Budget Work Session - Day Three

Everyone, thank you so much for joining us for our May 28th budget work session. We will be beginning today's presentations with the department of social services and we have director clap here and uh Joanne Pierce.

Good morning. Joanne Pierce, assistant county manager. I will present the director. Um Maggie Clap of social services and Margaret Fair uh cow. Thank you. And before they get started, I'll make a couple of remarks. Some of the conversations that we will have this morning are um discussions about future funding and the challenges that we'll see not necessarily in 26 27 but 27 28 and beyond. Uh when we plan these budgets, we adopt them for one fiscal year. We have a five-year look that we try to make sure that we do as we manage the horizon. So, um DSS is one area in which we do foresee on the horizon based on federal and state changes some potential impacts to the local funding um budget that are um quite significant. And so just wanted to give you the context for some of the conversations that we'll be having today and we will have some follow-up discussions at our next conversation about that.

Thank you. Uh good morning board of county commissioners and county manager and county attorney. Um I'm Maggie and this is Margaret and so we will get right into it. So some of the things that we have to

look for um down the road with um Durham DSS budget is the FNS cost. So FNS is food and nutrition also known as SNAP. So that has been changed um and we'll go into that under the new federal bill. Medicaid, children and family services and adult services. These are our main four programs that we're looking at for budget reasons. Good morning everybody. So, I will jump right in. Um, so, as we stated earlier, we're looking at roughly a 2 million um decrease in our administrative costs for um fiscal year 27 um with the food nutrition administrative changes. Um please do understand that this change is not tied to the error rate that you'll hear us talk about. This is not tied to that. Um looking forward into fiscal year 28, it will be a larger um decrease um because we will be at the 25% federal, 75% county. Um the reason and we're looking at more of a 3 million um decrease that could be a little bit more. Yes, ma'am. So I can be better understand like if you can say 25 75 like a lot of these things I don't I want to make sure I have a clear understanding what it is and so when you say that I'm trying to figure out okay what does that mean?

Yes ma'am. So, it is 25% federal reimbursement that we receive from from the state. It comes from the feds, but we we it passes through the state. So, it's um 25% federal dollars, 75% county dollars

for staff for staff

for staff for Yeah. for our

administrative costs for our staff. Currently, it's 5050. 50% federal, 50% county. The change will go into effect October 2026. So the first quarter of fiscal year 27, we will still receive the 50% 50%. Starting in October 2026, that's when the reimbursement rates will change. And then of course into fiscal year 28 and forward, um it will be at 75% um county, 25% federal. Um,

and can I just add, Margaret? Yes, ma'am.

In some states,

the states are helping with that administrative costs. They they are making sure that the burden does not fall on the local level, but at this point, is it correct that that it is we are not seeing that happen here in North Carolina? Our general assembly,

that is correct. and the state um our at our state level they also re receive reimbursement and their reimbursement is also cut um the same as um the counties. So um currently now they're not looking to pick up any of the the cost to relieve that burden on the counties. Um, so, um, I hope that the state continues to lobby, um, because they're hitting getting hit with this same, um, reimbursement decrease that we are to the next. Is it working? There we go. Okay, this one, this is our benefit cost. So, this is actually the costs that go on the EBT cards that our clients receive. Um, currently, and this is the one that is tied to the error

rate. Right now, the state error rate it is at 6.92%. This is better than when we had our um BOCC retreat, which was, I think, was at 10% at that time. Um, so the the state is currently working to to get this error rate decreased. Um the change in this is where if we are if our error rate is bel above 6% we will have to pick up a portion of the benefit cost. Currently the county does not pick up that cost. if the error rate um it in the future when the error rate um changes and I I should have put the exact date on here um but when this goes into effect we will have to pick up a percentage of the cost if the state error rate is above 6%. So in the chart I've showed you what it would cost right now the benefits that we have paid out um meaning that they have used I look at an issue um report so that's where they take their card and they actually use it at the grocery store. So if they have $100 and they use 95 my numbers pick up the 95 just just so you're aware. So currently um there has been 57 million to date through April um for Durham County. I went ahead and projected out two more months to put us um to look at what a yearly benefit cost would look at um and then did the calculations for you. So if our error rate is above 6% between the six and 8% um our cost would be 3.4 million and then it goes on. If it's 8 to 10, 6.8. If it's above 10, you're looking at 10 million. Um, so it's really important that that we work to

keep the error rate down. And it doesn't matter what DURM's error rate is, it's what the state's error rate is. Um, any questions?

Yeah. And the reason I ask these questions because when we go out into the community and people want to understand better, we want to make sure that we're giving them, you know, good correct information. So when you say when they say the error rate that means like the people who qualify for how much benefits is that what the error rate stands for? Right.

So the the error rate refers to um when someone comes in and applies for benefits. It could be um our error that we keyed in something incorrectly or it could be a client's error. So, let's say the client um did not think about their entire household income as they should. Maybe their, you know, partner was doing Uber and they left that off or something or um during the application process they ended up having another child or something. That could be an error rate then that gets picked up. So, unfortunately, the error rate is combined as one. So, it doesn't matter if it's a client error rate or if it's if it's um a staff error rate. And so, that's what that refers to. Um, and I just want to also say that as you're looking at this, we also need to think about the cost to the community. Um, if SNAP goes away because we don't get this error rate down, you're looking at 68 almost 69 million not going into our local grocery stores. Um, so that's another thing to project out there if this doesn't get resolved.

Also, Durham County's error rate is not is below 6%. Is that correct?

Not at this time. It was um in December. So, what's happened is um for the size of our county, they are only pulling um about three cases a month. So, if you have one error in one of those cases for Durham County, your error rate is going to go way up. So, in December, we didn't have any. So, that's why our error rate

was at 1%. Since then, every month, we get three cases pulled. So, I think right now, our error rate is at 18%.

Oh, wow.

Yeah. But that's um however I will say this. I'm aware that in other counties the state right now is micromanaging their FNS program and the states who are not doing well know that. We have not had any contact with the state about our error rate because I think as they notice pulling three of our cases a month for the size of our county is not a real adequate sample. So considering um and we're managing our own error rate internally because the state is about 3 months behind. So, we're tracking it internally monthtomonth so we can stay on top of that. So, again, I don't think the state has a real concern about our air rate because I know in other counties they've are really in there um with state staff kind of helping them and micromanaging that. We've not had that. Not like you. It does not like me. Oh, there we go. Okay. to go ahead and um paint some of the picture. Um because if I don't know if you noticed on the previous slide, there was um our total benefits cost for last year was like at 77 million. This year it's like 68 million. That that is a decrease, a significant decrease. Um but we've also had um several changes to go into effect um in the current year with the work requirements um um being one of one of the big ones. The um the citizen um eligibility changes, but I wanted to give you a snapshot of what it looked like in October of 2025 and April of 2026. So in October 2025, the total number of households receiving

benefits was 16,000 um with an expenditure rate of 6 million. And then in April of of 2026, this past um month, total households was 14,696 with an expenditure of 5.3 million. So, it's a a roughly a 10% decrease um in in usage um of the the benefits to with the households. And so, just something to think about in the bigger picture, that money is not coming into Durham County and those families are not getting food benefits. Um which is critical. that is a great deal of people um not receiving food benefits anymore that qualified for them and would still probably qualify if not for the work requirement and the non-citizen. And we don't know yet which um population is impacting this more if it's the work requirement or the non-citizen eligibility.

This is very concerning. I mean, this is this this is a red flag to all of us to see that already in basically a six-month period um the number of people uh families being provided food assistance declining 10%. in just six months. And at the same time in our budget this this year in the proposed budget I think is just 350,000 for food security grants. So to me this is a really big red flag about um what we're going to be seeing and facing with people who are losing access to food benefits. And as you noted also just the impact on our overall local economy with um less um money going into our local grocery stores and things like

that when when people are losing their SNAP benefits. Do we have any way of staying in contact with them? Is there any process where we follow up and make sure they know where there are local food resources? Are we is there any anything like that happening?

Not at this time. A lot of this could be though through EPASS which means we might not even know um at the county level and also just to be honest the manpower is not there. um we're having to our we don't have any additional staff but our staff are having to work on the work requirements and we still have to process every application that we get even if they don't end up getting benefits. So at this time it could be that we don't know because it's going through EPAS and the state denies it. Um or it could be through us that we know but we would not have the ability at this time to manage that. Well, it just makes me feel like I understand the burden can't just be on you, but how can we then working together with all of all of our departments um be pushing out information about food resources?

