge increase in individuals who are actually getting the treatment that we thought they always should.

The long acting onjectiles are also incredibly helpful.

I think the challenge that our colleagues spoke to is once they're released, once the medications are out of their system, making sure that they follow up with the peer care provider in the community.

That's still as complex.

Just stop there for a second.

I thought we had dealt with that problem.

We well, I'm just trying to pull this together.

Yes, we we had to some degree, we are seeing as a county a huge uh number of individuals who will engage, however, the factor that we're seeing is the intersections between continued use, homelessness, and joblessness continue to be impactful.

So uh it looks like a massive impact across all domains that we're not that we couldn't account for initially.

So even if a person, for example, does go to the their primary care provider, does continue the medications that we administered in the jail, that's wonderful.

Now, how they will elect to then function six months later is still complex.

So overall, we are seeing as a county, we are seeing a decrease and fit recidivism for people who have got bless you, mental health and substance use needs, that is accurate.

However, as far as opioid and drug use and the pain that's associated, that is still uh complex uh metric that we're seeing, particularly in African-American males, supervisor.

I can give one very specific example of this that is that um, you know, the the shots, the long acting injectables.

Maybe this is obvious, but maybe it's not, is that one thing that that does is it can bridge people.

So you know, when people get out of jail, there's a lot of life business that that's involved in that, but the shots last for 30 days, so that gives you some time, so it's a great strategy, but then you gotta get another shot.

And uh one challenge is that there are not a lot of pharmacies that offer the shots, partly because they get pressure, they get scrutiny from the from the DEA and you know, others around are you doing giving you know too much op, you know, open support for this?

So they get scrutinized, and that makes them kind of lean out.

Um, you know, they they're just other reasons why they're there's a short list.

So that's one of the places where we're all um working together is to figure out how to support more pharmacies and making it available.

So solving those pro those continuity of care issues is where we're it's it's huge news that we're able to offer this and people take it up, because if people aren't interested in it, we're dead in the water, but but we offer it and people take it up, you know.

So, then the how do we solve the downstream problems to make sure that having taken it up, we make it as easy as possible for people to do the healthy thing.

Right now we're made it's the world makes it hard for people to do the healthy thing.

How can we make it easier and easier and easier?

So pharmacy is one place, transportation is big, you know, bridge clinic is fabulous, but it's smack dab in the middle of the county, and it's a long way on public transportation to get from other places.

So those problems, where's Richard?

Highland Hospital.

That's it.

Okay, okay.

I'm gonna get back to that in a minute.

Okay, okay, yes, for one more thing, uh, supervisor.

And our our look our our colleagues here with uh Bayer Community Health and BACs, they know about this far better than we do, but but BACs.

Sorry.

Which is that, you know, many of the people, and we this is anecdotally what we hear from Wellpath and Santa Rita that are released out of AT, 90% are homeless themselves.

So even if they initiate treatment while incarcerated, many are just going back onto the streets, are unsheltered.

And so, you know, expecting the people are going to be able to maintain continuity of treatment when you know they're still homeless and you know unsheltered is very, very difficult.

Right, right.

So yeah.

So the one thing is we need to get these people housed and stay housed permanently, and that's going to help to have an impact of the opioid situation.

Okay.

Now another slide, it showed the highlighted interventions matted Santa Rita.

So the population that uh patients that are reporting uh SUD, it's about half of those that are screened.

Uh looking at the months of October, November, and December.

Um do we know, for instance, this I'm just answering the question because I'm trying to put it all together in my mind.

Um this the 626, for instance, do we have um a census on them?

Were they arrested?

Like, were they homeless?

Were a lot of them the what's you know, the census uh of that population, or where are they coming from?

Do we have a sense of that?

What's going on with no?

It's a level of detail in terms of like why people were incarcerated, and looking at those are looking at cross-referencing data of people who are on treatment for substance use and why they were incarcerated is something that we've not looked at.

I don't know if I even have access to the corrections data that would allow me to right now.

But we can we can know that, and you're right.

That's a good that we should know that.

Yeah, because it just kind of begs the question why half are on uh SUD.

And I don't know if this is kind of like a trend because you just showed three months here.

Yeah, you know if it's a if it's generally half of what enters the jail are on SUD.

It is.

