Welcome back, everyone. Thank you to the city for tasty lunch. Even the gluten-free bread was really good. It's never good. It was good. That was great. Okay, we've got a couple more hours together. Based on the good work that y'all just did with resources and gaps, I'm guessing that the last activity that we have planned for you might go a little bit quicker. There's probably going to be a little bit more alignment in terms of what we should do. So there's a chance we get you out a little early, but I'm going to go ahead and kick us back off. I meant to share this slide with you that you see up here behind me before resources and gaps. I forgot, but I think it's a decent place to start before we talk about the next activity. So let me just outline what that is going to look like, and then I'll come back and unpack most important. So we have all of these resources and we have all of these gaps. You all just heard a ton of data. You understand the allowable spends. Now what do we do? So we are going to walk through an activity that's actually called the nominal group technique. It's just a facilitation approach that allows everybody to think independently first, and then to get in some small groups and find some consensus about a decision. And then ultimately you're going to be ranking your top five priorities together as a group. So in order to be able to successfully do that, you got to pick what's most important. This is kind of the crux of this entire process, right? There's so much that we need to do, but we can't do it all with the money that we have. So how do we know where to start? I was talking to someone over here earlier. This can feel very daunting and scary because you don't want to pick the wrong choice. You got to pick something. And everything that we've put in front of you today, all of these gaps that you all have identified, they are evidence-based, they are good solutions, and they will make an impact. So don't get too caught up on perfection. What's the saying? Don't let perfection be the enemy of progress. I think that's the only cliche I've used all day. There's usually a lot of them. All right, so when you're trying to figure out what to pick, just a couple of helpful things to be considering before we get into the activity. We talked a lot about what the community's most immediate needs are. That's kind of what these gaps are. The data points to that that we unpacked earlier. But sometimes you can't do one thing until you do another thing first. The settlement is a long time, about 16 more years. Money is front-loaded. So if there's something that you need to do first, maybe you want to address the overdoses following release from incarceration, but you don't have anywhere for incarcerated folks to go when they're released. Maybe you want to first put your dollars towards a sober living home before you talk about community reentry supports. It was kind of a wonky example, but you're following what I'm saying, I hope. Seeing some head nods. Thank you for those. We talked a lot about this with different funding sources and the whole reimbursement or is it billable conversation. Are there funding sources elsewhere that you can use before you tap into settlement funds? So think, is this settlement dollar the right use of funds for this gap that I want to address? How many people can we positively impact? This is kind of a basic one. The more people we positively impact, maybe the better off the choice is. Not always, but maybe. Is the gap or need specific enough to the opioid settlement? I know this has been a sticking point for some folks because, geez, do we have mental health issues as well. At the end of the day, we're here to help you figure out how to spend your opioid settlement dollars, so can we tie this to the opioid settlement? If you're unsure, ask us, we'll help you flesh that out. And lastly, is there evidence that this is actually a good strategy and it's going to work? Talked a lot about that. I feel confident that the gaps that you see here are well informed. Any questions on kind of how to prioritize? Yes, sir. So can I just suggest there's sort of a corollary question to the how many people we could impact that we ought to consider? And that's sort of the Pareto principle or the frequent flyer thing that, you know, 20% of a population often creates 80% of an impact. And so where's the balance between helping as many people as we can and also recognizing that there may be a small, relatively small number of people that has a profound impact on the overall system that frees up capacity to help others? It was sort of rhetorical. I was thinking, why am I talking right now? Intention. I think that was a good use of your voice, so thanks for sharing. All right, let's set up the activity. This is also, before we've been talking about things kind of in abstract, like these are needs. It's also a time to start thinking about costs. And we can help with that because some of these cost a lot more than other things. And I'm not saying it's got to be low cost. There could be something that costs a million dollars up front and makes a big difference for a long time. But you're dealing with $500,000 now and another million over the next 20 years. That's about a full-time person a year. So if you're going to fund a position, there's only one. And so, for instance, residential treatment, you could put all your money into residential treatment and still not build the facility. So what's the aspect of that that is going to cost the money you have? And I'm not saying one or another is better, but start to think about those things now. So there's more nuance than just when we were talking about resources and gaps. There's, can we do this? And also starting to think about, is there an organization I can envision doing this? You can't pull in some great organization from Florida that you heard about. Most of these will be done, especially for $500,000 to a million dollars, will be done by organizations and government organizations already operating here. And so you have to think about capacity and not just what would be great. Yes, Scott. All right. I was just going to say, and maybe I don't fully understand the exercise quite yet, but are there some that you guys just have enough experience with, with you can just line through them because there just isn't going to be enough money. So there's no point in even talking about it. Great question. I think everyone, I don't want to put too many constraints on what you think about, but I would say things like when you talk about capital, right? $500,000 is not a ton for a capital project. What's that? Okay. So if you were going to go for something that was more capital oriented in there, I would say even sobering center, there's probably some capital aspect to it, like outfitting with beds, maybe a rental property or lease property, but specifically detox, residential, what aspect of that would cost less than six figures? I don't see a lot of those things as far as capital, unless it was a new parking lot or a new roof. Those are things, if that was really the barrier to you opening a facility, maybe that would be a really good use of it. So somebody donated a house and it just needed a new roof, and you could open it as a residential program. That's great. I don't know if you're in that situation. So those would be two that I'd say are much more capital intensive than some of the others. And the other question is, is the capital the barrier? If some, as I said to one group earlier, if somebody could open a profitable residential center here, they probably would have done it. And so is the capital what's going to get you over the hump to a sustainable program? And then there are other aspects of that, like workforce. Like, do you have 25 clinicians who are out of work right now that you could put to work in that residential center? I doubt it, but it's possible. So