Yeah, I definitely think we're going to have something on our website. We're working with some other community partners um by the end of the year to have resources and we can continue to push that out in social media and we can have flyers in our building. But as far as tracking, we're limited there. I'm going to move on to to Medicaid. Um while there are lots of changes um again with eligibility um work requirements um and then the redeterminations um for our expanded um Medicaid um every six months um will be a staff impact um

for that as well as the the work requirements because they have are required to follow up um and verify that as well. So, both those bullets are staff impacted. Um, however, I I do want to make sure that it is understood that there's no changes in the reimbursement for Medicaid for our administrative staff. So for our staff determining the eligibility, we will still receive 75 75% federal dollars um for those staff, 25% county. As long as we continue to have Medicaid expansion, we will also receive the additional um 704,000 is what they're estimating um for um fiscal year um um 27. I put 26, but I meant 27. um this year was an average of like um a little over 600,000. But that um there's no changes in in that right now. However, um I do want to emphasize while we still, you know, are not asking for any positions. Um we will have to evaluate once um they start doing the work requirements and the six months um redeterminations what that is going to look like. And just we didn't say this, but FNS, Food Nutrition SNAP is already doing this. That went in effect December. They're already having to do um six months eligibility reviews. So, um this is this can be a a a big burden that we will continue to to reassess um and how that is working um with with our staff. Um I kept this slide. kind of went over this once before that the keep in mind this is you know that press on Medicaid expansion if Medicaid expansion were to get pulled we would lose that 700 um

thousand additional dollars um and then there's the you know the loss to our citizens as well. So that that would be a huge impact on them and we would have to re-evaluate our our staff because at the time we still have to do the eligibility when they come in. So we would have to see what that impact would would be would you know the level of staffing that would still be needed um if they did pull Medicaid expansion. But just keep keeping that piece in mind. Before you go off that slide, that bottom bullet point really jumped out at me. I mean, the Medicaid expansion is associated with 422 fewer CPS cases per per 100,000 children under age six statewide. So, here we have it.

Yeah. that uh I've am on a committee in in the state and I recently learned this stat and I was um and I've done we've done the research on it and uh it's accurate and it makes sense because you have um you know Medicaid expansion covers um people that weren't traditionally covered by health insurance and under the even under the affordable healthcare act it was too expensive and so that adds additional stress on people when you're trying to keep one member of your house alive with critical medications and doctor's appointments But then you also have food costs um and health insurance and everything else rising. So that does add added stress. Um and I will say with the affordable health care act um costs have gone up this year. So they have seen less people enroll in uh the affordable healthcare act due to the increased cost.

And have we seen already a decline in our are we tracking our Medicaid numbers?

Yes, we haven't seen a a decline yet. Um we've stayed pretty steady throughout the state in Durham.

Um the next one um just taking a look at child and family services. Um we this is one thing keep looking into the future. We do want to keep

closer to you.

I'm sorry. Is that better? So keeping in mind just some things um for the future. We are have recently went into pathn C. Um while going into PA pathn C there was policy changes um that significantly increased um the immediate um um investigative track assignments and their immediate response times of the um 24-hour response time frames. Um and this gives you a snapshot of how our family assessments um case loads have increased. are investigative case loads increase and just increase across the board where we have not asked for the positions currently that's caused um staffing um we working to fill current positions um so we need to to fill current positions so we can continue to evaluate but I I do want to point out um the state recommends one worker per 10 fam families um if we're staff path. We're still averaging about 20 workers per family. So, um, director clap is 20

per worker.

Yes.

Yeah. Um, anything else? Oh, also one thing that um um I will let director clap speak to, but we're also looking to kick off um our fatherhood initiative um in in the next year and then get it up and and running in in the um concurrent years. Could you please um just give us a little overview about PATHNC and also the fatherhood initiative and just noting the in incredible um increase in now the cases that by law are that

you all are required to investigate?

Yes. Um so Pathn C was um North Carolina did not have a central uh case management system for all counties um to be in. So each county had their own system. We had Traverse for the past couple of years. So Pathn is rolled out um for CPS investigations and in November we'll be rolling out in permanency planning um which is foster care. Um, and so when they rolled it out, um, for us it was November of 2025, we immediately saw the impact because as Margaret said, when they rolled out that new database and, um, case management system, it came with new policies. So, um, usually you'll have, you know, some cases come in, it's an immediate response. You have to go out there immediately. Some is 24, some is, um, 72 hours. So what happened is the a lot of them that had initially been 48 or 72 are now immediate. Um and that requires our you know staff to turn around and keep going out and out and so there was no way for any county um this is throughout the state um that we've seen this increase in cases and we also had our old cases and traverse that we still had to close out. Um so that is where these case load numbers are coming in. We have just um as of yesterday we have uh closed out all of our cases in traverse. So now we are just working in pathn C which is going to make things easier but the immediates are still coming in every day. Um and so that's that's an impact. Um we have asked the state to look at that. They are um but in the meantime it is impacting all of us because all of us are having retention issues with this and um the ability to recruit. we're just not seeing it across the state that we're getting a lot of candidates. Um the fatherhood initiative is something that other uh states have looked into. Uh Virginia is doing a great job with at Oregon. Basically, it's that we know fathers have to be at the table for um families. So, you know, historically child welfare has dealt primarily with

the mother and not the father. And we now know that that cannot continue. Um and so this is we have identified a position um for it um that we've already had um that's already started. We've done surveys with the fathers um in the county. We're continuing to do more work. We're going to hold a Father's Day event. Um but our goal is is to can to continue to bring fathers to the table. Um and so that's changing our internal policies, the way we do things throughout the whole agency. My goal is is that every time one of our staff, whether it's in Medicaid, FNS, child support, talks about fathers and if they're not at the table, how we can get them there. Um, so that's the fatherhood initiative, our lowincome housing relief. Um for fiscal year 26 our total support that went to the citizens was um 1 million263588 which is slightly above the the one 1,250,000. Um so overall we approved 815 households um um with um 278 um denials. So I to me that that is very successful. Um um it worked really good this year. We we did not run out and um exhaust our funds until I think it was um ear late March or early April. Um and and ideally from financial standpoint that that that was great timing. Um there are going to be a few changes that they want to look at with with the policy. Um overall it is just making them in line um as some of our citizens supply a social security um document

versus um their tax return. So and when looking at that it is whether they're pulling from the the net or the gross. This is going to make it where they're pulling from the same. So, if if um we're both have an income level of $2,000, we're going to get the same equal benefit no matter whether we use our tax return or our social social security to provide um documentation. And then the other one is just um um verifying zero income households. Um before it was just an um at a test station um without additional verification. We're just going to ask for some verification and that's in line with other program. So that way we're sort of treating like cost alike um for that program. But that this was very good and and and um worked very well with partnering with the um city on this.

And did y'all um so you said that we didn't exhaust the funding till like April. So, how many of those 278 denials were related to loss of funding versus like actual they didn't meet the criteria?

Um, I would have to get that for you. I I think this was the criteria. I I think once they were out then they did not continue with applications. We sort of shut it down um since we there was not anymore unless we were going to add money to it. So, but I will verify it for you.

Thank you. And and I had a question too. I wonder how of those denials like how many people were just like right at the line with the income. Um like they were they made $200 more than what the threshold is because you know that that's a lot of people who may are living off of their pensions. State pensions aren't going up. um and you know wondering how we can help individuals like that. I know there was

someone that I know personally who said they just missed it at the cut off and so I was just curious to know that. And also adding to that, not just um the fixed incomes, but also I know we've had previous discussions about how some people may get pushed out of the criteria limits because of other benefit programs that they're eligible for and they kind of have to choose um do I get SNAP benefits or do I get my property tax relief? And is there ways that if we adjust the criteria that like multiple we could allow folks um we I will check with program on that. Um for this particular bro program I don't think that comes into play um for for this particular program but I will verify it for you and I'll get the other information as well.

I have one comment about that. I think it would also be helpful for the board to see the historical um levels that were criteria. I know we've increase the eligibility um standard to a higher level than it was when we first started. And uh y'all may know that right off the top of your head. If you don't, no worries. But there has been an intentionality as we've implemented this program to revisit how it meets the needs of our residents and as we could afford a higher level of reimbursement. We've adjusted over the years and so I I would say it's at least 20% higher if not more than where we started. Um but that context may be helpful as you share that information. Yes, ma'am. Manager Haggar, we will get that. And just so you know, this is the first year that we exhausted the the funds. Um, so it it made a difference in changing the the requirements. Um, um, so we did feel

that it it definitely was an overall success.

I ask, did we see like a huge Oh, sorry, James. uptick like when people got their um would you say that it was like pretty evenly spread like monthly or when people got their new property tax valuations we saw like a a jump?

I I the staff said when they saw the property there was a jump. Yeah,

but we can get that for you too so you can see.

