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Home My WebLink AboutAgenda 05-06-25; 6-a - Opioid Advisory Committee Settlement Fund Use Recommendations 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: May 6, 2025 Action Agenda Item No. 6-a SUBJECT: Opioid Advisory Committee Settlement Fund Use Recommendations DEPARTMENT: County Commissioners ATTACHMENT(S): INFORMATION CONTACT: PowerPoint Presentation Quintana Stewart, Orange County Proposal Application Form Health Director, 919-245-2412 Application Scoring Criteria Rubric Piedmont Health Services Proposal EI Futuro Proposal Freedom House Proposal UNC Student Health Action Coalition (SHAC) Proposal Reintegration Support Network Proposal PURPOSE: To: 1) receive an update on the Opioid Advisory Committee (OAC); 2) receive OAC recommendations for use of Opioid Settlement Funds that support Option A of the NC Memorandum of Agreement on the Allocation and Use of Opioid Settlement Funds in North Carolina; and 3) direct staff to present a final spending authorization resolution at the Board's May 20, 2025, Business meeting. BACKGROUND: In July 2021, a bipartisan coalition of state attorneys general announced the National Opioid Settlement — a historic agreement that provides 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. North Carolina is receiving $1,420,932,713 in opioid settlement funds from 2022 through 2038. Orange County is expected to receive $12,748,445 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 to follow Option A for the use of the settlement funds per the NC Memorandum of Agreement Opioid Settlement. Between Summer 2022 and Summer 2024, Orange County spent $376,438 to address eight (8) of the following Option A Strategies: • Collaborative Strategic Planning • Evidence-based addiction treatment • Recovery support services • Early intervention • Naloxone distribution • Post-overdose response team • Syringe Service Program • Reentry Programs The 2025-2026 Opioid Settlement Fund Proposal process began January 1, 2025, with the availability of applications. A copy of the application is attached, along with the application scoring rubric. Four (4) Application Workshops were conducted with both in-person and virtual options. Technical assistance was provided to applicants during the request for proposals (RFP) process. Fourteen (14) community applications were received by the deadline — February 21, 2025. The Funding Subcommittee of the OAC reviewed applications and made recommendations to the full OAC. On March 24, 2025, and April 14, 2025, the OAC discussed the Subcommittee suggestions and voted to approve the five (5) following funding recommendations: • Piedmont Health — $50,400 • EI Futuro — $50,000 • Freedom House — $72,000 • UNC SHAC — $37,600 • Reintegration Support Network — $20,000 The proposals for these five (5) applications are attached. All fourteen (14) community applications and the applications scorecard are available on the Opioid Settlement Funds webpage at: https://orangecountync.gov/2998/Opioid-Settlement-Funds. FINANCIAL IMPACT: Distribution of opioid settlement funds may support programs and services that serve persons with Opioid Use Disorder or any co-occurring Substance Use Disorder (SUD) or mental health condition in Orange County. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTHY COMMUNITY OBJECTIVE 1. Improve harm reduction, prevention, and support services for adults and children experiencing behavioral health issues, substance use disorder, and intellectual or developmental disability. RECOMMENDATION(S): The Manager recommends that the Board review and discuss the funding recommendations from the OAC and direct staff to present a final spending authorization resolution for approval at the Board's May 20, 2025, Business meeting. 3 ORANGE COUNTY, NC OPIOID ADVISORY COMMITTEE (OAC ) Orange County Board of County Commissioners May 6, 2025 4 NC Memorandum ofAgreement (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 government 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. Authorize spending. Before spending opioid settlement funds, a local government must authorize the expenditure 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 funds during a fiscal 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 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. https://ncdo-i.gov/wp-content/uploads/2022/o3/NCACC-web-version-Final-Opioid-MOA-.pdf 5 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 s. 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/2023./lo/Exhibit-A-to-NC-MOA-3.pdf 6 Orange County Opioid ACommittee Charge Discuss opioid-related health Advise the Board of Plan and host an annual concerns and issues impacting Commissioners on options to meeting open to the public to the residents of Orange expend funds to prevent receive input on proposed uses County; opioid abuse and remedy of the settlement funds and to opioid impacts; encourage collaboration between local governments. 7 Grange County is receiving $12,748,445 in opioid settlement funds from 2022 through 2038. �. � ■ Past fiscal year payment ■ Current fiscal year payment Future fiscal year payment $2.h $ssoK �s6t7K �s9i]K $740K $ssoK $szoK $54OK tSSOOK $SOOK $420K $30QK $30C, M -�r [n �D r" co Gs aD —i n - e r ry ou. ror ru cv N m m m m m m m m m m N M It Ln L.9 M1 IW 0-1 CD ci cv M V Ln LD r- w ML ['U [!r [V [V CV rV CV m r13 m n'+ m m m M m a- � LL s LL LL LL LL � L- s LL LL LL L.L LL LL LL LL LL LL LL LL. 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PAYMENT TIMETABLE HTTPS://NCOPIOIDSETTLEMENT.ORG/TRENDS/PAYMENT-SCHEDULE/ 8 2025 - 2026 Opioid Settlement Fund Proposals Process • Applications for the 2025-2026 Opioid Settlement Funds became available January 1 , 2025. • Application Workshops were offered: • January 6th and 15th - Whitted Human Services, Hillsborough, NC • January gth & 141h - Southern Human Services, Chapel Hill, NC • Open Question Period • February 3rd — 14 th, 2025 • Frequently Asked Questions (FAQs) posted online and updated • February 21, 2025, 5 p.m. — Applications Due via Email to Harm Reduction Coordinator, Tonya Stancil. • March —April 2025 — OAC Funding Subcommittee review applications • May 2025 — Funding Recommendations presented to BOCC • July 1, 2025 —Awarded Contracts begin 9 FundingProposal • Agency General Information • Proposal Summary (required but not scored) • Project Narrative (16 points) • Project Description & Program Sustainability (28 points) • Equity Impact (8 points) • Organizational Readiness (zo points) • Evidence of Collaborative/Partnerships (so points) • Performance Measures & Program Evaluation (18 points) • Supporting Documents Included: • Letters of Commitment and/or Support (Up to 5 letters) • Latest Audited Financial Statements, including Management letter (Attach letter of explanation if unable to provide) • Documentation of Tax Identification Number (can be IRS Determination Letter for non-profit agencies) • Certificate of Insurance • Non-Profit Agencies - IRS Determination Letter, Verification of 501(c)(3) status form, 990 Form Tax Form, Board of Directors Roster • For-Profit Agencies— Board of Directors Roster, Agency Org Chart, IRS Tax Form used for latest fiscal year filing 10 Subcommittee Criterion Discussion Application Scoring Criteria .Applications will be scored based on the responses to the application content areas in the ch an below. Criterion 3b: "Well-planned activity that is likely to lead to the ared Each content area shall be scon a wae lof 1-4 based or. scale below:the PDDR A=only m arginally a ddressed the applicationareaV intended opioid—related impacts, based on the evidence base 2- AVERAGE Applicant adequately addressed the application area 3- 6000 .Applicantdid athmroughlab of addressing the application areaabout strategy and/or activity effectiveness for the prioritized 4- EXCELLENT Applicant provided asuperi response to the application'area Each content a ma wi I I be vreighted and th a score of L to 4 will be multiplied by the assigned well population." the content area-The fallowing repremnic-the evaluation criteria and relative importance of each criterion{criteria weightj: The "priority population" as defined for this purpose: Evaluation Criteria Score eight Distrihutio Score 1. Proposal Summary:deduct 2 points if missing Opts• -- • Selective and indicated populations ( IOM terminology, for 2. Assessment of Need O Pn a. Clear and appropriate geogrephicarea tohaesrvsd ng. an explanation see * below) at high risk for opioid abuse, or h. Clear statement of needs and gaps in services O[henue 4 c. Thiel-or, escriptionofprimdtypopulatimnsthat iswellsuppmrted6y already manifesting signs and symptoms of abuse evidence 6-IS pts. 3. project Description and Sustainability a. Eaactry orze of the eligible Option A strategies is selected an .d projettan in 21yro,o it =bethe le°t to leaJteffy o!h Populations actively misusing opioids for whom drug b, W=[I-olann=_iproect that is likel;r to is•ad to!h imended opioid elated • -- - V tegyandloractivity Opts if treatment, with or without short term or extended MAT, is c. Clear and appropriate plans to incorporate feedback from programsling. participants to inform program delivery therwise, 7 d. ct et appropriate Intended impaof project will likely mecommunity needs�samice gaps 7-28 pts. e.. Applicant has engaged or will engage the priority population ningPollyin developing he proposed sed prmjeR Harm reduction supplies and approaches including F. Proposed project fits applicant's orgsnnatimnal goals well • g. Projecttimelines are achievable and adequate to make intended imparts h. Clear and appropriate pians for project sustainability naloxone distribution d. Equity Impart O pn•it a. Project is likely to im prove health ineq uities a in dfor social determinants sling. of health 6thenviae. 2 Users in recovery seeking ongoing support h. I u likely to reach,benefit,and equitabty engage historically • marginalized populations and uninsured and underinsured people 2-8 per, S. Organizational Read mess O pts.if a. Appkcant demonstrates the skills and capacity needed to manage the 5 fundis a yard and meet re ortin and compliance ie u mems. sing. 11 Opioid SettlementFundApplications (14) Applications Receive, 3.) Carpe Diem ($25,000) 8) Hillsborough Treatment Center ($200,000) z) C.E.C. Analytics ($35, 233.40) 9) Oxford House ($40,000) 3) EI Futuro ($74, 115.29) lo) Piedmont Health ($50,400) 4) Fathers on the Move ($20,000) 11) Recovery Support Network ($20,026) 5) Freedom House ($144,926.10) 12) Student Against Destructive Decisions 6) GrowYour World ($132,035.35) (sADD) 0600,000) 13) Student Wellness 0114, 906.24) 7) High Impact Opioid Abatement ($44076) 14) Student Health Action Coalition (SHAC) ($196,047) 12 Funding Recommendation : Piedmont Health • Option A, Strategy z (Evidenced-based addiction treatment) • Funding Period —July 1, 2025 —June 30, 2026 • Funding request — $50,400 • Funding recommendation — $50,400 • Description of Activity — ➢ Piedmont Health Services, Inc. (PHS) will use Orange Co. High Impact Opioid Abatement Strategies funding in order to provide Medication for Opioid Use Disorder (MOUD) services at no cost to a total of 36 new patients in our two Orange County locations (Carrboro and Chapel Hill). As all MOUD recipients will have a diagnosis of Opioid Use Disorder, they will represent a population which faces many barriers to care, including cost of care, transportation, and stigma. Additionally, the majority of PHS patients represent low-income, uninsured, unhoused, and other historically marginalized populations. ➢ MOUD program provides support in managing cravings, reducing withdrawal symptoms and preventing relapse into active addiction. Services provided at no cost to patients. 13 Funding Recommendation : EI Futurn • Option A, Strategy 6 (Early Intervention) • Funding Period —July 1, 2025 —June 30, 2026 • Funding request — $74,115.29 • Funding recommendation — $50,000 • Description of Activity — EI Futuro respectfully requests support to implement its Orangqe County Latino Early Intervention Program, expanding Community Mental Health�IVorker's (CMHW) capacity to prevent and address substance use disorder (SUD) and co-occurring mental health conditions among historically marginalized Latino individuals in Orange County. Strengthening early intervention efforts, reducing stigma, and strengthening community coordination will improve outcomes for Latino youth, young adults, and their caregivers. ➢This initiative will train CMHWs in Screening, Brief Intervention and Referral to Treatment (SBIRT) and Motivational Interviewing (MI) to strengthen early intervention efforts and expand access to culturally and linguistically appropriate services. 14 Funding Recommendation : Freedom House • Option A, Strategies io (Criminal Justice Diversion Program) • Funding Period — July 1, 2025 — June 30, 2026 • Funding request — $144, 926.10 • Funding recommendation — $72,000 • Provider— Freedom House Recovery Center • Description of Activity — y Freedom House connects with individuals screened in the Orange County Detention Center who have a history of Opioid Use Disorder. ➢The Peer Support Specialist assists individuals with getting to treatment, court appearances, linkage to community resources and other needs to curb recidivism. Funds would cover salary/benefits, cell phone service, mileage and training for a Peer Support Specialist. There is also indirect costs (office supplies'& space, clinical supervision, financial oversight, assessment software licensing, insurance) totaling $5,577. Position formerly funded Opioid Settlement funds 2023-2025. 15 Funding Recommendation : UNC SHAC • Option A, Strategy 9 (Syringe Support Program) • Funding Period — July 1, 2025 — June 30, 2026 • Funding request — x196,047 • Funding recommendation — $37,600 • Description of Activity — ➢UNC SHAC is a harm reduction-based organization providing sterile injection supplies{ fentanyl and xylazine test strips; also provides referrals to other social and health services for people who use drugs in Orange County. ➢Seeking funds for Syringe Support Program (SSP) supplies, educational materials, marketing, travel, and continued funding for paid Program Navigator position. ➢Desire to open a new SHAC SSP location to increase SSP access; current distribution occurs at Interfaith Council for Social Service and University Methodist Church; Hillsborough Pharmacy assists with storage needs Formerly funded Opioid Settlement funds 2023-2025. 16 Funding Recommendation : Reintegration Support Network ( RSN ) • Option A, Strategy 6 (Early Intervention) • Funding Period —July z, 2025 —June 30, 2026 • Funding request — $20,026 • Funding recommendation — $20,000 • Description of Activity — ➢Seeking support for additional mentor trainers to work with youth and emerging adults (ages 13-20) navigating substance use, mental health challenges, and/or justice involvement. ➢Mentors serve as allies and peer support workers, and often have personal experience with substance use, mental health challenges, and/orjustice involvement. ➢Mentors receive comprehensive training to recognize and nurture youth strengths, utilizing SAMHSA CORE Competencies (recovery-oriented, person-centered, voluntary, relationship-focused, and trauma-informed practices), active listening skills, SMART goal setting, and motivational interviewing techniques. Recognizing the profound impact of poverty and social identities on the youth we serve, RSN-is committed to addressing the root causes of inequity through culturally responsive and person-centered services. OAC to finalize funding recommendations for BOCC Funding recommendations presented to BOCC in May 2025 ' ' • • 7 a � � 7 � • 7 19 ORANGE COUNTY ORANGE COUNTY NORTH CAROLINA HIGH IMPACT OPIOID ABATEMENT STRATEGIES Funding Proposal Application Form Application Due Date: February 21, 2025 Applicant Agency: General Information Legal Name Click or tap here to enter text. Address Click or tap here to enter text. Type of Agency ❑ Government/ (check one) Public Authority ❑ Non-Profit ❑ For-Profit Business Telephone Click or tap here to enter text. Website Click or tap here to enter text. Primary Contact Full Name Click or tap here to enter text. Title Click or tap here to enter text. Email Click or tap here to enter text. Telephone Click or tap here to enter text. Name of Project Click or tap here to enter text. Total Application Funding Requested $ Click or tap here to enter text. Funding Period Requested Start Click or tap here End Click or tap here to (MM/DD/YYYY) Date to enter text. Date enter text. Selected NC MOA Option A Strategy(Number and Name) Click or tap here to enter text. Agency Mission and Vision Statements Click or tap here to enter text. Use font size 12 throughout document. As a separate Excel file, submit a completed Budget Worksheet. Submit application to tstancil@oranBecountync.gov with a subject line of— RFA: Opioid Settlement Funds— [Organization name]. Will receive Receipt of Application email upon submission. If email is not received within 24 business hours, reach out to Tonya Stancil, Harm Reduction Coordinator at tstancil@orangecountync.gov. i 20 1. Proposal Summary(no more than 250 words, required but not scored) Delete the following prompts to make room for your response. Provide a brief(no more than 250 words)overview of the planned project. Summary must include a purpose statement describing how your application will address the needs of people with Opioid Use Disorder(OUD)or any co-occurring Substance Use Disorder(SUD)or mental health condition in the community with particular considerations for historically marginalized populations. Click or tap here to enter text. ii 21 2. Project Narrative A. Assessment of Community Need (16 points, page limit: not to exceed 1 % pages) Delete the following prompts to make room for your response. • List the geographic area to be served by the proposed project and the overdose burden in that area. • Provide any pertinent and/or necessary information as it relates to the need for this work in your community. Identify any gaps in services you intend to address by identifying and/or defining current programs/providers. • Describe the needs of the priority population that this proposal will serve and how those needs were determined(e.g.,focus groups, survey, patient engagement). NOTE:Provide citations/reference sources for any included community demographic or health status data. Current and relevant data is available at: https://www.ncdhhs.goy/opioid-and-substance-use-action-plan-data-dashboard https.11iniuryfreenc.ncdhhs.govIDataSurveillancelPoisoning.htm https://nc211.orq/data/ https://medicaid.ncdhhs.gov/reports/dashboards#annual Click or tap here to enter text. B. Project Description and Program Sustainability(28 points, page limit:not to exceed 3 pages) Delete the following prompts to make room for your response. • Clearly identify which implementation strategy from the NC MOA's Option A list of eligible strategies are included in the proposal, including the number(e.g., "Strategy 2: Evidence-Based Addiction Treatment"). Only one eligible strategy may be selected for each proposal, however, other strategies may be referenced that apply. • Describe the proposed project in detail including its expected impact on preventing opioid overdose, increasing access and linkages to care for the most marginalized and underserved populations, and building local infrastructure to respond to the opioid overdose crisis. • Explain how you will engage or have already engaged the priority population in developing this proposed project. • Detail how this project will advance your organization's goals. • Include timelines for project implementation with specific program objectives as they relate to performance measures and budget(e.g., hiring staff or subcontractors, purchasing supplies, establishing policies and protocols, enrolling participants, etc.)including who is responsible for associated activities. • Explain how the project will increase the capacity of your organization or your community over time to address opioid use disorder. Note that applications must describe how they will plan for enhancements,improvements, or increases achieved during the project year to be sustained past the funding secured during the project period. • Describe obstacles that may affect your organization's ability to sustain this program after the project cycle and potential solutions to identified challenges. • Detail any other funding sources that will be used towards this project. 1 22 Click or tap here to enter text. C. Equity Impact (8 points, page limit: not to exceed % page) Delete the following prompts to make room for your response. • Describe how the proposed project addresses health inequities and reaches historically marginalized populations. Additionally, describe how the proposed project addresses the needs of the uninsured and underinsured. Finally, describe how the proposed project will address social determinants of health (transportation, housing, employment, etc.) directly or through collaboration with other agencies. Click or tap here to enter text. D. Organizational Readiness (20 points, page limit: not to exceed 3 pages) Delete the following prompts to make room for your response. • Describe the capacity of the fiscal agent/organization that will take total responsibility for the fiscal, reporting, and grant-related compliance requirements to manage grants and comply with financial and monitoring requirements. (If applicable, provide an example of a prior project.) • If applicable, identify any proposed subcontractors and their role on the proposed project. If the specific subcontractor is not yet identified, describe how the subcontractor will be selected. • Provide specific examples of the organization's or partnership/collaboration of multiple organizations'capacity to deliver information in a culturally humble, sensitive, and appropriate manner. The applicant must demonstrate an understanding of issues specifically affecting people who use drugs(PWUD)and/or other intersecting historically marginalized populations.A successful applicant will have staff and/or volunteers with diverse backgrounds who are sensitive to drug user health issues. o If applicable, provide specific examples of how any identified subcontractors demonstrate these capacities. • Describe your organization's or partnership/collaboration of multiple organizations'history promoting the health and dignity of individuals and communities impacted by drug use or your plans to incorporate this mission into your core activities and how your organization will be delivering program activities in a culturally appropriate manner. o If applicable, provide specific examples of how any identified subcontractors demonstrate these capacities. • If applicable, highlight if your organization or partnership/collaboration of multiple organizations and/or any proposed subcontractors serve the following prioritized groups: o Those experiencing homelessness and housing instability, o Black, Indigenous, and People of Color(BIPOC), o Federal or NC recognized tribal communities, and/or o Those transitioning from correctional settings to the community. Click or tap here to enter text. E. Evidence of Collaborations/Partnerships (10 points, page limit: not to exceed 1% pages) Delete the following prompts to make room for your response. 2 23 • Describe how you will collaborate on this project or initiative with other relevant organizations in your community and how this project will improve collaboration between local stakeholders and/or engage new ones. • Describe how you will verify that projects or services are not being duplicated in the community and with the population served. Click or tap here to enter text. F. Performance Measures and Program Evaluation (18 points, page limit:not to exceed 1 page) Delete the following prompts to make room for your response. • Detail how you will evaluate your project. • Describe how you will engage the priority population in the design and implementation of the evaluation of this project. • Recipients providing direct services will be required to report client-level data on elements including but not limited to demographic characteristics, substance use, diagnosis(es), services received, and types of medications for opioid use disorder received. Explain how you will capture this data. (See https.11nctopps.ncdmh.net/dev/gettingstartedwithnctopps.asp for a suggested tool.) • Explain how you will monitor the project and capture metrics for each of the supported strategy included in your project. You may wish to include metrics in a table format. Click or tap here to enter text. 3 24 Include in the same PDF document as this form, after the Certifications section below, the following required documents. If an item is not applicable to your organization, please indicate this by an "N/A" and explain why it is not applicable. 3. Letters of Commitment and/or Support (Up to 5 letters) 4. Latest Audited Financial Statements, including Management letter (Attach letter of explanation if unable to provide) 5. Documentation of Tax Identification Number(can be IRS Determination Letter for non-profit agencies) 6. Certificate of Insurance 7. For non-profit agencies only: A. IRS Determination Letter: provide a copy of an IRS determination letter which states that your organization has been granted exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code.The organization's name on the letter must match your current organization's name and address.This IRS determination letter can also satisfy the documentation requirement of your organization's tax identification number(TIN). B. Verification of 501(c)(3) Status Form: If applicable, an Authorized Representative must annually submit verification that the organization remains a qualified 501(c)(3)tax-exempt organization. C. Copy of Form 990 Federal Tax return filed for latest fiscal year. D. Agency organizational chart. E. Current Board of Directors Roster with names, addresses, office terms (with dates), and professional and/or community affiliations. 8. For-profit agencies only: A. Current Board of Directors Roster with names, addresses, office terms (with dates), and professional and/or community affiliations. B. Appropriate tax form filed with IRS filed for latest fiscal year. C. Agency organizational chart. Insert/Attach these required documents here. 1 25 9. Certifications and Required Forms A. Application Certification I have reviewed this application for accuracy. I understand that Opioid Abatement funds are intended to address specific remediation activities as identified under the NC Memorandum of Agreement(MOA) for the Opioid Settlement Funds. I understand that these opioid settlement funds are subject to State laws and regulations, and I have read the MOA and agree to the requirements. I certify that the requested funds will be used in compliance with these requirements and with all requirements outlined in the Orange County High Impact Opioid Abatement Strategies RFA. I agree to submit invoices and other relevant documentation to Orange County to pay or be reimbursed, as well as quarterly status reports, by the date stated in the contract. I understand that Orange County requires agencies with receipts less than $500,000 that do not have a financial audit (or a financial report), prepared by a certified public accountant(CPA)to complete schedule of Receipts and Expenditures form. An agency does not need to complete this form if it has a prepared audit/report it can submit for the calendar year ending December 31, 2022 or the fiscal year ending June 30, 2023. Agencies with receipts totaling$500,000 or more,from any source, must submit a CPA-certified financial audit. financial statements for each year that opioid settlement funding is provided to my organization, and that Orange County may monitor the program during the award period. Agency Authorized Official (print name) Click or tap here to enter text. Signature Title Click or tap here to enter text. Date Click or tap here to enter text. Board Chair/Elected Official (print name) Click or tap here to enter text. Signature Title Click or tap here to enter text. Date Click or tap here to enter text. 1 26 B. Non-profit agencies only:Verification of 501(c)(3)Status Form IRS Tax Exemption Verification Form (Annual) I, , hereby state that I am of (Printed Name) (Title) ("Organization"), and by that authority duly (Legal Name of Organization) given and as the act and deed of the Organization, state that the Organization's status continues to be designated as 501(c)(3) pursuant to U.S. Internal Revenue Code, and the documentation on file with the North Carolina Department of Health and Human Services is current and accurate. I understand that the penalty for perjury is a Class F Felony in North Carolina pursuant to N.C. Gen. Stat. § 14-209, and that other state laws, including N.C. Gen. Stat. § 143C-10-1, and federal laws may also apply for making perjured and/or false statements or misrepresentations. I declare under penalty of perjury that the foregoing is true and correct. Executed on this the day of , 20 (Signature) 2 27 C. Certification of No Overdue Tax Debts Date of Certification MM/DD/YYYY Certification: We certify that [ORGANIZATION NAME] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b. Sworn Statement: [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the Board Chair and [Title of the Second Authorizing Official], respectively, of[insert name of organization] of [City] in the State of[Name of State]; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Board Chair Signature [TITLE OF SECOND AUTHORIZING OFFICIAL] Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 G.S. 105-243.1 defines: Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer.The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." 3 28 D. Code of Conduct Policy Each recipient of award shall maintain a written Code of Standards of Conduct which shall govern the performance of its officers, employees or agents in contracting with and/or expending Older Americans Act funds and State appropriations. The recipient Agency's officers, employees or agents shall neither solicit nor accept gratuities, favors or anything of monetary value from contractors or potential contractors.To the extent permissible under state or local laws, rules or regulations, such standards shall provide for appropriate penalties, sanctions, or other disciplinary actions to be applied for violations of such standards either by the officers, employees or agents of the recipient Agency or by contractors or their agents. Awards will be made only to responsible Agency(ies) possessing the ability to perform successfully under the terms and conditions of a proposed procurement. Consideration will be given to such matters as Agency's integrity, compliance with public policy, record of past performance, and financial and technical resources. I have read and fully understand the context of the information above. Authorized Official Signature Title Date 4 29 E. Conflict of Interest Policy The Board of Directors/Trustees or other governing persons, officers, employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interest.The Organization's Board of Directors/Trustees or other governing body, officers, staff and agents are obligated to always act in the best interest of the organization.This obligation requires that any Board member or other governing person, officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the Organization mission. At all times, Board members or other governing persons, officers, employees or agents, are prohibited from using their job title,the Organization's name or property,for private profit or benefit. a. The Board members or other governing persons, officers, employees, or agents of the Organization should neither solicit nor accept gratuities,favors, or anything of monetary value from current or potential contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent. This is not intended to preclude bona-fide Organization fund raising- activities. b. A Board or other governing body member may, with the approval of Board or other governing body, receive honoraria for lectures and other such activities while not acting in any official capacity for the Organization. Officers may,with the approval of the Board or other governing body, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. Employees may, with the prior written approval of their supervisor, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. If a Board or other governing body member, officer, employee or agent is acting in any official capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization. c. No Board member or other governing person, officer, employee, or agent of the Organization shall participate in the selection, award, or administration of a purchase or contract with a vendor where, to his knowledge, any of the following has a financial interest in that purchase or contract: 1. The Board member or other governing person, officer, employee, or agent; 2. Any member of their family or personal relationship; 3. An organization in which any of the above is an officer, director, or employee; 4. A person or organization with whom any of the above individuals is negotiating or has any arrangement concerning prospective employment or contracts. d. Duty to Disclosure--Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately. 