Thank you, chair. We're ready to go. Thank you. Thank you all for your patience. I'd like to turn it over to Supervisor Cummings for a moment of silence. I just wanted to dedicate the moment of silence to two individuals. One was a friend named Cameron Long who last Monday died suddenly at his home. And the other moment of silence is for the 16 year old who was shot last week in Watsonville and who died as a result of his wounds. And his name was Danny. And so just wanted to dedicate the moment of silence to those two people who left our community. Thank you. Begin with the moment of silence, please. Please join us on a pledge of allegiance. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible with liberty and justice for all. Good morning, Mr. Plasio. So are there any changes to today's agenda? Yes, Chair Friend, members of the board, there's one revision on the consent agenda item number 26. There are additional materials. There's a revised memo, packet page 337, which is replaced with recommended action number three, which should read, authorize the director of information services to agree to non substantive changes and sign the agreement. That concludes the revisions to today's agenda. Thank you. Are there any board members would like to move an item from the consent to the regular agenda? Seeing none, we'll open it up for public comment. This is an opportunity for members of the community to address us items that are not on today's agenda, but within the purview of the board of supervisors or within on our consent agenda or on our regular agenda. If you're unable to stay, please feel free to step up forward. Good morning. Hey, good morning. It was at April 25, 2023. Here I am standing in front of the corporate pirate flags, which is the American flag and the California flag with a gold fringe. This is a citizen's rulebook as the US Constitution, all three of them in there. First one written in 1787. The next corporate was 1789 and then 1790. You go outside this building, there's an American flag and a California flag that actually represent the original Constitution and our Declaration of Independence, which is a pretty good document. Only thing I'd really change is it should be all men and women being created equal. So there's a lot of shenanigans going on in here. I'm not quite sure what to say. I know when I spoke here a month ago, for some reason, the executive staff and Sheriff Jim Hart and Gail Newell, they all left the room, probably because more than I as a citizen would like to talk to them publicly. So what else? What are you guys going to pass now? I mean, going through this agenda, let's go to the agenda. Consent agenda number 26. There's about 180 pages. There's quite a bit of information about the digital ID. People don't realize that we are in an open air concentration camp and very soon the life here will be very much like Gaza. So I actually had the opportunity to put my hands on one of the phased array frequency antennas. It's exactly what the military contractors who designed those weapons in military situations, but they're all over this city. The reason I didn't stand for the Pledge of Allegiance is that is not the US flag that I want to represent. I think there's a whole lot of education possible. Thank you. See you guys at 1045. Good morning and welcome. Good morning, members of the board. My name is Allie Hayes and I'm a homeowner in the San Lorenzo Valley. I'm a parent who raised my child here. And I also work for the Health Improvement Partnership. And in my work at our nonprofit, it's really about improving access to healthcare and resources for vulnerable populations. And a big part of my work is our opioid safety coalition work. And you're going to be hearing a presentation from Public Health Leader today about their harm reduction initiatives. And I want to let you know as a parent, as a homeowner, as a local, and as somebody who does public health work, I'm in full support of the Syringe Services Program and their efforts. And I want to let you know that in our opioid safety coalition work, there are many ingredients that we need in the mix to solve this opioid crisis. And our Syringe Services Program colleagues, they come to our convenings, they are engaged in our conversations around prevention and education resources for young people, improving access to treatment, working with us to look at data that tells a rich story that helps us, you know, solve this complex problem in our community. And we really appreciate the value of the harm reduction efforts in our community. And in my work, which includes safe prescribing, educating clinicians, educating parents, we also need to have a space for harm reduction. Folks struggling with substance use disorders, opioids, it's a very complex addiction issue, and harm reduction needs to be at the table. So I wanted you to hear from those various hats as you heard this presentation later on that this work is important. It's an important part of the agreement, the ingredient of really addressing the opioid crisis nationally and in our community. And I really support the public health department in their innovation and their best practices and their recommendations to the board. Thank you for your time. And I appreciate all your hard work. Thank you. Good morning. Welcome. Thank you so much. My name is Dr. Jen Hastings. I'm a family practice physician. I've lived in this community since. Oh, because you can't hear me. Actually, I can take this off while I'm facing you and the glass is hopefully protecting you all. I believe I'm covered negative, but I'm taking my precious minutes seconds. So I'm a family practice physician. I've lived in Santa Cruz County since 1998. I've also raised two children here. And I also like Ali Hayes work with the health improvement partnership. I'm the physician consultant. And I've worked since 2015 with our safe our ex Santa Cruz, which is as Ali shared an extraordinary collaboration of people from and organizations from throughout the county representing medical providers are pharmacists. We love we invite you as well to join us. My what I want to say today is that I would love to see the board of supervisors embrace science and evidence. And what we know is that harm reduction principles save lives. They decrease infection. And the principles are based in respect for all humans. And I would love to see this group of people. Recognize the value of every human in our community and do the best they can to support evidence based practices to decrease morbidity and death, including HIV and hep C. We know that the work of our syringe services program has made a difference. We've seen a decrease in syringe litter. I know that's one of the big concerns that you all have and we have good data showing both locally and nationally that syringe services make a difference and the principles of harm reduction do the same. Thank you so much. I appreciate your engaging with us. Thank you. Thank you, Dr. Hastings. Good morning. Welcome. Good morning. My name is Carl Barris. I've lived in this county for 50 years. I'm a general contractor, and I represent the contractors Guild of Santa Cruz. I have an issue with the building department, which is exacerbated by the fact that there are right now over 200 plants being reviewed, and the process is slowed down extremely.  I have built two homes in the CZU fire zone since the fire, and I had worked with four leaf a non contracted entity with the county, and now I'm working with the county building department, and I feel that there's an issue with too few people reviewing the plans and it's taking too long, and it's going to affect both my job and also those within the industry. I represent an industry that has over 20,000 employees in the building industry in Santa Cruz. There are 150 licensed general contractors. About half of them are right now working. Part of our job is if we stop because we can't get a change order approved by the county, then we're basically letting off our workers because we cannot continue working. This is a major issue. I wouldn't be standing in front of you unless I was asked to by the Guild. So I just, on my own part, think that there's a simple answer to this, that if we have a licensed professional stamp a change order, it should be enough for that change order to be effective. In other words, an architect, an engineer with a stamp on a change order should be enough so that the county. Thank you very much for your time. Thank you for sharing your story. Good morning and welcome back. Yes, good morning, honorable members of the board. My name is D Murray. And I just want to point out our building plan checkers are really hardworking people, but they're with a volume of plans. They just can't seem to get the work out. And they need help from the outside consultants to expedite issuance of building permits. The, not only will the client benefit, but the county will with the income that will be coming in. So we really appreciate whatever you can do to expedite the processing of these permits with a possible and excuse me, with a positive solution to our problem. Thank you very much. Thank you, Ms. Murray. Good morning, welcome. Good morning. I'm back. Very clear in two minutes. I remember when you went to Holy school for the P for a sister sister tonight on the agenda in Watsonville is that I asked for you to do research on what a county of Santa Cruz could do to research what kind of a sister sister. We could create economic development be the idea. So I hope that's clear. It does take research. I don't have that. But I do know that Bristol was big time down in Holy school. But what I want to do is it's not what you know it's what you don't know. If you jot this down, I'd be honored. Simply the words of youth or change and know that it's within a collective of government agencies that is designed for our children and youth. You can't do in two minutes what takes a cup of coffee. But if I've done my research, I respect all of you because we live in a very, very progressive Santa Cruz County with a college called Cabrillo. Please check out with Matt. See what you can do to move forward his vision for Cabrillo. As we know, I look at this today. I'm honored to be here. I've got my videos of when I spoke of what it would be to have a city youth commission that linked up to higher ed. So I'm honored to be here. Those of you who know I do the best I can to not be with another board. Let's build on what exists. And key is everywhere in our county, we have a firehouse look who's got my back in the sense of if we're going to see change, it takes some research. So let me repeat, it simply do a Google for youth or change and pass it on in your network to our young people, countywide. Thank you. Thank you very much for allowing me to blah, blah, blah, blah. Good morning and welcome back. Good morning. I'm playing liaison today because I go to all the CZU fire victims meetings. And I think you should know many of the complaints that they've got. So I'm just transferring information that I've been gathering to you guys. People are running out of rent money on their insurance. They can't afford both rent and they can't afford a mortgage. That's what I think is here pretty quick. I think the contractors name is Avalon that clean the property up. They cost my client about $100,000 worth of damage to her property. Three people at the last meeting had the same problem with them. They're a state contractor. I'm looking towards you people to buck the state and find out what's going on. I told my client don't pay a dime on that. It was disgusting what they did. They had a problem with a building inspector named Lincoln.  He's a little bit rude. I won't tell you what people say about him because I can't do it on a mic. Well, I could do it on a mic. I'll be a gentleman. Okay. So there's numerous problems here. I wish you people would show up at some of these meetings and find out exactly what's going on. Because I don't see you people there. I don't see any government officials there and these people are desperate now. It's been around three years. I could have had that house built. We went there in September to sign the first paperwork right after the fire. I could have had it built in April if you would have streamlined the system, but no, you had to do bureaucracy again. Please have some compassion here, guys. This is a time for human kindness, not egos. Okay. I'm giving out my number.<PHONE_NUMBER>. I'm in Koenig's district. I'm giving out my number. I got 45 years of experience with this planning department that you should know about. Thank you. Thank you. Good morning, Mr. Morris. Good morning, Randy Morris, the director of the county's human services department. I'm here to highlight Consent Item Number 44, which comes from my department to your board. And just with the large volume of items, I just want to raise this to your awareness to sort of double up on our support for this and let the community know why this is in front of you. This is a climate change initiative sponsored by my state association, County Welfare Directors Association, and we are fortunate to have our own state Senator John Laird sponsor this bill. It is a request of the state legislature to do what the state of California did for the California Department of Social Services in the last fiscal year cycle, which is to provide more resources to provide mass care and shelter response and disasters. The county human services in California are not funded to provide mass care and shelter services in communities. It was just a table talk exercise for 30 years, but in the last five years as disasters have multiplied. There's been seven here in the last three years, four in this calendar year alone to better serve this community. We asked the state legislature to support this ask. I appreciate Senator John Laird for sponsoring this budget bill and we asked the state legislature to provide the resources they provided the State Department to be able to provide mutual aid to counties so that we have that service locally to be able to better prepare better respond and better to support those in recovery efforts. So the ask of your board is to sign the support letter to send it to the state legislature and then we can all go to Sacramento to ask them to support this initiative. Thank you. I just want to follow up with that. Are you looking for more classes or anybody else in chambers? I'd like to address us. Just feel free to step forward. Good morning and welcome. I'm Robin Alleyga, and I just wanted to kind of expand on the slow process for getting a permit. been through plan check at five months. And then once we get them through plan check, we'll have to address the comments. It'll be another three or four months. Just regular permits for ADUs, for decks, they're taking four to eight months. And if it's not, decks are taken about four months. When I tell people it's going to be at least eight months for a permit. And it's really frustrating. Just be, you know, it would be nice if maybe we could get an outside consultant like CSJ or somebody to help out with the load, because I know they're doing their best. They just don't have enough people. So thank you. Thank you. Anybody else like to address us in chambers? Madam Clerk, is there anybody online? Yes, Chair. Colin, user one, your microphone is now available. Carolyn Garrett and I would like to excerpt from a speech given January 23 of 22 on democracy and intrusive technology. And the full printout is in the wise traditions, the spring edition of 22 WestinAcePrize.org, in part about censorship. Ms. Jefferson, James Madison, John Adams all said the same thing. We put freedom of speech in the First Amendment because all of the other rights that we were trying to protect relied on that right. If you give government the license