We good our final two groups Okay, I'm gonna do another temperature check. How did that feel? Good I didn't see any like physical fights break out. I I Prepared or like rock-paper-scissors Okay, here is how we are gonna take this home, so JK has started to record two of the group's ideas we are gonna have each group share their top five and Give the room the opportunity to ask questions. We really want everyone in this room to understand What each idea is so that when we leave and you all are deemed the task of figuring out how to execute it There aren't any questions So each group will share their top five and make sure everyone in the room understands what they meant by that While you're sharing JK is recording and tallying I'm going to once everyone shares Lead us into kind of the next steps final discussion that we're gonna have which is a little bit more open-ended and an opportunity for you all to ask questions while you have us and Then once he's done tallying it shouldn't take very long. He will share this like final list Ranked and give you the points for each of the strategies So that's kind of like the end deliverable this living list that you all can play with and work with moving forward Sound like a plan. Okay. Do we have a group that wants to go first? Okay for five points We have detox that accepts Medicaid. That was I don't know what to to You Okay, they need to accept Medicaid that was important to me and also I think for sustainability for four points we have so I work for HHS and one of the models we have is We call it our TTRS homes, which is transitional treatment recovery homes. And right now we have A mom with kids dad with kids and a family home But they need to be involved with DHS and we were thinking it would be great to have a home If either they're not involved with DHS or that they don't need kids so why it's a little bit different than like I guess I you weren't asking me to explain it, so TTRS home, but anyways They get treatment while they're living there and it's about a year we help them transition so we think it's a great model for three points We want to get a provider in the emergency room Instead of like calling us to go in for whatever we would like someone based in the emergency room so we can just be there on site and Then for two points we wanted to increase the activities for youth particularly during the summer We used to do something through HHS. It was a couple years ago pre kovat. It was called summer blast and They just used to do all sorts of fun activities. And so we thought picking something back up for you Specific after school or especially during the summer would be great. We don't have a number one just five through two Thank you. Are there any questions about any of those ideas pretty clear? Hold on. Let me bring you the mic The staffing at the hospital what would that look like is that a Staffing is that a budget thing or is that a one-time expense? What does that look like? So, it would be a funded position and a liaison where they would be available and it would be supplementing the normal ED staff. It could be either. Yes. Yes, the money can be spent that way. Did you discuss duration of time? That's okay. We don't need that level of detail yet. We're in the weeds, folks. So we have a vote for 24-7. I'm going to let this man decide how he wants to deal with that. Okay, thank you very much, group. Sorry for talking over you. Well done. Who would like to go next? Group four. Yeah, our number one, equaling five points, is similar. Number two, equaling four points, would be a sobering center. Number three, equaling three points, would be increased prevention and education in all school levels. And we didn't have any experts in our group. Well, we had experts, but not necessarily like, oh, exactly this program. So, number four, equaling two points, would be additional community response teams, giving them the flexibility of getting out into the public on a more regular basis. And number five, with one point, would be more community education programs surrounding addiction stigmas. Thank you. Do we have any questions? If we were to invest in the detox slash residential treatment facility, for example, and I think that's what you were advocating for was the facility, how do you structure it so that once that is opened, that you're not suddenly full of people from all over the state of Oregon, and now suddenly there's no room, no beds for people from Yamhill County, and we're right back where we started in the front end? Good question. I can give my opinion. I bet there are other people in the room who have opinions. We are doing this a little... Say again? Yeah, really. The only way you could do that is if you specifically fund a bed. So if a specific agency is like, I am going to pay for this bed, nobody can fill it, that's the only way you can. Yeah, all the time, used or unused, otherwise it would have to be open to everybody in the state. Do you want to add? One other thing, because we've looked at some of these models for residential beds for people with mental health challenges, is another possibility is having sort of county first right of refusal, so before they accept someone, this all goes into contracting and things like that. That can be built in. But I will say, there's need everywhere, and so it would be unlikely that people wouldn't be coming here, just like we take people to eastern Oregon and to the coast right now. And they usually come back to us. From a sustainability standpoint, having a full detox is not the worst thing. Most detoxes go pretty underutilized in my experience, and most people don't travel very far for detox. 