5 30 e. Board Action--When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body,the Board member or other governing person, officer, employee, or agent (person(s)) must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of committees with governing board delegated powers considering the possible conflict of interest. After disclosure of all material facts, and after any discussion with the person, they shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon.The remaining board or committee members shall decide if a conflict of interest exists. In addition,the person(s) shall not participate in the final deliberation or decision regarding the matter under consideration and shall leave the meeting during the discussion of and vote of the Board of Directors/Trustees or other governing body. I have read and fully understand the context of the information above. Authorized Official Signature Title Date 6 31 F. Appendix E: E-Verify STATE OF NORTH CAROLINA AFFIDAVIT COUNTY OF ORANGE ------------------------------------------------------------------------------- I, (the individual attesting below), being duly authorized by and on behalf of (the entity contracting with Orange County hereinafter "Employer") after first being duly sworn hereby swears or affirms as follows: 1. Employer understands that E-Verify is the federal E-Verify program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law in accordance with NCGS §64-25(5). 2. Employer understands that Employers Must Use E-Verify. Each employer, if employing 25 or more employees in this State, after hiring an employee to work in the United States, shall verify the work authorization of the employee through E-Verify in accordance with NCGS§64-26(a). 3. Employer is a person, business entity, or other organization that transacts business in this State and that employs 25 or more employees in this State. (Mark Yes or No) a.YES ❑ or b. NO ❑ 4. Employer's subcontractors comply with E-Verify, and Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer during the term of its contract with Orange County. This day of , 20 Signature of Affiant Print or Type Name NORTH CAROLINA NOTARY ACKNOWLEDGEMENT THE STATE OF NORTH CAROLINA, COUNTY OF Signed and sworn to (or affirmed) before me,this day of 20_. My Commission Expires: Notary Public, Notary Public Signature: [Official Seal] 7 32 G. Discrimination Policy Each recipient of award shall maintain a discrimination policy ensuring that they do not discriminate on the basis of race, color, national origin, disability, religion, age, sex/gender, sexual orientation, gender identity and expression, marital status,veteran status, or source of income in the administration of its programs or activities, as required by applicable loa wans regulations. The recipient agency should identify officer, employee or agent responsible for coordination of compliance efforts and receipt of inquiries concerning non-discrimination requirements implemented by 40 C.F.R. Parts 5 and 7, including Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973; the Age Distribution Act of 1975, and Title IX of the Education Amendments of 1972, and other applicable laws. Said officer, employee or agent's contact information shall be included below. Discrimination complaint form should be attached or link to discrimination form included below. Responsible officer/employee/agent: Responsible officer/employee/agent phone number: Responsible officer/employee/agent email address: Link to discrimination complaint form (if not attached): Authorized Official Signature Title Date 8 33 H. Authorization for Individuals to Sign Contracts and Submit Reporting [Letter from Board President/Chairperson identifying individuals as authorized to sign contracts, expenditure reports, and performance reports] I, , Board President/Chairperson of [Agency/Organization's legal name] hereby identify the following individual(s)who is (are) authorized to sign and/or submit documentation for the organization named above: Contracts: Printed Name: Title: Email address: Click or tap here to Click or tap here to 1. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 2. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 3. enter text. enter text. Click or tap here to enter text. Expenditure Reports: Printed Name: Title: Email address: Click or tap here to Click or tap here to 1. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 2. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 3. enter text. enter text. Click or tap here to enter text. 9 34 Performance Reports: Printed Name: Title: Email address: Click or tap here to Click or tap here to 1. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 2. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 3. enter text. enter text. Click or tap here to enter text. Board President or Chair printed name * Title Signature Date 10 35 I. Business Associate Addendum THIS ADDENDUM is made this day of Click or tap here to enter text., 20Click or tap here to enter text. to a contractual arrangement between the parties ("Agreement"). WHEREAS Orange County is itself a Covered Entity, as that term is defined in HIPAA and will be referred to as "Covered Entity"; and WHEREAS, Click or tap here to enter text. is, or may be, a Business Associate of Covered Entity and will be referred to as "Business Associate"; and WHEREAS, Business Associate performs certain services on behalf of or for Covered Entity that require the exchange of information about patients that is protected by the Health Insurance Portability and Accountability Act of 1996, as amended, and the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164 (collectively"HIPAA"). NOW,THEREFORE, the parties to the Agreement are entering into this Addendum to establish the responsibilities of both parties regarding HIPAA-covered information and to bring the Agreement into compliance with HIPAA. I. DEFINITIONS Except as otherwise defined herein,terms used in this Addendum shall have the same meaning as the terms are defined in HIPAA. II. OBLIGATIONS OF BUSINESS ASSOCIATE To comply with the Privacy, Security, and Breach Notification obligations imposed by HIPAA, Business Associate agrees to: A. Privacy and Security Obligations: 1. Not use nor disclose information other than as permitted or required by the Agreement,this Addendum or as required by law. 2. Use appropriate safeguards to prevent use or disclosure of the information other than as provided for by the Agreement and this Addendum. 3. Comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI (protected health information)to prevent use or disclosure of PHI other than as provided for by the Agreement. 4. Report to Covered Entity any use or disclosure of the information not provided for by the Agreement of which Business Associate becomes aware, including breaches of Unsecured PHI as required by 45 CFR 164.410. 5. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any agents or subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree, in writing, to the same restrictions, conditions, and requirements that apply to Business Associate with respect to such information. 6. Make available PHI in a designated set record set to Covered Entity upon request within three (3) working days as necessary to satisfy Covered Entity's obligations under 45 CFR 164.524. If Business Associate receives a request for access directly from the individual,then 11 36 Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 7. If Business Associate receives a request pursuant to 45 CFR 164.526 to make any amendment(s)to PHI in a designated record set directly from the individual,then Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 8. Maintain and make available upon request within three (3) working days the information required to provide an accounting of disclosures to Covered Entity as necessary to satisfy Covered Entity's obligations under 45 CFR 164.528. If Business Associate receives a request to provide an accounting of disclosures directly from the individual,then Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 9. Make its internal practices, books, and records relating to the use of PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, available to the Secretary of DHHS and Covered Entity for purposes of determining compliance with HIPAA. 10. To the extent practicable, mitigate any harmful effects that are known to Business Associate of a use or disclosure of PHI or a breach of Unsecured PHI in violation of this Addendum. 11. Use and disclose an individual's PHI only if such use or disclosure is in compliance with the applicable requirements of 45 CFR 164.504(e) and the terms of this Addendum. 12. Refrain from exchanging any PHI with any entity of which Business Associate knows of a pattern of activity or practice that constitutes a breach as defined by North Carolina State Law, HIPAA, or this Addendum. 13. To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). B. Breach Notification: In the event that Business Associate discovers any use or disclosure of PHI not provided for by the Agreement, including breaches of Unsecured PHI as required at 45 CFR 164.410, and any security incident of which it becomes aware, Business Associate agrees to take the following measures within three (3) working days after Business Associate first becomes aware of the incident: 1. To notify Covered Entity of any incident involving the acquisition, access, use or disclosure of Unsecured PHI in a manner not permitted under 45 CFR Part E. Such notice by Business Associate shall be provided without unreasonable delay, except where a law enforcement official determines that a notification would impede a criminal investigation or cause damage to national security. For purposes of clarity for this provision, Business Associate must notify Covered Entity of any such incident within the above timeframe even if Business Associate has not conclusively determined within that time that the incident constitutes a breach as defined by HIPAA. For purposes of this Addendum, Business Associate is deemed to have become aware of the breach as of the first day on which such breach is known or reasonably should have been known to such entity or associate of Business Associate, including any person, other than the individual committing the breach,that is an employee, officer or other agent of Business Associate or an associate of Business Associate. 12 37 2. To include in the above-described notification the names of the individuals whose Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach. 3. To provide a draft letter to Covered Entity to utilize to notify the individuals that their Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach. The draft letter must include,to the extent possible: a. A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known; b. A description of the types of Unsecured PHI that were involved in the breach (such as full name, Social Security Number, date of birth, home address, account number, disability code, or other types of information that were involved); c. Any steps the individuals should take to protect themselves from potential harm resulting from the breach: d. A brief description of what Covered Entity and Business Associate are doing to investigate the breach,to mitigate losses, and to protect against any further breaches; and e. Contact information for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an email address,web site, or postal address. III.TERMINATION A. This Addendum will terminate automatically, without further action by either party, upon termination of the Agreement to which it is attached. B. Covered Entity may terminate this Addendum if Covered Entity determines that Business Associate has violated a material term of the Agreement or this Addendum. C. Upon Covered Entity's gaining knowledge of a breach, as defined by North Carolina State Law or HIPAA, by Business Associate or any of its agents or subcontractors, of the Agreement or this Addendum, Covered Entity shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation, and if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity,terminate this Addendum and the attached Agreement; or 2. Immediately terminate this Addendum and the attached Agreement if either has been breached by a Business Associate, and a cure is not possible. D. In situations where it is not practicable to terminate this Agreement, Covered Entity shall report Business Associate's breach as defined by North Carolina State Law or HIPAA to the Secretary of DHHS, and continue under the existing arrangement with Business Associate until a reasonable alternative becomes available, or until directed by the Secretary of DHHS to terminate the Agreement. E. At termination of the attached Agreement and this Addendum, or upon request of Covered Entity, whichever occurs first, Business Associate shall: 1. If feasible, return or destroy all PHI that Business Associate still maintains in any form, received from Covered Entity or created, maintained or received by Business Associate on behalf of Covered Entity. Business Associate shall only destroy PHI with the written approval of Covered Entity. After return or destruction, Business Associate shall retain no copies of such information. 2. If return or destruction is not feasible, Business Associate will provide Covered Entity with documentation explaining the reason it is not feasible. If the PHI is not returned or destroyed, Business Associate will extend the protection of this Addendum to the 13 38 information and limit further uses and disclosures to those purposes that make the return or destruction of the information not feasible. F. The obligations of Business Associate under this Addendum shall survive the expiration, termination or cancellation of the attached Agreement and this Addendum, and shall continue to bind Business Associate, its agents, employees, contractors, successors and assigns, as set forth herein. G. Business Associate shall indemnify Covered Entity for costs associated with any incident involving the acquisition, access, use or disclosure of Unsecured PHI by Business Associate, any agent or subcontractor, in a manner not permitted under 45 CFR Subpart E. IV. MISCELLANEOUS A. All PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording and electronic display by Covered Entity or its operating units to Business Associate, or is created or received by Business Associate on Covered Entity's behalf, shall be subject to this Addendum. B. In the event of an inconsistency between the provisions of this Addendum and the mandatory provisions of HIPAA, as amended, HIPAA shall control. Where provisions of this Addendum are not included as mandated provisions in HIPAA, but are nonetheless permitted by HIPAA,the provisions of this Addendum shall control. C. Except as expressly stated herein or in HIPAA,the parties to this Addendum do not intend to create any rights in any third parties. D. This Addendum may be amended or modified only in writing signed by the parties. No party may assign it rights or obligations under this Addendum without the prior written consent of the other party. None of the provisions of this Addendum are intended to create, nor will they be deemed to create, any relationship between the parties other than that of independent parties, contracting with each other solely for the purpose of effecting the provisions of this Addendum and any other agreements between the parties concerning their business relationship. E. This Addendum will be governed by the laws of the State of North Carolina,venue Orange County. F. No change, waiver, or discharge of any liability or obligation hereunder on any one or more occasion shall be deemed a waiver of performance of any continuing obligation, or prohibit enforcement of any obligation, on any other occasion. G. In the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of PHI that are more restrictive than the provisions of this Addendum, the provisions of the more restrictive documentation will control. H. In the event that any provision of this Addendum is held by a court of competent jurisdiction to be invalid or unenforceable,the remaining provisions of this Addendum shall remain in full force and effect. I. Headings in this Addendum are for convenience of reference only and shall not define or limit any of the terms or provisions hereof. J. A reference in this Addendum to a section in HIPAA means the section as in effect or as amended. K. Any ambiguity in this Addendum shall be interpreted to permit compliance with HIPAA. L. Business Associate will not use an agent or subcontractor without written agreement by Covered Entity. 14 39 IN WITNESS WHEREOF,the parties have hereunto executed this Business Associate Addendum on the day and year first written above. Orange County By: [County Manager name], Orange County Manager ATTESTED: BUSINESS ASSOCIATE By: Title: ATTESTED: 15 40 Application Scoring Criteria Applications will be scored based on the responses to the application content areas in the chart below. Each content area shall be scored on a scale of 1-4 based on the scale below: 1. POOR Applicant only marginally addressed the application area 2. AVERAGE Applicant adequately addressed the application area 3. GOOD Applicant did a thorough job of addressing the application area 4. EXCELLENT Applicant provided a superior response to the application area Each content area will be weighted and the score of 1 to 4 will be multiplied by the assigned weight of the content area. The following represents the evaluation criteria and relative importance of each criterion (criteria weight): Evaluation Criteria Score Weight Weighted Distribution Score 1. Proposal Summary: deduct 2 points if missing 0 pts. -- 2. Assessment of Need 0 pts. if a. Clear and appropriate geographic area to be served missing. b. Clear statement of needs and gaps in services Otherwise, 4 c. Thorough description of priority populations that is well supported by evidence 4-16 pts. 3. Project Description and Sustainability a. Exactly one of the eligible Option A strategies is selected and proposed project clearly supports the identified strategy b. Well-planned project that is likely to lead to the intended opioid-related impacts, based on the evidence base about strategy and/or activity effectiveness for the prioritized population 0 pts. if c. Clear and appropriate plans to incorporate feedback from program missing. participants to inform program delivery Otherwise, 7 d. Intended impacts of project will likely meet community needs/service gaps 7-28 pts. e. Applicant has engaged or will engage the priority population meaningfully in developing the proposed project f. Proposed project fits applicant's organizational goals well g. Project timelines are achievable and adequate to make intended impacts h. Clear and appropriate plans for project sustainability 4. Equity Impact 0 pts. if a. Project is likely to improve health inequities and/or social determinants missing. of health Otherwise, 2 b. Project is likely to reach, benefit, and equitably engage historically marginalized populations and uninsured and underinsured people 2-8 pts. 5. Organizational Readiness a. Applicant demonstrates the skills and capacity needed to manage the funding award and meet reporting and compliance requirements. 0 pts. if b. Subcontractors are clearly identified, if applicable, and will enhance the missing. success of the project Otherwise, 5 c. Applicant (team) has demonstrated the capacity to conduct culturally humble, sensitive, and appropriate work 5-20 pts. d. Applicant (team)has demonstrated clear understanding of issues that affect people who use drugs 41 e. Applicant (team) has demonstrated experience and/or clear and adequate plans for promoting the health and dignity of people and communities impacted by drug use f. Applicant (team) has demonstrated experience serving those experiencing homelessness and housing instability; Black, Indigenous, and People of Color;federal or NC recognized tribal communities,and/or those transitioning from correctional settings to the community 6. Evidence of Collaborations/Partnerships, Letters of Commitment/Support a. Clear plan to collaborate with other relevant community organizations 0 pts. if that is likely to improve collaboration between local stakeholders missing. b. Clear plan to verify that projects or services are not being duplicated in Otherwise, 2.5 the community and with the population served c. Letters of commitment/support are present from all key project partners 2.5- 10 pts. and match partners' proposed roles in the project 7. Performance Measures and Program Evaluation a. Specific,achievable plans for program evaluation that will yield 0 pts. if meaningful assessment of project's success missing. b. Clear and appropriate plans to engage priority population in evaluation Otherwise, 4.5 design and implementation c. Clear and appropriate plans to capture client data (if applicable) and 4.5- 18 pts. proposed metrics,and to monitor project progress on a regular basis 8. Project Budget: If budget is incomplete and/or does not appropriately support the proposed project, deduct up to 5 points 0 pts. 9. Priority Population: Program meets the criteria as described below. Criterion 3b: "Well-planned activity that is likely to lead to the intended opioid- related impacts, based on the evidence base about strategy and/or activity effectiveness for the prioritized population." 0 pts if The "priority population" as defined for this purpose: missing. • Selective and indicated at high risk for opioid abuse, or already 8 Otherwise, manifesting signs and symptoms of abuse 8—32 pts. • Populations actively misusing opioids, for whom drug treatment, with or without short term or extended MAT, is appropriate • Harm reduction supplies and approaches, including naloxone distribution • Users in recovery seeking ongoing support Total 42 ORANGE COUNTY ORANGE COUNTY NORTH CAROLINA HIGH IMPACT OPIOID ABATEMENT STRATEGIES Funding Proposal Application Form Application Due Date: February 21, 2025 Applicant Agency: General Information Legal Name Piedmont Health Services, Inc. Address 88 Vilcom Center Dr. Ste 110 Chapel Hill NC 27514 Type of Agency ❑ Government/ (check one) Public Authority ❑X Non-Profit ❑ For-Profit Business Telephone 919-933-8494 Website www.pied monthealth.org Primary Contact Full Name Jasmine Fouts Title Grants Manager Email foutsi@piedmonthealth.org Telephone 919-933-8494 Name of Project I Community MOUD for Orange County Total Application Funding Requested IT 50,400 Funding Period Requested Start FDateTJune (MM/DD/YYYY) Date July 12025 30 2026 Selected NC MOA Option A Strategy(Number and Name) 2. Evidence-based addiction treatment Agency Mission and Vision Statements Our Mission:To improve the health and well- being of the community by providing high- quality, affordable, and comprehensive primary health care. Our Vision: Our vision is a healthy community in which all people have timely access to quality health care. i 43 As a separate Excel file, submit a completed Budget Worksheet. Submit application to tstancil@orangecountVnc.gov with a subject line of—RFA: Opioid Settlement Funds— [Organization name]. Will receive Receipt of Application email upon submission. If email is not received within 24 business hours, reach out to Tonya Stancil, Harm Reduction Coordinator at tstancil@orangecountync.gov. ii 44 1. Proposal Summary(no more than 250 words, required but not scored) Piedmont Health Services, Inc. (PHS) will use Orange Co. High Impact Opioid Abatement Strategies funding in order to provide Medication for Opioid Use Disorder (MOUD) services at no cost to a total of 36 new patients in our two Orange County locations (Carrboro and Chapel Hill). As all MOUD recipients will have a diagnosis of Opioid Use Disorder, they will represent a population which faces many barriers to care, including cost of care, transportation, and stigma. Additionally, the majority of PHS patients represent low-income, uninsured, unhoused, and other historically marginalized populations. Reimbursement will be requested for patient co-pays, lab work, and medications. iii 45 2. Project Narrative A. Assessment of Community Need (16 points, page limit: not to exceed 1% pages) This project will serve patients who receive Medication for Opioid Use Disorder (MOUD) services at Piedmont Health Services, Inc. at one of two clinical sites: Carrboro Community Health Center and/or Chapel Hill Community Health Center, both located in Orange County. In 2023, Orange County had an overdose death rate of 32 deaths; additionally, the rate of Orange County residents prescribed buprenorphine (a medication used for Opioid Use Disorder) has steadily risen in the last few years, with 605 residents being prescribed buprenorphine in 2023, up from 488 residents in 2020. In fact, Orange County has one of the highest rates in the state of deaths involving illicit opioid overdose, at 21 deaths in 2023, or 65.6% of overdose deaths. (https://www.dph.ncdhhs.gov/programs/chronic-disease-and-injury/iniury-and- violence-prevention-branch/north-carolina-overdose-epidemic-data) The behavioral health workforce shortage in North Carolina greatly impacts the ability of people with Opioid Use Disorder (OUD) to receive the services they need. The 2023 Treatment Services rate for Orange County was 336.6 out of 100,000 residents, which is low, even though it represents a 10% increase from the prior year. Additionally, 72.8% of children in foster care in Orange County were there due to parental substance use, one of the highest percentages seen in North Carolina. (https://www.dph.ncdhhs.gov/programs/chronic-disease-and-iniury/iniury- and-v_io_lence-prevention-branch/north-carolina-overdose-epidemic-data) One of the main barriers to care for MOUD patients is cost; patients relay this information to clinicians and staff at PHS frequently. According to the 2022 NC Behavioral Risk Factor Surveillance Survey (NC BRFSS), 11.9% of all adults in our service area had at least one instance in which they could not get the medical care they needed in the past 12 months due to cost; for Hispanic patients,the rate was 22%. Of adults who did not access needed mental health care in North Carolina, 44.8% did not because of cost. (https://schs.dph.ncdhhs.gov/data/brfss/2022/nc/all/medcostl.htmi) In the past 365 days, 52.6% of the Orange County assistance requests received by 211 were related to housing and shelter, while 19.8%were related to utilities. (https://nc.211counts.org/) When the cost of living is unattainable, needed services for OUD can fall to the wayside in lieu of keeping the lights on or making rent.This funding would allow PHS to offer MOUD at no cost to the patient,thereby eliminating the financial barrier to care. PHS offers 2-in-1 appointments to patients receiving MOUD, ensuring that the provider visit and Behavioral Health Consultant visit occur back-to-back, thereby cutting the burden of finding transportation in half. PHS also operates in-house pharmacies, essentially providing everything needed —provider visit, Behavioral Health visit, labs, and meds - in one appointment. 1 46 PHS also provides MOUD to the formerly incarcerated, another marginalized community, in Orange County. There are unique barriers for these patients, including having the necessary identification documents to find employment, which makes it very hard to pay for care. People who were formerly incarcerated are from 13 to 40 times more likely to die due to their substance use disorder, mostly by overdose; MOUD during reentry to society has been shown to cut the risk of death by 75 percent. (https://www.*coinctc.org/4ustice-involved-individuals- returning-to-the-community-are-at-high-risk-for- overdose/#:—:text=People%20who've%20been%20incarcerated,criminal%20justice%20system% 20every%20yea r) 2 47 B. Project Description and Program Sustainability(28 points, page limit:not to exceed 3 pages) PHS plans to use Orange County High Impact Opioid Abatement funds toward Strategy 2: Evidence Based Addiction Treatment. The following services will be provided at no cost for Medication for Opioid Use Disorder(MOUD) patients of Orange County: - Visit costs - Lab costs - Medication costs Providing MOUD at no cost is a vital strategy in preventing overdose deaths; individuals with Opioid Use Disorder (OUD) who participate in an MOUD program receive support in managing cravings, reducing withdrawal symptoms, and ultimately, preventing relapse into active addiction. MOUD blocks the effects of opioids and people with access to medications like buprenorphine are less likely to return to illicit opioid use. It is important to note here that illicit opioids are often contaminated with fentanyl or other substances that contribute to a high likelihood of overdose; by preventing relapse, MOUD prevents overdose deaths. MOUD programs also encourage individuals to engage with much-needed services like counseling, which has been show to improve long-term recovery outcomes. Alleviating the cost of visits, labs, and medications for patients means that those financial barriers will not stand in the way of much-needed MOUD services. Providing MOUD at no cost also communicates to patients that we support them in their process,thereby reducing stigma. PHS anticipates using this funding to enroll two new patients in our MOUD program each month at our Carrboro clinic and one new patient each month at our Chapel Hill clinic,for a total of three patients each month, or 36 patients in one year. PHS engages with community members who may require MOUD services by partnering with community agencies such as the Orange County Emergency Services Post Overdose Response Team (PORT), the NC STAR Network, and the Orange County Health Department, among many others. As a known and trusted presence in Orange County, PHS also participates in Health Fairs, often with our Mobile Health Unit, in order to provide health screenings and spread awareness of our services; occasionally we will receive interest in our MOUD services in-person, either from a person with OUD or from a family member or loved one. Referrals for behavioral health or substance use disorder services come from many places, including positive screenings from our medical clinics, patient insurance companies, and other community agencies. This project will advance PHS's vision of a healthy community in which all people have timely access to quality health care. Our hope is that by using this funding to provide services at no cost, we will reach the people who most need MOUD services, and not only provide much- needed care, but also help transition patients into utilizing PHS as a medical home. MOUD is 3 48 one step toward full recovery; the entire process requires a lot of support, including care for any medical or behavioral health issues that may have been overlooked or deprioritized during active addiction. People who have participated in an MOUD program and experience long-term recovery tend to have improved physical, psychological, and social well-being. Any enhancements, improvements, or increases achieved during the project year will be sustained via communication with Orange County Public Health Department, and will be aided by a pre-existing streamlined administrative process. All programmatic decisions will be based on evaluation of program data and patient survey results; input from community partners will also be solicited and considered. Current funding sources for our MOUD program include Federal and State government, insurance providers, and, in Chatham County, Opioid Settlement Fund dollars. In order to sustain this program, PHS will continue to seek diverse funding streams, strengthen community partnerships, and operate efficiently as an agency, with the goal of providing quality services while reducing overhead as much as possible. The current timeline for this program is as follows: July 2025: Training of patient care coordinators and pharmacy staff, begin enrolling patients August-September 2025: Continued implementation and streamlining of administrative process October 2025: Initial reporting and reimbursement documentation submitted; continued implementation; nine total patients enrolled November-December 2025: Continued implementation January 2026: Reporting and reimbursement documentation submitted; continued implementation; 18 total patients enrolled February-March 2026: Continued implementation April 2026: Reporting and reimbursement documentation submitted; continued implementation; 27 total patients enrolled May-June 2026: Continued implementation July 2026: Final reporting and reimbursement documentation submitted; evaluation of program; 36 total patients enrolled Obstacles to the success of this program may include: - Stigma, which can affect the ability to sustain funding for MOUD programs, as well as prevent patients from seeking the services they need; PHS anticipates that investing in providing MOUD at no cost to the patient will counteract stigma significantly - Transportation, which is difficult to find funding for; PHS anticipates that providing a "one-stop shop" for medical, behavioral, lab, and medication services will be a support as patients navigate this obstacle 4 49 Disruptions in consistent attendance, which is common for a treatment program; PHS strives to provide compassionate care and flexibility to patients who may need to reschedule at times, while still maintaining boundaries around the best use of staff and clinic resources Legal and Criminal Justice issues, which may present a barrier if a patient becomes involved in the criminal justice system during MOUD treatment and is unable to communicate with their healthcare providers; PHS will communicate with partners when appropriate, including the Orange County Criminal Justice Resource Department, in order to stay informed on a patients' status and be prepared to coordinate care when necessary, and continue care when possible 5 50 C. Equity Impact(8 points, page limit: not to exceed 3/page) PHS, including its MOUD program, has a long history of serving historically marginalized populations. In 2023, the total population served by PHS was 18.2%White, 17.5% Black, 2.6% Asian, 2.9%>1 Race and 54.4% Hispanic (of any race), with 47% best served in a language other than English. Nearly half(48.6%) of the total population served was health care uninsured, with 94.4%of those applying for sliding-fee care found to live below 200% of the Federal poverty guideline. While less diverse racially, the majority of MOUD patients at PHS are low-income and uninsured. PHS utilizes a sliding scale fee that makes all services, including MOUD, accessible to low-income and uninsured patients. PHS received a 2022 Health Resources &Services Administration (HRSA) Quality Award for its work screening for the Social Determinants of Health (SDoH). Many of our patients face health- related social needs that impact their ability to maintain good health and continuity with healthcare. Challenges include affordable, safe housing and utilities, access to healthy foods, access to reliable transportation, and challenges to personal safety including interpersonal violence and occupational exposure. PHS employs Medical Care Coordinators to follow up with patients after a need is reflected on their SDoH screening and to consult with our many community partners in order to assist patients. 