Yeah, I think the trend data would be really helpful. Um, from what I'm recalling, this is definitely a much larger number of households that qualified than we have before. Um, I'm just wondering though that I think the current budget um keeps the funding flat for this program. Is that correct, Manager Hager?

Yes, the current budget keeps it flat. Um as with um all of the budget, we will determine in the new fiscal year if realignments are required to cover gaps and if we can adjust it in that way. And so um for this year's budget it was 1 million can't remember

1,250,000 for um services.

Okay.

For the clients.

Okay. And and that's city and county contributions. county and that's another area that we talked about from the beginning is if there was a need that was higher we would come back and revisit um our capacity to do it. I have supported that we move forward um as the budget has um increased a little higher than what we've allocated with with some internal realignments and so um we we will see what the patterns are for next year but I feel this is something we can manage.

Okay. Yeah. I I feel like um

we need a process where there's a trigger where it can come back to both of our boards if it looks like the funding is running out and that we can make a decision to try to allocate more money because well for instance where if we already went over budget this year where did the extra 13,000 come from for example? So um for this year just just so um to lead into this it is 60% um county and 40% um city. The additional overage come from the county. We reallocated from our existing budget at DSS.

Well thank you to DSS for doing that. I

will say there's a reconciliation process that we go through for these. So, at the end of the fiscal year, which is where we are, um we we can handle that. Historically, we've had updates on this um at times during our joint meetings in the February meeting. We didn't get to this level until after that point. And so timingwise, we were in a tricky space, but um because of the way we were managing the budget and how I've reserved the or or frozen positions, I knew we had the capacity to to cover this and work through the reconciliation. So we will get the trend data for you um as quickly as possible on this program. Next.

Is there any other questions um for us?

Right.

Oh, Commissioner.

Director Clap. So, thank you for this information. As you know, as a leazison, I I hear these uh or hear this data uh

very often. Um, I'm concerned about us continuing to communicate, you know, the devastating impact some of these changes are going to have. Do you have an idea how we can work collectively across government about getting the word out?

I think um, for instance, I'm working with Lincoln Community Health Center very well to make sure that we're educating their staff and getting the word out as well as El Centro. So, I think um if we can continue that each agency that reaches um you know, Veterans Affairs, all of the county agencies that reach people need to be pushing out this message and need to be able to have that education and we're happy to provide it of the best way for people to apply for benefits. Um and what's needed to keep their benefits because I think the biggest issue is going to be with Medicaid um is if people fall off, how hard is it going to be to get back on? And so those reertification periods are going to be critical. So I think um if we all can encourage every county agency, the library, veteran services, and like I said, we're happy to go and train staff um as to, you know, where they can go best get support um and make sure that people know that six months reertification. That's going to be key because people are not used to that. They're used to a year. And so that's going to be key to get that message out. Uh, also we have a property tax potentially a property tax well not potentially we have a property tax amendment forthcoming as well as income tax uh amendment in addition to the HR1 requirements. Um, I mean this this could potentially be I mean devastating.

Yes.

Uh almost at a frightening level. Mhm.

Um it's almost like we're in a position where we can't even plan for the potential changes that could potentially occur overnight. Uh I'm actually afraid for our community.

I am too. I'm very afraid.

I mean, I have staff that get EBT

benefits, get SNAP benefits. So, I'm very concerned. Um I'm very concerned about the people who have already lost healthcare due to the rise in the Affordable Healthcare Act. um and the non-citizens who have lost um critical I mean children are not eating right now. That's just the bottom line if they don't have grocery bills are going up every time I go to the grocery store. So I can't imagine people um what people get already for SNAP is not going to cover a full months of groceries for a family. That's we're already there. So we're already below um behind the eightball. Now we're again every day time we turn around we're looking at cutting different populations from benefits and adding more um work requirements and and more um stipulations to get those benefits. So yes, it is a critical issue right now in this country and in our community.

So lastly, we have a a proposed budget before us. Uh do you see any ways where we could sort of realign money to to help in critical areas uh at DSS?

I don't right now. Unfortunately, our money is also um the federal and state dollars are tied to certain programs. So, we cannot move money around. Margaret's great at finding stuff in our budget that um we can like to cover that um LIHR, but we can't just move money from one line to another because it is tied to a certain program and the restrictions there. Um and so with the federal and state government, our funding is very strict.

Thank you for pointing that out. So when I'm out in the community, uh many of our residents believe we can just move money.

Yeah.

Um because we feel like uh money needs to be directed to a to a certain line. Uh but to the extent that uh we can do that, I think that uh we have a little bit and I mean a little bit of flexibility and uh I look to to help out in Evergard.

Yeah, we try every year. Um Margaret is great at it. Her wealth of knowledge on where we can move money. Um, and so we do look at that and we try to think outside the box. I don't agree with this restrictions. I wish we could give.

There's a lot of times we want to do something for a family that we cannot do because we just we don't have the line item budget that allows us to do it and we can't pull it. Um, and so I wish the restrictions weren't there, but they are. And if we ever go against those, we could lose our funding. Um, so and have a very big payback. And and one thing I I I just want to add um for the optics of that too. One um my a lot of our funding is tied to revenue. So if if I start moving stuff around then it's getting our budget out of balance. Um secondly on some of the things that um when when we're looking to do something um one thing we have to keep in mind is how often can we do this? um can we can we do this for everyone? You know, so we we have to be very mindful of that too. Um um from the state supervision um piece of it.

Thank you. And uh thank you for the work of your agency. Uh not because it's easy, but because it's hard.

Uh so thank you.

Commissioner Lam, did you have a question? No,

no, I was just going to say thank you all so much.

Thank you for coming here. Thank you.

Thank you all. Thank I just wanted to follow up on the comments of uh Commissioner Valentine about the collateral impact of these policies that are coming at the federal and the state level. It really does make you think what is the goal here?

It's to get people uninsured and lose their food. That's I mean

to leave people in our country without having enough food to eat, medical care.

Yeah. What what is the goal? And it is, as you said, it's going to put counties in very very difficult situations, especially if this constitutional amendment passes and we don't have the

ability to respond at the local level. Um, I was going to ask a followup around the work certification. Um, could you tell us a little bit more about what that looks like and what is being required of people? Has it changed um, the process for that? I I understand now we're having to do six month eligibility instead of a year which is from any business perspective is ridiculous. We're we're going to spend so much money on just bureaucracy. Um but could you talk about any what does that really look like with the work requirements?

Sure. So, um, one thing I want to say is that the work we're people thinking, um, that people on SNAP do not work or get Medicaid do not work. As I said, I have some staff on SNAP, so clearly they're working. So, it's a it's a fallacy that that is not the case. Um, what they did with the work requirements is they have upped the ages. Um, that's I would say that's the biggest impact. So, instead of it being um, and I don't have it right in front of me, but oh, I do. Um so it um children 18 or younger um are exempt. People with disabilities, but where it came in is um it requires some lowincome um adults ages 19 through 64 without disabilities um who are currently Medicaid beneficiaries or applying for Medicaid to participate. And they either have to be in school, they have to work, or they have to do volunteer. So prior to that, it was not that significant of an age group. It did not start at 19. Um, and it did not go to 64. It was it was less age and higher, if that makes sense. The ages changed. Um, what I will say is that, as I said, I'm working with Lincoln Community Health Center um, and Duke. We are going to put together um, I'm a

volunteer fair. Um, we had debated when to do it because we don't want to do it too soon. Um, so we're probably going to look at it in August, right before this takes effect in October so that people know um, places they can volunteer. Um, so we're going to bring agencies together who have volunteer opportunities and then we're going to all have a link to that on our website so it makes it easy for people to know exactly where to go to volunteer and we've committed to updating that as often as possible because some things that changes, but to ensure that people know where they can go to volunteer to meet this requirement. Um and in addition um you know the the work requirements they can work volunteer or if they're enrolled in school full-time.

And what is the factoring for people who are for instance in mental health treatment or in recovery um being treated for substance use disorder.

Um so people who are enrolled in substance abuse um programs are um exempt.

Okay.

Yeah. Um, and lastly to the county manager, so for this year in this budget, seeing that we have an additional $2 million in administrative costs, has that was that something that you covered for in our budget this year?

Yes. Um, the revenue adjustment did occur. So, the net county cost increases.

So, you had to factor in $2 million.

That is correct. And so um it's a similar scenario with some other departments where the cost shift occurred whether at the federal or state level. Um one that will come to mind that Dr. Jenkins will talk about is with our dying program where this federal government um discontinued its funding. So the net county cost um for that particular program increased. And so overall the budget may look very

similar, but the question is is who's paying that aortioned amount of that expense.

Thank you.