to silence its critics, you have given them the capacity to commit any atrocity they want and to obliterate all the amendments and rights of the Constitution. This board engages in censorship of the public speaking on consent agenda items, and it's also limited to the comments to two minutes. If you were speaking of people on the opioid crisis, criminal corporations, serial felons, the four companies that make all of our US vaccines for the children's program, Pfizer, Glaxo, Penelope, and Merck have paid 35 billion dollars in criminal penalties for hundreds of violations and damages in the last 10 years. Thank you, Ms. Garrett. Samuel, your microphone's now available. Thank you, members of the board. This is Samuel Singer. I'm a property owner at 175 Firm Rock Way in Boulder Creek. I just wanted to briefly give you an update on where our community stands in being able to move into our homes. There's been some great progress. So first, I want to thank Supervisor McPherson and his staff for showing up to the Water Board meeting last week. We greatly appreciate your support in being there and for the work that you're doing in helping to resolve the situation for us. So thank you for that. The Water Board did refer this situation with Dick Basin Water to the Attorney General, which is a great step forward. There was also a possible organization called Cypress Water, who might be working on a contract to manage the wastewater treatment plant that's currently non-functional on behalf of Dick Basin Water. If that agreement actually happens, it's another big step for us. However, the Water Board will still not request the lifting of the moratorium on certificates of occupancy, even if that contract is made between Cypress Water and Dick Basin, unless Santa Cruz County also agrees to work cooperatively with Cypress Water to make sure those wastewater treatment plant basins get pumped until the system is fully operational. If Santa Cruz County would do that, then we can actually get the moratorium on certificates of occupancy lifted immediately and be able to move in. There is at least one family who lost their house in the CZU fire who needs to move in within a month. Cypress Water can get the system operational in a month, but if the moratorium isn't lifted before then, it won't be able to move in. Thank you so much for considering to help us further. Thank you. Thank you for sharing that. Natalie, your microphone is now available. Hi, good morning, everyone. My name is Natalie Magana, and I'm a Project Manager with Midpen Housing. I wanted to take a moment this morning to let the public know that we have opened applications for a new affordable housing community in Live Oak. The project is Bienestar Plaza. It was formerly known as 1500 Capitola Road Apartments. It's 56-unit family and supportive housing developments. Applications opened yesterday and will be open through May 12th. They can be found at our website, midpenhousing.org, under the Find Housing button. The project includes 40 units of project-based vouchers, 25 of which will be filled through the Housing Authority's waitlist, and 15 will have direct referrals for supportive populations. For the remaining units, they will be selected through a lottery, so there's really no benefit in applying later or earlier, but people just have to get their applications in by the May 12th deadline at 5 p.m. We strongly encourage online applications. Again, they can be found at midpenhousing.org. I also just wanted to take this time to extend our gratitude for the county as a partner in developing this project. This housing, along with the Santa Cruz Community Health and Dantas Clinics, have been many years into making and could not have been made possible without the county's participation. Special thanks to Supervisor Manu Koenig and former Supervisor John Leopold for their direct involvement in this community, as well as the planning and housing staff that worked through us with the many details. This is an exciting time. Construction will end in September, and we are looking forward to moving folks in shortly thereafter. Thank you. Thank you. Mila, your microphone is now available. Do you hear me? Yes. Yes, somebody said the word ego, and this is what our life is for 10 years. It feels like an ego. And we live in definitely concentration, some kind of concentration camp. I write to the Supervisor of Board all those 10 years, and I never hear back. This is just unbelievable, and why all those people behind the desk, you know, five supervisors, never respond. I asked for help, and this help is very urgent. My daughter is completely destroyed. Her health is completely destroyed by the criminal syndicate that, within Behavioral Health Division, and that criminal syndicate never get investigated, nobody held accountable. And previous director, Eric Riera, was hiding behind his doors. Now Tiffany Cantrell Warren hides behind her door, and Robert Anon only, leading that criminal syndicate. And I am not allowed to talk to anybody else but to him, and he continued to keep our names on the blacklist that we never get help, and the Sheriff's Department gets distracted that they not allowed to assist for medical general services. So this is just insane.  And I'm asking you again, please respond. Thank you. Thank you, Chair. We have no further speakers. Do we have another gentleman, would you like to address us during public comment right now in chambers? Feel free to step forward, yes. Welcome. Hello, my name is Ahmed. I have submitted a change order after Thanksgiving 2022. I'm still waiting for the response. If you have any question or if you need documents, they are available. That's it. Thank you. Thank you. Good morning. Welcome. Good morning, folks. I'm Tony Taylor, 55-year resident of the county. And I'm basically here to say my wife attended a meeting that Zach Friend hosted about four years ago, about ADU on property for senior housing and so forth. You're shaking and hitting. You know what I'm not about? I wasn't there. I'm here to tell you I'm over four years and paying nice people fees and bureaucrats and so forth, trying to get an ADU on my five acres in the Aptos Hills area for my in-laws to move in. Thank you for listening to me. Thank you. Is there anybody else in chambers I'd like to address us? All right. We'll close public comment and we'll bring it back to the board to take action on the consent agenda. We'll begin with Supervisor Hernandez. If you have any comments on the consent agenda? No comments. Thank you. Supervisor Cummings. Yeah. Comments on items, the first one. So comments on a couple of items. The first was item number 21, which is the Santa Cruz light like me. I've met with staff a number of times to discuss this and staff has highlighted that and this was reflecting the report that through community engagement compensation is one of the factors of importance for people who are historically underrepresented to serve on committees and commissions and given that we're about to enter our budget session. I'd like to see if we can add some direction to have staff return on or before October 17, 2023 meeting with the proposal for commissioner compensation to help increase diverse commissioner participation for individuals make less than the area meeting meeting household income includes 70,000 in 2023-24 budget proposal to help support these efforts to increase diversity on commissions. And that would be something that it's a proposal to have this come during our budget session for consideration. It wouldn't be saying that we're allocating that money today, but through our conversations with our budget being able to have that discussion at that point in time. So that's one recommendation and maybe after I finish the other comments we can come back to it. The next was item number 42. I just wanted to thank the director of health services for applying for these funds towards opioid grants to help us address the opioid crisis in our community. I know we're going to have another discussion around certain services coming up, but having these funds really helps us address these issues that are taking the lives of people in our community. And then the workforce initiative, I don't know if Andy Stones here from that department. I just want to confirm for the board. Andy Stone is the director of the workforce board and he is logged in remote. If the clerk of the board sees him, he's prepared to respond to the questions that you brought to his attention. If that's what your point is, Supervisor Cummings. Andy, you should be able to speak now. Good morning. This is Andy Stone, workforce development board director. Andy Stone, first I just wanted to thank you for bringing this to our attention because workforce development is something that's really critical for our community. And I just wanted to, I just had two quick questions. One was, I'm just curious about what kind of outreach is being done with UCSC around workforce development. And then the other is really around what the workforce development board is doing to look at emerging industries and kind of future opportunities and skills that we might be able to develop to help prepare local talent for emerging industry needs locally. Sure. I'd be happy to talk about those. So the first one with UCSC, our primary relationship with the university is through the career services department. And we've teamed up with their career services department to help place students with employers. So most of the clients that come through the workforce development boards programs are community college or vocational school clients. And so by connecting with the UCSC, we've been able to offer employers a broader array of candidate. But that's been the primary relationship we have at the workforce development board. And oh, sorry, the next question was about emerging industry. So every year, the workforce development board prepares a state of the workforce report, which is on our website, workforcescc.com. And in that report, we examined the various local industries and job opportunities and highlights and emerging areas. So last year, we focused on healthcare jobs, which you know, make up 15% roughly of the jobs in the county. And this year, we'll be taking a deep dive into infrastructure related jobs. So related to transportation, housing, water, energy, and identifying some potential new training opportunities to prepare the workforce for those jobs. Yeah. Yeah. Great. Thank you very much. And that concludes my questions on that item. And then the last item number 44 disaster funding. I just wanted to see if we could provide a little bit more recommendation and add direction to send this letter also to the governor, the Senate and Assembly Budget Committees, Senator Laird and Assemblymember Pellerin, and to send an additional letter to Senator Laird thanking him for supporting the county on this issue. And that concludes my comments and recommendations. Thank you, Surveyser. Come in, Surveyser Koenig. Thank you, Chair. On item 31, support for EB-585, which would require the state to assess clean infrastructure needs across various sectors on a bi-annual basis and publish annual progress reports on where faster buildout of clean infrastructure is needed. I just want to add some additional direction that we also send a letter to Assemblymember Robert Rivas. I think there's a little confusion on which Assemblymember Rivas to write this letter to. And just to highlight the importance of this, our state is committed to achieving carbon neutrality by 2045 and it's anticipated that in order to do that, we would actually need 150% of the electricity that we use today. And that's largely because we need to electrify our transportation infrastructure. And of course today, only about 50% of our energy infrastructure is renewable. So that means that in the next 12 years, we need to triple our current clean energy capacity. Today, we're adding about 2 gigawatts per year of renewable energy and we need to get that up to 7 gigawatts per year. So I think we're going to hear a little bit more about this in a later item today as we hear an update from Central Coast Community Energy. But I think this is one small step our board can take supporting AB 585 and sending a letter to Robert Rivas. Then on item 32, supporting AB 1035, AB 604 and AB 318. These are all Assembly bills which preserve mobile home park affordability. And I am in my capacity as liaison to the Mobile and Manufactured Home Commission. I'll say that on March 16th, that commission did recommend that the board support all three of these. And just that we have letters signed by both the chair and vice chair supporting them. And mobile homes are an essential part of housing affordability in our county. And I think that these will all help residents throughout the community. Thank you. Thank you, Supervisor McPherson. Thank you, Mr. Chair. I have four or five items I'd like to comment on, like the supervisor coming from Santa Cruz like me, I want to thank the staff and committee members who have invested the time and effort to have our county commission better reflect the diversity of our community. I look forward to hearing more in October about the efforts to further engage the community on ways to make service that our commission is more accessible and responsive to our community dynamics. Our advisory bodies, we have about, well, at least three, two dozen, three dozen of them. They're incredibly important to us and they really help us a lot. I want to thank each and everyone that participates on those commissions and committees. On a similar note, I just want to point out in this County of Santa Cruz Employment Opportunity and Cultural Competence Plan that was adopted by the board in 2022, the Personnel Commission, it has to do with ethnicity and gender in our administrative staff and we exceed parity at least by 10 to 20% in every department. So in every category. So I really hats off, we're practicing what we preach and we want to keep at it. We've made some great advancements in that and I really appreciate from County Administrative Officer Collis Palacios on down for having us be reflective at our employment and what we're doing for our community to have people have equal opportunity employment opportunities. On item 25, Community TV, thank you for the information services department for bringing this item to us regarding our relationship with Community TV. It's really important that we continue to have public access to the meetings on Community TV I'm not so sure how many watch it but I get comments one way or the other on occasion. So thank you very much. It's really an important asset for people to know more about what's going on in the Santa Cruz County area. On item 42, the opioid response grant funding. Thanks to our health services staff for obtaining this grant and the additional resources it's going to provide for the treatment we have. It's a serious problem here as well as throughout the state and it's something that we really need to address and we are. It's important that we address the drug addiction in our community and we know that that's a contributing factor to homelessness and we can address this and make some headway in it. It's going to be very very productive for all of Santa Cruz County. On item 44, the disaster response funding for human services that was mentioned by supervisor Cummings as well. I'm in full support of this effort by Senator Laird to generate a disaster response funding for counties, human service departments in our state. As we saw during COVID, the fires, the heavy rains, the and other services that most vulnerable really are the most directly affected on this. It seems disaster in, disaster out and we should not have to, the county should not have to bear the cost of doing the right thing or awaits