6 51 D. Organizational Readiness(20 points, page limit: not to exceed 3 pages) PHS is a 501c3 Federally Qualified Health Center and has in place all relevant departments, staff, and financial processes needed to implement this program, bill for reimbursement, and meet compliance and monitoring requirements. Prior projects include grants from the Health Resources &Services Administration (HRSA), the North Carolina Department for Health and Human Services (NCDHHS), The Duke Endowment, and more. PHS will not be making new hires or using subcontractors for this project. PHS prides itself on serving a diverse population with a diverse staff, guided by a diverse board. Moreover, the current PHS Board of 10 individuals is 60%White, 30% Black/African American, while 10% are of Hispanic ethnicity. Our 2023 Equal Employment Opportunity Commission (EEOC) report shows that our staff overall were 39%White, 31% Black, 5%Asian, 0.1% Native American, 2% More than One Race, while 22%were of Hispanic ethnicity. PHS is also proud to have welcomed our first Latina CEO, Dr. Daniella Jaimes-Colina, PhD, in January, 2024. Our overarching goal is that our staff reflects the communities we serve, provides care with cultural humility, and improves equity while decreasing stigma. The PHS integrated behavioral care staff are a culturally and linguistically diverse group of professionals with deep understanding of the populations they serve, staff who prioritize the delivery of services with cultural humility and a trauma-informed lens. PHS providers are aware that marginalized patients often experience stigma and discrimination from healthcare providers; moreover, it can take time to build trust with individuals who have experienced stigma within the healthcare system. PHS policies encourage trust-building with patients as a primary focus, building rapport and therapeutic alliance, and getting to know the whole patient, not just their MOUD needs. Staff use body language, validation and other clinical skills to ensure that patient communication is respectful and reduces stress. PHS prioritizes patient safety, including emotional safety, and providers work at the pace that feels safest for the patient. PHS uses video interpretation services as necessary to meet patient language needs, and also employs contract interpreters for Burmese/Karen dialect interpretation.All written patient education materials are reviewed for literacy level. Alternative medication labeling is available for individuals with low literacy. PHS operates eight in-house pharmacies that stock a full formulary of medications for mental health and substance use concerns, including for MOUD naloxone and buprenorphine (tablets and films). On-site pharmacy allows patients continual access medications at an affordable cost, and to counseling with the pharmacy team. PHS serves marginalized communities, including those experiencing homelessness and housing instability, Black, Indigenous, and People of Color(BIPOC), and those transitioning from 7 52 correctional settings to the community. For the homeless population in Orange County, services are delivered on-site at the Inter-Faith Council for Social Service (IFC), a local homeless shelter, so as to be co-located with the social services provided there. Please see sections C. and E. for more details. 8 53 E. Evidence of Collaborations/Partnerships (10 points, page limit: not to exceed 1% pages) PHS collaborates with many partners in Orange County, including: 1.The NC STAR Network, a "statewide initiative with an overarching goal of expanding access to addiction treatment for all residents of North Carolina via a network model".Via bimonthly meetings to discuss complicated cases and provider forums with educational topics focused on substance use disorders, PHS both provides and receives support and referrals from NC STAR. 2. Orange County Health Department (OCHD): —PHS participates in the Orange Partnership for Alcohol and Drug Free Youth with the Orange County Health Department; quarterly meetings are held in order to learn about current substance use data trends, available resources, harm reduction supplies, medical services, and more. OCHD also refers patients to PHS for our MOUD program. 3.The Criminal Justice Resource Department of Orange County:Through its Lantern Project, a deflection, diversion, and reentry program which supports people with histories of substance abuse who are justice involved by connecting them to therapeutic services. PHS receives referrals of patients who are currently detained and in need of MOUD, as well as updates on current MOUD patients who are newly detained. Through this long-standing partnership, PHS is able to offer clinical coordination for patients involved in the criminal justice system. 4. North Carolina Formerly Incarcerated Transition Program (NC FIT):The NC FIT Program employs Community Health Workers (CHWs)with a personal history of incarceration to connect recently released people with substance use disorder to appropriate health care services. NC FIT sees patients at PHS's Chapel Hill clinic, and occasionally NC FIT will refer patients to PHS providers. 5. Orange County Post Overdose Response Team (PORT): PORT refers patients to PHS after they have experienced an overdose. PORT can administer MOUD for up to 7 days after an overdose; PHS offers clinical coordination for patients who are receiving MOUD through PORT, as well as a more sustainable program for the patient if desired. PHS offers a low-barrier Office Based Opioid Treatment (OBOT) program in Orange County. Other OBOTs in Orange County,such as Freedom House and UNC Family Medicine, provide some of the same services as PHS, however,there are enough differences between our programs that we are not duplicating services. PHS often provides care to patients that have been discharged from other OBOTs in the area; patient needs vary and not every program will be a good fit. PHS is the only OBOT in Orange County that is also a primary care medical home;we have access to a larger swatch of the population, and more possible entry points to treatment.We are also distinct in that we offer two clinic sites in Orange County,one in Chapel Hill and one in Carrboro; both of which see high numbers of patients each day and offer expanded hours of service. Additionally, patients who come to our MOUD program are able to have a "one stop shop"for all needs related to MOUD, as well as medical, dental, behavioral health, nutrition, and other specialists. 9 54 F. Performance Measures and Program Evaluation (18 points, page limit:not to exceed 1 page) This project will be evaluated via quantitative and qualitative data. Our quarterly goals are to serve nine Orange County residents with MOUD services at no cost to the patient, including four provider visits and four Behavioral Health Consultant visits per quarter, all essential lab tests, and monthly medication (amount/exact medication and labs will depend on patient need). Quantitative data will be captured via our Electronic Medical Records and will include the following: - Number of patients who receive MOUD services - Number of appointments/visits attended - Number and type of labs provided - Amount and type of medication provided - Patient demographics - Patient diagnoses Qualitative data will be captured via patient survey and will include: - Patient satisfaction level - Any comments or suggestions Evaluation will be performed by Admin staff at the midpoint and conclusion of the 12-month program. 10 55 1 56 3. Certifications and Required Forms A. Application Certification I have reviewed this application for accuracy. I understand that Opioid Abatement funds are intended to address specific remediation activities as identified under the NC Memorandum of Agreement (MOA)for the Opioid Settlement Funds. I understand that these opioid settlement funds are subject to State laws and regulations,and I have read the MOA and agree to the requirements. I certify that the requested funds will be used in compliance with these requirements and with all requirements outlined in the Orange County High Impact Opioid Abatement Strategies RFA. I agree to submit invoices and other relevant documentation to Orange County to pay or be reimbursed, as well as quarterly status reports,by the date stated in the contract. I understand that Orange County requires agencies with receipts less than $500,000 that do not have a financial audit(or a financial report), prepared by a certified public accountant(CPA)to complete schedule of Receipts and Expenditures form. An agency does not need to complete this form if it has a prepared audit/report it can submit for the calendar year ending December 31, 2022 or the fiscal year ending June 30, 2023. Agencies with receipts totaling$500,000 or more,from any source, must submit a CPA-certified financial audit. financial statements for each year that opioid settlement funding is provided to my organization,and that Orange County may monitor the program during the award period. Agency Authorized Official Daniella Jaimes-Colina (print name) Signature panieGGa 1721�ger—CoGlha Daniella Jaimes-Colina(Feb 17,)02514:58 EST) Title Chief Executive Officer Date 02/17/2025 Board Chair/Elected Official LeenaMehta (print name) Signature L 22rt��et Leena Mehta(Feb 17,2025 16:49 EST) Title Board President/Chairperson Date 02/17/2025 57 Ormige County Office: (919) 245-2301 Courdiouse Fax: (919) 640-1729 106 least Margaret Lane azirlccl@orangecouutync.gov Hillsborough,NC 27278 CRIMINAL JUSTICE RESOURCE DEPARTMENT February 14, 2025 Dear Dr.Jaimes-Colina, As a current partner of Piedmont Health Services and a representative of programs that serve people with Opioid Use Disorder in Orange county, I am writing this letter to express my support for Piedmont Health Service Inc.'s application to the Orange County High Impact Opioid Abatement Strategies funding. The Lantern Project is a Deflection, Diversion, and Reentry program that works to support people with histories of substance use who are justice involved by connecting them to therapeutic supports as soon as possible. One of the ways we plan to continue serving our community is through strengthening our partnership with Piedmont Health Services, Inc. (PHS), an agency which is implementing an impactful evidence-based addiction treatment program. By strategically partnering with an organization that is providing Medications for Opioid Use Disorder (MOUD) as well as primary care,we can help people achieve goals of stability, health, and well-being.This enhanced partnership has the potential to create a more streamlined, patient-centered approach to recovery and wellness. PHS provides much-needed, low barrier access to MOUD and medical care,and we look forward to strengthening our partnership with PHS with regards to client MOUD referrals and care coordination. Please feel free to contact me at the email below if you require any further information. Sincerely, AlliPZirkel, LCSW, LCAS Clinical Coordinator Criminal Justice Resource Department Office:919-245-2304, Cell: 919-748-2196 azirkel@orangecountync.go_v ORANGE COUNTY NORTH CAROLINA 58 NC STAR 'YNETWORK Shifting Cultures,Saving Lives February 10th, 2025 Dear Dr.Jaimes-Colina, As a partner of Piedmont Health Services and a representative of programs that serve patients with Opioid Use Disorder in Orange County, I am writing this letter to express my support for Piedmont Health Service Inc,'s application to the Orange County High Impact Opioid Abatement Strategies funding. The NC STAR Network connects community and academic partners across the state to expand equitable access to life-saving treatment for substance use disorders. NC STAR provides clinical expertise as well as didactic education to providers. One of the ways we plan to continue serving our community is through strengthening our partnership with Piedmont Health Services, Inc, (PHS), an agency which offers impactful evidence-based addiction treatment. PHS is NC STAR Network's oldest community partner and a vital collaborator in the evolution of addiction care delivery. By strategically partnering with an organization that is providing Medications for Opioid Use Disorder(MOUD) as well as primary care, we can help people achieve goals of stability, health, and well-being.This partnership has the potential to create a more streamlined, patient-centered approach to recovery and wellness. I look forward to strengthening our collaboration with PHS in order to serve the needs of community members with Opioid Use Disorder within Orange County. Please feel free to contact me at the email below if you require any further information. Sincerely, H. Claire st, MD Director, NC STAR Network Associate Professor of Medicine UNC-Chapel Hill School of Medicine Claire—west@med.unc.edu 984-974-4462 Vorth Carolina Substance Treatment and Recovery Network ncstarnetwork.org 59 � + Orange County 7 Emergency Services A Prepared,Coordinated,and Integrated Emergency Services System V E9-1.1 E-911 I Fire Marshal I EMS I Emergency Management EMS DIVISION February 14t`2025 Dear Dr. Jaimes-Colina, As a partner of Piedmont Health Services and as the manager of the Orange County Emergency Services (OCES) Post-Overdose Response Team (PORT), I am writing this letter to express my support for Piedmont Health Services Inc.'s intentions of utilizing Orange County High Impact Opioid Abatement Strategies funding to provide additional financial support for individuals receiving evidence-based treatment. One of the most impactful services we provide to our community is the ability to remove the barriers presented to an individual who is experiencing opioid-use disorder (OUD) in accessing medications for opioid use disorder (MOUD). However, an additional and critical barrier we have frequently encountered with the individuals that we serve is in their ability to afford ongoing access to these services as well as accessing and affording additional services for other healthcare needs. By strategically partnering with an organization that is providing MOUD as well as primary care, we can help people achieve goals of stability,health, and well-being. I look forward to strengthening our collaboration with Piedmont Health Services in order to further serve the needs of community members with OUD within Orange County. Please feel free to contact me at the email below if you require any further information. Sincerely, U4-. a • P. Wg"4. Landon Weaver Bureau Chief of Community Health and Safety EMS Division-Orange County Emergency Services lweaver@orangecountync.gov 510 Meadowlands Drive I Hillsborough, NC 27278 1 (919) 245-6100 Main Office www.orangecountync.gov/oces 60 ORANGE COUNTY ORANGE COUNTY HIGH IMPACT OPIOID ABATEMENT NORTH CAROLINA STRATEGIES Funding Proposal Application Form Application Due Date: February 21, 2025 Applicant Agency: General Information Legal Name EI Futuro, Inc. Address 2020 Chapel Hill Rd. Suite 23 Type of Agency ❑ Government/ ❑ For-Profit (check one) Public Authority ❑X Non-Profit Business Telephone 919-688-7101 Website Elfuturo-nc.org Primary Contact Full Name Kerry S. Brock Title Associate Director Email kbrock@elfuturo-nc.org Telephone 828-688-7101 ext. 632 Name of Project Orange County Latino Early Intervention Program Total Application Funding Requested $ 74,115.29 Funding Period Requested Start End (MM/DD/YYYY) Date 07/01/2025 Date 06/30/2026 Selected NC MOA Option A Strategy (Number and Name) 6. Early Intervention Agency Mission and Vision Statements EI Futuro's mission is to nurture stronger familias to live out their dreams, with a vision that all Latino families who seek mental health support can access appropriate services and function at their most vibrant at home, work, and school, strengthening our entire community. i 61 1. Proposal Summary EI Futuro respectfully requests support to implement its Orange County Latino Early Intervention Program, expanding Community Mental Health Worker's (CMHW) capacity to prevent and address substance use disorder (SUD) and co-occurring mental health conditions among historically marginalized Latino individuals in Orange County. Strengthening early intervention efforts, reducing stigma, and strengthening community coordination will improve outcomes for Latino youth, young adults, and their caregivers. Through recent investments, EI Futuro launched CMHWs trained in culturally responsive interventions for depression and anxiety. However, they lack SUD training and must refer out when clients present with SUD concerns, increasing obstacles. This project closes that gap by training CMHWs in Screening, Brief Intervention, and Referral to Treatment (SBIRT) and motivational interviewing (MI), expanding their service array and increasing access to culturally and linguistically responsive services. Expected impact includes: • Overdose Prevention: Partner with two agencies to provide harm reduction education, overdose recognition training, and distribute 50 bilingual naloxone kits. • Early Intervention: Screen 180 young adults (18+) and/or caregivers of younger youth for substance use risk factors and SDOH needs annually. • Referrals &Treatment: Connect individuals to EI Futuro services, Freedom House, or other county providers for treatment, behavioral health, or SDOH resources. • Community Capacity: Strengthen early intervention infrastructure through CMHW training and integrated services. • Community Engagement: Enhance local partnerships, including the Orange County Partnership Coalition, faith sites (St. Thomas More, Chapel Hill United Church, etc.), EI Centro Hispano, and Orange County Rape Crisis Center, among others, through psychoeducation, expert training, resource development, and outreach events. ii 62 2. Project Narrative A. Assessment of Community Need Geographic Area and Overdose Burden EI Futuro's proposed Latino Early Intervention Program will serve Latino youth, young adults, and caregivers in Orange County, North Carolina (NC). In 2021, NC saw its highest overdose deaths in a single year (4,041), a 22% increase from the prior year, with over 77% linked to fentanyl (The Daily Tar Heel, 2023). While NC saw some relief in 2022-23 due to expanded harm reduction efforts, opioid misuse remains a critical public health concern. Orange County alone reported 48 opioid-related ED visits and five heroin overdoses in 2023 (Orange County CHA, 2023), highlighting the need for expanded prevention strategies. Need for This Work and Gaps in Services Data and experience prove that Latino communities face disproportionate barriers to substance use and mental health care, including cultural stigma, lack of bilingual providers, and systemic inequities. Substance use is underreported in Latino populations due to fear and lack of culturally competent services (SAMHSA, 2021 and 2023 National Survey on Drug Use). Research confirms early intervention for alcohol, marijuana, and other drug misuse significantly reduces the risk of opioid dependency (Society of Adolescent Health and Medicine, 2023). Given that co- occurring mental health disorders are a primary risk factor for opioid misuse, targeted early intervention is crucial. EI Futuro has provided culturally responsive mental health services for over 20 years, observing a rising demand for substance use prevention and treatment. Nationally, 22% of Latino youth experience depression, the highest rate except for Native Americans, yet only 8% receive treatment, compared to 14% of white youth (University of Texas, 2017). Limited Spanish- language behavioral health services in Orange County further exacerbate this disparity. When services are available, financial barriers prevent many from accessing care. While Latinos make up 10.5% of Orange County's population (Census.gov, 2023), a disproportionate number (28.7%) of Latinos under 65 lack health insurance—over three times the rate of uninsured non- Hispanic whites (9.4%) (NC DHHS, 2023). Additionally, 20.7% of Latino residents in NC live below the Federal Poverty Level (FPL), further limiting access to treatment (NC Budget and Tax Center, 2023). Expanding affordable, culturally competent mental health services is essential. Priority Population & Determination of Needs Targeted populations include Latino youth and young adults at risk for substance use, caregivers, CMHWs, and community leaders. Latino youth often navigate complex cultural stressors, such as serving as family interpreters in medical and educational settings, increasing mental health burdens. 12.6% of Orange County residents are foreign born and 4.7% report limited English proficiency (Orange County CHA, 2023). Needs assessment findings include: 1 63 • Client feedback surveys showing significant substance use concerns among Latino clients with limited access to SUD treatment. • Community engagement events, including La Mesita, where Latino families repeatedly emphasize the need for Spanish-language education and resources. • Collaborations with local health and social service providers, who report a growing number of Latino individuals seeking behavioral health support for SUD without culturally competent access. Evidence for Early Intervention Rising fentanyl-related overdoses and substance misuse underscore the urgency for prevention- focused, culturally competent programming. National research consistently confirms early intervention significantly reduces long-term dependency risks (2023 National Survey on Drug Use). Early intervention for alcohol, marijuana, and other drugs can prevent opioid misuse by up to 40% in at-risk populations (SAMHSA, 2016). Despite this evidence, Latinos remain far less likely to seek treatment(SAMHSA, 2021). SBIRT is a proven, effective intervention. SAMHSA evaluations show that clients receiving brief interventions reduced substance use by 128.8% within six months. Additionally, 99.6% of clients reported fewer negative social consequences related to substance use following SBIRT implementation (SAMHSA, 2023). Integrating SBIRT screening and early intervention will bridge critical service gaps, expand access to culturally responsive prevention efforts, and reduce opioid misuse risks, ensuring long-term health equity for Latino families in Orange County. B. Project Description and Program Sustainability Implementation Strategy EI Futuro proposes to implement "Strategy 6: Early Intervention Services" from the NC MOA's Option A list of eligible strategies to enhance early identification and prevention of SUD among historically marginalized Latino youth and young adults in Orange County. This initiative will train CMHWs in SBIRT and Motivational Interviewing (MI) to strengthen early intervention efforts and expand access to culturally and linguistically appropriate services. By embedding SBIRT and early intervention into EI Futuro's existing mental health framework, the proposed project will expand access to screening, education, and intervention while ensuring seamless linkages to care. Project Overview and Expected Impact EI Futuro recognizes the gaps in opioid-related prevention and recovery support for Latino individuals in Orange County. To strengthen early intervention efforts, this proposal will expand support for Latino youth and young adults at risk of substance use disorders by: • Implementing SBIRT screenings: Training all CMHWs in SBIRT and MI to identify substance use risk factors and co-occurring mental health concerns at key entry points 2 64 within EI Futuro's services. CMHWs will use Spanish-language materials and a culturally tailored approach to ensure accessibility and encourage engagement. Enhancing coordination with local providers: Strengthening partnerships with hospitals, clinics, harm reduction programs, and behavioral health services to ensure wraparound support and expand access to care, including pain management alternatives. • Collaborating with schools and community centers to provide SBIRT screenings and prevention-focused workshops for youth. • Engaging caregivers in psychoeducation workshops to equip them with knowledge about mental health, substance use prevention, and harm reduction strategies. • Expanding early intervention services for young adults (18+) experiencing early signs of depression, anxiety, or trauma, which can be precursors to substance use disorders (SUDS), through the Strong Minds curriculum. • Culturally and linguistically responsive outreach and education: Developing and distributing Spanish-language educational materials and conducting bilingual workshops, social media campaigns, and youth-focused community engagement that increases knowledge of opioid risks, improves awareness of behavioral health services, and ensures targeted populations receive accurate, stigma-free information and access to early intervention services. This will include education on the dangers of medication sharing and harm reduction strategies. Expected impacts include: o Early Identification: Screen 180 individuals annually for substance use risk factors and SDOH concerns. o Timely Intervention: Offering SBIRT and MI to increase engagement in mental health and substance use services. o Increased Treatment Access: Comprehensive referrals for mental health and substance use treatment, including via Freedom House or other local providers. o Community Capacity Building: Strengthening local capacity for early intervention through CMHW training, integration with behavioral health services, and expansion of culturally responsive care. Community Engagement and Development EI Futuro has actively engaged community members, clients, and local partners in the development of this project through: 1. Focus Groups, Feedback, and Surveys: Latino clients consistently express a need for accessible and culturally competent substance use prevention services. 2. Collaboration with Healthcare and Community-Based Organizations: Partnerships with health clinics, schools, harm reduction programs, and faith-based organizations have informed service delivery needs and outreach strategies. 3. Staff Training and Professional Development: CMHWs will receive training in SBIRT, opioid harm reduction, and culturally competent early intervention strategies to ensure effective, linguistically appropriate care. 3 65 Alignment with EI Futuro's Goals This project directly advances EI Futuro's mission to provide accessible, culturally responsive mental health and substance use treatment for Latinos in North Carolina. By expanding early intervention screenings and strengthening provider coordination, EI Futuro enhances its commitment to integrated behavioral health, reducing stigma, and fostering a community- driven approach to opioid prevention. Implementation Timeline PHASE KEY ACTIVITIES TIMELINE STAFF RESPONSIBLE PHASE 1: Train CMHWs in SBIRT and July-Aug Program Director PROGRAM DEVELOPMENT MI 2025 PHASE 2: Integrate SBIRT screenings Sept-Oct Clinical team PROGRAM LAUNCH & into intake process 2025 OUTREACH Launch community-based Oct 2025 CMHWs and Project early intervention services Manager PHASE 3: Conduct impact evaluation Nov 2025 - Project Manager & EXPANSION & EVALUATION and adjust strategies May 2026 Program Director Capacity Building and Long-Term Sustainability This project will strengthen EI Futuro's capacity and Orange County's behavioral health infrastructure to better support opioid-affected individuals. Training bilingual, culturally responsive CMHWs in SBIRT will create a sustainable workforce equipped to identify and address substance use risks in Latino communities. By embedding SBIRT screenings into standard clinical practice, EI Futuro ensures that early intervention becomes a permanent part of service delivery. Obstacles and Solutions for Sustainability POTENTIAL CHALLENGE PROPOSED SOLUTION Limited funding for Seek diverse funding, expand insurance reimbursement, and CMHWs advocate for sustainable early intervention funding. Need for higher-level Develop a referral guide and strengthen connections with higher- care for clients requiring level care providers specialized treatment Limited awareness of Implement culturally tailored outreach via trusted peer networks, among Latinos Spanish-language materials, and social media campaigns. Workforce burnout and Provide ongoing training, group supervision, and operational retention challenges feedback sessions to support CMHWs in their roles. Other Funding Sources EI Futuro is actively pursuing additional funding sources to sustain and expand these services. 