30 to 60 minutes seems to be the limit, at least in Colorado, for how long people will go. And so we don't see that happen very often when a detox opens. People can go to Portland for detox, I'm sure there's plenty of detox beds there. So we don't usually see that happen, and if it did, you would be getting reimbursed for it, if it were a billable service. I think y'all covered it. All I was going to add was that we have a project in Colorado where we are trying to determine how to make sure beds are reserved for the region that is funding the majority of it, and it would happen in contracting conversations. But there's also a lot of unpacking whether that's actually best for the facility and the county, which is kind of what he was just getting at. Questions? Any other questions for group four? Okay. Who wants to go next? Group number one? I don't know that these are absolutely our order. They're the order we sort of thought of the ideas. So number one, we said sobering and or a detox. I'm not going to speak for the whole group. Number one is five points, if you want it that way. Yeah. Yeah, our top priority, sobering and or detox. There's a little bit of crossover there, but they also are meeting some different needs and we're kind of... I don't know. We didn't zero in on it. It had to be one or the other. And maybe that's 1A, 1B, or five point, split the points. You can do that however you want on the math. Five points for both. Okay. We're going to throw all of our weight behind it. Our second one, again, we left some room for decision making here, but we said youth prevention programs and we came up with ideas like increased afterschool programs for positive activities for youth, a recovery high school model, and a parent peer run organization that serves parents. Our third was residential treatment capacity. We thought primarily we'd be looking at startup costs for residential programming and what would it take for a dedicated bed for Yamhill County. And then number four, and this one does have some overlap I think with the others, is a better system for warm handoffs. Thinking primarily about the access or we'll say the contact points of citation by law enforcement, ED visits, jail, and sobering center if we had one. What is the access from there into treatment, particularly MOUD like next business day? You good on writing? Any questions from the group? Like a little crab. Okay. Last group. I don't know what number you are. Who has not gone yet? Have we gotten all four of you? I feel like only three have gone. Okay. Who hasn't gone? Somebody in here. Okay. Would you like to share? Yeah. I got lost in the building for a minute. Our top pick was the sobering center for five points, followed by transitional housing. And we defined that as a step in between the sobering center and sober living. So that sober living was three, four was peer organizations, and five was residential treatment. Are there questions for our final group? Okay. This man is tallying for us. Will you give me a click? Thank you, friend. Oh. Do we want a break or do we want to take it home? Usually people are like, go home. Excellent. Okay. Now what? This is a doozy of a next step, right? I want to first commend you all for getting this far. There are a lot of different types of people in the room, lots of varying perspectives, lots of differing priorities, and this has been really smooth sailing thanks to you all and how collaborative you've been. So well done. There are many things that you could do next, and it kind of all depends on how collaboration unfolds. So this has come up a couple of times in various ways today, and it's how McMinnville and Yamhill want to or maybe don't want to work together with their settlement dollars. Depending on that conversation, which I think is really the next piece of this puzzle, there are many different mechanisms for implementing your strategies that JK and I could talk specifically about. We could give you examples of what different things look like, but the kind of next steps conversation that we have is dependent on you all and what you want to hear about. So I guess the next thing I will say is, are there any questions for JK and I in terms of how we've seen implementation unfold, how we've seen collaboration between city and county unfold? There are a couple things we could dig into in that way, but we would want to hear from you all what might be most beneficial. This is kind of an open-ended convo. Is there anyone online? Okay. My question would be, I'm assuming we're not your first rodeo and that you've done this a few times, and I'm assuming that that list that already has the most important gaps might be very familiar to you all. And so I guess the question is, already ranked there, how close does that match up to the other communities that you've done this in? And if they've been exceptionally successful at one of those things, what would be one of those things that they were exceptionally successful at? It's been a lot of me talking. I'm surprised I got that out. Okay, good question. Yes, we have seen almost everything on that most important gaps list funded, with the exception at this point of detox and residential treatment for the reasons that JK was talking about earlier. But we are working through it. In many instances, this looks different depending on the community. So I'll give you an example. For detox, for a couple different regions in Colorado, they pool counties and call them regions. So a couple different regions that we've worked with. The first