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Agenda 12-12-23; 6-a - Opioid Advisory Committee Settlement Use Recommendations and Approval of Budget Amendment #4-B
1 ORD-2023-045 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 12, 2023 Action Agenda Item No. 6-a SUBJECT: Opioid Advisory Committee Settlement Use Recommendations and Approval of Budget Amendment #4-B DEPARTMENT: County Commissioners ATTACHMENT(S): INFORMATION CONTACT: Reintegration Support Network Proposal Quintana Stewart, Orange County OC-EMS PORT Proposal Health Director, 919-245-2412 Grow Your World Proposal Transition Support Network Proposal Harm Reduction Coordinator Proposal PowerPoint Presentation MOA Spending Authorization Resolution Year to Date Budget Summary PURPOSE: To: 1) receive an update on the Opioid Advisory Committee and recommendations from the Committee regarding the use of Opioid Settlement Funds that support Option A of the Memorandum of Agreement (MOA) on the Allocation and Use of Opioid Settlement Funds in North Carolina; 2) approve the attached resolution regarding the expenditure of Opioid Settlement Funds; and 3) approve Budget Amendment #4-B. BACKGROUND: In July 2021, a bipartisan coalition of state attorneys general announced the National Opioid Settlement — a historic $26 billion agreement that will help bring desperately needed help to communities harmed by the opioid epidemic. The State of North Carolina and all 100 counties, including Orange County, joined the agreement. Orange County is expected to receive $6,799,780 over an 18-year period. In September 2022, the BOCC approved the appointment of the Orange County Opioid Advisory Committee with the following charge: • Discuss opioid-related health concerns and issues impacting the residents of Orange County; • Advise the Board of Commissioners on options to expend funds to prevent opioid abuse and remedy opioid impacts; • Plan and host an annual meeting open to the public to receive input on proposed uses of the settlement funds and to encourage collaboration between local governments. 2 The Board also voted on Option A for the use of the settlement funds per the NC Memorandum of Agreement Opioid Settlement. In January 2023, Orange County received an additional payment of $44, 629 from the National Opioid Abatement Trust II (NOAT II). NOAT II is separate and distinct from the National Distributors/Janssen settlements. As of August 2, 2023, Orange County has received six (6) deposits for the Opioid Special Revenue Account in the amount of $1,337,170.67. The total allocation for Fiscal Year 2023-24 is $435,750.00. Fiscal Year 2024-25 allocations (Year 2 of Lantern Project, Freedom House and NC FIT) equal $374,902. A total of$526,518.67 remains for new opioid mitigation strategies. The Opioid Advisory Committee met on August 14, 2023, and September 11, 2023, and received and discussed a total of five proposals for use of Opioid Settlement Funds in Orange County. New funding requests include: Reintegration Support Network (RSN) ► $265,316 for a 2-Year Period ($132,658.00/year) OC-EMS Post-Overdose Response Team (PORT) ► Option 1- $1,060,132.75 (3-Year Period) ► Option 2 - $846,047.13 (3-Year Period) ► Option 3 - $582,378.50 (3-Year Period) Grow Your World ► $186,770.64 (Year 1); $192,170.64 (Year 2) ► $378,941.28 for a 2-Year Period Transition Support & Recovery ► $165,170 (Year 1); $165,630 (Year 2) Harm Reduction Coordinator ► $108,025/year for a 2-Year Period The Opioid Advisory Committee created a Funding Subcommittee to review each proposal in detail using the following criteria: • Must address one of the 12 mitigation strategies listed in Option A of the Settlement MOA ► 1. Collaborative strategic planning ► 2. Evidence-based addiction treatment ► 3. Recovery support services ► 4. Recovery housing support ► 5. Employment-related services ► 6. Early intervention ► 7. Naloxone distribution ► 8. Post-overdose response team ► 9. Syringe Service Program ► 10. Criminal justice diversion programs ► 11. Addiction treatment for incarcerated persons ► 12. Reentry programs • Program serves Orange County residents; population served • Government entity, 501c3, Non-profit Community Partner • Equity Impact • Evidence-Based Practices • Project Need (Orange County Data Supported) • Experience & Organizational Capacity • Budget & Budget Narrative 3 The Advisory Committee recommends the following use of Opioid Settlement Funds: Reintegration Support Network (RSN) ► $20,000.00 - 1 Year OC-EMS Post-Overdose Response Team (PORT) ► Option 2 - $846,047.13 (3-Year Period) ► $244,020.00 /1st year Grow Your World ► $20,000.00 - 1 Year Transition Support & Recovery ► $20,000.00 - 1 Year Harm Reduction Coordinator ► $108,025/year for a 2-Year Period The total dollar amount of Opioid Settlement Funds appropriated across the above named and authorized strategies is $412,045. FINANCIAL IMPACT: Budget Amendment #4-B recognizes $455,617 in new revenue for the Opioid Settlement Fund and authorizes projects for each of the named and authorized strategies. It also creates four (4) new time limited positions - three (3) Emergency Medical Services (EMS) Post-Overdose Response Team Members through December 31, 2026, and one new Harm Reduction Coordinator in the Health Department through December 31, 2025. Opioid Settlement Fund($64,200) -Fund#27 Revenues for this project: Current FY 2023-24 FY 2023-24 FY 2023-24 Amendment Revised Opioid Settlement Funds $881,554 $455,617 $1,337,171 Total Project Funding $881,554 $455,617 $1,337,171 Appropriated for this project: Current FY 2023-24 FY 2023-24 FY 2023-24 Amendment Revised Evidence-based Addiction Treatment (Lantern Project) $164,862 $173,105 $337,967 Recovery Support Services (Freedom House) $122,188 $128,297 $250,485 Reentry Program (NC FIT) $70,000 $73,500 $143,500 Naloxone Distribution $14,500 $0 $14,500 Student Health Action Coalition (SHAC) Syringe Service $64,200 $0 $64,200 Program Reintegration Support Network (RSN) $0 $20,000 $20,000 Post-Overdose Response Team (PORT) $0 $244,020 $244,020 Grow Your World $0 $20,000 $20,000 Transition Support& Recovery $0 $20,000 $20,000 Harm Reduction Coordinator $0 $108,025 $108,025 Unallocated $445,804 ($331,330) $114,474 Total Costs $881,554 $455,617 $1,337,171 4 SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable to this item: • GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY The creation and preservation of infrastructure, policies, programs and funding necessary for residents to provide shelter, food, clothing and medical care for themselves and their dependents. • GOAL: CREATE A SAFE COMMUNITY The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang activity, substance abuse and domestic violence. Efforts to address opioid abuse will create a safe community and ensure a community network of basic human services and infrastructure that maintains, protects and promotes the well-being of all residents in Orange County. ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal impact associated with this item. RECOMMENDATION(S): The Manager recommends the Board: 1) receive an update on the Opioid Advisory Committee and recommendations from the Committee regarding the use of Opioid Settlement Funds that support Option A of the MOA on the Allocation and Use of Opioid Settlement Funds in North Carolina; 2) approve the attached resolution regarding the expenditure of Opioid Settlement Funds; and 3) approve Budget Amendment #4-B. 5 Increasing Access to Specially Trained Mentors to Support Youth Under-resourced by the Local Community and Disadvantaged by Intersectional Social Identities High-Impact Opioid Abatement Strategies Option A: Recovery support services and Early intervention i Reintegration Support Network (RSN) Terence L, Johnson, MS Executive Director Email: Terence(a)rscnc.org Lorenza Wilkins, DBA Board Chair Email: Boardchair(a-rsnnc.org 117 West Main Street Carrboro, NC 27510 Phone: 984-777-5282 Website: www.rsnnc.orq Page 1 of 15 6 Table of Contents Proposal ................................................................................................................................... 3 RSN Staff and Qualifications................................................................................................... 6 MeetRSN's Mentors ................................................................................................................ 8 Budget ...................................................................................................................................... 9 Appendix .................................................................................................................................12 Letterof Support: EI Futuro ...................................................................................................12 Letter of Support: boomerang................................................................................................13 Letter of Support: Orange Partnership for Alcohol and Drug Free Youth ...............................14 Letter of Support: Grow Your World.......................................................................................15 Page 2 of 15 7 Proposal When 18-year-old Matt McQuiston died from a drug overdose following months of treatment, Matt's family and friends established a memorial fund to provide necessary support systems to prevent similar devastation to the lives of youth and their families. Since RSN's inception, RSN's purpose has been to interrupt the systemic barriers that youth and their families experience accessing mental health and substance use services. RSN's work builds upon current mentoring models by recognizing the unique value of youth being supported by adults with lived experience. Our work continues to be centered on inclusive and equitable practices that acknowledge the daily systemic and structural pressures that create gaps in opportunities for under-resourced and disadvantaged youth. The Reintegration Support Network(RSN) is seeking the support of the Orange County Opioid Advisory Committee to increase the number of specially trained mentors (Certified Peer Support Specialist and/or Recovery Coach Academy Certified) providing evidence-informed support to youth experiencing challenges related to substance use, mental health, and justice-involvement. Dr. Murthy, in the 2021 Surgeon General's Advisory, called for an urgent response to the "youth mental health crisis" and declared a National Emergency in Child and Adolescent Mental Health. In the North Carolina Child Fatality Task Force annual report, the 2021 suicide rate among children ages 10 to 17 was the highest it has been in 20 years and the death rate from 2012 to 2021 increased by 47% among youth ages 15-17. Furthermore, in a study of 10,000 adolescents in the United States, two-thirds of adolescents who developed alcohol or substance use disorders had experienced at least one mental health disorder. Dr. Murthy called for a swift and coordinated response to this crisis as the nation continues to battle the...pandemic." Nonetheless, essential supportive services (like RSN) are rare and underdeveloped, especially programs accessible to disenfranchised youth, those under-resourced by the local community, disadvantaged by intersectional social identities (race, ethnicity, culture and language, gender, sexual orientation), and disproportionately impacted by poverty, mental health, substance use, and justice involvement. Furthermore, in North Carolina's Opioid and Substance Use Action Plan, the task force prioritized equity, lived experiences, and acknowledging the systems that have disproportionately harmed historically marginalized persons who use drugs and implement programs that reorient those systems. Recent Orange County Racial and Ethnic Disparities (RED) in Juvenile Justice data, highlighted that youth of color are 5 times more likely to receive a complaint than their white counterpart(Relative Rate Index: 5.07). RSN is committed to interrupting the daily systemic racism that impacts the youth and their families we serve by continuing to serve on the Orange County JCPC Racial and Ethnic Disparity Subcommittee and implementing the eight REDuction Strategies in Orange County. For years, RSN has been leading local efforts to adapt an evidenced-based, adult peer-support model to meet the unique needs of youth in Orange, Durham, Chatham, and Alamance Counties. RSN uses specially trained mentors (NC certified peer support specialists, or Recovery Coach Academy trained)to interrupt the daily systemic and structural pressures that create gaps in opportunities for youth (ages 13-20) especially those with challenges related to mental health, substance use, and/or juvenile justice involvement. Our mentors provide one-to-one support and/or facilitated Life Skills Support Groups, creating a safe and resilient space for young people to center their needs and build agency while fostering a sense of belonging, healthy relationships, and positive engagement within the community. Community-based support that meets youth where they are by providing a supportive relationship between adults and youth is highly recognized as a protective factor and has been shown to positively impact social emotional well-being. Accordingly, the Surgeon General's Advisory recommended youth peer support programs as an effective service, and reminds us that, "Youth are experts on their own lives, so it is important to engage youth in community-based mental health efforts." (p. 30)These areas of practice continue to require greater scientific and programmatic support to continue to be adapted for youth. Page 3 of 15 8 If funded by the Orange County Opioid Advisory Committee, RSN will develop and launch a multi- pronged approach to harm reduction by: 1. Expanding RSN's current capacity to handle a 50%increase in referrals from 2021/22- 2022/23 by onboarding additional specially trained mentors to increase the availability of mentors in Orange County. RSN mentors provide individual and group support in addition to community outreach, sharing their personal stories of resilience and recovery and providing educational materials tailored to youth. RSN is currently partnering with Boomerang to provide informal mentoring services to community youth participating in their services, strengthening the protective support a youth is receiving. o In addition to increasing our contract mentor pool, RSN will designate a Lead Mentor to liaison with other youth-serving organizations, provide both formal and informal mentoring as well as act in the capacity of Lead Facilitator for Life Skills groups in Orange County. o RSN anticipates needing additional mentors to support the implementation of Orange County's Project Build Gang Intervention Program and a new initiative to design a "warm handoff' process where RSN's mentors attending juvenile justice court counselors and clients meeting to build rapport and facilitate referrals. o RSN has also identified the need for additional funding to separate the Director of Operations and Programs position into two positions, Director of Operations and Directors of Programs, providing additional organizational capacity as our services expand. 2. Continuing to provide Connecticut Community for Addiction Recovery (CCAR) Recovery Coach Academy training within the community at no cost to stakeholders. RSN Mentor Program Manager, Lucy Battles, is a certified CCAR Trainer. Utilizing Ms. Battels' expertise, RSN will offer the following trainings (including offering continuing education hours): o Recovery Coaching Basics: This curriculum provides a basic, introductory version of Recovery Coaching in order to meet the needs of those who want a general understanding of the recovery process to better understand and support the recovery of their loved ones, friends, and colleagues. ■ The goal of this training is to: (1) Define and increase fluency in the language of recovery, (2) Build capacity to understand, support and advocate for recovery, (3) Learn about specific skill sets key to supporting recovery, (4) Create a learning community to advance the recognition, and (5) acceptance and support of recovery. o Recovery Coach Academy and Recovery Coach Academy for Young People: The CCAR Recovery Coach Academy is a 5-day intensive training academy focusing on providing individuals with the skills needed to guide, mentor and support anyone who would like to enter into or sustain long-term recovery from an addiction to alcohol or other drugs. More and more the population of persons seeking recovery from substance use are getting younger and younger. The CCAR Recovery Coach Academy for Young People was Page 4of15 9 developed to enhance the skills of young people supporting other young people on their recovery journey. ■ The goal of this training is to: (1) list the fundamental principles of recovery coaching, (2) build communication skills to enhance relationships, (3) discover attitudes about self-disclosure &sharing your story, (4) describe the different roles and applications for recovery coaching, (5) increase awareness of culture, power& privilege, (6) experience recovery wellness planning, and (7) practice newly acquired skills. RSN completed fifteen key stakeholder interviews in Orange County and received funding from the Strowd Roses Foundation to host community listening sessions with youth and their families and guardians to understand how RSN can adapt its services to support a culturally and linguistically diverse community (RSN will intentionally recruit and accommodate a diverse sample representing BIPOC, LGBTQIA+, rural communities, individuals with disabilities, refugees/immigrants, and Spanish speakers). These activities will contribute to RSN's ongoing work to create community informed services that meet the evolving needs of youth, and adapting RSN services to be responsive to current and future needs. Page 5 of 15 10 RSN Staff and Qualifications Terence Johnson is a dedicated professional with over 6 years of experience as a public health researcher. He has significant experience managing Clinical,as well as non-Clinical, research studies within academia. He has served as the Study Coordinated on several large- scale,federally funded, multi-site research projects involving vulnerable population groups, including Terence L. Johnson juveniles, incarcerated offenders, and substance- Executive Director abusing and treatment-seeking individuals. (Pronouns: He/Him/His) The Reintegration Support Network Executive Director (ED), in conjunction with the Board of Directors is responsible for ensuring the organization has a long- range strategy, sustainable financial plan, and adequate staff and resources to carry out the organization's mission and scope of services. In addition,the ED is responsible for organizational development and financial sustainability. Jamie is an ICF accredited Mentor/Coach with a I` background in leadership and organizational development, program design and implementation. Jamie is also a person in long-term recovery and uses j� her coaching and peer support background in service to II both individuals and groups on the recovery path. Director of Operations Interim Director of Programs The Director of Operations works directly with the RSN (Pronouns: She/Her/Hers) Exec. Director, and is responsible for overseeing the day-to-day operations of RSN ensuring that proper policies, procedures and internal systems are in place to maintain official records and compliance with federal, state and local regulations as well as grant reporting requirements.The DO also works directly with the ED in regard to financial management and fiscal monitoring. The Director of Programs oversees program development and implementation, ensuring coordination among the organization's primary components:the Mentor Program, Participant Engagement, and Community Outreach and Education. RSN is in the process of completing an organizational restructure to align with its 2023-2025 strategic goals. RSN is in the process of separating the Director of Operations and Programs position into two positions, Director of Operations and Directors of Programs. Page 6 of 15 11 Lucy Battles joined the RSN team in 2020. Since starting her journey of recovery in 2011, she has been an advocate for recovery equity and stigma reduction on both state and national levels. Lucy has worked in the mental health and recovery field since 2015, locally at UNC Horizons and UNC Behavioral Health ED, and ;A I nationally with the NY State Department of Health. Mentor Program Manager (Pronouns: She/Her/Hers) The Reintegration Support Network Mentor Program Manager(MPM)is accountable for managing all aspects and day-to-day operations related to the mentor program.The MPM works directly with the RSN Program Director,the Participant Program Manager (PPM)and community partners to support participant engagement as it relates to our specially trained mentors. Jeremy Smith serves as RSN's Participant Program Manager. Jeremy played college basketball at Lenoir Community and Chowan University, and after getting offers to play professionally, decided to turn over a new leaf and work in higher education while going back to � . school for his masters in Leadership Management. `f Since 2017, Jeremy has been working in higher Participant Program Manager education in different sectors such as nonprofit, (Pronouns: He/him/his) universities, and private institutions. Jeremy loves connecting with the youth and giving back! Participant Program Manager(PPM)is responsible for managing all aspects and day-to-day operations related to the participant engagement program.The PPM works directly with the RSN Program Director,the Mentor Program Manager(MPM)and community partners to support participants who are receiving RSN services. RSN Lead Mentor The Orange County Lead Mentor will serve as a key member of the RSN support team to provide participants with a sense of belonging and the skills and capacities for self-advocacy, healthy relationships and positive engagement in the community.The Mentor works with participants one on one or in a group, supporting them in setting and achieving goals through shared activities, goal setting, support and encouragement. The Lead Mentor would be responsible for tapping into the potential within our mentor pool to increase Outreach and participant recruitment. Page 7 of 15 12 Meet RSN's Mentors �1 N . 