grants that the burden of finding evidence-based best practices trying to verify the credibility of the data and evidence behind them while they're preparing a grant proposal that that burden doesn't fall on them during the application process. So we are working really hard to get these tools as functional and comprehensive as possible before the RFP is released. And so at that I will turn it over to Emily who's going to share more about how these will be used and what the actual process will look like over the next few months. Thank you, Nicole and good morning, board. Over the next six months, HSD staff will examine the many lessons learned from the last RFP process evaluation and determine how to incorporate those lessons into the next RFP framework. We will also be collaborating with stakeholders including the city of Santa Cruz to align our goals for the RFP. Additionally, Nicole and her team will continue the work they've been doing to help people across the county learn about the suite of connected tools and practice applying them to various uses including but not limited to funding proposals. In August, we will return to your board to present a draft framework for the core RFP. After incorporating your feedback, we plan to release the RFP in the fall. As in the past, we will provide opportunities for individual and group technical assistance to answer questions from applicants and connect them to existing tools and resources like the core results menu, data share indicators and promising practices database. Next slide, thank you. Proposals will be due in the winter and will be reviewed in the spring. Later in the spring, we'll return to your board with award recommendations for approval and agreements will begin in July of 2022. As Nicole mentioned earlier, we are weaving together the core funding model and movement with the goal of moving together toward the shared aspiration of more equitable health and wellbeing across the county, across the lifespan and across the core conditions. And this concludes our presentation at this point and we're happy to answer any questions you may have. Okay, thank you for that presentation. I'd like to just praise the work of both the county staff and our nonprofit partners who provide the services under the core contracts. It's been a great cooperative effort. I think that the core approach to funding community programs as it came forward several years ago with the full support of the board, we recognize the need to align these services with the county's strategic objectives that we've developed. And we also recognize the need to raise the bar for effective outcomes serving the most vulnerable in our community. I believe this approach has substantially worked well and I look forward to the next round of proposals for these services. I think we are going to have a more efficient, more efficient delivery of healthcare and human services under this core proposal than we have in the past and it's moved forward very well. Are there any other questions that the board might have? Members of the board? Chair, I'll just jump in if that's okay. Sure, please do. Yeah, go ahead. So first let me say when we looked at reforming community programs, funding, about a decade ago at the city and then at the county, I don't think we envisioned such a robust and thoughtful process. And I wanna appreciate all the people who took the sort of desire by the board and have run with it to create such an integrated thoughtful process. And I also wanna say, we just went through a long recognition of county departments who have been working under very difficult circumstances and our community programs have been doing similar work under very difficult circumstances and really excellent work serving the needs of our community. I think we all wish we had more money to allocate them to them so that they could only increase their impact but I appreciate the framework and the analysis that you all are doing. My only brief question is what's your plan to engage with the city of Santa Cruz and the other cities, frankly, in the county to see if we can all align our community programs, funding to meet shared needs? Am I coming through in response to the supervisor community? Yeah. Okay, so I do wanna first and foremost recognize the city of Santa Cruz and lock and step with us. We actually, given the board agenda and made a decision in collaboration with them that they were fine with not co-presenting with us but we are working with the city staff and so we are in active conversation with them. The other three cities predate me but we do have plans to engage them to see if, as I understand was asked during the last round when the city of Santa Cruz agreed to see if there's any interest which is of course their jurisdictional decision to align. So both Santa Cruz is active and conversations with the other cities will happen between now and August. Great, and are you gonna do a study session or something similar with the city council? You know that's planned. I don't think we have that plan. We will take any direction or advice from your board and when we consult with the cities we'll follow the lead with the city of Santa Cruz staff to see how we lift that up. I understand that did happen with the city of Santa Cruz before. So I would imagine they would ask the same. Yeah, I won't give direction because it's obviously up to them but I think it would be helpful to bring not only city staff but the elected leaders of Santa Cruz to make sure that they're understanding this process and where the opportunities for collaborations and focus on outcomes is. So I'd encourage it if they're open to it I'd encourage us to make that offer. And similarly for the other elected bodies around the county. And in fact, as I think about it some of the maybe perhaps the other funders who I know are involved but making sure that we're getting out to their boards of the community foundation or the other institutions in town to make sure that the boards are aware and that we're building a bigger army who's moving forward collectively to address the many needs. But thank you for all the good work and I look forward to hearing more as we get closer to the summer. Any other comments from board members? There. Yes, Mr. Koenig. Thank you. I want to thank the Human Services Department for this great presentation. I certainly understand how we arrived where we are today on some of the challenges with the past way that we allocated some of these funds. My concern with looking at the presentation today is just how intensive the process has become of creating these metrics. My understanding is that we're looking to allocate roughly $4 million, that could change but based on past allocations we're looking at about $4 million, is that correct? Yes, after the 10% cut it's just about $4 million depending on budget process it will or won't incrementally move up again but that's approximately correct. Right, and how much staff time do we anticipate we'll go into creating this framework for allocating those funds? Oh, I'd have to calculate really quick but yes, I think your point is it is a body of administrative work and I don't know if this is also where you're going but it's a body of administrative work for us as staff to make sure we bring forward a framework that hopefully your board can support and it's a body of work for community providers to put the time and energy into applying which is always the conundrum of competitively awarding contracts. So yes, I don't have the answer and we can get back to you with the calculation if you'd like but it'll be work of our contracts often and us as department leaders to sort of work that through with the community between now and August. Right, yeah, you correctly defined my point there. You know, we're spending $50,000 on a consultant. I understand that's not all county general funds but nine, you know, nine and a half thousand dollars.  And just to point out the promising practices if I'm looking at this website correctly there's 234 pages of them. So that's a lot of information for anyone to either collect or sift through. And I really think the more complex that the framework becomes, the harder it becomes the more time it consumes both for staff as well as for these organizations who are trying to compete for these dollars. So, you know, I would really encourage us to create a framework that sort of does what it says on the tin. It is, you know, extremely straightforward. We have a very clear idea of whether or not people, you know, are meeting the goals they set out to and you know, what we're communicating to organizations to do is clear and the longer the list of metrics or requirements becomes the more difficult and time consuming it becomes to do that. I'll just hoping I'm on point with what you're bringing up. I think it's worth reminding the community or maybe letting the community know and putting in perspective to the board. As a department whose 90% of its budget is federal and state money and therefore the regulations that govern what we do are not in your jurisdiction. This is the one program that's 100% in your jurisdiction as the board of Santa Cruz County. So we completely take your lead on trying to find that sweet spot in that middle ground and going from no competitive procurement with no clear rules, no outcomes to trying to create a framework that I think I'm hearing from you is digestible and understandable. But I would extrapolate not so simple that you end up with the wild west of saying, you know because we will have way more applications for way more money than the four million even if your board finds a way to increase it. So it's trying to find that sweet spot so that your board doesn't get put in the position of arbitrating when we go through the process, have panels and then we come back to you with recommended awards that you can have confidence that we've found that balance. So the process had the right integrity. This being a local process we don't have the feds and state telling us how to do it. I think our job as staff is to come back to you in August with a framework that strikes that balance and your points are heard. Great, thank you. Thank you, Supervisor. Any other comments from supervisors? Yes, Mr. Chair, I have a brief one or actually it's a questions from Mr. Morris. Now, thank you Mr. Morris for the presentation. Thank you Ms. Young as always for your presentation. My questions deal a little bit with the set aside funding, you know, the board as you well predates you but the history of this was and a little bit to Supervisor Koenig's point we had a pretty complex process for the larger funding. So we tried to have a simpler process for the set aside for new and emerging programs but also for smaller programs. Do you feel that that smaller set aside is actually meeting those goals of addressing these smaller programs? Oh, I'm gonna talking to an elected official. I'm gonna probably sound like one in my answer and I'm gonna lean on Emily a little bit who has some history. I would say first and foremost I wouldn't wanna speak for those smaller programs because I'm in a very different position as a funder and particularly a new one year new county employee. What I understand was to have $150,000 to sort of purpose to fill a few small holes for some smaller organizations had real merit but I think ultimately the question if I'm hearing right Supervisor Friend is those got coupled by a board action looking at my notes. It was back in November of 2019 to merge it all together before they were decoupled. So I'll ask Emily if she can come in. I think I hear your question is, are they filling those holes? Are they meeting those needs with the humility that I think the community-based providers would get that money would be differently and well-positioned to answer how they feel it's working. I know for us it's a lot of workload to go through a procurement process for $150,000 mindful of what Supervisor Koenig just said. So there is something very efficient about having them bundled together but ultimately will follow your direction. So Emily, could you share more to see if I didn't quite respond to Supervisor Friend's question? No, I think you did. And I think the intent of the set aside was also to provide a more lesser cumbersome process for those smaller agencies that may not have the administrative support to go through the entire the larger RFP and our intent is to at least to do the same that they will have access to those funds for one time and some emerging needs. So Supervisor Friend, could I just ask, would it be helpful if when we come back in August we delineate the process for set aside funding as part of a presentation in August? Would that get at your point? Well, I think to Ms. Bali's point, I just want to reiterate what the board's purpose of creating it in the first place was and it wasn't for, say, COLA applications for existing programs, right? And so what I think we need to do is be very specific. It shouldn't be a large processing on your side if we simplify the application and expectations of the applicant. So the idea of the set aside wasn't to be hard for you and it wasn't to be hard for them. It was for, as Ms. Bali had noted, small programs, 15,000 in funding, for example, that didn't have the capacity or the potential for a new and emerging need. We have a pandemic. Maybe there's an add-on component to something. The funding was designed to be flexible by design. I just wanted to be sure that that's what it was. If you're getting inundated, for example, with a lot of applications for requests that maybe you're outside of what the board had sought, then maybe there should be greater clarity in the application process or if you need greater direction from the board as to what we wanted that funding to be for. Because I don't want you to be getting 500 applications with 450 I'm just making this up, but 450 are COLA requests. When the whole point of this was you had $5,000 programs, $12,000 programs, $15,000 programs that for 30 years weren't allowed to participate in this process. And we wanted to come up with a way that they could do it and not have to meet the greater metric argument that the larger programs do. So to your point, should you come back? And I mean, I don't really need the framework. I'm trying to ask your help and whether we need to provide greater clarity on what it's for or whether you feel is so that it can be narrowed to be a more effective and sort of easy program for both you to administer and others to apply for. Emily, I'm going to turn to you again. I now think I hear the more focused question from Supervisor Friend if we feel like we understand or we need to get asked the board for more direction. I think we understand the board's direction and I think when we provide the framework, that's another opportunity when we incorporate the set aside for feedback from the board. Okay, and I'll speak a little bit to the point that my colleague made Supervisor Koenig on the metrics.  