round of funding, we did this activity with the regions, and they identified detox as a primary need. Then we worked with county procurement, and we ended up RFPing all of the gap ideas that were prioritized. Then a council of subject matter experts essentially has to evaluate all of the RFPs and make selections, and that's how they got money into the community for a wide range of different topics, including a lot of the things other than detox. This was pretty successful. We got sober living funded. We got peer recovery coaches funded. There's a really cool youth recovery summer leadership program that was funded through this RFP mechanism. But this isn't a big resourced urban county, so keep that in mind. I started this off, though, to talk about detox. None of the people who bid on the detox RFP even answered our question or were qualified to do it. We ended up not funding anyone for detox for the two different regions that we went through this mechanism of implementation with. They had more money than you all have. We had to go back to the drawing board and talk about a different way to move this forward. Now it looks a little bit different, depending on how much money and the size of the community. One of these regions is developing what they're calling a market-sounding event, where they are bringing in community partners who are invested in this work and who might have the capacity to do this work. We are asking them in this market-sounding event exactly what they would need on an RFP to successfully be able to bid on it. In this way, we're asking the community to tell us what to do, because the people who do this know way better than we all know exactly how to do it. This has taken a year and a half, and market-sounding event is in February, so slow burn in terms of detox. I think the second round, because we've done the work and a little bit more research and preparation, community readiness, is going to go much better. The other thing I'll say about detox is that we have also moved into a more collaborative approach. Two of the regions in Colorado that I'm talking about both tried to fund detox, flopped. They happen to be geographically next to each other, so now we're talking slowly with electeds and county staff about the potential of collaborating and pooling funds. That's also been very slow, and these are two counties that have some history of having a difficult time playing nice together, and we're still chugging forward and chipping away at this. If this were to work in a community like this, you need a champion who has the time to actually move this forward, so that piece of the puzzle is a good thing to be thinking about when you're like, What's our first next step? Who's going to really run with what we've developed today. Does that give you some info, a start to answer some of your stuff? JK, anything you wanna add? Yeah. I would just say any capital project is gonna be two to three years. You have to think about site control, permitting, NIMBYism, feedings, capital expenses, procurement. We've found it's actually easier to wait for somebody else to come in and do it. In the time that we've been trying to procure this, somebody's just come in and took over a nursing home and started up a residential facility, which accomplished our goals and did it a lot faster. So, good example, where the private sector sometimes is just better off doing things. That's just my experience. And so, ray of hope on that. I would look at what counties around you are doing, get in on their decision making, see if they're making RFPs, and if they're not, try to get them invested in what you're doing, and at least get some joint investment into some of those bigger projects, because other counties may have no idea how to spend money, and they'd welcome your ideas. For instance, as she mentioned, one of our counties will just end up piggybacking up on a larger county's procurement, which I think is a great outcome for them. Other things that are more personnel-based are a lot easier to find and procure, and I think we've learned that RFPs are not always the best way to go. They take a long time, and don't always even get anything, much less a better outcome. But direct procurement, especially in a county this size, if you can do it, is something you should explore. That's our experience. If there's a partner in the community who is doing this work, and they're a trusted partner, and they're showing you good outcomes, run with that partner, especially the size of your county, the amount of money that you have. Don't be a surround and waste all of that time. Just trust the trusted partner to get it done. Another thing that I would add here, it's really important. I'm getting on a public health, what's it called, stool? I've been talking all day. Soapbox, thank you, help me. Whatever you fund, you gotta set aside some money to evaluate. Because this is a lot of money, this is a long time, we don't wanna end up like the tobacco settlement and produce outcomes that are the exact opposite of what we want. And so be thinking about that now. Whatever you are throwing your dollars at, how are we gonna check back in and make sure that it's working effectively? They're doing what they said they were gonna do. If it is, great, maybe you give them some more money, and you simplify how to spend in the next iteration of this. If they're not, that's okay. Sometimes you gotta scratch it and start over again, but at least we know and we can catch it early. So evaluation and that feedback loop, we haven't talked a lot about it today, but it's a very important piece