1 became a mentor to be a part of the (They seek to]empower latinx youth `I have been in recovery for over 10 solution" and support their journeys to reach their years and after gaining the tools needed Linda Brandariz highest potential." to maintain it,it's led me to become a Pablo Robles mentor." Shawn Baker �%®r "I believe that there is not a`one size fits `I've been in recovery since 2014,and 1 became a mentor after seeing so many all"path to recovery and I became a love helping others discover their young people guys come through the mentor to help youth find solutions that strengths and ability to overcome prison system.It made me want to make work for them.I want to use my life challenges.I wanted to become an RSN a difference in our community." experiences to help others who are mentor as a way of giving back to Edward Scott(Scottso) facing challenges similar to those I have others." faced." Kimberly Shoulars Emily Branson i' e. "I became a mentor so that 1 could share `I have been in recovery for over 10 "I've chosen to help others struggling positivity to the youth in the community." years and I wanted to be a mentor with various forms of Mental Health Joe Miller because I have learned a lot on my Disorders,including but not limited to continuous journey of self healing and Substance Use Disorder(SUD),and to growth and I hope to share some of that use my personal life experiences to help with others." benefit others going through similar Jen Galvin struggles as my own." Joe Euler Page 8 of 15 13 Budget Each- Years 1 A. Personnel and 2 Salaries&Wages Exec.Dir.(Strategic Planning and Resourcing, Finances, HR,Board Development,Community Partnerships and Collaborations) $14,803 Director of Operations (Responsible for Financial Management,Grant Management,day-to-day operations) $15,817 Director of Programs (Youth and Family: Program design, development, implementation and evaluation) $23,625 Participant Program Manager(PPM) $19,467 Mentor Program Manager (MPM) $19,467 Total Salaries&Wages $93,179 B. Fringe Benefits FICA Taxes FICA ED $1,132 FICA-Dir.of Ops $1,210 FICA-Dir.of Programs $1,807 FICA-PPM $1,489 Page 9 of 15 14 FICA-MPM $1,489 Total FICA Taxes $7,128 Workers'Comp $500 Unemployment Insurance Unemployment-ED $171 Unemployment-Dir.of Ops $171 Unemployment-Dir.of Programs $171 Unemployment-PPM $171 Unemployment-MPM $171 Total Unemployment Insurance $853 Total Fringe Benefits $8,481 Total Personnel Expenses $101,660 C.Office and Occupancy Expenses Office Supplies $300 Printing&Copying $300 Total Office Expenses $600 Occupancy Expenses Rent(3%increase per year) $800 Total Occupancy Expenses $800 Page 10 of 15 15 D.Supplies/Other Operating Expenses Participant Incentives(Group and Individual Skill Building, $25/participant, 120 participants) $1,500 Mentor Program:Background checks(25 applicants @ $45/mentor) $500 Website Hosting,includes domain reg.fees $450 Subscriptions (e.g.,Constant Contact,G suite,Zoom, Adobe) $1,000 Translation and Interpretation Services $1,100 Total Supplies/Other Operating Expenses $4,550 E.Contract Contractors/Consultants Bookkeeping,includes audit and legal fees Mentor Services(formal and informal services, supervison and support) $9,864 Lead Mentor $9,880 Program Support(incl. workshop,events and training logistics,marketing materials, &general admin.support) $4,875 Total Contractors/Consultants $24,619 F.Other Payroll Processing $429 Total Other $429 Total Each Year $132,658 Total Two Year $265,316 Page 11 of 15 16 Appendix Letter of Support: EI Futuro 06 El Futuro May 16, 2023 Terence L.Johnson Executive Director Reintegration Support Network 117 West Main Street Carrboro,NC 27510 RE:Orange County Opioid Settlement Funding Dear Terence, I am writing with full support for your application to the Orange County Opioid Advisory Committee to create an Orange County Youth Advisory Committee that includes a subcommittee,entitled Substance Use Prevention and Harm Reduction,to develop and lead a coordinated effort focused on intervention and early identification of youth experiencing challenges related to substance use,mental health,and justice-involvement. EI Futuro provides bilingual and culturally-responsive mental health services(including youth and emerging adults)in a welcoming environment of healing and hope.RSN has been working with EI Futuro's Technical Assistance and Consultation program to expand RSN's capacity to provide culturally responsive care and linguistic access using the Culturally and Linguistically Appropriate Services(CLAS)Standards as our benchmarks.RSN and EI Futuro are working together to be more responsive to Latine populations in this current youth mental health crisis. We believe it would be useful for families in Orange County to have access to youth-centered educational materials and workshops(focusing on Fentanyl,Naloxone,harm reduction,mental health,substance use and addiction,community support and stigma)and a coordinated referral and intervention program system to support youth identified as experiencing challenges related to mental health. If possible,we request that RSN considers developing materials in Spanish and continuing to enhance their capacity to provide interpretation services to families.Additional incentives that would be valuable to Latine populations include transportation to services and compensating youth fortheir intellectual property and time.We will support RSN by recruiting youth and families in Orange County,supporting evaluation activities,and ensuring the success of the coordinated efforts. Sincerely, Molly Hayes,M.Ed,LCMHCS Director of Clinical Enhancement Services 2020 Chapel Hill Road, Suite 23 www.elfuturo-no.org Tel:919-688-7101 Durham,NC 27707 Fax:919-688-7102 Page 12 of 15 17 Letter of Support: boomerang ��1 FA W4 C UE4INC,C,=�NNECTKINS-011ILD1NC RESILIENCE May 16,2023 Dear Committee Members: I am pleased to write in support of Reintegration Support Network's request to the Orange County Opioid Advisory Committee. I understand that the proposal serves to create an Orange County Youth Advisory Committee that includes a subcommittee,entitled Substance Use Prevention and Harm Reduction,to develop and lead a coordinated effort focused on intervention and early identification of youth experiencing challenges related to substance use, mental health,and justice-involvement. We work closely with Reintegration Support Network staff to provide capacity-building support in our efforts to effectively serve the youth in our community who have challenges with substance use,mental health and,or justice involvement.This program year,we deepened our partnership to provide mentoring and program support for students who attend both the Alternative to Suspension and after school programs that Boomerang offers,and established a referral pipeline to directly support students who are experiencing acute substance use and/or mental health challenges. We will continue our strong and successful collaboration to ensure ongoing support and critical programming remains available for our community youth. As a partner agency serving Orange County youth,our work with Reintegration Support Network helps enrich and deepen the impact of our respective efforts with the children we serve,and move the needle on equitable health opportunities our wider community. It is my pleasure to stand in continued partnership with Reintegration Support Network,and to offer this letter of recommendation on their behalf for funding through the Orange County Opioid Advisory Committee. Sincerely, Tova Hairston, Executive Director 825-A North Estes Drive, Chapel Hill, NC 27514 919.968.2146 www.boornerangy .r Amd Page 13 of 15 18 Letter of Support: Orange Partnership for Alcohol and Drug Free Youth � 0 DRUG 101 May 31,2023 Terence L.Johnson Executive Director Reintegration Support Network 117 West Main Street Carrboro,NC 27510 RE:Orange County Opioid Settlement Funding Dear Terence, On behalf of Orange Partnership,I am writing to express our support for Reintegration Support Network (RSN)'s proposal to the Orange County Opioid Advisory Committee to create an Orange County Youth Advisory Committee to develop and lead a coordinated effort focused on intervention and early identification of youth experiencing challenges related to substance use,mental health,and justice- involvement. Orange Partnership for Alcohol and Drug Free Youth envisions a community where young people live safe,healthy and productive lives,free from the influence of alcohol and drugs.The coalition accomplishes these goals by using evidenced based community impact strategies through collaboration, education,advocacy and empowering youth.RSN is an Orange Partnership coalition member and funded to provide one-on-one mentoring and life skills groups to youth in Orange County.We are supportive of RSN's proposed plan to develop a multi-pronged approach to address the national youth mental health crisis by:(1)Developing a Youth Advisory Committee by expanding the Alcohol and Drug Abuse Prevention Team(ADAPT)program,(2)Developing youth-centered educational materials and conducting workshops(e.g. mental health,opioid and other substance use disorders,community support and stigma);and(3)Collaborating with Orange Partnership coalition members to develop and implement a coordinated referral system for youth at risk of substance use and/or mental health challenges to receive interconnected services. We recommend RSN continue to enhance their capacity to provide interpretation services and provide materials in multiple languages.Incentives to eliminate barriers to engagement,such as transportation and compensation for their time are also recommended. We will support RSN by working with Orange Partnership coalition members,coordinating professional development and substance use training,as needed,and supporting evaluation activities to ensure the success of the coordinated efforts. Sincerely, Gayane Chambless Program Director 104 New Stateside Dr. Chapel Hill NC 27516 Page 14 of 15 19 Letter of Support: Grow Your World GROW YOUR WORLD May 30, 2023 Terence L.Johnson,Executive Director Reintegration Support Network 117 West Main Street Carrboro,NC 27510 RE:Orange County Opioid Settlement Funding Dear Terence, am writing with full support for your application to the Orange County Opioid Advisory Committee to create an Orange County Youth Advisory Committee that includes a subcommittee,entitled Substance Use Prevention and Harm Reduction,to develop and Lead a coordinated effort focused on intervention and early identification of youth experiencing challenges related to substance use,mental health,and justice-involvement. Grow Your World is a youth-centered community-building organization that uses a near-peer and intergenerational mentorship model to create access to new opportunities,skills and experiences that heal past traumas and shifts personal and systematic structures,beliefs and outcomes toward equity,justice and inclusion.Reintegration Support Network coLLaborated with Grow Your World to provide youth focused training to the volunteers participating in their Tutoring after 6pm initiative that partners 4-12th graders with college students to work together 1-2 times a week on academic subjects of need.RSN and Grow Your World are working together to be more responsive to the national youth mental health crisis. We believe it would be useful to increase access to specially trained mentors with lived experience In Orange County to coLLaborate with youth serving organizations that provide mental health and substance use services for youth and their families. If possible,we requestthat RSN considers developing materials in Spanish and continuing to enhance their capacity to provide interpretation services to families.Additional incentives that would be valuable to include are transportation to services and compensating youth and their families fortheir intellectual property and time.We will support RSN by recruiting youth and families in Orange County,supporting evaluation activities,and ensuring the success of the coordinated efforts. Sincerely, Sophie Suberman Co-Founder and Co-Director Grow Your world(84-1845124E is a 501(c)(3)non-profit organization with a mission to connect community members through multigenerational and inclusive relationships that build sustainable personal and professional enrichment opportunities. www.erowvourworld.org I Carrboro,INC 1919-525-1374 Page 15 of 15 20 Orange County EMS Post-Overdose Response Team Proposal Services related to Exhibit A of NC MOA:High-Impact Opioid Abatement Strategies' Establishes item 8 (Post-Overdose Response Team) and supports or expands items 2, 7, 9, 10 and 12 DEPARTMENT: Orange County Emergency Services �y @,R,a CO`A INFORMATION CONTACT: 5 Landon Weaver, 919-245-6127 Kim Woodward, 919-245-6133 Kirby Saunders, 919-245-6123 Executive Summary Orange County Emergency Medical Services (OC-EMS) has observed a 226% increase in annual opioid overdoses requiring EMS from 2018 to 2022. OC-EMS is seeking funding for the development and implementation of a Post-Overdose Response Team (PORT). OC-EMS is prepared to provide this service but is in need of funding support for additional staff, a response vehicle and program supplies. PORTs are specialized teams that respond to opioid overdoses in real time or within 24-72 hours of the overdose event.Upon implementation,the OC-EMS PORT will meet individuals where they are at in their addiction by providing harm reduction resources, linkage to treatment services, and medication-assisted treatment(MAT)induction and administration. This service will be available to all eligible individuals that OC-EMS interfaces with during EMS incidents, and will be provided as a referral for collaborating departments, emergency departments, organizations and the community at-large. PORTS have become the standard of care in post-overdose services nationally and locally,with 41 North Carolina counties currently having an active PORT in place. MAT services have been directly associated with reduced relapse rates and chance of overdose(Jaeger & Fuehrlein, 2020). In the last five years, 23% of OC-EMS incidents involving an opioid overdose were the result of individuals who required EMS opioid overdose treatment on more than one occasion. With each consecutive overdose, the potential of death increases. By providing this service to the community, the following items as defined in Exhibit A of`NC MOA: High-Impact Opioid Abatement Strategies' will be established or directly supported: Item 8:Post-Overdose Response Team Item 2:Evidence-Based Addiction Treatment Item 7:Naloxone Distribution Item 9: Syringe Service Program Item 10: Criminal Justice Diversion Programs Item 12:Reentry Programs 1 21 We anticipate that approximately 50 unique individuals will directly benefit from this resource in year one, and that 190 individuals will directly benefit from this service over three years. This estimate is based on a five-year upward trend in opioid overdose incidents paired with anticipated inbound referrals once services have been established. Projected Annual MAT Enrollees 140 120 100 80 60 40 20 0 2023 2024 2025 2026 2027 2028 Projected MAT Enrollees Assessment of Need and Proposal Summary Between 2018 and 2022, OC-EMS has responded to 466 opioid-related overdose incidents equating to a 226% annual increase. Of all opioid overdose incidents from 2018 through 2022, 68% of the affected persons were transported by OC-EMS to local emergency departments, 30% refused transportation, 1.5% were deceased on scene and 0.4%were transported to an inpatient alternative destination facility for OUD treatment. Of the 466 total incidents, 106 (23%)were the result of 42 individual patients that utilized OC- EMS for an overdose on more than one occasion. When OC-EMS responds to an opioid overdose, there are currently three possible disposition pathways: (1)transport to an Emergency Department; (2)transport to a local inpatient treatment facility; or (3)refusal of transport. Buprenorphine use, as part of MAT,has been associated with a significant reduction in illicit opioid use for persons with opioid use disorder(OUD) (Soeffing et al., 2009). MAT with buprenorphine has been shown to be more effective in the reduction of illicit opioid use, risk of drug-related overdose, and overall healthcare and utilization costs when compared to abstinence-based addiction treatments for those with OUD(Kinky et al.,2019).Although OC-EMS offers harm reduction efforts aimed at providing specialized alternative destinations of transport, a specialized overdose refusal protocol (attachment E), as well as distribution of naloxone, sterile syringes and educational materials; there is no pathway in place for an individual to be offered MAT from the scene of an EMS incident. Further, even in the event that an individual is transported to a local Emergency Department (ED), there is no guarantee that they will be offered services consisting of MAT or connection with ongoing treatment options upon exit from the ED. Although Orange County has a range of opioid treatment programs (OTPs) and office-based opioid treatment (OBOT) options available within the county, there is an identifiable void in connecting individuals with these services. Even in the event that an individual is aware of these services, the time- 2 22 sensitive nature of each persons need for help, paired with the difficulty of urgently enrolling in these services and the efforts involved to do so creates great difficulty and frustration in obtaining the necessary treatment for OUD (McLean&Kavanaugh, 2019). The Post Overdose Response Team(PORT) service proposed within this document will provide a proven and effective strategy for filling this gap by connecting individuals who experience an overdose or withdrawal directly to treatment, regardless of their disposition from the scene of an EMS incident. This PORT response model has become the standard of care in providing field-based MAT and connecting individuals in need with the services that they require to ensure survival and well-being. As of this year, at least 41 counties within North Carolina have an active PORT (NC-DHHS, attachment Q. In addition to providing this critical service to all eligible individuals who have interfaced with Orange County EMS,the PORT will create a pathway for any other eligible individuals to have direct access to the services provided by this program. This resource will be available for partnering county departments, emergency departments, local organizations and the community at-large. The services offered will be flexible in order to accommodate an array of potential needs ranging from temporary gap coverage in someone transferring treatment services, to accommodating the treatment needs of any eligible Orange County resident who is independently reaching out for help. OC-EMS is requesting funding to create a PORT that operates seven days a week, and consists of services provided by community paramedics (CPs) and Peer Support Specialists (PSSs) within OC-EMS. During active hours, the PORT will be capable of responding directly to the scene of an opioid overdose or withdrawal incident and initiating MAT on location when appropriate. In addition, the OC-EMS CP program will conduct daily surveillance of EMS PCRs and other external referral pathways to begin connecting eligible individuals to PORT services between 24-72 hours of EMS incident or submission of external request. For each eligible individual, the PORT will be equipped to provide daily dosing of buprenorphine at the location that best suits the individual for up to seven consecutive days. During this time, the PORT will actively navigate the individual to the most appropriate treatment provider for their specific situation, at which time a warm hand-off will be provided when applicable. Project Description OC-EMS will create, operate and manage a PORT within the geographic constraints of Orange County, NC. Available resources will be utilized to identify, contact, assess, treat, and navigate individuals to ongoing treatment and recovery resources. This team will be built directly upon the Orange County Emergency Services ETHOS of integrity, respect, fairness and compassion. All eligible opioid overdose patients encountered by an OC-EMS response will be offered PORT services on the scene of the incident by the responding EMS unit. In addition,the PORT will be dispatched alongside the responding EMS unit to any suspected opioid overdose or withdrawal incident as available. The PORT response will be active twelve hours per day, seven days per week. EMS response data,along with external referral pathways will be reviewed daily for all other potential clients. Potential clients will then be contacted urgently, not to exceed 72 hours of incident or referral. Upon successful contact and expressed interest from any potential client, a visit will be scheduled by the PORT and will be based on the client's convenience of location and time. In the event that the PORT directly interfaces with an eligible participant on the scene of an EMS incident, MAT services will be initiated at location as applicable. 