♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ Thank you, everybody, for being here. Carmen, would you like to do the roll call? Yes. Chair Stephanie Raglin. Chair Stephanie Raglin. Vice Chair Stanfield. Chair Stanfield. Here. Kimberly Baird. Here. Sierra Bowman. Great House. Here. Moses. Here. Ms. Neal. Here. Ms. Yano. Here. Mr. Sanders. Here. I was going to say Mr. Webster. Dr. Woods. Present. And Ms. Evans. Here. Thank you. We have a quorum. Thank you, Carmen. Next we'll look to adopt the agenda. If everybody will take a second and look at it. I'll accept a motion to adopt. Move to adopt the agenda as is. John Moses. Dale Sanders, second. All right. We have a motion and a second. All in favor? Aye. Any opposed? All right. We have an agenda. Next let's review the minutes from the June 13th meeting. We've had time to review it. I'll accept a motion to adopt. Move to adopt the minutes from the last meeting as is. John Moses. I'll second that motion. Peace Cano. We have a motion and a second. All in favor? Aye. Any opposed? All right. Approved. Next up we have our executive board report out. I was not present at that meeting. So, Dr. Woods, can you give us the report? Yeah, absolutely. We met and, of course, designed the agenda for today. But some of the other things that we discussed were the vacancies that we have both for the executive committee and the full council. We have one executive committee sort of vacant position and we need, we have two vacancies for the full commission. And, yeah, so I think Chair Raglan discussed both. We threw out some options of people that may be interested in that and people that have expressed interest. And let's see here. I think that it's moving forward and being taken to the mayor, I think, some of those recommendations are. And then Connie, of course, if that's not accurate, please correct me. Those next steps, yes. But I would also say for the group here, I mean, there may be a small discussion that we should have to, if there's other people that have recommendations for both the executive committee or the full council, I think we could have that here for sure. So I'll open that up. Any recommendations for the full council or that we should at least explore? John Moses. I think that Mr. Jeff Wilson might be a good person to consider for the commission as well. We talked about Jeff, but we, the bylaws indicate that no one who is a LFUCG employee is eligible to sit on the board. Gotcha. Yeah, we didn't know that. I didn't either. We didn't either. He came up and we talked about him extensively until it was pointed out that he wasn't able to. For the good news, we all thought the same. We didn't make a great candidate, but yes. Okay. And, you know, that was essentially it. I think under new business, you can see some of the names that were sort of considered for some of that. Dr. Lindsey Jasinski, Chris Peck, Tonya Fogel, T.C. Wilson, Alex Elswick, and Maria Hill from the paramedicine team were all sort of like put on a list to be approached and talked to, so. And that's, I think that's it. Thank you, Dr. Woods. All right. So we got two presenters today. Our first looks like iChampion Health from the University of Kentucky. I'll tell you all, we'll ask you to come up here to speak. Speak into the microphone. If you move too far away from it, the sound doesn't pick up, which has been a challenge for us sometimes. But we're excited to have you. Thank you. All right. Y'all can hear me okay? And I think our, will we have slides up or just we'll have them in the packet? Okay. Great. Oh, okay. Great. Well, I can start out with introductions while they're pulling those up. First of all, thank you so much for having us. And more importantly, for your continued work in this space. It is so important. And as we're out listening to the community and being engaged in the community, continually substance use prevention is a priority and something that we're hearing we all need to keep working together to make a better world. So thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. And we all need to keep working together to make an impact. So I'm Mindy Eckes. I'm a health promotion professor in the college of education at the university of Kentucky. I'm also our associate dean of research for the college of education. My background is in youth prevention, thinking about ways to strategize health promotion programming from a community engaged perspective. And so today I'm joined by Jacob Hester, our program coordinator for iChampion Health. And so, we're going to talk a little bit about the programs that we've been working on, and then kind of wrap around how we feel we can support substance use prevention, specifically youth and family prevention here at Fayette County. I guess this is my clicker. All right. So who we are, iChampion Health has been around for about two years, and we're a community centered, youth and family focused initiative housed within the U.K. college of education. But I would say that we don't really work as a community organization. We work in the community. And iChampion Health is dedicated to advancing health for all in Fayette County through strategic partnerships that educate, empower, and engage young people, caregivers, and individuals working with youth and families in school and community settings. Did we start here? No. We've really evolved based on the community feedback and the community voice we've received over the last two years. And so, we're going to talk a little bit about what we're doing. We're going to talk a little bit about what we're doing. We're going to talk a little bit about what we're doing. We're going to talk a little bit about what we're doing. We're going to talk a little bit about what we're doing. And then, we're going to talk a little bit about the community voice we've received over the last two years. And we had the opportunity to initiate iChampion Health with state office of health equity funding where we actually were working on COVID and vaccine hesitancy. And while we know that that continues to be an important issue with public health, we listened. And we found that, you know, that wasn't necessarily the priority of the community. And so, we have been able to respond to what we've heard. And I'll share a little bit about that shortly. So, what we know, you know, this is not news to you all, but we've made some strides with substance use prevention, specifically with overdose death prevention here in Kentucky. But there are still some gaps. There are still some opportunities, specifically here in Fayette County. And so, while Fayette County did really well and, you know, is recognized as recovery ready, we have noted that there is a gap in evidence-based youth prevention and education in schools. And this really indicates a need to implement proven school-based prevention strategies. And while there are some really great national programs, we're seeing that they don't always resonate with our communities. You know, they aren't really based on the community needs, the voice, the gaps that our community members are telling us they need. So, why a community-engaged model? You know, I feel like I'm probably preaching to the choir here. Community-centered health initiatives are not just an option, they're integral in building trust, ensuring relevance to our communities, and then also promoting sustainable change, which we know is needed specifically with substance use prevention. And engaging directly with the communities not only strengthens public health efforts by creating shared ownership, but they're locally informed and co-created strategies. And that leads to more effective outcomes. You know, so I feel like here in Lexington, we are blessed that we have this community-engaged, community-centric model with so much of what we do. That is not necessarily the case. When I go elsewhere, I'm reminded, oh, we're doing something special here in Lexington, and we need to lean into that. We need to foster that community-engaged model even more when we're talking about prevention. So some of our priorities, again, driven by community voice, and I love this sentiment. Simply put, the community's priorities are our priorities. And so, we have focused on mental health promotion, substance use prevention, violence prevention, and financial capability. Today, I'm going to lean into the intersection of mental health promotion and substance use prevention. We are very lucky that we do have current funding right now from the Kentucky Opioid Abatement Advisory Commission, and then a small pot of funding from UK Healthcare Healthy Kentucky Initiative. But in full transparency, our funding will be ending in December, and we feel like we're just getting started. And so, you know, it takes time to build community engagement, rapport, and trust, and accountability. And I think that we've gotten to a place where we're really excited what the future can hold. And one of the reasons for that excitement and enthusiasm is the collaborations that we've had the opportunity to build. And many of you are involved in some of these organizations, or you're very familiar with them. We work really closely and collaboratively with all of these organizations and more. And I think what that's allowed us to do is to truly be community centric. And it's not me as a professor at the University of Kentucky coming into a community and saying, this is what I think you need. It's bringing together this cohesive effort and allowing all of us to work together and to synergize towards prevention efforts. So what do we do more broadly? This