So we went from, I mean, some would argue there were metrics in the previous programs, but really we was, for example, a number of meals serve, but it didn't actually talk about whether there had been changes to the underlying conditions of the individual that was seeking the services. And those were in many respects, not helpful metrics. One of the challenges I find with having sort of a simplified program, although it's a good ideal is that these programs are so fundamentally different and cross so many different sectors of the county's strategic plan. I mean, they crosswalked all kinds of different worlds that we're interested in. It's really hard to standardize a system that shows across the board metrics. For example, very different from like a road situation where we can standardize number of miles paved is actually a very interesting metric versus number of meals serve doesn't talk about how many people have left poverty as a result of the program, which is what this is about is about cycle breaking. So I'm all for a system. And by the way that the providers have expressed concern over what they believe to be, you know, a onerous system of application. And understandably so, because it's much different from it was, you know, a decade ago. And if there's a balance to be made, I'm all for a balance, but I think that I was just trying to present why I think it's more complex than simply just refining the system. I mean, it really is, I mean, a Meals on Wheels is fundamentally different from something the diversity center does, which is fundamentally different from what Lifeline does, which is fundamentally different. And so these services are so different. And what we seek out of them are so different that it might be hard from a metric basis to standardize that. But if there's a way to do it, that I'm missing them all for it, but I wanted County staff to know that I completely understand why it appears the way it does. I mean, we're trying to meet a lot of varied goals that different programs do. And I just appreciate the transparency and the effectiveness now that's outlined that wasn't done historically. So for me, just moving forward that my interest is really also in that set aside and ensuring that it's not harder for you than it should be for 150,000. I mean, this was meant to be easy for everybody all around. I mean, I didn't need a 50 page thing on each deal. And I also wanted to make sure that people weren't trying to apply just maybe because they didn't know what the board's goal was. Use the application process to meet other needs than what the board was doing, which made your life harder on that. So that was all. Thank you all for your presentation. Thank you. Any other questions from board members? Yeah, if it's all right. Sure, go ahead. Supervisor. Yeah, let me put my hand down. Sure. You're good. Go ahead. There we go. Yeah, I want to thank you very much, Randy and Nicole and Emily. When we first were dealing with CORE in the beginning, the concern I had was like a supervisor friend was actually asking me about is that we wouldn't prevent small groups from getting some money to help projects that are very dear to the community of each district that we represent. I don't know some of the programs that are very vital, the small programs that are very vital to Santa Cruz, Felton, Scott's Valley, Davenport, Aptos, but I do know South County and I think you've done a wonderful job in getting the input of each supervisor from each district that knows their district better than others that don't represent that area. So that concern is not something that I have now because I've worked with you and I see that you are open to the idea that South County is different than Davenport or some of the other areas. And you answered a lot of questions. Supervisor Friend actually asked what I was gonna ask and I think you answered them. I don't wanna see the small programs get buried under paperwork, especially during the COVID crisis we have going on now because they don't have a big staff. They're not good at writing term papers and presenting them to the core in order to get money. I don't want it to become like a competition where who writes the best paper. I wanna get actual input on what we see as representatives of our community that the money is being used well. And Meals on Wheels is a great example. I believe a lot of the money that we give to the Community Action Board, they're under that umbrella, am I correct? If any of you can answer that. Meals on Wheels is under Community Bridges. Community Bridges, okay. So we're watching to make sure Meals on Wheels is taken care of both in South County and Mid and North County. Yeah, it's an open-ended question. Meals on Wheels for the entire County, North, South, Mid County, they're all under Community Bridges. Yes, and they are currently funded under the existing core programs. Okay, I just don't want to get much behind because I've seen, especially during COVID, how important it is for people that cannot get out and to have a meal actually delivered to them and that actually also that person will contact other than the post office. I think you're frozen. Okay, I think Mr. or Supervisor Caput completed his remarks. I'm not sure what's happened there, what the hangup is. I think each Supervisor has asked a question. Are there any comments from the public? Yes, Chair, I have one speaker. Go ahead. User five, your microphone is unmuted. You have two minutes to speak and the timer will begin as soon as you begin speaking. Hello, this is Marilyn Garrett. I'm a retired teacher. I was listening to your presentation. In the future, I think it would be helpful to spell out the acronyms and what they stand for, but it seems to me we're talking about, I agree with Supervisor Koenig, this seems like a questionable use of money and isn't the county facing bankruptcy like many counties during this COVID crisis policy that is putting more people in poverty. Supervisor Fran, you asked how many people have left poverty? More and more have fallen into poverty by these policies. So it seems to me not in touch with the real, real problems or hunger, housing, unemployment and policies that are increasing that, I heard that 84% of the so-called COVID relief money has actually gone to corporations and banks and there's been a huge shift of money upward to the corporations and CEOs of Google, Facebook, Amazon, et cetera. So I feel like this is totally an adequate funding for the needs that are increasing by the policies the county is adopting to make the situation more. I'm not sure what happened to Ms. Garrett's audio, but I think she made her point. Is there any other comments from the public? There are no other speakers from the public chair. Okay, we'll turn it to the board then. This is a study session, so I don't think we'll wait for your August report. We thank you for this. And I think the evidence-based best practices criteria that you're using is showing some real dividends for the people of Santa Cruz County. So thank you for this report and we'll look forward to your coming back on this in August. Thank you very much. Hi. Pardon me, Chair. Yes. There is a vote on this item to direct staff to return. Oh, I'm sorry. I thought it was read into that. Okay, we'll have a motion for direct staff. Thank you very much to return. A lot of before August 24th. Unmoved. Coonerty. Coonerty moved. Seconded by, I think it was Catholic. I'm not sure. Okay, please call the roll. Thank you. Thank you, Supervisor Koenig. Hi. Friend. Coonerty. Hi. Caput. Hi. McPherson. Hi. Thank you, motion passes. Thank you very much. Okay, it is just about noon and we have one more item on the regular agenda before we go into closed session and we have a scheduled 130 item. I would like to just go ahead. I don't think that item number nine should take more than 20 or 30 minutes. So I would like to move forward with that. We will then take a, we're going to our closed session, probably about 1230. It may be that that scheduled 130 item could be at 145 or something, but I'm not sure. But let's go ahead and move on to item number nine. Consider authorizing county participation in state rental assistance program or RAP RAP, except 8.123 million in federal ERA grant revenue adopt resolution authorizing the county administrative officer designed a state agreement and related documents to secure 8.742 million dollars through the state RAP. Authorize the planning department to administer your local section of ERA administrative funds and take related actions as outlined in the memorandum of the planning director. That is the BCSH letter to jurisdictions January 28th, 2021. And it was Senate bill, state Senate bill 91 expression of intent for the state RAP or the rental assistance program, federal ERA program, conforming local rental assistance program February 3rd, 2021, a resolution authorizing the participation and Senate bill 91 stakeholder meeting presentation. We will go ahead with this item. Is there a presentation? Yes. Good afternoon, chair McPherson. This is Suzanne Isay with the planning department housing division. And I'll be giving a brief presentation if I could ask the clerk of the board to show the PowerPoint please. Ms. Isay says on the departments to share their presentations. Oh, okay. Can everybody see the slide presentation? Yes. Okay, great. Okay, so some of you may recall last year we implemented a rental assistance program related to the COVID pandemic through the CARES Act federal fund. We used a portion of the CARES Act funds that the county received to provide that program. In late December, Congress created a new funding program for a similar program at the national level. And that was through the Federal Appropriations Act of 2021. So that appropriation provided $25 billion for this rental assistance program nationally. So it is similar to the type of program we had in 2020 through the CARES Act, but it is now a little more defined both at the national level and also at the state level. And it has a specific funding stream associated with it in the federal budget. So that federal appropriation essentially split the funds into two different pots. One pot of funds went to the states directly and then each state is responsible for determining how best to distribute those funds throughout their state. And then the second pot went to cities and counties that had populations of 200,000 or more. Santa Cruz County, when we include the population of our four cities meets that threshold. And so we received a grant of slightly over 8.1 million directly from the federal treasury. In addition, we were notified in January by the state of California that we were eligible for an allocation of nearly 8.8 million through that pot of funds that went directly to the state. And I'll be going into a little bit more detail about that state distribution. So the state essentially several weeks ago, informed us of the results of the Senate Bill 91 which was passed in Sacramento at the state level to do several things. One of which was to extend tenant protections for tenants and landlords that had been provided last year through AB 3088. And then it also provided a little bit more guidance and specificity for the state's use of the funds that it got through this federal rental assistance program. And so it created a system for distributing the money statewide as well as some pro guidelines to be implemented by both the state and any local governments that would be getting these funds. So a couple of key parameters about the program, both the federal legislation as well as the state guidance makes households eligible if they are low income according to this definition, which is if their income is 80% or less of the area median income. However, it does prioritize households that are very low income, which means their income is at 50% or less of area median income. The program funds themselves can be used, 90% of the program funds must be used for rental assistance, which can include rent and utilities of rears, as well as a certain amount of prospective rental assistance for a limited time. Overall, Santa Cruz County is eligible for a total of nearly $16.9 million of this type of funding when both our direct grant from the Treasury as well as the state funds that were eligible for are combined. So the state informed us that we had essentially three options with respect to the funding that the state received that the county is eligible for a portion of those funds. So they provided us options A, B and C. Option A is that we join with the state in a statewide platform that will be available for all participating jurisdictions as well as a number of smaller counties that did not meet that 200,000 population threshold. This option would mean that we would essentially commit the local grant that we got into the pot that will be administered at the statewide level. However, all funds that are designated for our county will be reserved specifically for our county's eligible households. In doing this, we essentially save on all of the overhead costs, the costs of procuring sophisticated software that would be needed both to accept applications as well as do all the backend accounting and audit trails and fraud prevention on all these other requirements of the program. And instead we can focus at the local level on getting the message out to our local communities and helping folks apply and get through the process of applying. So the program design that was set up through the state actually requires the state to contract with what they call local partners within each participating county. That means local community-based organizations that will be brought on board by the state to ensure that there are actual locations within the county where people can get in-person assistance if needed to apply. For instance, if people do not have smartphones or good internet or cell phone connections to be able to do the online process, there will be facilities locally where they can submit those applications on paper or however they need to do it. And also to ensure that we have local entities that can really do outreach and ensure that those least likely to apply will become informed about the program. The program design includes provisions for language access in multiple languages. They've built into the system capabilities for communications in 18 languages. But in addition, if we have any languages at the local county level with or not among those 18 languages, we can have those accommodated as well. And so there'll be a process for our local CBOs and other stakeholders to communicate with this statewide contractor to make sure that our language needs are met. The state has provided this website. It has actually been operational since last year with information on the prior programs for renters and landlords that are impacted by COVID-19. There's a shortcut URL, it's housingiskey.com. If you type that in, it brings you to a specific page on the Department of Real Estate's website. It also has a calculator so people could type in their income and their household size and figure out what income level they are. And it has a language line to provide phone assistance in multiple languages. This is a snapshot of what that website looks like. Here we go. Oops, I'm sorry. Whoops. So like I mentioned, there were three options provided to us. Option A was that we join with the state and that will make us eligible for this extra 8.8 million in state funds as well as including our local grant with the pot for our county. The second option was option B, which was that we would request that the state provide us with the block grant of the 8.8 million. And we would be responsible for administering the entire program for our county locally. However, in order to be eligible for that option, we would have had to have a program already running and operational by early February that met all of the requirements in SB 91. Now, the SB 91 requirements have a long list of both programmatic and also technical criteria that the program has to meet in including things like robust fraud prevention mechanisms within the software, the ability to deliver payments at a large number of households, the ability to have a website that won't crash even if it has 20,000 active users at the same time, just a whole laundry list of technical and programmatic criteria. And we do not actually have any rental assistance program that even comes close to meeting that kind of scale or sophistication at this time. So option B was really not something that we could have pursued. In addition, if we had pursued option B, the state would have had to review our program and