3 23 On initial visit, whether scheduled or as part of EMS response, the PORT will engage in a motivational interview with the client to determine that specific individuals personal needs and wishes.If the client meets eligibility for, and consents to, MAT, the responding CP of the PORT will follow the OC-EMS MAT protocol (attachment F) and provide buprenorphine treatment as defined therein. This treatment will continue as a daily-dose intervention by the CP up to a maximum of seven consecutive days at the place of convenience for the client. Upon initiating treatment, the PORT will determine potential referral pathways for ongoing treatment in consultation with the client, and then make an urgent referral to the appropriate ongoing treatment provider to initiate transfer of care. Upon successfully scheduling the transfer of care to partner OBOT or OTP, a warm hand-off will occur by the PORT at the provider's location to ensure continuity of care and address any questions or needs that may arise. Upon transfer, the client will remain with direct contact information to members of the PORT should any additional needs arise following the transfer of care. In addition to providing MAT, an intake tool will be utilized during initial and subsequent visits to determine additional client needs. Based on the results of this intake tool,referrals will be made with other services within the county. Education will be provided on each applicable visit along with distribution of harm-reduction resources such as naloxone, fentanyl test strips, resources within the area and sterile syringes as appropriate. Providing MAT will not be a requirement for a PORT visitation with a potential client. The success of this program is directly dependent upon its flexibility to the client's current needs. The PORT will provide non- judgmental, non-coercive care to allow the individual to determine what they need and which services will assist them in addressing those needs. In establishing this rapport and always remaining client-centered,the PORT will ensure that each individual has a personal path to help, at the moment in which they make the decision to utilize it. This resource will also be available to partnering departments, local organizations, emergency departments and the community at-large in the form of direct links to our case management software (Apricot), direct phone numbers, email and text messages. Active efforts will be made throughout the life of the PORT to establish and increase public awareness of this service.These efforts will include availability on the Orange County website, news releases, presentations to be utilized throughout the community, as well as direct education provided to our local first responders and emergency departments. As one example of alternative needs that will be addressed with this service,joint efforts have been made to establish a partnership with the Orange County Criminal Justice Resource Department(OC-CJRD).This partnership will create a pathway for treatment of individuals released from the Orange County Detention Center who are at risk of a temporary gap in treatment availability prior to being successfully connected with external treatment. We foresee one of the key benefits of the PORT team as its flexibility to accommodate similar needs as they are identified, in a `plug-and-play' model once this service is established. Beneficiaries We are able to estimate potential beneficiaries as a calculation of patients in which EMS has interfaced, as well as individuals identified by the OC-CJRD that potentially have a need for gap coverage.We are unable to accurately estimate the number of individuals outside of these two pathways that will directly benefit from this service. We fully anticipate that this service will be an asset to the community and that as knowledge of the PORT existence increases,incoming referrals will increase accordingly.In providing two FTE CP positions and two FTE PSS positions for this service (to ensure seven day a week coverage), we 4 24 are confident that the PORT will be prepared to accommodate the increase in external referrals as the program becomes more visible to partners and the community. Agency and program data will be routinely reviewed to ensure that the service capacity of the PORT team is capable of sustaining the anticipated number of clients. Utilizing the data of Stanly County,NC,we anticipate ten percent of individuals encountered by OC-EMS for an opioid overdose will become successfully enrolled in receiving MAT by the PORT (State Medical Director's Update, 5/3/22). Having no available data for eligible individuals who interfaced with OCDC and required this specific gap service at release, we will estimate ten percent successful enrollment for individuals released from OCDC that reported OUD upon intake. Utilizing EMS and Orange County Detention Center data form the 2022 calendar year, an estimated 40 individuals would have received MAT services from the proposed PORT program. If we are to calculate the maximum duration of medication administration at seven days for each of these individuals, we can estimate 280 days within the 2022 calendar year in which MAT would have been provided to a patient through these two pathways alone. We are unable to identify a reliable means of estimating the number of eligible individuals that would come from the additional pathways of Orange County departments, external partners, or community members at large. The number of incoming referrals from these pathways is expected to be largely contingent upon outreach and duration of time that the PORT has been an active service in the community. Eligibility Requirements to Receive Service In order for an individual to receive MAT service via this PORT, they must be at least 18 years of age; accessible within the geographic constraints of Orange County, NC; and not be otherwise excluded as defined by criteria set forth in the attached MAT Protocol. Incidents and referrals involving individuals under 18 will be addressed on a case-by-case basis due to the complications associated with these situations along with the rarity of these events (Of the 466 individuals encountered by OC-EMS for opioid overdoses in the past five years, two (0.4%) have been under the age of 18). A team consisting of the PORT, the OC-EMS Medical Director and the OC-EMS Community Paramedic Coordinator will urgently convene to determine the best steps in determining which services to offer these individuals. Throughout the duration of this program, emphasis will be placed on exploring and engaging with any available services for this population. Addressim! Community Needs By providing this critical service, OC-EMS will fill an identified void and offer proven services that currently do not exist for individuals in Orange County that suffer from OUD. In achieving this goal, we will decrease the incidence of death, and improve the quality of life of persons within Orange County,NC by accommodating the needs of our community. 5 25 Project Goals, Objectives and Outcomes Goals: I. Develop, maintain and grow the PORT program; ll. Provide PORT services to each; a. eligible opioid overdose and withdrawal patient encountered by OC-EMS; b. eligible gap coverage client at time of release from the Orange County Detention Center; c. eligible client referred to the program from other Orange County departments, emergency departments, organizations and the community at large Objectives: i. Implement a state-approved Medication Assisted Treatment Protocol(attachment F); ii. Train CPs and PSSs on the state approved protocol; iii. Develop MOU with all partnering OTPs and OBOTs; iv. Update Overdose Refusal Policy to include offering of PORT services to all eligible patients by responding EMS unit; V. Create partnership and referral process for local Emergency Departments as well as other community partners to connect patients with program; vi. Create and provide training for all OC-EMS staff to ensure all potential referrals are captured and educated on service; vii. Provide training on PORT program to all partner first responder agencies to ensure awareness of service; viii. Support and expand current harm reduction efforts with availability of service; ix. Identify all potential clients through daily surveillance of each referral pathway; X. Screen and assess every eligible referral and patient for services; xi. Adhere to PORT MAT protocol for all eligible referrals; xii. Provide buprenorphine in eligible patient's homes for up to 7 days; xiii. Provide referral and warm handoff of patients to appropriate OTP to OBOT; xiv. Conduct follow-up with successfully enrolled PORT MAT participants to determine ongoing needs and quality of interaction with EMS providers, community paramedics, etc. xv. Collect all program data; xvi. Provide quarterly reports pertaining to PORT program Outcomes: i) Each eligible patient is provided access to the PORT program; ii) Improved program efficacy through utilization and review of monthly program data; iii) Increased connection of individuals with OUD to effective resources; iv) Decreased incidence of opioid overdose death within Orange County; v) Decreased Emergency Department OUD utilization by individuals enrolled in PORT program; vi) Decreased OUD related utilization of EMS by individuals enrolled in the PORT program; vii) Decreased repeat OUD related utilization of individuals who have previously interfaced with OC- EMS and are enrolled in the PORT program; viii) Increased EMS provider abilities to effectively interface with OUD patients; ix) Improved EMS provider morale and engagement as it pertains to OUD patient encounters; x) Increased intake of enrollees through referrals from community partners; xi) Decreased frequency of individuals released from Orange County Detention Center experiencing a gap in MAT 6 26 Outcome Reporting: All related data pertaining to the PORT program will be reported as part of the quarterly Orange County Peer Review Committee. De-identified quarterly data will be provided to the Opioid Advisory Committee. Duration of Service We are requesting the utilization of the Orange County, NC allotment of Federal opioid settlement funds to provide three years of the outlined service. By the final year of service, program and surveillance data will be utilized to determine ongoing need and sustainability of services. Proiect Implementation Timeline PHASE I(months 0-4) This initial phase will consist primarily of program development, staffing, logistics and training. During this phase, MOUs will be established with partnering OBOTs, OTPs, Orange County Departments, emergency departments and local organizations. Internal protocols and policies will be updated to reflect the availability of this service, trainings will be created and conducted with all potential partners and stakeholders,and program processes and logistics will be executed.During program development,feedback will be solicited from stakeholders and individuals with lived experience. All physical items required to provide service will be obtained during this phase. PHASE II(months 5-12) PORT program implementation will begin with this phase and will include responding to opioid overdose incidents,providing services to inbound referrals and executing all program processes. Outreach efforts to ensure community awareness of program and services will take place during this phase. Project staff will begin quarterly reporting to partners including the Opioid Advisory Committee. PHASE III(years 2 &3) Throughout phase three, the focus will be on program continuation, adjustments to accommodate community needs that arise, and preparation for sustainability of the program. In approaching the final year of service,program data will be further analyzed to determine ongoing sustainability of services. 27 PHASE I • Submit MAT protocol the State Office of EMS (completed and approved) • Solicit feedback from individuals with lived experience and community partners for program planning • Hire and train(2)FTE CPs and(2)FTE PSSs • Develop necessary components of case management software for PORT program • Develop and deliver EMS training internally and to all first responder partners • Create portal for external referrals • Finalize MOU between OC-EMS and CJRD for gap coverage of CJRD clients upon exit from OCDC • Identify other potential inbound referral partners, create MOUs • Create and execute MOUS between OC-EMS and ongoing treatment locations • Acquire proper legal clearances to manage buprenorphine (completed) • Acquire buprenorphine, create and execute associated logistics plan • Create ongoing follow up process for enrollees • Determine quarterly Peer Review templates for data sharing • Identify similar PORT resources within surrounding counties and begin establishing partnerships PHASE II • PORT begins responding to scenes of opioid overdose and withdrawal incidents, addressing incoming referrals and administering services as defined • Initiate ongoing program responsibilities o Conduct daily surveillance to ensure all eligible patients are offered services within 24-72 hours o Interface directly with overdose and withdrawal incidents alongside responding units o Provide all appropriate services to client o Determine proper ongoing treatment service based on client needs o Provide warm hand-off to ongoing treatment service o Complete all required documentation o Submit all required data to Opioid Advisory Committee o Continued review of outcome data to ensure there are no existing gaps o Analyze needs of the County for potential areas of expansion of program o Utilize ongoing feedback from individuals with lived experience and community partners to adjust to community needs o Conduct follow-up survey of program participants at proper intervals o Provide QA on all PORT documentation • Establish partnerships with other potential surrounding county resources and organizations PHASE III • Continue all previous ongoing program responsibilities with addition of: o Plan for ongoing program sustainability s 28 Budget Proposal In order to provide the PORT services outlined in this proposal,funding will be required.We are requesting three years of service funding, during which it is expected that PORT operations will be fully functional for greater than 2.5 years of that duration.In approaching the final year of service,program and surveillance data will be utilized to determine ongoing needs and sustainability of services. Below are three budget options to provide these services for three consecutive years. Further descriptions and yearly values of these options are viewable in(attachment B). OPTION Item Description Services Provided Cost Staff (2)FTE CP positions Provides complete PORT staffing: $921,716.25 (2)FTE PSS positions CP and PSS staffing 7 days per week, 12 hours per day Other Response vehicle,medications Provides response vehicle,and all service- $138,416.50 and all program supplies& related items to successfully conduct program equipment for 3 years Total Cost: $1,060,132.75 OPTION Item Description Services Provided Cost Staff (2)FTE CP positions Provides partial PORT staffing: $709,970.63 (1)FTE PSS positions CP staffing 7 days per week, 12 hours per day and PSS staffing M-F, 8 hours per day Other Response vehicle,medications Provides response vehicle,and all service- $136,076.50 and all program supplies& related items to successfully conduct program equipment for 3 years Total Cost: $846,047.13 OPTION Item Description Services Provided Cost Staff (2)FTE CP positions Provides CP-only PORT staffing: $498,225.00 No PSS CP staffin 7 days per week, 12 hours per da Other All medications and program No response vehicle. $84,153.50 supplies&equipment. Provides all other items to successfully conduct program services for 3 years Total Cost: $582,378.50 9 29 Summary OC-EMS is prepared to create and implement a PORT to address the growing rates of opioid overdoses within Orange County by filling an identified gap in connection to treatment. We are requesting funding for this initiative in order to support additional staff, a response vehicle and program-related supplies for three consecutive years. By providing this service in Orange County, we anticipate a reduction in opioid overdose deaths, increased access to harm-reduction resources and an improvement in quality of life for individuals suffering from OUD. References Jaeger, S., &Fuehrlein,B. (2020).Buprenorphine initiation to treat opioid use disorder in emergency rooms. Journal of the Neurological Sciences,411, 116716.https://doi.org/10.1016/J*jns.2020.116716 Soeffing,J.M.,Martin,L.D.,Fingerhood,M.L,Jasinski,D.R.,&Rastegar,D.A. (2009). Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 Year.Journal of Substance Abuse Treatment,37(4),426-430.https://doi.org/10.1016/J.jsat.2009.05.003 Kinsky, S.,Houck,P. R.,Mayes,K.,Loveland,D.,Daley,D.,&Schuster,J.M. (2019).A comparison of adherence, outcomes, and costs among opioid use disorder Medicaid patients treated with buprenorphine and methadone: A view from the payer perspective.Journal of Substance Abuse Treatment, 104, 15-21. https://doi.org/l0.1016/J*jsat.2019.05.015 McLean,K.,&Kavanaugh,P.R. (2019). "they're making it so hard for people to get help:"motivations for non- prescribed buprenorphine use in a time of treatment expansion.International Journal of Drug Policy, 71, 118-124.https:Hdoi.org/10.1016/j.drugpo.2019.06.019 NC-DHHS. (2023)Post Overdose Response Teams Coverage Map.Retrieved from https://www.ncdhhs.gov/about/department-initiatives/overdose-epidemic/first-responders State Office of EMS Medical Director's Update,May 3`d,2022 Greensboro,NC 10 30 11 Attachment A EXHIBIT A TO NC MOA: HIGH-IMPACT OPIOID ABATEMENT STRATEGIES ("OPTION A" List) In keeping with the National Settlement Agreement, opioid settlement funds may support programs or services listed below that serve persons with Opioid Use Disorder(OUD) or any co- occurring Substance Use Disorder(SUD) or mental health condition. As used in this list, the words 'fund"and "support"are used interchangeably and mean to create, expand, or sustain a program, service, or activity. 