I've looked at this data for about the last 18 months, and it's very consistent in terms of uh the number of patients who are either screened or report substance use disorder as being about 40 to 50 percent, 45 to 50 percent of uh the patients are intake.

And then again, about 45 to 50 percent of those um who are then on MAT, and again, this is the MAT that we're referring to is for treating opio use disorder primarily.

Um, and so you know, we'll see people that are screened for substance use disorder, which may be methamphetamine use, but then don't receive uh medication, you know, there's not really a good medication for for treating that.

Um, yes, it is consistent.

This is not a good right, you're gonna begin to try to dwell more into that, okay?

Because I think that's once again if they're if they're there because they're homeless, that's one thing.

If they're there for other reasons, I'd like to kind of get a sense of the connection if there's any root causes that are um some people are just you know on drugs, but you know, I don't want to make any assumptions here.

And then with EMS, how are we going to address that?

Because you mentioned that that's a priority.

How are we going to deal with that?

So you have a sense of that.

We're we're supportive to our colleagues in EMS who are very active in this area, actually.

So they've got a lot of plans.

I'm gonna try to reproduce what I know about them.

Yes, um, they are when they go on on a call, uh, but they and we know when their ambulance contractor goes on a call, if they see anything in the environment that suggests to them or someone tells them that this is related to a drug overdose, and they then they are now authorized to leave behind Narcan in that household, and also to they are now authorized to offer MAT to people immediately, a dose to be able to mitigate if they show signs of withdrawal, they're evaluated for signs of withdrawal.

So that can happen.

And then they're working on being able to, along with uh behavioral health and uh other resources are working on being able to do a call to people who've had a non-lethal overdose to be able to follow up with them after they had the emergency went to the hospital to be able to do a call back with them to say, hey, this was very dangerous, we'd like to offer you services.

Obviously, that's gonna feel a little invasive to the individual, but their risk that individual's risk of dying in the short term is so high that um it's that it's worth it to be able to plant that seed or or reach that handout.

And I don't know if you know the Dr.

Triple for details about that program.

I think the I think it came up um I think in your earlier question about outreach and engagement, and so at the same time that EMS is doing their work on the crisis system.

We're trying to close the gap and doing more proactive uh engagement.

Um our substance use continuum of care has also launched follow-up post-uh Santa Rita as well as coordination of care.

So there's a it literally is at discharge, the follow-up, as well as making sure that we proactively uh reach out to them before they get incarcerated to see what there's something that they can be can be done because I think that appears to be the panacea as you mentioned.

Homeless is all the socio factors that we can't control initially is is mounting, it's not decreasing in terms of that.

So we think proactive engagement is about what the best we can do.

So those are the something we have.

Let's see here.

What's the status of St.

Regis?

What's the status of St.

Regis?

The status of the State Region Hospital.

No, Anika, if you'd like to respond.

That's a capital project, right?

Oh, oh, I'm sorry.

I thought you meant the medication piece.

So I think we have already provided the capital, and the Max is here, so we've already provided that.

I think, and they're still working through the construction.

So we have distributed the funds, and that's wonderful.

I'm sorry, I thought you meant for the housing.

Yes, yes.

And I'm I'm sorry, the people are moved in.

Okay, they are okay.

So it's up and running.

What about la familia?

We had a ribbon cutting last week, so it's already open.

Okay.

Those additional bids are completed.

Okay.

And then I was really interested from Kelly's presentation.

Um funds that have been awarded.

We're still waiting to see the results of that.

Yes, I think the first go round, and I'll defer if you'd like to add more.

We're looking at November to bring in all the data and information.

So I think there's concurrent ongoing uh data analysis, but they're having to do a formal update.

So we want to say we heard it at the halfway point.

We we um did a check-in with every single group and they gave us an update of their budget as well as um any challenges and some highlights.

So we we are collecting that, but we haven't packaged it as a presentation yet.

We're just wanting to make sure that people are on track and um we're trying to, you know, kind of help them in any way we can anything that some of them did encounter challenges with some because of the federal funding that they were relying on for other things, and so we've allowed them to make some adjustments, but we haven't packaged anything to share formally, we've just been informally collecting the data, and I believe that's scheduled for the fall.

But I think we heard from one of the speakers earlier um use of opioid money to help with the um mental health prevention.

Is there any next in terms of that?

Um, again, we heard that feedback.