determine that it does in fact meet all of those criteria and performance criteria set out in SB 91. And if they determined that it did not, then they would reject our request for that block grant. Option C was that we could administer our 8.1 million federal funds locally through a rental assistance program. And then the state would administer their statewide program and also offer that program to residents of this county. So essentially any interested residents would be trying to figure out which of the two programs they should apply to, they would be getting different outreach messages different application platforms that would just create a lot of confusion. And more importantly, it would set both of the agencies up for a high risk of what is called duplication of benefits, which is not allowed with federal funds, which means that there's the potential for, for example, let's say a family wanted to apply for rental assistance and they applied to both programs at the same time and received assistance for the same months of rent or the same arrearages through both programs. Then, when the federal treasury is getting this, they would create findings against both us and the state for allowing that agent of benefits to happen. So we felt like that was not a risk that we could recommend that the board take. The state also provided that any jurisdictions going with option C, those jurisdictions would assume all liability for that risk of duplication of benefits. And we felt like that's just a risk we can't really take. So we are recommending that the county pursue option A. In order to go with that option, we would need the board to adopt the resolution that is attached to this item today for your consideration. And let me just go back to slide. So prior to writing up this item, staff met with the staff of all four cities in the county, the housing authority. We had multiple meetings with COPPA and also communications with a representative of all the water districts in the county who had reached out to us because they're concerned about water bill arrearages. We also discussed and reached out with various service providers, nonprofits in the county that do provide these types of rental assistance programs and other stakeholders that contacted us about this program. All four cities, the housing authority and the water district after learning all the details about SB 91 and about the program, both at the federal and state level agreed that option A made the most sense. In addition, after talking with COPPA and the service providers, then after they reviewed all the detailed information that was available from the state, they also agreed with option. So we feel very confident that this is the right path with respect to this program. By participating in option A, the state hasn't informed us that we are eligible to participate in a statewide advisory body that they're setting up so that all the participating jurisdictions can give input to the program's contracted statewide vendor. That is LISC, which is the Local Initiative Support Corporation, which is a CDFI or Community Development Financial Institution. They were selected by the state after an RFP process for this purpose. And so the state has indicated that the first meeting of that advisory board will be this Thursday at 1 p.m. And initially at least staff, myself and Melody Serino in the CAO's office have been designated to be representatives on that advisory body at the board's discretion. Let's see, the program is scheduled to launch. This is one of the criteria that was noted specifically in SB 91 that whoever is going to roll out this program, it has to launch on March 15th, no later than March 15th. That was another significant reason why we felt that it was beneficial for the county to go with option A because we did not feel that if we went with one of the other options that we would have the ability to roll out the program that fast. And then of course it is of benefit to all the people who would want to seek this assistance to be able to obtain it sooner rather than later. So the recommendations are on the slide before you. And I am happy to answer any questions you may have. I have a couple of questions. The way I understand the program is that any rent in arrears has to be dealt with before the tenant is eligible to get support for a future rent. How does that clearing up the unpaid rent effect whether they're eligible for 12 months of support? Would they be eligible for a shorter period in the future then? Yes, my understanding of the program design is that it does prioritize arrears first. And the reason for that is they want, the ultimate goal is to prevent eviction. And so part of the program design when the legislature was debating SB 91, they had a goal with this funds of maximizing the number of households that could be stabilized. And so they came up with a requirement that essentially in order to accept this assistance, participating landlords would agree to accept 80% of the rent arrears for a given tenant as payment in full. And essentially what that means is this program will have a savings of 20% across any households that are assisted and stabilized. And that way they'll be able to make the funds go that much further and assist more households. So by accepting that 80% payment, the funds can go further. And then there's a certain time period for which arrears can be paid. It is April of 2020 through March of 2021. And depending on certain other factors specific to the household, the client can also obtain forward-looking rental assistance for I believe it's up to three months. So it's not necessarily that somebody's gonna get a 12 month forward-looking assistance. The priority is really on the arrears so that the landlord would not be able to go and evict that tenant. Okay. And can landlords change the amount of rent charged during the period of their tenant is drawing support? How will the leases that include a scheduled rent increases impact the amount of funding available for two tenants? Can they go back and increase their rent? I don't think they can do it retroactively. So if they had a lease in agreement in effect for the period in which the arrears occurred whatever the rent was in effect at that time is what the program administrator would use to determine the amount of the arrears. Now, nothing is to say that they can't increase their rent going forward, but the priority is on the arrearages. So I think in most cases it wouldn't be possible for them to say, okay, I'm gonna implement a rent increase now for last year. I don't think tenant landlord law would allow for that either. Right. Okay. Thank you. Any other questions from the board? I don't see any. We have supervisor Caput has a question. I got my head up. There you go. Thanks, Chairman McChryson. Go ahead. Thank you. Yeah, you know, with the state, I guess option A, you know more about this than I do, but it's very complicated even with option A. We've got, are we gonna be ready when the money comes in to make sure that the money goes where it's supposed to go? And what I'm talking about is the small landlords, the tenants that are having a really hard time and are we able to distinguish between someone trying to manipulate money that's coming in. I wanna make sure that it comes in and it goes to where it's supposed to go. If the state is gonna run it, I guess locally we're pretty much responsible that it goes where it's supposed to go. Is that correct? Sort of. I will say thank you've identified one of the main challenges in running a program like this. Right, because obviously there's gonna be a lot of people wanting to pursue these funds. And so there's a challenge in sorting out legitimate requests for assistance from potentially fraudulent claims, correct? So that's a big challenge that's going to be faced by the program administrator. In this case, if we pursue option A, we will not be the program administrator. So LISC is this statewide nonprofit entity that will be administering the funds and they will be responsible for vetting all documentation and applications to determine who is eligible and who is not. The county again would be able to provide some guidance and maybe some problem solving suggestions and things like that by participating in this advisory committee, but we will not be responsible for the day-to-day administration of the program. Now, another point I think you raised is that you can be challenging to try to make sure that the small landlords, your mom and pop landlords have one unit or an ADU or something like that that they can access the program equally. That is also a priority of this program design as laid out by SB 91. So there is really a priority in trying to get information out and to make the program as accessible as possible and prioritize the household's most in need. And so we would be helping with that at the local level, both county staff as well as these local nonprofit agency partners that are likely going to be subcontractors to that statewide administrative entity. So we would help by messaging and getting word out in multiple channels, for instance, at community events through local radio PSAs, through social media blasts. There's all sorts of ways that we will be able to help push out information at the local level in various formats and channels to make sure that those who might not be on social media all the time or have good internet access and so forth or maybe speak other languages to make sure that they are getting the message and have an opportunity to apply. In addition, the program requires prioritization. So there's going to be essentially three application rounds. The first round will be open only to very low income households. So that's the first priority. The second priority will be for those locations and essentially neighborhoods or county subregions that were the most impacted by COVID and that data will be based on state maps that show communities that are most in need by a lot of your kind of usual parameters, high poverty, census tracks and things like that. In addition, we will be able to advise the state advisory board and the contractor as to areas we feel specifically in the county need some special level of outreach or might qualify as heavily COVID impacted neighborhoods or zip codes or any kind of geographic areas of the county. So we will be able to provide that local input to the statewide operator to make sure that the right neighborhoods can be prioritized for that second round. And then the third round will be open to anyone who is low income who was not already assisted by the first two rounds. So anyone up to that 80% AMI level. Okay, thank you. You're pretty much answered because with big money comes big responsibility. And what we're looking at here is having to cooperate with the state obviously is dealing with 58 counties and we'll probably be dealing with local cities housing authority and different agencies locally to make sure that money actually goes where it's supposed to go. I guess I'm concerned with the bigger picture of multimillionaires that actually owned a lot of rentals and whether or not a year ago or two years ago, they raised the rent way up and making it more difficult for the people that are actually trying to pay the rent. So I guess I just don't wanna see where we get money and we find out that it's going to people that don't necessarily need the money as much as all landlords that might own a couple of rentals and people are having a hard time paying the rent. Right, any other questions from supervisors? Okay, are there any questions from the public? There are no public speakers for this item. Okay, we have entertained a motion to adopt a resolution now authorizing the county administrative officer to sign the state agreement and related documents to secure 8.7 for two million through the state rental assistance program. Mr. Chair, I'll move the recommended actions. Mr. Heath, did you have something that you wanna do, Adam? No, thank you, supervisor. I was just getting ready for the next item. Thank you. Okay, no, sure. So Mr. Chair, I'll move the recommended actions with great appreciation to our county playing department and CEO's office on this. I believe that any of the administrative challenges really gonna pay in comparison to the challenges that members of our community have been facing that may need assistance. So I appreciate their leadership on helping to obtain this funding. So I'll move the recommended actions. Okay. I'll second it unless somebody else wants to second it. That's okay, motion by Friend, second by Caput. Clerk, please call the roll. Thank you, Supervisor Koenig. Aye. Friend. Aye. Coonerty. Aye. Caput. Aye. Ferson. Aye. Thank you, motion passes. Motion passes unanimously. We will now go into closed session. Two questions, Mr. Palacios. How long do you think this might take? And then Mr. Heath, is there any reportable action? What's your guesstimate on the timeframe, Mr. Palacios? Yes, I think closed session will take at least an hour. Okay. It's 1230. So I'm going to move the scheduled item for 130 to 145. I think I can do that. All right. Would you, will this open up the public, the scheduled item for 130, it won't be until 145. And Mr. Heath, is there, Council Heath, is there any reportable actions? There are not. Okay. No reportable actions. Thank you. Okay. We will recess into closed session and come back to address item, the scheduled item number 11 and one, we hope at 145. So let's take 10 minutes and then get into closed session. All right. Or should we just stay on, Mr. Heath is, we can do that. All right. We can certainly stay on and gather everybody together then we can decide. Okay. Why don't we just do that? Let's just go into the closed session right now that, okay. Pardon me, Chair. You do have a quorum of supervisors, although we're still waiting for Supervisor Caput to join. Okay. We'll go ahead and reconvene the February 23rd, 2021 meeting of the Santa Cruz County Board of Supervisors. It, the time is about 10 minutes to 2 p.m. We have a scheduled item for 130. We knew we were going to be a little late. This is a study session on the injection drug use crisis in Santa Cruz County with presentations from the Sheriff's Office, the Superior Court and the Health Services Agency. And defer to May, 2021 report with recommendations to improve syringe litter reporting as outlined in the memorandum of the Director of Health Services. We have two items, the risk of infectious disease outbreaks associated with injection drug use and county syringe services programs role in prevention. And that is attachment A and B. We have syringe access and disposable and disposal in Santa Cruz County attachment B. And if we refer to SSP, it is the syringe services program. I think we do have a presentation coming from the Health Services. Hi. Yes, this is Jen Herrera, Chief of Public Health. I will share my screen. And our health officer, Dr. Gal Newell, will start with opening comments. I'll go ahead and start speaking as Jen shares her screen. I want to thank the supervisors for the opportunity for education, for all of us and our greater community on injection drug use and its impacts on our county. And I want to thank our partners who participated in preparing the study session and who have proved to be invaluable partners as we work on this problem together with special shout outs to the sheriff's office, the courts and probation. And I want to express my special gratitude to the sheriff and his office for his willingness to initiate Matt in the jails, medical assisted therapy. This is a pioneer and landmark effort in our county along with WellPath, our jail medical services provider to provide treatment for substance use, including injection drug use in our jails, so that when our inmates are released into the community, they