uncertain reimbursement for this. So we need to share the burden of taking care of our community during our disasters and I'm glad to see that Senator Laird has introduced this legislation and finally on item number 47, the emergency repairs to the January storms. Thanks again to our public works department and with within community development and infrastructure for bringing this item to our board. I'd like to highlight for the public the huge amount of work that has been gone into the response for repairs. Since the storm in January, these contracts are for $15 million, about $3 million coming from local funds. We can't understate the importance of having the state legislation. Senate bill one in recent years, but we'll also be tapping our general fund at a time when we're really going to be under some budgetary stress as we're going to find out in the end of next month when we have our budget discussions. This underscores our need again to think about disaster response as a more permanent part of our general fund budget reserves in future years. And as it is, we're really still working through getting funding back from the 2016-17 storms. It takes a long time. We will keep at it. We wish we could get there more quickly, but our public works department is doing a fantastic job with the funds that it has to get our, we're literally mostly in the transportation network that we have back on track. So I appreciate what their efforts throughout this year and the years that since 2016-17. Thank you. Thank you, Survisor McPherson. I'll just briefly comment on item 26, which is the digital wallet pilot project appreciation to all the county team that worked on it. I believe we are one of the first, if not the first county in the United States to engage in such a project. And it really is a way to ensure that those that don't typically interact with local government younger, especially younger constituents have an opportunity to engage with us in a way that they're used to engaging, which is through technology. So to have these use cases, to digitize a number of these records and to have this access to the greater community, I think it's going to only increase access and opportunity to our local government. On Survisor Cummings' additional direction on 21, I think that it's something that would be useful to have the CAO come back with how this could be done. I think that we probably need to at some point have a broader discussion or maybe this would be the right time when that comes back in October about the number of commissions we have and the efficacy of some of those commissions and maybe it makes sense. It would actually maybe even make it easier, by the way, if we were thinking of compensation, if the number actually had to be, if some of them had to be consolidated or shrunk. I think that some of the feedback that I get from some of my commissioners is that maybe some of the values run its course. And I think that it's some of the discussion I recognize. Some of them are state mandated. Some of them are essential, as Supervisor McPherson said. But there is also a reality that there's a significant cost that county maintaining a certain number of these commissions, both in time and effort. And the key thing here is to ensure that voices from the community are elevated in the greater policymaking process. And it's worthy of reviewing whether or not the current commission structure does that or not. So this may be an opportunity as this comes back, because the one thing we shouldn't have is having commissions that structurally ensure that certain voices aren't maintained. And so while we're having this broader discussion about compensation, maybe we could also have that discussion as well. So, Roger Cummings, I'll turn to you for emotion if you're comfortable because you got an additional direction. I'll move consent with the additional direction that was provided on item number 21 and the additional direction that was provided on item number 44 and adding to 44 that we also send a letter to Assemblymember Rebus. I'll say 31. Oh, sorry. Sorry. I'm just thinking. Yeah. Yeah, 31. Oh, the item number 31 and item number 44 to also send a letter to Rebus for 44 as well. To confirm, I show additional direction on items 21, 31 and 44. Correct. Thank you. Survisor Hernandez. Yeah, I'll second it. And I think I want to comment just on the additional direction. I think it is important that our commissions reflect our communities and that we adopt the principles of diversity and inclusion and equity even within our own structure of our commissions. And I've seen other communities that actually other counties that actually have adopted compensating the commissions. I know that Monterey County does with some of their commissions. So it's something that we should really look at and do that set aside. All right. Any additional comments? No additional comments? All those in favor? I'll let you do roll call. If we get a roll call vote, please. Supervisor Koenig. Aye. Cummings. Aye. Hernandez. Aye. McPherson. And Friend. Aye. Thank you. That passes unanimously. We'd like to move on to the first item of the regular agenda, which is a presentation of awards to the Santa Cruz County Fire Department firefighters of the year as outlined in a memo of the chair. This year we're pretty excited to have two different awards. One is to the 2022 Queer Firefighter of the Year for Ryan Johnson. The Volunteer Firefighter of the Year is Kyle Bretton. If we could have Captain Tilson come up for the presentation. Captain, thank you for being here and waiting through the first hour. I appreciate everybody that's here so far. Welcome. Good morning, everyone, to the board and the members of the public. My name is Sam Filson. I'm the battalion chief for the Santa Cruz County Fire Department and Cal Fire San Mateo Santa Cruz Unit. For over 10 years, the Santa Cruz County Firefighter of the Year award is given to one volunteer, one paid member of the Santa Cruz County Fire Department. This award is given to members that give exemplary effort in supporting their community and the Santa Cruz County Fire Department. For paid firefighter of the year, I'd like to award Ryan Johnson, who's a fire apparatus engineer at the Los Cumbres Company 29 station. Ryan is being recognized for his dedication and hard work at the Los Cumbres Fire Station. He is known as an enthusiastic professional with a positive attitude. He demonstrates initiative, inspires county fire volunteers and dutifully assists with training. Ryan has been a member of Company 29 Los Cumbres since 2020. He is very involved in the rope rescue program, getting all new rope rescue gear for the company and training the company members on its use. He's also worked through the process to get a new training props for the company, including forcible entry and vertical ventilation props to help prepare the company to respond to emergencies and assist the community. Ryan is a great asset to the Los Cumbres Community Volunteer Company and Santa Cruz County Fire. He currently resides in the Stockton area with his family and sends us off time riding motorcycles. Ryan, congratulations from your community, your fellow company members and all of Santa Cruz County. And next, I'd like to bring up Kyle Brennan and an engineer for the Bonnie Dune Volunteer Fire Company. He's being recognized for volunteer fire for the year. Kyle is being recognized for his dedication and support of the Bonnie Dune Volunteers and Santa Cruz County Fire Department. He's described as going above and beyond to serve his community by giving his time to multiple local agencies such as the FireSafe Council Teen Survival Programs and is known to be a dedicated leader among his peers. Kyle has been a member of Company 32 since 2021 and promoted engineer in December of 2023. Kyle is very involved with many aspects of Company 32. He's the company liaison being the main point of contact for the Company 32 Bonnie Dune Volunteers. Kyle is instrumental in organizing training for the company as well as organizing community outreach events. Kyle has consistently gone above and beyond first community and the Bonnie Dune Volunteers including flying to Sioux Falls, South Dakota right before Christmas of last year to do a final inspection on the Bonnie Dune Volunteer Company's new water tender. Kyle resides in the Bonnie Dune community with his family and is off time. He enjoys riding motorcycles and spending time in the beach with his family. Kyle, congratulations from your community, your fellow Company members and all of Santa Cruz County Fire. Thank you. Thank you to the board for this board. Thank you. Thank you and I just like to say congratulations to the awardees of this year. We really appreciate your service and dedication to our community and you know look forward to seeing the great work that continues to come out of your departments. Thank you. Supervisor Koenig, Supervisor Koenig. Yeah, I'll just echo that. Thanks, particularly hopefully folks are watching this and you know it's great to recognize you too today and I also hope that this inspires lots more people to join both our volunteer and professional firefighting force. I mean, you guys are holding the line for us and we definitely need more folks in the ranks. So thank you. Supervisor McPherson. The heroes of Santa Cruz County in my opinion and along with our law enforcement too in the CZU fire and so many of the catastrophes that we've had have come to the front and helped to everywhere possible. And homes were lost and that's terrible, but only one life was lost and that speaks something to what you did and how you responded and really protected our community. Thank you for getting out front of it and I hope that our community gets out in front of it. We're going to have a dry summer, it looks like. And so we need to be prepared to not let something like we had in the recent years go on again. So thank you very much for everything you do to protect us and make us safer. Thank you. Thank you, Supervisor Hernandez. I also too want to thank you guys for all your hard work, determination, esprit de corps and you know, you guys are out there on the front lines and we've been through a lot recently from the CZU fires, the floods and again, you guys are the tip of the spear and making sure that people are safe. So thank you for all your courageous hard work. And thank BC for coming to give the presentation. Thank you too for your well-deserved awards and Kyle, I just have to say, I mean, I don't know how many hundreds and hundreds and hundreds of hours you've dedicated to this community without really any pay, but it's a really remarkable thing to think about how important the volunteers are to our local, in particular our local rural areas and as Supervisor McPherson and Cummings have noted with the CZU fires.  I just want to acknowledge that this isn't a takeaway from our paid firefighter by any stretch of the imagination, but to just know that you are dedicating all this time and energy without pay to keep your community safe. I really admire that dedication. And in generally speaking, those that work in the greater county family and Cal Fire family, you really do face hazards and dangers that some of our more urban fire agencies don't face. And I think that we need to acknowledge that work in particular, going into areas that are dangerous, you're saving people's lives on the medical situation and you're providing a sense of security for those that live in relatively rural areas or in our community, really suburban areas, quite frankly. I just want to admire your work that it's been a tough road leading up to this year and then this year is probably leading to something that who knows what kind of additional fire situation we're going to face in the summer and the coming summers as a result of these wet winters, but we support you and appreciate all your work and you deserve this award. So congratulations. All right, we're going to move on to the next item on our agenda, which is a presentation by Central Coast Community Energy, three CE on the annual member agency update as outlined in the memo of the CAO. Our presentation today will be by Ms. Judy Young, a senior customer accounts manager from Central Coast Community Energy. Welcome. Thank you for sticking with us this morning. Thank you. Hello. Thank you. Let's see, Sasan. Okay. Thank you, members of the board. It is my honor to be here today to highlight Central Coast Community Energy's recent accomplishments as well as our plans for 2023 and beyond. My name is Judy Young and I am senior customer accounts manager with three CE, but focus on supporting our member agencies. I will start with a brief introduction. We are going to look this way with a brief introduction to community choice aggregation for anyone who is new to how the CCA model works and how it differs from the investor owned utility model. And then I will highlight Central Coast Community Energy's history and role in your community. Once a community signs on to a CCA, the CCA takes over electricity procurement while the existing investor owned utility continues to handle transmission, distribution, metering and billing. CCAs are public agencies and return revenue to their communities in the form of programs, incentives and rebates and can also assist with local job creation and renewable energy development. Our agency has seen tremendous expansion since we formed in 2017. We expanded from Monterey Bay to the entire Central Coast and your community joined in 2018. Today, three CE is made up of 34 member agencies throughout five counties, serving nearly 450,000 customers and securing over $1 billion in renewable energy and storage agreements while returning $26 million to our communities. Over 94% of utility customers in our communities are enrolled with three CE and in the year 2022 alone, we delivered over five gigawatt hours of electricity throughout our region. In the last year and a half, we enrolled the community of Builton, completed enrollment of unincorporated regions of Santa Barbara County and welcomed the city of Atascadero as our newest community. And just last month, the San Luis Obispo County Board of Supervisors voted to join our CCA. There's a whole lot of news to report and I'd like to like to focus on the four major benefits we promised to our communities when we formed in 2017. So I'm going to start with local control. Community choice aggregation allows local government to have greater control over the type and cost of energy supplied to their communities to ensure energy sources and rates reflect the community's values and goals. With three CE decisions about where your power comes from and how you are charged for it are made by your local elected officials. We are making progress on climate goals together as a region and we are far ahead of both state and federal targets to decarbonize our energy supply. Here in Santa Cruz County, you are represented by Supervisor Bruce McPherson and County Administrator Officer, Administrative Officer Carlos Palacios on our boards. Supervisor McPherson and Mr. Palacios also serve on our Executive Committee. So let's talk about rates, our second commitment. In March of 2022, we decoupled our rates from PG&E's and established our own rate setting procedures based on cost of service, resulting in an average of about 18% savings for residential customers. Small and medium commercial customers saved between two and 19% during the year 2022 once we switched to cost of service and we expect our competitiveness with the incumbent utility to continue. As you can see, we have worked to keep our service affordable for our communities. Now I will shift focus to our efforts to procure clean power. Today we are at 50% clean and renewable and on track to be at 60% by the year 2025, which is five years