REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
July 23, 2024
FROM
LUTHER SNOKE, Chief Executive Officer, County Administrative Office
SUBJECT
Title
Revision to Opioid Settlement Funding Expenditure Plan
End
RECOMMENDATION(S)
Recommendation
1. Approve the revision to the County Opioid Settlement Funding Expenditure Plan to address the opioid epidemic within the county.
2. Authorize the addition of five positions to assist with the opioid initiatives for the Department of Public Health, under the following classifications:
a. One Public Health Epidemiologist, Professional Unit, Range 56, ($64,126-$92,643)
b. One Statistical Analyst, Administrative Unit, Range 56C, ($69,264-$95,222)
c. Two Health Education Specialist I, Administrative Unit, Range 46, ($53,352-$73,341)
d. One Health Education Assistant, Administrative Unit, Range 43, ($49,566-$68,203)
3. Authorize the addition of one Administrative Analyst II, Exempt Group, Range 66C ($90,064-$128,274) position to assist with the review and analysis of various administrative work pertaining to the opioid epidemic and other projects for Human Services Administration.
(Presenter: Georgina Yoshioka, Director, 252-5142)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of additional Discretionary General Funding (Net County Cost). It is recommended that, upon availability, the County set aside an estimated one-time amount of $14,116,519 of opioid settlement funds received from several pharmaceutical companies and $7,267,425 received to assist in addressing the opioid epidemic within the County for 2024-25. The estimated amount of $14,116,519 one-time and $7,267,425 annually, as long as funding is available, will be included in a future Board of Supervisors’ (Board) action or recommended budgets, as needed.
BACKGROUND INFORMATION
The County has been a party to several settlements against pharmaceutical companies for their involvement in the opioid crisis across the country. To date, the County has secured $13,060,132 in settlement funds and anticipates receiving additional funding spread over an 18-year period to be used to combat the effects of the opioid crisis.
On July 11, 2023 (Item No. 21), the Board approved the County Opioid Settlement Funding Expenditure Plan allocating $23,500,000 in available opioid settlement funding toward the following three strategic initiatives: 1) The Department of Behavioral Health’s (DBH) Substance Use Disorder (SUD) Services ($2,100,000), 2) The Department of Public Health’s (DPH) Opioid Response Initiative ($1,400,000), and 3) DBH’s SUD Withdrawal Management/Residential Facility Infrastructure Support ($20,000,000).
To continue and effectively address the opioid crisis within the County, DBH, and DPH are requesting a revision to the previously approved County Opioid Settlement Funding Expenditure Plan and to allocate $21,209,602 in available opioid settlement funding toward the following three strategic initiatives:
|
Department |
Initiative |
Type |
2023-24 Approved Total |
2024-25 Revised Total |
|
DBH |
SUD Services |
On-going |
$2,100,000 |
$5,218,083 |
|
DBH |
SUD Withdrawal Management/Residential Facility Infrastructure Support |
One-Time |
$20,000,000 |
$14,116,519 |
|
DPH |
Opioid Response Initiative |
On-going |
$1,400,000 |
$1,875,000 |
|
Total |
|
$23,500,000 |
$21,209,602 |
The DBH SUD Services Initiative will consist of the following investments:
• DBH and Children and Family Services (CFS) Collaboration ($600,000):
DBH continues to collaborate to address the County’s youth substance use problems involved in the child welfare system by expanding inter-department collaborations through screening, linkage, substance use treatment, and care coordination. An estimated 120 youth are anticipated to be served, resulting in increased education, recovery, permanency, and lifetime abstinence.
• Criminal Justice Population - SUD Services ($600,000):
DBH will continue to provide SUD outpatient services at several County Probation Department Day Reporting Centers for approximately 200 clients This funding supports the implementation of SUD outpatient services at the San Bernardino location.
• Pacific Village Phase II - SUD Services ($900,000):
As part of the Homeless Initiatives Spending Plan, adopted by the Board on March 23, 2023 (Item No. 21), the Pacific Village Phase II expansion includes the construction of a new 16-bed withdrawal management/residential facility, serving approximately 350 individuals annually. The Pacific Village Phase II construction is not projected to be completed until April 2027. Given the construction timeline, DBH is requesting to reallocate the previously approved funding to existing withdrawal management/residential treatment contracts with community-based organizations until Pacific Village construction is completed and fully operational. This will allow DBH to expand the number of beds in the meanwhile to meet the needs of the community across the county.
• Targeted Overdose Prevention and Outreach ($50,000):
This new project will provide targeted outreach using opioid dashboard data to address community needs. Strategies will include educational information and awareness on fentanyl, stigma, and treatment information. Outreach will include providing overdose prevention kits and training on their use to community members in the identified areas servicing approximately 1,400 individuals. In addition, targeted outreach will be made to high school staff, students, and parents using youth friendly resources and skill-building trainings such as Naloxone administration. DBH intends to purchase overdose prevention tools including Narcan (Naloxone), fentanyl test strips, Deterra drug destruction pouches, and educational materials This project would:
1. Expand existing County outreach efforts by increasing access to naloxone and providing education to adolescents, parents, and community members.