I just want to add actually Commissioner Jacobs made me think of one question around the food access piece. Do we know has there been any like studies that show okay for us to actually provide food for everyone in Durm County that needs it? Like what that cost gap is um obviously like we can't close that full gap, but to just to be able to know like the breadth of the situation.

I'm not aware of any.

I'm I'm not aware of

unless the co-op has done some a study. I'm not DS. We have not a DSS. reach out to Donna and see maybe there's a way that we could also talk to like nonprofits, local farmers, and seeing like preparing for as much as we can how the community can come together even though it's not the responsibility of the community, but to step on. Yeah.

Yeah, I think that would be a good idea.

Okay,

thank you so much.

Thank you very much. Now I believe we have uh Department of Public Health uh with director Dr. Jenkins

to this great board. I say good morning. Uh thank you so much for your support public health to manager Hager and executive staff. We extend that uh thank you to to you as well. Again, I'm Dr. Rod Jenkins, public health director. With me is my personal financial whiz, finance administrator for public health, Micah Quindon, uh chief architect of our budget and uh purveyor of all things

finance. I promise not to be before you long because we normally tee up a lot of the things that my great friend Maggie Clap and uh Margaret would talk about, but uh we won't have to. So with that, I will say we endeavor to really talk about and highlight a few things to include care management programs, Medicaid, not too much on Medicaid, HR1, one big beautiful bill act and its impact, HIV STI services that are targeted, and North Carolina House Bill 307, Ireina's law. Um, I will also start off by saying I guess the good thing is that not too much has changed since the last time we stood before you uh with a few uh caveats. Uh again, you have heard from DSS about Medicaid and to be clear uh the requirements for states to confirm each person is eligible for Medicaid twice a year. That's going to be arduous. We've talked about that. It's going to lead to higher costs to run the program and also presents a lot of challenges for the North Carolina General Assembly in their decision to fund Medicaid increases. That in turn of course affects North Carolina DPH and that's where you know we are most concerned. Uh, I will also say a quick word about North Carolina House Bill 307, Arena's Law. Uh, went into effect December 1st, 2025, and it requires courts to more strictly weigh bail decisions leading to higher ADPs, average daily populations, which is a metric that we follow closely along with the sheriff because we manage the jail health contract. We are already seeing that those higher ADPs are here in Durham. Uh again, it definitely has some impact on the contract because we set a certain amount for um ADP uh through our contractual obligation. Anytime it blows past that, there's some additional costs involved. So, uh we have that. So, let's go into

care management. Uh two programs, two acronyms. Uh we love our acronyms in public health and healthcare. Uh care management for high-risisk pregnancy, affectionately known as SIMHARP. care management for atrisisk children. We call it cmark. Uh the contract transition from CCNC, which is community care of North Carolina, to the prepaid health plans was originally supposed to be set for uh couple weeks uh July 1st, 2026. However, we were granted a six-month extension uh to move the transition to January 1st, 2027. uh we will be fully funded through that and we are grateful to uh the North Carolina Division of Health Benefits or NC Medicaid for granting us that. Why it's important um I apologize for the typo. It's supposed to be the North Carolina Association of Local Health Directors uh which I serve as the past president. Um through our efforts we were able to s you know provide the transition support through the charitable contribution of KP Reynolds Charitable Trust uh which yours truly used to be a part of the health improvement advisory committee. Um so that's going to allow us to contract with outfit called health management associates to provide support for care management and their platform and contract readiness. So we certainly need subject matter experts to help us through this. Virtual health is the platform that they use in order to do their care management work. Uh it is a little janky but we are working to try to have a more direct relationship as this is still being funneled through CCNC. Uh the association uh is in communication related to this transition. We have begun to reach out to every prepaid health plan uh to work on the necessary information for them to finalize decisions. Um prepaid health plans know that this is a local effort that is evidence-based, award-winning,

and best done on the local level. However, um we still have to go through the contracting process. So, more clarity along the contracting process is expected in early July and it will be available. Um the association is also committed to taking every possible step to maintain these programs on the local level. Um we'll explain in the next slide what we're trying to do to do that. But staff and leadership will begin to provide routine updates. And that has started in the form of us having um really robust discussions with all care management teams in all 100 counties in order to apprise them of where we are and what's going on. In terms of emphasis on these um priorities, we certainly want to talk about the personal engagement that care management staff has with citizens and patients. Um, it's not them dialing a 1-800 number and talking to somebody in a different state. It's them talking to their neighbors, uh, people who they, uh, congregate with at churches and co-workers. Uh, so again, opportunities to enhance outreach and programs through innovative staffing supports such as the possible use of community health workers uh, is is being explored. Uh we certainly need care uh management staff to prioritize care management services for patients while they're in transitional care settings such as immediately following up in hospital hospitalizations. And then of course we have also delved into uh local health departments working locally and regionally to support one another across county lines. Uh we happen to be in health director region 5 which we have a robust uh relationship with all health directors in that particular region. I'm not going to go to too much detail about Medicaid because my great friend Maggie Clap, director Maggie Clap has already talked about it. But it is important to note that we know that Medicaid is increasing because of inflation, uh, new expensive drugs, uh,

of course increased demand for behavioral health services. No one is exempt. All localities are suffering in behavioral health services uh, needs. And I guess make it more plainly, more locally, it just requires us to really, you know, really dive into what Maggie talked about at last the last last part uh to to uh Commissioner Jacobs, which is the reertifications. That is going to be a beast. I'm proud to say that we are working with DSS. Um, as Maggie has indicated, she certainly wants all departments to really think out of the box and how we can help spread the word, but we have been innovative to really think about a position that can exist uh be embedded in public health uh to ensure that uh no one slips uh slips through the reertification crack, so to speak. So, we're able to really check and see whether or not patients are up to date on their certification. and if if not then we can take action almost immediately. So that's something that uh we are working with DSS on uh at present and I do believe that we're close to the finish line when it comes to that. So just want the commissioners and executive staff to know that we're doing our part to make sure that we can take care of the reertifications. HR1 has had a tremendous effect on our dying program. Uh the members of this illustrious board, I'm not going to um hammer you again about dying because you have heard this uh one time one time before or three times before, but I will say again on July 4th, HR1 eliminated SNAPED funding. Uh a loss of 1.4 million for fiscal year 26. Uh funding for dine, which was 13 positions, was impacted uh with support from Durham County. SNAPED carryover funds and grants. DIN has retain retained 10 grantf funed team members through se September 2026. So

it's important for me to say that effective September 2026 dying as we know it will no longer be in existence. It's also important for me to point out that only four county funded staff will remain after September 2026 uh to continue this continue this essential work. Uh we are grateful that the county has always funded four uh four of these positions uh to to do this great work. Uh of course you know that dine is an award-winning program has been in existence since 1999 and does a whole lot for the community to address food insecurity which is something that director clap just really mentioned a few me moments ago. the impact. We certainly know that dine is, you know, again, we deal with policy systems change and environmental change. Um, it is the double bucks, EBT, WIC, senior, FM, FMNP. All of those programs are direct partners uh from a governmental perspective of Dime. Uh so for the fiscal impact again uh 1.3 million a little over one 1.3 million 13 positions to include 12 dieticians and again a recent study showed that for every dollar spent returns at least $5.36 for future economic benefit. And um I'd like to point out that um you know of course director clap did point out how much money I think it was somewhere in the neighborhood of 26 million that goes into the community uh because of food and nutrition services in some the future again 912,907 is what's been recommended of course reallocations from us in our internal budget 459,216 county budget request was4 453,691. That will allow us to retain nine

registered dieticians in one processing assistant. And again, just to reiterate the fact that four positions have always been funded by the county and we continue to be grateful. Going into some of the cuts, uh we expect decrease in funding for HIV STI partner services to the tune of $21,026. uh that eliminates two bridge counselors who work directly with HIV and STEI uh patients uh for the health services. One of the actions that we've already taken was to reclassify one vacant position to retain one counselor who works with the state uh to create a position uh and we're also working with the state to create a contract position for a second counselor. So public health is being uh what public health does which is we we take a cut, we do what we need to do and we retool in order to continue the mission and continue the services. As far as child health, we're looking at a $737,000 reduction. Uh that impact is going to drastically reduce our ability to respond to one major community health priority, which is mental health. uh and supporting youth and families with mental health. We also know that without this funding uh with the 737,000 uh we were not be able to support 6 to10 organizations with approximately 50 to $200,000 to strengthen the sense of belonging for youth and social support for families and supportive relationships for non-parent adults with young people. Uh when this funding is cut, we expect to possibly support one to two organizations with less than two thou $20,000 per year. When we go to refugee health, we already know that fewer refugees are being settled in Durham and the US proper, but