is kind of big picture thinking. We have enacted strategies that allow for that trust and relationship building through unique community listening. I don't know if you all have ever been asked to take a community needs assessment survey. Sometimes you fill it out, sometimes you don't, right? We've learned that in some communities, they're very hesitant to share their voice through surveys like that. And so we've adopted some really unique listening boards and engaging prompts to elicit community voice. And it not only allows them to share their perspective, but we're hearing stories. We're hearing the anecdotal narrative of their lived experience, and that's allowed us to develop responsive health promotion programming. Whether that's through educational programs in the schools, whether that's through social and creative media projects, and adapting existing materials that maybe some of our partner organizations have created, but maybe aren't resonating with all of our residents here in Fayette County. And then another thing that's really, I would say, a tenet of what we do is capacity building and empowerment. And we do that through youth leadership programs, community champion initiatives. And we really try to bring adults and youth together with that multi-generational focus so that we can ensure that there's future growth and prevention. And then I already mentioned the strategic partnerships. So that's pretty vague, right? What in the world does any of that mean? So let me show you some examples of how we do those things. And I'm going to start with our community health champions and community collaborators. This really started out to ensure that we were co-creating and hearing community voice in all of the strategies that we were developing, but it has transitioned into so much more. These community health champions and community collaborators drive action planning. They go back into their communities and they're sharing resources, they're co-creating resources that then they're bought into. They know, they're very proud to share the resources and the things that they've created. And also just anecdotally, watching youth see that they can make a difference in their community is probably one of the most meaningful things that you can observe in your career. We do a lot of outreach events, and you can see the board there with the stickers. So that's kind of what I say we're trying to think of innovative ways to collect community voice. We've had over 900 responses on our community engagement methods where that drives what we do, how we do it. We have also leaned into multimedia and creative art projects, and as one example, we have our very successful iChampion Health Chat, so we hope you'll follow along. And we have Gerald Gibson, he's helping to facilitate those conversations, and we bring in community leaders, we bring in community members, so that we're talking about what's happening in our community, but not just what's happening, what we can do about it. And so last, I want to focus on our youth lessons, because that's really what I think is a pivotal opportunity here with this group. We developed a series of four lessons, and they really were intended to be from fourth to sixth grade, based on really thinking about how can we ensure it's primary prevention. We're reaching youth before they start using substances, before they are struggling with mental health. We know that we probably need to start earlier, actually, as we look at our data. But these lessons are aligned with our national and Kentucky health education standards. They focus on youth making informed decisions, identifying supportive relationships, understanding and talking through peer and social influences, goal setting, and practicing healthy coping strategies. And now you might say, you don't say anything about substance use prevention right there. Well, we know that all of those things are protective factors for substance use. And so when we develop these lessons, we really wanted it to be responsive to what the youth were telling us, what the communities were telling us they wanted to talk about, they needed to talk about. But that's all wrapped into substance use prevention. And so here are a couple of examples of our slides throughout our curriculum. I do want to mention that these lessons have been vetted by the community, our community partners, our champions. We also have experts within school psychology, public health, health promotion who have helped develop all of the content, ensure that we're aligned with best practices. And so we talk about things. We talk about real life and what's happening. And you can see that we try to use relevant examples. We infuse creativity so that the youth are doing something every time we're there. And anecdotally, I have been involved with a lot of youth prevention initiatives, and the teachers and the students are asking us to come back for more. They want more content, they want more engagement, because they're feeling like they're being heard, like they're connecting with the content, which in reality, that's how we see an impact. And so this is one, of course, we had to throw in, because this is probably one of the most popular activities. This is our Gratitode, and so the youth love this. And I bring this to you because we can't always talk about the risk factors and the negatives. We have to talk about the protective factors and how we can change the trajectory of youth substance use. And so we talk a lot about mental health and resilience and gratitude, because these are things that they can take on into their life, whether they're in the classroom with a lesson or not. And one of the best things is that teachers are saying they're seeing this carry on when we leave. The youth are talking about gratitude, they're expressing it to one another. So we're really seeing some positive impacts. And here's just a quick highlight of our impact summary. You also have that in your folder here. In just a year, we've reached almost 2,200 people through our community events. Like I said, we have over 30 community health champions. We've reached over 260 youth with our school lessons, and it just continues to grow. And so again, I see a lot of promise with our strategies, the rapport we've built, and people coming to us. And so generally, what have we learned? I think I've talked about some of these throughout, so I'm not going to harbor on them. But the one I really want to point out again is that responsive programming matters. And while there are great national models, our community is not always connecting with those models. And so we're building an evidence informed program that Fayette County can stand up against national models. And I think that's really exciting. And so what do we want to do? We need to continue to listen. If you develop some prevention materials and programs, that's not the end of it. You need to continue to collect feedback. You need to continue to adapt. You need to continue to respond to the needs of the community. We also need to work together. We need to synergize our efforts. And so that's one of the things that I think we have the most opportunity for. We should not have 25 different programs in our schools. We should synergize efforts, and we should build on those efforts. And I think that we have the opportunity to do that. And so this brings me to just three key priorities I think we could really focus on. Adapting the lessons so that we're reaching a broader range. I would love for every student in Fayette County Public Schools to receive these lessons. And then there's an opportunity to have developmentally appropriate lessons. They're not only getting it one time, they're getting it in elementary, middle school, high school. So there are multiple touch points. Developing the infrastructure for sustainable universal implementation. What's the point of having some of these prevention resources and materials if nobody has access to them? So we can create a hub to share those resources, to disseminate, to connect school officials, personnel working with students every day to professional development training, the resources they need to be successful. And then our champions are at the heart of what we do. So how can we continue to build these future cohorts of community leaders who are really wanting to support prevention in our community? And so I think that's it, and I'm happy to answer any questions you might have. Thank you so much. Anybody got questions? Just a great presentation. I love the work, and don't misconstrue my question as if this is not the case. But protective factors, protective factors are a great way to address a myriad of health issues, sexually transmitted diseases, pregnancies, you name it, risk-taking behaviors, suicidal mental health and suicidal ideation and stuff like that, drug use as well. My question to you would be, do you guys do anything that is directly educational regarding drug use, misuse, that sort of thing? That's a little more concrete than just how to make better decisions and relationships and things like that. Yeah, no, that's a great, great question. And so our curriculum is infused with real life scenarios where we talk about substance misuse. We talk about what might happen when a friend approaches you to use something. One of the scenarios is an athlete who is in pain, and they're trying to get some pain pills from somebody. And kind of going through that decision making process. So we address it in a way that I think resonates with youth, where I'm not out there just lecturing them that drugs