4 66 • State and Federal Funding: Exploring new and continued funding via state/federal programs as they are available and accessible, including NC DHHS and SAMHSA grants for Latino early intervention and substance use prevention. • Private Foundations: While this proposal seeks Orange County Opioid Settlement Funds, EI Futuro is actively pursuing additional funding sources to sustain and expand these services, including: We will also continue to seek funds from the Orange Co ABC Board (a regular funder) and other private foundations as appropriate. • Insurance Reimbursement: SBIRT is an existing Medicaid-billable service in North Carolina under the T1015 HCPCS code, including HI and SC modifiers when appropriate. EI Futuro will ensure its CMHWs are trained in billing and documentation to maximize Medicaid reimbursement opportunities. C. Equity Impact At the heart of EI Futuro is improving access for historically marginalized Latino individuals. The Early Intervention Program will address health inequities for Latino young adults and parents/caregivers in Orange County, who face language barriers, stigma, and a lack of culturally competent providers, delaying care and increasing reliance on costly emergency services. This initiative will provide free, bilingual SBIRT screenings, identifying individuals at risk early and preventing crisis situations. Additionally, EI Futuro will leverage its referral network to connect un/underinsured individuals to affordable addiction treatment, behavioral health resources, primary care, and other essential services. Addressing the Needs of the Uninsured and Underinsured When services are available, financial barriers cause additional access challenges. While Latinos make up 10.5% of Orange County's population (Census.gov, 2023), a disproportionate number (28.7%) of Latinos under 65 lack health insurance—over three times the rate of uninsured non- Hispanic whites (9.4%) (NC DHHS, 2023). With your support, EI Futuro will improve access to services, regardless of insurance status. Bilingual and free early intervention services and support will help young people overcome administrative barriers to accessing care. Addressing Social Determinants of Health (SDOH) Substance use risk is closely linked to social determinants of health (SDOH) such as housing, employment, transportation, and social support. Unmet basic needs increase substance use rates and create barriers to treatment. Addressing these factors through targeted interventions promotes health equity and improves outcomes. EI Futuro's case management program has strong ties to local resources in Orange County. This program will expand CMHWs' capacity to screen for SDOH concerns and provide care navigation, connecting individuals with housing assistance, workforce development, 5 67 transportation support, and culturally tailored psychoeducation to reduce stigma and increase community-wide support for early intervention and recovery. D. Organizational Readiness Capacity for Fiscal, Reporting, and Grant Compliance EI Futuro, a trusted nonprofit serving Latino communities in North Carolina since 2004, has a proven track record in grant management, financial compliance, and program sustainability. The organization has a proven track record in grant management, financial compliance, and program sustainability, successfully managing federal, state, and private funding, including from NC DHHS, the Governor's Crime Commission, the FM Kirby Foundation, and the Blue Cross Blue Shield Foundation of NC, among other reputable funders. EI Futuro has effectively administered multi-year, high-impact grants, such as a $900,000 general support grant from the William R. Kenan, Jr. Charitable Trust and a $600,000 general support grant from the Oak Foundation to expand culturally responsive, community-based programs. Additionally, EI Futuro's local LME/MCO committed $3.4 million to support its expansion of behavioral health services, further demonstrating the organization's ability to scale programs and sustain services beyond initial funding periods. EI Futuro's finance and grants management team ensures rigorous fiscal oversight, reporting accuracy, and compliance with all funding requirements. The organization undergoes an annual independent financial audit, reinforcing transparency and accountability. EI Futuro also employs a robust data tracking system to monitor client engagement, program outcomes, and expenditures, ensuring timely and accurate reporting for funders. Culturally Appropriate Service Delivery and Community Engagement EI Futuro's service model is community-centered, linguistically responsive, and culturally competent, ensuring programming aligns with the lived experiences of Latino youth, young adults, and their caregivers. Over 75% of EI Futuro's staff identify as Latino, ensuring deep cultural competence in engaging young people and families struggling with substance use and mental health concerns. Bilingual, bicultural CMHWs and Peer Support Specialists (PSSs) deliver services in a culturally humble and sensitive manner, deepening trust and improving accessibility. EI Futuro actively partners with youth-serving organizations, schools, and faith-based groups to reach historically marginalized populations and young people experiencing early signs of substance use. Sin Ataduras, EI Futuro's substance use prevention and treatment initiative, reached 830 community members in FY2024, highlighting the growing need for substance use services. Additionally, EI Futuro's LAYA Advisory Council (Latino Adolescents and Young Adults) plays a key role in shaping youth-centered programming. The LAYA Advisory Council is comprised of young Latino leaders who provide ongoing feedback on mental health, prevention, and intervention 6 68 programs. Their insights have been instrumental in: Identifying the need for psychoeducation workshops for caregivers to better understand mental health, substance use prevention, and harm reduction; reducing stigma around seeking mental health and substance use support through peer-led engagement and community outreach initiatives; leading prevention activities, such as Simulacros (mock emergency drills), where they educate their peers on substance use risks and intervention strategies; and providing quarterly feedback to enhance programming and outreach efforts. Their input ensures services remain relevant, engaging, and effective for Latino youth. Experience Serving Historically Marginalized Populations EI Futuro has successfully served historically marginalized populations with culturally- responsive, bilingual services since inception. The organization and its staff are committed to promoting the health and dignity of Latino youth, young adults, and caregivers impacted by mental health and substance use challenges. By leveraging its deep community relationships and culturally tailored programming, he organization's early intervention approach will expand early intervention strategies to empower Latino youth, young adults, and their caregivers to seek support, reduce substance use risks, and build a strong foundation for mental well-being and recovery. E. Evidence of Collaborations/Partnerships EI Futuro has a long-standing commitment to collaboration, partnering with key community organizations across Orange County and North Carolina to ensure Latino youth, young adults, and their caregivers have access to culturally responsive mental health and substance use services. Through this project, EI Futuro will strengthen existing partnerships and establish new collaborations to enhance early intervention. Key Partnerships and Collaborative Efforts • Orange County Health Department (OCHD): Collaborating with OCHD's Harm Reduction Program and the county's Harm Reduction Coordinator to provide culturally appropriate harm reduction education and distribution of naloxone, increase awareness of resources, integrate SBIRT into community-based settings, and provide referrals for Medication-Assisted Treatment (MAT) as needed. • UNC Health and Federally Qualified Health Centers (FQHCs): Strengthening existing partnerships with UNC Health clinics and local FQHCs to ensure that individuals identified through SBIRT receive timely referrals to addiction treatment, primary care, and mental health services. These providers will also serve as referral pathways for individuals needing more intensive care. 7 69 • Alliance Health (Local Managed Care Organization - MCO): This partnership will help connect uninsured and Medicaid-eligible individuals to substance use treatment services covered by Medicaid, supporting long-term sustainability for the program. • Faith-Based and Grassroots Organizations: Many Latino families turn to churches and grassroots organizations for support before seeking formal treatment. EI Futuro will work with Latino-led churches, community groups, and trusted leaders to increase awareness, reduce stigma, and promote culturally competent prevention and intervention services. • Behavioral Health & Crisis Services: Coordinating closely with behavioral health partners such as Piedmont Health Services, Freedom House Recovery Center, and local crisis response teams to facilitate referrals for individuals requiring higher levels of recovery support and specialized care. Avoiding Duplication of Services EI Futuro is committed to complementing— not duplicating—existing opioid response efforts in Orange County. To ensure efficient resource allocation and prevent service duplication, the organization will: • Actively participate in the Orange County Opioid Response Task Force to align activities with county-wide prevention and intervention strategies and contribute to broader strategies. • Maintain strong referral networks with behavioral health and substance use providers to ensure that clients receive the most appropriate level of care. • While EI Futuro currently uses multiple internal data tracking platforms (IMS, Monday.com, and soon RedCAP), efforts will be made to streamline communication between program teams to ensure continuity of care and avoid service redundancies. • Engage the community through focus groups, surveys and feedback mechanisms like the LAYA Advisory Council to continuously assess service gaps and adjust programming to meet evolving needs. F. Performance Measures and Program Evaluation EI Futuro will implement a comprehensive evaluation plan aligned with SAMHSA and NIH best practices to measure client progress, program impact, and community engagement. This program follows SAMHSA's SBIRT framework, which has been shown to increase early identification of substance use risks, reduce long-term addiction rates, and improve access to treatment. Research highlights that early intervention prevents escalation to severe opioid use and co-occurring mental health disorders, reinforcing the need for structured evaluation measures. To assess progress and effectiveness, El Futuro will track the following key indicators: • SBIRT Screening Metrics: Number of individuals screened for substance use risks, interventions delivered, and referrals made to behavioral health services. • Pre- and Post-Assessment Surveys: Client-reported changes in substance use behaviors, mental health status, and service access. 8 70 • Client Tracking via NCTOPPS: Demographic, service utilization, and treatment outcome data collected per state reporting requirements. • Program Utilization and Retention Rates: Attendance and engagement in SBIRT screenings, psychoeducation, and early intervention services to assess long-term impact. • Community Feedback and Stakeholder Input: Focus groups, youth advisory meetings, and satisfaction surveys to improve culturally responsive service delivery. Data Collection and Monitoring Plan PERFORMANCE METRIC TARGET DATA SOURCE COLLECTION MEASURE FREQUENCY # of clients screened using SBIRT 180+ Intake records Monthly % of screened clients receiving early 65% SBIRT Tracking Quarterly intervention support Forms % of clients reporting improved 70% Pre/Post client Quarterly substance use outcomes surveys % of clients referred to treatment 50% Referral Monthly services documentation % of clients screened for SDOH 100% SDOH Assessment Monthly concerns Engaging the Priority Population in Evaluation To ensure that evaluation methods are informed by the lived experiences of Latino youth, young adults, and caregivers, EI Futuro will integrate culturally relevant feedback mechanisms into the assessment process. • Community-Led Feedback Loops: Latino youth will help shape evaluation tools and service improvements to ensure relevance, accessibility, and effectiveness. • Culturally Responsive Data Collection: Surveys and assessment tools will be available in Spanish and English, ensuring linguistic and cultural accuracy. • Continuous Quality Improvement (CQI) Process: Program evaluation findings will be reviewed quarterly to refine intervention strategies based on participant feedback, increase engagement in SBIRT screenings and psychoeducation, and ensure equitable access to services for all priority populations. 9 Orange County 71 Z%N sto, Rape Crisis Center Support. Advocacy. February 20, 2025 Tonya Stancil, Harm Reduction Coordinator Board of Directors Orange County Government tstancil@orangecountync.gov Anna Lynch Nick Dantonio E: Letter of Support for EI Futuro's Early Intervention and Prevention Program Board Co-Presidents Dear Ms. Stancil, Alvonia Baldwin Elexia Bostic I am pleased to provide this letter of support on behalf of Orange County Rape Crisis Center for EI Chandra Hollier Futuro's application to the Orange County opioid settlement funds.Addressing the opioid crisis Shama Holman Corey Jones within Latino communities requires innovative, culturally responsive approaches, and EI Futuro is Heather Nash uniquely positioned to implement such a program through their Early Intervention and Prevention Robert Pleasants Initiative. Cathryn Rich Tora Taylor-Glover EI Futuro's proposal,which integrates Screening, Brief Intervention, and Referral to Treatment G.Montez Thomas (SBIRT)within their existing mental health services, aligns seamlessly with Orange County's strategy to mitigate opioid-related harms. By providing early intervention and ensuring accessible referral pathways, this initiative will expand support for individuals and families impacted by substance use. Rachel Valentine Executive Director As a longstanding partner of EI Futuro, OCRCC recognizes their proven track record in delivering high-quality, culturally competent behavioral health services.We strongly believe that their approach will be instrumental in reducing barriers to treatment and ensuring that more individuals receive the support they need before reaching crisis points. OCRCC is committed to supporting this initiative by engaging providing referrals for OCRC clients who are a good math to the SBIRT program and fielding any relevant referrals for EI Futuro SBIRT clients who may benefit from the case management and peer support services offered by our agency. Many victims of the opioid crisis are also victims of trauma, and a collaborative approach to addressing the complex trauma care needs of these clients is part of our commitment. We are also looking forward to continued serving as a mobile advocacy and counseling site for EI Futuro community health workers who may be engages in identifying eligible clients for the SBIRT program. . Our partnership with EI Futuro underscores our shared commitment to promoting health and wellness in the Latino community and beyond. We urge Orange County to support this vital initiative,which will play a critical role in expanding early intervention and prevention efforts.Thank you for your time and consideration, and we look forward to continuing our collaborative efforts with EI Futuro. Sincerely, °oc�. ` Rachel Valentine Executive Director CDE9938FABC7493... Orange County Rape Crisis Center 72 ORANLE PhRTNERSHIP FOR ALCOHOL AND DRUG FREE YOUTH February 19, 2025 Tonya Stancil,Harm Reduction Coordinator Orange County Government tstancil@orangecountync.gov RE: Letter of Support for El Futuro's Early Intervention Initiative Dear Ms. Stancil, I am writing on behalf of Orange Partnership to express our strong support for El Futuro's proposal to implement the Orange County Latino Early Intervention Program through the opioid settlement funds. As a key collaborative organization in youth substance use prevention, Orange Partnership recognizes the urgent need for early intervention strategies tailored to the Latino population in Orange County. El Futuro's proposed initiative aims to bridge critical service gaps by incorporating Screening,Brief Intervention, and Referral to Treatment(SBIRT)within their culturally competent mental health framework. This approach aligns closely with the county's priorities in addressing opioid use and related behavioral health challenges,particularly among underserved Latino residents who often face language and systemic barriers to care. Orange Partnership collaborates regularly with El Futuro in various capacities, and has witnessed firsthand their dedication to holistic, community-centered care. By working together, we aim to strengthen referral networks, enhance service accessibility, and promote proactive intervention strategies that prevent early initiation and interventions of opioid misuse, and support long-teen wellness in our community. As a committed partner in support of El Futuro's work to serve the Latino communities of Orange County, we will contribute to this initiative by encouraging coalition members in cross-referrals, co-hosting educational events,provide training resources, or other needed supports. We believe this initiative will provide much-needed resources and support to individuals and families impacted by substance use. We hope Orange County will invest in this important initiative to provide these needed services, which will benefit Latino individuals and families navigating substance use and mental health challenges. We look forward to continuing our partnership with El Futuro in improving health equity and access to essential service Sincerely, Gayane Chambless,M.A.NCC Program Director Orange Partnership Orange Partnership for Alcohol and Drug Free Youth 104 New Stateside Dr. Chapel Hill NC 27516 www.orangepartnership.org 73 -(W% Freedom House Recovery Center Integrated behavioral health care for children and adults February 18, 2025 Tonya Stancil, Harm Reduction Coordinator Orange County Government tstancil@orangecountync.gov RE: Letter of Support for El Futuro's Early Intervention Initiative Dear Ms. Stancil: I am writing on behalf of Freedom House Recovery Center, Inc. to express our strong support for El Futuro's proposal to implement the Orange County Latino Early Intervention Program through the opioid settlement funds. As a key provider of behavioral health services for children and adults in Orange County we recognize the urgent need for early intervention strategies tailored to the Latino population in Orange County. El Futuro's proposed initiative aims to bridge critical service gaps by incorporating Screening, Brief Intervention, and Referral to Treatment (SBIRT) within their culturally competent mental health framework. This approach aligns closely with the county's priorities in addressing opioid use and related behavioral health challenges, particularly among underserved Latino residents who often face language and systemic barriers to care. Our organization has collaborated with El Futuro in various capacities, and we have seen firsthand their dedication to holistic, community-centered care. By working together, we aim to strengthen referral networks, enhance service accessibility, and promote proactive intervention strategies that prevent opioid misuse and support long-term wellness in our community. As a committed partner, Freedom House will contribute to this initiative as a service provider of SUD, OUD and mental health services for individuals and families referred through El Futuro. We will also make referrals to the organization to ensure individuals and families receive culturally competent care and treatment. We believe this initiative will provide much-needed resources and support to individuals and families impacted by substance use. We highly encourage Orange County to invest in this important initiative, which will provide significant benefits to Latino individuals and families navigating substance use and mental health challenges. We look forward to continuing our partnership with El Futuro in improving health equity and >1y, sential sere' Sin J yce Harper Chief Executive Officer 104 New Stateside Drive Chapel Hill,NC 27516 Phone:919-942-2803 Fax:919-942-2126 www.freedomhouserecovery.org Federal Non-Profit Tax ID 56-1082674 74 -THE- CATHOLIC COMMUNITY of ST. THOMAS MORE February 17,2025 Tonya Stancil, Harm Reduction Coordinator Orange County Government tstanci[Porangecountync.gov RE: Letter of Support for El Futuro's Orange County Latino Early Intervention Program Dear Ms. Stancil, On behalf of St Thomas More Church at Chapel Hill NC, I am pleased to provide this letter of support for El Futuro's proposal for the Orange County Opioid Settlement Funds.As a dedicated partner in addressing the opioid crisis in our community,we recognize the critical role El Futuro plays in ensuring that Latino individuals and families receive culturally and linguistically appropriate substance use and mental health services. El Futuro's Orange County Latino Early Intervention Program is uniquely positioned to meet the needs of historically marginalized Latino residents by integrating early intervention strategies, such as Screening, Brief Intervention, and Referral to Treatment(SBIRT), into their existing mental health services.This initiative directly aligns with Orange County's priorities for opioid response, expanding access to early intervention,treatment referrals, and recovery support for individuals at risk of opioid use disorder(OUD)and co-occurring mental health conditions. St Thomas More Church has a long-standing collaborative relationship with El Futuro,working together to improve behavioral health outcomes for Latino communities.Through this partnership, we have witnessed firsthand El Futuro's commitment to providing high-quality, culturally competent care to Latino families facing significant barriers to treatment, including language access, stigma,and lack of healthcare coverage. Our organization is eager to support El Futuro's proposed project by making referrals, sharing resources they should have, and co-hosting educational workshops.We firmly believe that this initiative will enhance the county's capacity to respond effectively to the opioid crisis by engaging trusted community health workers to work with Latino individuals affected by substance use. We strongly urge Orange County to fund this important initiative,which will have a lasting impact on improving access to care and supporting long-term recovery for Latino residents in our community.Thank you for your consideration of this request,and we look forward to continuing our partnership with El Futuro in addressing substance use and mental health disparities in Orange County. Sincerely, I � Rev. Fr. Rafael Leon Valencia Pastor 919.942.1040 940 Carmichael St, Chapel Hill, NC 27514 www.stmchapelhill.org 75 Orange County JUSTICE UNITED Orange County Justice United PO Box 9484 Chapel Hill, NC 27515 February 20, 2025 Tonya Stancil, Harm Reduction Coordinator Orange County Government tstancil@orangecountync.gov RE: Letter of Support for El Futuro's Orange County Latino Early Intervention Program Dear Ms. Stanch, On behalf of Orange County Justice United, I am honored to provide this letter of support for El Futuro's proposalforthe Orange County Opioid Settlement Funds. Orange County Justice United is a coalition of 22 congregations and nonprofits working to ensure Orange County residents can thrive. Improving behavioral health is consistently a top priority for our membership,which includes over 3,000 Latino households. Our partnership with El Futuro has been essentialfor making real change for these members.We see firsthand the critical role El Futuro plays in ensuring that Latino individuals and families receive culturally and linguistically appropriate substance use and mental health services. We believe that El Futuro's Orange County Latino Early Intervention Program is uniquely positioned to meet the needs of historically marginalized Latino residents by integrating early intervention strategies, such as Screening, Brief Intervention,and Referral to Treatment(SBIRT), into their existing mental health services.This initiative directly aligns with Orange County's priorities for opioid response, expanding access to early intervention,treatment referrals, and recovery support for individuals at risk of opioid use disorder(OUD)and co-occurring mental health conditions. Orange County Justice United has a long-standing collaborative relationship with El Futuro, working together to improve behavioral health outcomes for Latino communities. Over 100 Latino community members in our organization worked together with El Futuro to create a vision and strategy for expanding behavioral health services in Orange County. One of the primary results,the "Strong Minds-Mentes Fuertes" community health worker program, has been a stunning success and already measurably improved the mental health of over 200 residents.Through this partnership,we have witnessed El Futuro's commitment to providing high-quality, culturally competent care to Latino families facing significant barriers to treatment, including language access, stigma, and lack of healthcare coverage. Our organization is eager to support El Futuro's proposed project by connecting the Latino community leaders in our organization to promote this work within their networks, and by continuing to ensure full financial support for the community health worker program.We firmly believe that this initiative will enhance the county's capacity to respond effectively to the opioid crisis by engaging trusted community health workers to work with Latino individuals affected by substance use. 76 Orange County JUSTICE UNITED We strongly urge Orange County to fund this important initiative,which will have a Lasting impact on improving access to care and supporting long-term recovery for Latino residents in our community.Thank you for your consideration of this request, and we look forward to continuing our partnership with El Futuro in addressing substance use and mental health disparities in Orange County. Please be in touch with any questions, if needed. Sincerely, Julia Sendor Lead Organizer/Executive Director Orange County Justice United julia@ocjusticeunited.org 1 (336)524-7985 77 ORANGE COUNTY ORANGE COUNTY HIGH IMPACT OPIOID ABATEMENT STRATEGIES NORTI I ( AR01ANA Funding Proposal Application Form Application Due Date: February 21,2025 Applicant Agency:General Information Legal Name Freedom House Recovery Center, Inc. Address 104 New Stateside Drive, Chapel Hill, NC 27516 Type of Agency ❑ Government/ ❑ For-Profit (check one) Public Authority N Non-Profit Business Telephone 919-942-2803 ext. 1010 Website www.FreedomHouseRecovery.org Primary Contact Full Name Joyce Harper Title Chief Executive Officer Email Joyce.H@FreedomHouseRecovery.org Telephone 919-879-6073 Name of Project Reentry Support for Justice Involved Adults Total Application Funding Requested $ 144,926.10 Funding Period Requested Start End (MM/DD/YYYY) Date July 1, 2025 Date June 30, 2027 Selected NC MOA Option A Strategy (Number and Name) 10: Criminal Justice Diversion Programs Agency Mission and Vision Statements Our mission is to serve all in our community on their path to recovery—no matter who they are or what challenges they face. Our vision is that all seeking recovery are connected to the care and resources they need to reach their fullest potential. 1 78 2. Project Narrative A. Assessment of Community Need (16 points, page limit: not to exceed 1% pages) Drug addiction often increases the likelihood of continued criminal activity, with high rates of relapse and recidivism among drug-involved offenders. More alarmingly, an individual's death within the first two weeks of release from incarceration is more than 12 times higher than other individuals. (news.unchea/thcare.org). Multiple studies have consistently shown that drug overdose is more common when a person relapses after a period of abstinence. These statistics are individual lives that could potentially be saved, or diverted from ongoing justice system involvement, with proper screening and referral to substance misuse treatment that begins during incarceration and continues without lapse upon release. According to the North Carolina State Bureau of Investigations' Index Offenses by Agency by County, 2023, the Orange County Sheriff's Office reported a total crime index of 508 offenses, with 56%for larceny, 18%for burglary, and 8%for motor vehicle theft—Class H or I offenses. The same report shows that Chapel Hill reported 1803 offenses, with 70% for larceny, 12%for burglary, and 11%for motor vehicle theft. Hillsborough reported 485 offenses, with 84%for larceny and Carrboro reported 556 offenses with 67%for larceny. Furthermore, 2023 data pulled from the North Carolina Injury and Violence Prevention Branch shows the estimated Illicit Opioid Overdose rate in Orange County is 65.6% of overdose deaths. This rate is considered a high rate in the state of North Carolina. This rate is also a 3% increase over the previous year. In addition, the rate of children in foster care due to parental substance misuse in Orange County was 72.8%of children in 2023. This rate is among the highest rates seen in NC even though it is 1% lower than the prior year. These numbers, combined with the alarmingly high mortality rate among justice- involved individuals, highlight the immense need for continued substance use treatment, especially during and immediately following incarceration. For the greatest impact we believe treatment that begins as early as booking and continues uninterrupted after release could have the greatest impact. We based this assessment on the North Carolina Injury and Violence Prevention Branch report which states that the number of people accessing Treatment Services in Orange County was 336.6 out of 100,000 residents in 2023, representing 507.0 uninsured people and Medicaid beneficiaries who received treatment for their Opioid Use Disorder (OUD). This is an increase from the 461 uninsured people and Medicaid beneficiaries who received treatment for their Opioid Use Disorder(OUD) in 2022 which represented a rate of 306.8 out of 100,000 residents. Freedom House Recovery Center (FHRC) proposes to continue our partnership with the Criminal Justice Resource Department (CJRD) on Lantern Project, serving as the primary 1 79 treatment source for justice involved individuals exiting the Orange County jail with substance use diagnosis (SUD). Together FHRC and CJRD have served nearly 150 justice involved individuals, connecting them to treatment, peer support, housing and ongoing community-based support. Freedom House Recovery Center has partnered with CJRD on Lantern Project to further the evidence-based treatment options and recovery support services available since its start in 2021. Lantern Project is a law enforcement diversion, harm reduction and treatment resource for justice-involved individuals with substance use disorder (SUD) and opioid use disorder(OUD). Freedom House will continue to help the Lantern Project to reduce trauma and the unnecessary cost of court involvement and incarceration. FHRC provides critical treatment resources and peer support that enhance recovery and healthy outcomes among historically marginalized justice involved populations. FHRC helps decrease the cost to law enforcement and the court system for low level Class H or Class I offenses where substance use has been an underlying issue. FHRC provides Lantern clients with re-entry treatment aid and support that help to reduce recidivism and relapses while improving the likelihood of sustained recovery, including gainful employment, housing stability and family reunification. B. Project Description and Program Sustainability(28 points, page limit:not to exceed 3 pages) Freedom House Recovery Center is submitting this proposal under Option A, Implementation Strategy 10: Criminal Justice Diversion Programs to support pre-arrest or post-arrest diversion programs and pre-trial services for justice involved individuals with SUD and OUD. In partnership with CJRD, Freedom House will continue working on Lantern Project to provide evidence-based addiction treatment, recovery support, harm reduction services, housing support, employment related services, peer support services and ongoing outpatient treatment for justice involved individuals in Orange County. The Lantern Project has consistently worked to increase the number of justice involved individuals with a history of opioid use who are connected to proper treatment- particularly among marginalized populations. FHRC employs a full-time licensed clinician and a Certified Peer Support Specialist (PSS)to work with Lantern Project to divert individuals with SUD from the Orange County justice system and jail into substance misuse treatment, which could be a more appropriate path to stifle continued justice involvement. FHRC also helps decrease the number of opioid overdoses as individuals enter treatment immediately from jail engaging with the supportive care needed to avoid relapses among those recently released from incarceration. 