August 30, 2022 Minutes

Weld Regional Opioid Council Meeting

Weld County Department of Public Health and Environment, Room 103
1555 North 17th Avenue, Greeley CO 80631
August 30, 2022 @ 9:00 am to 10:00 am

Council Members in Attendance:  David Angelo – Firestone Police Department; Joel Smith – Nunn Police Department; Eric Aakko – Weld County Department of Public Health and Environment; Kim Emil – Town of Windsor Government; Mike Zeller – Greeley Police Department; Scott James – Board of County Commissioners; Scott Moser – Town of Eaton; Jamie Ulrich – Weld County Department of Human Services; Zo Stieber Hubbard – Town of Fort Lupton

Non-Council Members in Attendance:  Tanya Geiser – Weld County Department of Public Health and Environment; Holly Smith – Weld County Department of Public Health and Environment; Matthew Elbe – Weld County Sheriff’s Office; Caitlin Perry – Weld County Government; Bruce Barker – Weld County Attorney; Allyce Torres – North Range Behavioral Health; Jenny Wallace – North Range Behavioral Health; Mickey Pirraglia – Weld County Government; Lesley Brooks – North Colorado Health Alliance; Richard Zeigler – Town of Windsor; Rafael Gutierrez; Melissa Wiley

Minutes

1. Review and Approve Agenda
   • Kim Emil moved to approve the agenda for the 08/30/2022 meeting. There was a second by Scott James. Agenda for 8/30/2022 was approved. Scott James moved to approve the minutes of the 08/23/2022 meeting. There was a second by Zo Stieber Hubbard. Minutes for 8/23/2022 were approved.
2. Status of Representative from Judicial
   • Bruce explained that Judge Hartman did not want anyone from the Judicial District to be a part of the council, as he viewed it as a conflict of interest. Judge Hoskins, who will be taking over for Judge Hartman, may have a different thought, but as of right now the Judicial District does not have a representative. Once Judge Hoskins takes the position, the council can approach her to see if there is a representative for the Judicial District that they would like on this council.
3. Approval of Appointment Terms for Council Members
   • In the bylaws it states that council members will hold a 2-year term. It was discussed by the council as to when that term should take effect, since the work of the council has already started. Per Bruce, Weld County Attorney, terms should have started by the time the first quorum was held, which was August 23, 2022. Therefore, Zoe Stieber Hubbard motioned for council member terms to be effective August 23, 2022, and go for 2 years, through August 23, 2024. There was a second by Scott James. Motion carried.
4. Discussion of Potential Funding Areas
   • Eric explained that he spoke with Jack Patterson with the Attorney General’s office for clarification on the budget. When we submit our 2-year plan in the COST portal, it’s a 2- year plan but it’s a 1-year budget. Funding for next year may go up or down depending on different factors, and then it will slowly go down over the next 18 years. The funding available for this first year is $1,258,326.07. The three areas to look at categorizing funding priorities into are treatment, prevention, and additional areas.
   • Tanya and her fiscal team put together a spreadsheet for allocations to different areas such as equipment, staffing, miscellaneous, workforce development (education/internship), municipal funding applications requests, and administration. Based on some of the ideas that were thrown out at the last meeting, those were added to the spreadsheet already (including equipment and staffing ideas).
   • Jenny with North Range Behavioral Health discussed their ideas.
     • The first is in regard to a medically enhanced detox. This would allow for medical clearance on site. Admits would occur faster which means quicker turn around for police and less people in the ERs. It would also allow for more complicated withdrawal symptoms. Having medical personnel would allow for expansion of who is able to be supported. A lot of this would be conversion of current positions rather than hiring new ones. Medical oversight would be $145,000 (no current position), nursing would be $132,000, and clinical staff would be $50,000 for a total of $327,000. The idea would be that once this is done, North Range would be able to bill Medicaid at a higher rate which would then make this self-sustaining and the council would not have to pay for it every year. After discussion it was decided that due to the current staffing shortage, it would be better to break up these costs over the next two years instead of all up front which then allows for more money to be prioritized to other areas as well.
     • The second idea is in regard to staffing. The council could set aside funds for people working in the field of substance use addictions (i.e. treatment providers, first responders, medical professionals, etc.) to make extra money for doing a great job in the fight against opioids. Unsure of a specific amount and what exactly this idea would entail but could be an area of discussion. Could even just be any additional funds that are left over. The application process would be developed in a collaborative effort between community partners. Placeholder was set in Workforce Development for $10,000.
     • The third idea is in regard to a Substance Use Career Path Educator. The role of this person would be to provide career path training and support to bring people into the addictions field. They could also help with recruitment of staff that have been difficult to hire. Total for this position would be $104,000 (broken down into $94,000 for the salary and $10,000 for marketing).
   • Michael Pirraglia with the Weld County District Attorney’s office proposed adding another MX908 Mass Spectrometer under Equipment. This would allow for a quicker process of people getting into treatment and cases being moved along. We have a big county and having only one piece of this equipment at the task force would make it difficult for everyone to use if/when needed. Could have one centrally located with the task force and work out where to store the other one (possibly south county). County will purchase these items and then they become capitalized items that will need to be tracked.