are bad for you. And so I think that there's a way to talk about substance use and still educate them through their own decision making skills. And kind of watching them creatively decide how they might deal with that in their life. That's good, thanks. I don't actually have a question, but I will say I'm thrilled that you mentioned that you can't just do 25 different programs in 25 different schools. I've always said that the only way to fix this problem is to make sure that every child is getting the same information. And that it's not based on whether the principal is on board or if parents, or whatever the case may be, that's always the reason why not my child. And otherwise, we're just going to continue the cycle of missing some and catching some and never really get it under control, so thank you for that. Thank you, and I really appreciate that. I think, I do not want to make light of the incredible work going on in the schools and all the organizations that are wanting to support this effort to support prevention. I think there's just a way where we can maybe work collaboratively, work smarter not harder, so that we know that all youth are connected to these resources. And then we're also training the teachers and the school personnel and the student or the adults who work with youth in that same mentality. Can we get these slides? I don't, can we get the slides? Do we have the slides? Yes, they are in your handout and happy to share any additional information that you might need. I hope you all follow us on social media and check out our podcast. You can learn a little bit more about what we're doing. I have one question for you. Can you speak a little to the conversation that happens around financial, maybe capabilities, is that what the slide was? Sure. What does that look like in the program? Sure, so I would say that that has been derived from a lot of our conversations with our adult community voice. But we use just some examples within the program, but I think this kind of goes back to our community engagement, our community events. One thing that came up when we were doing health related health fairs basically, right? People are not coming to those. And so our community champions said they would come to something where they could try to find a job. And so we actually ended up inviting a bunch of vendors who were looking for employees and paired that with sharing health related information, connecting to local health related resources. And so that was one way that we recognized this is important to our community, and so we have to start making those connections. And then the other thing is, when we engage our youth and adult champions, they're compensated. So it becomes a way, and it's not a ton of money, right? But for youth, if you're getting $1,000 or $1,500, we're also talking through how you might start your own bank account, savings account. And so we've been able to build on that. But I still think there's some more opportunity to continue there. I have a quick question on Dale Sanders. Thank you so much for your exciting work that you're working on. Are you getting good feedback from school systems, or does it depend on site-based councils, principals? Do you have to work through each one? Are you getting an overall good response for this program? Yeah, I would say so. We started out smaller to make sure that we could get some of the kinks out and make sure that we were getting the positive feedback before we would have a wider launch, which is what one of our goals would be for this coming year. And we have worked directly with principals, teachers. And I have to say that there has been overwhelming positive feedback. Not just from the students, but from the teachers. And it's opened doors, I think, because now they're saying, we would love for you to come back and do some training on trauma-informed prevention. We would love for you to come back and talk about mental health care resources for our staff and for our teachers. And so I do think that just having these open conversations has been impactful. Great, thank you. Thank you so much, we appreciate it. Thank you, appreciate you all. Next we have the Billion Peel Pledge, Goldfinch Health, welcome. Thank you. I promise I won't make you say that three times fast, but I appreciate the opportunity to speak today. I'll give a second to pull up our slides, but otherwise they are in your packet. But we'll start off with an introduction. My name's Michael Doty. I'm the Director of Provider Success for an organization called Goldfinch Health. We are the creators of the Billion Pill Pledge program, an innovative primary prevention strategy that targets a large avenue where we know opioids are often first introduced. And that's surgery within hospitals. So our mission, or our vision, actually, at the Billion Pill Pledge is to eliminate 1 billion pills from circulation within our communities. Research shows that there's over 3 billion pills that are left over every single year after surgery. So we are on this mission to eliminate 1 billion of those. Not by just doing what a PDMP has done by setting prescribing limits, but by actually empowering surgeons and care teams to provide more effective pain management strategies. Where the biggest byproduct is going to be a less need and a less reliance on opioids to treat pain after surgery. As we're all acutely aware, opioid prescribing is what got us in this situation where we are today. And over-prescribing is still a challenge today. The average number of prescriptions that are dispensed across the United States is over 37 prescriptions per 100 Americans. Those areas in orange are much higher than that. Kentucky, I believe, is at about 58, just over 58 prescriptions per 100 people. Here in Fayette County, I believe that number is just over 100 prescriptions per 100 people. In Tennessee, where I live and where I work with this program today, we are right in line. We're at about 58 prescriptions per 100 people. So there's a lot of work that can still be done on how we can change prescribing practices. Again, not by limiting the number that are prescribed, but actually implementing evidence-based practices that a big result is just less reliance on opioids to treat pain after surgery. So how have prescription opioids gotten us into this predicament by surgery as an avenue or a gateway? And how do they still play a part today? The research actually shows that between 6 and 10% of opioid naive patients who go and have surgery will ultimately become dependent on those medications after surgery. Think of some of the most vulnerable populations out there, those that are on Medicaid. That number is almost one in three, or 30%, this was a study that was done out of Stanford, will ultimately become new persistent opioid users after their first exposure to an opioid prescription from an acute pain episode. And we know that opioids are actually just a gateway. 80% of heroin users reported beginning their abuse of substances with a prescription, whether their own, a valid prescription, whether their own or somebody else's. You might say that's outdated data, but there's actually a survey that was published in JAMA a couple of months ago that shows 75% of those who use illicitly manufactured fentanyl in the last 12 months started their drug abuse with a valid prescription, whether theirs or somebody else's. So it is still a challenge today and simply a gateway to what's to come. As I mentioned, there's a leftover pill problem. There's over 3 billion pills that are left over after every single year. And this creates a whole host of risks for not just the person that's prescribed that medication, but for everybody under the same roof. Now the leading cause of poisoning related deaths of children under five are attributed to opioids. Half of those poisoning related deaths are attributed to opioids. And this creates a risk of somebody overdosing in the same household as somebody who has a prescription for an opioid. One study showed, again published in JAMA back in 2023, a six times higher increased odds of an opioid overdose if there were two opioid prescriptions under the same roof. And so simply we can do better. Just some local statistics that I'm sure you all are acutely aware of. There are still significant number of residents who are at risk of starting opioid prescriptions that are lasting over 30 days. 1,400 residents are starting opioid prescriptions that last over 30 days. That was the latest data from 2023. And as I mentioned, Fayette County dispensing over 100 opioid prescriptions per 100 residents. So I lay all this background and framework to talk about why this is important and how this program can help the community here in Fayette County. So what is the Billion Pill Pledge Program? Most often it is funded through opioid settlement dollars. We're currently active in six states with this program today, and I'll share some results from that here in another slide. But we actually got our start in the state of Iowa from a grant from the Attorney General a little over two years ago. So we've been active in the state of Iowa, where I live. We have a statewide program in the state of Tennessee. We also have programs in the state of Nebraska, South Carolina, and most recently the city of Mobile, Alabama, as well as the state of North Dakota. So a lot of communities are seeing benefit in this program as a primary prevention strategy, really trying to get upstream from this epidemic itself. First, recognizing that, to use a metaphor, we have a hole in our boat. And that boat is taking