2 80 CJRD collaborates with the magistrate and district attorney to identify low level offenders who have a history of substance use. Clients who are screened as eligible for enrollment with Lantern Project are referred to Freedom House with client consent for ongoing treatment. Our clinician then visits the individual while incarcerated to engage the potential client for further assessment. Then, if appropriate, the licensed clinician will refer the client to a FHRC Peer Support Specialist (PSS)to begin supporting the client in preparing for their next steps following release from jail. Individuals referred to Freedom House begin their journey by meeting with a licensed clinician for a clinical assessment. The assessment allows the clinician to gain an understanding of the client's history, current needs, and wants, as well as make a treatment recommendation based on the client's needs. Clinicians are trained to use the evidence-based practice of Motivational Interviewing (MI)to help each client recognize their overarching desire for change and to expose any ambivalence towards change. MI allows clients to progress at their own pace while addressing barriers that may present during the assessment process. Following the clinical assessment, and once the client is released from jail,the Peer Support Specialist helps facilitate the next steps, including an appointment with the Psychiatric Mental Health Nurse Practitioner (PMHNP) for medical assessment. The PMHNP will meet with the client to determine if medication such as Buprenorphine or Naltrexone is the best course of treatment for the client. When appropriate,the client will be scheduled for their first dose to begin evidence-based Medication Assisted Treatment (MAT) in combination with counseling and behavioral health therapies to treat opioid use disorders (OUD). Clients who come to Freedom House already on MAT are screened by the PMHNP to ensure the safe continuation of MAT services. As part of the clinical assessment process, the clinician will also assess individuals with a history of addiction who are re-entering the community from prison for enrollment in treatment services including Seeking Safety therapy, an evidence-based treatment that helps people with trauma, posttraumatic stress disorder, and substance misuse. Seeking Safety (SS) is a coping skills approach to help people reach safety from trauma and/or addiction. It is present-focused and designed to be safe, optimistic, and engaging. The treatment is highly flexible which allows clients to join the group at any point in the program and stay engaged through completion of all sections. It can be used early in the treatment process as it is stabilization oriented. If substance use halfway housing is determined to be a need for the client,they can begin the enrollment process for the halfway house. Enrollment includes the Halfway House Manager, who has QP credentials, collaborating with the client to develop a person-centered treatment plan. The treatment plan includes the goals and objectives 3 81 the client would like to achieve while living in this supportive environment. The substance use halfway house is a structured, six-month residential program that is staffed 24 hours a day, seven days per week by trained and certified Peers who help the client solve problems, connect to resources, and stabilize their mental and physical health. Peers also facilitate evidence-based practices such as Wellness Recovery Action Planning (WRAP), Wellness, Management and Recovery (WMR), and other life skills groups to help clients develop critical living and coping skills. The interdisciplinary treatment team and the client work together to ensure the strategies implemented are working for the client.The team meets weekly to evaluate each client's progress towards their recovery goals, behavioral health goals, physical health goals, and activities of daily living goals. When appropriate, the goals will be updated or changed as they are achieved or as the client becomes clearer about their desires for the future. FHRC takes recovery as a step- by-step process that includes several small victories in route to the goal of long-term recovery and stability. The FHRC clinician and PSS will also serve as liaison between FHRC and the ORD staff. With proper consents in place,the FHRC clinician and PSS will advise ORD of each Lantern client's progress towards their goals and assist with tracking outcomes. The FHRC staff will communicate with ORD weekly via scheduled case conferences, or as needed,to review each client's care and progress throughout treatment. ORD will also communicate with FHRC as needed to convey new referrals and to update the FHRC clinician and PSS on each client's status around court involvement/appearances. FHRC PSS also aids the client in adhering to court ordered appearances and/or conditions. FHRC maintains a team approach to serving justice involved clients. During weekly team meetings the interdisciplinary team will discuss the needs and challenges faced by clients to connect them with a broader service array. The treatment team discussion can begin when the client engages with FHRC clinician regardless of whether they are still incarcerated or living in the community. In the treatment team meeting is where the FHRC staff discuss the unmet needs of their current or soon to be released clients. The Lantern PPS and clinician also work to ensure that in addition to treatment, we address the social determinants of health as well.This includes ensuring the client is enrolled in Medicaid so they can see a physician,the client is connected to proper housing and food options, helping with job skills training and/or employment opportunities as well as other identified needs. As with all our clients, FHRC encourages ongoing connection to some level of treatment support for up to 12 months—which most experts agree is the length of time recommended for "sustained recovery" exemplified by significant improvements in life functioning and decreased incidents of relapse. 4 82 Freedom House has been working with CJRD on Lantern Project for four years. The North Carolina Overdose Epidemic data from the Injury and Violence Prevention Branch of the North Carolina Division of Public Health reflects the positive outcomes occurring across Orange County in the efforts to overcome the opioid epidemic. Most recent data show Orange County has recorded a drop in Fentanyl Positive Deaths 2024 YTD to 11 which represents a decrease from the high of 28 in 2021. In addition,the estimated rate of Overdose Deaths in Orange County in 2023 was 21.0 out of 100,000 residents. This rate is a decrease from the 36 out of 100,000 residents in 2022 who died of overdose in Orange County. These statistics also stand for the realization of the Freedom House vision that all seeking recovery are connected to the care and resources they need to reach their fullest potential. We work towards this vision daily because we believe all are worthy of a full life in recovery and that hope in recovery awaits all who seek it. FHRC currently has a full-time licensed clinician and peer support dedicated to the Lantern Project. As we continue to expand the program and our support of justice involved individuals, we will increase engagement in ongoing recovery groups for graduates of the program. We will also look to begin providing Seeking Safety support for individuals while incarcerated.This evidence-based curriculum is designed to be used one on one or in a group setting. Incorporating this into our treatment opens the possibility of engaging added justice involved individuals in various settings with the goal of ongoing engagement upon release from incarceration. C. Equity Impact (8 points, page limit: not to exceed % page) For the justice-involved population in Orange County, barriers related to mental health and social determinants of health have made access to substance use treatment more challenging. Barriers to recovery services include lack of transportation, uncontrolled mental health, uninsured or underinsured individuals, and a lack of knowledge of local resources. In addition, social determinants of health such as housing instability or homelessness, food insecurity for themselves and their families as well as feeling overwhelmed often contribute to illicit drug use. According to the December 2023 North Carolina Criminal Justice Data Snapshot, in 2022 more people died of a drug overdose than by suicide and homicide combined. In January 2022,9,382 people in North Carolina were experiencing homelessness at a rate of 88 per 100,000 residents, which is the 8th-highest state homelessness rate in the region. Of the people released from prison in 2012, 71 percent were rearrested within 5 years of release, 54 percent were convicted of a new offense, and 46 percent returned to prison. Across the state, the arrest rate for Black individuals is 2.3 times higher than it is for White people. And the prison incarceration rate remains over 5 times higher for the Black population compared to the White population. In North Carolina in 2022, 19 5 83 percent of Black people and 22 percent of Latino people earned incomes below the federal poverty level. The two priority populations Lantern Program serves are incarcerated or recently incarcerated with opioid use disorders, and individuals at risk of becoming justice- involved due to addiction-related behaviors and encounters with law enforcement. Although neither age nor race will impact participation, Freedom House will work with Lantern to outreach individuals in the county jail from historically marginalized populations, such as Black and Hispanic communities where resources and services are harder to access. Freedom House has a history of collaborating with community providers to ensure our clients have access to culturally competent services and resources. Freedom House utilizes evidence-based practices to engage clients, and their families and natural supports in an array of services to begin and maintain sustained recovery. Individuals referred to Freedom House are served regardless of their county of residence, insurance status or ability to pay. The assessment process allows the clinician to gain an understanding of the client's history, current needs, and wants, as well as make a treatment recommendation based on the client's needs. Clinicians use evidence- based skills to help clients progress while addressing emotional, psychosocial and/or environmental barriers that could impact their goals. The licensed clinician and PSS work with the individual to connect them to local resources including housing, food, public benefits and healthcare, harm reduction resources, etc. D. Organizational Readiness (20 points, page limit: not to exceed 3 pages) For 50 years, Freedom House Recovery Center, a 501(c)(3) non-profit organization, has been a pioneer in behavioral health treatment in our community. Our mission is to serve all in our community on their path to recovery—no matter who they are or what challenges they face. We are committed to promoting, enhancing, and supporting recovery for men and women affected by substance misuse and/or mental health diagnoses through an evidence-based, comprehensive, and person-centered approach. The agency began in 1974 as a social setting detox and halfway house in Chapel Hill and has consistently grown to address the critical and changing needs of North Carolinians in our service areas. Currently, Freedom House operates outpatient behavioral health clinics in Chapel Hill, Roxboro, Durham, and Warrenton. We also operate a 10-bed men's house and a 12-bed women's house in Chapel Hill; an 11-bed men's house and a 6-bed women's house in Durham with a second 6-bed women's house opening in Durham in March 2025; a 12-bed men's house in Norlina and we will be opening an 8-bed men's house in Roxboro by July 2025. In addition to our outpatient clinics and halfway houses, Freedom House also operates a 16-bed facility-based crisis unit in Chapel Hill that 6 84 receives clients from all 100 North Carolina Counties, and we provide mobile crisis services in Alamance, Person, Durham, Orange and Caswell counties. Freedom House is credentialled and contracted with all four Tailored Plans in addition to the Standard Plans and other private insurances. This agency has consistently held contracts with LMEs/MCOs dating back to their origination. Our contracts have consistently been renewed without loss and have never been stopped early. Contracted services include clinical assessment, outpatient individual and group therapy (SAIOIP, SACOT), medication management, medication-assisted treatment, peer support individual and group (WRAP, WMR); facility-based crisis, substance use halfway house; and mobile crisis team. In the last four years, Freedom House has received three SAMHSA grants, including a two-year Community Mental Health Center (CMHC); a four- year grant for Increasing Mental Health Awareness (MHAT) and a two-year Certified Community Behavioral Health Clinic (CCBHC) grant resulting in Freedom House receiving full attestation from SAMHSA for certification. Freedom House offers a variety of services geared toward meeting client needs in the community. Our outpatient clinics provide individualized and community-based services to adults and children who have a moderate to chronic substance use diagnosis, mental illness, or those who are dually diagnosed with MH/SUDs or MH/IDD or SUDS/IDD. The intensity and frequency of services depend on the client's readiness for treatment and life-domain needs. Freedom House utilizes evidence-based practices to engage clients, and their families and natural supports in an array of services to begin and maintain recovery or crisis stabilization. We hold a strong belief that by supporting people in need, Freedom House is supporting positive changes to help the entire community. Freedom House has strong connections with law enforcement in each of the counties we serve, along with many local and regional treatment courts, probation and parole boards, local juvenile justice coalitions, and hospitals—including a contract with Person Memorial Hospital to provide crisis support services. Freedom House's experience of working on behalf of justice-involved individuals includes its work with the Drug Treatment Courts in Orange and Durham Counties, and its work with the Orange County Criminal Justice Resource Department (CJRD) on multiple grant funded diversion projects to support justice-involved individuals with an Opioid Use Disorder and Mental Health diagnoses. Since its inception, the Criminal Justice Resource Department has partnered closely with Freedom House Recovery Center. Freedom House has served as a primary treatment referral source for hundreds of CJRD clients. The Lantern Project is a partnership between Orange County Criminal Justice Resource Department and Freedom House and works to support justice involved people with substance use disorders by connecting 7 85 them to treatment support as soon as possible and staying with them through their journey by providing a licensed clinician and peer support. The Lantern Project has two referral paths—the diversion path works with people who have been arrested or are about to be arrested and the re-entry path collaborates with people who are currently incarcerated and working towards reentry. Freedom House works collaboratively with multiple service providers to ensure all the clients we serve are connected to the care and resources they need to reach their fullest potential. Our agencywide referral partners include Oxford House for step down housing, EI Futuro for culturally competent training and services, Healing Transitions for aftercare services, UNC Hospital, Duke University Medical Center, Person Memorial Hospital as referral partners and Morse Clinics for support with Methadone dosing—just to name a few of our partners. Currently, Freedom House employs over 150 staff across disciplines serving over 3,000 clients per year. We have learned that recovery is not a one-time event, and it does not occur in a particular order. Our clients require flexibility, consistency, and understanding. They thrive when they have someone who can walk with them without judgment— regardless of how long the walk may be. Freedom House makes employing"peers" — people who are in long term recovery or who are supporting a loved one in recovery—a priority at every level throughout the organization. We acknowledge that where a person starts their recovery journey is not as important as where they end up. Which is why we work with our clients to restore the benefits and privileges that may have been lost due to substance use or uncontrolled mental illness including, driving privileges, safe housing, steady employment, and family relationships. We do this by collaborating with each client individually and by providing safe, supportive opportunities for families to talk, learn, connect and heal. E. Evidence of Collaborations/Partnerships (10 points, page limit: not to exceed 1% pages) Clients served by Freedom House from the Orange County jail are referred by Lantern Project's Linkage Coordinator. Clients referred are screened for substance abuse and will either be actively incarcerated at the Orange County jail or have recently been released from state prison and working with the Orange County Local Re-entry Council to rejoin the community. Freedom House is now the largest community-based behavioral health provider in Orange County serving adults, children and adolescents with mental health and/or substance use disorders. Most of our clients are indigent and/or uninsured. Despite extensive growth over the years, we have kept a treatment philosophy that values peer intervention and hiring practices that support that philosophy. Freedom House provides evidence-based clinical treatment services and Peer Support, for the Lantern Project in partnership with Orange County Criminal Justice Resource 8 86 Department and local law enforcement. Freedom House has served as a primary treatment source for Justice Department clients in the pre-trial phase, actively enrolled in treatment courts and post-incarceration services since its inception. We have worked with CJRD on Lantern Project since the program began in 2021. CJRD screens individuals incarcerated in Orange County Jail and those recently released from state prison for substance use disorder with priority placed on serving those with Opioid Use Disorder. CJRD provides a warm handoff to Freedom House for our team to begin engaging with the individual while incarcerated to decide the clinically right evidence-based treatment options and social supports that are needed prior to release and/or immediately following release from incarceration. CJRD and Freedom House both work to provide harm reduction education to incarcerated individuals and to provide harm reduction kits upon release to help reduce the risk of overdose. The Lantern Project's linkage coordinator will work with colleagues at the court,jail and other CJRD staff to oversee all the re-entry services for the county. Lantern staff will ensure that they are not working with reentry or diversion services in another county. FHRC will screen each client at intake and assessment to ensure they are still not enrolled in duplicative services with another North Carolina agency. If we find that the client is enrolled in SLID, OUD or mental health services with another provider, FHRC staff will work to reconnect the client with those services, if still appropriate. If the client is enrolled, but it is decided that the level of care or the services a no longer clinically appropriate, FHRC will work with that agency to have the client discharged or transferred to a more proper level of care. F. Performance Measures and Program Evaluation (18 points, page limit:not to exceed 1 page) FHRC's Vice President of Quality Assurance and Training and the Data Analysis team will oversee the preparation and submission of reports. Quantitative and qualitative data will be collected and analyzed to decide the effectiveness of interventions and the accomplishment of project goals. Quantitative data collected will include: • Number of unique individuals served • Number of contacts with individuals • Demographic information of individuals served (race, ethnicity, age, gender, other identification) • Number and type of connections to services • Number of harm reduction kits distributed • Number of referrals made to other naloxone or harm reduction services Qualitative data collected will include: • Challenges to completing project goals, strategies for overcoming these challenges • Engagement in services, identification of barriers and efforts to address barriers 9 87 • Substance use diagnosis and the types of services and treatments received including outcomes For process evaluation, qualitative data will be collected to report on progress toward grant goals, accomplishments, success stories, barriers, and how barriers were overcome. Data will be collected through client surveys, observations from the interdisciplinary team, input from the ORD linkage team, and follow-up reports from the PSS. Disparities in service delivery will be recorded and analyzed by the evaluation team. The results will be shared with the program staff to figure out whether any adjustments are needed to ensure we are achieving program goals.The evaluator will analyze data and prepare monthly reports for funders and program staff. Based on the findings, the team will decide if project goals are being met, or if adjustments are needed to achieve the expected outcomes. Quantitative data will be recorded on reports by the direct care staff. The evaluation team has developed tracking tools to capture accurate, timely data. Information will be collected on the stated outcomes. Clients will also be surveyed to understand their mental health functioning, employment status, substance use characteristics, housing status, and other indicators through self-report. Data will also be analyzed to decide if the program serves a representative number of historically marginalized groups and whether disparities by gender, ethnicity, and race exist in numbers served, service use, functioning, and other outcomes. The evaluation team will track disparities to figure out whether they have been reduced over time or if service adjustments are needed to outreach to enroll more under-represented individuals. 10 88 9. Certifications and Required Forms A. Application Certification have reviewed this application for accuracy. I understand that Opioid Abatement funds are intended to address specific remediation activities as identified under the NC Memorandum of Agreement(MOA)for the Opioid Settlement Funds. 1 understand that these opioid settlement funds are subject to State laws and regulations, and 1 have read the MOA and agree to the requirements. I certify that the requested funds will be used in compliance with these requirements and with all requirements outlined in the Orange County High Impact Opioid Abatement Strategies RFA. I agree to submit invoices and other relevant documentation to Orange County to pay or be reimbursed, as well as quarterly status reports,by the date stated in the contract. I understand that Orange County requires agencies with receipts less than$500,000 that do not have a financial audit(or a financial report), prepared by a certified public accountant(CPA)to complete schedule of Receipts and Expenditures form. An agency does not need to complete this form if it has a prepared audit/report it can submit for the calendar year ending December 31,2022 or the fiscal year ending June 30,2023. Agencies with receipts totaling$500,000 or more,from any source, must submit a CPA-certified financial audit. financial statements for each year that opioid settlement funding is provided to my organization,and that Orange County may monitor the program during the award period. Agency Authorized Official (print name) Jo ce rper Signature Title Chief Executive Officer Date 2/18/2025 Board Chair/Elected Official (print name) Paula Harrington ` ignature Title Board Chair Date 2/18/2025 1 89 B. Non-profit agencies only:Verification of 501(c)(3)Status Form IRS Tax Exemption Verification Form (Annual) I, Joyce Harper , hereby state that I am Chief Executive Officer of (Printed Name) (Title) Freedom House Recovery Center ("Organization"),and by that authority duly (Legal Name of Organization) given and as the act and deed of the Organization,state that the Organization's status continues to be designated as 501(c)(3) pursuant to U.S. Internal Revenue Code,and the documentation on file with the North Carolina Department of Health and Human Services is current and accurate. I understand that the penalty for perjury is a Class F Felony in North Carolina pursuant to N.C. Gen. Stat.§ 14-209, and that other state laws, including N.C.Gen. Stat. § 143C-10-1,and federal laws may also apply for making perjured and/or false statements or misrepresentations. I declare under penalty of perjury that t oregoing is true and correct. Executed on this the 18 day of February (Sig 2 90 C. Certification of No Overdue Tax Debts Date of Certification 02/18/2025 Certification: We certify that[ORGANIZATION NAME] does not have any overdue lax debts,as defined by N.C.G.S. 105-243.1,at the federal,State,or local level.We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c)is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b. Sworn Statement: [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn,say that we are the Board Chair and [Title of the Second Authorizing Official], respectivelif,of[insert name of organization] of [City] in the State of[Name of State];and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us.We also acknowledge and understand hat a misuse of State funds will be reported to the appropriate authorities for further action. Boar air Signa i( CExecutive Officer 4�fvl Sworn to and subscribed before me on the day of the date of said certification. M Janice Lee fit � ( 'tarySignature and Seal) Chatham County NC My Commission fres,li I 1 G.S.105-243.1 defines:Overdue tax e t A& s unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer.The te'm does not include a tax debt, however, if the taxpayer entered into an installment agreement for th(!tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." 3 91 D. Code of Conduct Policy Each recipient of award shall maintain a written Code of Standards of Conduct which shall govern the performance of its officers,employees or agents in contracting with and/or expending Older Americans Act funds and State appropriations. The recipient Agency's officers,employees or agents shall neither solicit nor accept gratuities,favors or anything of monetary value from contractors or potential contractors.To the extent permissible under state or local laws, rules or regulations,such standards shall provide for appropriate penalties, sanctions, or other disciplinary actions to be applied for violations of such standards either by the officers, employees or agents of the recipient Agency or by contractors or their agents. Awards will be made only to responsible Agency(ies) possessing the ability to perform successfully under the terms and conditions of a proposed procurement. Consideration will be given to such matters as Agency's integrity,compliance with public policy, record of past performance,and financial and technical resources. I have rppd and fully un stand the context of the information above. Chief Executive Officer 2/28/2025 40/rizCd Official Signature Title Date 4 92 E. Conflict of Interest Policy The Board of Directors/Trustees or other governing persons, officers,employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interest.The Organization's Board of Directors/Trustees or other governing body, officers, staff and agents are obligated to always act in the best interest of the organization.This obligation requires that any Board member or other governing person,officer, employee or agent, in the performance of Organization duties,seek only the furtherance of the Organization mission.At all times, Board members or other governing persons, officers, employees or agents,are prohibited from using their job title,the Organization's name or property,for private profit or benefit. a. The Board members or other governing persons,officers,employees,or agents of the Organization should neither solicit nor accept gratuities,favors,or anything of monetary value from current or potential contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent.This is not intended to preclude bona-fide Organization fund raising- activities. b. A Board or other governing body member may,with the approval of Board or other governing body, receive honoraria for lectures and other such activities while not acting in any official capacity for the Organization. Officers may,with the approval of the Board or other governing body, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. Employees may,with the prior written approval of their supervisor, receive honoraria for lectures and other such activities while on personal days,compensatory time, annual leave,or leave without pay. If a Board or other governing body member, officer,employee or agent is acting in any official capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization. c. No Board member or other governing person, officer,employee,or agent of the Organization shall participate in the selection,award, or administration of a purchase or contract with a vendor where,to his knowledge, any of the following has a financial interest in that purchase or contract: 1. The Board member or other governing person,officer, employee, or agent; 2. Any member of their family or personal relationship; 3. An organization in which any of the above is an officer, director,or employee; 4. A person or organization with whom any of the above individuals is negotiating or has any arrangement concerning prospective employment or contracts. d. Duty to Disclosure--Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately. 5 93 e. Board Action--When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body,the Board member or other governing person, officer, employee,or agent (person(s)) must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of committees with governing board delegated powers considering the possible conflict of interest.After disclosure of all material facts, and after any discussion with the person,they shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon.The remaining board or committee members shall decide if a conflict of interest exists. In addition,the person(s) shall not participate in the final deliberation or decision regarding the matter under consideration and shall leave the meeting during the discussion of and vote of the Board of Directors/Trustees or other governing body. I have r nd full ers a context of the information above. Chief Executive Officer 2/18/2025 Aut ized Official Signature Title Date 6 94 F. Appendix E: E-Verify STATE OF NORTH CAROLINA AFFIDAVIT COUNTY OF ORANGE 1,Joyce Harper (the individual attesting below), being duly authorized by and on behalf of_Freedom House Recovery Center, Inc. (the entity contracting with Orange County hereinafter "Employer")after first being duly sworn hereby swears or affirms as follows: 1. Employer understands that E-Verifyis the federal E-Verify program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law in accordance with NCGS§64-25(5). 2. Employer understands that Employers Must Use E-Verify. Each employer, if employing 25 or more employees in this State, after hiring an employee to work in the United States,shall verify the work authorization of the employee through E-Verify in accordance with NCGS§64-26(a). 3. Employer is a person, business entity,or other organization that transacts business in this State and that employs 25 or more employees in this State. (Mark Yes or No) a.YES ® or b. NO ❑ 4. Employer's subcontractors comply with E-Verify, and Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer during the term of its contract with Orange County. This 18th day of Febryo 202 Signature of Affiant Af Print or Type Name Joyce Harper NORTH CAROLINA NOTARY ACKNOWLEDGEMENT THE STATE OF NORTH CAROLINA, COUNTY OF �04 Signed and sworn to(or affirmed) before me,this `day of f7 20 My Commission Expires:,14 Notary Public,`Jca)lct, Notary Public Signature•r [0 Janice Lee Bass NOTARY PUBLIC Chatham County,NC My Commission Expires July 04,2029 7 95 G. Discrimination Policy Each recipient of award shall maintain a discrimination policy ensuring that they do not discriminate on the basis of race,color, national origin,disability, religion, age,sex/gender,sexual orientation,gender identity and expression, marital status,veteran status, or source of income in the administration of its programs or activities,as required by applicable loa wans regulations. The recipient agency should identify officer, employee or agent responsible for coordination of compliance efforts and receipt of inquiries concerning non-discrimination requirements implemented by 40 C.F.R. Parts 5 and 7, including Title VI of the Civil Rights Act of 1964,as amended;Section 504 of the Rehabilitation Act of 1973;the Age Distribution Act of 1975,and Title IX of the Education Amendments of 1972,and other applicable laws. Said officer, employee or agent's contact information shall be included below. Discrimination complaint form should be attached or link to discrimination form included below. Responsible officer/employee/agent: Joyce Harper Responsible officer/employee/agent phone number: 919-942-2803 ext 1010 Responsible officer/employee/agent email address: Joyce.H@FreedomHouseRecovery.org Link to discrimination complaint form (if not attached): attached Chief Executive Officer 2/18/2025 �Vorizecl Official Signature Title Date 8 96 H. Authorization for Individuals to Sign Contracts and Submit Reporting [Letter from Board President/Chairperson identifying individuals as authorized to sign contracts, expenditure reports,and performance reports] I, Paula Harrington Board President/Chairperson of Freedom House Recovery Center, Inc. [Agency/Organization's legal name] hereby identify the following individual(s)who is(are)authorized to sign and/or submit documentation for the organization named above: Contracts: Printed Name: Title: Email address: 1. Joyce Harper Chief Executive Officer Joyce.H@FreedomHouseRecovery.org Click or tap here to Click or tap here to 2. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 3. enter text. enter text. Click or tap here to enter text. Expenditure Reports: Printed Name: Title: Email address: 1. Shaneka Parker Chief Financial Officer Shaneka.P@FreedomHouseRecovery.org Click or tap hereto Click or tap here to 2. enter text. enter text. Click or tap here to enter text. Click or tap here to Click or tap here to 3. enter text. enter text. Click or tap hereto enter text. 9 97 Performance Reports: Printed Name: Title: Email address: 1. Joyce Harper Chief Executive Officer Joyce H@freedomhouserecovery.org Heather Griffin- 2. Dolciney VP QA and Training Heather.G@freedomhouserecovery.org 3. Amanda Church Data Analyst Aman Ja.c@freedomhouserecovery.org Paula Harrington Board Chair _ Board President or Chair printed name *Title Signature Date '-B 98 1. Business Associate Addendum THIS ADDENDUM is made this 18th day of February, 2025 to a contractual arrangement between the parties("Agreement"). WHEREAS Orange County is itself a Covered Entity, as that term is defined in HIPAA and will be referred to as"Covered Entity"; and WHEREAS, Freedom House Recovery Center, Inc._is, or may be,a Business Associate of Covered Entity and will be referred to as"Business Associate";and WHEREAS, Business Associate performs certain services on behalf of or for Covered Entity that require the exchange of information about patients that is protected by the Health Insurance Portability and Accountability Act of 1996, as amended,and the Privacy,Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164(collectively"HIPAA"). NOW,THEREFORE,the parties to the Agreement are entering into this Addendum to establish the responsibilities of both parties regarding HIPAA-covered information and to bring the Agreement into compliance with HIPAA. 