1. Collaborative strategic planning. Support collaborative strategic planning to address opioid misuse, addiction, overdose, or related issues, including staff support, facilitation services, or any activity or combination of activities listed in Exhibit C to the MOA (collaborative strategic planning). 2. Evidence-based addiction treatment. Support evidence-based addiction treatment consistent with the American Society of Addiction Medicine's national practice guidelines for the treatment of opioid use disorder— including Medication-Assisted Treatment (MAT) with any medication approved for this purpose by the U.S. Food and Drug Administration —through Opioid Treatment Programs, qualified providers of Office-Based Opioid Treatment, Federally Qualified Health Centers, treatment offered in conjunction with justice system programs, or other community-based programs offering evidence- based addiction treatment. This may include capital expenditures for facilities that offer evidence-based treatment for OUD. (If only a portion of a facility offers such treatment, then only that portion qualifies for funding, on a pro rata basis.) 3. Recovery support services. Fund evidence-based recovery support services, including peer support specialists or care navigators based in local health departments, social service offices, detention facilities, community-based organizations, or other settings that support people in treatment or recovery, or people who use drugs, in accessing addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they need to improve their health or well-being. 4. Recovery housing support. Fund programs offering recovery housing support to people in treatment or recovery, or people who use drugs, such as assistance with rent, move-in deposits, or utilities; or fund recovery housing programs that provide housing to individuals receiving Medication-Assisted Treatment for opioid use disorder. 5. Employment-related services. Fund programs offering employment support services to people in treatment or recovery, or people who use drugs, such as job training,job skills, job placement, interview coaching, resume review, professional attire, relevant courses at community colleges or vocational schools, transportation services or transportation vouchers to facilitate any of these activities, or similar services or supports. 6. Early intervention. Fund programs, services, or training to encourage early identification and intervention for children or adolescents who may be struggling with problematic use of drugs or mental health conditions, including Youth Mental Health First Aid, peer-based 12 Attachment A programs, or similar approaches. Training programs may target parents, family members, caregivers, teachers, school staff, peers, neighbors, health or human services professionals, or others in contact with children or adolescents. 7. Naloxone distribution. Support programs or organizations that distribute naloxone to persons at risk of overdose or their social networks, such as Syringe Service Programs, post-overdose response teams, programs that provide naloxone to persons upon release from jail or prison, emergency medical service providers or hospital emergency departments that provide naloxone to persons at risk of overdose, or community-based organizations that provide services to people who use drugs. Programs or organizations involved in community distribution of naloxone may, in addition, provide naloxone to first responders. 8. Post-overdose response team. Support post-overdose response teams that connect persons who have experienced non-fatal drug overdoses to addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they need to improve their health or well-being. 9. Syringe Service Program. Support Syringe Service Programs operated by any governmental or nongovernmental organization authorized by section 90-113.27 of the North Carolina General Statutes that provide syringes, naloxone, or other harm reduction supplies; that dispose of used syringes; that connect clients to prevention, treatment, recovery support, behavioral healthcare, primary healthcare, or other services or supports they need; or that provide any of these services or supports. 10. Criminal justice diversion programs. Support pre-arrest or post-arrest diversion programs, or pre-trial service programs, that connect individuals involved or at risk of becoming involved in the criminal justice system to addiction treatment, recovery support, harm reduction services, primary healthcare, prevention, or other services or supports they need, or that provide any of these services or supports. 11. Addiction treatment for incarcerated persons. Support evidence-based addiction treatment, including Medication-Assisted Treatment with at least one FDA-approved opioid agonist, to persons who are incarcerated in jail or prison. 12. Reentry Programs. Support programs that connect incarcerated persons to addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they need upon release from jail or prison, or that provide any of these services or supports. 13 33 Attachment B Budget Option 1 We anticipate that this budget option is required to ensure provision of PORT services as described in this proposal. MAT services and PSS services will be available twelve hours per day,seven days per week. This budget option includes: • 12 hour CP coverage,7 days per week • 12 hour PSS coverage,7 days per week • A designated vehicle for the PORT • All applicable supplies and technology for effective provision of services YEAR ICATEGORY 1ITEM I NARRATIVE 1AMMOUNT YEAR 1 SALARY WAGE (2)FTE Community Funds(2)FTE Community Paramedic positions with fringe benefits.Note:3.75%increase added to each subsequent year in SALARY/WAGE departmental $160,000.00 Paramedics alignment p p pay increase. SALARY/WAGE (2)FTE Peer Support Funds(2)FTE Peer Support Specialist positions with fringe benefits.Note:3.75%increase added to each subsequent year in $136,000.00 Specialists alignment with departmental step pay increase. Chassis($27,134),lights/siren,graphics,console($8,595),screen partition/divider($1000),800mHz Motorola Radio($7,500),slim OTHER Response Vehicle antenna($90),portable charger($450),tax($814).Allows for the CP to respond to the scene of the active overdose and to provide $44,583.00 daily treatment at location.Allows for transportation of patient for warm handoff at OTP site as needed. Portable 800mhz Motorola Radio($5000)allows for safe communication between community paramedic,responding EMS units,and Radio,Monitor,Laptop, the 911 Center when responding.LifePak($36,250)and Meret bag for ALS response($1000),allowing for community paramedics to EQUIPMENT and IPAD,Merit Pack, Provide ALS intervention in event of patient emergency,laptop computer($2261)allows for data entry and real time referal to OTP $50,161.00 as well as patient documentation.iPad($650)will provide the ability for virtual MAT visits through UNC ASAP or other OTP.Phone Service Provides adequate suboxone dosing for 40 unique patients annually throughout grant cycle(assuming 1 dose of suboxone=$4.75). SUPPLIES& Includes supplies to carry suboxone,community naloxone kits) MATERIALS Suboxone,Naloxone $9,000.00 NOTE:25%increase in supplies added to each subsequent year of service SOFTWARE Apricot User (3)years of(4)users access to Apricot case management software $9,360.00 YEAR 2 YEAR I `:r• r- SALARY/WAGE (2)FTE Community Continuation with 3.75%increase $166,000.00 Paramedic SALARY/WAGE (2)FTE Peer Support Continuation with 3.75%increase $141,100.00 Specialists SUPPLIES& MATERIALS Suboxone,Naloxone Continuation with 25%increase $11,250.00 YEAR3 YEAR 2 TOTAL: e SALARY WAGE (2)FTE Community Continuation with 3.75%increase SALARY/WAGE $172,225.00 SALARY/WAGE (2)FTE Peer Support Continuation with 3.75%increase $146,391.25 Specialists SUPPLIES& MATERIALS Suboxone,Naloxone Continuation with 25%increase $14,062.50 TOTAL: $1,060,132.75 14 34 Attachment 6 Budget Option 2 This budget alternative will ensure seven day per week coverage by a PORT CP,but will limit PSS services to a standard Monday through Friday workweek. With this option,there will be no limitation in the proposed ability to provide MAT services,but we anticipate a decrease in beneficiary engagement due to decreased availability of a PSS with lived experience. This budget option includes: • 12 hour CP coverage,7 days per week • 8 hour PSS coverage, 5 days per week • A designated vehicle for the PORT • All applicable supplies and technology for effective provision of services YEAR ICATEGORY I ITEM- I NARRATIVE _ AMMOUNT YEAR 1 SALARY/WAGE (2)FTE Community Funds(2)FTE Community Paramedic positions with fringe benefits.Note:3.75%increase added to each subsequentyear in Paramedics alignment with departmental step pay increase. $160,000.00 SALARY/WAGE (1)FTE Peer Support Funds(1)FTE Peer Support Specialist position with fringe benefits.Note:3.75%increase added to each subsequent year in alignment Specialist with departmental step pay increase. $68,000.00 Chassis($27,134),lights/siren,graphics,console($8,595),screen partition/divider($1000),800mHz Motorola Radio($7,500),slim OTHER Response Vehicle antenna($90),portable charger($450),tax($814).Allows for the CP to respond to the scene of the active overdose and to provide $44,583.00 daily treatment at location.Allows for transportation of patient for warm handoff at OTP site as needed. Portable 800mhz Motorola Radio($5000)allows for safe communication between community paramedic,responding EMS units,and Radio,Monitor,Laptop, the 911 Center when responding.LifePak($36,250)and Meret bag for ALS response($1000),allowing for community paramedics to EQUIPMENT and IPAD,Merit Pack, provide ALS intervention in event of patient emergency,laptop computer($2261)allows for data entry and real time referal to OTP $50,161.00 as well as patient documentation.iPad($650)will provide the ability for virtual MAT visits through UNC ASAP or other OTP.Phone Service SUPPLIES& Provides adequate suboxone dosing for 40 unique patients annually throughout grant cycle(assuming 1 dose of suboxone=$4.75). MATERIALS Suboxone,Naloxone Includes supplies to carry Suboxone,community naloxone kits) $9,000.00 NOTE:25%increase in supplies added to each subsequent year of service SOFTWARE Apricot User (3)years of(3)users access to Apricot case management software $7,020.00 TOTAL: •® (2)FTE Community SALARY/WAGE Continuation with 3.75%increase $166,000.00 Paramedic SALARY/WAGE (1)FTE Peer Support Continuation with 3.75%increase Specialist $70,550.00 SUPPLIES& MATERIALS Suboxone,Naloxone Continuation with 25%increase $11,250.00 YEAR 3 • $247,800,00 SALARY/WAGE (2)FTE Community Continuation with 3.75%increase $172,225.00 Paramedic SALARY/WAGE (1)FTE Peer Support Continuation with 3.75%increase $73,195..63 Specialist SUPPLIES& Suboxone,Naloxone Continuation with 25%increase MATERIALS $14,062.50 TOTAL:l $846,047.13 15 35 Attachment B Budget Option 3 This budget alternative will ensure seven day per week coverage by a PORT CP,but will not provide staffing of a PSS or a designated vehicle for the PORT. With this option,there will be limitations in the proposed ability to provide treatment services.In addition, beneficiary engagement will be placed solely on the CP due to no PSS availability.There will also be no designated vehicle for the PORT,and instead the PORT will be utilizing a shared EMS administrative vehicle with no guarantee of its availability. This budget option includes: • 12 hour CP coverage,7 days per week • No PSS coverage • No designated vehicle • All applicable supplies and technology for effective provision of services YEAR CATEGORY ITEM NARRATIVE AMMOUNT SALARY/WAGE (2)FTE Community Funds(2)FTE Community Paramedic positions with fringe benefits.Note:3.75%increase added to each subsequent year in / Paramedics alignment with departmental step pay increase. $160,000.00 Portable 800mhz Motorola Radio($5000)allows for safe communication between community paramedic,responding EMS units,and Radio,Monitor,Laptop, the 911 Center when responding.LifePak($36,250)and Meret bag for ALS response($1000),allowingfor community paramedics to EQUIPMENT and IPAD,Merit Pack, provide ALS intervention in event of patient emergency,laptop computer($2261)allows for data entry and real time referal to OTP $45,161.00 as well as patient documentation.iPad($650)will provide the ability for virtual MAT visits through UNC ASAP or other OTP. Phone Service Provides adequate suboxone dosing for 40 unique patients annually throughout grant cycle(assuming 1 dose of suboxone=$4.75). SUPPLIES& Suboxone,Naloxone Includes supplies to carry suboxone,community naloxone kits) MATERIALS $9,000.00 NOTE:25%increase in supplies added to each subsequent year of service SOFTWARE Apricot User (3)years of(2)users access to Apricot case management software $4,680.00 YEAR 2 YEAR I TOTAL: 4.R, SALARY WAGE (2)FTE Community Continuation with 3.75%increase SALARY/ Paramedic $166,000.00 SUPPLIES& MATERIALS Suboxone,Naloxone Continuation with 25%increase $11,250.00 YEAR 3 YEAR 2 • M ••• (2)FTE Community SALARY/WAGE Paramedic Continuation with 3.75%increase $172,225.00 SUPPLIES& Suboxone,Naloxone Continuation with 25%increase $14,062.50 MATERIALS TOTALI $582,378.50 16 36 Attachment C NC-DHHS. (2023) Post Overdose Response Teams Coverage Map. Retrieved from https://www.ncdhhs.gov/about/department-initiatives/overdose-epi demi c/first-responders County does not have any active PORTS - County has at least one active PORT 17 37 Attachment D Orange County Emergency Medical Services extends a special thank you to the following agencies and organizations that have indicated their full support and partnership through letters of support: • Orange County Health Department • Orange County Criminal Justice Resource Department • Hillsborough Recovery Solutions • Orange County Department on Aging • Orange Rural Fire Department • Chapel Hill Police Department • Carrboro Police Department • Freedom House Recovery Center • UNC Horizons • Hillsborough Police Department • Orange County Partnership to End Homelessness • UNC School of Medicine • UNC Addiction Medicine Program • Orange County Housing Department 18 Standards Policy: Medical Policy Section Opiate Overdose Policy: Attachment E Patients who have experienced an isolated IV opiate overdose should be offered a variety of options to more appropriately manage their addiction. Purpose: The purpose of this policy is to: Ensure that the patient is offered various options for treatment of substance abuse. Provide harm reduction measures. Procedure: 1. All patients must be over 18 years of age and must not have been in cardiac arrest during the incident. 2. The patient must regain a normal mental status and respiratory effort after the administration of Naloxone. 3. Transport to the Emergency Department should be offered to all patients. 4. For patients who decline transport to the Emergency Department, alternative destinations should be offered when possible. These options could include assistance with inpatient treatment centers such as Freedom House, outpatient facilities, mobile crisis solutions, addiction specialists, other local treatment options. 5. In order to decline transport, the patient must meet the following criteria: a) Be 18 years or older b) Maintain a GCS of 15 c) Fully alert and oriented d) Be able to understand the risk of refusing transport, as described in Universal Protocol 1 (UP 1) 6. If the patient declines transport to the Emergency Department, an additional dose of 2mg Naloxone should be administered IM by EMS. A Naloxone kit should be left with the patient, family, and/ or friends on the scene. EMS will provide education on how to use these kits. 7. In addition to the medication, the following items should be utilized when possible: a) Offer to dispose of any dirty needles b) Provide clean needles/syringes when possible c) Refer to a community peer support team if available d) Leave literature on resources for substance abuse treatment e) Notification of policy utilization should be made to the EMS Operations Manager via email after any naloxone kits are distributed. MAT ttachment F History Signs and Symptoms Differential • Opiate use disorder • Nausea/vomiting/diarrhea 0 Viral of Bacterial Infection • Recent use of opiate (IV or 0 Chills 0 Opiate Withdrawal oral) 0 Restlessness • Alcohol Withdrawal • Mydriasis • Body Aches • Runny Nose Patient presents with opioid withdrawal symptoms On scene with patient from initial EMS encounter or external referral As indicated in PEARLS Ondansetron 4mg YES Nausea and/or IV/lO/ODT/IM Vomiting? NO Exclusion Criteria YES Present? NO No Buprenorphine Exclusion Criteria indicated COWS scale>87 NO 10 Provide Harm Reduction • Methadone use within last 72 hours Resources,Education and • Unable to consent YES Contact Information • Unstable patients requiring • emergency interventions Obtain release of • Unwilling to provide name AND date patient information of birth and buprenorphine • Less than 18 years of age consent • Allergy to buprenorphine • Buprenorphine 16mg SL Reassess COWS scale after Do Not Administer 10 minutes NO 10 Additional Buprenorphine COWS scale>8? YES Buprenorphine 8mg SL REFER TO PEARLS SECTION FOR NEXT STEPS 20 Attachment F COWS Clinical Opiate Withdrawal Scale Rest!nQ Pulse Rate Measured after patient is GI Upset over last 112 hour sitting or lying for one minute 0 No GI symptoms 0 80 or less 1 Stomach cramps 1 81-100 2 Nausea or loose stool 2 101-120 3 Vomiting or diarrhea 4 Greater than 120 5 Multiple episodes of diarrhea or vomiting Sweating over last 112 hour not accounted for by Tremor observation of outstretched hands room temperature or patient activity 0 No tremor 0 No reports of chills or flushing 1 Tremor can be felt, but not observed 1 Subjective report of chills or flushing 2 Slight tremor observable 2 Flushed or observable moistness on face 4 Gross tremor or muscle twitching 3 Beads of Sweat on brow or face 4 Sweat streaming off face Restlessness observation during assessment Yawning observation during assessment 0 Able to sit still 0 No yawning • 1 Reports difficulty sitting still,but is able to do so 1 Yawning once or twice during assessment 3 Frequent shifting or extraneous movements of legs/arms 2 Yawning three or more times during assessment 5 linable to sit still for more than a few seconds 4 Yawning several times/minute Pupil Size Anxiety or Irritability 0 Pupils pinned or normal size for room light 0 None 1 Pupils possible larger than normal for room light 1 Patient reports increasing irritability or anxiousness 2 Pupils moderately dilated 2 Patient obviously irritable or anxious ' 5 Pupils so dilated that only the rim of iris is visible 4 Patient so irritable or anxious that assessment participation is difficult Bone or Joint Aches if patient was having pain Runny Nose or Tearing Not accounted for by cold previously, only the additional component attributed to symptoms or allergies opiate withdrawal is scored 0 Not present 0 Not present 1 Nasal stuffiness or unusually moist eyes 1 Mild diffuse comfort 2 Nose running or tearing 2 Patient reports severe diffuse aching of joints/muscles 4 Nose constantly running or tears streaming down cheeks 4 Patient rubbing joints or muscles,unable to sit still because of discomfort Gooseflesh Skin Total Score: 0 Skin is smooth The total score is the sum of all 11 items 3 Skin piloerection can be felt,or hairs standing up on arms 5 Prominent piloerection 21 IF k � Attachment F Pearls THIS PROTOCOL CAN ONLY BE UTILIZED BY COMMUNITY PARAMEDICS, EMS SUPERVISORS, EMS-1 OR EMS-2. EMS Supervisor: • If unable to respond to scene, contact shall be attempted with EMS-1 or EMS-2 if within standard business hours, M-F • Following initiation of MAT, contact Community Paramedic Coordinator immediately at 919-441-2659 to ensure treatment continuation. If unable to reach, provide email containing applicable infiormation of intervention and flagged as `high importance'. Alternative Patient Origin: LANTERN: In the event that a client is referred from Criminal Justice Resource Department's LANTERN Project for a gap in treatment access at jail release,that person may be continued on their prescribed dosage of buprenorphine for up to 7 days from the last available dose of the medication supplied at release.This pathway does not require a COWS scale to be performed. Upon receiving referral from LANTERN, the Community Paramedic Coordinator is responsible for confirming the following prior to initiation of MAT: • Patient's prescribed Buprenorphine dosage at release from Detention Center • Patient is active client of LANTERN and is being connected to ongoing treatment by LANTERN staff Buprenorphine can not be administered without both of the previous criteria in place. 