on a lot of water, and we need everybody on board bailing out that water. We have to keep people alive. It's things like naloxone, and we have to get people to recovery, or get them to treatment, and get them to recovery, and help them stay in recovery. If we never patch the hole in our boat, we're going to continue to bail out water at this unsustainable pace. And so we're trying to do our part in patching that small hole, or patching that big hole with our program. So what we do is we partner with hospitals and communities. This says to support rural patients. It's really any patient that's approaching surgery, whether urban or rural. You can imagine that the impact in a rural community, though, is a little bit greater, just given the disproportionate amount of people that are usually on Medicaid within those communities. But really trying to work with hospitals to provide better pain management, a better patient experience, and recovery through surgery. And you'll see that the biggest byproduct is just less reliance on opioids to treat pain after surgery. These are our results so far to date. We've been able to reduce the average opioid prescription by 60%. That's pill count with the hospitals and surgeons that we work with. Importantly, we've been able to reduce the opioid refill rate by 92%. A refill on an opioid prescription after surgery is usually an indicator that you're moving down the wrong path towards your recovery. So if we can minimize that refill, it's going to provide a better outcome to the patient and certainly a better chance at just getting off of those medications as soon as possible. And then another byproduct of our program is just we're seeing less people go back to the ER or be readmitted to the health systems after their surgeries. Less than 2% of patients enrolled in our program are going back or being readmitted to the hospitals that they had surgery at. A key component or pillar of a foundation of what our program is founded on, it's an evidence based or clinically based practice called enhanced recovery after surgery. I don't expect anybody to know exactly what that is. But just know that there's thousands of research articles that exist out there on it that have been peer reviewed and studied that show immense clinical benefit to patients going through surgery. And in fact, enhanced recovery after surgery is a bit of a misnomer because this actually starts before the scalpel even hits the skin. Some key aspects of it are this prehabilitation or things that you can do to optimize a patient prior to surgery. So often we go into surgery, whether you or a loved one you may know has gone into surgery and you're told don't eat or drink anything after midnight. It's probably the case for most hospitals these days. Some are a little bit more forward thinking. They tell you don't eat or drink anything after midnight because the risk of aspiration during the surgery if you have something in your stomach. Well, it turns out that's actually a really bad way to prepare somebody for surgery. You can imagine if you were to go and run a marathon or a 5K or do any sort of exercise 12 hours from now. And you were told that you can't have anything to eat or drink before then. You probably wouldn't be very successful at doing that. When you go under general anesthesia for surgery, it's a huge impact to your body. And the American Society of Anesthesiologists, the foremost body that sets guidelines for anesthesiologists across the country. Actually for the last 20 plus years has been recommending a clear carbohydrate beverage two hours prior to surgery. Or something like a Gatorade two hours prior to surgery. Because there's immense benefit in having those essential electrolytes in your system to help your body recover after surgery. Harvard did a study on this that showed when they gave their patients who were getting their knee or hip replaced a Gatorade two hours prior to surgery, they went home an entire day sooner. So real clinical impact on just having something like a Gatorade in your system. The next element that we really rely on is called multimodal pain management, or just multiple legs of the stool to help manage somebody's pain. It's things that you can do prior to the scalpel or even hitting the skin. Things like Tylenol, things like a medication called Celebrex or a Pregabalin that when administered before the patient's ever wheeled back for surgery that shows great clinical benefit and better pain efficacy once the patient wakes up after surgery. You can imagine when you can continue those in the recovery period after your surgery, it still has much better clinical benefit than an opioid at managing somebody's pain. We're not here to eliminate opioids entirely because we know they serve a purpose. We want it to be the last thing that you reach for, or the highest thing on the medicine cabinet, to use another metaphor. And the first thing that you get off of, because of the dangers of taking an opioid for just a matter of days can ultimately lead to a dependency for certain people. And importantly, you'll see here in a second, what we do is we support patients with a nurse navigator through surgery. That's also a big component of enhanced recovery after surgery. It's not simply just having the patient's care stop once they're discharged from the hospital after surgery. There's a two week period that exists primarily when you have surgery, you get discharged with your prescription, and you're told to follow up with your doctor two weeks later. Maybe you get a phone call after that surgery. Our philosophy is that you should have routine check-ins with a nurse to talk about where your pain score's at and what to do to help get more effective pain relief instead of relying simply on a monotherapy like an opioid to treat that pain. So what does this program really look like in practice? As I mentioned, these enhanced recovery after surgery protocols are well-published, well-studied. Your thoughts are probably thinking, well, why aren't they well-adopted? Because, like anything in healthcare, it takes a really long time. Research actually shows it takes 17 years for clinical research to get put into practice. And enhanced recovery after surgery has been around for about 20 years, so that it's starting to build steam. But it's minimally adopted because it takes a true village within a hospital to all get on the same page. You have to have pharmacy, surgeons, care teams, administration, nurses, all of these folks working together in tandem to get these principles adopted. And so that's really our role is to help hospitals understand the benefit of this, to talk through some education around the dangers of opioids, what conscientious opioid prescribing looks like, what some experts like Johns Hopkins and the University of Michigan recommend when it comes to opioid prescribing. Just talking about the efficacy of opioids. This was a report done by the National Safety Council that, to get to the punchline, shows that when you alternate ibuprofen and Tylenol, it's three times more effective than Percocet. So the good stuff is not actually an opioid. It's not a Percocet. The gold standard today, though, to treat pain is still an opioid for most surgeons. So there's an entire generation of surgeons who, unfortunately, were trained by the likes of large pharmaceutical manufacturers. And so a lot of what we do is academic detailing and counter-detailing, really, to help all folks along the surgical spectrum understand that there are better ways to treat pain, and it shouldn't just rely on a monotherapy like an opioid to treat that pain. The next part that we do is help to implement some of these practices within the hospitals. Helping them to implement what we call the liberal NPO status, or allowing patients to have a Gatorade two hours prior to surgery. We're working with hospitals to implement some of these multi-modal pain management strategies, making it easier and more sustainable for hospitals to implement on an ongoing basis. And then indefinitely, we help to support patients through their surgical journey. Every patient that goes through our program is given one of these prepared for surgery tool kits. This prepared for surgery tool kit has a bunch of items that help to optimize a patient prior to surgery, as well as help them to recover afterwards. Two of the things I'll point out, that VibraCool device that you see on the left-hand side of the screen is a mechanical stimulation device, or vibration therapy device, that essentially vibrates at a research frequency that confuses your nerves. It doesn't allow the nerves to send the signal of pain back to the brain. It's been researched to reduce opioid consumption by 35%, and then we're all about getting rid of unused medications, not keeping them in your medicine cabinet to potentially be misused or diverted later on. Every patient gets a drug deactivation pouch within their tool kit. I'm not sure if you've seen these before, but they're awesome to use. All you do is rip the top off, fill them halfway with water. Any unused tabs, pills, patches, or liquids, just dump inside there, zip it up, shake it up. Renders the drug inert, safely denatures it, so you can just toss it and dispose of it in the comfort of your own home. Whenever you're done taking those medications, you no longer have a need for them. The next part, the last couple of parts are probably the biggest part of this. As I mentioned, every patient that goes through our program is given a Goldfinch Health Nurse Navigator. These are registered nurses who have