can already be drug free and ready to be active community participants. And this has been supported by the courts and probation as well. So a big thanks to all of them as we move forward with that effort. And I want to remind all of our community that when we work with this population, with this problem with injection drug users who are our community members, we are not just serving that population of individuals, but serving our entire community. It's all of us who are impacted by the problem of injection drug use in our county, not only those who use drugs and their families, but the greater community as well. And by working on this problem of injection drug use, we're serving everyone in our community, preventing infectious disease like HIV and hepatitis C, and also disability and death due to overdose and other increases in mortality due to injection drug use. So with that, I'll turn it over to our staff. And again, thanks to all of you who are here to learn more about this problem. Thank you, Dr. Newell. And thank you, Chair McPherson and board. Again, I'm Jen Huera. I'm the Chief of Public Health and I will be facilitating this presentation today, this study session. On December 10th, 2019, following a presentation from HSA Surringe Services Program, the board directed the program to hold a future board study session by March 2020 on the IV drug crisis facing our county with presentations requested from the Sheriff's Office, the Superior Court, and the Health Services Administration on the law enforcement, criminal justice system, treatment and prevention efforts that are being made to address this crisis. HSA requested a deferral of the study session from March 2022 today as public health had been coordinating the pandemic response. Today, I am grateful to be joined by a panel of experts to support this study session. This session will cover the following topics, an overview of injection drug use, a review of available local data with a presentation from the Sheriff's Office, injection drug use and substance use disorder with presentations from HSA's Behavioral Health Division, the county's medication assisted treatment program and the SAFE-RX Coalition facilitated by the Health Improvement Partnerships of Santa Cruz County. And lastly, we'll have an overview of injection drug use in the criminal justice system with presentations from the Superior Court and the probation department. Defining injection drug use. Injection drug use or IDU is the act of using a needle to inject drugs under the skin. A common route is into a vein, hence the commonly used term IV drug use. However, there are other routes to inject drugs, including under the skin and into the muscle. Why do people inject drugs? It can reduce a rapid and powerful drug high, notably when injected into a vein or artery. However, the reasons why people inject drugs are personal. It can be based on personal preference or because their drug of choice is available through this route. Injection drug use is associated with drug addiction. As Dr. Gabbarmate had said, it is impossible to understand addiction without asking what relief the addict finds or hopes to find in the drug or the addictive behavior. Injection drug use is associated with an increased risk for illness and death and the public health impact. Because it involves breaking the skin barrier, injection drug use makes an individual vulnerable to diseases and serious medical conditions, as Dr. Newell had mentioned, such as HIV, hepatitis B, as well as heart infections, such as endocarditis. Repeated injection drug use causes skin damage like abscesses. These conditions have impact on our healthcare system and communicable diseases can be difficult to control if widespread. Those who inject drugs may have a drug addiction, also known as substance use disorder. Addiction is a disease that affects both the brain and behavior. Drug addiction is a chronic disease characterized by compulsive or uncontrollable drug seeking and use despite harmful consequences and changes in the brain, which can be long lasting. These changes in the brain can lead to the harmful behaviors being in people who use drugs. And lastly, the consequences of repeated injection drug use is intensified by social determinants, such as homelessness and poverty. For example, someone who does not have access to clean running water has a higher risk for infection. This is a list of notable California laws related to syringe possession. In summary, it is lawful for individuals to possess syringes for personal use acquired from an authorized source, such as a pharmacy or a syringe service program. SSP participants shall not be subject to criminal prosecution for possession of syringes and safer use materials. And it is lawful to possess syringes regardless of source as long as they are in a safe disposal container. This next section will review available local data related to injection drug use. Though there is limited data sources available, we have a SSP program data through the county SSP program, as well as drug related fatality data through the coroner's office. The county SSP collects information on the characteristics of its participants, which are posted monthly on the program's website. The following few slides show preliminary data for the entire year of 2020. From January through December 2020, the program served 481 unique individuals. The majority of participants are between the ages of 25 to 44, slightly more males and females, primarily those identified as white. Next slide, we'll come through it for a while. If you can please mute, please. Thank you. In 2020, the majority of SSP participants were from the city of Santa Cruz. 48% of participants noted that they are experiencing homelessness. Of the 481 clients served, the SSP had 2,110 total visits. The majority being secondary exchange, which for our program definition, that means exchanging for themselves and for other people. The primary drug that is injected is heroin. Due to COVID safety precautions, the SSP staff have limited the face time with participants. However, at nearly every single encounter, we reinforce and support harm reduction education, and we continue to provide referrals and or education around drug treatment services. 73% of participants also receive overdose prevention education. As the opioid overdose reversal medication, naloxone or Narcan is distributed at SSP. In addition to the regular monthly SSP reports, the program conducted a more in-depth review of people who inject drugs in our community through the syringe access and disposal report. The full report includes field work and focus group conducted in October, 2019 and was presented to the board on December 10th, 2019. The following slides highlights some findings from the field surveys and focus groups providing a glimpse into the injection drug use in community in Santa Cruz County. And I do wanna emphasize that it is a glimpse of the community, the results of these findings can't be generalized to the entire community. The table on this slide shows the demographic breakdown of the field survey participants, all of which support self-report as injecting drugs. The majority of those surveyed fit the primary clientele of the SSP demographic, the SSP program demographics, which are primarily white male and between the ages of 25 to 54. This table shows that the majority of participants of the survey were currently experiencing unstable housing, many of which live in Santa Cruz. However, this is likely due to the design of the study as our field surveyors focus on outreach and walking in neighborhoods and asking people out in the community if they could participate in the survey. This table shows the health outcomes among the survey participants. From these types of questions, we found that gaps in syringe access were associated with riskier injection practices, like reusing and sharing syringes, both of which have negative health consequences. Additional findings of the survey population include that participants who obtain syringes exclusively from a syringe service program were nearly half as likely to share use syringes with other people. 75% of survey participants reported reusing their own syringes, 29% of participants reported sharing syringes, and participants who share syringes were found to be more likely to have skin abscesses. In addition to the field surveys, we also conducted focus groups of people who inject drugs. The next few slides highlights some quotes, which provides a qualitative glimpse into the perspective of this community. For us drug addicts out there, it's a problem. It's an addiction. And I think clean needles is safe needles. I think that makes a difference. I have a lot of friends who do use the needle exchange. I think that has a lot to do with recovery. They give hope. It's like, if they can do it, well, I can change things too. When you're sick, you have to take care of that first and worry about the rest. But if that is removed from the equation, it's one step toward a decision to better for your situation. You start somewhere, just having clean needles. Okay, I'm taking care of myself a bit. Sometimes that's snowballed into, I don't want to use as much as I have been, you know? It can. That's what harm reduction is. It starts somewhere. As opioid overdose is a significant risk with injection drug use, we also asked focus group participants about witnessing overdoses and their experience using naloxone. I can't tell you how many people I've had to bring back in the past couple of years, but grateful for the opportunity to do it. Another quote, there's a lot of fentanyl going around. Just in the last month, I've had to bring back five people. Fentanyl is a very, very different overdose than heroin. And this segues to the next portion of our presentation around drug-related fatalities in our community. And this next report out is from Dr. Stephanie Fiore, our sheriff coroner. And you're on mute, Dr. Fiore. There it is. Can you hear me now? Yes. Okay, thank you. Jen, are you moving the slides forward? Are you advancing slides? Yes. Yes, I am. Go to the next slide. The sheriff coroner's office is mandated to investigate the circumstances, manner and cause of death of all deaths that occur in violent, non-traumatic, non-natural, sudden and unexpected circumstances. Next slide. And this includes investigating all deaths that are related to drug use, including those from injected drug use. The way that we can help is by providing data to folks in the healthcare community and the lawmakers to show them what some of the current drug trends are that we're seeing, and as well as highlighting the geography where this drug use is occurring in our community. And I do want to say that while injected drug use is certainly one of the most visible types of drug use we see in our community, it is only a fraction and there is more going on than just the injected drug use, which you'll see in the following slide. Next slide. When I came to the county back in 2014 and when people started becoming interested in the opioid epidemic, this was the graphic that the California department of Public Health was putting out about the where Santa Cruz County fit in the state distribution of opioid drug overdoses. And this is a per capita graphing showing that Santa Cruz, which is highlighted with the arrow and I understand this is pretty hard to see but Santa Cruz is towards the top. It's number six in this graphic showing that we had one of the highest drug overdose deaths per capita of all the counties in California. The state average is highlighted by the red bar. And when you look at the neighboring counties, San Benito County, San Mateo, Santa Clara, Monterey County, they all fell below the state average where we were way towards the top of this grid. And when they reported out a three-year average, we ranked number 41 out of 58 counties for our drug death statistics. Next slide. Over the years, we've improved our ranking in the subsequent grouping of three years, 2015 to 17. We dropped our rank down to 36 out of 58 counties. These reports I have to stress are for opioid deaths only, which are not the only drugs that we see in our county. But we did improve our statistics. And by 2018, you can see that there was quite a bit dropped in the number of deaths per capita in our county. We have seen a slight rise in those cases but the two bars on the far right show the national objective and the current average for the state of California. So we've been staying below that in the last couple of years. Next slide. This is more reflective of what I'm seeing. And the bars are showing the percentage of my caseload and below the bars I have the actual number of acute drug overdoses versus the total number of my cases for a given year. And you can see that from 2015 to 17, we did slowly drop that number of overdose deaths. But then in 2018, that number started to climb again as opposed to what CDPH is reporting with just opioid deaths. In 2019, we saw quite a few deaths compared to what we saw in 2018. Last year with 2020, where the nation has been reporting a surge in drug deaths related to the COVID pandemic, we have not seen that in our county. The actual number of overdoses between 2019 and 2020 were actually the same. The percentage of my caseload, however, it was decreased because I saw quite a few more deaths overall last year than just drug deaths. So that's why we're seeing a slight decrease in my overall percentage, but the actual number of overdoses remain the same. Next slide. This is a graphic that kind of shows the class of drugs that we've seen over time from 2008 to 2018. And the red line across the top are opioids. And you can see that that has always been the most prevalent drug we've seen in our county, but from 2014 on, those numbers have been decreasing over time. The other line I wanna point out is the light blue line, which has been raising, increasing the number from 2013 to date. And that's reflecting stimulant use. And we're starting to see more and more stimulant use and less opioid use over time. And we'll get back to that again in a few more slides. Next slide. This is a slide, our graphic shows opioid trends over time with heroin being detected on the bottom and the orange bars and methadone, the blue color. The green is what we would consider prescription opioids like hydrocodone and oxycodone, but they're not necessarily reflecting that they were prescribed, they're just that class of drugs. And then we have the designer drugs coming in in 2015 depicted by the gray bar at the top. We never saw a lot of fentanyl or the other fancy designer drugs that have been hitting the east coast in the Midwest portions of this country over the last few years, but we're starting to see more fentanyl now. But you can see that both in 2011 and 14, we had some spikes in drug use. Since 2014, the prescription drugs, the opioid epidemic that we've been hearing about has kind of disappeared. The numbers have decreased over time, but heroin has stayed relatively stable throughout the years. Next slide. This is the slide comparing methamphetamine use and heroin. You can see that from 2010 on heroin use has stayed pretty stable in our community, but methamphetamine use has continually risen. And in 2019, we saw a sharp increase in the number of deaths related to methamphetamine use. Next slide. This is a preliminary results for 2020. I have most of my cases reflected here, but there's still some that are not closed out. Heroin use compared to last year has stayed again, relatively stable. We are seeing a lot more fentanyl this year than we ever have. And it is a more challenging drug to reverse with the Narcan. The medics will say it takes more than one dose of Narcan to get somebody to come around. So it is much more challenging to reverse these deaths than with