earlier than the goal set by the State of California. Our strategy commits 3CE to meet 100% of its demand with clean and renewable resources by the year 2030 with balancing on a monthly basis, which is a full 15 years ahead of the goal set by the State of California that Mr. Koenig mentioned. Koenig, thank you. 3CE is also pursuing offshore wind generation as an emerging technology in California. The auction for leases in federal waters off the Central Coast in December 2022 was an important step in bringing these resources online. In order to achieve these goals, 3CE's procurement team has prioritized long-term contracts that bring new clean resources online as quickly as possible. To date, 3CE has executed 19 long-term power agreements, power purchase agreements, and energy storage agreements. Five of those projects came online in 2022 and add up to nearly 275 megawatts of generation and energy storage combined, or about 22% of our current annual load. Meeting greenhouse gas reduction goals is also about electrification. As individuals, the biggest impact we can make to cut greenhouse gas emissions and improve air quality is to replace fossil fuel vehicles with EVs and replace the gas appliances in our homes. As 3CE works to clean the grid, electric cars and appliances will be emissions-free in their operation, and the electricity that powers them will be 100% clean and renewable. The final 3CE commitment that I am reporting on today is a continued investment in your community and all of the communities in our service area. This slide highlights our accomplishments over the last year, and looking more broadly over the past three years, 3CE has helped put more new and used electric vehicles on Central Coast roads by distributing more than $2 million in cash rebates paid directly to our customers. By electrifying our transportation sector, these EVs have spared more than 6,000 metric tons of regional CO2 emissions. Additionally, in a collaboration with funding partners like the California Energy Commission, 3CE has delivered rebates that will help build more than 1,000 new electric vehicle charging stations for our region. We've also paid to make more than 2,000 new affordable housing units all electric, and that support continues. Residential customers within unincorporated county of Santa Cruz are eligible for rebates up to $4,000 toward EVs and chargers and toward replacing certain gas-powered appliances. We also have programs aimed at helping our member agency partners advance electrification and stay up to date with building codes that advance electrification. And we have business-friendly programs designed to electrify new housing, including farm worker housing, to upgrade ag equipment, and to install DCFC level 3 chargers. With an eye to equity coupled with an awareness that many of these enhancements are out of reach for our underserved communities, we provide an additional $1,000 electrify your ride and electrify your home rebates for income-qualified customers. In partnership with the state, 3CE has garnered over $7 million for your community. Please see the rebates and the census page on our website for more information and to apply. With the continued support of the county of Santa Cruz staff, supervisors, and community, along with the rest of our communities, 3CE will continue to deliver innovative solutions, impactful programs, and exemplary service along with clean and renewable energy. This concludes my presentation. Thank you for your time. Thank you and thank you, Supervisor McPherson, for your leadership on this. Do you have comments? Yeah, thank you very much. A lot has happened in the five years. Monterey Bay Community Power was formed before it became Central Coast Community Energy. Actually, the effort and the planning stages started 10 years ago, but there was a lot of points made, positive points. I just can't say how much I am appreciative of the cooperative effort and the willingness to listen and have this explained the system over and over again. It's not an easy explanation. We're trying to get new members and now we're over 30, as was mentioned. One of a couple more things that might be, I think, could be mentioned. We were the first Community Choice Aggregation Agency to receive an A credit rating from Standard and Poor's, and we still have maintained that. The agency is debt-free and was mentioned. We've given back $25 million plus to the community to reach our goals, which we're going to receive that 100% renewable energy power within its portfolio by 2030, 15 years ahead of the state standard. You mentioned that, but that is really significant. That's because we really have a cooperative understanding agency and members of local governing agencies. It can be overstated how important their input has been for making this a reality. We do have some challenges ahead, but CCE, CCCC has built a financial and customer service foundation. I think it's going to outlast any of those challenges. It's truly a pleasure to have been part of this and to keep moving forward because that's what we're doing and we're going to be the best in the state. Thank you. Mr. Palacios? I just want to emphasize a few things. One is just for the new board members, especially to realize that Central Coast Community Energy began here in these board chambers. Santa Cruz County was actually the founding agency and the main impetus for the creation of the agency. That's a very proud moment, I think, and Supervisor McPherson deserves a lot of credit for that especially because he went against my advice. My advice was to stay in Santa Cruz County and not go beyond. He said, no, we're going to go to the Monterey Bay and we went to Monterey Bay and then he said we're going to go beyond that and now we're in five counties. It shows the power of vision and Supervisor McPherson certainly had that vision. The other thing to note is that we are creating carbon-free energy, renewable energy. We are actually creating it. We are taking money that used for our electric bills that used to go to shareholders and the private corporation and investing that in new renewable energy facilities. So we're taking that money and we are now buying and creating solar utility-sized solar energy fields, geothermal and even potentially offshore wind in the San Luis Obispo area. So we're actually creating clean energy with our dollars and that's an important thing. And then the other thing is that we are reinvesting money that used to go to the corporation and shareholders into our community and so we are actually investing in creating more electrical investment in our homes and vehicles and affordable housing as well. There's been a number of affordable housing projects that are 100% electric because of 3CE. So we're taking that money and investing it back in the community. So it's really a success. However, we are having some problems, especially with the Public Utilities Commission. There's just sort of a key moment right now where the PUC seems to be trying to stop the growth of Central Coast Community Energy and other CCAs in favor of investor-owned utilities. And so that we're working with the legislature very hard on those issues, but it's something to be aware of that it's you would think that there would be a lot of support for CCAs, but there's a lot of fear in the investor-owned utilities and they're pushing the PUC and that means that we're having regulatory issues at that level and we're having to battle. And so we appreciate our help from our state legislators who are helping us, but it's a unique moment right now because we're trying to grow in a very successful model, but we are having problems with the PUC right now. Thank you for your work too on this, Supervisor Konin. Thank you, Chair. And thank you, Ms. Young, for the presentation. I will say when you've got a problem that seems insurmountable like dealing with the climate crisis, the best way to approach it is actually to break it up into pieces and solve one at a time. And this organization has done that for the electric grid and we're seeing, I mean, it's really a bright spot in terms of our, the progress we're making to reduce emissions community-wide. And that was really evident as we looked at our climate action plan at the end of last year and moving forward that in many ways, I mean, the work is not done, but we've got a very comprehensive strategy on how to eliminate emissions for our electricity grid. And that allows our county to focus on the other pieces of it now.  I think, you know, when you take out the electric grid now, it's 50 to 50% of our emissions from the that we can measure locally are coming from passenger cars. And then it's up to 70% when you consider other commercial vehicles. So we're really focused on that now. Of course, we're making great progress thanks to things like the Metro, which just got a grant from the California State Department of Transportation to buy 24 all hydrogen buses. So that'll be a quarter of our fleet. It'll give a lot more people an opportunity to have access to a zero emission vehicle. And of course, then we can also focus on the other piece you mentioned, which is gas appliances. And hopefully replacing some of those. And also, of course, we updated our building code at the end of last year to require that all new construction in the urban area be all electric. So piece by piece for making progress on this. Really appreciate the vision and leadership by Supervisor McPherson and CAO Palacios. And of course, all the good work that you're doing every day moving us towards the future. Thank you. And I'd also like to acknowledge Ms. Johnson in the back, trying to hide it here from Chambers but who took a regional leadership role in ensuring that this was possible. And to those points, we went from extreme drought and fires to extreme floods in our community and region in a time period of just 24 months. And greening of the grid and greening of a vehicle fleet isn't just the right thing to do. It's an existential issue for us, for our future generations. And to have a lot of things that happen in Santa Cruz County and California end up in other places across the United States and world. And so I think that what's being done here is being seen as a model and hopefully will have a legitimate impact on future generations on the climate issues that we're dealing with. Supervisor Cummings. I just want to start by thanking Supervisor McPherson for his hard work on getting us moving forward and getting us to a place where we're making traction statewide on this. And as somebody who has a background in environmental sciences and became a biologist because of these efforts that we need to make around the same air climate, I just want to appreciate all the work that you all are doing at CCC to really continue to keep pushing this forward because time is running out and we've been sounding the alarm for decades and now we're starting to see the impact. So I think it's critical that we were, that this community has really been at the forefront and spearheading these efforts and whatever we can do to continue to help support these efforts. Please let us know and see how Palacios as well with the CPUC if there's anything that we can do to try to get community support for these kinds of efforts and to keep this effort going. Please let us know as well so that we can communicate that to our constituents and and get them to write letters of support for these kinds of efforts. Thank you, Supervisor Hernandez. Did you have anything? Sure. Yes. No, I want to thank first of all 3CE for all their work and Supervisor McPherson and Carlos for all their dedication as well. I was part of the city at the time and I'm proud of being with the city at the time when we were also early adopters and joined in and it was a community power at the time when we joined in. But it's great to see now that we're moving and doing all this great work beyond the county and we're moving beyond the central coast even. So thank you for all the hard work and making sure that we're continue being stewards of the environment as well. So thank you. Thank you. Anybody from the community like to address us on this item here in chambers? Please, Mr. Brody, welcome. Thank you very briefly. I hadn't planned on commenting, but this happened before I was here, happened to be at the at the board when when CCE was presenting. I just want to say and I said it last time as a citizen, sorry, I'm David Brody, I'm Executive Director of First Five Santa Cruz County, but as a citizen of this county, I am tremendously proud of what this represents. I believe I said this last time or something of this effect when my kids honestly look at me across the dinner room table and say, what are we doing in our community about climate change? Because as you know, our youth are tremendously affected about what's happening in our world and what the future that they face. And I'm able to look at them and I point to this project in particular. This is something that we're doing at scale in our local community to address the future. And I'm extremely grateful to Supervisor McPherson. I'm extremely grateful to Administrator Palacios. I'm extremely grateful to this board for the leadership that you've shown to support a project like this and all that you do to address climate change in our future. I mean this from the bottom of my heart. I want to thank you for your leadership on this issue and Jeannie as well, the first person who ever educated me about this project years ago. Thank you very much. Thank you. Anybody else in chambers on this item? And I'm clear. Can anybody online on this item? Yes. Colin, use your one. Your microphone is now available. Marilyn Garrett, I think this is a false narrative and unsubstantiated that it will solve all our problems. And I want to refer you to some sources. One is called The Body Electric by Becker. It tells about natural signaling in our bodies to function and how these artificial frequencies from the only electric, the wireless, interfere with our health basically. Another book is called The Invisible Rainbow, A History of Electricity and Life by Arthur Verstenberg, giving the history of electricity and the corresponding chronic illnesses and increased mortality that have increased since the late 1800s. There's another book called The Great Power Line Cover-Up, How the Government and Utilities Are Hiding the Cancer Hazard Caused by Electromagnetic Fields by Paul Brodure. Electricity is very problematic. And what happens when there's a power outage that is frequent? And PG&E plans these power shut-offs for extreme fire danger periods. And also problems with surges cause when power lines are re-energized, can cause arcing and fires, for instance, in the smart meters and digital technology. Are there any other speakers? We have no further speakers, Chair. All right. This is a non-action item. So thank you for the presentation. That'll end item eight. I'm going to slightly take an item out of order. Mr. Machado, this is a brief item. So I'd rather have you just do item 10 now so you don't have to wait for the next two items. Item 10 is a public hearing to consider the proposed 22, 23, 24 benefit assessment service charge reports for various county service areas and adopt a resolution confirming the benefit assessment service charge reports. As outlined in the memo, the Deputy CAO and Director of Community Development and Infrastructure, Mr. Machado. Thank you, Chair and Supervisors. Matt Machado, Deputy CAO and Director, CDI. The item before you as the Chair presented is a public hearing to approve 23, 24 benefit assessment service charge rates. In order to complete the 23, 24 benefit assessment service charge process for the various county service areas, CSAs, it'll be necessary for the Board to open the public hearing, take public