2 42 Grow Your World Opioid Settlement Fund Proposal Option A Mitigation Strategy: 1. Collaborative Strategic Planning, Activities A (Engage Diverse Stakeholders), F (Identify and Explore Root Causes), & L (Identify Organizations) In collaboration with community partners throughout Orange County, Grow Your World proposes to address Option A Mitigation Strategy#1. Collaborative Strategic Planning to address The Urgent Need to Focus on Orange County Youth. Grow Your World proposes to use these funds in three complementary ways: 1) serve 60 youth through an arts-based mentorship and diversion program (INKounter) for youth who are justice-involved, justice-impacted or at risk of disconnection; 2) provide 180 slots to Orange County middle school youth to participate in community-based after school enrichment programming (Grow Your World After School); and 3) provide materials and training to 300 youth-serving community members to equip them to better support youth facing the opioid crisis. Each program is described in greater detail below. 1. INKounter: Arts-based + mentorship diversion programming INKounter is our arts-based mentorship program, which serves as an alternative to court involvement for referred youth in Orange County. Working closely with school counselors, court counselors, and judges, we provide a creative outlet and positive mentorship experiences for young individuals. Through various artistic mediums, we encourage self-expression, personal development, and the exploration of individual talents. Funds from the Opioid Settlement Funding will support sixty (60) youth to participate in INKounter, receiving an average of 25 one-on-one mentorship hours with an artist-mentor, tailored resources and support developing a network of support. Youth will also have the opportunity to join Grow Your World, After School as part of their support plan. 2. Grow Your World After School: Community-based after school enrichment programs Grow Your World After School provides a safe and inclusive environment for youth to learn, grow, and have fun. We provide mental, emotional, and physical enrichment through small group ratios (1 staff: 4 youth), facilitated workshops, hands-on experiences, tutoring support, and arts enrichment. Grow Your World After School will be based at The ArtsCenter (Carrboro) and Eno Arts Mill (Hillsborough) to ensure we are reaching youth across Orange County. 43 Funds from the Opioid Settlement Funding will support 180 youth slots in prosocial after school programming. Each young person will receive 120 small group programming hours aimed at lessening Risk Factors, reducing opportunity deficits, and remediating learning loss. 3. Community Training: Stipends and materials to train and equip the youth-serving community Education is one of the ways studies state we can combat the crisis. One study published in the National Library of Medicine noted, "Experts suggest that prevention efforts should aim to increase knowledge of the risks associated with opioid misuse and decrease stigma against those suffering from opioid misuse. (Source) Decreasing stigma about opioid dependence among the youth-serving community can help support youth suffering from the impacts of the opioid crisis. since the Good Samaritan Law has passed, we believe equipping people with training on naloxone use and other opioid overdose prevention is vital to protect youth. Funds from the Opioid Settlement Funding will support stipends for at least 300 youth-serving community members to receive training and offset costs associated with participation. 44 Grow Your World Opioid Settlement Funds Proposed Budget Year 1(Jan-Dec 2024)and Year 2(Jan-Dec 2025) T � Line Item:Description Program Budgets INKounter Staffing Explanation Year 1 Budget Year 2 Budget Provides stipends for 30 mentors at$500 per Artist-Mentor Stipend:Provides a monetary stipend so each participant receives mentorship INKounter Project.Students receive an average of from a local artist 30 mentorship hours during their project. $15,000.00 $15,000.00 Program Coordinators:Provide funding to INKounter staff to track INKounter project Positions are filled by UNC Work Study Students, Progression,research additional community supports for families,and provide support to who receive$15/hour.Students typically work 5-10 mentors and program supervisor to ensure program is running effectively. hours per week. $9,000.00 $9,000.00 Positions are filled by UNC Work Study Students, Court and School Liasion:Staff provision of court and in-school support for justice-involved who receive$15/hour.Students typically work 5-10 youth. hours per week. $8,700.00 $8,700.00 Program Supemislon:Provide program oversight,management,training and supervision. Coordiate programming and design,update and maintain curriculum to meet market needs and Position is filled by Solana Shepperson, ensure materials are accessible to the target audience.This position would also provide Co-Founder and Co-Director of Grow Your World outreach in OCS for in-school club,targetted community spaces such as Gateway Community and INKounter creator.Pays$30/hour for 10 hours and large-group speaking opportunities a week. $15,600.00 $15,600.00 Supplies Materials/Family Stipend:Provides a material stipend for each project so the material needed does not come out of mentors materials. Provides$200 per family. $6,000.00 $6,000.00 Workbooks:High quality,tailored materials for each participant that walks them through learnings and tracks growth over time.Measures are used for program development and enhancement. Provides 30 workbooks at$25 per workbook. $750.00 $750.00 Food:We provide a food budget to allow mentors and students to share meals as a way of facilitating the mentorship relationship. Provides$100 stipend per INKounter project. $3,000.00 $3,000.00 Transportation:Transportation is key to ensuring access to mentorship opportunities for people who are justice-involved,justice-impacted and/or at-risk of disconnection.We provide stipends for transportation to ensure this is not a barrier to access. Provides$100 stipend per INKounter project. $3,000.00 $3,000.00 Operating and Indirect Costs Provides up to 60 background checks to ensure all Background Checks:Provide background checks for mentors adults participating in mentoring are fully vetted. $1,050.00 $1,050.00 Provides.075%of payroll costs for employer taxes, Payroll Fees and Taxes:Pays for employer portion of payroll fazes along with monthly payroll and includes$6 per employee for the length of their fees associated with our payroll service. employment for payroll fees. $3,800.63 $3,800.63 Total Cost $65,900.63 $65,900.63 Total Minimum People Directly Impacted 65 65 Total Minimum Youth Directly Impacted 30 30 Total Cost Per Youth $2,196.69 $2,196.69 Grow Your World,After School @ Eno Arts Mill(Hillsborough.NC) Staffing Explanation Year 1 Budget Year 2 Budget 2 facilitators per week for 30 weeks of programming.Each day of programming provides Facilitators:Provide workshops to students to create exposure opportunities to a variety of $301hour for implementation and a$40 stipend for professional and artistic outlets. pre-planning $4,200.00 $4,200.00 1 lead coordinator @$30/hour for 15 hours per Program Coordinator:Oversees daily functioning of the program and all aspects of week to organize schedule,communicate with implementation.Manages communications with family,facilitators and staff. families,supervise program,and Gain staff. $13,500.00 $13,500.00 6 counselors @$15/hour everyday of programming Counselors:Supports daily functioning of the program,provdiing mentorship and support to to ensure 1:4 youth ratio for 30 weeks of youth. programming $21,600.00 $21,600.00 $150 food stipend per week for healthy afterschool Food snacks $4,500.00 $4,500.00 $50 materials stipend per daily workshop;2 Materials workshops/week for 30 weeks $3,000.00 $3,000.00 Transportation:Transportation is key to ensuring access to mentomhip opportunities for people who are justice-involved,justice-impacted and/or at-risk of disconnection.We provide stipends for transportation to ensure this is not a barrier to access. $3,000.00 $3,000.00 Operating and Indirect Costs Background Checks:Provide background checks for mentors $1,050.00 $1,050.00 Payroll Fees and Taxes:Pays for employer portion of payroll taxes along with monthly payroll fees associated with our payroll service. $3,800.63 $3,800.63 Rental Space:Provides access to Arts Space in the Eno Arts Mills twice weekly. $35/hour for 6 hours per week for 30 weeks $6,300.00 $6,300.00 Total Cost $60,950.63 $60,950.63 Total Minimum People Directly Impacted 121 121 Total Minimum Youth Directly Impacted 48 48 Cost Per Youth $1,269.80 $1,269.80 Grow Your World,After School @ The ArtsCenter(Carrboro.NCI Staffing Explanation Year 1 Budget Year 2 Budget 2 facilitators per week for 30 weeks of programming.Each day of programming provides Facilitators:Provide workshops to students to create exposure opportunities to a variety of $30/hour for implementation and a$40 stipend for professional and artistic outlets. pre-planning $4,200.00 $4,200.00 1 lead coordinator @$30/hour for 15 hours per Program Coordinator:Oversees daily functioning of the program and all aspects of week to organize schedule,communicate with implementation.Manages communications with family,facilitators and staff. families,supervise program,and train staff. $13,500.00 $13,500.00 3 counselors @$15/hour everyday of programming Counselors:Supports daily functioning of the program,provdiing mentorship and support to to ensure 1:4 youth ratio for 30 weeks of youth. programming $16,200.00 $21,600.00 $150 food stipend per week for healthy afterschool Food snacks $4,500.00 $4,500.00 $50 materials stipend per daily workshop;2 Materials workshops/week for 30 weeks $3,000.00 $3,000.00 Transportation:Transportation is key to ensuring access to mentorship opportunities for people who are justice-involved,justice-impacted and/or at-risk of disconnection.We provide stipends for transportation to ensure this is not a barrier to access. $3,000.00 $3,000.00 45 Operating and Indirect Costs Background Checks:Provide background checks for mentors $1,050.00 $1,050.00 Payroll Fees and Taxes:Pays for employer portion of payroll taxes along with monthly payroll fees associated with our payroll service. $3,800.63 $3,800.63. Total Cost $49,250.63 $54,650.63 Total Minimum People Directly Impacted 106 121 Total Minimum Youth Directly Impacted 36 48 Cost Per Youth $1,368.07 $1,138.55 Community Trainings; Naloxone Training(Offered in person and online),Naloxone and Hands-On CPR(Offered in person),and Mental Health First Aid(Offered in person and online) Description Explanation Year 1 Budget Year 2 Budget Training Stipends:Ensures individuals who would otherwise not be able to attend due to Offers up to$75 stipend to at least 100 people. missed income and/or inability to access transportation and/or childcare. $7,500.00 $7,500.00 Naloxone Distribution Kits:Ensures youth providers have access to Naloxone after training. 50 Naloxone kits at$45/kit+tax $2,418.75 $2,418.75 Distribution Budget:Ensures distribution of Naloxone kitds to youth providers Covers transportation for naloxone drop-offs. $250 $250 Provides printing,social media costs,and graphic Marketing:Ensures our trainings are marketed in the communities most impacted. design costs. $500 $500 Total Community Traininos Cost $10,668.75 $10,668.75 Total Minimum People Directly Impacted 150 150 Totals Across For Each Year Total Cost Across All Projects $186.770.64 $192,170.6 Total Minimum People Directly Impacted 442 457 Total Minimum Youth Directly Impacted 114 126 Totals Across Both Years Total Cost $378,941.28 Total Minimum People Directly Impacted 899 Total Minimum Youth Directly Impacted 240 46 Orange County Opioid Settlement Fund Proposal being submitted by: The Transition Support and Recovery Collaborative A Pilot, Peer Supporting Initiative for those Engaged in Opioid Recovery, Harm Reduction, Comorbidity Support, and Successful Reentry from Incarceration Collaborative Led by Wounded Healers of NC and including partners Offer House Reentry House Plus Success While in Transition September 5, 2023 47 Orange County Opioid Settlement Fund proposal being submitted by: The Transition Support and Recovery Collaborative A Pilot, Peer Supporting Initiative for those Engaged in Opioid Recovery, Harm Reduction, Comorbidity Support, and Successful Reentry from Incarceration The Transition Recovery and Support Collaborative (TSRC) is a five-partner mutual effort to provide direct Recovery Support Services' and Reentry PrograMS2 to those with opioid use disorders, related substance use disorders and other comorbidities.TSRC's role is to collaboratively augment and extend clinical and other traditional evidence-based addiction treatment services for these disorders and comorbidities.The Collaborative is led by Wounded Healers of North Carolina (a 501(c)(3)).TSRC also includes the following organizations described further below: Offer House; Success While in Transition (SWIT); Reentry House Plus; and STSG Reentry House. Wounded Healers Board Chair and Grant contact: Dorel Clayton; woundedhealersnc@gmail.com; (919) 282-7901; http://woundedhealersnc.org/ Service Area,Target Audience and Demographics: Orange County residents to be served: 200.This Includes those who may be incarcerated or reentering the community following incarceration. Most TSRC program leaders and staff will be those with lived experience of incarceration. All TSRC direct service program providers will have lived experience of incarceration and the majority will also have lived experience with the targeted disorders.All direct service providers will become NC Certified Peer Support Specialists. Reflecting those to be served, most participants and providers will be Black/African American and male, although we anticipate a substantial percentage will European American and female. Funding Request: $165,170 for Year 1 and $165,630 for year 2. (Note: A mirror request is being made to Durham County's Opioid Settlement Funds.During this grant program there will be some fluidity in programming and related staffing carried out in Durham and Orange Counties. For example, someone released from Orange Correctional Center and entering transitional housing in Orange County may eventually move to Durham during their reentry. Further,the Director of Collaborative Operations may be funded to oversee work in both counties.The TSRC will carefully allocate funds so that: 1) programming in Durham County is charged to funding sources from/targeting Durham County, 2) programming in Orange County is charged only to funding sources from/targeting Orange County; 3) we will avoid any duplication of effort; and 4)there will be no double- charging or duplication in funding. We will keep discrete financial accounts for our work in each county, and both will be open for inspection.) 1 Memorandum Of Agreement,Exhibit A3,page 1. 2 Memorandum Of Agreement,Exhibit Al2,page 2. 1 48 Overarching Goal and Its Achievement.TSRC seeks to make its direct service, reentry support programming broad and robust enough to make a difference in the success in the transition of those persons recently released from incarceration, especially as it relates opioid-related substance use disorders and comorbidities. To that end,TSRC employs strength-based approaches that promote reduction of harm and desistance (that is, adoption of a law-abiding identity).TSRC's program theory is that multiple intensive peer support interventions, when structured, systematic, networked, and provided with sufficient length and intensity, can improve adoption of recovery and harm reduction living, as well as a successful transition to the community, and reduce recidivism and post-release morbidity and mortality.TSRC will collaboratively supplement and support existing SUD and related services for persons with opioid disorders, related substance use disorders, and comorbidity. Success in these areas is intimately tied to other aspects of successful transition and reentry: housing, financial stability, community embeddedness and engagement, and psycho-social-cultural transition and support. While not providing this full array of services,TSRC will be a force for broad integrative collaboration among all Orange County service providers. TSRC will leverage its own programming with other interventions such as professional SUD treatment to reinforce and increase the longevity and effectiveness of all reentry support systems. TSRC's aim is neither to duplicate nor compete with others' services, but to enable returnees from incarceration to experience the constellation of support as consistent, holistic, cohesive, community-based and deeply infused with the wisdom of lived experience. In the long term,TSRC seeks to create a sustainable collaborative capable of expanding over time in both programming scope and geographical footprint. Target Population.The Transition Support and Recovery Collaborative's (TSRC) target populations comprised of persons who have experience with opioid use disorders and related substance use disorders and comorbidities who are preparing to return, are transitioning, or who have recently returned from incarceration to the Orange County community.This includes those in, or returning from, incarceration from Orange County Detention Center, Orange Correctional Center, and the North Carolina Correctional Institution for Women. Most participants will be Black/African American and male though we anticipate substantial percentages will European American and female. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "approximately 17 percent of people incarcerated in state prisons and 19 percent of people incarcerated in jails report regular opioid use." Further, according to the Federal Bureau of Prisons, nearly half of those in prison (44.5%) are there related to "drug offenses." The National Institute on Drug Abuse states, "85%of the prison population has an active substance use disorder or were incarcerated for a crime involving drugs or drug use." (2020) 2 49 North Carolinas Experience "A recent study in North Carolina found that, in the first two weeks after being released from prison,former inmates were 40 times more likely to die of an opioid overdose than someone in the general population. When restricted to heroin overdoses only, formerly incarcerated individuals' likelihood of overdose death increased to 74 times the norm within the first two weeks after release. Even an entire year after release,overdose death rates remained 10-18 times higher among formerly incarcerated individuals as compared to the general N.C. population." According to Shabbar Ranapurwala, PhD, assistant professor in the Gillings School's Department of Epidemiology, "Preventing overdose deaths and treating substance use disorders in formerly incarcerated people may prevent the spread of the epidemic in the general population." 