again, we're looking at $72,28 in reductions. And as a result, the nurses who were working with refugee health have shifted their opportunities uh and their time to work in CD and TBS. So they're going to ensure that they can continue to assist in the event of an outbreak. But again, we are continuing to see fewer and fewer refugees in Durham. As far as TB control and HIV uh in order to uh ensure that the entire state is covered as far as their funding, we have had a funding formula change at the state as agreed upon by the North Carolina Association of Local Health Directors. Uh the impact of Durham $19,136 will be reduced in our effort to control TB and $13,229 will be reduced uh through the merging of three braided grants uh for HIV STI prevention treatment and services. Title 10 family planning minimal impact but we do see a reduction of close to $8,000 uh for the federal portion. But again, minimal impact to our title 10 efforts. Conversely, a little bright news if you will. Uh there have been some increases. Uh our BAP program, breast and cervical cancer screening control program. Uh we'll see a modest increase of $2,185 to support patient navigation, partner development, and additional services for high-risisk individuals. Durham continues to lead the way when it comes to tobacco control and prevention. We host the regional tobacco control manager, Miss Jasmine, Mrs. Jan Jasmine Sturvant, who is the region 5 tobacco control manager. we will see an increase in funding of $66,250. And she is doing great work in expanding in-person technical assistance, regional

meetings for county staff and partners, but most importantly, the formation of a youth council uh to across all nine counties to really increase awareness about vaping and tobacco control and smoking and all of that. So, we're happy about that. Additionally, we were the recipient of the public health infrastructure funds uh that will be increased uh to the tune of 14,650 $52 and that also supports patient navigation partner development and allows us to really uh do a lot with a lot of less restrictions on the funding. Maternal child health, I do believe this is a duplicate. I do apologize for that. Again, that increase is going to be to to the tune of 15,000. The times continue to be uncertain and you know, again, we control what we can control. Uh make no mistake about it for public health, grants and Medicaid continue to be our highest source of revenue, but it is that which we control the least. So, we're continuing to stay focused on factors within our control. We continue to expect an overall revenue increase of $210, uh,91 for fiscal year 2627 and we're going to continue to focus on process improvements. I'd be remiss if I did not say that I did have an opportunity on yesterday to meet with the CDC and the state of North Carolina's Department of uh, Health and Human Services uh, to really talk about funding and local impact. And uh I counted it a blessing to be at the table to let them know all the great things we were doing in Durham, but I did stress to them that we need more funding. We need more funding. So I'm grateful that they took time out of their schedule to come to really talk to the locals as they say. But again, as mentioned, we continue to be very grateful to this

illustrious board for your support. We couldn't do it without you. And we know that uh although there are cuts uh nationally and statewide, we continue to be somewhat stable in public health. At this time, we're happy to take your questions.

Thank you, Director Jenkins. Um any comments or questions from board members? Commissioner Burton,

I just really have a comment. I just want to say thank you for your hard work. It's really great to see um when I'm out in the community seeing public health staff out um educating residents um serving residents. Um I went to an event on black maternal health saw public health there. I went to something I I was um facilitating a book talk um around motherhood. Public health was there. So, I just want to say thank you for your great work and um you know, I know we got some tough challenges ahead. It's really disappointing that the federal government decided not to fund those dying positions. Um I experienced it firsthand. That's how I met Raina because she was at Spring Valley Elementary School. She worked with those students. She helped with the garden. She did really, really great work. And the kids really gravitated to that information about healthy eating. And we know, and I know I've said this before, they take that information back to their parents to implement at home. So, it's really disheartening that we're not going to do that SNAP education. So, um, just thank you. Thank you for all your hard work.

And I'll just say to you, Commissioner Burton, right back at you. Thank you for being out in the community. We can count on seeing you at various events. and that really uh exposes your leadership uh to the community. But I will say yes, I agree. Uh the dine program is evidence-based, award-winning, and has been in existence since 1999. It is

still here to the commissioners. still here. And I look forward to just really letting you all know that pretty soon on a very prominent um uh educational platform that's broadcast throughout the state of North Carolina. You will soon see Dine uh doing what it does best, which is talking about nutrition for children. So, please be on the lookout for that. Thank you so much. Director Jenkins.

Yes, sir.

So, you lead in so many spaces in our community. Uh, you work with the, uh, the dorm partnership for children, uh, board of health, uh, and you certainly assist me. So, so thank you. So, I have several questions, so, so bear with me. I'll present them, then you can answer them accordingly. So, you talked about continuing to manage the contract in the detention center. Can you provide a little bit more context?

Let me I'm gonna ask all three.

It's all good.

Okay.

Yes, sir.

And then uh HIV in the detention center. And so we had some we showed we had a briefing a number of months ago and it showed some numbers in the detention center that were a little perplexing to me. So what are we doing about that? and also can you give a little bit more contextual uh information about Dyn's impact in the schools and what the loss of that uh those assets will mean for our community. I'll go in reverse if you don't mind. First and foremost, thank you for your leadership to the board of health and within the community. You are appreciated, Commissioner Valentine. Um I will say Dyn's impact on schools is just tremendous. Um they get to learn about nutrition, they get to learn about healthy eating, they get to learn uh about public health. Uh for some of them

that is their introduction to public health, a loss of dying which again I did not want to inundate you with a lot of the screens but there is one screen in which it showed all our partners. It was probably upwards of 70 partners that are direct partners or or recipients of Dyn's education efforts. Um it it would just be devastating. Uh I do believe that um you know and I don't use that word lightly. I do believe that you know kids as as director Clap has indicated kids kids will go hungry. They're going hungry. And we teach them how to eat properly. We teach them that it's not expensive to eat healthy and um just that ability for the kid to take those recipes home and peak the interest of their parents will be gone and uh I don't want that to happen. So again uh to manager Hager and to the budget staff and to the executive staff I just thank you all for even the consideration of extending extending this program because it's highly effective. It's award-winning. It's trailblazing. There's nothing like it in the state of North Carolina. So, we continue to uh partner with um you know, again, uh the superintendent and uh his staff. They are heavily involved in the shacks. They're heavily involved in just about anything you can think of. Uh DPS did win an award from the North Carolina Association of Local Health Directors for uh our involvement with dime and that was just in 2024. So it's recognized as an industry leader. Let's talk about a little bit more sobering topic which is HIV. Um we do realize that you know again um it was asked by Commissioner Jacobs which we look forward to presenting you with that information by close of business today as it relates to um HIV rates in Durham and uh black maternal health. We look

forward to getting that information to you expeditiously. But I will say uh we continue to have work to do. Uh Durham is a vibrant community, but I do believe uh resources say that we're probably in uh the top 10 in the state as far as HIV prevalence. Uh we continue to reap the benefits of having uh this board afforded us the uh HIV navigator position, which I regret to inform is vacant at this time. However, the work continues on. uh we continue to work with our community- based partners. We continue to do a lot of great work. However, a little bit more effort is needed. So, I will say uh as mentioned by the sheriff and his staff, of course, what goes into the jail is what's coming out of the community. And we certainly know that uh additional work is um needed and I own it. I certainly own it and I do know that more work is needed. So, we look forward to continuing to really ramp up our efforts. But um please believe on to the third topic. A lot of those efforts are impeded by a lot of the work that we have to do with a couple of contracts that are not necessarily public health in nature and that is again the jail health contract and aging well Durham. We do it with a smile. We really do. But we would rather be doing HIV work and doing food nutrition uh policy systems and environmental health work. So, I will say um the jail health contract is managed by us. We continue to work hard to continue to ensure that um that uh statutory requirement from the sheriff is met. Uh however, that does not align with general statute 130, which is all about public health. It's general statute 153. Uh with that, we continue to do all that we can to ensure that uh the provision of health services are met at the jail. We have a fantastic relationship with the sheriff. Uh I do believe that sheriff has um at present

all that he needs to manage that contract. Uh to include the prospect of a medical director uh chief of staff uh legal counsel and a bevy of staff to include a very very co very very competent uh chief warden. So with that, uh, we look forward to continuing to provide that guidance and whatever the sheriff needs because he and I continue to maintain an excellent working relationship. I hope I answered your question.

Uh, yes, you did. And let me just uh end by saying that I have said publicly that I believe that the sheriff should have his authority and he should be managing his contract accordingly. And so to the extent that uh anything that I might say would nudge that forward, I I think that needs to happen. the responsibility belongs in the sheriff's department and uh I think we should do that.

Thanks, sir.