comment, consider objections or protests, if any, to the reports. And at the conclusion of this public hearing, adopt the attached resolution confirming the reports, let to mention that the report today includes 40 CSAs, 26 of those are proposed at the same assessment rate and 14 include an inflationary rate increase so the recommended actions today are to conduct a public hearing to hear objections or protests and then to follow following the public hearing adopt a resolution confirming the benefit assessment service charge reports for the various CSAs and I can answer any questions that you may have. Thank you, Mr. Rashada. Any questions for we open the public hearing? Seeing none, I would like to officially open up the public hearing on this item. Is there anybody in chambers that would like to address this on this item? Seeing none, Madam Clerk, is there anybody online that would like to address this? Yes, Chair. Calling user one, your microphone is now available. Marilyn Garrett, I'm opposed to this increased tax where already it's called benefit assessment, of course, have extremely high taxes and I don't really see much benefit and it seems to me it used to be there would be a CSA one CSA at a time and I just heard you say there are 40 CSAs so my vote is for no and I wish we would have more services that actually benefit the public and I see very little of that from the county. I see a lot of harm in many areas like the wireless technology, you know, so-called green energy, etc., digital lawless, all this is a lot of harm not benefit. That's my vote no on 10. Thank you, Ms. Garrett. Anybody else online? No further speakers, Chair. All right, we will close the public hearing. We'll bring it back to the board. There are two recommended actions. Is there a motion for the recommended actions? Second. We have a motion from Supervisor McPherson, a second from Supervisor Hernandez. If we get a roll call, please. Supervisor Koenig. Hi. Cummings. Hi. Hernandez. Hi. McPherson and Friend. Hi. Thank you. Thank you. That passes unanimously. We'll move back to Item 9, which is to consider the Health Service Agency's 2122 biennial report for the Syringe Services Program and adopt the recommendations from the Syringe Services Advisory Commission as outlined in the memo. As the Director of Health Services, we have an agenda brought in a memo and debate by annual report. And here for presentation, we have Monica Morales, our Director of our Health Services Agency, Dr. Gail Neweller, County Health Officer, and Emily Chung, our Director of Public Health, who's starting us off. Dr. Borowski. Good morning, Board of Supervisors. Good morning. For the record, Monica Morales, Health Services Agency Director. Monica, if you could just check your microphone to make sure it's on. The little green lights on. Let's see. Hello. Maybe I should project a little bit more. Does that help? Thank you. There we go. Good morning. Thank you for having us here today. I'm here with my colleagues, Health Officer Dr. Newell and Public Health Director Emily Chow. We're here to present to you three components of our Syringe Services Program that you're very familiar with. We do have a mandated report that will highlight some key indicators by our Health Officer. And also then touch a little bit on the summary biennial report that you have in your packet. We'll be pertaining to our SSP program. What we're noticing, too, is that you'll hear some of the key indicators that Dr. Newell will be highlighting for you in terms of increases. Unfortunately, in some of our HIV or Hep C, for example, indicators and the need really to continue our work pertaining to our Syringe Services Program. We also want to highlight for you the recommendation by our SSP Advisory Committee to really consider a mobile pilot program. This aligns with your recommendation that you provided to staff in August to basically explore an off-site from our MLN campus. And so today, I just want to pass it and thank our staff for their hard work in putting this report together for you and consideration of the recommendations from our SSP Advisory. With that, I'll just transition it now to Emily so she can give you guys and Dr. Newell the rundown on the data. Thank you. Good morning supervisors, others in the room. I appreciate your patience with my voice. There we go. That's better, too. I'm on the tail end of a respiratory virus here and I have a bad laryngitis. So I've been saving my voice for you. I'd like to very briefly give you an overview of the state of the health of Santa Cruz County before we dive into the bloodborne pathogens. We're so lucky to live and work and play in this beautiful county where we have so many recreational opportunities, fresh fruits and vegetables, lots of opportunities to live healthy lives. Earlier in the month, the annual national county health rankings were released and I'm proud to report that we ranked number nine out of 58 counties in the state of California. Nationally, we're among the top 20 percent. And when you look at both health outcomes like length of life, as well as health opportunities like access to fresh fruits and vegetables, we rank in the top quarter of the state and as well as the nation. I do want to take this opportunity as well to thank the community and all of you for your support during the last three plus years of the COVID pandemic and report that we have one of the nation's best mortality rates in terms of COVID. When you look at COVID deaths per 100,000 people and we rank very high in the state, tied for tops with San Mateo. So better than San Francisco, better than many other places that have been lauded for their COVID response, less than one third of the COVID deaths nationally and less than half of the COVID deaths in the state. So our community came together to do this. Your leadership played a big important part in that and we can save lives in other ways, not just COVID in this community. When we look at the county health rankings, there are several areas in which we stand out in a negative way. And I was surprised to see some of these and many of them are around substance use. And so we need to think about that as the context for this presentation today. One of the ways we stand out is housing. I don't think any of us are surprised about that. And lack of housing leads to crowded housing, which is left less healthy and homelessness, which we are all aware of in this community and contributes to the problems we're talking about today. Another concerning area is that we have more folks in our county reporting, self reporting, severe mental health issues. And then we have more excessive drinking of alcohol and also more alcohol related traffic accident deaths. We also have a higher tobacco use in this county, which I was surprised to see higher than the state, not higher than the nation, but significantly higher than the state average. And of course, as we all know, we have a higher opioid overdose death rate than the state significantly so. So next slide. Oh, that's me. My mandate to you today is to talk about the bloodborne pathogens associated with intravenous drug use. And that crosses a number of different categories of conditions that are required to be reported to the public health department. A really important component of this slide got reduced in size, but I want you and the public to know there's another slide later on, but all of this data is accessible to the public and all of our title 17 reportable conditions every quarter updated from the state of California at www.datasharescc for Santa Cruz County. So datasharescc.org. Congenital syphilis is one of the canaries in the coal mine in the bloodborne pathogens. Congenital syphilis means a baby is born with syphilis. So they got it from their mother who got it from someone else during or before their pregnancy. And congenital syphilis, it's a tragedy. Each case costs over a million dollars in governmental funds. And most of the conditions caused by congenital syphilis are not treatable. We've had increasing cases of congenital syphilis, although just a handful each year in Santa Cruz County, fortunately, most of our cases have been in persons experiencing homelessness, persons with mental illness, persons with addiction, people who did not access prenatal care for a variety of reasons. You can see here the market increase in congenital syphilis between 2011 and 2020. Locally here, when we look at syphilis compared to other sexually transmitted disease, we see both county and state rates that for the most part, the other sexually transmitted illnesses, chlamydia and gonorrhea did not increase significantly over the past 10 years. However, syphilis has been rising significantly, especially in our male population. And partly this is because syphilis is a blood-borne illness. So you don't get it only through sex, but also through sharing needles and other blood-borne roots. When you look specifically at our risk factors for syphilis in Santa Cruz County in the last two years, these are predictable as in terms of our same population that uses needles, our same population that reports severe mental illness. These are syphilis risk factors having been incarcerated ever, meth use within the past year, using internet for seeking sex services, persons experiencing homelessness and intravenous drug use in the past year. Our HIV rates have been rising as well, although the trend is slow and perhaps not yet significant. This is remarkable in our county and that statewide we're not seeing the same kind of increase, but in Santa Cruz County we are. Hepatitis C, on the other hand, is fantastic news. We've seen an 86% decrease in the last four years. That's because we can now treat hepatitis C, so there's much less of it circulating in our community than there has been in the past. Again, a reminder about DataShare that all of the data I'm sharing today can be found at www.datasharescc.org. This looks like good news. This is a trend of opioid prescriptions. In Santa Cruz County since 2009. You see this sharp trend downward, or a definitive trend downward, as physicians and other health care providers are prescribing fewer opioids.  Then we see this downward trend to very low prescription rates. The bad news about this, however, is that we as a medical profession and a health care system were not ready to meet the needs of the population no longer getting their opioid prescriptions. As a result, many of these people turned to the street to illegal substances to meet their addiction needs. The medical community was not there for them. And as we improve our medication-assisted treatment services, and as we increase our wraparound services in our syringe services program and throughout the community, we continue to see startling opioid trends. These are numbers from our county coroner. These are the number of deaths and from what cause. And what you see is a stark decline in heroin, even from last year to this year. And my understanding is it's almost impossible to get heroin on the street now, that what is on the street, the only option is fentanyl. And as a result, our opioid addicts need more opioids. They're harder to treat and much more likely to die of overdose. So just a brief breakdown by zip codes, I think it's easier to see on this map. And this is the opioid-related overdose deaths by zip code, by area of our county. And it's no coincidence that this correlates very strongly with opioid prescriptions written over the past 10 years. These are the neighborhoods, the areas where the most opioid prescriptions were written, leaving these areas most vulnerable. I'm going to turn it over now to Public Health Director Emily Chung for details about what we're doing in the county's syringe services program. Thank you so much, Dr. Noll, for that report. That's really great basis for the update around our county syringe services program. So Emily Chung, Public Health Director, thank you so much for the time this morning. Just I'll start with sharing a little bit about what our syringe services program is set out to do. It is a harm reduction program to prevent infectious diseases. We have a three-pronged approach that drives our work, starting with syringe distribution to prevent spread of disease. We exchange clean needles with used needles. And typically, we give out more clean needles than we receive in terms of used needles in our exchange sites. We use evidence-based practices to ensure we provide the best services in this anonymous program. Our syringe collection helps improve the public's health overall with safe disposal of used syringes. We work to reduce the impacts of syringe waste by managing seven public kiosks for disposal of syringe litter, as well as funding, training, and providing technical assistance to two local nonprofits that provide syringe litter collection services for us in the community. Finally, we provide enhanced linkage and referrals to improve participants' health and well-being. We are a client-centered program, and so these types of services to help access drug treatment services, medical services, mental health, and infectious disease testing all help promote a well-being of our participants. We also distribute tools for harm reduction like naloxone, also known as Narcan, safer-smoking kits, and fentanyl test strips, which help reduce the impacts of opioid overdose and death in our community. The Bayana report, which is in your packet, covers a two-year comprehensive set of information, so I want to thank our program staff and our population health unit for putting together this excellent report. In the report, the high-level trends that I will highlight include a decline in county exchange participation and encounters, so fewer participants and unique visits have been the trend the last two years. We are seeing a decline in the syringes dispenses and collected from county exchange sites compared to previous years. However, we are seeing an increase in the use of the community public kiosk for disposal of syringes. I'll share some additional data on that next. We're also seeing an increase in distribution of harm reduction items such as Narcan safer-smoking kits and fentanyl test strips. For instance, during our reporting period of 21-22, we dispensed over 4,000 Naloxone kits to program participants and partner organizations. From our participants surveyed, we found that exchanges have helped support Naloxone and saving lives over 300 times with those Naloxone kits. To emphasize the trends, this table, this graph shows us the trends from 2019 through 2022. In 2019, you see the percentage of needles only was nearly 100% of the reason why clients were coming into our county syringe services program. By 2022, we are seeing a trend that shifts to where individuals are coming for both needles and for safer-smoking kits. This is a potential suggestion that there's a shift in modality of drug use among our syringe services exchange participants. This slide here provides a visual and information about when we installed our community syringe waste kiosk throughout the county. We currently have five kiosks in the city of Santa Cruz and two in the city of Watsonville. We are in negotiations now for two additional syringe kiosks to be installed in our communities and that will be announced hopefully soon. These seven kiosks have helped increase the utilization of these public syringe litter sites or kiosks and in the last two years in 2021-22, the kiosks have collected an estimate of 1.2 million syringes and that is an estimate based on weight. Our exchange sites have collected over 350,000 needles during that same time period. If you would like to see additional data on the waste that we collect of syringes, you can find that in the biennial report on page 21 of the report as well as appendix documents. The final component of