extensive operating room background experience, and they're all experts in these enhanced recovery after surgery protocols. Their goal is to really help prepare a patient for surgery, helping them to stay in compliance with what the hospital is telling them prior to surgery. But also helping to relieve anxiety that they may have about their upcoming procedure, answer any questions that maybe they didn't get a chance to ask their doctor. There's good research that shows when you go into surgery with less anxiety, it means less pain when you wake up from that surgery. So we want to help patients feel at ease prior to going into the operating room. After surgery, our nurses are reaching out and communicating with those patients proactively to talk about what's normal versus what's not normal. What's your pain score at? What are you doing to treat your pain? What were you prescribed for pain? Letting them know that alternating ibuprofen and Tylenol is going to be more effective than the opioid at treating their pain. We did a survey of our patients that showed only 8% of patients know the difference between ibuprofen and Tylenol. Yet when you alternate those in combination, it's three times more effective than that opioid. So we want to provide as much education as we can at a level that they understand to enable their effective recovery after surgery. So in the last piece that we do, we believe that the most impactful data that providers and health systems can have is data on their own hospital, data on their own patients. So we will actually ask every patient who's enrolled in our program how many opioids they were prescribed and how many opioids did they consume? Excuse me, because the data shows pretty consistently that doctors are still over-prescribing. I'll give you a perfect example of a hospital that we worked with in Iowa who loved this program, implemented it, but didn't want to change their prescribing practices quite yet. They wanted to see some data first. So after two weeks, we went back to this rural hospital in Iowa. They had written 500 doses of opioids in those two weeks, which isn't abnormal, but their patients had taken a combined six. That's not six each person. That was six out of 500 across all those patients were consumed. So he's over-prescribing by 98%. And frankly, today, that's a black box that providers simply do not know. They only know if they're not writing enough because they get calls back at their office that say I need a refill for my medication. They don't know if they're over-prescribing though, and we can help with that and provide them with that information. So they can make more informed prescribing decisions for their community and the patients that they serve. The value in participating, certainly for hospitals and communities, everybody gets this expert training and enhanced recovery after surgery, which has so many benefits just beyond the opioid prescriptions. They get additional perioperative support, which isn't necessarily relevant to this conversation, but there's a huge nursing shortage. And we can certainly help with that. There's great earned media that comes from this for hospitals showing the innovative care that you can get within the four walls of your own community facility. And then importantly, just better patient outcomes, whether it's through improvements in survey scores or reductions in length of stay or readmissions or just reductions in opioids overall. There's a lot of benefits that can come from this program that we're seeing today in practice. Our goal is to always help hospitals reduce their prescribing by about 50% within the time period that we start with them. This says 18 months, usually that's within about six months after we start. In a hospital, we can help them to reduce their prescribing after surgery. And you can see through the data that we've shared that we've been able to hit that mark so far. And just a case study of where I work out of in Tennessee with one rural hospital that we work with in Tennessee. These are only two procedures that they do at the hospital. Now they do probably a dozen, but just taking two procedures that we help them reduce their prescribing on, it'll eliminate over 5,000 pills from ever being prescribed within that community. The best part about that is that's in perpetuity, that's never going to change. So some really impactful results for this community in Tennessee that we're seeing. And importantly, we now have a clinical validation to this. This was a public, we partnered with the Rothman Institute out of Pennsylvania to look at the impact of our program on the nine hospitals that we worked with in the state of Iowa. That data was recently published a couple months ago in the Journal for the American Academy of Orthopedic Surgeons, JAAOS. And that showed an average opioid reduction of prescribing opioids after surgery within joint replacements of 47%. So some really significant impacts that are now peer reviewed and clinically validated. And I'll stop there, I appreciate the time again, and I'll be happy to answer any questions, so. Thank you, I think that's pretty fascinating. I can remember, it was probably about ten years ago, I got invited to do kind of an anti-stigma campaign with surgeons around Narcan, encouraging we know that you're going to be prescribing these medicines, would you be willing to also prescribe this to have it in the home? And I was amazed at the response from the medical community of a lack of interest in that conversation. So I'm curious, what has your experience been, what are you all doing to get buy-in, what feedback do you get? Yeah, what's interesting is when you work with surgeons, my role specifically is to work directly with the providers to help them, provide them with the data that others are doing across the country, the data that the research shows. So they can make more informed decisions for their patients and feel confident in those decisions as well. Most often, when we work with surgeons, they just want to operate. They're great anatomists, and they're great with a scalpel in their hands, but they're not pain management specialists, and I'm not going to claim to be one of those either. But we've spoken with surgeons in the past who will tell us, I don't even know how to write anything else. Because they go off what they were trained on, from their attending physicians, or in their fellowship, or what have you. And so when you help to give them alternatives, when you help to say that, hey, you're actually going to see less calls back in your office, because one, the research shows that you're going to do that. But two, you'll see anecdotally from the hospitals that we work with, that our nurses can handle most of the calls. And two, the pain is well managed to where they don't need to call about anything. So you're going to see less calls back at the office, you're going to see less readmissions from your patients. And when you share things like that, where it actually makes their life easier, and all they have to do is click approve to the order sets that we really advocate for those hospitals, it's a pretty easy sell for them. And then you mentioned, in the state of Tennessee, the program's entirely free, the toolkits are free. Our nurses' time is free to work with those patients, because it's funded at the state level through the Opioid Abatement Council. It's an easy sell to the hospitals. That's great. Anybody else have questions? I do. I'm Margaret Piscicano. Thank you for coming today. Fascinating work and data. And it just occurs to me with all these over prescribed opioids that are then in people's medicine cabinets. Has anyone done any studies on contingency management techniques, which is behavioral management with incentives attached to change behavior? If you bring back your pills to our office and here's a gift card, and I know that sounds like that might not be effective, but there have been tons of opioid studies where contingency management has been really effective in changing behavior. I think that's a really good thought, and that's something that we haven't really thought about or done with our program yet. We have actually tried to build into our proposals with states, actually incentives to encourage hospitals to make changes to where they don't even need to prescribe those medications afterwards. We call them strategic data fees, where we'll pay the hospital a fixed amount based on the number of procedures that are supported through this program. Because we know that there might be a cost with referring patients through our program, or a cost to update their EMR to include some of these things that we really advocate for. So we've tried that type of contingency management with hospitals, not necessarily with patients to bring their medications back, but it's certainly an interesting thought. I think the challenge that at least I've run into in my experience is I don't believe pharmacies really want to take these medications back. And so finding areas or places to where patients can bring these medications to is a challenge. Drop boxes and drug take back days are great, except for the challenges with those is you have to find out when they are, where they are, and how to get there. And for many patients, that how to get there part is the biggest hurdle. You just had a knee replaced, and you're taking care of yourself, or you only have a friend to take care of you. You can't drive, how are you supposed to dispose of those medications? So we try to make it as easy as possible for patients, and our nurses will help to