1. DEFINITIONS Except as otherwise defined herein,terms used in this Addendum shall have the same meaning as the terms are defined in HIPAA. II.OBLIGATIONS OF BUSINESS ASSOCIATE To comply with the Privacy, Security, and Breach Notification obligations imposed by HIPAA, Business Associate agrees to: A. Privacy and Security Obligations: 1. Not use nor disclose information other than as permitted or required by the Agreement,this Addendum or as required by law. 2. Use appropriate safeguards to prevent use or disclosure of the information other than as provided for by the Agreement and this Addendum. 3. Comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI (protected health information)to prevent use or disclosure of PHI other than as provided for by the Agreement. 4. Report to Covered Entity any use or disclosure of the information not provided for by the Agreement of which Business Associate becomes aware, including breaches of Unsecured PHI as required by 45 CFR 164.410. 5. In accordance with 45 CFR 164.502(e)(1)(ii)and 164.308(b)(2), if applicable,ensure that any agents or subcontractors that create, receive, maintain,or transmit PHI on behalf of Business Associate agree, in writing,to the same restrictions, conditions,and requirements that apply to Business Associate with respect to such information. 6. Make available PHI in a designated set record set to Covered Entity upon request within three (3)working days as necessary to satisfy Covered Entity's obligations under 45 CFR 164.524. If Business Associate receives a request for access directly from the individual,then 11 99 Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 7. If Business Associate receives a request pursuant to 45 CFR 164.526 to make any amendment(s)to PHI in a designated record set directly from the individual,then Business Associate will forward the individual's request to Covered Entity within three(3)working days to be fulfilled by Covered Entity. 8. Maintain and make available upon request within three (3)working days the information required to provide an accounting of disclosures to Covered Entity as necessary to satisfy Covered Entity's obligations under 45 CFR 164.528. If Business Associate receives a request to provide an accounting of disclosures directly from the individual,then Business Associate will forward the individual's request to Covered Entity within three (3)working days to be fulfilled by Covered Entity. 9. Make its internal practices, books,and records relating to the use of PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, available to the Secretary of DHHS and Covered Entity for purposes of determining compliance with HIPAA. 10. To the extent practicable, mitigate any harmful effects that are known to Business Associate of a use or disclosure of PHI or a breach of Unsecured PHI in violation of this Addendum. 11. Use and disclose an individual's PHI only if such use or disclosure is in compliance with the applicable requirements of 45 CFR 164.504(e) and the terms of this Addendum. 12. Refrain from exchanging any PHI with any entity of which Business Associate knows of a pattern of activity or practice that constitutes a breach as defined by North Carolina State Law, HIPAA,or this Addendum. 13. To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 CFR Part 164,comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). B. Breach Notification: In the event that Business Associate discovers any use or disclosure of PHI not provided for by the Agreement, including breaches of Unsecured PHI as required at 45 CFR 164.410, and any security incident of which it becomes aware, Business Associate agrees to take the following measures within three (3)working days after Business Associate first becomes aware of the incident: 1. To notify Covered Entity of any incident involving the acquisition, access, use or disclosure of Unsecured PHI in a manner not permitted under 45 CFR Part E.Such notice by Business Associate shall be provided without unreasonable delay, except where a law enforcement official determines that a notification would impede a criminal investigation or cause damage to national security. For purposes of clarity for this provision, Business Associate must notify Covered Entity of any such incident within the above timeframe even if Business Associate has not conclusively determined within that time that the incident constitutes a breach as defined by HIPAA. For purposes of this Addendum, Business Associate is deemed to have become aware of the breach as of the first day on which such breach is known or reasonably should have been known to such entity or associate of Business Associate, including any person,other than the individual committing the breach,that is an employee, officer or other agent of Business Associate or an associate of Business Associate. 12 100 2. To include in the above-described notification the names of the individuals whose Unsecured PHI has been,or is reasonably believed to have been,the subject of a breach. 3. To provide a draft letter to Covered Entity to utilize to notify the individuals that their Unsecured PHI has been,or is reasonably believed to have been,the subject of a breach. The draft letter must include,to the extent possible: a. A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known; b. A description of the types of Unsecured PHI that were involved in the breach (such as full name,Social Security Number, date of birth, home address, account number, disability code,or other types of information that were involved); c. Any steps the individuals should take to protect themselves from potential harm resulting from the breach: d. A brief description of what Covered Entity and Business Associate are doing to investigate the breach,to mitigate losses, and to protect against any further breaches; and e. Contact information for individuals to ask questions or learn additional information, which shall include a toll-free telephone number,an email address,web site,or postal address. 111.TERMINATION A. This Addendum will terminate automatically,without further action by either party, upon termination of the Agreement to which it is attached. B. Covered Entity may terminate this Addendum if Covered Entity determines that Business Associate has violated a material term of the Agreement or this Addendum. C. Upon Covered Entity's gaining knowledge of a breach, as defined by North Carolina State Law or HIPAA, by Business Associate or any of its agents or subcontractors,of the Agreement or this Addendum, Covered Entity shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation, and if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity,terminate this Addendum and the attached Agreement;or 2. Immediately terminate this Addendum and the attached Agreement if either has been breached by a Business Associate,and a cure is not possible. D. In situations where it is not practicable to terminate this Agreement,Covered Entity shall report Business Associate's breach as defined by North Carolina State Law or HIPAA to the Secretary of DHHS, and continue under the existing arrangement with Business Associate until a reasonable alternative becomes available,or until directed by the Secretary of DHHS to terminate the Agreement. E. At termination of the attached Agreement and this Addendum,or upon request of Covered Entity,whichever occurs first, Business Associate shall: 1. If feasible, return or destroy all PHI that Business Associate still maintains in any form, received from Covered Entity or created, maintained or received by Business Associate on behalf of Covered Entity. Business Associate shall only destroy PHI with the written approval of Covered Entity.After return or destruction, Business Associate shall retain no copies of such information. 2. If return or destruction is not feasible, Business Associate will provide Covered Entity with documentation explaining the reason it is not feasible. If the PHI is not returned or destroyed, Business Associate will extend the protection of this Addendum to the 13 101 information and limit further uses and disclosures to those purposes that make the return or destruction of the information not feasible. F. The obligations of Business Associate under this Addendum shall survive the expiration, termination or cancellation of the attached Agreement and this Addendum, and shall continue to bind Business Associate, its agents, employees,contractors, successors and assigns, as set forth herein. G. Business Associate shall indemnify Covered Entity for costs associated with any incident involving the acquisition,access, use or disclosure of Unsecured PHI by Business Associate, any agent or subcontractor, in a manner not permitted under 45 CFR Subpart E. IV. MISCELLANEOUS A. All PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record,oral communication,audio recording and electronic display by Covered Entity or its operating units to Business Associate,or is created or received by Business Associate on Covered Entity's behalf,shall be subject to this Addendum. B. In the event of an inconsistency between the provisions of this Addendum and the mandatory provisions of HIPAA,as amended, HIPAA shall control.Where provisions of this Addendum are not included as mandated provisions in HIPAA, but are nonetheless permitted by HIPAA,the provisions of this Addendum shall control. C. Except as expressly stated herein or in HIPAA,the parties to this Addendum do not intend to create any rights in any third parties. D. This Addendum may be amended or modified only in writing signed by the parties. No party may assign it rights or obligations under this Addendum without the prior written consent of the other party. None of the provisions of this Addendum are intended to create, nor will they be deemed to create,any relationship between the parties other than that of independent parties, contracting with each other solely for the purpose of effecting the provisions of this Addendum and any other agreements between the parties concerning their business relationship. E. This Addendum will be governed by the laws of the State of North Carolina,venue Orange County. F. No change,waiver,or discharge of any liability or obligation hereunder on any one or more occasion shall be deemed a waiver of performance of any continuing obligation,or prohibit enforcement of any obligation,on any other occasion. G. In the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of PHI that are more restrictive than the provisions of this Addendum,the provisions of the more restrictive documentation will control. H. In the event that any provision of this Addendum is held by a court of competent jurisdiction to be invalid or unenforceable,the remaining provisions of this Addendum shall remain in full force and effect. I. Headings in this Addendum are for convenience of reference only and shall not define or limit any of the terms or provisions hereof. J. A reference in this Addendum to a section in HIPAA means the section as in effect or as amended. K. Any ambiguity in this Addendum shall be interpreted to permit compliance with HIPAA. L. Business Associate will not use an agent or subcontractor without written agreement by Covered Entity. 14 102 IN WITNESS WHEREOF,the parties have hereunto executed this Business Associate Addendum on the day and year first written above. Orange County By: [County Manager name],Orange County Manager ATTESTED: BUSINESS ASSOCIATE Freedom House Recovery Center, Inc. ter. By: a ' Title: Chief Executive Officer ATTESTED• 15 103 0Occ' 0l� 2��4 0�� Cn�� . Coud]xousc . }�x� (Ql9) 640'l729 lO6EaxiMargaret I,wim az-lrkol@oouigecouoLynic.&pv Hillsborough, NC27278 [R|yN|NAL]UJT|CERESOURCE DEPARTMENT February 12,Z0Z5 1 am writing this letter to support Freedom House's application for renewed funding from opioid settlement funds so that ongoing collaboration with the Orange County Criminal Justice Resource Department and the Lantern Project may continue. Currently,two positions at Freedom House are funded:a full-time clinician position and a full-time peer support specialist position. Both positions have been critical in supporting court-involved individuals on their recovery journey. The clinician's work in completing comprehensive clinical assessments has been extremely valuable in identifying clients' needs, clarifying diagnoses,and making treatment recommendations.The clinician has also recently implemented a new therapeutic support group called Seeking Safety, an evidence- based treatment modality for people with co-occurring substance use disorders and post-traumatic stress disorders.This group is specifically for Lantern Project clients.The peer support specialist work is also highly valued in providing recovery support to people who are incarcerated in the detention center as well as bridging them to longer-term supports in the community upon their release.The partnership between Freedom House and the CJRD is critical in supporting a continuum of care for court-involved people struggling with addiction. Please let nneknow ifyou have any additional questions. Thank you, . i/ ~~ v ' AUbo8�]rke|, LC8VV LCAS Clinical Coordinator Criminal Justice Resource Department � Ofhce: 91Q-I4S-23O4 Cell: 919-748-2196 ` ` ORANGE �"'OUNTYi NORTH GAR0ULINA 104 ORANGE COUNTY ORANGE COUNTY NORTH CAROLINA HIGH IMPACT OPIOID ABATEMENT STRATEGIES Funding Proposal Application Form Application Due Date: February 21, 2025 Applicant Agency: General Information Legal Name University of North Carolina at Chapel Hill 104 Airport Dr, Suite 2200 Campus Box 1350 Address Chapel Hill, NC 27599-1350 R Non-Profit/State Type of Agency ❑ Government/ Related Institution of ❑ For-Profit (check one) Public Authority Higher Education Business Telephone (919) 966-3411 Website https:Hosp.unc.edu/ Primary Contact Full Name Leah Taraskiewicz Title Director of Outreach,Training, and Education Email leahkt@unc.edu Telephone 517-262-4639 Name of Project I Student Health Action Coalition Syringe Service Program Total Application Funding Requested $196,047.00 Funding Period Requested End (MM/DD/YYYY) Start Date 7/1/2025 Date 6/30/2028 Selected NC MOA Option A Strategy(Number and Name) Strategy 9: Syringe Service Program Agency Mission and Vision Statements The Student Health Action Coalition Syringe Service program is a joint project of the UNC Student Health Action Coalition and the UNC Injury Prevention Research Center.As such, we are including the mission statements of both organizations. The Student Health Action Coalition is a student-led organization whose mission is to: 1. Provide free health services to our uninsured and underinsured neighbors in Carrboro, Chapel Hill and Durham. 105 2. Partner with communities to develop and implement sustainable programs. 3. Create an interdisciplinary service learning environment for students in the Health Science programs at UNC. The UNC Injury Prevention Research Center's vision is to conduct innovative research,training, and outreach that strengthens and disseminates the scientific base for injury and violence prevention. The mission of the Injury Prevention Research Center is to advance injury and violence prevention through interdisciplinary research and training the next generation of injury researchers and practitioners. 106 1. Proposal Summary Student Health Action Coalition Syringe Services Program (SHAC SSP) is a harm reduction-based organization providing sterile injection supplies, naloxone, first aid supplies, fentanyl and xylazine test strips, and referrals to other social and health services to people who use drugs (PWUD) in Orange County. We seek to address participant needs through an evidence-based approach including providing them with safer use supplies and education and training on overdose response, and connections with substance use disorder (SUD) treatment resources if desired. With our prior Orange County Opioid Settlement Funding we greatly expanded our program, more than doubling numbers of syringes and naloxone doses provided, and adding an additional weekly supply distribution shift. With this application we seek funding to continue to expand supply provision to PWUD in Orange County, grow from two to three weekly shifts to serve additional participants, develop emergency use naloxone boxes in critical overdose hotspots throughout Orange County, streamline our referral process, further incorporate PWUDs' perspectives in our program development, and enhance dissemination of our work. Our program serves the historically marginalized population of PWUD in Orange County, including many who are also experiencing marginalizing socioeconomic conditions such as homelessness and unemployment. Our innovative structure as a student-led and -run SSP allows us to foster a passion for harm reduction in students across the University of North Carolina (UNC), and our participants benefit from our connection with other student-run clinics within UNC including free primary care, HIV and STI testing and treatment, dental care, and other necessary resources. 107 2. Project Narrative A. Assessment of Community Need SHAC SSP serves PWUD in Orange County, NC through our weekly service distribution locations at the Inter-Faith Council (IFC) in Carrboro and the University United Methodist Church (UUMC) in Chapel Hill, as well as our satellite site of Hillsborough Pharmacy, where we stock safe injection supply and naloxone kits that can be requested by anyone who comes to the pharmacy. IFC, UUMC, and Hillsborough Pharmacy all have missions focused on serving others, with the focus of IFC being "to confront the causes and respond to the effects of poverty in our community." The Community Services Manager at IFC and several SHAC SSP volunteers speak Spanish, so we can offer services to participants who prefer or exclusively speak Spanish, making our services accessible to a broader community. We are currently the only SSP with physical locations of distribution shifts in Orange County, with NC Harm Reduction Coalition and Starting Point Rural Harm Reduction Coalition providing mobile supply distribution but no drop-in services. In this way, our program fills an important gap in services for PWUD who do not have a home address for delivery, do not have access to technology for placing mobile orders, are unaware of mobile resources, or prefer drop-in services. The below map shows locations of every incident run by Orange County EMS in the southern region of Orange County, where many calls were concentrated in calendar years 2018-2023 that involved primary or secondary impression of opioid use disorder (blue circles), according to Orange County Post Overdose Response Team, with yellow stars representing the locations of SHAC SSP's current operations. Our two primary SSP locations in Chapel Hill are within walking distance or public transportation of the majority of these local hotspots. According to NC DHHS Overdose Epidemic data "the estimated Overdose Death rate in Orange is 21.0 out of 100,000 residents in 2023, representing (projected) 32.00 people who died of an overdose," and "the Overdose ED Visit rate in Orange was 59.1 per 100,000 residents in 2024, representing 89.00 ED visits for an overdose."' Orange County is focusing their public health efforts between 2024-2028 on access to care, behavioral health including mental health 1 https://www.dph.ncdhhs.gov/programs/chronic-disease-and-injury/injury-and-violence- prevention-branch/north-carolina-overdose-epidemic-data#monthly-reports 108 and substance use, and connections to community support. Of Orange County's population, SHAC SSP specifically serves those with highest need for access to care, behavioral health support, and connections to community support. Through our collaboration with community partners such as IFC and Orange County Overdose Response Team, we are able to effectively serve this population, contributing to the efforts of Orange County as a whole. The needs of our participants are determined by standard offerings of SSPs supplemented with additional resources based on participant needs. When participants come in to receive supplies, they are informed of everything we offer, and we use this opportunity to seek guidance on additional services and supplies that our participants could benefit from. We are then able to incorporate these requests into our standard offerings to better fit the needs of our population. While the focus of our program is to distribute safe injection and overdose reduction and response supplies, we believe in treating and caring for the whole person, so our harm reduction efforts extend beyond offering safe injection supplies alone. The population we serve is largely unhoused and/or living below the poverty line, so we make an effort to expand our services to fit the additional needs they have. For example, we received participant requests for and now offer bug repellent spray during summer months and hand warmers during the winter as these are highly valued items for our participants experiencing homelessness. By offering these items, we not only benefit our participants but are also able to establish better caring relationships with our community, building trust and familiarity with our program participants. Due to this approach, we often observe that participants initially coming in requesting items like hand warmers later return seeking harm reduction supplies. 109 B. Project Description and Program Sustainability The primary implementation strategy addressed by this proposal is Strategy 9: Syringe Service Program. Our work also addresses Strategy 7: Naloxone Distribution. The proposed project is funding for the Student Health Action Coalition (SHAC) SSP. SHAC SSP is a volunteer- based organization that seeks to improve health outcomes for people who use substances and improve community knowledge of drug safety. We are founded on the principles of harm reduction, which seek to center the humanity of people who use substances while working to reduce higher-risk behaviors through delivery of non-judgmental care. We aim to "meet people where they are" and rebuild trust between people with substance use disorder(SUD) and the medical community. SHAC SSP serves a diverse clientele and is the only fixed location SSP operated out of and focused exclusively on Orange County. Our parent organization, SHAC, is a 501(c)(3) nonprofit that is managed through the UNC Health Foundation and is part of the National Association of Free Clinics and North Carolina Association of Free and Charitable Clinics. SHAC's mission is to provide free "comprehensive health care and social needs support." Due to capacity constraints, SHAC is unable to administer large awards in-house. Therefore, we are applying with the UNC Injury Prevention Research Center (IPRC) who will administer the award, including overseeing the financial, personnel, and compliance aspects of the program. SHAC SSP was awarded Orange County Opioid Settlement funds in a previous cycle and the contract is currently administered through IPRC. SHAC SSP registered with the North Carolina Department of Health and Human Services as an SSP in Spring of 2022. Since our inception in 2022 we have provided safer use supplies to over 175 unique SSP clients, including more than 456 doses of naloxone and 2,002 syringes. We also provide sterile injection supplies, fentanyl and xylazine test strips, first aid supplies, drug checking kits, referrals to local organizations for substance use disorder treatment, and referrals to other clinics within SHAC for free medical and dental care, STI and HIV testing and treatment, and more. Our leadership team has been trained to lead educational activities related to naloxone administration, harm reduction principles, North Carolina Good Samaritan laws, and fentanyl awareness. In the last year, our volunteer base increased from 15 to 83 active volunteers with undergraduates, nursing students, public health students, and medical students receiving training on topics important for SSP shift staffing including how to teach participants about naloxone use. Our tracked statistics from May 2022-May 2023, prior to receiving Orange County Opioid Settlement Funding, compared to June 2023-June 2024 with funding show that we substantially increased our supply provision to participants. Overall, our number of participants served increased from 65 in 2022-2023 to 124 in 2023-2024. Our provision of naloxone doses increased 109% in 2023-2024 compared to 2022-2023 from 99 to 207, and our number of syringes distributed increased 115% from 439 to 946. Additionally, we expanded from one to two weekly supply distribution shifts during the last funding period. We are seeking funding for SSP supplies, educational materials, marketing, travel, and continued funding for the paid Program Navigator position within SHAC SSP. Supplies include purchases of naloxone, syringes, fentanyl and xylazine test strips, basic first aid supplies, and other items comprising the total inventory of 26 harm reduction-related items we supply.The program navigator hired within the last funded year provides program management and support, including development of educational materials, volunteer management and training, 110 program expansion, management of community partnerships, and direct staffing of supply distribution shifts. This funding will let us meet organizational goals by increasing supply distribution and starting new initiatives as detailed below. Our grant through the Orange County Opioid Settlement Fund is currently our only source of funding. Challenges for our program beyond the current project cycle include maintaining our Program Navigator role, which is currently a temporary position pending grant funding. However, we will work with our program navigator for whatever time we can fund this position to create streamlined workflows that are more sustainable for a student-run organization. Streamlining processes for inventory, supply ordering, maintaining records, and interfacing with other programs will enable us to continue to grow and maintain access to necessary safer use supplies for residents of Orange County. Another challenge for our program is that we currently receive nasal Naloxone for free via the Addiction Medicine program at UNC but are not guaranteed to continue receiving this resource indefinitely. To address this, we developed our budget such that if needed we can shift spending to be able to purchase Naloxone. We would also explore other sources of free or reduced cost Naloxone via connections with other SSPs. For the initiatives below, three student co-directors and the program navigator will share responsibility for oversight and completion of all tasks, with our student volunteer base providing staffing for routine SSP activities. Upcoming initiatives for new funding period: 1. Open a new SHAC SSP location to increase SSP access: With our program navigator available to staff shifts weekly and the significant growth of our volunteer base, our bandwidth for shift staffing has increased greatly. We are actively seeking an additional location in Chapel Hill to host a third weekly distribution shift. This location will be selected to complement our weekly shift locations in Chapel Hill and Carrboro and our supply site at Hillsborough Pharmacy and serve a population to whom these locations are not easily accessible. We are utilizing participant feedback and EMS data on overdose locations to select this site. An additional distribution shift per week in a visible and easily accessible location within Orange County will enhance the quantity of safe injection supplies and Naloxone we can distribute. We will seek to start shifts at our new site at the start of the Fall undergraduate semester in August 2025. 2. Initiate SHAC SSP material distribution within the UNC Emergency Department (ED): We are in the process of incorporating information on the SHAC SSP into discharge materials for patients admitted to the UNC ED with substance use-related chief complaints or those who discuss substance use with their provider. Through discussions with ED leadership, it became apparent that the current guidance materials for treatment of SUD are out of date and our program is assisting in revision of these materials. Our program will also be giving a presentation to the UNC Emergency Medicine Residency Program to educate medical residents on SUD treatment, harm reduction, and SSPs. This will benefit patients in our community by streamlining the process with the UNC ED for patients to access lifesaving resources through our program. This will represent a significant improvement in how patients who use opioids are treated within the UNC Healthcare system and open a line of dialogue so we may continue to improve healthcare providers' knowledge and awareness as the opioid crisis evolves. The presentation will occur in Summer 2025 and guidance materials updated throughout Fall 2025, with this initiative led by the program co-directors in conjunction with medical student volunteers. 3. Establish Emergency Use Naloxone Boxes: We plan to expand access to free naloxone in 111 Orange County through a selection of data-driven locations with a high risk of opioid overdoses. This initiative will include installing emergency naloxone boxes (similar to public-use AEDs and EpiPens) in locations that were sites of overdoses in 2020-2023. These efforts will initially focus on parking garages and public spaces, with further locations determined through ongoing collaboration with Orange County PORT. We plan to initiate this project during Summer 2025. This project would build local infrastructure to respond to the opioid crisis by significantly increasing access to overdose resources in our community. We will commit to continuously restocking these boxes throughout and beyond the proposed funding period. 4. Improve and streamline referrals: During the prior fiscal year we strengthened our connections with local programs providing resources that may be helpful for our participants such as free primary care, dental care, counseling and mental health care, and STI and HIV testing. We have previously referred participants to these resources on an as-needed basis upon request or based on volunteers' assessment of participant needs. In this grant period, we will seek to streamline and increase the frequency of referrals by integrating a standardized checkout form for our distribution shifts that will include referrals as items to offer every participant. This will increase frequency of referrals, improving linkage to needed resources for vulnerable Orange County residents. We will also continue to offer referrals to substance use disorder treatment centers in a non-prescriptive, participant-initiated manner. The standardized checkout form will be iteratively improved to incorporate feedback from participants throughout the funded period. 5. Engage with and compensate SSP participants for their feedback to improve services: As an organization composed of and led by UNC students, we are conscious of our need to incorporate perspectives from individuals with lived experience with substance use into the direction and leadership of our program to better serve our population. In the next fiscal year, we will strive to integrate participant feedback and include the input of community members with lived experience in a more regimented manner. We will develop and implement surveys on the performance of our programs, including any unmet needs, and compensate participants financially for filling out these questionnaires. We will also identify our most engaged participants and create a community advisory board (CAB) so they can share their input on the program with us at quarterly meetings and as needed throughout the funded period. CAB meetings will begin in Fall 2025. 6. Disseminate our program's work and continue building collaborations through educational conferences:To further engage with other agencies in the state, learn about new harm reduction approaches, and increase our awareness of other local resources, we plan to have our program directors and navigator attend conferences in this fiscal year. They will attend the twice-yearly NC Safer Syringe Initiative Learning Collaboratives for education and training on topics such as wound care that will enhance the services our SSP offers. We will also seek to disseminate our program's unique student-led SSP model by presenting at the American Society of Addiction Medicine conference in April 2026, with abstract submission in January 2026. We hope that the presentation will inspire and guide the creation of student-run SSPs at other institutions. 