2. Reduce harm associated with fentanyl use.
3. Expand access to SUD treatment to help individuals address their substance use and reduce risk of overdose.
4. Foster collaboration between community-based organizations, school districts, healthcare providers and individuals with lived experience to expand current overdose prevention strategies.
• Expansion of Withdrawal Management/Residential Treatment Services ($3,068,083):
DBH has a contract in place with Phoenix House Orange County, Inc. (Phoenix House) to provide withdrawal management/residential treatment services on the St John of God property for the contract term of January 1, 2024 through December 31, 2028. Phoenix House is currently pending Drug Medical Certification from the Department of Health Care Services. Once certified, Phoenix House will be able to provide 24-hour care for withdrawal management/residential treatment and expand its capacity from 40 to 66 beds, serving an additional 271 residents annually who are in need of this level of care. This expansion will provide additional access to residential treatment in a high-need area of the county where the high desert region represents 30% of all consumers served in the SUD Continuum of Care countywide. The opioid crisis has contributed to the primary diagnosis of opioid use disorder across the SUD Continuum of Care and is the leading cause for the need for this service.
The DBH SUD Withdrawal Management/Residential Facility Infrastructure Support Initiative will fund a Capital Improvement Project to renovate a facility which provides SUD withdrawal management and residential treatment services to residents countywide. On April 11, 2023 (Item No. 44), the Board approved acquisition of 29.5 acres, including a 17,770 square foot facility in the City of Victorville. This is a 60-bed facility that has a capacity to serve 960 individuals annually. The cost of this Capital Improvement Project was initially estimated to be $20,000,000. However, a more recent estimate was conducted and received on April 4, 2024 which has revised the estimated one-time cost of the project to $14,116,519. The estimate includes the remodel of the existing withdrawal management/residential facilities, new driveway, and upgraded furnishings.
The DPH Opioid Response Initiative aims to promote healthier communities through increasing awareness and education regarding the dangers of opioid use and consists of the following:
• A Countywide Data Dashboard ($446,652):
DPH will continue to enhance the Countywide Data Dashboard to respond to the opioid crisis within the county. Utilizing Business Analyst Pro, this dashboard will potentially integrate Geographic Information System mapping, demographic, and location analysis to provide a comprehensive and actionable conceptual overview of the opioid crisis. This tool will help provide insights that can advise on potential areas for healthcare service enhancements and harm reduction strategies by analyzing geographic and demographic factors. Additionally, Power Automate will be utilized to enhance responsiveness by setting up automated alerts that notify public health officials of sudden spikes in overdose incidents, thus facilitating timely interventions. This dashboard aims to support the DPH in identifying intervention opportunities and advising on service delivery enhancements across the county.
• Friday Night Live (FNL) Program Expansion ($662,851):
The program expansion is a youth-based/youth-driven program aimed at preventing substance use/misuse among youth and promoting healthier lifestyles. The program builds leadership skills for youth and provides advocacy opportunities in their communities. Expansion efforts include integration of social emotional learning components, emphasis on educating middle school and high school aged youth and parents on the dangers of opioids through focus groups, parent forums, and media-campaigns targeting FNL aged youth. These funds will support efforts to increase FNL chapters 35% over academic year 2023-24 numbers; deliver a minimum of two parent forums/focus groups in each health planning region; host a social emotional learning conference for youth with a goal of 50% increase in youth participation over 2024 attendance; and launch a social media campaign reaching youth across the county.
The planned expansion targets additional school sites/school districts across the county and support a media campaign in collaboration with DBH.
• Outreach and Education ($765,497)
This program is a combination of two previously approved initiatives: Street Level Outreach and Overdose Prevention kits. It is focused on increasing awareness and providing education on the dangers of opioid usage to the community, including unhoused individuals, throughout the county. The program includes strategies to avoid substance use and information on seeking treatment resources for those in need as well as distribution of Naloxone and related resources. Education venues may include small/large group presentations, community events, as well as street-based outreach interventions. Also included is the ongoing purchase of supplies for overdose prevention kits. The kits will include, but not be limited to: fentanyl test strips, Narcan/Naloxone, instruction cards, resource list, face shields, and limited first aid items such as Band-Aids, etc. These kits will be provided to community members, community partners, law enforcement, and individuals at post-release from County detention facilities. Education training opportunities will also be provided to law enforcement agencies, as needed and appropriate.
To provide administrative support for the County’s opioid initiatives, Human Services is requesting the addition of one Administrative Analyst II ($124,530 salary + $49,812 benefits = $174,342). This position will review opioid regulations and make recommendations for County compliance, develop and manage County opioid budgets and fiscal processes, and review and complete reporting requirements.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on June 18, 2024; Behavioral Health (Tan Suphavarodom, Deputy Director of Administrative Services, 388-0826) on May 30, 2024; Public Health (Janki Patel, Assistant Director, 387-9146) on May 30, 2024; Human Resources (Gina King, Assistant Director, 387-5560) on June 26, 2024; Finance (Chris Lange, Deputy Director, 386-8393) on May 29, 2024; and County Finance and Administration (Cheryl Adams, Deputy Executive Officer, 388-0238, and Matthew Erickson, County Chief Financial Officer, 387-5423) on July 2, 2024.