those were the two that I kind of had my eyes on of. Is this funding going to be the unique thing that gets that over the hump? All the others are mostly personnel-based, I would guess. Somebody like a care coordinator, a peer recovery coach, something like that. So more accessible. It just felt like perhaps a valuable time to share. Not that necessarily these funds will end up being commingled. But just so there is awareness, the county has a little over $1.4 million right now that is sort of already accumulated. And then, of course, whatever comes over the course of the next several years is yet to come as well. Again, this is focused on McMinnville, but I think as we're thinking big picture, and if there are ways we decide we want to move forward sort of more uniformly, that might be helpful. So just the McMinnville corollary to that is that we'll probably, you know, we've got about $470,000 so far. We'll probably double that amount in the next three to four years because of the front loading of the payouts. Just plus or minus. Are you aware of any other cities in Yamhill County that are also getting funds? I only know one other city in Yamhill County, and it's Newburgh. Yeah, so they got, I had that slide on their first year. I think it's a pretty similar size city. It must be because they got $150,000 in their first year, which was pretty similar to what McMinnville got. Not for this afternoon, but yes, that could happen. And in fact, in Colorado, it's a little bit different scenario. The county or groups of counties are usually in charge, and the cities are kind of subsidiary. Generally, they've commingled their funds with a few exceptions where there was a really large city that was kind of dominant in the county. Often, the city would kind of keep it and not spend it on rural areas. So that is very common. Oh, yeah, absolutely. Yeah, and she had said earlier, you can actually have your funds just flow to the county without handling them, or you could take control of them and take an administrative fee. There's a lot of different permutations that you could make work. Like I said, they're getting about the same amount as McMinnville. So if they've only spent that youth prevention, they would have about $300,000 on hand. And then I think you've got some more coming for this next year soon. Although, the specific funding was harder to find, I tried. Only add on for me around that whole kind of side quest we just went on. If what you need is residential treatment, and you're like, I want to die on this hill, this is what I think we should, no pun intended, spend our dollars on, there's going to be an opportunity to articulate that in this activity, and I guess I'm just offering to you all there are potential ways through county collaboration, through municipality collaboration within a county to start to get closer to achieving that goal. So I don't want you to throw it in the trash. That's all I'll say. So like I said, it gets more nuanced, so generally you think of, oh, these are great, and so we're going to fund the gaps. One thing to think about is the gaps are gaps, and they're hard to fill. Resources are strengths, and that might be better if, say, for instance, there's a waiting list at some of the peer-based organizations to say, well, gosh, if we just hired another recovery coach, we could fill that easily without a lot of difficulty for the city and county. And maybe there are geographic gaps, like I was going to give a bad example, say there are peers in the northern part of the city and not in the southern part of the city, that might be a way that you turn a strength into another strength through funding that. So not limited to funding only the gaps, you may fund niches within some of the strengths too, which is administratively easier. We actually didn't explain how we organized these. So first of all, we only recorded resources for you here if they were said more than once. We didn't want to lose all of the extra additional resources that you all listed, so those are still up. They're just back here. For gaps, the tallies are the number of times it was stated by a group. So literally every group brought up sobering centers. But we included all of the gaps. So you don't have to look to the other pieces of paper for that. Every gap mentioned is here. Anything else we want to get on the table before we talk about how we're going to do this? Okay. This slide says spending strategies. What's a spending strategy? This could be as like big and broad as detox beds or transitions, but it could be as specific as peer recovery specialist at provoking hope. So folks of us who work in public health are more used to thinking about things in activities. Sometimes that's a more foreign concept for people who don't work in that world. So if you're having a hard time sizing your idea, don't get too stuck on it. Just make sure your idea and what it's trying to accomplish is captured. Does that make sense to folks? Okay. All right. There's a couple steps to this activity. I'm going to walk you through the first two. So first up, and nobody start yet, I'll release you to your own brains here in a sec. We're going to take about 10 minutes to individually think about everything that we've talked about today and write down all of your spending strategy ideas. Now here they are. There's like a lot of really good things right here. You don't have to only pull from this list. If there is something that you really believe is important that we should spend dollars on and we haven't talked about it yet, this is your opportunity to write it down and then advocate for it. After you jot down all of your ideas, more ideas is not necessarily better. So don't feel like you need like a 50 item list. You don't. We're going to get into small groups again. We'll do another count off. It'll be random. And you all will be tasked to find consensus of all of the ideas that each group member came up with. And you're going to be asked to pick the top five. So there's going to be some advocating and some bartering and some explaining and like really fighting for what you believe is best. At the end of that, we're going to ask you to share those top five strategies out with the room. We're going to make sure everyone understands what they are. And then of all of the top five strategies, so 5, 10, 15, there will be 20 of them unless there are duplicates. You're going to get back with your group. And you're going to be asked to rank the top five strategies that you pick. I'll talk more about the points when we kind of get here. But that is the basic process. So individual work time, group consensus, share out, group ranking. By the end of this activity, you're going to have this long list of spending strategies that are prioritized by everyone in this room for how important we think they are, whether we should spend money on them or not. This list can be used year over year. So you can fund what you can. Maybe you can only fund the top two strategies. Once you get those funded, more dollars are released. You can come back to this list, reassess, and pick your next few items. Is there any settlement dollars are just given to us? There's no time frame on spending, right? Stumped us there. This is different state to state. There might be a year limitation. In some states there are. We're going to find out right now. Good question. Yeah, in Colorado you don't lose it if you don't spend it. So we'll find that out. All right. Why don't we go ahead and take the next five to ten minutes. I have paper if you all need it to individually jot down what you think are all of the things, spending strategies we should spend money on. Would folks like some paper? Would that be helpful? Maybe raise your hand if you want a little notepad and I'll bring you one.

opioid settlement funds

spending strategies

community needs

nominal group technique

collaborations

fund utilization