'In North Carolina, between 22,000 and 27,000 individuals are released from prison each year. These individuals are particularly vulnerable to the opioid epidemic for three key reasons. First, two-thirds of them already have a substance use disorder(which is classified as a mental health condition....). In fact,many former inmates initially were imprisoned for offenses that stemmed from substance use. Second,formerly incarcerated individuals undergo forced withdrawal during incarceration,and therefore have a very low tolerance when released from prison. Finally, there are few support systems in place for most inmates upon release —this includes a lack of access to health care. "A host of other problems like stigmatization, loss of dignity, loss of family for some, and discrimination in housing and employment only compound existing substance use problems," Ranapurwala explained. "This leads to premature deaths." "As a society, we do not do enough to rehabilitate formerly incarcerated individuals back into our world," he added. "What's more, both medically and scientifically, we know that substance use disorder is a health condition — an illness."' (Former inmates at high risk for opioid overdose following prison release,July 19,2018.Gillings School of Global Public Health communications team. These findings,published online July 19 by the American Journal of Public Health). Italics added. While the exact proportion of residents of North Carolina correctional facilities who have a history of opioid abuse is unknown, a very high percentage of the nation's prison and jail population suffers from drug addiction. The Bureau of Justice Statistics (BJS) estimated in 2017 that two-thirds of offenders held in state prisons and local jails had substance abuse problems. Further, a 2016 study estimated that between 24 and 36 percent of all opioid-dependent adults cycle in and out of jails each year, demonstrating the need to break this vicious cycle of dependence, criminal behavior, and incarceration.3 Reentry Partners, Collaborations and Services:This Collaborative involves five partner organizations, four of which are relevant to this Orange County proposal. Each partner will assign a Collaborative Leader/Liaison for its organization.Together,these liaisons will constitute the TSRC leadership team. 3 https://www.prisonlegalnews.org/news/2019/sep/5/opioid-epidemic-impacts-prisons-and-jails/ 3 50 Each partner will maintain its independent status and communicate and collaborate with the Director of Collaborative Operations (DCO) for matters pertaining to the collaborative. All partners will assist in recruiting people to serve both as TSRC mentors,trainers, and participants.The initial partners are: 1.Wounded Healers of North Carolina, the lead organization,will assign overall administrative, cross-collaborative, and programming integration responsibilities to its Director of Collaborative Operations. WHNC will maintain all centralized records, monitor referrals, and coordinate mentor-matching and programming activities with partners. It will also be responsible for grant accounting and reporting. 2. Offer House will develop and seek NC state certification for a new, innovative reentry-specific Peer Support Training and Certification program. Currently,there is no such credentialling in NC. With permission, Offer House will use the state and/or nationally approved curriculum, materials and methods developed by Dr. Sandra Smith at Via Hope in Austin,TX as the basis for the NC training and certification program. It will also train peer support mentors with lived experience of incarceration and substance use disorders to assist and support others with reentry needs and guidance in social and cultural acclimation, overcoming barriers to reentry, and mental health needs.These needs may be related to depression,post incarceration disorder(PID), a form of PTSD4 3.Success While In Transition (SWIT) will conduct its reentry training course based on 21 principles its leaders identified through lived experience in successful reentry.The SWIT training manual and methods are designed for use throughout TSRC initiatives, and to be exported to other reentry initiatives.Though we have explored reentry programs nationally,TSRC is unaware of any similar programs focusing on reentry skill development that include behavioral, social, cultural, and community integration components.These will complement the treatments and services being provided by local SUD treatment and support practitioners. 4. Reentry House Plus will provide transitional living and support for those recently returned, make cross organizational referrals, provide venues for TSRC programming for those within and outside its house, and promote participation in all TSRC events. S.STSG Reentry House (not to be funded under this grant) will provide transitional living and support for those recently returned, make cross organizational referrals, provide venues for TSRC programming for those within and outside its house, and promote participation in all TSRC events.These will occur in Durham. Other collaborations:The Collaborative will build on and strengthen close networking relationships with organizations separately serving the target population.These will include: • Medically Assisted Treatment (MAT) programs; • In-and out-patient treatment programs for opioid and other substance use disorders (SUD); • Local health departments, including their prevention and harm reduction initiatives; • Narcotics Anonymous and similar programs; • County-based Criminal Justice Resource Programs,jails, prisons, and diversion programs; and 4 Facer-Irwin, E., Blackwood, N. J., Bird,A., Dickson, H., McGlade, D.,Alves-Costa, F., & MacManus, D. (2019). PTSD in prison settings:A systematic review and meta-analysis of comorbid mental disorders and problematic behaviors. PLoS one, 14(9), e0222407. 4 51 • Other programming including that targeting mental and physical health comorbidities. Organizational and Individual Allies �f Transition Support and CI11©r P�rd�s Recovery Collaborative A r0 V1h d,� erg 4e, 4 �Jf,3 Wounded Healers Lead Organization One-on-One Mentoring Success While Offer Reentry House In Transition House Plus Reentry Training Peer Support Housing and Specialist Training Program Venue TSRC will create and maintain referral systems and cooperative relationships with others such as staffs/programmers in the above jails and prisons,treatment programs, programs serving incarcerated or recently reentering persons (e.g., with Melinda Thompson-King the Regional Director of Treatment Accountability for Safer Communities (TASC) and Regional Coordinating Entities in Orange County;the Lantern Project (Orange County),the Formerly Incarcerated Transition Program (FIT), Freedom House (in Orange), Health Departments, volunteers, peers, etc.). While the preferred onset of support is six months prior to release,TSRC services will occur in all pre-and post-release phases of reentry where it has access. Programming.TSRC will integrate the following programming to maximize its effectiveness and to assist in creating a more holistic reentry support community.This programming will include: 1.Creating a Cadre of Certified Peer Support Specialists.TSRC partner, Offer House, will train those with lived experience of incarceration using NC state-certified peer support specialist trainers and a NC state- approved curriculum.Those completing this program will also be trained in Wellness Recovery Action 5 52 Planning(WRAP). For those who successfully complete these two programs, Offer House will assist them in obtaining the status of NC Certified Peer Support Specialist(CPSSs)'. Offer House will also assist CPSSs in their annual recertification. CPSSs will be the foundation of TSRC programming. 2. Creating Additional Peer Support Trainers. Success While In Transition (SWIT)will prepare persons with lived experience of incarceration as additional SWIT trainers.There will be cross-training for all TSRC trainers to become NC Certified Peer Support Specialist (CPSSs) and thus able to lead groups of participants and serve as one-on-one mentors. 3. Reentry/Transition Workshops. TSRC partner, SWIT, will engage TSRC participants in 22 structured workshops covering 21 key principles/topics. The locally developed course includes subject matter that is deemed key by those with long-term success in reentry and transition.This training, using a continuous improvement process, is being developed by a SWIT Curriculum Team with lived experience of substance use disorders, incarceration, and successful reentry, and assisted by a Doctor of Public Health.The training is designed to increase participants' individual and collective capacities for success in treatment, harm reduction, addressing comorbidities and reentry into the community. (See Sample Training Module, attached) 4. One-on-One Reentry/Recovery/Harm Reduction/Transition Mentoring. Wounded Healers of NC (WHNC) will engage TSRC participants in One-on-One Peer Mentoring using a Wellness Recovery Action Planning (WRAP) model that will focus on successful transition and reentry, and recovery and/or harm reduction. WRAP is a personal mental health recovery plan designed to: a) decrease and prevent intrusive or troubling feelings and behaviors; b) increase personal empowerment; c) improve quality of life; and d) assist mentees in achieving their own life goals and dreams. Mentors will provide specific support to those in treatment programs and engaged in harm reduction, will address comorbidities, and will also support those who are grappling with reentry into the community. Mentors will also attend SWIT reentry trainings with TSRC participants and work with participants to integrate WRAP goals, learnings from SWIT trainings, life experiences, and community engagement. 5. Reentry Housing. Reentry House Plus (in Hillsborough) will each prioritize enrolling its residents into TSRC programming as well as accepting TSRC participants as residents.The house will strongly encourage residents to participate in all TSRC programming and to create a culture consistent with belonging to a Reentry Community. More, broadly,the houses will serve as a TSRC programming venue for non- residents of the house as well. Goal and Objectives. Goal:To provide the target population with support sufficient to enhance their capacities for successful harm reduction/recovery, reentry, and desistance (that is, adoption of a law-abiding identity), and therefore, harm reduction, reduce return-to-use, rearrest, and recidivism. In doing so,this initiative will work with the full constellation of community organizations and government entities to address comorbidities, socio-cultural transformation from incarceration norms to those of a healthy community, and to satisfy participants' basic needs for healthy living(e.g.,jobs, training and basic income, affordable and accessible housing, healthy community reintegration, etc.). S Memorandum Of Agreement,Exhibit B.B2,p 4. Provide the full continuum of care of treatment and recovery services for OUD and any cooccurring SUD/MH conditions,including supportive housing,peer support services and counseling,community navigators,case management,and connections to community-based services. 6 53 Objectives. By the end of the 2024 fiscal year,TSRC will have: 1. Mentoring. By the end of the XX fiscal year,we will have: A. Populated Orange and Durham counties with 24 state Certified Peer Support Specialists (12/year) for whom TSRC will have paid training and certification fees and enlisted them into a reentry/SUD community of support. B. Advanced the peer support competencies of 24 TSRC CPSSs (12/year)with on-the-job training including co-facilitating peer support groups, co-mentoring, and providing opportunities to participate in community engagement. We will team new certified CPSSs with experienced mentors for six months of mentoring-of-mentors. C. Engaged 30 participants in one-on-one peer support mentoring (12 participants/yr1 and 18 for yr2 for 26 weeks/participant; 3 -6 hours/week (this will include two mentoring sessions per week, and when possible and appropriate, accompany participants in transition training sessions. D. TSRC staff will have developed and piloted a Reentry Peer Support Specialist (ReCPSS) curriculum and submitted it to the NC governing body at the UNC School of Social Work for accreditation. 2. Reentry Acclimation Course. By the end of the 2024 fiscal year,TSRC will have: A. Completed the upgrade of and piloted all 22training modules. B. Conducted "train-the-trainer" sessions led by two Master Peer Support Workshop Leaders to prepare candidates (3/year)to lead the Reentry Acclimation Course.These Leaders will have also supervised these candidates in "student teaching"to fully prepare them, as pairs,to independently lead the Course. C. Engaged 30 TSRC participants (e.g.,three classes of 10) in 22 structured workshops (two hours each) covering key community acclimation principles/topics.A Curriculum Team, composed of both those with lived experience of successful reentry and Doctor of Public Health, developed the course materials and methods and will use proven methods to continuously improve. Collaborative Strengths. Successful recovery from prison is a heroic act. Prison is an ongoing ritual of dehumanization that takes a toll day after day, month after month, and year after year. For many, it is decade after decade.Accordingly, a major function of TSRC is to support reentrants at chipping away at the psycho-social, cultural, and economic aspects of prison life to reinvigorate returnees' sense of identity and value as self-regulating, community-engaged, empowered, and decision-making individuals. Essential to these processes of"re-humanization" and reintegration are the knowledge, skills, and capacities of those who have already successfully made the re-entry journey and are poised to "give back"They are our collaborative's central source of power. Prolonged and intense direct service in these areas is designed to supplement and leverage the effects of practitioner-provided SLID services. Each of the five TSRC collaborating organizations infuses their work with the leadership of those with the lived experiences of SUDS, incarceration, and reentry. In essence, each of these successful returnees that serve as TSRC trainers and/or mentors and/or reentry house staff exemplify the inherent strength possessed by reentrants who populate our programs.The para-professional status attained by leaders 7 54 and staff through state peer support specialist certification is a recognition of TSRC's strength-based approach. "We've been there, done that, been on the yard," says a formerly incarcerated person and Wounded Healers board member and mentor. "Who better to mentor someone that's coming home than somebody who actually walked that same walk?" Recently(2021), Dr. Esther Matthews published findings of a study that found, "a history of incarceration is perceived as the most important characteristic for peer mentors." Lived experience with incarceration gave peer supporters both credibility and the ability to serve as role models. Further she stated, "This credibility was almost exclusively linked to a lived experience of incarceration.."6 Integrating Lived Experience into Decision Making. Collectively,the organizations in this collaborative understand the profound importance of placing those with lived experience of incarceration and SUDS at the center of practice. Thus, those with lived experience serve as members and officers of our boards of directors, are staff leadership and programmers, and contribute as volunteers. Lived experience manifests itself in the development of training curricula and programming, in training of participants, in outreach and speaking roles, and in the roles as mentors, and reentry house programmers. In each case, these are meaningful, powerful, and substantive roles. As an example, Wounded Healers has incorporated lived experience requirements into its bylaws and staffing. Three of the collaborating organizations were founded by those with lived experience of incarceration and reentry, and two of those organizations are led and operated solely by those with lived experience. TSRC will continue to place lived experience at the center of all that we do including governing, staffing, developing programming,training, mentoring, and community education and outreach. TSRC Community Partners. Each of the five partners have years of experience working together.This Collaborative will be formalized using memorandums of understanding among the lead organization, Wounded Healers, and of each partner organization.These memoranda will emphasize the formal partnership among all partners, each partner's roles and responsibilities, and the sharing of decision- making and leadership.These agreements will build on pre-existing formal and informal agreements among partners. 6 Memorandum Of Agreement,Exhibit B.B13,p 5.Create or support culturally appropriate services and programs. 8 55 Proposal Budget Budget—Page 1 56 Orange County Opioid Settlement Request Year 1 Year Wounded Healers of North Carolina (WHNC) Salary %FTE Director of Consortium Operations $ 51,000 50% $25,500 $25,500 Key Shared Collaboration Staff(Day-to-day management of CPSS Mentors) $ 40,000 15% $6,000 $6,000 Mentoring(Paid CPSSs direct service mentoring) Per Hour Hours/ Cost/ Menteesl Mentee Mentee Year $22 155 $ 3,410 12 $40,920 $22 155 $ 3,410 18 $61,380 Totals WHNC $72,420 $92,880 Success While In Transition (SWIT) Salary %FTE Manager of SWIT Programs and Operations ° (includes TTT of 3 additional trainers) $ 51,000 2D/° $10,200 $10,200 Trainers/ Session Key Shared Collaboration Staff (Covers CPSSs Conducting SWIT Training-5 $ 40,000 15% 3 $18,000 $18,000 courses,110 Sessions) Totals SWIT $28,200 $28,200 Offer House Salary %FTE Manager of Offer House Programs and Operations duties,also including CPSS Mentor training,technical $ 51,000 55% $28,050 $28,050 assistance and continuing education(covers 12 CPSSANRAP trainees) Totals Offer House $28,050 $28,050 Reentry House Plus (RHP) Space rental(SWIT Trainings,Mentoring Sessions Sessions Rent per and Other TSRC Programming) Session 110 $ 150 $16,500 $16,500 Totals RHP $16,500 $16,500 Consortium Purchase rights to Reentry Peer Support Specialist Curriculum from Via Hope,Austin TX $20,000 $20,000 $0 (cost only for year 1) Grand Total $165,170 $165,630 Budget-Page 2 57 Attachments A - C Collaborative Partners Letters of Commitment Appendices— Page 1 58 Success While In Transition 2411 Faucette Ave Durham, NC 27704 To Whom This May Concern, Success While In Transition (SWIT) is writing this letter to express our unwavering support for Wounded Healers and their proposal that will include SWIT in the Transition Support and Recovery Collaborative dedicated to serving individuals battling opioid use disorder. Having had the privilege of working alongside Wounded Healers in the field of peer support addiction recovery, I have personally witnessed their profound dedication and empathy towards those who are grappling with the challenges of addiction. Wounded Healers' tireless efforts and passion to make a meaningful difference in the lives of people with opioid use disorder are truly commendable. Wounded Healers has consistently demonstrated a unique ability to connect with individuals in their journey towards recovery, providing them with the necessary support and resources to overcome the hurdles associated with substance use disorders.Their approach is not only compassionate but also highly effective in creating lasting positive changes in the lives of those they serve. We wholeheartedly believe that Wounded Healers are instrumental in addressing the opioid epidemic that continues to affect countless lives across our community.Their unwavering commitment to this critical cause is deserving of every support and resource available. As an organization providing grant funding, I urge you to consider The Transition Support and Recovery Collaborative's application for support.The Collaborative's work is aligned with the mission of our organization, and I have every confidence that we will use the funding provided efficiently and effectively to make a significant impact on the lives of those battling opioid use disorder. Please do not hesitate to reach out to me if you require any further information or would like to discuss Success While In Transition's qualifications and achievements in more detail. I wholeheartedly endorse their efforts to serve the community and