instruct patients on how to dispose of those medications. I don't think we've got a great system for those medications that are sitting in someone's cabinet. The take back days are sparse, and they're not well advertised. I'm just brainstorming. It'd be great to have that component. Let's incentivize patients and have an easy way for them to return those drugs and be rewarded for it. Sure, yep, good thought. So you said free, everybody likes free, but it's free in Tennessee. What is- Yeah, so how it works in the state of Tennessee is we had to apply for a grant. The state has a different, they have an OAC as well, an Opioid Abatement Council, where they are responsible for actually being the administrator for the state funds that are coming from these opioid settlements. So they have a competitive RFP process that opens every single year. We applied for a two year grant at the state to support a fixed number of surgeries throughout the entire state to support up to 20 hospitals. And within that proposal, it included the cost of employees, the nurses, my time, because this is certainly not a linear relationship when you start to work with hospitals. It's not just you go in one time and it's fixed, and then the cost of the tool kits to do this. We built in those strategic data fees, which I mentioned briefly, so it's a full package that comes with the proposal that we submit. And then once we got awarded the grant from the state, our work started to traverse the entire state to find interested parties and primarily hard hit, impacted areas you can imagine up in Johnson City, Northeast Tennessee, Appalachia, etc. Thank you. Any other questions? All right, well thank you so much. Thank you. All right, Carmen? Carmen's going to give us some updates about our proposals. All right, good afternoon everybody. So basically, we just have to circle back in regards to our meeting last week with some revisions for our recommendations. There were a couple things on there that we had touched base on and wanted to revise. One being the recommendation for setting aside funds for the health department, and so that is something that we would have to vote on because it was a conflict of interest, so that that is no longer a recommendation. And also there was questions about our recommendation number seven, which discussed housing, which we had a question come up about House Bill 5. And so since then, I have spoken with Brittany in legal, and she came up, we came up, well I came up with some wording to best highlight the things that we would want to do to be able to still support those in need of housing that have substance use and mental health issues, so we can take a look at that rewording to see if that's something that we can adopt and agree on to move forward. Brittany is here to provide more information about that house bill as well as to get us going to vote on moving forward with the health department recommendation. So in the packet, today's packet, these are the new recommendations that are revised. If we should keep them and vote to take that off from the health department. So I did not print that packet, or those set of recommendations again from last week, because that's kind of a lot, but yet the ones that we're moving to adopt. So once we review those two things, if we want to take a look at it, then we can move forth as heresies fit with the agenda to vote on those recommendations. Any questions before I leave? Brittany is also here to answer any questions as it pertains to recommendation number seven and house bill five. Do we need a vote on the amendment of the language to number seven? Yes, okay. There you go. She said yes. And would the group like to hear from Brittany a little bit about the research that she found about the need for the amendment, do you think? Yes, because I know she shared it with Ms. Baird, but if you could come forth and share it with the rest of the group, and then that would help you to better understand some of the things. I know one of the old, I have my packet from last week, and it sounds great because we want to meet people where they are and that kind of thing. But there was no preconditions, they didn't require sobriety, all those kind of things. We want to make sure that that wording matches that of House Bill 5. And look, handy dandy Brittany in the overhead, there we go. So yes, just for some context for the commission, Commissioner Baird asked whether or not House Bill 5, which House Bill 5 was enacted last year, it was codified into what you see up on the screen. And it does prohibit the expenditure of certain funds for initiatives to provide permanent housing to homeless individuals if those initiatives would lack certain requirements. So, I'll be candid, I don't know if this is the most clearly written statute that I've seen, but it would be my opinion that based on the language that I've highlighted there, regarding any restricted fund, because restricted funds are normally understood to apply to funding sources where state statute restricts how they can be used, and we do have that here, state statute does restrict how opioid settlement abatement funds can be used. That this could qualify, this could apply to restrict how these funds are used. So, just pointing a couple of things out though, by its text, it only applies to permanent housing. And the recommendation, as I read it, didn't really specify if this was permanent, temporary, transitional. So, if the recommendation were couched for transitional housing, as an example, by its text, this wouldn't apply. Alternatively, if there were the minimum initiatives that you see underlined in that last sentence, there also wouldn't be a conflict whether it's permanent or not. So, in the new one, I combine the two, the transitional, temporary, and added services, so that those individuals receive those necessary services, wraparound services, counseling, case management, job training, that kind of thing. And that's what you'll see on the new one versus the old one. Any questions for me about that? So, if we don't have any questions for Brittany, I'll entertain a motion to accept the amended language in number seven. Well, no one, I'll second the motion for the purpose of debate and conversation. So, second, because I still have questions. Do we have a motion? Yeah, that's what I was like. Sorry. It's okay, you're ahead. So moved. I forgot what the original motion was. To- To accept the amended language in number seven. I move to accept that, the amended language. For number seven. For motion, for number seven. Connie Neal, second. Okay, discussion. So, I guess I just want the opinion of the law department. So, is number seven in contradiction to what the statute is? Because our number seven- The original number seven. So, I don't know if you were here last week. I'm sorry if you were not. So, it was, what is it? Last month. Well, I'm looking at what's in here. This is from last month? The one, the packet from today is the revised one. Yes, ma'am. Okay, but it still says transitional or temporary housing models. So, we can have that as long as we have, is this correct? Yeah, because this just says permanent. So, it applies only to, by its text, to permanent housing. So, arguably, maybe my opinion, if you wanted to do a transitional housing model, then I don't think that this would apply to restrict the funding. I think there are a couple of ways that you could work around number seven with what this restricts. As it was last month, it didn't specify what type of housing and it didn't have any sort of requirements that were behavioral or rehabilitative. Okay. I mean, my understanding is, excuse me, last month's version looked very much like the low barrier models that we all know and value, I think, and see some value there that Jeff presented to us on at some point last year. But then the question came up, wouldn't that be a problem with House Bill 5, thus the amended language here to keep us in compliance, which is disappointing. Personally, I will say I hate that, because I do think that- It takes out that meeting people where they are kind of piece. There's a need for that, but from a regulatory standpoint, I guess we are where we are right now. I would agree with that. I think that we spend so much time on trying to get people into recovery that we're not doing enough for people who are either unable, unwilling, or scared of treatment in that moment. And all of the recommendations that we're making, yeah, we can provide naloxone to people who are using drugs in this moment. But the rest of it is just pretty much we only care about you if you're willing to go to treatment. That just breaks my heart, because I've spent 15 years or so trying to reduce that stigma and help people who in that moment just cannot get recovery or treatment, be that mentally, financially, whatever the case may be. And I hope that the commission will consider that when we have discussions. That there are several thousand people within this area that are using drugs. That these recommendations will not be available. And hopefully, with us making a recommendation for grants, there will be different programs that will be able to facilitate in those efforts. Although this may not be specific, but if they're able to facilitate in those efforts, then that will be able to lead them to the resources that they need. So can I, I'm going to say clarify, this is based on my conversation with you. And maybe it can be worded, I know there's a motion on the floor, so I'm just getting there in a minute. But my conversation with her when we were