heroin. And it's a big concern for me to see this rise in cases. The stimulants cocaine is a little bit up. It's never been a big player in this county, but we can see that methamphetamine walled down in numbers a little bit, still maintains the number one slot for the drugs, the drug that I'm seeing most prevalently in that scene. And then alcohol, alcohol is a big player as well. And we see it mixed with both illicit drugs and prescription drug use. Next slide and my last slide. I don't know, it's not my last. So this is a graphic kind of showing some of the distribution of drug use and just like with Jen's data, most of it is taking place in Santa Cruz city. And these plots are showing actually where the death, not the death occurred, but the drug use occurred that related to death. And you can see that it most frequently occurs around the San Lorenzo River Belt in the downtown area. And that's why, with the drug use and the bench signs around the county building, it's right in our face and we see it a lot because that's where most of it is taking place. Next slide. This is the Watsonville, which is the other high incident location in our county. And again, most of it taking place in the downtown areas. Next slide. Rout of administration. For us, we don't always know what the route of administration is for our deaths. We do have some information on them and then Jack, this is data from 2019 provided by California Department of Public Health. Inject, and these are numbers of cases, not percentage, but injection was listed in a fair number of cases that when you can take in smoking, snorting and ingestion, it's still a small percentage of the number of cases that we see for deaths. It does cause a significant amount of health issues for the individuals because most of our cases have hepatitis C infections with a few also HIV. But hepatitis is ubiquitous in our client population. I think that's my last slide. Thank you, Dr. Fiore. This next section, injection drug use and substance use disorder will be covered by a few speakers, including our behavioral health director, our MAC program and a presentation from the SAFAREX Coalition. As stated earlier, someone who injects drugs and suffers from addiction may experience multiple barriers to access health and social services. Some of these barriers include stigma, trauma, isolation, lack of trust, and even just an unawareness, not being aware of resources. Harm reduction is an approach to minimize the barriers that someone who injects drugs may experience. Harm reduction is a movement focused on shifting power and resources to people most vulnerable to structural violence. It incorporates a spectrum of strategies, including safer drug use, managed use, and abstinence. And it meets people where they're at, but doesn't leave them there. Harm reduction does not minimize or ignore the harms associated with illicit drug use and sexual activity. It applies evidence-based interventions to reduce negative consequences of drug use. It moves past judgment of a person's drug use and sexual activity and addresses the whole person. It works to elicit any positive change based on the individual's needs, circumstances, and readiness for change. There are benefits, the benefits of harm reduction include challenging stigma, increasing trust, improving community and individual health, engaging people into care and reducing utilization and cost in the medical system. These are the principles of harm reduction in the following presentations of this study session. You'll find that these principles are incorporated in our community's approach to support people who are injecting drugs. This slide shows the different types of harm reduction services, which includes medication-assisted treatment and syringe services. A syringe service program, like the counties, provides clean syringes and safe disposal of used syringes. It's existed since at least the 1970s and it's played a central role in dramatically reducing HIV infection among people who inject drugs. SSPs are one piece of the harm reduction paradigm for promoting health and safety with people who use drugs and it's never just the syringes. An SSP is always part of the system of care. SSPs are at the intersection of multiple epidemics and provides a gateway to services which support linkage and education around things like overdoses and other infectious diseases. Syringe services supports the entire community through a variety of ways beyond just the distribution and collection of syringes. Again, it's never just the syringes, it's always part of the system of care. This next section covers another major part of the system of care to support people who inject drugs. HSA Behavioral Health Director Eric Riera will cover the county substance use disorder services. Good afternoon and thank you, Jen. If I could get the next slide. So we are very fortunate in the county to be actively participating in a state and federal waiver that has allowed us to significantly expand substance use disorder services within the community. And these are a highlight of some of the services that we provide to the residents of our county, including early intervention and outpatient treatment, intensive outpatient and residential treatment, our narcotic treatment programs, which you'll hear a little bit about later along with medication assisted treatment, withdrawal management, physician consultation services, case management, recovery support and 24 hour access to treatment resources in the community. Next slide, please. So the drug MediCal organized delivery system known as the ODS waiver has allowed us to expand services in the community and most importantly, leverage additional federal funds to support service expansion. Programs and services are targeted to individuals with MediCal as their primary insurance. And in order to leverage those additional federal funds, local matching dollars are required. The ODS waiver also comes with a significant amount of state and federal requirements around access to care, timeliness requirements and the use of a standardized assessment tool to determine the appropriate level of care for a client called the ASAM. Next slide, please. This is a listing of our primary service providers within the county, our Santa Cruz County Health Services Agency, Janice's Santa Cruz, Encompass Community Services, Pajaro Valley Prevention and Student Assistance, New Life Community Services and sobriety works. In addition, if we lack capacity within the county to provide services to an ODS recipient, we do have contracts and agreements with out of county providers to provide access to those critical services as well. Next slide, please. This is some summary data in terms of treatment volume. You can see the different levels of service that we're providing within the different service categories as well as the total number of clients served in fiscal year 19 and 20 in our current fiscal year 2021 through December 31st. Next slide, please. This is a breakdown of the primary substance for those participants in our withdrawal management programs. And you can see that 38% of the participants are being treated for an opioid addiction or abuse. And of that 38%, the majority of those individuals are using heroin as their primary drug. And that's it for my section. Thank you. Thank you, Eric. And next, I'd like to introduce Danny Controse, the Health Services Manager for the County's Medication Assisted Treatment Program. And Danny will provide an overview of this program. Hi, can everybody hear me? Yes. Yeah. Yeah, you sound good, Danny. Okay. So good afternoon, everybody. Like Jen said, my name's Danny Controse. We have three clinics, the homeless persons health project, Santa Cruz Health Center and the Watsonville Health Center where we provide medication assisted treatment. Basically anybody can come in as long as they have Medi-Cal and we can get them connected with services. We have groups, we have everything integrated in all our clinics. IVH integrated behavioral health, therapy, psychiatry. So they get pretty much everything wrapped around them as far as the services they need. And we have a pretty robust and I would say strong program for patients to get involved. And with that, I'm gonna pass it along to one of our peer mentors right now. We also have where we're training up some of our patients that are in long-term recovery to be able to get back in the community, work shifts and needle exchange do outreach. And if they choose to outside of this, they can step into the field and become drug and alcohol counselors another and anything in the field that they wanna do as far as that. So I have a couple of people before I introduce Coach, one another guy who wasn't able to be here today. He's actually working at Salvation Army and the disaster service workers. He's been with us for about four, four or five years and he's got about that much time sobriety. He accessed care through the needle exchange and for the needle exchange got connected to HPHP because at that time we only had Matt at HPHP and he was from Watsonville. So he would catch a bus or whatever he needed to do to get HPHP to get on Matt's services. And that guy's house now got his family back in his life working a couple of jobs and he's just doing great. He couldn't be here today but he wanted to let everybody know what he's been able to accomplish and stuff like that. And so I'm gonna introduce you to Coach. Let's see if I start my video. No, I won't let me do it. Okay, well, Coach, go ahead. Okay, hi, my name is Kim Campbell and I'm sorry you're on the set. Oh, are you there? My name is Kim Campbell and I'm a resident here in Santa Cruz. Now I came here around December of 2017. After I was recently, or I mean in 2017 I was released from federal prison from doing a parole violation on what was more commonly referred to as a career bank robber. And I came to your city to get cured. I am from San Francisco. I was at the end of my rope. Everyone had given up on me. I'd been in and out of prison. The majority of my life I spent a good 35 years behind bars mostly in federal prison for bank robbery. Those were unarmed bank robberies I might add.  I did all of that to secure the money behind the counter for heroin.  As I said, three and a half years ago I came to Santa Cruz on the wings of my parole officer who got me into Santa Cruz residential community drug treatment program up on Riggs Street here in town. I spent roughly four months there going through the program. I left there and moved directly next door to the sober living environment where I started to learn a new way of life. I also became involved in the Suboxone program here through the County of Santa Cruz, the Medication Prediction Treatment, MAT as it's known. I've also been through the, I believe it was 16 week program for peer mentorship and I come down the road but being on the Suboxone program I won't want to go into that is I made a big change. I'd been on methadone and things like that before but through the new MAT Suboxone program it has worked miracles in my life and I'm here to share them with you. I have basically turned my life entirely around with the help of the MAT program here at the county. And I mean, one of my jobs, I worked for a year and a half as an Uber driver. Made a nice living at that. Of course, the pandemic came up and I've been integral in a lot of volunteer work through the program here. I have been able to make what are commonly referred to as good choices as opposed to bad choices. And even though my old way of thinking disagreed with those choices, I made the good choices and they're working. What I do is, let me get one thing to show you. They can't see you. Okay, I'm gonna come right back to you for right now. But they can't see you. Oh, okay. They can't much turn up. Okay. They got them turned off?  So anyway, I want to put out that the program here through the county is something that if a person is willing and able to take a small bit of direction from people like Danny or even myself and involve themselves in the program that's being offered over here, a person has a living chance of turning themselves around. And it is something that is true. And I'm a prime example. I was a given up person by my family and everyone that knew me. And finally, through the program here and through making good choices and learning as I go, I've been able to come up and become an integral part of their community. And to be quite truthfully honest, I'm having fun doing it, even though some of it's not fun. And it's a whole different ball of wax when you do things and do them correctly. I can't recommend this program enough. Thank you. Thank you, coach. So there's a bunch of other testimonies of the work that we've been doing as like coach coaches put in a lot of work. I just want to give some numbers. Last month, we had about 274 patients in our Suboxone part of the MAP program and about 113 on our Vivitrol. So that's the patients that are suffering from alcohol use disorder. So there's a lot of patients coming through it's just us working with them wherever they're at. Jen talked about harm reduction and it's just creating that safe space to be able to work with people where they're at and help them get to where they want to be as far as in the recovery. So thank you. Thank you, Danny and thank you, coach. This next presentation will be on the SAFARX Santa Cruz County Coalition. Our county MAP program has strong collaboration with other MAP programs in our county through the hub of the SAFARX Coalition. It is facilitated by the Health Improvement Partnership of Santa Cruz County and Shelly Barker, the Behavioral Health Director for HIPP will provide the overview of SAFARX. Thanks, go ahead and explain, Jen. So SAFARX was initiated in 2015 and we have these three primary goals and we've placed some logos to just a partial listing of partners. As Jen described, our intention is to really be a hub to foster ideal practices and to be also pragmatic in acknowledging that this is a challenging problem. And so when we think of SAFARX prescribing practices as all of you are likely very aware, in the 90s the tendency was to say that if a person was experiencing pain, especially chronic pain, that the answer from Western medicine was prescription opioid. And I think we've clearly learned that that has provoked a lot of problems. And so to be part of the solution, SAFARX since 2015 has really been convening local players from multiple sectors. But our work around SAFARXcribing practices we're really pleased with in the sense that we launched a concept called opioid failure. So really again, being pragmatic and trying to foster person-centered care and realistic solutions for people. The concept of opioid failure that's embedded in our pain management guidelines is to help providers have frank conversations where, so let's say someone has been coming more frequently for higher doses of opioids, that prescriber can have a conversation and say, look, you know, we started, I started offering an opioid because of your lower back pain a year ago. And here we are today and you're using a lot higher dose.  