There's certain our ability to if there is active work to prevent opioid use or abatement yes and that could be preventative and some of the projects that we funded through the many grants and other other activities were in that vein I think the only piece is as as I think Dr.

Kelly mentioned is looking at the delta to look at see what we have left what potentially could and how we want to get that back on the community but that yes that's possible as long as they restrict the scope to that to fit exactly with uh opiate settlement so they could braid funding in a program that's possible um but yes logistic it is possible yeah okay and I think that might be all of my questions for the moment let me just make sure and I I can I don't want to speak for my colleagues but I can add a little bit to the question that you mentioned before certainly we'd have to defer to our share of partners for the data but we are aware that most of the charges aren't necessarily just related to a person's substance use we've actually seen a decline on simply being picked up for mental health behavior health most of those uh individuals are being diverted through some of the other programs existing the folks that are coming in just happen to also have a substance use disorder or use and it may be um more quote criminogenic factors that we're seeing but that's some of the shift that we've been seeing last few years okay then I think my final question I'll stop we like page 12 your slide uh Dr.

Tribble implementation update programs supports and services crosswalk of opioid listing sessions input and activities so with the activities um do we have actual numbers what we've achieved yes uh I mean I don't have them available to me now but as you can see most of these are there's uh concrete activities for example Alabama health system um we did some bridging to some of the detox beds so some of them will be outcome in terms of whether the facility has been completed you you had asked about the family for example in the St.

Regis the other piece that we're looking at the MAT expansion that is some of more qualitative feedback that or or data that we're looking at and so we are seeing I think has been reported a huge increase in utilization and um betterment for for lack of a better word with their engagement and treatment the piece that we're um challenged to see is post that initial as we've said administration of the of the activities for the remaining the mini grants that's November that's we hope to see again we've heard hints about it we've seen promising results some of the uh funders appear to have been doing exactly what they said we would do but we they would do but we want to really look at it more clearly so is for the SUD outreach same thing we'll have concrete data on the number of individuals who are served we'll be able to see outcomes how they were served whether they were deferred from incarceration or hospitalization so for the treatment based or the service base yes we will have data but for the facility base it's the outcome the construction.

And I promise this is my last question.

So when back on the earlier presentation so it's trending down the overdose deaths do we think that you know start trending up because of Crop one and HR1 we have any concern there.

For sure we have concerns.

And it's that, you know, the that's also those major source social forces, like the, you know, the keeping up with uh not having more people homeless again, etc.

Those major social forces, as well as the things that we do um are are at risk because of these funding cuts for sure I see.

Okay.

And I will add uh most definitely the the impacts that you've heard have a strong correlation to a person's well-being, which theoretically puts them in greater risk for using opioid and others.

Uh so we we will have to be careful and we will have to watch that.

There's no doubt about it, there'll be impact.

All right, thank you.

That's very informative.

Let's have the speakers.

Do you have any other questions at the moment?

Okay.

Speaker, I have the speakers on the side.

Can I just add one thing, Supervisor?

So with regard to Chowder Interim Director for Alita County Health.

Um, just one thing as you saw in the data trends that impact on people experiencing homelessness is just so massive uh in terms of deaths from overdoses.

Uh, that's an area that we're just continuing to dig in deeper.

And I don't know if maybe Dr.

Clanning might want to talk a little bit if if it's um appropriate uh with regard to our street health outreach teams, right?

So for people who are literally homeless and and on the streets, uh, there are uh over the last couple of years we've been able to embed more and more psychiatric um support to that.

Um and so interested to hear uh if there's anything you can share a little bit more about how they're connecting people to MET or to um if the or if there's more work for us to do in that space.

So yeah, for sure there's more work for us to do in that in that space, but so as you know, the the we we fund as along with the alliance and other funding sources, the street teams that are going out.

Their work has gotten a little complicated lately because of the uh in abatements in the encampments that mean that it's harder to go to a place and know that you're gonna have a lot of customers there, a lot of you know, a lot of people to do outreach to, but they're still out there and doing that work, and they they're smart about figuring out where people have scattered to and people know that so that so um they are still able to contact people.

So um we uh as there's a requirement for all the teams to be able to uh start people to have expertise on using these medications, the MAT medications, um, and also to be able to connect in to um people who can help navigate, you know.