today's presentation is regarding the board director from August 2022 asking our syringe services advisory commission to look at the possibility of moving our North County syringe site out of the Emeline campus and look at other possible locations like the Coral Street location or other mobile options. We are here to report that the syringe services program advisory commission has worked with our program staff and has provided the following recommendation. The recommendation is to pilot a hybrid model which will reduce exchange services at our fixed site locations and then use those hours to provide exchange services at outreach in collaboration with the homeless person's health program through HSA. The recommendation also includes a recommendation to remove the certain operational directors from the board such as the fixed location and fixed hours which will allow us more flexibility and ability to adjust to the community's needs. Currently we operate the fixed sites seven hours at Watsonville and 12 hours at Emeline each week. The syringe services program advisory commission has been very helpful and thoughtful and I want to thank them for their time in providing these recommendations. What the advisory commission found to be the strengths of this hybrid model as we are calling it, it will allow us to reach people where they are at in that client-centered way. Our fixed site participants, many of our participants prefer the fixed site given its confidentiality and its location that is regular and routine for them and only half of our participants are persons experiencing homelessness so these fixed sites allow a more diverse community to use the syringe services program. By going mobile in this hybrid model we can reach new participants that we are currently not already serving and meeting them where they're at to bring them safe disposal of syringes and provide them clean syringes as well as harm reduction tools and linkages to services. This will also give us a stronger opportunity to collaborate with the community and flex to responding to changing community needs without having to actually expand. We will pair with established partners such as HPHP, street medicine to provide the medical wound care and referrals into their medical assistant treatment and we can work with our neighborhood partners to enhance relationships to test and learn whether this will address the neighborhood impacts to syringe service programs. This table shows the resources that will be shifted during the hybrid model pilot if approved. You'll notice that it is a cost-neutral impact because we are shifting hours from the current SSP model of fixed site staffing over into the outreach with HPHP and it typically actually use we anticipate using less staff actually in an outreach model because we'll be leveraging existing resources with HPHP and if approved we would anticipate beginning this hybrid model as soon as May in terms of planning and updating policies procedures and engaging with our community for to understand how this will be best rolled out. We would transition in August operating the existing hours and outreach simultaneously for a month until we can fully implement starting September where we would remove the the two shifts for at the fixed sites in order to to offset the outreach and then we would analyze the impacts beginning October through November to in that first quarter as we test and learn and make some adjustments. So as a reminder this this does not suggest any increase in hours it's really a shift of hours and we would find a this to be cost-neutral financial impact where we would not be requesting any vehicles or additional supplies or additional staff during this pilot. Current supplies would be sufficient to allow us to do this outreach option. So in summary our recommended actions we respectfully ask the board to accept and file our report and to consider adoption of the recommendations from the advisory commission. Thank you. Thank you. Questions from board members? Supervisor Cummings? First I just want to appreciate all the work that you all have done behind this and appreciate our commissioners who put a lot of time in to come up with you know pilot project that you know will allow us the opportunity to see how a mobile program could actually help us reach more people and hopefully reduce more harm in our community. I guess I'm just kind of curious about I started hearing from some folks in the community about the heroin issue and how heroin is pretty much gone and fentanyl is now the new thing and so I'm just wondering if that's really I don't really know much about fentanyl consumption so I'm just wondering if that's you know the the fact that we're seeing the needles requests go down is that because fentanyl can be I mean I know that can be consumed in different ways but I'm just wondering if that's kind of contributing to it that it's not something that people usually use intravenously and as a result we're starting to see less needles with the loss of with heroin now no longer being available. Anecdotally that's what we're hearing is from our participants is that they're shifting from intravenous use to smoking that doesn't necessarily protect them against fatal overdose but it certainly would help with the blood-borne pathogens that we talked about today so that is one factor in the decreasing. Certainly the ongoing and increasing distribution of syringes by our partners the health reduction harm reduction coalition of Santa Cruz county is also impacting our services. And then I was just wondering if you I'd never heard of the smoking kits before so I'm wondering if you just talk about like what those are and what's distributed. Great question. Those are new resources we started implementing in 2020 and I actually would like to defer to my program staff if I could ask Roshan to speak about what's in a smoking kit please. Well Roshan makes essentially what it is it's basically also a harm reduction model for us for educate them in terms of if you're going to smoke whatever item product these are some of the considerations or best ways for you to kind of do the smoking and I'll pass it on to Roshan for more information. Good morning Roshan Williams the program coordinator for the syringe services program and approximately two years ago we began to distribute smoking kits it's something that's available through the state clearinghouse and a harm reduction tool so we did some research firstly to get some buy-in from our participants to see if it was something that they were interested in and we received feedback that yes there was interest in smoking kits so we put together a brochure to include in these kits which includes some of the comparisons or I should say benefits of smoking versus injecting which has been pointed out a reduction in blood-borne pathogens spread and then also a lower risk of overdose and that was based on resource primarily around heroin use fentanyl as Dr. Newell has pointed out there's still of course a very high risk I digress we also included condoms information about our health services and especially the homeless person's health project there are ours mat services signs of overdose and other tools to promote health while smoking including alcohol wipes pipe holders etc but it is a harm reduction tool to give persons the opportunity to switch modalities and decrease the spread of disease primarily. Great Matt I just had one more question please I'm just so when when you all go out and this might be linked to what is currently offered at the fixed site but are there opportunities to connect people to different types of county programs whether it's Medi-Cal CalFresh housing vouchers I'm just kind of curious what kind of opportunities there are to connect people for to more services and if that's something that's going to be deployed with these kind of mobile services as well. Yes that would be the intent to increase the enhanced linkages and referrals to services including eligibility enrollment staff dependent on who's there pairing with HP HP really does connect many of our health services agencies best components of clinical services and harm reduction tools so we certainly hope to expand what we can provide in terms of resources as Mr. Williams shared we provide flyers information and hopefully can do more warm handoffs in this pilot model with that outreach. Great well thank you all for your work and really excited to see you know what information we're able to learn from this because you know connecting with people where they are also helps to keep needle-litter from going into our environment and so just want to thank you all for your work on this and look forward to seeing how we can support your efforts. Thank you Supervisor Hernandez. Just two questions on the maps that you had it looked like the centers were one on the Freedom Center right and what was the other one it looked like West Beach. Yes it's actually in the name about the sorry I have it written. It looks like the industrial area to me. It is. Oh it is. It's the I want to say it's the waste disposal site in the in the Watsonville. Oh the service center the city service center. Okay okay and then just you know I well I guess that's a good location because there is going to be that collaboration between the city and the counties and Monterey County as well that's close by walking distance at first and Riverside but there's you can't really walk in those areas either. Yeah we would love to see a different church but it's like literally two blocks away but it's not really that walkable in that area. My other question is what is that I noticed most of District 4 is beige but what's that little pink spot in the middle which location is that on the other map that shows the color coordinated where that most use is that. We can find that out for you. Do you know I see it put it up really quick and I was trying to figure out where where that hot spot was in District 4. We will go back to our population health unit and find out which zip code that is specifically.  We'll get the region. Supervisor Hernandez. I also just want to highlight that a lot of the chaos locations are due to our partnerships with the cities so the more we can partner with the cities to increase some of those locations the stronger I think the kiosk outreach will be as well so putting a plug in for sure. You may be starting to hear about Zilazine. Santa Clara County has now had several cases of Zilazine confiscated and this just this last week they had a Zilazine overdose death so that's the first one in California that we know of and that's an additive also called Dope or or Trankdope. It's a veterinary medication and it's being used to prolong the effects of the fentanyl so the drug manufacturers in Mexico when it's manufactured there are adding this Zilazine and so it is not reversible by Narcan and it creates terrible skin wounds even if it's smoked and so we're watching for that it's increasing throughout the United States especially the east coast but just for your education information you'll be hearing more about Zilazine and we of course want everyone to continue to use their Narcan even if they think it might be Zilazine because there's a chance of reversal. Never too much Narcan in there and there's no wrong time to use it. A little unrelated but do you have any maps of like this or for District 4 for methamphetamine use like hotspots? There probably are maps like that and I can find that out for you as well. Thank you Surveyor Hernandez, Surveyor Konig. Thank you Chair. I want to begin by appreciating this transition plan that's here before us to a hybrid model and all the work that the Surringe Services Program Advisory Commission did to review the data and formulate this recommendation and that it's a recommendation that does not add any cost to the program that will meet people where they're at as said and works with our existing healthcare outreach staff and vehicles with the homeless persons health project and will really enable a warm handoff between Surringe Services Program outreach members and folks with homeless persons health project. Also, I mean it didn't mention it but it was in the report that actually a large amount of the budget that does come directly from our general fund for this program actually does go to fund the downtown streets team and clean neighborhoods most impacted by Surringe use or drug use. So I think it's we just want to highlight that because you know we are really making every effort to be responsive to the community's concerns at large as well. For me the biggest thing missing here is just a couple things. First of all the supervisor Cummings alluded to this but the lack of data about handoffs to other services. I know you guys mentioned that you're you know it's not necessarily an easy problem to solve but you know just I know that Surringe Services do provide you know as you said an essential benefit just in reducing transmission of bloodborne pathogens but of course we don't want that to be sort of the end of the road for people accessing these services hopefully. It's the beginning of a journey to greater health overall and I mean in the data we have today I don't see how you know any sense of how successful we are helping people on that journey and of course in identifying how we can help people be more successful in moving along and accessing other services. So I mean we can speak to that you know where are we as far as measuring those handoffs and outcomes. So I'll highlight a little bit we know that when folks come into our facility for the drop-in center we always hand out information to them. It is anonymous so we can't track if in fact that individual you know if there was a follow-up will we do track that and we're talking internally and the program can elaborate a little bit more about bringing some of that information to you guys we do track it but again making that link will be statistically for us very difficult to align however it is being encouraged it is being the information is being provided by our staff. What I can say also is that we have seen a high increase in mat services from our clinic and also services for in our other community program symptoms of rehab so we can present some of that information to you obviously again I can't say that it's a correlation but we are seeing high need for some of those services in our community and I'm not sure if you want to elaborate. It is challenging because of the anonymity of this program to find out if we've closed the loop in terms of referral. Our staff continue to survey participants and try to learn if they've actually used the resources that are provided and we have plans to enhance how we understand our referral success if as we got hybrid and with some future hopefully funding opportunities that we're applying for. Okay, great it would be helpful to see some of the mat data side by side and you know maybe also this is a question at the intake for many places to treatment services is you know how did you hear about us and maybe there's an opportunity to collect some data on that end as well. The other area where I think we're not seeing the whole picture at least not in this report is in the work that other folks in the space are doing I mean you mentioned the harm reduction coalition which was licensed in 2020 and is clearly doing I mean presumably a lot of the work that our own program used to do right I mean we've seen a 70% decrease in total use of this syringe services program over the past few years so clearly they've they're doing a lot and it's not really evident you know again exactly what service I mean we know what service they're providing but you know how our services can intersect any information they have around you know total syringes distributed collected and then linkages with