And anyway, noting some behavior and then really saying, so it seems that this treatment isn't serving you, that the opioids have failed you. And so I share that brief story as an example of trying to be pragmatic and provide realistic, appropriate beneficial solutions, which can open that door to new opportunities as coach just described. Also, another layer of our work that has been very robust is around medication-assisted substance use disorder treatment. And go ahead to next slide, please, Jen. This is admittedly a very busy slide and I think it shows that SafeRx is complex and more busy and we're doing lots of prongs of our work. What I wanted to really highlight here is we have always, we have a metrics work group, so there are several initiatives and we have our medicine-mapped advisory group. And as you likely are also aware, so clinicians who need to, who wish to prescribe medications like Suboxone and Vivitrol, need to take an additional training. And so in that additional training, that training is not so onerous, although it's difficult to find the time, but then there's often a reluctance. And so what that advisory group has done is to really foster peer-to-peer connections amongst prescribers so that they can be more confident in utilizing their ex-waver, their license to prescribe those medicines and therefore increasing access so that we can, we as a community, when a person is potentially ready to seek recovery or to look at their life differently, they have access to evidence-based best practices. The other thing I'd like to note here is, you know, our prescriber practice initiative, I already mentioned the prescriber guidelines, those were developed in a multidisciplinary way, so we're very much rounded in the goal of offering multiple solutions that could include behavioral health as in mental health, mild to moderate, mental health services, as well as medicine. So I think the other layer here that I wanted to mention is we also are deeply committed to community education and our goal is always to be nimble and responsive. So as Dr. Fiore shared, we've noted recently the trend is that there is a lot of stimulant use, but yes, there's an opioid problem, but there's also a lot of multiple drug use and stimulant use in our community. And so SafeRx has pivoted, the bottom left there is we've launched a polysubstance work group. And Jen, go ahead to next slide, please. This list, I'll let you read it, but what I wanna speak to, some of the accomplishments of this group, and when I say this group, it's the people on this conversation with you today that have been working together on a lot of these efforts. So this polysubstance work group really is an example of SafeRx being driven by data and trying to respond and be effective in matching people with the resources they need. So as we've seen stimulant use increase, SafeRx has brought together folks who want to focus on that and we've brought stakeholders from multiple sectors and we've really, we've featured Danny Clumthreades' efforts, part of one of the prongs of the work that he leads is contingency management, which is one of the few well-evidence-based practices around a response to stimulant use disorder, as well as Dr. Dimitri Bakos, you have amazing county leadership within your health services agency. He has fostered an approach to using medicines for stimulant use, medicines to treat stimulant use disorder that has some promising outcomes and has been featured regionally and nationally recently on some webinars. I know that your reading as I'm talking, we've partnered, some other things we're proud of is really, when we think of medication access, that means really starting, if people are ready, starting MAT in the emergency room settings as well as having access to MAT in primary care settings, both safety net and private. And as Dr. Nual alluded to, also in the jails. So there's been a lot of progress and we feel that we want to be a part of the solution and we're really pleased. And I will stop there and make sure that there's time for other components of this important conversation. Thanks so much, Shelley. This next section covers the overlap of injection drug use in the criminal justice system. First, we will hear a report from Katie Maida, Collaborative Court Manager from the Superior Court of California. Then we will hear from Fernando Geraldo, Chief Probation Officer with the County's Probation Department. Hi, thank you so much for having us. It's really been an exciting time at the Superior Court over the last three years. We have had complete investment in decreasing the population of mental health and substance use in our criminal justice system. And that really has happened through a couple of different grants including what we had, which was the innovation grant that developed the collaborative justice system. This is in partnership with the DA, the public defender, county behavioral health, county substance use, as well as multiple other players that are on this meeting today. And within that process, we have leveraged drug medical funds in order to set up an assessment and screening process throughout the court system that we have expedited significantly so that judges and attorneys can have professionals that work with substance use and also work with mental health to provide input on the direction of the criminal case regarding to the person's needs and their current access to treatment. And so we are able to within a week to two weeks do a screening for our clients to find out what their substance use concerns are and whether or not they qualify for any treatment within our community. And so we've partnered with the Sheriff's Department to really allow for what Eric mentioned earlier about the drug MediCal to be able to access treatment. We're doing the ASAM assessments within incarceration so that the judges can make the determination to release someone from custody into treatment right into residential treatment. And so that process alone has created just so much education for the judges and the court staff on how to address the overwhelming need for substance use treatment within our community. And we've also been able to establish several collaborative courts that really focus on providing treatment in lieu of incarceration or penalties within that process. And so we have partnered with County Behavioral Health to have a court clinician that is available Monday through Friday for court in order to do assessments, to do recommendations for attorneys and judges so that they can move forward with an educated and more understanding as they move forward in the process of sentencing or moving forward to possible diversion. We have a veterans court that works with substance use. We also have behavioral health court. We have a reentry court for people who are on parole. And we have a family drug court that works with dependency in order to support families and reuniting. And then we also have our PACT court, which I know that you guys are very familiar with, which really supports the high utilizers in our community that really struggle with substance use that affects every aspect of their life. And so within this process we have really been able to identify people that have needs, identify people so that we can reduce the recidivism and really prevent them from coming back into our services. The one thing with the criminal justice system is we don't wanna see people again. And so these programs and the systems that we've put in place have really taken us into a brand new, really exciting movement and part of that is through the champion of probation and their support as well as the DA's department to really implement neighborhood courts, which is another way of being able to divert people out of the criminal justice system. And in all of these, we do address IV drug use as well as other multiple drug use and mental health. So we're kind of really excited what's going to be happening because we have several new grants within the court system to continue these programs for another three years. What this does is this also provides treatment and housing options for people within our programs. And thanks to the CAFE's program that I'm sure will be mentioned right after me, we have access for people that do not have MediCal to get into programming as well or people who do not qualify for other types of funding sources for them to really get the treatment needed. So I'm actually really excited about kind of where we're launching to and how far we're gonna progress within the next three years within our criminal justice system. So thank you. Thank you, Katie. And we'll turn it over to Fernando, our probation officer. And don't see. I am not seeing Fernando on the attendees or the panelists list either. We have contacted the department. Okay, thank you. So I'll just go ahead and read the slides. This is these slides were the content was developed by the probation department. So what probation does is they complete assessments and recommendations to the court regarding custodial status and sentencing as well as providing monitoring and supervision for justice-involved individuals under the jurisdiction of the probation department. How probation interacts with the injection drug-using population. As part of monitoring and supervision for the IDU population, they provide program and resource referrals associated with injection drug use, as well as other risks or need areas to support the individual's overall health and wellbeing to promote public safety. Building relationships and trust with injection drug users is especially important in creating readiness for treatment and recovery. How probation is part of a greater system of care to support people who inject drugs. Probation staff are actively involved in the organized delivery system of SUD services throughout the county. They provide oversight of AB 109 treatment dollars and BSBC Prop 47 grant funds for treatment and housing under the FES project. They are under an active partner with Collaborative Court. They've initiated the early Vivitrol project and they run a probation service center which serves as a co-location for a variety of services targeting justice-involved individuals, including SUDs assessment and program referrals. And this is the final slide of the study session. A quote that comes to mind is as I was putting this slide together is the opposite of addiction is connection. This is a quote that's said by many in the field of addiction. The opposite of addiction is connection. An effective response to injection drug use requires a coordinated system of care. All of these agencies who presented today, the voices of those who inject drugs through our focus groups, we all are connected to ensure that those who are using drugs have access to health and social services. And this concludes the study session. I want to express sincere gratitude to all of the panelists and their respective agencies for their contribution. I also wanna thank the CAO's office for their support and coordination of the presentation. And I will stop sharing my screen. Thank you very much. Okay, thank you for that very detailed presentation from a broad range of participants. We appreciate it very much. And I wanna thank you for this report today. I know that drug use has taken a heart wrenching toll on our individuals and families and our community at large and Santa Cruz County. In fact, it's true across the nation, as we know, unfortunately. We also know that law enforcement response alone really can reduce the amount of IB drug use and we need a strong public health response focused on prevention, treatment, and harm reduction. And it's really encouraging to see the coordinated effort from the federal and state governments on down to the county level. But I know that preventing disease through exchanges and preventing harm to the community by properly discarded needles are equally important. We have an obligation to approach really all of this work with the goal of improving public health for everyone. And you are really doing a dynamite job and it's good to hear some testimony. And first of all, I wanna congratulate and say thank you to those who have gone through the effort. And I imagine it's not a very easy regression to go through, but thank you for your efforts and keep at it. I just wanna encourage you for your own cause in particular, but for the community's cause as well. And we don't really have data, I think on the people using IB drugs, but what's really been a concern is the litter and we'll get more to that later, I think in a presentation later in the year. But I know Supervisor and Coonerty especially, and we have some of the city of Santa Cruz in our district have long supported the downtown streets team, which is a tremendous organization that are making individuals are making great comebacks in their lives. They've contracted with the county to collect needles in our districts as part of a work training program for people experiencing homelessness. And some of the data that they have got received or collected, I should say, from I think it was July 2019 to December 2020 and just 18 months, just that downtown streets team picked up 12,000 needles in the city and on the North coast. And that's a lot of, well, I think somebody said it was 168 gallons of litter. So we have a problem, we know it's undeniable and we need to act swiftly on a more comprehensive response, especially for the litter issue as we're looking at, but from purely health perspectives and the collaborative effort that you've put forth and we have done here in Santa Cruz County, I just wanna say thank you to those who participate in getting, helping get a lot of people get their lives back together. And for those who have done so and we heard some of those from I think it was Coach Campbell and so forth, congratulations, just stick with it and you're gonna be a shining example for others in their road to recovery, I hope. And so I really wanna thank you for stepping out in front and I know nobody could be happier about that than you. So just stick with it and I hope we can have many more like you that participate in this program, the programs that have been mentioned. I don't know if there might be any other comments from members of the Board of Supervisors. Yeah, Mr. Chair, I have some questions, if you don't mind. Sure, please go ahead, Supervisor Coonerty. Sure, so one, I wanna thank the staff.  