Well, thank you um to you, Director Jenkins, and all of your staff um and also for always being an optimist. You you always and this uh this presentation is also reflective of that. Um trying to lift up the uh the positive with the negative. Um, I I will say though, it is really devastating to see that cut of $737,000 for children's health. Again, if we connect the dots here, uh, about the impacts to our most vulnerable families and children, uh, it is very very concerning. So again, the same families who need support. Uh we know, you know, themes at our at our public hearing uh on m on Tuesday night were around, you know, how do we keep children with their parents and support families and um you know, workers who are who are un you know, not making a living wage. And

then at the same time we see these these cuts to programs that would at the same time help people who are struggling. Um could you talk a little bit more about those cuts for this particular program? I know you talked a little bit and is there going to be any way to try to provide any of those services in any other ways without that funding? Thank you so much, uh, Commissioner Jacobson. And yes, ma'am, I do believe in being an optimist. I believe in being a a a motivated collaborator and I certainly believe in working with my partners. And what I found is that um when cuts happen and um entities such as the state or the federal government know that you have a capable staff and you have the the will and the support of boards like you to get things done, then they think it not robbery to revisit things and sometimes they give us money. So that's what I'm counting on. Um but it does it look promising? Not necessarily. But again, we're going to continue to be optimistic. Um, those funds were were for the one-time funds. They were one-time funds again as a result of having capable staff, having a positive attitude, having a supportive board. Um, they were used for the purpose of support to support communityled mental health programs here in Durham. Um I did have um the division of um child and family family well-being reached out um I want to say about a year ago and just said hey you know we have these funds would Durham be interested um it did allow us to really kind of get our bearings and do some great things. So so with that we were able to you know again support 10 to six to 10 organizations but I think the question that you have is like what can

we do now? Um the only thing we can do is probably continue to try to use grants uh to seek grants and to petition the state to continue these funds. Um I do believe that um in in in certain order it will happen. Uh we just have to really see how things shake out. Um, I'm just about positive uh that we probably will get a budget, state budget. You know, I mean, I'm not I'm not holding my breath, but I will say we're closer than we ever been. And I think when that happens, it's going to give us the opportunity, Commissioner Jacobs, to really be in line uh to to to receive additional funding or continue this great work. So, that's my outlook. Um, and and I I I I stand firm on that. I I do believe it'll happen.

So, one thing that is in our proposed budget is um half a million dollars for youth focused organizations. So, um and then we also have our the ECAP funding that we normally have. That's we'll have to talk about that later. But um I don't know, maybe maybe those um those grant that grant opportunity may be something that we make sure those nonprofits know about um going forward.

There may be some alignment there.

We would love to be able to connect the dots and make that alignment. Commissioner Jacobs.

Okay. Um and just following up on the dime program. Um, I agree. We have an award-winning uh transformative program that we know, you know, we we like to focus on upstream investments that also impact um, you know, the whole system and the entire family and that's what the dime program was doing. Um, I would just like to say to our board that if we do come into some money in the

future, uh, I hope that is something that we will look at as a board as something to revisit, um, to to support in any way that we can to try to bring back as much of that as we can. Um, and I was going to ask you about what you all are seeing at the health department related to people coming in for visits and appointments. Um, I will just to share as a member of the Lincoln Community Health Board, we have it is very concerning that we are seeing um our people who are just disappearing. uh and we can't track them down. We don't know what's happened to them. You know, these are long-term time patients who've just disappeared from we don't know if what's happened to them, if they've moved out of the county. Um but we are seeing declining enrollments uh in terms of people not coming for their appointments. And I'm just wondering what you're seeing at the health department as well.

About the same, Commissioner Jacobs. um particularly uh as it relates to the presence of ice in um our community. Uh we saw a precipitous drop in our patient volume and Durham is not an anomaly statewide. It's what we've been seeing. Uh however, I will say our numbers have been steady uh for the most part. Um but you know uh I of course uh keep in contact with um CEO Clever Foy and she's recommenerated at times and she did indicate that they've seen uh a very heavy dropped in their patient population. However, uh I cannot necessarily say the same. You know, we have seen a dip and I will just categorize it as a dip. Uh but we continue to stay busy. So, um, hasn't

gotten to the point where I have to like kind of get like a billboard or or or some additional advertising, but, um, Durham Public Health is known for providing great service and people know where to come.

Absolutely. Um, and then just related to um the point that um, Commissioner Burton raised about Yes. really appreciate how you and your staff are out at community events, also DSS as well. Um, and upcoming, um, there's going to be a new approach. I don't know if you've heard yet, but, um, for Pride, the there's going to be actually Pride week, um, in June, the week of June 27th. And I know that's always a great opportunity for public health to partner with the LGBTQ plus center and have folks um, our HIV prep folks and everyone out there. Um, so that will I'm sure you're going to get get some someone reaching out to you about that. Um, and um, sorry to hear that the HIV navigator position is open. I know we had a great person there. Um but yeah, I it is something that we have to keep working at because unfortunately we have disparities, very large disparities in Durham County related to um the black male HIV rate and also related to black maternal health that we have to keep working on. Um and I will just say related to the um you know supervision of the medical contract um you know by by authority it it needs to be ultimately supervised by public health and that is very very important because we the county are ultimately responsible for the well-being of any everyone in the jail and if there's any ever a problem it

will come to the county as it has in the past unfortunately and so it's very important there are checks and balances and ultimately that um oversight from public health and from our board so um any other questions or comments

certainly thank you my esteemed colleague I just happen to disagree

and I hope that we'll have other members of this board to look at that and consider where it belongs Yeah, I would like for us to discuss it more um as to you know the pros and the cons of of the situation and to really understand what's the best path forward for all of us. Um, I totally understand, you know, that the sheriff has, you know, autonomy over the detention center, what goes on in the detention center, and just figuring out, okay, how does that affect us as a board if something happens um with the people who are in the detention center under our care? So, I guess that's something that I would like for us to discuss more.

Stand ready to discuss at any point in time. I will say I have been u somewhat of a veteran of uh three counties and I've seen where it's been done differently, but I will say uh in two out of the three the sheriff has certainly had uh direct control of the contract. Uh to Commissioner Jacob's point, uh be it by committee, be it by audit, be it by uh medical review, uh public health has always been at the table in order to ensure that the provision of care has been done uh decently and in order. And uh we stand ready to do that if given the opportunity. But uh under all of those circumstances in those two counties, it was it belonged to the

sheriff. And I when I was chair of the board, we every there were a whole group of people that had to sell sign off on the medical plan

still still exists.

And that that is according to state statute. Is that not

Yes, ma'am. Um that is

and that's what I'm referring to. Yes, ma'am.

Is that by state statute there still has to be oversight.

I agree 100%.

Yes,

I agree 100%. Uh Commissioner Jacobs.

Yes. But the authority for the daytoday uh oversight of the contract is not under the purview of public health. It's under the purview

of the sheriff. So I I don't want to split hairs.

You give that back to the sheriff and he needs

No, I'm in agreement with you on that. No, I'm just saying I just want to clarify that there still has to be oversight.

Thank you. And I see I see the head nod from uh manager. I

I just saw I saw the affirmative from Commissioner Jacobs. Uh are you ready for the question? I'm just kidding. I

I just wanted to just weigh in um where we are now as a county compared to where we were three years ago with our overall approach with health management and resources is is much different. and and I will say having a medical director that is an employee versus a contractor um is helpful and puts us in a position of um representing best practices across the state and the nation. So that uh alone I I think is is helpful as we coordinate between the sheriff's office and the public health department. you can't do this work without that intimate coordination. So regardless of where it sits, um we want it to be seamless and I know the director Jenkins is um working

with the sheriff's office to ensure that that continues. And so I feel confident that we're in a great position and as always as we need to refine, we can do that and we have the right parties around the table to do it.

In conclusion, I just want to say again to this great board, thank you so much for your support of public health.

Thank you.

Okay. Um, next we have um opioid fund uh discussion with Jason Smith, our opioid settlement program manager. Joanne Pierce, assistant county manager. And also let me introduce we have I know in the beginning we had both co-chairs here but we have um our co-chair for the opioid advisory council Shelishia Martinez Howard. Welcome. And Britney Price was here earlier who was also one she's I think she's left. Is that right? Yes. All right. Good morning.

Sorry, I said your name wrong. Shalisa Howard Martinez. My apologies.