believe that your support would be an invaluable contribution to this vital cause. Sincerely, Tommy Green CEO, Success While In Transition (919) 339-2410 Visit us at: www.successwhileintransition.org Appendices—Page 1 59 The Offerhouse Inc. 4902 Miller Dr. Durham, NC 27704 September 4, 2023 To whom it may concern, I am writing this letter to express my wholehearted support for Wounded Healers of N.C. and the initiative,Transition Support and Recovery Collaborative, aimed at addressing the opioid crisis in our community. It is with great admiration and enthusiasm that I endorse Wounded Healers' efforts to include Offer House in our collective effort to combat this devastating epidemic. The opioid crisis has had a profound and far-reaching impact on countless individuals and families in our region. It is an issue that demands immediate attention, concerted action, and unwavering commitment. I am pleased to see that our Transition Support and Recovery Collaborative is taking up the challenge and is actively working towards alleviating the suffering caused by opioid addiction. The Collaborative's and its partners' dedication to healing and recovery is evident in the compassionate approach we have adopted. By providing support, education, and resources to those affected by addiction, you are not only helping individuals on their journey to recovery but also contributing to the overall well-being of our community. I commend your tireless efforts in organizing workshops, awareness campaigns, and support groups that empower individuals to overcome the challenges posed by opioid dependency.The Collaborative's commitment to reducing stigma and promoting understanding around addiction is crucial in creating a more compassionate and supportive environment for those in need. Transition Support and Recovery Collaborative work aligns perfectly with the values of empathy, compassion, and community support that our society desperately needs in the face of the opioid crisis. This Collaborative is dedicated to making a positive impact on the lives of individuals struggling with addiction is inspiring, and I am confident that our efforts will continue to bring about positive change. Please do not hesitate to reach out if there is any way I can further support your important mission. Together,we can make a meaningful difference in the lives of those affected by the opioid crisis and work towards a healthier and more hopeful future for our community. Thank you for your unwavering commitment to this critical cause. Sincerely, Dorel Clayton, CEO, CHW/CPSSF The Offerhouse Inc. Appendices—Page 2 60 Reentry House Plus, Inc. PO Box 361 Hillsborough, NC 27278 Email: reentryhouseplus@yahoo.com Web page: reentryhouseplus.wildapricot.org "I was in prison and you visited me." Matt. 25:36 September 4, 2023 Reentry House Plus is a nonprofit organization devoted to assisting formerly incarcerated people reintegrate back into the community as healthy, productive citizens. We at Reentry House Plus believe in second chances and are committed to doing our part to ensure that people receive the support, skills, and encouragement they need to rebuild their lives. Reentry House Plus is excited to be included in the proposed Collaborative under the overall guidance of Wounded Healers of NC. As our mission suggests, we are both housing justice-involved men at our residential house in Hillsborough, NC as well as hosting A/A, N/A, Living Healthy-chronic conditions, and SWIT classes for men and women in greater Orange County. We believe that full involvement in the Consortium will allow us to reach out to many more men and women who have been touched by Opioid Addiction. Our classes, led by state certified Peer Support Specialists, can be instrumental in each person's journey back into society as a strong and productive citizen. We believe that the Consortium will make us stronger both due to the strength that comes from banding together for a common cause as well as due to increased emphasis on proved training programs with trained leaders. Finally, I will report that at our regularly scheduled Board meeting on August 21, 2023,the Board unanimously voted to be included in the Consortium Proposal lead by Wounded Healers that will be presented to the Orange County Opioid group. We look forward to a mutually beneficial program with all the included parties, and especially for the men and women which this program will touch. Faithfully, Douglas Peterson President, RHP Appendices—Page 3 61 Attachment D Attachment D Succes While In Transition Reentry Acclimation Course Sample Training Module Appendices— Page 4 62 Module 2. Win or Learn Purposes 1. To learn how we can transform ourselves from the hopelessness of prison life to a belief that we are beginning a new life where we will seize opportunities and hope. 2. To learn about tools that will help us in this change. Appendices— Page 5 63 Task 1 1. In the group as a whole, each person state what "Win or Learn" means to you? The leaders will write each one on an individual sheet of paper and put them on the wall. 2. What ideas do we share? Where are there interesting differences? Appendices— Page 6 64 2. What the principle, "Win or Learn" means to SWIT. Even when we make mistakes, we can learn lessons from them and apply the lessons to our mindset, thinking, decision-making, and actions that lie ahead. Appendices— Page 7 65 Task 2 1. Read and consider the Ten Principles of Winning or Learning on the next page. 2. After you have read all 10, each person should put a checkmark next to one, two or three Principles that are very important in your reentry. Next, one at a time, each person should say one of their picks and why it is important. Once everyone has presented their first pick, the group should discuss their choices. What is similar and what is different? 3. As time permits, repeat the process with a second choice, and then the third. Depending on the size of the class, this task can be done with the entire class, or in small groups. 4. As a whole group, think about any other principle of Win or Learn you might add. Appendices— Page 8 66 WIN OR LEARN — Principles 1. Some of What We Learned Can Help Us: As we endure and survive years of incarceration, we learn skills and ways of acting that can sometimes be helpful in the community. 2. Some of What We Learned Can Hold US Back: Some skills and ways of acting we learned inside are not acceptable or helpful in the community. 3. Which Learnings to Leave Behind and Which to Keep: It will take time, but we need to develop the skill to know what skills to keep and use and which to leave behind. ❑ 4. Our Traumas Can Burden Us: Many of us who have been incarcerated have experienced deeply disturbing incidents that cause us emotional or physical shocks. Past traumas can harm our thinking, emotions, or reactions to events. ❑ 5. Stubborn Pride Can Hold Us Back: Sometimes stubborn pride blocks us from admitting mistakes or learning from them. ❑ 6. Make Your Time Valuable: Make the time you did have value. Don't throw away or devalue the important things you learned inside. ❑ 7. Act Our Own Values and Beliefs: We must continually work at being our best selves — living by acting our core values and beliefs. F] 8. Shed Stigma: Others may hold our past against us and think we are defined by our worst mistakes. We are not. We can't afford to take on their stigma. We must overcome it. ❑ 9. Slow Down: We can't make up for the time we lost. We can't get that time back. The outside world will try to get us going faster than we are used to. We need to adapt from prison time to community time. ❑ 10. Change Mindsets: Incarceration can make us think "we lost." We can make it, "we learned" and "we won." Group 11. Other: Group 12. Other: Group 13. Other: Appendices— Page 9 67 Task 3: 1 Quit. What now? In this activity we pose a problem for you to consider. We will ask a few questions that will help us think about and discuss this together. Billie I just want you to know, I'm gonna quit my job. Tim: What's goin on? Why you gonna do that? Billie: My boss is getting on my last nerve. I'm not making enough money. I'm worth more. Tim: You got another job? You got money saved? What you gonna do for rent? Let's begin with talking about what we see in this situation. For Instructors Only: Use the acronym, SHOWeD, the generic forms of discussion questions (Shaffer, 1983). DESCRIPTION What do you See in the code? What strikes you about this situation? How would you describe what you see? PROBLEM DEFINITION What's really Happening? What do you think each of the people in the code is thinking? Feeling? What are your early thoughts on the problem? PERSONALIZE How does this relate to Our lives? Have any of you experienced these situations in your lives? ANALYZE SOCIAL CONTEXT Why does this problem exist? How come we face these problems in our communities or worksites? What makes this a shared problem? DEVELOP STRATEGIES FOR ACTION How would we Evaluate action alternatives? What can we Do about this problem? Nina Wallerstein and Elsa Auerbach Problem-Posing at Work: Popular Educator's Guide(2004) Appendices— Page 10 68 Task 4: Trusted Advise 1. For this task, consider who in your life now, or who you would like to involve in your reentry. Who could help you stick to the Principles of Win or Learn. Also, think of your Own Core Values and Beliefs and who could help to live by those. Using the space below, make a list of people you would trust to advise as you face the challenges of reentry. In making this list, you might consider a parent, a brother or sister, a spouse or partner, a son or daughter, someone you grew close to during your incarceration, a mentor (peer support specialist), a religious or spiritual leader, a social worker, or other persons who you trust could help and support you. You can update this list as needed. Trusted Advisors You Can Turn To • • • • • • • Appendices— Page 11 69 Task 4: Role Play — Win or Learn Participants will work as pairs. One person will take the role of: A) a person reentering the community, or B) someone who they have turned to for advice. Each person will have the opportunity to play a role. Card 1. Card 2. Role:Bobby: Laid off and looking for work. Role: Dilemma of reentering person Role: Tony: Manager interviewing Bobby. Role: Whitney: Bobby wife who is pressuring him to look for work. Role ferry Bobby's mentor. Role: Supporter/counselor Problem: Bobby goes to interview and doesn't get the job,then meets with his mentor for advice. --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ Card 3. Card 4. Role: Dilemma of reentering person Role: Dilemma of reentering person Role: Supporter/counselor Role: Supporter/counselor ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- Card 5. Card 6. Role: Dilemma of reentering person Role: Dilemma of reentering person Role: Supporter/counselor Role: Supporter/counselor ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- Appendices— Page 12 70 Task 5: We Don't Really Learn Lessons Until We Use Them 1. Think about a difficult situation you are facing in your own reentry— where you could apply one or more ideas from today's class. Problem or issue: Ideas or principles you can apply: People you trust who might help you think this through: 2. We'll begin the next class with a brief discussion of these problems issues and ways you may have applied today's lessons. Appendices— Page 13 71 Summary 1. We can apply principles of Win or Learn to help us change our mindset and the actions we take even when we make mistakes. 2. We can also work to win or learn using our own core values. Appendices— Page 14 72 Public Health Education Program Manager: Harm Reduction Coordinator The Orange County Opioid Program Manager will be responsible for overseeing the development, administration, budget, grant management, and reporting for Orange County's Opioid Settlement Program. This position will work with closely with Orange County staff and community partners involved in community overdose prevention, education, harm reduction, treatment opportunities and recovery support. They will ensure all reporting requirements are met for the Opioid Settlement Fund and pursue additional resources to advance this work. ESSENTIAL DUTIES: This position is a highly responsible position implementing harm reduction activities within Orange County including but not limited to: • Coordinating and facilitating various harm reduction and prevention activities in the community that have either been identified as a need or have been requested by a community member; • Assisting with coordination and facilitation of harm reduction group meetings, activities, and events; • Planning and coordination for the Opioid Advisory Committee in Orange County; • Preparing, selecting, and assembling educational and informational materials pertaining to substance use/misuse, harm reduction, prevention, and mental health to be distributed through a variety of channels while ensuring equitable access to health information to all county residents; • Developing partnership opportunities with various cross sector community organizations, and stakeholders to promote harm reduction guiding principles within the community to ensure available resources are equitable; • Coordinates and helps to manage harm reduction (syringe exchange, naloxone and fentanyl strips) distribution for the Health Department; • Oversee program budget and allowable spending based on state guidelines; Lead relevant procurement process as needed for program implementation including develop, negotiate, and review contracts associated with opioid settlement funds. FULL PERFORMANCE OF KNOWLEDGE,SKILLS,ABILITIES • Requires advanced knowledge in the areas of harm reduction principles and practices, • Thorough knowledge of the principles and practices of public health education and social/economic determinants of health, and/or age-and population-specific health and safety issues. • Ability to establish rapport, provide support and advocate for a diverse range of populations including individuals who use substances and are living with significant health challenges; • Knowledge of social justice, health promotion and public health approaches and models of social support and health care; • Ability to communicate and demonstrate interpersonal skills and commitment to working within a collaborative,team approach; 73 • Skills and understanding around community mobilization, group convening, facilitation and coordinating and engaging large groups of people. • Knowledge related to the operation of government and grant funded programs; • Knowledge of public and private substance abuse facilities resources, and personnel. • Thorough knowledge of the public health rules, core responsibilities, and general statue 130A. • Thorough knowledge, skills with and understanding of government accounting, budgeting management and practices and grant application procedures. • Thorough knowledge, skills and understanding around data collection and analysis. • Thorough knowledge of the principles and practices of organizational and administrative processes and techniques. • Thorough knowledge and skills around written and verbal communication with the ability to communicate in an articulate manner for public speaking. • Thorough knowledge of available public and private funding sources for health services and available community resources. • Skill in decision making and problem solving. • Ability to demonstrate and utilize cultural competency, racial equity, inclusion, and diversity when working with internal and external partners and the public. • Ability to interpret policies and protocols into operational procedures and work priorities. • Ability to lead,train, supervise and perform conflict resolution among employees,volunteers and community members. • Ability to plan, implement, evaluate, strategic plan and write SMART goals around identified programs and priority health issues. • Ability to effectively communicate and market program activities and initiatives to target identified populations. • Ability to develop, complete and administer contracts. • Ability to perform research techniques and methods related to priority and health issues. • Ability to effectively use computer applications such as spreadsheets,word processing, calendar, e-mail, database software and office equipment. • Ability to demonstrate sound judgment; integrity; resourcefulness; accuracy; thoroughness and the physical condition commensurate with the demands of the position. QUALIFICATIONS: • Graduation from an accredited college or university with a master's degree in public health, health education or related field AND two (2)years of professional experience with a primary function in program development and management of health-related programs, OR • Graduation from an accredited college or university with a bachelor's degree with four(4) years of professional experience where the primary function is program development and management of health-related programs, OR An equivalent combination of training and experience as defined above. A higher degree does not substitute for work experience. 74 EXPENSES: SALARY RANGE $52,137.00-$68,783.00 Annually FRINGE & BENEFITS $39,241.63 TOTAL $108,024.63 75 ORANGE COUNTY, NC OPIOID ADVISORY COMMITTEE December iz, 2023 76 NC Memorandum of Agreement ( MOA • The MOA governs the allocation, use, and reporting of certain opioid settlement funds in North Carolina. • To comply with the MOA, a local government receiving opioid settlement funds must do the following: • A. Establish a fund. A local overnment receiving opioid settlement funds must secure them in a special revenue fund. These funds are subject to audit and cannot be commingled with other funds. • B. Authorizes endin . Before spending opioid settlement funds, a local government must aut orize the expen i tire of such funds. This must take place through a formal budget or resolution that includes certain details including the amount, time period, and specific strategy funded. • C. Understand and follow the options. A local government must spend opioid settlement funds on opioid remediation activities authorized under Option A or Option B as detailed in the MOA. • D. Report spending and impact. A local government that receives, spends, or holds opioid settlement tunds during a isca year must file an annual financial report within go days of the end of the fiscal year. (This report is required if funds are received or held, even if they are not spent.) A local government that spends opioid settlement funds during a fiscal year must file an annual impact report within go days of the end of the fiscal year. • E. Hold annual meeting. The MOA requires that each county receivingg opioid settlement funds hold at least one annua meeting open to the public, with all municipalities in the county invited to the meeting. The purpose of the meeting is to receive input from municipalities on proposed uses of the opioid settlement funds and to encourage collaboration between local governments. https://ncdoj.v ov/wp-content/uploads/2022/o3/NCACC-web-version-Final-Opioid-MOA-.pdf 77 Orange County Opioid ACommittee Charge • Discuss opioid-related health concerns and issues impacting the residents of Orange County; • Advise the Board of Commissioners on options to expend funds to prevent opioid abuse and remedy opioid impacts; • Plan and host an annual meeting open to the public to receive input on proposed uses of the settlement funds and to encourage collaboration between local governments. 78 Current Opioid Settlement Funding Orange County has received 6 total Deposits for the Opioid Special Revenue Account: • June 3o, 2022 - $261, 244. 68 • November 15, 2022 - $295, 555 -44 • November 15, 2022 - 28o,123- 59 • JanuarY 31, 2023 - $44, 629.84 • July 20, 2023 - s163, 816.78 • August 2, 2023 - $291, 800.34 TOTAL $1,337,170.67 79 Payment Timetable 18 Year Payment to Orange during 2022-2038: $6,799,780 Payments Over Time-Orange GOOK 400K 200K _E w 'k Next Deposit: 2'J-3 2025 203_ 2033 2035 2037 2075 Payment Table-Orange Summer 2024 - Year Season 2022 Spring $548,423 Summer $574,522 2023 Summer =-=-- 2024 Summer $yi8,423 2025 Summer. ,574 2026 Summer 5350,132 2027 Summer 2028 Summer 5=a3.5cc 2029 Summer 2030 Summer 445 e.