discussing it last time was more focused on permanent housing. Having known what that bill said is when I said, well, that might conflict. So my response to her was either you're doing, you can do both, but either you're going to do permanent housing with those requirements or transitional housing or temporary housing or what have you. Where you're not required to have those because it doesn't kick into that statute. So theoretically, you can have both. I don't think, the way it's worded, it kind of says one, but you could have both. You just have to make sure you're wording it correctly because of the restricted fund part. So if you're using restricted funds for permanent housing, you've got to abide by that statute. If you then say transitional or low barrier housing, that doesn't kick into that, then those treatment services are not, they can be provided but are not required to be provided. Does that make sense? Much better sense. Okay, so you can do both and it can be worded to say both. It may not, I don't think it's necessarily worded that way right now, but you can word it to say both. Does that make sense? Yeah, I was misreading what that meant when it was described to me. Yeah, I'm all on board for that, yeah. This may be a really dumb question, but since we're not talking about permanent housing, do we need to reference House Bill 5 in our language? Well, you don't necessarily. I would say you better be very clear about what it is you're saying in this recommendation so that you don't run afoul of that. So if you say something like transitional housing, not permanent, and the option to offer, I mean, I think you can say something like that. But you have to be very clear about how you're wording it and what you're saying. It just seems to me that when we're not talking about any language that's in House Bill 5, we're kind of changing that language, why do we want to tie ourselves to House Bill 5? You don't unless your recommendation was about permanent housing. Yeah, I would keep the comply with House Bill 5 in it, just for clarity purposes, that it's, that the intent of this is to maybe be directed to transitional and what are the terms, transitional or temporary housing, but with a nod that we recognize House Bill 5 is out there. We are in compliance with it. This program will be in compliance with it. I think it raises less, it might raise less questions. And it leaves the option open too, that if the time comes that we can provide permanent housing with these restrictions, the commission may want to recommend that. This is the time for us to get whatever it is that we need in the wording so that we can adopt it. I know there's a motion on the floor that we have to deal with about the amendment, but before we do that. Could it be that in our number seven I think of is our housing topic and we've all, from the beginning, no housing should be a piece of this. Could it be that there's a housing topic with two buckets in it? One for permanent housing, which includes all this stuff that has to be there. And another separate for transition and temporary housing that does not. Yeah, I think that's what Ms. Beard says, we could do both, but we would just have to word it as such. So are we ready to vote on this initial motion, which is to accept number seven as is? Well, I'm not, because I think I agree with Connie that I don't think we need to reference House Bill 5 if we're talking, if we specifically have transitional or temporary housing models in this, then I don't think. I mean, the statute clearly says permanent housing. And it was, from what I remember, this was to get, it was about housing, but yeah, permanent housing. When we're talking about permanent housing, we're talking about sober living homes or whatever. I feel like that's kind of what this is talking about. That you can't just redo a hotel with no services and put homeless people in it. In my understanding, the General Assembly said, no, you can't use funds just for that, there's got to be services connected to it when you're talking about permanent housing for people. If we're just talking about temporary housing, then I don't, I think it's apples and oranges at that point, so I do think it actually does confuse it. So in plain language, talking to the public, number seven for us just won't include sober living homes. Is that, I mean, because they won't fall underneath this. Well, I think this is an amendment to fix what that conversation was, well, the email conversation was, versus last month. So I guess here's your two options at this point. Number one, you vote it as it is. Number two, you vote the motion down, and you have two separate pots. Yeah, that's right. So either, and under number seven, under the new one, you would have one that says permanent with that language. And then you would have a subsection B that says temporary with that. And you can take House Bill 5 out of that one when you're saying it very specifically. So you either vote as you are now, or you vote the motion down and fix it and just say two separate category A and category B. Yeah. Does that make sense? And we can do it, however, because it's still in draft phases. Yeah. I just wanted to be clear for the public, are we going to, because it sounds like our intention is to cover housing in whatever form it is. But again, this right now doesn't cover a sober living home that may or may not provide services. So I'm just trying to make sure the public understands what these will be. And if we're covering, if we're allowing funds for both types of housing, so I guess, yeah, I guess we would have to separate it out and do that. So yeah, I just needed to be clear, because right now I know it wasn't really clear to me. So I think we need to go vote this one down and separate it out. So you don't want to put, this funding should prioritize permanent, comma, transitional, or temporary housing models, you want to have it separated? Yeah, you're going to need to separate it to make it very clear. So subsection A would say, could say, permanent housing that offers, and then you have to put the language of the statute, in compliance with House Bill 5. And then subsection B would say probably what this is, what you currently have now, you are combining the two when you say supportive housing with integrated treatment services. I think that's going to be the optional part right there. They can offer it, but they don't have to offer it. I mean, they can offer it, but they don't have to take it, I guess is what I'm saying, according to what John was pointing to. House Bill B would basically be as is with the services. And A, I guess I should have said that first, would be the permanent housing with the services, but as it complies with House Bill 5. Correct, so A is that. Yes. B is this, with the optional. Without the House Bill 5 option, with the optional. Yes. Do you think that covers it well? Yeah. Let's take care of the motion that's on the floor first. Yeah, is there any more discussion, and does everybody think they know what's, everybody clear on this first vote? All right, so the original motion was to accept the amended language that is in number seven in front of you right now. All in favor? Any opposed? I oppose. All right, so that motion's gone. How are we going to go to work on a recommendation for a motion for the second version? Just rewording for that, yes. Do I need to make that motion? Or does Kim need to make that motion, because she's said so well so many times. Do you want me to make this motion? And try to remember what I said? Okay, so. Okay, you got it. Okay, so I move that we amend number seven to an A and B section. A would be for permanent housing with the services that are outlined in House Bill 5, the 198A027, to be in compliance with that. And that subsection B would be pretty much the wording that's written under subsection seven now regarding temporary or transitional housing with the option of the integrated treatment services. John Moses, second. All right, we have a motion and a second. Is there any discussion at this point? Okay, so I'll work on that and make sure you all get that before moving forward. But we need to go ahead and vote. Yes, you got to vote. Oops, go ahead. We don't want to use that prioritization element as well. Remember we said- I can't hear you, Dr. Woods. I just want to make sure that we don't lose that language of the prioritization of temporary and transitional as well. Just suggesting that, so. Well, ultimately, once I tweak it with the recommendations, then you guys will vote on it again, so if we lose it, we'll bring it back. But I'll keep it. Although I think the way you've worded it is probably- Yeah, I'll keep it and just do the additions. So now we're voting that you are going to redo number seven, bring it back to us, and then approve it? I mean, if I would think that we would have to, and Brittany, you can help, do we have to vote on this all at once to move forward, or can we do it now once those recommendations- I think you could do it now. You've already done with the other ones, and you've got the motion to approve it. So I'll make those recommendations. If you guys vote on it, whatever, we can vote on it now. I'll make the, not recommendations, revisions to the recommendation as stated, and then you can vote on it. Yeah, say that. So I think, once again, is there any discussion about it? Just one more comment, and I think maybe to prioritize that, we could make A, temporary and transitional housing, and make B, the permanent housing with House Bill 5. If that will help to prioritize. Just