of making sure you do this successfully over the duration of the settlement. I'm guessing you're done tallying. So we could reveal the things. Are there any other questions folks have before we drum roll it? People are like, stop talking at me, give me the list. Okay, here you go my friend. All right, I can't really reveal this one by one, but I'll narrate. So number one was detox with residential. It got 12 and a half, and I did some judgment. I have the way I tallied things, but I split number one into, sure. Okay, so I split that in half. So detox and one group stated with residential was their stipulation, but detox was the commonality to that. Got 12 and a half as top score. Second was the sobering center, 11 and a half. That didn't have any caveats with it. Third and fourth respectively, and actually scored the same, were school-based prevention and youth school prevention. So suggestion I have for you is that you maybe think of those in the same bucket and look at procuring them alongside one another based on who the best candidate is. Next was a navigator, and that was specific to an ED, but then somebody put in jail and sobering center. So I just clumped that under navigator. One thing I would note on that is 24-7 services are extremely expensive. It's about seven full-time equivalents to do a 24-7 position. So a benefited position, 24-7 is about minimum a half a million dollars a year. So keep that in mind, 24-7 sounds great. It's really hard to operate. Acute transitional living and long-term transitional living. So my note, I'm used to transitional living being a longer-term post-residential treatment, even post-sober living thing, where people are living in the community, working, getting back on their feet. So these were just two different ways folks use the term transitional living. I think one group was looking at acute transitional living as kind of a residential to sober living transition. I'm not familiar with that personally. So I grouped these together as kind of transitional living. And actually, I would group that with sober living, kind of think of those all as what does an ideal reentry situation look like from leaving the ED or jail all the way to reentering the community into independent living. And then residential treatment got 4.0 and then down a little bit lower. CRT got two, peer organizations, two, and community stigma reduction, one. So nice thing is you have two that are really clearly top and there's some overlap between them, detox and sobering center. And then you've got some groupings of two or three together so that ideally you could look at probably a couple of these that are less capital intensive as shorter term funding. And I know that there's some funding, I think through the opioid settlement for prevention too. And then looking at some of these like navigation services while considering what to do with capital. So questions on these first. Less upset about having to turn on the mic when I'm up at the dais. So I guess this is kind of a Lindsay question and to you all. So what we just talked about with detox and grouping together entire regions and counties. So to legitimately look at a detox facility, we'd be talking about partnering, I would assume, with other counties, local counties to actually get over the hump for that facility with that type of price tag? Maybe. Maybe? Okay, there you go. I'm in good company. So I think there's a number of things at play that would impact whether that was necessary or not. Some of it being, is there identified space already that needs less significant remodeling? Those types of things, right? And I think the answer is there may be some of those spaces. We're certainly looking at what the county may already own that certainly gets us much further along from a funding standpoint. So I think that's part of it. I think there are regional conversations happening with both Marion and Polk County and the subsequent CCOs, Yamhill CCO, which serves us, and Pacific Source, which serves them, that are going to be happening, hopefully, in the next several weeks. They are specific to detox and residential and looking at how we expand those services. And so I don't know what the outcome of those conversations will be, but certainly they'll be happening. So there's strong collaboration among those three counties. Not sure about the CCOs, but definitely within the county structures and operations themselves. So that lends itself nicely to that. And then I think the other pieces are just going to be, like you said, sometimes other things happen that sort of like, oh, well, they already took care of that, so now we can divert our attention here. There could be those types of opportunities that pop up, things may happen. I will say it sounds like a big barrier in Colorado has been finding a provider. And here locally, certainly I don't anticipate that being easy peasy by any means, but there is at least one interested provider who has said they would be interested in expanding into Yamhill County. I wanna be thoughtful that I'm not like sharing that broadly because it's just very, they've just said, hey, yeah, we'd be interested. And they know what they're doing, right? It's not someone who's just starting for the first time saying, yeah, I'd do this for the first time. It's an organization that has done this before and we've worked closely with and they have expressed interest in that. So there are a lot of things that feel like they are lining up nicely. And those are the types of things where there has to be a lot of dominoes that fall for it to all congeal and finally come