Good morning everyone. Uh good morning to uh each commissioner. Um also Madame Manager Haggar as well. Um, just want to

first of all thank you guys all for the opportunity uh to be able to present today around the opioid settlement funding. Uh, my name is Jason Smith. I have the opportunity of serving as the opioid settlement uh manager um, and I sit in Dorm County Public Health and I am also joined by um, our opioid settlement one of our co-chairs um, Sisa uh, Howard Martinez and also Britney Price who was also present as well. Um and today's presentation um should be relatively brief. Um but we will but we do want to provide a uh a solid comprehensive overview of Dorm Countyy's opioid settlement funding. um including um the progress that has been made uh current investments um community engagement efforts and also we'll kind of close out with the FY27 uh OSAC recommended budget and then we'll also consider some strategic uh considerations for future funding cycles as um opioid related um emergency visits um opioid related um emergency visits department visits have also declined by uh approximately 40% as well. And if you guys are um attuned to any of our our newsletters, you probably see this this data pretty consistently, right? It's pretty clear. It's pretty consistent um that we're seeing. Um but at the same time um these impacts are not being experienced uh equally um across the community. It's something that we always see um pretty clear and data also shows and continues to show that there are significant disparities um among black and also white males between the ages of 25 and 64. uh with black males experiencing the highest rates of fentanyl related deaths um in Dorm County. And so this this is a this is a reality that really reinforces um the importance of maintaining focused um targeted uh approaches um investments across our prevention, treatment and also recovery and harm reduction strategies. So, um, as we move forward in this presentation, we'll kind of drill down to some of these opioid summon investments and also, um, see how these, um, our our current investments

are helping to drive progress while also addressing some of these populations.

Jason, can you repeat that again? You said black males are the ones who are driving

the fitnob overdoses. They're the majority of

Okay. So,

I'm trying to make sure I read this chart right. So, I didn't realize that because when you see the face of opioid addiction, you don't usually see it as a black males, right? It's usually of the white community. And so I think that is something that we have to do better education on because we got to figure okay what is happening? Why isn't this being more um I guess publicized or why people are not being aware of that and so I just wanted to put that out there. Thank you for that.

Absolutely. Uh Commissioner Burer, thank you for raising that point. Um that's something I have been looking at. um across the state as well. It looks quite differently across each county. Um but in Dorm County specifically, this this data has been pretty clear and consistent uh that black males are experiencing um the highest effects and impacts of the opioid crisis. All right. So we'll move on to um kind of just talking about the opioid um the funding itself. And uh talked about opioid now we just more so talk about the funding. So, as a part of the national opioid settlement, uh, Dorm County, and you guys have probably seen this slide a million times, um, but we're expected to receive about $20 million, uh, over the 18 years, uh, so from 2022, uh, through 2038. Um, this this is where the the the funding that we receive. So, on average, uh, we'll receive about $1.1 million, uh, annualized is how we tend to to spend

this. And we just get that number by just dividing that out by by the 18 years. Um, one of the also things that you'll notice is that the the payments that come to us each year, it does fluctuate and it does decline over uh over over the years. Um, and so, um, just in to date, uh, Dorm County has already received, uh, nearly, uh, $7.9 million, which is essentially more than a third, uh, of this funding that we have already um, received. Um, I do have a slide later on that I show you how much we've actually spent so far, but this is amount to how much we've actually received at this point. Uh but because these these funds are are spread out over the years and and also in a declining fashion here, um it's going to be very important that we uh our approach has uh focused on really sustainable investments that can really have impact um that can demonstrate impact over time rather than you know one-time um one-time payments here, one-time spending. Uh we want to look for a long-term structure that really allows the county to evaluate outcomes. we really respond to changing um community needs and also um strategically adjusting adjustments as the epidemic uh evolves. Okay. One of the next things that I'll just share here just some of the broad uh requirements that we have to make sure that we are attuned to as we are um utilizing the opioid sement funds. Uh one of the first things is that these funds are highly restricted uh to opioid remediation. Um so these are we are under option A which means that these funds have to be utilized towards uh strategies that are directly uh affecting individuals who have opioid use disorder. Um and so that's very very um important to note. Also the second thing is that we have annual public reporting that is required. We we report uh on the data all the data that that is um collected from all of our recipients um be it be county departments or um contractual um but that also helps to ensure trans u transparency and also accountability. Uh third one of the m some question that we do get is can these funds be carried over? Uh they can they can be carried over from year to year. They do not expire um at all which

al also allows us to um be more strategic for long term. Um and then lastly um all investors must be must align with the approved uh MOA which is the memorandum um of agreement strategies under option A. And finally uh community engagement is also encouraged uh to also help inform uh priorities and also funding decisions. Um it's also one of the things that's also required for us to get and receive um input um across the municipalities also our dorm residents and also uh staffing as well. This is also very helpful for us in terms of planning, also encouraging collaboration and coordination and also sharing progress. So I'll jump into um how have the opioid uh funds been spent. Um very popular question that we tend to get. And so as you can see here, our largest investments so far to date have been focused on the lock zone distribution. Um that is also seconded by uh recovery uh support services. And we'll we'll dive into this a little bit more. Um and that is actually through a contract with uh recovery innovations. Um that uh followed also by a post overdose response team or a port team which you'll see in the office of emergency services. Uh and we've also supported collaborative strategic planning efforts which supports uh my position and some of the work that we do with the collaborative strategic planning and then also um syringe service program through uh department of public health harm reduction team. So the next several slides we'll just jump into some of the highlights around some of these current investments. I'll skip through that one here. So some so one of the first uh investments that that I'll share is uh our Nlloxxone distribution. Um this is remember this is our number one um expenditure that we have across the the um the fund. And so Nlloxxone or or or better known as Narcan um it's a medication used to reverse opioid uh overdoses and also save lives. And so uh once so far this fiscal year uh we just uh distributed more than 5,100 kits um

across Dorm County. Um about half of those were distributed through our our harm reduction uh coordinator. Her name is Morgan Cver, assistant public health um and also doing a fantastic job um using community partners. Um we have uh around 40 plus community partners um that is helping out with this distribution. Uh we have she's also utilizing outreach events and also um she distributes the lockone throughout uh the overdose response trainings. Um the other half of the the this number here that we see here with the nlloxxone distribution is actually coming from our vending machines. Uh we've initially had uh we've expanded from two vending machines probably from the last presentation that you may have heard me uh give. We just had we had two vending machines. one was in public health and one at the sheriff's department. Um but this year throughout the hard work of that specific team uh they've been able to expand those two um venom machines to four. Um and those those two are actually um in the community and that's where you see the picture here. One is at St. Joseph's uh Episcopal Church and then the other one is in front of Morse Clinic. So this does help increase access to to the lock zone. Uh, one of the other major things that I'll share from this chart as well that we just started picking up on this metric is all of these self-reported uh, overdose reversals that we have seen in the community. Uh, and so far uh, we have uh, to report that there's been 75 self-reported overdose reversals connected to these efforts. Uh, which really shows the impact of really getting the lock zone into the hands of uh, residents. I move on.

Sorry. Thank you. Is there a plan? And I know we've talked about in the past about getting um some of these vending machines like into the libraries especially like I know um we've heard a lot from public library employees about seeing that it would be a benefit to be able to have at like main library.

Sure. Sure. We I think think there's still some talks around that. Um, and I think also just uh we're we're in the early um early efforts of of having

looking at the outputs across uh this specific uh vending machine and also looking at the one at St. Joe's. I will say that I did check the data for one of the newer ones at St. Joe's and it's also doing really well. I would suspect that that that the library would also be a good place or something I can also bring back to the harm reduction team just to see what that looks like um to see if that would be

great. Thank Yeah, I would just say one of the issues is looking at the census data and seeing where overdoses are happening and like getting back to uh you know, Commissioner Burton noticing the data, we we've been very very aware of this data and tracking it for 10 years as part of Durham joins together. Um, and so I think that's really key is I know that that's what you all have been using to decide where is the most important location is to look at where the overdoses are happening and where where the need really is. So

absolutely I think one of the things that we're just we're coming out with now is more of a heat map as well as we want to make sure that we are constantly watching the evolving changes that are happening um across Dorm County uh specifically. So we're we're constantly watching that.

And I just want to note it's the Hai Heritage Center which is the historical location for St. Joseph's but St. Joseph's had moved down the street where they actually uh have hold service but it's the Hai Heritage Center where one of the vending machines is located.

Excellent. Noted. So, we'll we'll move forward um to the uh um the syringe service distribution, which is another as um another uh current investment. And this slide really just shows us how quickly Durham County's uh syringe service and also harm reduction efforts have grown over the past year. Uh so through March and this is just through Q3 um that the syringes that we we distributed more than 122,000 uh syringes across uh the community um just in just in three

quarters uh compared to just over 7,400 uh last year. Uh, one thing to note too is that 65,000 of these um um syringes were distributed through our partnership with the North Carolina Harm Reduction Coalition um which also represents about half of their total distribution um in Durham County. Um one other thing to note as well is that uh through the SSP we also expanded services through the partnership with the city of Dorm's HART program uh which is a 911 crisis response that you guys are familiar with. But this partnership has really been a gamecher um for for this team. Um and we're now reaching about twice as many participants uh distributing nearly double uh the supplies and also dramatically um increasing um the ability to safely collect and also dispose of of used syringes from public spaces across the county.