112 C. Equity Impact The mission of SHAC SSP is to address health inequities experienced by PWUD by providing them with safe injection supplies, overdose reversal kits, and direct referrals to other medical and social services. Through our services, we aim to improve health outcomes, including comorbidities associated with drug use, for this population. While we do not currently track participant demographics, we are uniquely situated to reach historically marginalized populations through our collaboration with IFC. IFC serves a highly diverse population (-70% Black, Indigenous, and People of Color), which is reflected in the population we serve at the SSP. Due to the services offered by IFC that are largely focused on housing and financial security, our location there allows participants to receive comprehensive services in a single visit. They are able to receive not only harm reduction resources from SHAC SSP but also free dinner and connections to housing and job support without needing to travel between services. In this way, we are able to serve historically marginalized communities including diverse populations, those experiencing homelessness and unemployment, and people who use drugs. SHAC SSP is also in a unique position to address health inequities because of our connection with the overarching Student Health Action Coalition (SHAC) organization at UNC. SHAC offers many services, including primary care, gender-affirming care, mental health and counseling services, pediatric care, dental clinic, nutritional counseling, and more. Two branches of SHAC that are particularly impactful for community members who are uninsured or underinsured are Get Covered Carolina and SHAC Medication Assistance Program (MAP). Get Covered Carolina works with underserved local populations to help vulnerable patients navigate options for health insurance and apply for coverage. Their program has Certified Application Counselors that work individually with patients to navigate the complicated online insurance marketplace and weigh options for their health. This is particularly helpful for those who do not have the necessary literacy skills to navigate application or are uncomfortable in government-operated spaces for assistance. SHAC MAP works with similar vulnerable populations of our community to provide free access to their medications through state and manufacturer patient assistance programs. Most of these efforts focus on medications used to manage chronic diseases, such as diabetes, hypertension, and smoking cessation, which are conditions that disproportionately impact people living in poverty. Without the ability to pay for medications, these conditions often go untreated, worsening the burden of disease on patients and the overall population. 113 D. Organizational Readiness All awards received by the SHAC SSP are fiscally administered by IPRC. IPRC's mission is to build the field of injury and violence prevention through interdisciplinary research and the training of the next generation of researchers and practitioners. IPRC is one of eleven Injury Control Research Centers (ICRC) funded by the Centers for Disease Control and Prevention and is one of two ICRCs to be continuously funded since the program's inception in 1987. Since July 2023, IPRC has successfully been awarded and managed over$4 million in external funding. IPRC has excellent resources to administer externally funded projects and administers a multitude of contracts and grants whose projects require sophisticated levels of support. IPRC's administrative support for funded projects consists of such tasks as personnel actions (hiring and payments), purchasing, travel administration, accounting, financial management, and reporting to sponsor agencies. IPRC currently administers SHAC SSP's Orange County Opioid Settlement Fund award. To date, we have successfully met all reporting and compliance requirements outlined in our contract with Orange County. No subcontractors will be involved in the proposed work. All proposed and ongoing SSP work is done by student co-directors, student volunteers, and the program navigator. Grant management is performed by members of IPRC in conjunction with SHAC SSP co-directors and program navigator, as established in the prior funded period. We have demonstrated organizational readiness during our prior grant period of Orange County Opioid Settlement Funding by successfully managing the award in conjunction with IPRC, providing progress reports and compliance requirements as stipulated by Orange County, delivering information to community members in respectful and ever-adapting ways, and promoting health of underserved and vulnerable populations in Orange County that are prioritized for this funding source. Due to the student-led and -staffed nature of SHAC SSP, we are in a unique situation as many similar organizations are run by people with lived and living experience with substance use. While many of our volunteers may have personal or witnessed experience with drug use, we do not assume or necessarily know if our primarily undergraduate and medical student volunteer base has lived experience with drug use unless they share this with us. Therefore, input from people who use drugs is something that we are striving to better incorporate into our program and has been a primary focus as we seek to improve our program. Firstly, we have hired a program navigator who also staffs an additional SSP that is run by people with lived and living experience. She is able to incorporate insights from her work at this program to ensure that we are delivering information and supplies in a way that is both empowering and helpful. As an institutional principle we also believe strongly in compensation for work and are seeking to implement paid participant surveys to evaluate the success of our program and help us fill gaps in the resources we provide. We are also planning to develop a Community Advisory Board (CAB) composed of individuals with lived experience with SUD to inform evaluation and future directions of our program. These individuals will be compensated for their time and input, with structured meetings with SSP leadership and the CAB on a regular basis with additional consulting as needed. A strength of our program from our unique background is the diversity of viewpoints of our members: we have volunteers from all parts of the university, including undergraduates, public health students, nursing and dental students, and medical students. Our volunteers are 114 eager to learn and bring insights from their unique training programs to better the SSP, staffing shifts with enthusiasm, humility, and a genuine interest in getting to know participants' and their needs. For example, public health students bring knowledge of how policy changes impact our participants, while medical and nursing students can educate participants on wound care and overdose reversal. Undergraduates have superior knowledge of campus and town resources that may be useful to our participants such as food banks and other volunteer efforts, and dental students can direct participants with dental needs to free clinics. These volunteers connect at our staffing shifts, learning from each other and bringing their own unique perspectives to conversations on harm reduction and opioid use. While our primary organizational focus is supply provision to people who use drugs, we also take pride in our ability to start conversations and engage students from across campus to create more support for and dialogue surrounding harm reduction. We prepare our volunteers to staff our SSP by providing them with education on discussing complex topics, including roleplaying conversations between them and potential participants about the benefits of SSPs and harm reduction. For supplies that may garner comments and questions from participants and community members at our supply distribution shift, such as Plan B and condoms, we provide literature for volunteers so they can respond with educated and measured answers. We also provide education on identifying and avoiding stigmatizing language and how to speak with participants about drug use in a nonjudgmental and approachable manner. We source our information for volunteer trainings and educational events, such as talks to UNC Emergency Department physicians, from reputable sources within and outside of North Carolina, including the Department of Health and Human Services, the UNC Street Drug Analysis Lab's newsletter and website, and peer reviewed scientific papers on opioid use trends and SUD treatment (among others). When preparing written materials for distribution from our SSP, we cite a variety of academic sources and cross-reference our supplies against those of other SSPs nationwide to ensure that we include all necessary information. In the next funding period, when new written materials are developed, they will be assessed by our CAB members prior to dissemination to ensure they deliver information in a culturally sensitive and appropriate manner. Our program navigator also attends NC SSP Advisory Board meetings to incorporate insights from other SSPs into our volunteer education and service provision. Since our registration as an SSP in 2022, our organization has promoted the health and dignity of individuals and communities impacted by drug use by offering a judgement-free environment where participants can receive services that they are often denied elsewhere. We follow a harm reduction framework, meeting participants where they are and following the lead of each individual to support them on their own path, never placing pressure on participants to enter a recovery program unless they express a desire to pursue it with our assistance. We provide supplies on an as-needed basis and do not place strict limits on quantities of supplies provided to ensure that participants are covered until the next time they are able to visit us. We also incorporate participants' feedback into our service provision, ordering new types of supplies based on individual requests. Our co-directors and program navigator stay up to date with the most accurate and accepted harm reduction language and practices by attending SSP advisory board meetings, and reading reports disseminated by NC DHHS. Leadership and volunteers also engage with materials made by and for people impacted 115 by the war on drugs including books such as Saving Our Own Lives by Shira Hassan and Drug Use for Grown-Ups by Carl L. Hart, and podcasts like Crackdown. We have compiled a running list of these educational resources that we provide to volunteers seeking to learn more. Moving forward, we plan to incorporate more direct voices from participants and people directly impacted by drug use through formal surveys, informal feedback discussions, and structured meetings with our CAB. All assistance provided will be voluntary and monetarily compensated. SHAC SSP serves a diverse population with a wide range of lived experiences and identities with a high degree of overlap with the prioritized groups for this funding source including Black, Indigenous, and People of Color (BIPOC) and those experiencing housing instability. Our program does not currently track participant demographic information, but IFC serves a population that is approximately 70% BIPOC, so our population at our weekly shift at IFC roughly reflects these demographics. We recognize the importance of collecting more comprehensive demographic information for improving our services and addressing health disparities, so moving forward, will enhance our data collection efforts to incorporate this data to better understand and meet the needs of the communities we serve. We will collaborate with our CAB to ensure that this information is collected in a manner that is sensitive, respectful, and prioritizes participant dignity over all else. Through our partnership with IFC, we provide critical support to individuals who use drugs who are also experiencing homelessness and housing instability. IFC provides emergency financial assistance for rent and utilities and provided over$110,000 in emergency assistance in 2022-2023. They supported 387 households with rent payments in 2023-2024. IFC also runs 24- hour shelters for individuals experiencing homelessness as well as a temporary cold weather shelter in the winter. Finally, IFC offers permanent supportive housing for community members with complex barriers that prevent them from being able to obtain and keep other housing. Our location within IFC enables us to offer harm reduction services to people reporting to IFC for housing assistance and to connect people seeking safe injection supplies directly to housing resources if needed. In this way, our collaboration with IFC expands our reach and generates a more integrated support network for vulnerable Orange County residents. We also serve people experiencing homelessness who do not use drugs but seek our services for first aid supplies, naloxone, and other materials. In addition to safe injection and overdose reversal supplies, we offer resources requested by the communities we serve, including items that help address some of the challenges of homelessness, such as bug spray, hand warmers, and hygiene products. Finally, we are also working to collaborate more closely with Orange County's Post Overdose Response Team (PORT). Their team can provide MOUD and gap coverage for individuals who are between providers or are having difficulty accessing their medication and can direct people to our resources for safer use and overdose response if interested. They also have a partnership with the Lantern Project working with individuals involved in the criminal legal system, which is crucial for managing overdose in the vulnerable post-release period and helping these individuals with reintegration. Though our program does not specifically focus on those transitioning from correctional settings, our broader network through collaborators like PORT can assist us in reaching these individuals with essential harm reduction supplies. 116 E. Evidence of Collaborations/Partnerships SHAC Syringe Service Program actively collaborates with a range of community partners to ensure our services are comprehensive, accessible, and non-duplicative. We seek to complement rather than duplicate existing efforts within Orange County. By integrating harm reduction efforts into multiple healthcare and community settings, we expand access to care while maximizing the impact of available resources. As the only fixed location-based syringe service program in Orange County, SHAC SSP remains distinct from on-campus, student-focused harm reduction initiatives as well as from mobile SSP services. We provide twice weekly, in- person support and supplies, serving different demographics and meeting distinct community needs as compared to SSPs offering mobile supply distribution. SHAC SSP Organizational Collaborators include: 1. Inter-Faith Council for Social Service (IFC) Collaboration: Our partnership with IFC in Carrboro enables us to offer harm reduction services in conjunction with their social support programs. Our supply distribution shift is scheduled at IFC on Tuesdays from 4:00 to 6:00pm to overlap with free hot meal distribution at 5:00pm. This strategic collaboration allows us to reach individuals who may otherwise face barriers to accessing harm reduction supplies, providing a convenient opportunity to receive supplies in a supportive environment. This coordination of timing also provides the SSP visibility with community members who were previously unaware of our services, expanding our number of participants. 2. University United Methodist Church (UUMQ We maintain an ongoing partnership with UUMC, hosting weekly clinics every Thursday from 5:30 to 6:30 pm. Located in a central, high- traffic area near a bus stop, UUMC provides an accessible space for individuals who rely on public transportation or have limited travel options to Carrboro. Though the location is highly accessible, our distribution space within UUMC is designed to be private for more discreet distribution. This UUMC location complements our distribution efforts at IFC during a highly trafficked mealtime and allows us to serve participants that are most interested in privacy. 3. Orange County Post-Overdose Response Team (PORT): SHAC SSP has partnered with PORT to provide individuals who have experienced an overdose with immediate access to harm reduction resources and treatment options. PORT connects individuals with a peer support specialist and access to medication for opioid use disorder(MOUD). SHAC SSP collaborates with PORT to provide information to connect individuals with SHAC SSP services and recovery programs. We are also working with PORT to assess EMS data on overdose locations to guide our selection of an additional supply distribution location. 4. SHAC Clinics: Over the past year, we have collaborated with SHAC Medical and Dental Clinics to ensure naloxone is available to patients in both clinical settings. Free naloxone is advertised on posters throughout the primary care clinic and provided upon request, supplied to SHAC Medical by SHAC SSP. We also provided naloxone to stock first aid kits in the SHAC Dental Clinic and plan to install posters and provide free naloxone to patients in this context as well. Additionally, SHAC SSP can connect participants with various SHAC clinics, including SHAC XYZ for HIV and STI testing and counseling, the Gender Affirming Care Clinic, and Get Covered Carolina, which helps uninsured individuals apply for health insurance through the ACA. 5. UNC Emergency Department: SHAC SSP is in the process of incorporating harm reduction resources into discharge materials for patients admitted to the UNC Emergency Department with substance use-related concerns. This initiative aims to provide individuals with immediate 117 access to information on syringe services, naloxone, and recovery pathways, ensuring they leave the hospital with resources for continued care. 6. UNC Street Drug Analysis Lab: Through our partnership with the UNC Street Drug Analysis Lab, SHAC SSP provides drug checking kits to identify contaminants in the local supply and reduce the risk of overdose. This initiative helps participants make informed decisions about their substance use while contributing valuable data on emerging local drug trends. 7. Hillsborough Pharmacy: We continue to distribute safe injection supplies and naloxone through our valued partnership with Hillsborough Pharmacy. Additionally, we provide naloxone administration and harm reduction training for pharmacists upon request. This collaboration ensures individuals can access essential supplies in a discreet environment. The location in Hillsborough complements our staffed shifts in Chapel Hill and Carrboro and allows us to serve additional Orange County residents, as transportation to our shift locations would pose a challenge for many of our participants that reside in or nearer to Hillsborough. 118 F. Performance Measures and Program Evaluation We will track initiative-specific metrics and general metrics to evaluate the success of our program. While these metrics provide analytical context for our program's success, we will also solicit participant narratives, including program feedback and unmet needs, to inform future initiatives. We plan to work very closely with users of our SSP in the design and implementation of our program evaluation plan. The program metrics listed below are preliminary and may be added to based on feedback from our CAB, once it has been developed, on what they think are the most important metrics of success of the program. Additionally, we will involve our CAB in designing our SSP participant-facing surveys to ensure that we are asking participants demographics and outcome-related questions in the most appropriate manner. The data from these surveys will contribute directly to our program outcomes. Finally, we will periodically review our progress towards our program metrics with the CAB, and brainstorm to address barriers to achievement of our outcomes. Our program already has a robust system for monitoring general metrics, which are reported to Orange County biannually. UNC's Injury and Prevention Center houses and helps manage our budget and inventory. Additionally, we currently employ a program navigator, who plays an active role in program oversight and growth alongside program co-directors. Outside of our organization, in expanding these initiatives, we will set goals and be in active collaboration with community partners. These initiatives will include, but are not limited to (1) Opening a new SHAC SSP location to increase SSP access within the community (2) Initiating SHAC SSP material distribution within the UNC Emergency Department (3) Establishing Emergency Use Naloxone Boxes (4) Improving and streamlining referrals (5) Identifying, engaging, and compensating SSP participants for their feedback to improve responsiveness of our services (6) Disseminating our programs work and continue building our network of collaborators through attendance at educational conferences. Table 1. A) Initiative specific metrics tracking. Example of tracking for specific SSP initiatives. B) General Metrics Tracking, shortened. All general supply distribution will be tracked similarly. A. Emergency Use Naloxone Boxes Initiative Indicator Data source Measurement frequency H of boxes implemented SSP inventory tracking Recorded after each initiation. H of naloxone doses used(nasal and intramuscular) SSP inventory tracking Recorded monthly or upon restocking of naloxone at specific location. ✓t of overdose reversals reported Orange County EMS or site Recorded after notified by Orange County EMS, collaborator notification,SSP participants or naloxone box site collaborators. participant intake form B. General Metria q of needles and syringes distributed SSP participant intake form Recorded at each SSP visit,tracked monthly q of safer injection supplies distributed(cookers,cottons, SSP participant intake form Recorded at each SSP visit,tracked monthly tourniquets,vitamin C,etc) q of wound care supplies distributed(gloves,antibiotic SSP participant intake form Recorded at each SSP visit,tracked monthly ointment,masks,Band-Aids,gauze,etc) q of naloxone doses distributed(nasal and intramuscular) SSP participant intake form Recorded at each SSP visit,tracked monthly k of drug(fentanyl,xylazine)test strips distributed SSP participant intake form Recorded at each SSP visit,tracked monthly N of referrals made(SUD treatment,housing services,health SSP participant intake form Recorded at each SSP visit,tracked monthly and social services 119 Include in the some PDF document as this form, after the Certifications section below, the following required documents. If an item is not applicable to your organization, please indicate this by an "N/A"and explain why it is not applicable. 3. Letters of Commitment and/or Support (Up to 5 letters) 4. Latest Audited Financial Statements, including Management letter(Attach letter of explanation if unable to provide) 5. Documentation of Tax Identification Number (can be IRS Determination Letter for non-profit agencies) 6. Certificate of Insurance 7. For non-profit agencies only: A. IRS Determination Letter: provide a copy of an IRS determination letter which states that your organization has been granted exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. The organization's name on the letter must match your current organization's name and address. This IRS determination letter can also satisfy the documentation requirement of your organization's tax identification number (TIN). B. Verification of 501(c)(3) Status Form: If applicable, an Authorized Representative must annually submit verification that the organization remains a qualified 501(c)(3) tax-exempt organization. C. Copy of Form 990 Federal Tax return filed for latest fiscal year. D. Agency organizational chart. E. Current Board of Directors Roster with names, addresses, office terms (with dates), and professional and/or community affiliations. N/A Department of Injury Prevention Research Center at University of North Carolina at Chapel Hill doesn't have their own board of directors. Please refer to departmental organization chart below. 8. For-profit agencies only: A. Current Board of Directors Roster with names, addresses, office terms (with dates), and professional and/or community affiliations. B. Appropriate tax form filed with IRS filed for latest fiscal year. C. Agency organizational chart. Insert/Attach these required documents here. 0 120 February 12,2025 Dear Orange County Officials, It is with great enthusiasm that I write in fall support of the Student Health Action Coalition Syringe Service Program (SHAC SSP) applying to receive Orange County Opioid Settlement Funds. S SSP is a student-nin organization that provides evidence-based services to people who use drugs (MUD). This is a community that is often ignored, but the students involved with SHAC SSP provide judgement-free services, including but not limited to, free harm reduction supplies, educational information about how to use xylazine and fentanyl test strips, on-the-spot naloxone trainings,and linkages to other types of care through partnerships with other branches of SMAC and outside organizations. SHAC SSP is an ideal organization to receive this funding as they provide direct services to people living with opioid use disorder(OUD)and other types of substance use disorder( ITIS)and mental health conditions in general.With locations on Franklin Street in Chapel Hill and at the Inter-Faith Council in Carrboro, S SSP is able to reach some of the most marginalized people in the area, working particularly close with folks who are experiencing homelessness. S SSP is filling a need that would otherwise not be filled,and I believe strongly in the work they are doing. Inter Faith Council for Social Services is the only day center open 365 days a year, serving waryn meals supplies and community resources and continues to be the only shelter in Orange County. IFC strives to support through the help of staff,volunteers and community partners such as SAC SSP individuals facing food and housing insecurities and those dealing with behavioral health issues. With programs such as S SSP we continue to create a safe place for all those that visit and reside in the community through a harm reduction approach. By supporting individuals that participate in substance use with first aid supplies, fresh needles, sharp containers, can, and education we have managed to see an increase in safe practices and a decrease in elevated behaviors. Our members look forward to these resources and supplies and ongoing support. In summation, S SSP provides invaluable resources to the Orange County Community. 121 I fully support their application for funding. Please feel free to contact me with any questions, or for additional evidence of support. Sincerely, Cry�st 1 Ferguso Inter-Faith Council for Social Service 110 W. Main St. Carrboro,NC 27510 Community Service Navigation deer us ,''i�',ifcLn,,ill2� work. (919) 919-929-6380 2025 fax. (919) 929-3353 122 STAFFIFC TEAM COMMUNITYIMPACT; ADMINISTRATION,OPERATIONS& DEVELOPMENT FY 2021-24 Jackie Jenks,President and CEO , ` Asia Fowler,Deputy Director Jennifer Bowden,Finance Director KFFF°NG PEOPLE HOUSEDNAVIGATING THE COMMUNITY Stephani Kilpatrick,Development and TOGETHER Communications Manager $146 893 Allan Rosen,Facilities Manager , IN EMERGENCY FUNDS • Gunzo Bethea,Facilities Advocate for utility bills,rent R other essentials HOUSEHOLDS ACCESSED Chris Horton,Facilities Advocate 52,690 HOT MEALS NAVIGATION PROGRAM ACTIVATE! IFC enjoyed by people who were hungry during Nate Jones,Activate!IFC Director Paris Miller-Foushee,TAP BIPOC Project Lead ' 11,494 Alyssa Hinton,Voter Engagement BAGS OF GROCERIES ¢, Project Lead taken home by members of IFC COMMUNITY SERVICES =WILDING COMMUNITY POWER � �� 4 Kristin Lavergne,Community tlrroagh i otlu;-.leadershili ckreloI neil . 30,423 fX71fI F'OP7XJltltflljPSft�t'l3': f OF PEOPLE Services Director NIGHTS who left our shelters moved CrystellFerguson,Community Services �t IIFCCOMEDMUNITYMEMBERS spantInourshelters into permanent housing by adults and Manager through voting related programs IIBBii// chitdren Joseph Adams,Kitchen Team Lead 83 NEWLY REGISTERED VOTERS LOCAL LANDLORDS Nat Flow,Food Resources Team Lead 12 partnered with us to offer no+ PEOPLE REACHED lower than market rate rent Katina Welch,Community Services through community safety cyphers forpermanentsupportive Advocate and conversations,phone banking, # housing members and doar-to-dovrcanvassing Bk Hart, Kitchen Advocate PEOPLE REACHED 150+ SHELTER AND HOUSING through training workshops Jessica Aldave,Shelter and 301,,. Housing DirectorCA Tracey Hagan,HomeStart Manager •' ' ' . ., ` Ka'Tiera Truett,Community House Manager NataleeAtwater,HomeStart Team Lead ` • • • t Tra'Von Outlaw,Community House .VOLfaT • • • i Team Lead TAF F MEMS RS res Bernestine AustinCommunity House Case Manager EMSERS Linda Ellison,HomeStart Case Manager Debra Vestal,PSM Team Lead Tom Bainbridge,PSH Case Manager 'F C BOARD O F DIRECTORS CarmenJohnson,PSH Case Manager Angela Clapp,Resident Advocate OFFICERS MEMBERS AT LARGE Annette Clark,Resident Advocate Donna Carrington,Chair Lynn Allen Mariela Hernandez David French,Resident Advocate Tom Fenn,Vice Chair Don Arbuckle Jay Miller Charlotte Horton,Resident Advocate Dow Williamson,Treasurer April Scales Barber John Ring Anna Kenion,Resident Advocate Darin Campbell,Secretary Laura Batts-Thomas Rachel Waltz Ronnie Kimble,ResidentAdvoeate Susan Laidlaw,Past Chair Michelle Hamilton Rhonda Lee,Resident Advocate PUBLISHED BY Kaneesha Person,Resident Advocate 110 W.Main Street•Carrboro,NC 27510 sit us on Designed By Vi Scherrie Smith,ResidentAdvoeate ® Facebook �• (919)929-6380 Fax:(919)929-3353 Algin Wiley,Resident Advocate fC info@ifcmaiLbox.org instagram& Rayneesha Meadows,Resident Advocate ifcweb.org Twitter! M �� 2 123 February 12,2025 To whom it may concern, It is our pleasure to write in fervent support of the Student Health Action Coalition Syringe Service Program's(SHAC SSP)application for Orange County Opioid Settlement Funds. We represent the overarching organization, SHAC,under which SHAC SSP is housed. Our mission is to provide health care services and social needs support to vulnerable and marginalized groups in our local community at no cost. SHAC SSP's mission supports that of our organization in providing nonjudgmental support services for individuals who use drugs, including free harm reduction supplies, education for drug testing and overdose response,naloxone training, and bridging to additional medical and social needs support. SHAC SSP is one of few organizations in the area that provide direct services to people living with opioid and/or substance use disorder and is the only SSP providing weekly drop-in supply shifts in Orange County. SHAC SSP fills a previously unmet need in our community, and we strongly support the organization. Over the past year SHAC SSP strengthened connections with SHAC Medical Clinic and SHAC Dental,including but not limited to,making Naloxone available in clinic as well as providing Naloxone administration trainings for volunteers and patients.Naloxone is a lifesaving medication that our weekly medical clinic and patients would otherwise not have access to. This initiative was years in the making but including SSP in conversations helped move the initiative quickly to garner results within a matter of months. Additionally,this year, SHAC SSP implemented a new supply distribution shift weekly at an additional location including recruiting volunteers, developing marketing,and installing signage. SHAC SSP was also able to hire a program navigator due to their exponential growth based on community demand. This new team member brought years of experience and expertise to SHAC SSP and was able to streamline existing operations as well as develop and implement new programs over the past year. In sum, SHAC SSP increased the number of syringes and doses of naloxone distributed by over 100%compared to prior years. SHAC SSP is an invaluable resource to the Orange County community, and we fully support their application for funding. Thank you for considering SHAC SSP. Please feel free to contact us with any additional questions. Best regards, Anysa Z. Fe andez Ryan M. Trate Chief Executive Officer Chief Executive Officer Student Health Action Coalition Student Health Action Coalition shac_ceo@med.unc.edu shac_ceo@med.unc.edu 124 ORANGE COUNTY ORANGE COUNTY HIGH IMPACT OPIOID ABATEMENT NORTH CAROLINA STRATEGIES Funding Proposal Application Form Application Due Date: February 21, 2025 Applicant Agency: General Information Legal Name Reintegration Support Network RS Address 117 West Main Street Carrboro,NC 27510 Type of Agency ❑ Government/ ❑ For-Profit (check one) Public Authority x❑ Non-Profit Business Telephone 984-777-5282 Website https://www.rsnnc.org/ Primary Contact Full Name Terence L. Johnson Title Executive Director Email Terence@rsnnc.org Telephone 910-612-8529 Name of Project Reintegration Support Network: Individual Mentoring Total Application Funding Rea uested $ $ 40,000.00 Funding Period Requested Start End (MM/DD/YYYY) Date 07/1/2025 Date 06/30/2026 Selected NC MOA Option A Strategy (Number and Name) 6. Early Intervention Agency Mission and Vision Statements Mission: RSN is a community that embraces, empowers, and inspires youth and