switch them. So you're saying, Mr. Moses, to keep both of them AB, but to put for A, the transitional and temporary, and B, the permanent? Okay. I have a question. I don't live in the housing space. So, will it be clear to people seeking grants, the difference between permanent, transitional, and temporary? I can probably answer that one. I would say most definitely. Okay. I deal with that frequently with the grants department. Is anybody in front here from grants? My instinct would be yes, that will be clear. Yes. And then, ultimately, of course, these recommendations, once we agree upon them and vote on them, they'll go to the mayor. And if she has any questions or wants us to elaborate, then we can from that point. Okay. Okay, so while I'm up here, do you want to go ahead and revisit the health department allocation so that we can vote and do that the proper way? Do we still need to vote on this one? Yeah, we didn't say. Okay, so we have a motion and a second on the floor for our number seven housing topic to have two sections. Number A, the first one, to apply for transitional and temporary housing. And number B, the second, to define permanent housing opportunities that are in compliance with House Bill 5. All in favor? Aye. Aye. Aye. Any opposed? All right, motion passes. Okay. Thank you, Carmen. You're welcome. Stick around for this next one to make sure I remember it correctly. So in this packet, last month, there was another item on here that was based on a recommendation to allocate funding directly to the health department for harm reduction type of services. The discussion as of last month was, because we went in the same direction with the schools and other identified entities, that would it be better to not have that direct recommendation to the money to go to the health department? And instead, the health department be an obvious candidate for applying for grant funding throughout the rest of the, whichever other item in here that we have already approved, that will allow organizations to apply for grants. Right, so although harm reduction and our partnership with the health department is much appreciated and valued, that would be seen as a conflict of interest, so Brittany can help us moving forward with that. Just to recap a bit what I've said last month for those who weren't here. So under Article 16 of the Code of Ordinances, which is applicable to this commission, if you are employed by an entity that would receive a direct financial benefit from something that is in front of that commission, that is defined as a conflict of interest that would require first disclosure of the conflict. That's the first thing that has to happen. But second, it would require recusal, so you could not participate in the discussion or vote on the matter. We recommend in the law department that if recusal is required, that you actually leave the room when that matter is up. It's just best practice. I can't make you do that, but that's what we recommend. So that's what we're talking about right now. So, with that being said, Mr. Moses, can you step out for just a couple seconds? Okay, thank you so much. And then we'll discuss that, and then we'll vote, and we'll move forward from there. Thanks, Brittany. So, again, the conversation last meeting, and I think we didn't have a quorum to vote, potentially, without John. Yes, we had a bare quorum. Yeah. So the conversation was just, you know, we approved all of the other items under the thought that organizations would be able to apply for grant funding. And totally recognize the importance of the health department's harm reduction model, and that they're the people who've really been down and dirty doing the work for years. So no conversation there whatsoever about their deserving of financing. It was more about, you know, do we really have the right, or do we really want to chisel any one entity out to be able to apply for that funding when we're not doing that for other entities? Anybody else? Does that sound pretty? I have seen these before. Further, we voted that direction for Fayette County Public Schools to be, along the same lines, able to apply for grant funding, but not necessarily chiseled out as their own piece within the document. If I could just add to it. I think, maybe hopefully, soften the conversation from last month's, is that we know, like you said, this is an important organization, and we want them to get monies to continue to do the awesome work they're doing. It's just, there's many other organizations that we didn't carve anything out for in the same manner. We did for the jail, but that's the city government, right? That's all connected to the city government. So that really, to me, was the initial sort of piece. It was like, I felt, oof, there's a lot of other organizations out there that we should probably also, if we're going to do that, have a long list of other people that we consider to recommend to the mayor to give directly to them. There's a platform for all those organizations to submit to, and I would imagine everybody that we represent here. I'm sure Connie's group is. I'm sure Terry, you'll have something. And you know UK's going to have something, and all these other groups. But it's a platform for us to be able to analyze all those things and say, they've got a really good plan for doing this. And we know the work they're doing, so we're going to make that recommendation. And that, to me, given that to the mayor, just feels solid. Feels like a solid recommendation, so. It wasn't to take anything away from John's organization, so. And I think he understands that, so we just can go ahead and move forward. He's okay with that, so. Okay, so I will accept a motion to remove a direct allocation to the Health Department for Harm Reduction Services to reflect the current document that we see in front of us. Where it's no longer present. Connie Neal, I make the motion that we remove the separate allocation for the Health Department, allowing them to apply for grants along with other community agencies. Angela Evans, second. We have a motion and a second. Is there any discussion? All right, all in favor of removing a carved out allocation to the Health Department for Harm Reduction Services, say aye. Aye. Any opposed? Motion passes. Carmen, for the next item, review, revise, and adopt recommendations for finalization, are we still doing that for the full package, even though we've done each one individually? The only changes are the ones that were mentioned, so you can do as you please. I think you have to adopt to do the whole package to send to her for recommendations. Okay, so what we- And the revisions were made for number seven. This is kind of like a finalization. Yeah. Yes, we agree, we're sending this forward, so. With revisions. What we've got right now are items one through seven, each have been addressed individually. Number seven has some amendments that we just voted on earlier. John, we voted to take away the eighth directive to the health department. So I will accept a motion to accept this package, including number seven amendments, for final approval to go to the mayor's office. Once number seven's revised, is that? Yeah, with the amendments of number seven. Were you bringing that back before us next month? Were you bringing number seven, the revised number seven back next month? Did you say that? Well, that was something that they asked, but they said you didn't have to if we worked out what needed to be said and what it needed to entail. Okay. There's a motion maker over there. Do you want me to do it? Mark's going to do it. Are we making a motion for this? Okay, so I make a motion that we approve with the adjustments, I think, that are going to be made to number seven and the removal of the recommendation for the health department, that we approve these finalized recommendations to be given to Mayor Gordon. Is there a second? I'll second that motion, Margaret Piscicano. Right, we have a motion and a second. Any discussion? All in favor? Aye. Any opposed? Motion passes. Can I ask one question? When do we anticipate that'll happen, or how does that happen? Is that just an email, or is that tomorrow, or is that? Not tomorrow, it's Saturday, I am off. Hopefully by midweek, and I can send it all out to you guys prior to sending it on. But I'll keep you in the loop, the commission in the loop. Carmen, do we have anybody for open comment? We do, Erica Davenport. All right. Ms. Davenport, we'll just remind you to stay on the microphone there. If you get too far away from it, the online situation can't hear you. Okay. Second the motion for that file. Margaret. Good morning. My name is Erica Davenport. I represent TETO. TETO is very dear to me. TETO stands for Attorney and Securities to Opportunities. That's my organization of a transition home for women. I know you haven't heard of me yet, but I'm working and striving to bring my vision to life. I am very involved in the community. I am putting together a community picnic for people who struggle with mental health, really for everyone. I just wanted you guys to know who I was. I will be presenting next month with more details on my organization. I just wanted to thank you for allowing me to be in your meeting. Thank you. Thank you. Thank you. Anybody else, Carmen? All right, I don't think we have any more items of business. I will accept a motion to adjourn. Angela moved. Is there a second? I second the motion. All in favor of adjournment? Aye. Aye. Any opposed? Thank you all. Thank you. Thank you. 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