This was requested before we were in that pandemic and while I think you've given us some really important information and great work is being done in the midst of the pandemic, I do think that as we emerge hopefully soon from the challenge of COVID, we can really focus on this public health crisis that our community faces. I guess I have a lot of different questions but I guess I'd start with, do we know how many methamphetamine users there are in Santa Cruz County or heroin users there are in Santa Cruz County? How it will defer to other members of the panel, maybe our Behavioral Health Director, Eric, if you can take that? I don't have that specific information, Supervisor Coonerty, no. Do we know it and you don't have it or do we not know it? I don't think we know it. Okay, because I was looking during this presentation, I was looking, we know 15.6 of the adult population smoke and 12.4% of teenagers smoke and 18.2% of our population binge drinks. I think we should, as part of our data dashboard, be able to have a sense as to what that number is in order to understand the scope of the problem. Do you think, not again, I understand everyone's very busy responding to a global pandemic, so not right away, but over time, is there a mechanism by which we can assess the number of people using those specific drugs? I can look into it further. I think as one of the things we showed during the presentation today, the use rates vary pretty dramatically by substance, by county, as reflected in Dr. Fiori's presentation. The data that we have is based on people who are actually engaged in services, but what we don't have are the actual prevalence data or estimates by population in the county, but I can certainly continue to look for that sort of information to make some estimates. Okay, yeah, I think it could be helpful to sort of know where we are within that county. I guess for Dr. Fiori, my question was, Santa Cruz County, both the board and the health department have long been sort of national leaders in a harm reduction strategy. How come the adjacent counties to us who are engaged in less harm reduction strategies, but have similar rates of poverty and underlying health disparities, why are their overdose rates lower than ours? That's a good question. I think that when you're looking at San Benito County, which is a really high Hispanic population, most of the drug use in our county has to do with our Caucasian population. There is some in the Hispanics, but it's actually underrepresented for the number of Hispanic people we have in this county. So maybe that's part of it. And then I think in the larger counties like Santa Clara, it's probably just because of the size of their population and the demographics and other things go with it. So I don't really have a good answer. It's an interesting thing. And as we've improved, they still remained below the state average. Some of the other counties have shifted around like San Francisco now is towards the top of the ranking because their fentanyl cases have shot through the roof. But I don't know. It just probably has to do with the way the demographic of the individual counties. And I just don't know. I don't really have a good answer. Okay. And I mean, that's sort of, I appreciate that. And I don't think we are similar to San Benito County, but I think we are on a per capita basis, probably very similar to Monterey, San Mateo and Santa Clara counties, demographically. And so it's trying to figure out a little bit about what's going on, especially when we know they're handing out fewer needles less Narcan, they're engaging in less harm reduction. You would think that their numbers would be higher. Yeah. I haven't looked at their numbers lately. I mean, this is from 2014 before we really started doing a lot of harm reduction. So we've improved our status. And I don't know how they are in comparison if they maintain a status quo instead of improving it. I haven't looked at the other counties as much. I don't have that similar graphic to compare the rankings of the other counties to compare it with. Yeah. I just did a quick look at the health data website, but I, because I saw that that data was from a little while ago. So I thought that I checked, but it seemed as though while we had improved, they had also stayed steady. So it's a little bit, I don't know if Catherine, if you have an answer to the question. Yeah. I don't have an exact answer, but I can tell you that those countering counties have a lot more programming that is targeted towards substance use comparison to our program, our programs here. We do not have a lot of detox beds or residential treatment facilities. Unlike these other programs, they have a lot of other nonprofits that already do provide that treatment. And so I think that when we're talking about addressing this need, we're addressing it with minimal services. And so the progress that we have made has been really incredible with that limited access of detox beds as well as residential beds that focus on substance use only. I think, and again, recognizing everyone's really busy, I think that would be incredibly helpful as a follow-up information, which is to look at the availability of detox or these other residential options on a per capita basis for comparable counties that may be performing better. And if that is a solution or I guess a tool in addressing the issue, it would be helpful to know because then we can start building strategies to construct more beds. Because I think if that's, certainly there seems to be there's a need and if other counties are getting better outcomes then we should be looking at where deficiencies are and what we can do to address them. So I'd love follow-up information on that if there's time. Katherine, can you also let us, for the drug Medi-Cal and the efforts, I think it's been great to have these vertical courts or these specialty courts. Do we know how many people complete treatment who have been diverted and then how many re-offend versus in the years prior where we didn't have these programs? Great question. We're actually in the process of finalizing some evaluations right now that have that data. I can tell you that with our re-entry court, we have, it's about 90% it's, I think it might be like 92 or something of people who have not committed new felonies while they've been participating within the program. A lot of the complications come to trying to find comparable data for people either after they graduate or also if they're people who are not on parole, we wanna have a comparison and we haven't been able to do that. We can say with our PACT court that we have had a lot of success but that court has only been relaunched within the last two years. And so an evaluation of the relaunch is in process right now and I can get you that data. It will be posted to our website probably by next month. That would be great. I mean, I think for all folks here whether it's expanding mat treatment or detox beds, getting that information as sooner as we come up on budget time would be helpful because it helps us evaluate where we wanna make these investments. Can I ask Danny Contreras if you're still around? Yeah, what was that? Yeah, so how have you had to adjust SSP operations during COVID? Oh, I think we would have to bring Roshana and I'm not in the SSP. So my staff are in SSP and maybe Jen can speak a little bit more to that but they've still been running SSP and like I said, our peer mentors have been working shifts in there too. So I don't know if Jen wants to share a little bit more. Sure. Yes, for our sovereign services program what we've done is we've adjusted the physical location of it's still on the Emeline and Watsonville campuses but we've reorganized it to ensure that physical distancing is in place. We're minimizing the amount of space time that our SSP staff have with individuals. So, just to minimize the amount of time people are in a closed environment, obviously we are enforcing masks, face coverings at all times. We have over this past year per the board's direction, we've expanded hours, so we're operational five days a week and we expanded our hours based on participant input which was primarily that we should have more evening hours and we're looking to improve upon our South County services as well as Dr. Fiore's presentation showed there is a need in Watsonville in South County area for syringe services, so we wanna make sure that we're accessible. And it looks like even under COVID restrictions you've been able to essentially maintain the same number of participants as in 2019. Is that correct? In 2020 you were able to. I believe it actually decreased but I'll have to review that data. Okay. Yeah, I'm trying to, I have this data here but it's a little hard to read, it looks like maybe it was a little over 500 at times but it dropped below that in Q4 2019. We'll plan on having that information included in the SSP biennial report this spring. Okay. And then Coach Campbell, are you still around? I am, I am here. Cool, so one congratulations on your sobriety, that's great. I wanna thank both of you gentlemen for complimenting me. That means a lot to me to have people of your stature say something about an old guy like me. So can I ask like what brought you to Santa Cruz? Like why, of all the places, why Santa Cruz? I'm so glad you asked me, there was something that I did not say during that presentation which I put together in part time, we can see it now. Federal judge in San Francisco, believe it or not, the men that used to send me to prison for 10 years at a pop decided that prison wasn't working for me and he insisted that I get treatment when my own attorney, my own parole officer and of course the USUA wanted me back in jail as a lesson. The judge said, no, I want him in treatment. They sent me to Santa Cruz residential and I guess I got the luck of the job because the program in New York City came to my aid. And there were many times I wanted to walk out and go right back up into the tender line, right back into the jaws of nastiness. But I stuck and I stayed and that's part of what I preached during my peer mentorships to people that are trying to come in and get help that you gotta stick and you gotta stay. Even if it hurts, you have to stay and listen. They've cotton out of your ears and stick it in your mouth as we say and listen to people that have the experience and that have leadership skills to help you in the right direction.  He's always been there for me and he's got me going here and doing volunteer work and I'm enjoying every bit of it and I've come to really like Santa Cruz and love it. And I heard you talking about why maybe things are a little higher in Santa Cruz. You know, the reputation of Santa Cruz to beautiful town. It's always been that town that people come from all over the world here and the people that use, they probably look at it as a party town. So it might be kind of up a little bit there but that just gives us more work to work on. You know, I turn a negative into a positive there. But that's about all I wanted to add and I'll just say that if you stick with it, yeah. And you're right. The first man that gave me a kudos, you're right. I'm the person that's the happiest out of this. And then comes my family that talks to me again and is instrumental in our relationship. So yeah, it works gentlemen and ladies, it works if you work it and stay with the prescriptions from the clinicians here kind of back up. I'll be 70 next year. And it took me till this age to learn that I need to follow the rules that we're talking about my mother and father and I learned at school and the stuff and make good decision. That's all I can say for today. And I really appreciate you guys wanting to get a part of your meeting today. All right, well, thank you for your, also thank you for your volunteer efforts. Sounds like they're making a difference. So I've taken too much time but I just wanna, I wanna thank everybody for taking the time to provide this information. I do think as we emerge from one public health strategy, hopefully we can take some of the lessons learned from that sort of a multi-departmental, multifaceted approach and apply it to this health crisis. We spend a lot of time in this community responding to I think what is the consequences of drug abuse and homelessness and property crime and violent crime, need a litter and I'd like to spend some time. We certainly need to address all those impacts but I think I'd also like to spend some time trying to do more upstream work and more preventative work. So thank you, thanks for all for taking the time and hopefully as more capacity emerges we'll be able to address this crisis. Thank you. Thank you, Supervisor Coonerty. Any other Supervisor have any comments they wanna make or input? Chair, I've got some questions. Yes, Mr. Coonerty. Thank you. My first question and just some clarification is that my understanding is that we currently have no dedicated funding for this range services program. Is that correct? That was correct. We did recently receive some additional funding, a grant called the California Health, California Harm Reduction Initiative, also known as CHERI, but it is primarily funded through general funds. Okay, so we received, and roughly how much was that grant for? What were those specified funding? It was approximately around 150,000 for multi-year grants. So for how many years we'll back cover? It is a three-year grant. Okay, thank you. And then my next two questions are in line with what Supervisor Coonerty was asking, just trying to get a sense of the overall population that we're dealing with here in our county. I noted in one of the attachments that there were 1,170 HSA clients who inject drugs. And I just wanted clarification if that was necessarily illegal drugs, such as the ones we're talking about, or if that could include insulin or other regular medications. Supervisor Coonerty, this is Mimi Hall. So what you're referring to is information from our clients who are accessing services through behavioral health. So when they're reporting on their primary routes of delivery, so it would not be for insulin, for medical reasons, for injection, and the question is posed as regarding your drug use. And I'll provide another point of clarification regarding Supervisor Coonerty's question, kind of around the same area, is for tobacco and other things, the state provides a lot of comprehensive efforts across the entire state and each of the counties to do surveys regarding certain risks and behaviors. And it's easy for us to have that data because it's collected statewide, but when it gets down to the more detailed information, local information that we don't, in order to get what's being asked for, we would have to start an effort to proactively collect it. But what we can do is provide data that we do have in terms of the patients who see us, of those people who are either our patients or our clients, their reported use. And that provides somewhat of a picture. Right, that's great. So we've got 1,170 clients who inject drugs of how many total? We have about 7,000 substances to sort of find out. So, okay, so then others would be using alcohol or not injecting, but that's the universe of 7,000 clients who are dealing with some kind of drug addiction. Correct, and this is reporting primary route or preferred route of administration. I see, got it. Regardless of the drug. Okay, thank you. Again, just to try to get a sense of how we compare with to the rest of the state, I really appreciated Dr. Fiore's review of some of the overdose deaths and how we compare to other counties. Although I'm a little confused at this point, I read again in one of the attachments that in 2018, our opioid overdose rate was 48% higher than the state average. So whereas it seemed like some of the other numbers that were shared suggested we were perhaps now lower than that, but is that approximately still where we're at? Is 48% higher than the state average? So again, I will defer to some of my panelists. Again, Behavioral Health Director Eric Riera or Dr. Fiore. So were you talking about one of my graphics that said that it was 40% higher in 2018? Actually, that stat came out of the attachment, risk of infectious disease outbreaks associated with injection drug use in the county's range service programs, role in prevention. And I was trying to reconcile it with some of the graphs that you'd shared, Dr. Fiore. Right, the data that I gave you was from California Department of Public Health in combination with my caseload. We have had some disparities in the past, but we have been working in collaboration over the last couple of years to tighten up the consistency with the data from my cases to what they're reporting. But in 2018, there isn't, for me there has been an increase in deaths since you were asking about deaths in 2018 for all comers of all drugs. I know that in the graphic from California Department of Public Health, it showed a decrease, but that was just with the opioids. And I'm not sure what this other data that you got where that came from. So I can't speak for their data, but as far as my graphs, I'm the only one investigating drug overdose deaths. So I would think that my data is more accurate because it reflects my reality. So I'm not sure where they got their data from. Yeah, looks like either, maybe according to CDPH. Yeah, you have to be careful with the data that comes from CDPH because they talk about very specific things. So they may be reporting specifically out of one type of drug and they also normalize all their data to a per capita basis too. So that kind of sometimes skews the data. I'd have to see exactly what you're looking at in order to help you interpret it. Okay. And just generally speaking, if we're seeing whatever the number is, I'll just use that for sake of comparison or example, this 48% number, if we were seeing 48% more overdoses from