%Sc 2031 Summer 2032 Summer -.......5 2033 Summer = 2034 Sum- 2039 Summer 2036 Summer - 2037 Summer 5=231'4 2038 Summer - 80 Opioid-O tion A- Hi hIm act Abatement p g p 1. Collaborative Strategic Planning Strategies 2. Evidence-based addiction treatment 3. Recovery support services 4. Recovery housing support 5. Employment-related services 6. Early intervention 7. Naloxone distribution 8. Post-overdose response team 9. Syringe Service Program 1o.Criminal justice diversion programs 11.Addiction treatment for incarcerated persons 12.Reentry Programs https://www.morepowerfulnc.org/wp-content/uploads/2021/10/Exhibit-A-to-NC-MOA-_�,pdf 81 As of June 6, 2023, BOCC A Funding Recommendations Lantern Project • July 1 , 2023 — June 30, 2025 • $164,862.00 (Year 1 ) ; base funding +5% (Year 2) Freedom House • July 1 , 2023 — June 30, 2025 • $122,188 (Year 1) ; base funding +5% (Year 2) NC FIT Program • July 1 , 2023 — June 30, 2025 • $70,000 (Year 1 ) ; base funding +5% (Year 2) County Vending Machines/First Responders • July 1 , 2023 — June 30, 2024 • $14,500 UNC SHAC • July 1 , 2023 — June 30, 2024 • $64,200 TOTAL ALLOCATION TO DATE FOR FY 2024 - $435750.00 REMAINING FUNDS - $901,420.6/ 82 FiscalYear2025Commitments Lantern Project • July 1 , 2024 — June 30, 2025 • $173, 105.00; base funding +5% (Year 2) Freedom House • July 1 , 2024 — June 30, 2025 • $128,297.00; base funding +5% (Year 2) NC FIT Program • July 1 , 2024 — June 30, 2025 • $73,500.00; base funding +5% (Year 2) TOTAL ALLOCATION FOR FY 2025 - $374,902.00 REMAINING FUNDS - $526,5i8.67 83 New FundingRequests Reintegration Support Network (RSN) • $265,316 for a 2-Year Period ($132,658.00/year) OC-EMS Post-Overdose Response Team (PORT) • Option 1 - $1 ,060, 132.75 (3-Year Period) • Option 2 - $846,047. 13 (3-Year Period) • Option 3 - $582,378.50 (3-Year Period) Grow Your World • $186,770.64 (Year 1 ) ; $192, 170.64 (Year 2) • $378,941 .28 for a 2-Year Period Transition Support & Recovery • $165, 170.00 (Year 1 ); $165,630.00 (Year 2) Harm Reduction Coordinator 0 $108,025.00/year for a 2-Year Period 84 Funding Subcommittee Criteria for Consideration of Funding • Must address one of the 12 mitigation strategies listed in Option A of the Settlement MOA • Program serves Orange County residents; population served ( Intentional effort to support programs serving youth) • Government entity, 5016, Non-profit Community Partner • Equity Impact • Evidence-Based Practices • Project Need (Orange County Data Supported) • Experience & Organizational Capacity • Budget & Budget Narrative 85 Funding Recommendation Reintegration Support Network (RSN) • Option A, Strategies land 6 (Recovery support services & Early Intervention) • Funding Period — January 1, 2024 — June 30, 2024 • Funding recommendation - $201000.00 • Provider — Reintegration Support Network • Description of Activity — • Increase the number of specially trained mentors (Certified Peer Support Specialist and/or Recovery Coach Academy Certified) providing evidence-informed support to youth experiencing challenges related to substance use, mental health, and justice-involvement. • Adapt an evidenced-based, adult peer-support model to meet the unique needs of youth in Orange, Durham, Chatham, and Alamance Counties. RSN uses specially trained mentors (NC certified peer support specialists, or Recovery Coach Academy trained) to interrupt the daily systemic and structural pressures that create gaps in opportunities for youth (ages 13-2o) especially those with challenges related to mental health, substance use, and/or juvenile justice involvement. • Per the proposal narrative/budget, the committee would like to support some of the operating expenses and contractual needs. 86 Funding Recommendations OC-EMS Post-Overdose Response Team (PORT) • Option A, Strategy 8 (Post-Overdose Response Team) • Funding Period — January 1, 2024 — December 2026 • Funding recommendation - $244,020.00/1st year (Option 2 - x846,047.13 for a 3-Year Period) • Provider — Orange County Emergency Services • Description ofActivity — • Development and implementation of a PORT within the geographic constraints of Orange County, NC; funds will support staff salary, supplies and needed software. • PORTs are specialized teams that respond to opioid overdoses in real time or within 24-72 hours of the overdose event. Upon implementation, the OC-EMS PORT will meet individuals where they are at in their addiction by providing harm reduction resources, linkage to treatment services, and medication-assisted treatment (MAT) induction and administration. • This service will be available to all eli ible individuals that OC-EMS interfaces with during EMS incidents and will be provided as a referral for collaboratin departments, emergency departments, organizations and the community at-large. PORTS have become the standard of care in post-overdose services nationally and locally, with 41 North Carolina counties currently having an active PORT in place. 87 Funding Recommendations Grow Your World * Option A, Strategy 6 (Early Intervention) * Funding Period — Januaryl., 2024 — J u n e 30, 2024 * Funding recommendation - $ 20, 000 • Provider — GrowYour World • Description of Activity materials and training to youth-servinq community members to equip them to better support youth facing the opioid crisis. • Per the proposal narrative/budget, the committee would like to support the naloxone, CPR andMental Health First Aid community training program . 88 Funding Recommendations Transition & Support Recovery Collaboration • Option A, Strategy 3 and 12 (Recovery Support Services and Reentry Programs) • Funding Period — January 1, 2024 — June 30, 2024 • Funding recommendation - $201000.00 • Provider —Transition & Support Recovery Collaboration • Description ofActivity — • The Transition Recovery and Sup ort Collaborative (TSRC) is a five-partner mutual effort to provide direct Recover �u port Services and Reentry Programs to those with opioid use disorders, related s�bstance use disorders and other comorbidities. TSRC'sprole is to collaborative) augment and extend clinical and other traditional evidence-based addiction treatment services for these disorders and comorbidities. The Collaborative is led by Wounded Healers of North Carolina (a 501(c)(3)). • Per the proposal narrative/budget, the committee would like to support the pY pp p urchase of the Reentr Peer Support Specialist Curriculum from Texas. 89 Funding Recommendations Harm Reduction Coordinator • Option A, Strategy i. (Collaborative Strategic Planning ) • Funding Period — January i, zoz4 — December 31, 2025 • Funding recommendation - szo8,025/year • Provider — Orange County Health Department • Description ofActivity — • The Orange County Opioid Program Manager (Harm Reduction Coordinator) will be responsible for overseeing the development, administration budget, grant management, and reporting for Orange County's Opioid Settlement Program: This position will work with closely with Orange County staff and community partners involved in community overdose prevention education, harm reduction, treatment opportunities and recovery support. They will ensure all reporting requirements are met for the Opioid Settlement Fund and pursue additional resources to advance this work. 90 BOCC Funding Recommendations REMAINING FUNDS after FY 2025 Commitments- $526,518.67 Reintegration Support Network (RSN) • $20,000.00 — 1 Year OC-EMS Post-Overdose Response Team (PORT) • Option 2 - $846,047.13 (3-Year Period) • $244,020.00/1 St year Grow Your World • $20,000.00 — 1 Year Transition Support & Recovery • $20,000.00 — 1 Year Harm Reduction Coordinator • $108,025.00/year for a 2-Year Period Total Allocation- $412,045.00 Remaining Funds - $114,473.67 91 Additional Committee Deliverables Plan the Annual Community Meeting • The MOA requires that each county receiving opioid settlement funds hold at least one annual meeting open to the public, with all municipalities in the county invited to the meeting. • The purpose of the meeting is to receive input from municipalities on proposed uses of the opioid settlement funds and to encourage collaboration between local governments. 92 Additional Committee Deliverables • Set Date for next RFP Process • Advertise time frame for Proposals (August- September2024) • Develop application to include Evaluation Process and Criteria, Eligibility, and any project requirements; DevelopTraining MaterialforApplicants; schedule training webinars. • Strategic Planning • Sequential Intercept Mapping for Substance Use Disorder 7 • 94 RES-2023-077 A RESOLUTION BY THE COUNTY OF ORANGE, NORTH CAROLINA TO DIRECT THE EXPENDITURE OF OPIOID SETTLEMENT FUNDS WHEREAS Orange County,North Carolina has joined national settlement agreements with companies engaged in the manufacturing, distribution, and dispensing of opioids, including settlements with drug distributors Cardinal, McKesson, and AmerisourceBergen, and the drug maker Johnson& Johnson and its subsidiary Janssen Pharmaceuticals; WHEREAS the allocation,use, and reporting of funds stemming from these national settlement agreements and certain bankruptcy resolutions ("Opioid Settlement Funds") are governed by the Memorandum of Agreement Between the State of North Carolina and Local Governments on Proceeds Relating to the Settlement of Opioid Litigation("MOA"); WHEREAS Orange County has received Opioid Settlement Funds pursuant to these national settlement agreements and deposited the Opioid Settlement Funds in a separate special revenue fund as required by section D of the MOA; WHEREAS section E.6 of the MOA states: E.6. Process for drawingfrom revenue funds. a. Budget item or resolution required. Opioid Settlement Funds can be used for a purpose when the Governing Body includes in its budget or passes a separate resolution authorizing the expenditure of a stated amount of Opioid Settlement Funds for that purpose or those purposes during a specified period of time. b. Budget item or resolution details. The budget or resolution should(i) indicate that it is an authorization for expenditure of opioid settlement funds; (ii) state the specific strategy or strategies the county or municipality intends to fund pursuant to Option A or Option B, using the item letter and/or number in Exhibit A or Exhibit B to identify each funded strategy, and(iii) state the amount dedicated to each strategy for a stated period of time. NOW, THEREFORE BE IT RESOLVED, in alignment with the NC MOA, Orange County, authorizes the expenditure of opioid settlement funds as follows: 1. First strategy authorized a. Name of strategy: _Recovery Support Services b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Exhibit A Strategy 3 d. Amounted authorized for this strategy: $__$173,105.00 e. Period of time during which expenditure may take place: Start date July 1, 2024 through End date June 30, 2025 f. Description of the program,project, or activity: The Lantern Project is a collaboration between the Criminal Justice Resource Department and subcontractor Freedom House Recovery Center. The mission is to support justice- 95 impacted individuals with substance use disorder through evidence-based strategies, interventions and programming designed to reduce their vulnerability to overdose, death, COVID-19 infection and recidivism. The mission is to light the path to recovery through harm reduction, diversion, reentry support and treatment. g. Provider: Criminal Justice Resource Department 2. Second strategy authorized a. Name of strategy: Evidence-based addiction treatment b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: Strategy 2 d. Amounted authorized for this strategy: $_128,297.00 e. Period of time during which expenditure may take place: Start date July 1 2024 through End date_June 30, 2025 f. Description of the program,project, or activity: Freedom House connects with individuals screened in the Orange County Detention Center who have a history of Opioid Use Disorder. The licensed clinician will conduct a Comprehensive Clinical Assessment to ascertain the best treatment options for the individual prior to or upon release from incarceration. Freedom House will utilize a Peer Support Specialist post incarceration to assist individuals with connecting to the recommended treatment. The Peer will work with the individual as long as needed to connect them with treatment, community resources, court appearances and to support the individual in recovery to curb recidivism. The clinician will reevaluation as needed when and if life circumstances change prior to engaging in treatment. g. Provider: _Freedom House 3. Third authorized strategy a. Name of strategy: _Reentry Program b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy 12 d. Amounted authorized for this strategy: $ 73 500 e. Period of time during which expenditure may take place: Start date July 1 2024 through End date_June 30, 2025 f. Description of the program,project, or activity: _ The NC FIT Program is a comprehensive reentry program that focuses on unmet health needs for people released from incarceration. NC FIT provides connections to primary care, behavioral health and substance use disorder treatment. All NC FIT Community Health Workers have personal histories of incarceration. The NC FIT Program is based on the Transitions Clinic Network Model which is an evidence-based program that complies with Strategy A in the settlement MOU. We request funding to continue a grant funded position for 1 FTE CHW that has been hired by the OC Health Department. CHW position will focus on assisting people being released from the Detention center with a diagnosis of Opioid Use Disorder. This FIT 96 CHW position will work closely with efforts supported by the Lantern Project run through the CJRD. The NC FIT Program will continue to provide regular support and technical assistance to Orange County supporting the Orange County FIT Program, Jail-based MAT at the Detention center, collaboration with the CJRD and linkages to Piedmont Health Services. g. Provider: NC FIT 4. Fourth strategy authorized a. Name of strategy: _Recovery Support Services &Early Intervention b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Exhibit A Strategy 3 and 6 d. Amounted authorized for this strategy: $ $20,.000.00 e. Period of time during which expenditure may take place: Start date January 1, 2024_through End date_June 30, 2024 f. Description of the program,project, or activity: Reintegration Support Network(RSN)will increase the number of specially trained mentors (Certified Peer Support Specialist and/or Recovery Coach Academy Certified)providing evidence-informed support to youth experiencing challenges related to substance use, mental health, and justice-involvement. RSN will adapt an evidenced-based, adult peer-support model to meet the unique needs of youth in Orange, Durham, Chatham, and Alamance Counties. RSN uses specially trained mentors (NC certified peer support specialists, or Recovery Coach Academy trained)to interrupt the daily systemic and structural pressures that create gaps in opportunities for youth (ages 13-20) especially those with challenges related to mental health, substance use, and/or juvenile justice involvement. Funds will support some of the operating expenses and contractual needs. g. Provider: Reintegration Support Network 5. Fifth strategy authorized a. Name of strategy: _Post-Overdose Response Team b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: Strategy 8 d. Amounted authorized for this strategy: $ 244 020.00 e. Period of time during which expenditure may take place: Start date_Janua . 1, 2024 through End date_December 31, 2025 f. Description of the program,project, or activity: Development and implementation of a PORT within the geographic constraints of Orange County,NC; funds will support staff salary, supplies and needed software. PORTS are specialized teams that respond to opioid overdoses in real time or within 24-72 hours of the overdose event. Upon implementation, the OC-EMS PORT will meet individuals where they are at in their addiction by providing harm reduction 97 resources, linkage to treatment services, and medication-assisted treatment (MAT) induction and administration. This service will be available to all eligible individuals that OC-EMS interfaces with during EMS incidents and will be provided as a referral for collaborating departments, emergency departments, organizations and the community at-large. PORTs have become the standard of care in post-overdose services nationally and locally, with 41 North Carolina counties currently having an active PORT in place. g. Provider: —Orange County Emergency Services 6. Sixth authorized strategy a. Name of strategy: _Early Intervention b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy d. Amounted authorized for this strategy: $_20,000 e. Period of time during which expenditure may take place: Start date_January 1, 2024 through End date_June 30, 2024 f. Description of the program,project, or activity: _ Grow Your World(GYW)plans to serve youth and provide materials and training to youth-serving community members to equip them to better support youth facing the opioid crisis. Funds will support the naloxone, CPR and Mental Health First Aid community training program. g. Provider: _Grow Your World 7. Seventh authorized strategy a. Name of strategy: _Recovery Support&Reentry Pro rg ams b. Strategy is included in Exhibit Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy 3 & 12_ d. Amounted authorized for this strategy: $_20,000.00 e. Period of time during which expenditure may take place: Start date_January 1, 2024 through End date_June 30, 2024 f. Description of the program,project, or activity: The Transition Recovery and Support Collaborative (TSRC) is a five-partner mutual effort to provide direct Recovery Support Services and Reentry Programs to those with opioid use disorders, related substance use disorders and other comorbidities. TSRC's role is to collaboratively augment and extend clinical and other traditional evidence-based addiction treatment services for these disorders and comorbidities. The Collaborative is led by Wounded Healers of North Carolina(a 501(c)(3)). Funds to support purchase of the Reentry Peer Support Specialist Curriculum from Texas. g. Provider: _Transition Recovery and Support Collaborative 8. Eighth authorized strategy a. Name of strategy: _Collaborative Strategic Planning_ b. Strategy is included in Exhibit_Exhibit A (Exhibit A, Exhibit B) c. Item letter and/or number in Exhibit A or Exhibit B to the MOA: _Strategy I 98 d. Amounted authorized for this strategy: $_108,025.00 e. Period of time during which expenditure may take place: Start date_January 1, 2024 through End date_December 31, 2025_ f. Description of the program,project, or activity: _ The Orange County Opioid Program Manager(Harm Reduction Coordinator)will be responsible for overseeing the development, administration, budget, grant management, and reporting for Orange County's Opioid Settlement Program. This position will work with closely with Orange County staff and community partners involved in community overdose prevention, education, harm reduction, treatment opportunities and recovery support. They will ensure all reporting requirements are met for the Opioid Settlement Fund and pursue additional resources to advance this work. g. Provider: Orange County Health Department The total dollar amount of Opioid Settlement Funds appropriated across the above named and authorized strategies is $786,947. Adopted this the 12th day of December, 2023. Jamezetta Bedford, Chair Orange County Board of Commissioners ATTEST: Laura Jensen, Clerk to the Board COUNTY SEAL 99 Year-To-Date Budget Summary Fiscal Year 2023-24 Opioid Fund Budget Summary Settlement Fund Original Budget Revenue Interfund Transfer Revenue Fund Balance Appropiation Total Original Budget $0 Additional Revenue Received Through Budget Amendment#4-B (December 12, 2023) Grant Funds $455,617 Non Grant Funds Additional Interfund Transfer Revenue Additional Fund Balance Appropriation Total Amended Budget $455,617 Dollar Change in 2023-24 Approved Budget $455,617 % Change in 2023-24 Approved Budget 100.00% Authorized Full Time Equivalent Positions Original Approved Full Time Equivalent Positions (includes Permanent and Time Limited) 3.000 Changes to Full Time Equivalent Positions 4.000 Total Approved Full-Time-Equivalent Positions for Fiscal Year 2023-24 7.000