Like if your problem is not an opioid, but it rather is methamphetamine or some other drug, um, and also uh, you know, to help assess people and then move them into appropriate treatment, so they all have connections in to central places to do that work.

Um we got a grant from the feds for a mobile pharmacy to support um just one so far, so not able to cover everything.

Um, and that project is uh we'll be addressing uh HIV medication prevention and medication, which is also important in uh a lot a lot of transmission can happen in among people who are homeless of HIV, but um the long-acting injectable MAT medications and also long-acting injectable psychiatric medication, so all three of those things we're hoping for the mobile pharmacy strategy because it you know it solves two of the problems that are a problem now for people, which is no pharmacies and no transportation.

So if we can get it, get it to people.

I foresee that we may be shifting more and more to shelter to be going to people uh in shelters and other transitional locations, uh, rather than literally outside.

Um for various reasons, that's a better place to provide that kind of care for people, but making it available to people in the form of bringing medication to them and the expertise to be able to uh talk with them about its benefits for them and to safely administer it, are things that we are doing with the street teams.

And in the shelters, is there a prohibition uh against people coming and being in the shelters if they're impacted by SUD and other substances?

There are, you know, if people if people are really intoxicated in the moment, then that there can be behavioral parts to that that would mean that they would not be able to stay at night.

But but no, there's not um there's not uh uh get tossed out if you have it.

Okay.

Collar, you're on the line.

We're on item two.

You have two minutes.

Uh good morning.

Um, supervisors and health committee.

My name is Amy Lang.

I'm the current medical director at Santa Rita jail.

I actually trained in emergency and addiction medicine at Highland in the bridge clinic, and um I came to Santa Rita in 2023 in a different position, but I just wanted to echo that one of the most common stories I hear from our patients here at the jail is you know, I wish I wasn't in jail.

Um, but they often say that they've never been in treatment prior to coming to jail and they can finally feel normal.

And so I'm just really proud to have witnessed the impact that the opioid settlement funds have had for our patients here who do have opiate use disorder.

And so thank you for giving me some time to add to what has already been presented.

Um, our MAT program census used to encompass 100 to 200 patients, but as you can see now it's increased to the 300s, and sometimes I see it go up to 500 patients at times.

And that is a direct reflection of how often we respond to the need to start and continue buprenorphine for people who are here.

And as we've seen this treatment number increase, we've also seen opioid overdoses and Narcan similarly decrease narcan use.

In January 2024, it was about 18 times I have the data here in front of me, and in January 2025, it was five times.

January 2026 was zero.

And I really think our patients are incredibly vulnerable to overdose for a huge variety of reasons.

Um, and so grateful for the support that we have received from the county so far because this is truly life-saving and has prevented overdose.

Specifically, this long-acting injectable bupinorphine that we've rapidly embraced, as you can tell.

We have initiated it from multiple doses prior to release, and that provides an even greater than 30 day buffer to prevent overdose in that vulnerable period post-release.

So I feel incredibly passionate to be here today to try to advocate for our patients and to not limit these medications if we can, especially with Cal Ames going live this July at Santa Rita, and the ability to build Medi-Cal for the patient's first 90 days of incarceration treatment, that will certainly help offset costs and significantly decrease the amount of funds that we'll be able that we would have to use from the opioid settlement funds.

So thank you for the time to speak today.

Okay.

And I know Supervisor Tim did ask about the medical.

Those they lose Medicail when they're incarcerated.

You got a response then, right?

Yeah.

Can you repeat the response?

Because I want to make sure.

So yes, currently there is the provision that can't be billed, but as was mentioned, there will be the ability to do 90 days in Santa Rita jail.

That benefit is going to start in July.

Again, thank you for the position partner to let us know July 1st of this year.

And so when that happens, there is the ability for the county to step in to do even leveraging.

And you said it's just for 90 days.

90 days exactly.

That's right now all the benefit that it allows.

The good thing is that again, once a person comes in, you have 90 days to plan.

But even if the person stays longer, you can still use an active time to connect and deal.

Okay, okay.

Let's it's a start.

Okay, good.

All right.

Okay.

I think we heard public comment prior to the meeting, but I just want to make sure is there any public comment on non-agendized items from anybody that we haven't heard?

No speakers.

Well, we're adjourned.

Thank you.

Thank you.