opioids in our community, could we assume that we have 48% more or larger per capita population of people who are using those substances in our community? I don't know where this 48% of drug overdose is coming from. That's a huge amount of increase, but if there are more deaths, then there has to be more people using in order to get that increase in deaths, but I don't know where that 40% increase is coming from. That seems just like a huge amount for this county. Maybe that number is for the state as a whole. I'm happy to share the document. It was one of our attachments for this item. That would be helpful. Sure. I wanted to move on to the SRIM Services program a little bit. I was looking at the December 2020 report and it looks like of 137 visits. Just six people or 4% of total visits received some kind of, I believe this is a drug, matte type referral. So yeah, drug treatment. So I'm just kind of curious, how come we're not prioritizing matte referral more in our process of working with people who visit SRIM Services? I can take that question and I definitely invite Danny or others to chime in. So when it comes to through our SRIM Services program, part of using a harm reduction approach, meeting people where they're at, is we provide that referral when people are interested in that referral. So when our remark that education was provided or referral was provided for drug treatment services, it's because there's a specific engagement and the participant identified motivation to seek drug treatment services. It is offered to every participant and we offer people wanna get no more information. Many times they don't, but whenever there's the opportunity for people to be engaged in a conversation, we take that opportunity and provide that referral. But certainly Danny would be able to provide more input on that. Okay, so you're saying that potentially 100% of patients who visit the SRIM Services program are offered some kind of drug treatment. I'm just asking for clarification because the SRIM Services program report says education offered drug treatment 4%. So is that, maybe there's some confusion there that that's like acceptance versus. So when, yes, I'm happy to clarify Supervisor Koenig. So when people, when an individual, a participant goes into a service program, we ask them what they need. We usually, so it is typical that our SSP staff will ask, would you like any information about MAP or other social service referrals? And then, but what we do is we don't check the box that we provided education or referral unless we had a significant conversation with that individual. Maybe they actually asked about resources for MAP. It could be that one of our peer mentors was down there working SSP and they were able to engage in a more detailed conversation and were able to actually do a referral for MAP services and set up an appointment. So that's when that box is checked that there was a, it was a significant encounter related to drug treatment education. Great, yeah, and I'm glad you mentioned peer counselors. I don't know if coach is still on the call, I also really wanted to commend you for overcoming a really difficult and debilitating addiction and emerging that much stronger today. And I'm really inspired to hear your story and I'm heartened to hear that you're also working as a peer mentor today. So my question is, do we currently, we're currently employing some number of people who have personally overcome addiction in the syringe services program? And is that correct? And if so, how many? Am I there? Can you hear me? Yes. Can you hear me now? Yep. Okay. So our peer mentors, our peer support specialists, they go through a curriculum that we have set up for them on those services, you know, and once they go through that training and we get them through our VIP process and basically they're just, none of them are paid positions. I wish we had some paid positions. That'd be awesome to give them some paid positions, even if it's some extra help or something. I don't know if there's some way to work that in some way, but they're basically volunteering and they come in and they get a give back in that way. And that's what we have set up for now.  I mean, I would love it if we can offer them a job and then they could step right into the field that way, you know, or even that experience. Right now they're getting all the experience and they're giving back. Some of them, like I said, are in school. There was a couple other guys that wanted to share today too, but they have class at two o'clock. And so they weren't able to come and then other ones were working. So, but they're not paid, not paid positions. Got it. And how many people currently volunteer? And this is at the Syringe Services Program This is through our this is through our MAP program in partnership with the Syringe Service Program. So COVID, COVID, you know, like Mike Tyson said, everybody has a plan to get hit in the mouth, right? COVID hit us in the mouth and we had to rearrange and do everything and how we do our workflows and whatnot. And so that kind of really hampered things of getting people in here. You know, we had to change how we did stuff in the clinics, telehealth and whatnot. And a lot of our patients weren't coming in or they were coming in every couple months and it was just real quick in and out. So right now we have, I want to say we have like maybe around five, I'd have to go look that are actual peer mentors. We have, I think there was about 20 of them that went through the curriculum. And right now I'm in the midst of working with UCLA. We have a more updated and better curriculum for them that we're going to start teaching them and through more of our cohorts in there. So there's probably about five right now, but we're starting to ramp up. It's a little process. I'm not sure if you know for the VIP process just it's like getting a job. They got, we help walk them through, get in a cover letter explaining criminal background, the resume, saying a letter, why they want to be in this field. They have to go do fingerprints. There's a whole process of going through that. That takes some time sometimes. And you can imagine that with this pandemic and going in and out. So we're starting to ramp up. And I feel like we're going to start to get more and more of our patients that are in long-term recovery in vault and we're going to have more of our cohorts of these guys and women go through the training that I'm getting set up through UCLA for all of them. Great, that's really encouraging to hear. And I have to say, if I, you know, again, coaches experience was really inspiring. I can't think of a better use for some of that $150,000 grant that we got then creating some paid positions for people like coach to really be part of the face of our county program and directly working with people who are still struggling with addiction today. Yeah, so Rashan corrected me. We got three actively in working through the exchange.  When I say in the works, they're doing the completing all those processes and steps. Okay, but those are still volunteer positions. They're all volunteer, yes. Right, right. Maybe we can get everybody to make some permanent positions for them. Right, happy to look at that. So this is just a simple question that I've been asked by folks in the community, various constituencies, just, you know, why wouldn't the county just totally focus on leading with a MAT program, right? Whether it's methadones or Suboxone. Why don't we just put all our resources in leading with that program instead of providing needles to people? Is that question to me or everybody? It's whoever wants to answer it. I mean, I'm just curious if, you know, have other communities tried this kind of approach? I mean, I definitely understand, you know, the public health challenges around limiting, diseases related to IV drug use. But has any community tried leading with offering MAT related services instead of needles? So to answer your question, this is Mimi. I'll help those as agency director. Thank you for your question. You have to think about the reason that we provide services and the approach that public health takes for any public health issue. It's kind of like saying we only wanna prevent heart disease by one approach and that's diet and exercise or one approach, it's medications. So the primary reason for syringe services programs is to address communicable disease from injection drug use. And there's a reason that these programs are under the California Office of AIDS because HIV is one of the key diseases that we're trying to prevent transmission, including other blood-borne pathogens, such as hepatitis. And so for that approach, if we're only focused on that and we know that harm reduction means you meet people where they're at. So rather than saying you cannot receive any services unless you agree to a full solution, really means that there are so many people in our community who are actively drug users that will not be able to access a whole school of services. We take the same approach when it comes to preventing pregnancy, when it comes to preventing STDs and chronic diseases as well. Rather than saying we will withhold treatment or not provide access unless you take the best, what we deem as the path for you to take, we meet people exactly where they're at. And so that's the approach for SSP and then the reason for SSP is always to reduce disease. The end goal of MAT is not to reduce communicable disease transmission of blood-borne pathogens. The two programs work hand in hand and MAT is an avenue to get people have drugs, to get them into recovery, but it's certainly not the solution for reducing HIV transmission and hep C transmission treatment. Thank you for that explanation. I would also say, this is Danny, you can't force nobody to do anything, you know? There's a saying, you know, what if you could take a horse to the water but you can't make them drink? But the other part of that is you can make them thirsty, right? And so the way we make them thirsty is having our peer mentors and our other staff be in there to be able to be there to catch them at that time and meet them where they're at. You can't say, everybody has to do MAT because this ain't, I always tell people, this ain't a cookie cutter treatment, you know? Well, for some people doesn't work for other people, you know, and that's why this, like me was saying, this is one avenue, you know? So we can't try to force everybody down that avenue. We're gonna have a lot of problems with that, you know? And we just got to work with people where they're at and when they're ready to come and us making them thirsty, every time they come in there, you see how Jen was saying it's offered to everybody. You know, they're gonna say one day and that's been my experience. All right, man, Danny, I'm ready, man. I'm tired of this, man. How do I get connected, man? You know? Mm-hmm, thank you. Yeah, I like that analogy. You can't force a, you can lead on horse to water, you can't force them to drink, but you can make them thirsty. Just a couple more quick questions. I was really encouraging to hear that we began a MAT program in jails in August and the midst of the pandemic. And I'm just curious, you know, how we're managing the transition when people get out. I, you know, I understand from other programs like Rhode Island that that's really the critical piece is making sure that when people get out and now they, you know, have access again to maybe some of the injection drugs that they were using before, how do we ensure that they continue treatment? So we're on a, it was every Tuesday and now I think we're going once a month with the jail, a bunch of different agencies and the county and we've been working through that since August, maybe a little bit before August. And so if somebody needs MAT services, they call us, whatever agency that is and then they connect them. And so that is working. And as if things don't work out, we kind of check in all with each other and figure out what went wrong and how we do things better. And, you know, people are still learning, we're still growing as a county and different agencies. And so that is working right now. It is up and running. And it's starting to, people are starting to come in. I know Catherine, you want to say something? Yeah, thank you, Danny. I know it's weird calling me Catherine. My name's Katie, but it says Catherine. So actually I just wanted to address, I know that Sarah Fletcher is actually on, she was going to be doing the presentation for probation. And so I just want to kind of add a little bit about our Prop 47 cafes grant. Part of this is that the sheriff's department does have a position that's a discharge planner that is specifically for the MAP program. And so once someone is connected, there is one position that is currently in the process of getting hiring that will link them to the clinic or other services for MAT. But then part of the cafes grant is a six million, a little bit under $6 million grant that came into probation that really supports decreasing the population with substance use in the criminal justice system. And part of that is that there are two positions that are called discharge planners that are currently hired by Encompass that can provide linkage to services from the jail into treatment. And so it kind of goes beyond just doing the assessment and being able to case manage to support for people who are not linked to other services or other programming. And so with someone that's linked to collaborative courts, we work with them, we get them out of the jails as soon as possible, but then there are several other people that are not linked. And so these discharge planners are specifically for that. And a lot of that is not only linking to MAT services, but also linking to detox treatment and also housing. So part of the cafes grant also has a significant portion that is for treatment funds for people who don't qualify for maybe AB 109, things like that. And so there's this full continuum of care that is happening in order to get people out of incarceration, link to services, and then also moving them forward so that they can kind of address their substance use in advance before it becomes kind of a repeat into the criminal justice system. Right, so the majority of people have a discharge planner to work with is what you're saying. And our goal is to hire two, but we have one today. We have two discharge planners that are through the cafes grant that is within Compass. And then we have one that the sheriff's department has hired that is just about to start that's specifically for the MAT program that's in the jail. Got it, thank you. My final question is, I know we're trying to create a centralized syringe litter reporting service. And I was just curious, I think this would be a question for Mimi. If we've looked at using the My Santa Cruz County app as a way to do that, I know today that I pull up the app on my phone as a way to report encampments or potholes or other kinds of trash. And it would seem natural enough to use that same app to report needle litter. And maybe there's already have been some reports through that app and have any needle related reports come through that app today and have you considered using it in the future? Thanks for the question. Yes, we have had lots of discussion about using the existing app as well as other apps. I think the barrier, the reason we're deferring the report and recommendations is less because we don't have ideas, but more because we want to engage not only our FSC advisory board, but also we have city partners that we need to work with because the directive of the board was for a centralized systemic approach. And we want to make sure that all of the partners that are a part of public works of disposal of all, there are many, many stakeholders