emerging adults who need support. We serve youth and emerging adults who experience challenges related to: • Substance Use • Mental Health • Justice Involvement i 125 Vision: RSN envisions local communities supporting, inspiring, and empowering youth in all forms of recovery. Values: narrative of each value appears at www.rsnnc.org • Youth First • Authenticity of Voice • Diversity and Inclusion • Independence, Partnership, and Collaboration As a separate Excel file, submit a completed Budget Worksheet. Submit application to tstancilgoran ecountync._ov with a subject line of—RFA: Opioid Settlement Funds— [Organization name]. Will receive Receipt of Application email upon submission. If email is not received within 24 business hours, reach out to Tonya Stancil, Harm Reduction Coordinator at tstancil@orangecountync.gov. H 126 1. Proposal Summary (no more than 250 words, required but not scored) To better serve Orange County youth and families impacted by substance use, RSN seeks support from the county to address the critical gap in mental health and substance use resources, especially for those at risk of opioid use disorder or in need of harm reduction interventions. RSN's mission is to empower youth and emerging adults (ages 13-20)navigating substance use, mental health challenges, or justice involvement. We employ a strengths-based, one-to-one mentoring model,pairing youth with specially trained mentors, many of whom have lived experience. These mentors, serving as allies and peer support workers, often have personal experience with substance use, mental health challenges, and/or justice involvement. They support youth and their families through individualized mentoring and enrichment activities, fostering a safe and resilient space for young people to focus on their needs, build agency, and strengthen connections with themselves, school, and community. Our mentors receive comprehensive training to recognize and nurture youth strengths, utilizing SAMHSA CORE Competencies (recovery-oriented,person-centered,voluntary, relationship-focused, and trauma-informed practices), active listening skills, SMART goal setting, and motivational interviewing techniques. Recognizing the profound impact of poverty and social identities on the youth we serve, RSN is committed to addressing the root causes of inequity through culturally responsive and person-centered services. We strive to create a supportive environment where all youth can thrive. By investing in RSN, Orange County invests in the well-being of its youth and the future of its community. iii 127 2. Project Narrative A. Assessment of Community Need (16 points, page limit: not to exceed 1 1/2 pages) National data reveals a disturbing decline in youth mental health, with alarming increases in sadness, hopelessness, and suicidal ideation (CDC, 2024). North Carolina's low ranking (42nd) for youth mental health treatment access underscores a critical service gap (Hopeful Futures, 2024). Orange County data confirms this: 49% of youth struggle with substance use and 33% with mental health issues, yet only 2-14% receive treatment (NC DJJ, 2024). Further, 9% of youth have a family member with substance use or mental health treatment needs, 35%have a family member with prior justice system involvement, and 29% experience inadequate guardian supervision. These statistics highlight systemic inequities and service gaps. RSN emphasizes immediate action, especially caregiver support, to mitigate the impact of substance use and ensure youth thrive. RSN's "Family Resilience Framework" engages families to build crucial support networks to help youth develop coping skills, self-worth, and optimism (Surgeon General, 2021). RSN prioritizes evidence-based adult-youth relationships to foster social-emotional well-being (Surgeon General, 2021) and integrates harm reduction strategies to equip families with knowledge and skills to support youth navigating substance use, promoting open communication and reducing stigma.A recent Surgeon General's report emphasizes the need for family-focused youth programs, given parental stress, financial strain, and isolation, which increase risks for children (Surgeon General, 2024). RSN serves as a vital community hub, connecting youth and families to resources, building resilient relationships, and fostering healthy development. RSN provides individual skill-building utilizing 1:1 mentoring to youth (13-20) in Orange County impacted by or at-risk for substance use, and their families and collaborates with other mentoring programs matching youth with appropriate programs and sharing resources. RSN's one-to-one mentoring approach cultivates a strong sense of belonging, nurtures healthy relationships, and activates positive community involvement by fostering supportive adult partnerships, collaborative goal setting, and wellness action plans that build on inherent resilience. In addition, RSN expands access to enriching opportunities for both participants and their caregivers and collaborates with local youth-serving organizations, court counselors, and families to provide comprehensive wraparound support that amplifies existing strengths. Grounded in SAMHSA best practices, RSN's evidence-based program recognizes and empowers youth to identify their aspirations and build upon their existing capabilities through a participant-centered approach. Mentors are expertly trained to recognize and nurture youth strengths,utilizing: SAMHSA CORE Competencies (recovery-oriented,person-centered, voluntary, relationship-focused, and trauma-informed practices), active and compassionate listening, SMART goal setting, and motivational interviewing skills that unlock potential (Substance Abuse and Mental Health Services Administration, 2023). Mentors provide at least two hours of individualized skill-building based mentorship weekly for up to 16 weeks, focused on SAMHSA's 8 Dimensions of Wellness, investing in youth capabilities to achieve their goals and further develop their agency. RSN mentors use self-disclosure, empathy, and acceptance, drawing on lived experience and community knowledge to build trust and navigate sensitive topics, fostering authentic connections and illuminating pathways to successful transformation. 1 128 Our program is participant-centered, ensuring trauma-informed care, and dismantling systemic barriers that limit opportunity. Prioritizing anti-racist practices, RSN actively cultivates community support through genuine and caring interactions that affirm inherent worth. Through youth-focused mentoring, RSN strengthens belonging, acceptance, and adult-youth connections, building a foundation for thriving. B. Project Description and Program Sustainability (28 points,page limit: not to exceed 3 pages) Since 2019, RSN has become a vital resource for youth and emerging adults, receiving 200 referrals for one-to-one mentoring or Life Skills support groups, demonstrating the community's trust in our services. To date, 136 young people have actively engaged in our programs, with roughly half benefiting from individualized mentoring and the other half participating in peer-led Life Skills groups. This impact stems from strong partnerships,with most referrals coming from Juvenile Crime Prevention Councils and other youth-focused organizations. Of 165 participants with demographic data, 63.64% identify as male, 36.75% as female, and 0.61% did not disclose their gender identity; over three-quarters (77.9%) identify as BIPOC. These young people demonstrate remarkable resilience despite significant challenges: 75.4%navigate mental health concerns, 61.1% face substance use challenges, 55.6% have experienced trauma, 44.4% have justice system involvement, and 69.4% experience family conflict. Participants in our skill- building program receive an average of 5.25 months of consistent one-to-one support, working weekly with their mentors to build skills, explore wellness, develop positive intentions, and achieve goals related to school/employment(63.1%), self-care (45.8%), and relationships (46.5%). RSN is experiencing significant growth in Orange County, on pace to serve twice as many youth this year. Since July 2024, we've received 25 referrals and supported 13 participants in Individual Skill Building activities. This growth reflects our model's success and the urgent need for our services. RSN is also dedicated to increasing language access with bilingual staff and mentors. Original funding to develop RSN's unique youth-focused program model utilizing specially trained mentors to provide support came through a SAMHSA"Building Communities of Recovery" grant and our work has continued over the years to be supported by local, state and foundation grants including the Orange Count JCPC, OC Outside Agencies, Oak Foundation and Blue Cross Blue Shield Foundation of the Carolinas to name a few of our continued supporters. During the proposed grant period between July 1, 2025 and June 30, 2026, we will enhance programming by integrating harm reduction principles and providing overdose prevention training to staff and mentors in addition to continuing to implement our Family Resilience framework. RSN seeks support for program support staff dedicated to intake, training and supervising mentors in harm reduction, and onboarding up to seven new mentors throughout the 2025/26 program year in addition to funds for direct service of our mentors. In turn, our specially trained and supervised mentors will engage 18 at-risk youth and, or youth engaged in substance use, in at least 2 hours of individual mentoring over 16 weeks, creating a safe environment focused on emotional well-being, understanding substance use, and developing harm reduction strategies. This approach prioritizes minimizing harm and stigma. RSN requests funding to support mentors as independent contractors,providing them with valuable training and 2 129 professional development opportunities in the healthcare and recovery field. This investment will benefit mentors directly and strengthen our community's ability to address the growing crisis of inadequate mental health and substance use support—a crisis intensified by systemic inequities. C. Equity Impact(8 points,page limit: not to exceed 3/a page) The Reintegration Support Network(RSN) was born out of tragedy but fueled by hope. When 18-year-old Matt McQuiston tragically died from a drug overdose after months of treatment, Matt's family and friends established a memorial fund to provide necessary support systems. The aim of this fund was to prevent similar devastation to the lives of other youth and their families. Since RSN's inception, its purpose has been to interrupt the systemic barriers that youth and their families experience when accessing mental health and substance use services. Centering racial equity, RSN employs inclusive practices that recognize systemic pressures, creating opportunity gaps for under-resourced youth,particularly youth of color. Leveraging a mentoring model with adults who possess lived experience, RSN builds supportive communities; communities designed to embrace, inspire, and empower young people. This approach ensures culturally responsive services, addressing the root causes of racial injustice and fostering a more just and equitable system where all youth, especially those from minority populations, can thrive and avoid tragedies like Matt's. RSN directly addresses health inequities by serving youth disproportionately impacted by systemic barriers to mental health and substance use treatment,particularly youth of color and those involved in the juvenile justice system. Recognizing that poverty and social identities compound these challenges, RSN provides culturally responsive, person-centered services. Our harm reduction philosophy prioritizes the safety and dignity of youth and families, moving beyond punitive approaches to substance use. We specifically target disparities in access to care by offering free services and online resources for uninsured/underinsured families. Our mentors address social determinants of health, such as transportation barriers,by connecting families to local resources and facilitating access to enrichment activities. This ensures that youth, especially in rural areas, can access essential services and opportunities. D. Organizational Readiness (20 points,page limit: not to exceed 3 pages) In 2019, RSN developed a unique mentoring model for youth,utilizing trained paraprofessional mentors with lived experience to provide support services to young people impacted by mental health challenges, substance use, and/or justice involvement. This innovative approach leverages the power of shared experience to build trust and connection, offering youth a unique form of support from individuals who understand their struggles. RSN began implementing its programming through a three-year partnership funded by a Substance Abuse and Mental Health Services Administration (SAMHSA) "Building Communities of Recovery" (BCOR) grant.' This initial funding provided crucial support for program development and implementation.Although BCOR grant funding ended in July 2022,RSN has demonstrated its sustainability by continuing to provide high-quality, culturally responsive services that support 3 130 the social and emotional well-being of youth. This commitment to continuity underscores RSN's dedication to the youth it serves. The past six years have also allowed RSN to cultivate and solidify crucial community- based partnerships and project collaborations with numerous youth-serving organizations. Most recently, RSN staff and our mentor collaborated with youth-serving organizations Grow Your World, Boomerang and Alliance Health to provide comprehensive wrap-around services to an RSN participant in need of housing, substance use and mental health interventions. Other collaborations have been essential to adapting and expanding RSN's reach and impact. For example, RSN has partnered with El Futuro and El Centro Hispano to culturally adapt its programming to meet the unique needs of Latinx youth, ensuring that these young people receive culturally competent and linguistically appropriate support. RSN has also facilitated skill- building groups within Orange County at Boomerang and United Voices of Efland-Cheeks, further extending its service delivery network and reaching youth in diverse community settings. Beyond direct programming, RSN actively participates in numerous coalitions focused on improving the mental and behavioral health of youth. These include the Orange County System of Care Collaborative, the Orange Partnership for Alcohol and Drug Free Youth, the Durham/Orange Juvenile Justice Behavioral Health Coalition, and the Orange County Juvenile Crime Prevention Council. RSN's involvement in these collaborative efforts demonstrates its commitment to a systems-level approach to addressing youth needs. Current funding from the BCBS Foundation of the Carolinas, the Oak Foundation, and Orange County's Juvenile Crime Prevention Council has enabled RSN to solidify its original program model and ensure its continued operation. Furthermore, RSN successfully completed the reporting requirements for its 2024 Orange County Opioid Settlement award, demonstrating its accountability and responsible stewardship of funds. RSN has also successfully passed both one-year and three-year Orange County JCPC programming monitoring and financial audit reviews, further reinforcing its commitment to operational excellence and fiscal responsibility. This diverse funding portfolio and demonstrated compliance reflect the community's recognition of RSN's value and the effectiveness of its programs. E. Evidence of Collaborations/Partnerships (10 points, page limit: not to exceed 1 1/4 pages) RSN prioritizes collaboration, recognizing its crucial role in providing comprehensive support to youth and families. We have a strong history of building and maintaining community partnerships, and we are committed to both strengthening existing collaborations and forging new ones. For example, RSN staff and mentors recently collaborated with Grow Your World, Boomerang, and Alliance Health to provide wraparound services, including 4 131 housing, substance use, and mental health interventions, to a participant in need. Our partnerships with El Futuro and El Centro Hispano have enabled us to culturally adapt our programming for Latinx youth, ensuring culturally competent and linguistically appropriate support. Furthermore, our collaboration with Boomerang and United Voices of Efland- Cheeks to facilitate skill-building groups demonstrates our commitment to reaching youth in diverse community settings. While other mentoring programs exist in Orange County, RSN's program is uniquely designed for youth currently using substances, those with a history of substance use, and/or those at risk due to mental health challenges or justice involvement. Our mentors receive specialized training in evidence-based practices to support these youth for four months, focusing on goals to improve emotional well-being and linking them to community resources. RSN actively collaborates with other mentoring programs to ensure youth are matched with the most appropriate services, creating a coordinated and efficient system of support. RSN is actively expanding its collaborative network. In September, we partnered with the ArtsCenter in Carrboro to launch family-centered enrichment activities. This initial event, which included a 3-D printing activity and separate discussions with youth and families to gather input for our advisory committee, engaged four youth and their families and mentors. We are building on this momentum with planned enrichment activities, including a five-week cooking class with Mel's in Carrboro culminating in a community meal prepared by the youth, and a community dialogue with youth and families at Beautiful Together Animal Sanctuary in Chapel Hill. These activities not only provide enriching experiences but also serve as opportunities to engage new stakeholders and strengthen existing relationships. RSN's referral network is broad and includes Orange County's DJJ counselors; District Court staff; clergy;Youth Deflection Program; mental health professionals; Multi-Purpose Home Services; law enforcement; school staff and resource officers; self-referrals; Teen Court; camp staff, the Orange County Department of Social Services; truancy court; substance use treatment and recovery programs; participants in the Juvenile Justice Behavioral Health partnership; members of the Orange County Juvenile Crime Prevention Council; youth- serving community-based partners; and parents. We will continue to cultivate relationships with these existing referral sources and actively seek new partnerships to ensure comprehensive wraparound support for youth and families. By strengthening existing collaborations and engaging new stakeholders, RSN aims to create a more integrated and responsive system of care for youth in Orange County. F. Performance Measures and Program Evaluation (18 points,page limit: not to exceed I page) RSN measures program success through a multi-faceted evaluation process incorporating both qualitative and quantitative data. To track improvements in participants'perceived emotional well-being and personal relationships, youth complete an eight-dimension wellness assessment at intake and monthly thereafter. This data demonstrates changes in the key elements of SAMHSA's 8 Dimensions - emotional, physical, occupational, social, 5 132 spiritual, intellectual, environmental, and financial wellness. RSN also monitors participants' community involvement and engagement through mentor interaction logs and consistent communication between program staff,participants and their parents/guardianThese data points are used to evaluate progress toward our short-term outcomes: increased youth connection, support for healthy relationships, enhanced positive engagement, and improved emotional well-being, coping skills, and agency—all of which contribute to improved overall well-being. Through these outcomes, RSN programming contributes to breaking cycles of stress and building healthier, more resilient youth, families, and communities by strengthening relationships and providing access to essential support. This grant will significantly enhance RSN's support for youth and families impacted by substance use. Key goals include: 1) Increasing staff knowledge and skills in youth-centered harm reduction strategies, youth-tailored drug education, and overdose prevention. 2) Deepening the integration of harm reduction principles into RSN's programming, ensuring increased access to overdose prevention resources, especially in rural communities. 3) Fostering community understanding that substance use is a complex issue requiring a collaborative approach that prioritizes youth and family well- being. 4) Raising awareness of how societal and racial inequities increase vulnerability to substance use.Achieving these goals will empower youth and families to navigate challenges and improve their emotional well-being. 6 133 A. Business Associate Addendum THIS ADDENDUM is made this day of Click or tap here to enter text., 20Click or t_p here to enter text. to a contractual arrangement between the parties ("Agreement"). WHEREAS Orange County is itself a Covered Entity, as that term is defined in HIPAA and will be referred to as "Covered Entity"; and WHEREAS, Click or tap here to enter text. is, or may be, a Business Associate of Covered Entity and will be referred to as "Business Associate"; and WHEREAS, Business Associate performs certain services on behalf of or for Covered Entity that require the exchange of information about patients that is protected by the Health Insurance Portability and Accountability Act of 1996, as amended, and the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164 (collectively "HIPAA"). NOW, THEREFORE, the parties to the Agreement are entering into this Addendum to establish the responsibilities of both parties regarding HIPAA-covered information and to bring the Agreement into compliance with HIPAA. I. DEFINITIONS Except as otherwise defined herein, terms used in this Addendum shall have the same meaning as the terms are defined in HIPAA. II. OBLIGATIONS OF BUSINESS ASSOCIATE To comply with the Privacy, Security, and Breach Notification obligations imposed by HIPAA, Business Associate agrees to: A. Privacy and Security Obligations: 1. Not use nor disclose information other than as permitted or required by the Agreement, this Addendum or as required by law. 2. Use appropriate safeguards to prevent use or disclosure of the information other than as provided for by the Agreement and this Addendum. 3. Comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI (protected health information) to prevent use or disclosure of PHI other than as provided for by the Agreement. 4. Report to Covered Entity any use or disclosure of the information not provided for by the Agreement of which Business Associate becomes aware, including breaches of Unsecured PHI as required by 45 CFR 164.410. 5. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any agents or subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree, in writing, to the same restrictions, conditions, and requirements that apply to Business Associate with respect to such information. 1 134 6. Make available PHI in a designated set record set to Covered Entity upon request within three (3)working days as necessary to satisfy Covered Entity's obligations under 45 CFR 164.524. If Business Associate receives a request for access directly from the individual, then Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 7. If Business Associate receives a request pursuant to 45 CFR 164.526 to make any amendment(s) to PHI in a designated record set directly from the individual, then Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 8. Maintain and make available upon request within three (3)working days the information required to provide an accounting of disclosures to Covered Entity as necessary to satisfy Covered Entity's obligations under 45 CFR 164.528. If Business Associate receives a request to provide an accounting of disclosures directly from the individual, then Business Associate will forward the individual's request to Covered Entity within three (3) working days to be fulfilled by Covered Entity. 9. Make its internal practices, books, and records relating to the use of PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, available to the Secretary of DHHS and Covered Entity for purposes of determining compliance with HIPAA. 10. To the extent practicable, mitigate any harmful effects that are known to Business Associate of a use or disclosure of PHI or a breach of Unsecured PHI in violation of this Addendum. 11. Use and disclose an individual's PHI only if such use or disclosure is in compliance with the applicable requirements of 45 CFR 164.504(e) and the terms of this Addendum. 12. Refrain from exchanging any PHI with any entity of which Business Associate knows of a pattern of activity or practice that constitutes a breach as defined by North Carolina State Law, HIPAA, or this Addendum. 13. To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s)under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). B. Breach Notification: In the event that Business Associate discovers any use or disclosure of PHI not provided for by the Agreement, including breaches of Unsecured PHI as required at 45 CFR 164.410, and any security incident of which it becomes aware, Business Associate agrees to take the following measures within three (3) working days after Business Associate first becomes aware of the incident: 1. To notify Covered Entity of any incident involving the acquisition, access,use or disclosure of Unsecured PHI in a manner not permitted under 45 CFR Part E. Such notice by Business Associate shall be provided without unreasonable delay, except where a law enforcement official determines that a notification would impede a criminal investigation or cause damage to national security. For purposes of clarity for this provision, Business Associate must notify Covered Entity of any such 2 135 incident within the above timeframe even if Business Associate has not conclusively determined within that time that the incident constitutes a breach as defined by HIPAA. For purposes of this Addendum, Business Associate is deemed to have become aware of the breach as of the first day on which such breach is known or reasonably should have been known to such entity or associate of Business Associate, including any person, other than the individual committing the breach, that is an employee, officer or other agent of Business Associate or an associate of Business Associate. 2. To include in the above-described notification the names of the individuals whose Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach. 3. To provide a draft letter to Covered Entity to utilize to notify the individuals that their Unsecured PHI has been, or is reasonably believed to have been, the subject of a breach. The draft letter must include, to the extent possible: a. A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known; b. A description of the types of Unsecured PHI that were involved in the breach (such as full name, Social Security Number, date of birth, home address, account number, disability code, or other types of information that were involved); c. Any steps the individuals should take to protect themselves from potential harm resulting from the breach: d. A brief description of what Covered Entity and Business Associate are doing to investigate the breach, to mitigate losses, and to protect against any further breaches; and e. Contact information for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an email address, web site, or postal address. lIl. TERMINATION A. This Addendum will terminate automatically,without further action by either party,upon termination of the Agreement to which it is attached. B. Covered Entity may terminate this Addendum if Covered Entity determines that Business Associate has violated a material term of the Agreement or this Addendum. C. Upon Covered Entity's gaining knowledge of a breach, as defined by North Carolina State Law or HIPAA,by Business Associate or any of its agents or subcontractors, of the Agreement or this Addendum, Covered Entity shall either: 1. Provide an opportunity for Business Associate to cure the breach or end the violation, and if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity, terminate this Addendum and the attached Agreement; or 2. Immediately terminate this Addendum and the attached Agreement if either has been breached by a Business Associate, and a cure is not possible. D. In situations where it is not practicable to terminate this Agreement, Covered Entity shall report Business Associate's breach as defined by North Carolina State Law or HIPAA to the Secretary of DHHS, and continue under the existing arrangement with Business 3 136 Associate until a reasonable alternative becomes available, or until directed by the Secretary of DHHS to terminate the Agreement. E. At termination of the attached Agreement and this Addendum, or upon request of Covered Entity,whichever occurs first, Business Associate shall: 1. If feasible, return or destroy all PHI that Business Associate still maintains in any form, received from Covered Entity or created, maintained or received by Business Associate on behalf of Covered Entity. Business Associate shall only destroy PHI with the written approval of Covered Entity. After return or destruction, Business Associate shall retain no copies of such information. 2. If return or destruction is not feasible, Business Associate will provide Covered Entity with documentation explaining the reason it is not feasible. If the PHI is not returned or destroyed, Business Associate will extend the protection of this Addendum to the information and limit further uses and disclosures to those purposes that make the return or destruction of the information not feasible. F. The obligations of Business Associate under this Addendum shall survive the expiration, termination or cancellation of the attached Agreement and this Addendum, and shall continue to bind Business Associate, its agents, employees, contractors, successors and assigns, as set forth herein. G. Business Associate shall indemnify Covered Entity for costs associated with any incident involving the acquisition, access, use or disclosure of Unsecured PHI by Business Associate, any agent or subcontractor, in a manner not permitted under 45 CFR Subpart E. IV. MISCELLANEOUS A. All PHI that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording and electronic display by Covered Entity or its operating units to Business Associate, or is created or received by Business Associate on Covered Entity's behalf, shall be subject to this Addendum. B. In the event of an inconsistency between the provisions of this Addendum and the mandatory provisions of HIPAA, as amended, HIPAA shall control. Where provisions of this Addendum are not included as mandated provisions in HIPAA, but are nonetheless permitted by HIPAA, the provisions of this Addendum shall control. C. Except as expressly stated herein or in HIPAA, the parties to this Addendum do not intend to create any rights in any third parties. D. This Addendum may be amended or modified only in writing signed by the parties. No party may assign it rights or obligations under this Addendum without the prior written consent of the other party. None of the provisions of this Addendum are intended to create,nor will they be deemed to create, any relationship between the parties other than that of independent parties, contracting with each other solely for the purpose of effecting the provisions of this Addendum and any other agreements between the parties concerning their business relationship. E. This Addendum will be governed by the laws of the State of North Carolina, venue Orange County. 4 137 F. No change, waiver, or discharge of any liability or obligation hereunder on any one or more occasion shall be deemed a waiver of performance of any continuing obligation, or prohibit enforcement of any obligation, on any other occasion. G. In the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of PHI that are more restrictive than the provisions of this Addendum, the provisions of the more restrictive documentation will control. H. In the event that any provision of this Addendum is held by a court of competent jurisdiction to be invalid or unenforceable, the remaining provisions of this Addendum shall remain in full force and effect. 1. Headings in this Addendum are for convenience of reference only and shall not define or limit any of the terms or provisions hereof. J. A reference in this Addendum to a section in HIPAA means the section as in effect or as amended. K. Any ambiguity in this Addendum shall be interpreted to permit compliance with HIPAA. L. Business Associate will not use an agent or subcontractor without written agreement by Covered Entity. IN WITNESS WHEREOF, the parties have hereunto executed this Business Associate Addendum on the day and year first written above. Orange County By: [County Manager name], Orange County Manager ATTESTED: BUSINESS ASSOCIATE By: Title: 5 138 ATTESTED: 6