other county services so I know there was mentioned in the report of some collaboration with them in terms of community events I think that's a good start and I think anything we can do to have more data sharing between our entities would be helpful as well. Yeah this is something that we recognize and want to strengthen our partnership with our community partners that are doing similar work or work around this space so we can come back to the board report on that progress for sure when we present to you on the pilot outcomes. Okay great and the last thing I'll mention is I mean with this startling rise of fentanyl use and overdose deaths in our community I mean I've heard a lot of stories about this impacting I mean everyone including students in our middle and high schools I mean it's pretty terrifying and when you started this presentation Dr. Noll by talking about COVID and how we really rallied and made incredible gains as you know some of the best outcomes ultimately in the whole state and country I'm wondering when do we really change our messaging around the fentanyl epidemic to be similar to what we did with COVID right I mean that was just such a huge public information effort and it really feels like we need the same kind of effort now around the fentanyl crisis because you know I'm concerned that you know there's there's students who this is affecting their classmates and maybe they don't even realize that and realize that they're at risk I mean we need to encourage parents to have this conversation with their with their children and ultimately the more people that know about it the more lives we can save but I guess yeah the question is we're always far as treating this as really the epidemic that it is. Well you heard from our partners at SafeRx today and so they're the collaborators across four counties now actually including San San Luis Obispo as part of our partnership and we're working together with law enforcement the courts the jails everywhere that's touched by this epidemic and so that's a great start Governor Newsom just announced yesterday a big push from law enforcement side to try to really blockade these cartels from bringing the supplies in but the answer here in our community as well as nationwide is really the greater context of why is the demand for these substances there why is Santa Cruz County using substances of all kinds at a higher rate what can we do to build resilience in our community and better mental health without the use of substances I think that's that's the biggest question. I also want to add the scale of the problem is so significant and I think the resources allocated to it on the prevention side are very minor compared to the issue so there's definitely more education we can be doing I mean with COVID we saw literally billions of dollars come our way to address the issue and with the prevention pieces we're very we are under resourced and so I think it's going to take a comprehensive approach obviously a policy approach what are we doing as a county to basically reduce policies or increase policies to really combat this issue as well as education and outreach in the schools and to parents parents play a key component or caregivers on education as well so you know I think we're all very familiar with the practices it's just the capacity from from the perspective of programming that can be elevated for sure. Yeah I mean I understand that there's certainly a resource differential we had a lot more resources available when it came to tracking the COVID pandemic and then we do for tracking the fentanyl one but you know I think just the more we can in a real almost have real-time reporting of new fentanyl related deaths I mean the way we did during the COVID epidemic it seemed like you know you got we got a news article every time you know someone passed away in our emergency room as a result of COVID and I mean even just the data that was shared today around fentanyl deaths I think what it was 41 and last year 39 this year I think that 39 number actually doesn't include all of last year right I mean I was saying 22 numbers are only through September exactly so what is that you know here we are like six months later it'd be great to understand what did 2022 end up surpassing 2021 you know we I think we just need to keep sharing this data up to date data so that it does break through people's consciousness and real and help people realize this is something that's happening now right this month this week so anything we can do to accomplish that would be much appreciated thank you sir resident person yeah I'm going to thank the health services staff both past and present for as well as you know our commission that and the community members for addressing this issue you know we've there's been an enormous amount of work on policy work that we've collectively done in this program over the past decade especially in the last five years and I we shared the collective goal of providing a harm reduction in our community and trying to also address the concerns about how the SSP program fits into a broader community desire to see a reduction in drug addiction my hope is to bolster our county program that we have is in some ways that have been mentioned as much as possible while reducing the impacts for the community at large I really appreciated the county leadership in this as we have done there's some good positives we have some real big concerns that we have to address as we know I also appreciate the recommended actions today to support the hybrid service model I think that's a great model that supports the increased mobile response that many many people in our community had suggested I think this pilot period is going to help us determine the level and type of services we we need to meet our community's needs itself and I can but I'm continued to be concerned about the drop in use of our county SSP as evidenced by the Sharpe decline and visits and a unique ID clients which creates some issues itself and lack of cumulative data regarding improperly discarded syringes I know staff has had difficulty in collecting the data from other agencies and partners but I think it's important to our community to know that we understand the magnitude of this issue it's upon us I think we're addressing it and I want to thank especially agencies like our downtown streets team that's helped us in this area I do have some additional questions comments before I would like to make a motion on when appropriate but wait to hear some community comments first and thank you for your efforts and following our direction that we we we issued not so long ago thank you thank you sir rather my person just this is a public health crisis and it needs to be viewed in the same way as other large public health crises we've had in our community in our country the data is stark and sobering and clearly while we're doing a lot we're not doing enough or we're not doing enough of the right things and so to come in with a modification is not just appropriate as needed right now so I'm supportive of the recommended actions as they are and I look forward to that item when it comes back for the board for action like to open it up for the community on this item is where anybody in chambers would like to address us on this item good morning still James Gilling Whitman I reshared a article that came up two years ago on the 20th of April and I went to try to find it to find some particular information but Facebook's already erased it it had to do with a young mother picking up a dollar bill on the ground and because of the fentanyl on it she had an extreme reaction just touching that substance so this is really a great time to you know give an example of a wagon the dog I don't remember the physician's name who in 1996 wrote a book called the medical mafia where she described western medicine as a petrochemical finance sickness over health profits over cures she she asked her patients a lot of questions one of the questions was what presented what percentage of you trust your doctors and it was 76 percent what percentage of you trust your politicians and it was 6 percent now with the lobbyists and what's going on it's the politicians that are actually controlling the medical professionals so I admit that I missed I came in late at about 10 30 I didn't hear this whole thing but some of the quotes I took down I don't really have time to share I wish I did but people are making comparisons between this epidemic and covid and there's a lot of things that are synthetic they're really damaging people you thought that heroin addiction was bad enough I don't know how much more toxic fentanyl is I don't remember I think it's I just don't know I think it's more than a factor of 50 so it's you know I could I really have a lot of compassion for you guys you're in such a state of fear about doing what's right I'm here for another item and I'll speak on that thank you thank you anybody else in chambers I'd like to address this on this item I believe you already actually addressed this on this item correct when you spoke during oral communications this morning oh okay that's fine I can send an email thank you thank you so I apologize to do that but that's that was the opportunity anybody else thank you good morning hi good morning my name is Sucorro Gutierrez excuse me I think I have your larynjites just kidding and I am the health services manager over care team integrated services of which the syringe services program is part of I just wanted to address a couple of things one is Supervisor Koenig you mentioned the harm reduction coalition of Santa Cruz County so I just wanted to highlight that they are a partner Rashawn Williams our program coordinator does a great job at you know communicating about ensuring we're not duplicating services also about our operations and how we can better leverage our resources also you know as a staff and team of two we've also been looking for funding opportunities one of which will be coming next month to to the board about a funding opportunity that is specifically around working in our SSPs to improve referrals and linkages to MAT so we'll be able to hopefully hire some extra help staff to be able to actually track you know move from an anonymous program to somebody you know to a confidential meaning they're able to be linked to a navigator to complete their services and link to MAT navigation services so we're doing a lot of incredible work definitely having a program coordinator for the last two years has not only improved the level of services that we're providing to our participants but we've gone a long way around our partnerships um with all the cities so I just want to highlight that for all of you thank you thank you anybody else in chambers is there anybody online yes chair serena your microphone is now available hi thank you good morning my name is serena king and i'm one of the commissioners of the seren services advisory commission and i wanted to thank the staff uh specifically rashon and sequo for their work that they've done and putting together um best pick best practices and recommendations on how to move forward and I really want to encourage the board to adopt the recommendations that were brought forward today um the pilot model they put together seems like it'll work well for everyone and it's really low risk to start with um I also want to thank Dr. Newell and Emily Chung for their attendance at our ssp advisory meetings and their support for the work um and finally I want to encourage the board to fill the open spots on the advisory commission currently there are four commissioners out of seven available spots and I think it would be really helpful and nice to have some more diverse representation on the advisory commission um one last thing I wanted to mention around um the comments about harm reduction coalition and reviewing their numbers and understanding their work we did at our last commission meeting chair brooder brought harm reduction coalition's last annual report and we reviewed all their numbers in detail and did do a comparison so that work is being done and I believe it should be in our um minutes from our last meeting if you were interested in seeing that that's all I have thank you thank you anybody else online call in user one your microphone is now available Jared and I'd like to thank James for his comments the companies that are gave us this opioid crisis are Pfizer, Black souls, Sanofi and Merck I'd like to see these corporations prohibited from doing the harm they're doing and these are the four companies that make all of the US vaccines for the children's program you referred to COVID deaths there have been many deaths from the COVID shots as reported to there was the figure is that there have been more adverse reactions and deaths from the COVID shots than from all the other vaccines combined over the years that's a horrific figure I'm referring also to a dog a paper COVID shots for adults and children what we know now this is from WesternAprice.org I suggest Gail Neumann that you study this in addition you're talking about where I think I just walked from page here has a whole picture here's an overview this is from Robert F. Kennedy Jr's book the real Anthony Fauci Bill Gates big pharma and the global war on democracy and public health took the lockdown caused so many of these problems thank you miss here thank you and just as a reminder this item is regarding certain services is there anybody else online that would like to comment on the item before us I don't believe so chair all right I think we have one more person in chambers hi good morning my name is Leslie Goodfriend I am a community member retired county health services senior manager I'm speaking in support of this and sitting here today I'm remembering back to probably 15 to 20 years ago when our needle exchange program was providing the service out in the community and it makes my heart warm to hear that we're going back to that public health model that serves people where they live where they engage whatever practice they are and that is a client-centered approach so I appreciate that back in the early days the health services agency operated on a drop-in center on front street that was a partnership with Santa Cruz AIDS project and the then needle exchange program was which was its own entity and by a collaborative partnership approach we were able to serve people who are at high risk for HIV and hepatitis C that drop-in center provided an amazing service to help people get off the street and get the care they needed including referrals to other services we know that that takes a long time and it's about developing relationships so I'm really really glad that we're moving back to going out and serving people that need it where they are so thank you thank you anybody else would you like to address us on this item um yeah feel free to step forward yeah okay yes thank you I'll just be brief I know that we go over some of this information in our in the report which you have but speaking of leveraging our resources and partnerships and specifically for the harm reduction coalition of Santa Cruz county I just wanted to point out that for our program we do in fact collect more syringes at our exchange than we distribute we have a one-for-one model and in in doing so we never go above what people earn in in what we distribute the harm reduction coalition on the other hand does not they have a in and as need practice which is which is a best practice as far as meeting people's needs and we also utilize our communications with them so for instance when the county is closed on holidays we put up signs referring persons to the harm reduction coalition if they do come by the exchange and find that we're not there and they can connect with them however they only operate