together at the end. But I do think that we have a lot of things going for us that other places necessarily don't have in the works already. And just, we do have, just for those of you who have been really focused on the prevention activities with youth, as a public health person, it sort of pains me to be advocating for something outside of that space. I told that to my group because that's where my heart and soul is. And I'm aware of so much work happening and additional funds coming in specifically for primary prevention, which is often targeted towards youth. And so for me, I feel like there's already some other pieces coming into the mix that will help support a lot of those activities. Thank you. Yeah, I think that was a good summary for DTACs and residential. The big thing is line up a project and figure out your stack because you're not gonna get all the funding from one place. Think about these funds, opioid, sorry, M110 funds. Is that something that you could leverage? And that's where we've had a lot of success is using Opioid Settlement Council as a forum to line up a project, find maybe a site, a provider, and then write up, not a pro forma, but really a plan that we can then leverage into federal grants, state grants, and just know that it's gonna be two or three years. I think that's the best way to look at these longer term capital focused type of projects. Other questions? When you say two to three years, what aspect of that two to three years has taken the longest for you? Is it building the facility or is it actually stepping up the program? Cool, good question. Honestly, procurement takes forever. Just writing the RFP and getting it out has taken six months, and that may not be the case here. You may have a much faster process, but we found with projects like that, it generally takes almost a year just to write the procurement, get everybody on board, allocate funds from here, get it out, and score, and get a contract to people. So that's a year just to write things down and get somebody, and we haven't even gotten into site control. The closest to this that we're looking at is a bigger recovery campus, and the county has three sites that they have access to that are not gonna be sold otherwise. But even then, we're looking at, some of these get funded through pretty complex structures like new markets tax credits or low-income housing tax credits. Low-income housing's for more of the transitional living, and new markets is for treatment-type projects, and those take a year to two years just to get, there's certain deadlines, like low-income housing is due in December, and you need to have an operator on board, and they write your low-income housing. So like you said, lots of dominoes, and they all take six months to a year. So I guess there's not one single place that's been the big holdup. They're all, and that you could bypass that, but you'd leave a lot of money on the table. I mean, low-income housing tax credits is like, you wouldn't do a housing, I wouldn't do a housing project without it, and new markets also, I wouldn't do a residential project without it, but you're adding 12 to 18 months on the project for each of those. So everyone's like, womp, womp, we're not gonna do anything for years. This list, which I'm really excited to see, provides, and I think I talked to someone about this earlier, a couple different types of things. We have some low-hanging fruit opportunities that we could quickly fund that are a little bit more affordable, and that start to make an impact in the community right away, and then your community is happy that you're spending your opioid settlement dollars, and you're starting to really chip away at the problem, even if it's a smaller chip. You're doing something, you're moving the needle, you're progressing towards a goal while you get your dominoes in a row for detox, and so you have the potential to maybe set aside a certain percentage of each year's funds for detox, start planning, start figuring out other funding sources, start figuring out what collaboration looks like, but you don't have to just wait to do anything until that's figured out. You can do some of the quicker, more direct funding things, like a navigator in ERs or jails, or expanding sober living. I know you have a lot of Oxford houses here. It's a quick and easy way to spend money, make an impact, keep engagement, and we're doing it. That goes really far for a while, so I just wanted to make that point. Other questions, comments from the team? I can't believe how many of you are still here. Thank you for staying. Okay, just a dramatic pause while everyone gazes into the abyss. All right, y'all, this has been a pleasure. Thank you for having JK and I. You all have been a fabulous group, to work with. We will make sure that this list and your points will connect with Lindsey and David to make sure you have the juicy takeaways that you need. And yay, I did not forget. Okay, so the ORN, which has funded us to be here and helped make all of this happen, is requesting you all scan this QR code and fill out the evaluation survey link. This is a big gift that they have funded in order to enable this conversation. So please take the time, fill out the survey. The ORN is a great resource. Thank you for inviting us. Are you talking about this stuff? Not long, by the end of the week, we can get that in your hands. We got to fly home and trying not to break ORN rules. Reasonable answer.

opioid settlement funding

addiction recovery

detox facility

school-based prevention

community collaboration

resource allocation

evaluation