   • Matt Elbe with the Weld County Sheriff’s office discussed law enforcement areas of need.
     • The price tag of current Medically Assisted Treatment (MAT) is pretty high. The majority of jails, with exception of Larimer and Denver counties, are only dealing with continuity of care patients. Hardly any are doing induction. Everyone’s MAT programs are being funded by Jail Based Behavioral Health Services (JBBS) money from the state. There is no way that funding will support the requirements that House Bill 1326 will be putting on local jails. This year they have just under $1.5 million allocated for medications for all county jails to run the MAT services program. Last year they ran out of money. It’s not sustainable. Denver is running a full MAT service at $1.2 million. This includes transition specialists, RNs, continuity of care, induction, and a high percentage of their 1800 inmates are on MAT services. Our county jail runs about 560 inmates, but the percentage on MAT services is usually fairly high. From the Sheriff’s office perspective, an RN would be needed to manage that program. Current nursing staff is at about $55/hr. Have zero funding for medications that would be required for the inmate population. County jails are looking at anywhere from $10,000 per year to $157,000 per year for continuity of care. No projections for what that budget would need to be to be in compliance with new legislation next year. In addition, the requirements of the bill in relation to Narcan is huge. Appropriation of over $19 million at the state level for Narcan. May not always be able to access those funds. Everyone leaving the jail that is diagnosed with having substance abuse disorder or on MAT services must be provided 2 doses of Narcan when they leave the jail. A large percentage of inmates leaving the jails will need to leave with those doses. Would like some money to go to that expense as well. Looking at nursing staff at $150,000, Narcan at $100,000, and additional cost for medications at $200,000. This will allow sustainability of the program to be in compliance with new legislation requirements. The county may also seek other funds. This is a large ask, but there is a need to be in compliance. Looking to seek funding that affects the taxpayers as little as possible. With what we are able to do with the funding, the funds would be supporting other entities as well.
   • Jenny mentioned that if there are extra funds it might not hurt to set aside some additional funds for administrative costs for partnerships coming together. $19,000 set aside for this purpose.
   • There was a mention that with what was discussed, there wasn’t much focus on prevention. Eric explained that the proposed Health Educator position with the Weld County Health Department would focus on prevention, along with giving them a budget for prevention efforts.
   • Discussion of bucket of money for municipalities and prevention. Council decided that $25,000 could be set aside for that area.
   • Discussion of media efforts (such as geotargeting) with funds of $20,000.
   • Leslie with North Colorado Health Alliance (NCHA) discussed their ideas.
     • Proposal of 2 care coordinators. $100,000 for 1 year. Those care coordinators would be embedded in the place that makes the most sense (i.e. Weld County jail or somewhere else where they may be needed). Would be available during the flexible hours that are needed. Both could be embedded in the jail, or one in detox and the other in the jail, or wherever the needs are. May need one of these coordinators in the small municipalities for coordination of care services. These individuals could also help write grants, coordinate training, and could be involved in a variety of ways to go alongside law enforcement. Grant writing at $10,000 built in.
     • Thought about hiring a peer supervisor. This is becoming more common around the state. Use in a variety of spaces. Peers are being hired all over the place. There is learning that is needed to support this workforce. The job would be to manage peers (currently there are 10 peers and North Range has more). This person would live between NCHA and North Range and be deployed to the community to help people understand how to use a peer. You pay a peer for their lived experience with different things. That takes a unique employment environment to support that person. Looking at $61,000 for the year for this position.
     • Finally, thought about setting aside $10,000 for training, such as turning care coordinators into certified addiction counsellors or certified peers.
   • Discussion of prevention efforts to include guidelines for doctors to follow on how to prescribe less opioids to their patients.
   • Next Steps:
     • Budget is due September 15th. The sooner we submit the budget, the quicker we will get the funds. Council was good with the budget as is without needing to review it in more detail. Matt Elbe motioned to approve the budget. There was a second by Scott James. Budget was approved.
     • Meeting minutes and budget will be sent out to all council members.
     • As soon as budget is submitted and approved, should receive the funds, hopefully around October.
     • Council will be kept up to date via email on the status of the budget approval.
5. Selection of Next Meeting
   • Council agreed that meeting quarterly would be a good timeframe. The third Tuesday of every quarter as a hybrid option was agreed upon. However, with the next meeting date falling the end of December, the council agreed the next meeting would be the third Tuesday in January which is January 17th from 9:00am-10:00am at WCDPHE with a Teams virtual option.
   • At the next meeting the council will need to discuss a reimbursement cycle and reporting process. Each agency will need to determine what will work for them.
6. Adjourn
   • Motion by Kim Emil to adjourn the meeting and set meeting for January 17, 2023, at 9:00am. There was a second by Zoe Stieber Hubbard. Meeting adjourned at 10:01am.