on on certain days of the week so in this hybrid model we are looking to expand our outreach collection in distribution and trying to operate on days when they are not operating so that we can provide that service to persons who are not able to access syringes because of lack of means or or lack of programs where they can receive them thank you thank you all right we'll bring back to the board for actions supervisor yeah I might have I think let's clarify one of the questions I had if you will the new mobile outreach will not provide syringe exchange directly and but rather just testing and referrals is that right and if it is right what are the reasons we're not recommending the exchange so to clarify this would include exchange of needles in outreach alongside hphp staff so a syringe services program staff would accompany our hphp street medicine during their outreach events as well and the s the syringe services program staff would provide exchange services and provide any tools for harm reduction that they would need whether it's safer smoking kits Narcan etc and also provide the referrals over to hphp who are already going to be there for any medical care wound treatment um any testing um other services that are per our ssp staff don't do all right thank you for that clarification and in the buy-in report I think it's on page 46 the number of total syringes that was collected went down while the number collected at kios specifically increased um does that mean we're seeing a drop in the number of syringes collected or at the fixed exchange rate or exchanges um related to the decrease correct so the fixed exchange collection of syringes the trend is we are collecting fewer needles from the fixed site exchanges but seeing an increase in the kiosk use for collecting syringe waste okay thank you thank you do you have a motion yeah I did you I'd like to make a motion but go ahead no I got a question so with the mobile response it where it's it's fixed right now at the msc center so afterwards it can be moved from like the roadway in case we do get the the grant application awarded for the roadway in and at the presbyterian church where we're doing the work there so in theory yes so we would at each of the fixed locations so we have one in wasimal one in emeline we would remove the shift that has the fewest participants based on averages and so that would be a two hour shift we would reduce those hours and staff would then be used for outreach in the community and they would shift and move depending on where the need is so if the need would be at the presbyterian church or roadway in our staff would consider that and work with hphp on shifting and moving at where this participants could be I survive like first yeah um I'd like to make a recommended action that we approve the one or two of the staff report uh but with some additional direction if I might um have the hsa hsa staff uh come back to the board no later than march 2024 uh your about a year from now on the status of the 18 month um hybrid program and provide any resource adjustments needed at the time uh also have uh and you've been asked to do a lot and you've done a lot so excuse me but there's three things uh the second one being have the uh staff continue working with other jurisdictions uh county contractors and community partners to collect data on uh improperly discarded syringe litter and provide an update on the board by december uh this year and um have the hsa staff continue to examine alternatives to citing a fixed north county program exclusively in emeline including opportunities to include ssp services and a broader community planning for curl street negative navigation services and other homelessness uh programs responses second okay um we have a motion and a second with some additional direction just um would it be possible supervisor McPherson because you acknowledged the sort of the workload issue that they combine those two reports you have one coming in december one coming in march can you definitely do them both in march potentially so i i would defer to them if that's possible now or it would it be better i'm sure it'd be better both were in march we are doing a lot of work with our city partners for sure um and i think we just need a little time to uh you know give you guys a comprehensive update on how those efforts are going okay okay well for the second directive um the update by march of 24 as well okay thank you all right so we have a motion from supervisor McPherson a second i believe supervisor commings beat you out by a tenth of a second sorry you won't get in the minutes um if we could have a what was the question yeah i'm just gonna i'm just gonna add a couple comments okay please um so again i just want to thank you all for your hard work on this microphone i think just sorry hear me now all right so um again wanted to thank you all for bringing this to us and just a couple comments um just based on kind of the conversation we're having um but for future consideration um i think we might want to consider potentially changing the name of this program it sounds like when it was first created it was really focused on syringes and now that's really changed and so i think in terms of people wanting to go to these programs and getting more participation really trying to frame it around harm reduction in some way or whatever other term is appropriate but it does seem like even with the syringe um services commission you know this is really getting more broad and as we're looking at fentanyl with it not being something that's used intravenously and it's more used in other ways how we can frame you know the services we provide around really trying to reduce um bloodborne pathogens reduce um drug use in our community um the other comment i wanted to make was that it really sounds like we need to start moving forward with a pretty strong campaign on um educating people on the dangers of fentanyl use and so to the extent that there's grants available to um work on that or if there's ways that we can work with you all to put on community forums or work with our schools um i know that when we had a meeting in live oak recently um supervisor konig and i there was a um an individual there whose child is um addicted to fentanyl and they were really expressing you know what are we doing in these schools how are we getting information out and so to the extent that we can really try to start getting ahead of this issue um or actually play catch up since it's in the community i think would really be helpful and um and that concludes my comments so all right i'd like to get to that let's be quick because we're 30 minutes late on a scheduled item we go ahead supervisor who knows and at some point you know there's no schedule no timeline but i would like to see you know my supervisor's office kind of served as the uh the shelter during covid the winters during the winters the floods to shelter the houseless right and so i got the opportunity to talk to a lot of people a lot of young people too and i realized that a lot of them talked to me about methamphetamines and i think that if we can bring up that issue and have a discussion about south county and some of the issues that we have there because it's been a really quiet problem and i mean quiet amongst families family members and also quite amongst summer service providers so uh at some point if we can meet up about that offline and have a discussion about that as well absolutely thank you all right we could have a roll call please absolutely supervisor conic hi Cummings hi Hernandez hi McPherson and friend hi that item passes unanimously with the additional direction thank you for the presentation we'll move on to our 1045 ish scheduled item which is item 11 to consider a port on the collective of results and evidence-based or core investments including a five-year look-back lessons learned in mid-year assessment and direct the human services department to return on a before december 12 2023 with an annual summer of core investments funded programs is outlined in the memo director of human services we have the agenda board memo the five-year look-back report the lessons learned the mid-year assessment the funding sources summary the bridge awards and the awards budget and presenting today we have randy morris the director of human services department kimberley peterson our deputy director of hsd good morning and welcome thank you for your patience mr morris okay thank you 1045 ish here we are randy morris human services director co-presenting to my right kimberley peterson uh the deputy director of the department um and before the clerk of the board pulls up the powerpoint for public display i don't know if it's public or yet not just want to make a few introductory comments um first i want to recognize that as is the partnership of this effort uh named core today this is a partnership with the city of santa cruz supervisor comings was there last time we're in front of him with this item now he's a county board member um so kimberley and i will be co-presenting to the city of santa cruz this afternoon we try to align our presentations to recognize that partnership um this is uh 4.8 million dollars of your general fund money and a little over million dollars of the city's money so i want to make sure the community and your board knows that this is a very close partnership with the city manager's office in the city second i want to let you know that today's presentation is um primarily focused on an after action review a look back a lessons learned process but i i feel like it's important to name this is a priority and value of your board as run through our ceo's office to always do continuous quality improvement on everything we do in government and so this is um just one of many many examples uh from our department and many county departments to always look back at what we do and try to improve and always keep an eye on improvement um the other item i want to share is to put in perspective this is 4.8 million dollars of your general fund money that you have discretion over for how it is purposed how it is procured um and it's not enough so it's always very controversial but i thought it would be really important to put in perspective how 4.8 million dollars fits in the larger context of the safety net services that we run in human services in partnership with our health care agency that just presented in a number of contracts in the community um so first we did a tally of all the community-based organization contracts we have amongst all the large departments with our community-based organizations working in the safety net and it uh in total is all just size of 75 million dollars in contracts so this 4.8 million dollars is actually about seven percent of cbo contracts i just want to make sure that context is understood and then if you add the public system safety net programs we run in county human services and in county health like our partners just presented we actually have about 415 million dollars of public funds delivering services to the safety net so this 4.8 million dollars is about one percent of the safety net so i think that's just important to understand and that leads to my final comment that is why people before me the board before me my predecessors were asked to look at this in the context of collective impact because if you just have one percent or seven percent of contracts doing one thing and it's not aligned with the rest of what the county is doing it's very difficult to track how collectively we're bringing together all these different services so much of the materials today speak to that movement speak to that history speak to what collective impact is and my final comment is there are a lot of materials in the packet um supervisor friend listed many of them um but i want to really summarize we are in front of you because of five specific directives from the board and we are only going to speak to one of them today but i want to make sure the public is aware of all five and we are here to answer questions on any of their four um so one attachment is called a five-year look back we were directed by your board to review the first round of core contracts which were from 2018 uh to 2022 when this new term started there is also a directive by your board to help the cbo's that lost funding in the last procurement to have a three-month bridge there's a whole report on that we are now beyond six months of current core contracts so there was a snapshot of the current core contracts a mid-year report we call it so that is in the materials and then the last of the four that we will not be speaking to specifically in our presentation today is your board directed us as did the city council to try to find alternative funding sources for cbo's who had core contracts before and lost money so there's a whole attachment on those efforts that were made and um both past and future what we are going to speak about today is the continuous quality improvement effort or we call it lessons learned and there's a whole packet of material there and the reason for focusing that is this is today at least from a staff perspective a looking forward what is the next steps what is a roadmap before we are back in front of you with a procurement and applying those lessons learned so that hopefully the experience has improved for all and with that said if i could ask the clerk of the board to pull up the presentation so if you can go to the next slide thank you so um i'm going to present on the first two items a very quick summary of what's actually in front of you for a vote uh the recommended actions i'm going to cover um a quick summary of what came of the lessons learned um effort and i'm going to turn it over to kimberley who is going to speak to the importance of community voice a lot of the lessons learned was interviews with elected officials county and city staff but mostly community-based organizations who have been a major partner in this effort and then kimberley will end the presentation with what we are proposing as the roadmap going forward in the time frame go to the next slide so the recommended actions um just to summarize the many that are listed in um and supervisor friend repeated there's a host of materials we're asking you to accept and file it's actually not written in the board materials to approve a timeline and next steps that's folded into our presentation which was where how kimberley will end the presentation and to return with an update to the board and to the city council with what comes of the work we do between now and back in front of you in december so next slide so the lessons learned was a very comprehensive effort many months of interviews with stakeholders community-based organizations elected official staff and the feedback can be summarized into three buckets one is there was some misunderstandings about some of the facts about what actually happened it's understandable there was so much emotion about some organizations not getting funded and we want to take some time to summarize what came from the effort to clarify some misunderstandings second is because many of those misunderstandings sort of dominated a lot of the discussion there was a number of things that worked well that did not get a lot of public discussion and they were reflected in the feedback from stakeholders we wanted to lift those up to make sure we move those things that worked forward and then finally we do have a series of proposed adjustments because there were a number of areas of constructive feedback given to us that we think are very actionable and we comply in the next rfp so that's the lessons learned summary and if you go to the next slide i will walk through each so four areas of misunderstanding first the rfp process itself i do want to disclose th