And Jason, I this is just astounding. I mean it it is incredible. Um could you talk a little bit about why this is important like the collateral health impacts related to um opioid use and then the syringes and why this is important from a public health perspective.

Sure. Um and feel free to anyone else they want to add to it. Um but I think one of the things too I mean from a public health perspective I mean the SSP uh it creates a nice hub or a space for uh individuals to be connected um and to also find connection across that but also um the the syringe the syringe exchange program what I'm used to actually calling it um and so but it's something that is um preventing infectious disease exposures um that we see so from anything from HIV and hepatitis all those type of things. I used to work in HIV and hepatitis for like decades. Um and so but that's something that that we see that's highly prevent highly preventable and um a great public health um standard of practice if you will um for that um but also it also works as a place for trusted connections uh to get overdose prevention trainings as well. Um they have safer use practices um as well um and also be able to get connected to

treatment recovery services, housing resources. I mean, there's there's a ton of things that that you're able to um do through the SSP work um that we're seeing here in Dorm County, but really um um across the country, uh if you will. So, and I don't know if anyone else wants to add anything to that. Good. All right. Moving forward, Lisa, you coming up soon. All right. So, big number here. This is another investment we have, which is the post overdose response team. Um this is with the office of emergency services. Um and this is um with um the Helen Trip and her team as well. And this is just showing that um through through March of this fiscal year, EMS um they responded to 548 opioid related calls. Um so this meaning that roughly about one out of every 83 calls that they get are opio involves an opioid overdose. Um so port they focus on really this critical window that's uh immediately after an overdose. That's where we really see them. So, following an overdose, uh we see this team specifically, their MAT or or uh they're trained in and medication assisted treatments. Um and they're the medics that can administer uh buponorphine uh which is in the field to really help stabilize uh withdrawal symptoms and also provide Narcan kits as well. Um and also um once that individual is ready, they also provide recovery information to start bringing that individual to care. So this is a part of u in the budget request why they were asking for a peer support last year and have spent most of this fiscal year trying to get this person on board. One of the last thing that I would say around around this uh this team well team as well is around within 12 to 24 hours um these paramedics are typically following up directly with these with these uh individuals. They also are providing individual support and also connecting them to long-term care. I'll show you one more thing here uh in regards to some of the work that they've been doing. Um and they've identified 400 um 458 overdose patients. Mind you, this is all through Q3, just three

quarters. Um and they have successfully engaged 163 of them directly after an overdose event. Um so during those um interactions that the team had um also distributed uh more than 350 nlloxxone kits and also help connect individuals to treatment um primary care recovery services as well. So these really lead to connections and also they also lead to real outcomes. about half of the treatment referrals that we see here uh resulted in successful connection to care uh which also is a strong success a strong it's a strong success rate given the challenges of engaging people during a crisis. Um so very very good numbers um that that we're that we're seeing here. This is really what makes uh port so impactful as it does combine um both emergency uh response with also ongoing support. So this position that that you're uh describing uh in EMS that that's being funded through the opioid uh settlement funds, is that correct?

Yes. Um yes, we have last during last fiscal year it was approved. Um we had to make made an amendment to improve uh to approve that to get this person on board. Uh we did have they had some workarounds and um a little some lag there in terms of trying their best to to get this person on board. Um and so we were not they were not able to to get them um hired just yet. And I think there was many other reasons and factors why that was. Um but they they still a strong need to um get this person connected to care, have a dedicated person to you know follow up with this individual and make sure that they're that they're connected to care.

So a county manager does uh from a fiscal sort of um and budgetary perspective does that make sense to to fund that through opioid funds versus uh you know making an avenue through the regular budgetary process? I will say uh based on our practice with this fund and what we talked about earlier um in setting it up, it was determined

there would be some county related activities that were recurring that would be funded through the opioid funds. There were a few others. Um there's a medical director that's a position that's funded through the sheriff's office and some of the other um ones are slipping my mind at the moment. With that commitment though um we know the dollars will sunset. So, the county will have to plan for um when those dollars are no longer in place. Um from a a cost benefit, return on investment, we knew if we were funding areas and certain um recurring um pockets within the county, they would have to be places that we knew had the data to support um the work. and based on um and the evidence to show that it was an investment that would yield the kind of um outcomes that we desired. And so for those scenarios, we we did in fact do it. Now um again long-term um what will be the strategy and as we've uh managed other types of funds that uh eventually went away it would be in our fiveyear or 10year outlook of how do we start absorbing those expenses if it's determined is something that should occur beyond the the funding the temporary funding. Uh thank you for that. And I merely highlighted that because I don't want the the county to be in a position uh where we find ourselves in some instances with the ARPA money.

Oh, absolutely.

And having, you know, the expectation that in the out years

uh that the money will be available. I just think that's a a uh I don't want to use the word terrible way that the budget

that is not the right. Yes, sir. That's not the best practice. And as such for

ARPA, there were a few positions that we placed that were county related on ARPA dollars because of that very fact. and and for those entities that were funded by the county, we made it very clear there will be no local dollars to offset these funds um once those dollars are are are no longer here because the our opioid funds were for over at least a decade. uh we felt comfortable we would have a an approach to cover that expense and step it down over the years but to your point that is not a best practice when you don't have those dollars for a long time. Um, but it's it's also an approach to use when you're trying to um bridge a gap that's not there and and so sometimes we may choose to go that route. Okay,

that's a great question.

Well, I don't know if this is the appropriate time to say, but uh it's been mentioned that there's 40 partners in the community um that are helping in this in this uh in this work. And I think uh more appropriate use of the funds would for that uh a great deal of that money which is not a really a lot of money 1.1 million annually I think that you described or discussed here this morning but I think a large uh large percentage of that money should go out to to some of our partners to help with this work. Um it seems like uh from what I've been hearing and al also what you presented already uh here today that a lot of that money is staying within you know the county's existing uh programs. So I look forward to hearing more about that. Uh but that would be my my uh my position on how we move forward with regards to this money. Well, I know we're going to get to it in it later, but actually the current budget that's recommended is a 50/50

split between the county and the organizations. If you remove uh the position for the management of the fund which is required by the state, if you remove that from the budget and you add up what is going to fund the county programs and what is being funded for non directly to nonprofits, it's I I added it up, it's almost 5050. So um but I just want to mention about the peer support u position. Um, I know from being in in in conversations that this was identified as being really important position because the peer support is someone with lived experience and that the uh port program felt like that was really important for them even improving on the followup and getting people into treatment is having somebody having the peer support position. So I just wanted to share that.

I just want to note um agenda wise we are around like the hour mark. So let's try to save our questions till the end so we can let our presenters get through their full presentation.

I promise I won't ask any more questions.

Thank you.

And we'll move uh pretty briefly here. This is going to be our next one here. This is going to be our sorry let me move forward here. our uh recovery support services um which is one of the other strategies that that are eligible for this uh these investments and this is being uh conducted by recovery innovations which many of you guys probably already familiar with which is one of our our only community partnership that we currently have uh but their job is really just been to focus on helping people um to not just in a recovery but also to connect them to long long-term uh recovery. So this year uh recovery innovation served 133 individuals with opio use disorder which is an increase from 91 uh the year before. Uh we also saw a major increase

in recovery support referrals and also connections to uh peer support services as well. Um and so what's also especially encouraging are the long-term um the long-term outcomes that we're that we're actually starting to see which is about 70% of participants remain engaged in treatment after about 3 months which shows a really good uh retention uh which um 23% obtained employment and 40% secured stable housing uh through recovery uh support engagement and I'll try to move quickly here. This is the last one here. Um this is the the last strateg which is our collaborative strategic planning. Uh Commissioner Jacobs had mentioned it uh briefly. Um but this the collaborate strategic planning is um a strategy that actually holds the administration part of this and it's actually u mandated by the state that we have someone in this this type of role type of position um to really help build a more coordinated and community informed uh opioid uh response. A part of that response uh was actually bringing to the table our opio advisor committee. Um we saw that to be pretty best practice to have an advisory committee bring inviting communities uh to the table. Um so that's where we launched on September 4th. Uh we onboarded and launched our set advisor committee uh also known as OSAC. Um and the goal of OSAC really is to embrace uh the collaborative strategic planning by really bringing community voices um through the community um which is why we have Celisa here as well. um but bringing um not just community voices but um subject subject matter expertise um also as well to the table um and also incorporating their recommendations into the county's opioment planning and also funding process. Um so um I can kind of move briefly through this one but we we've hosted 14 comm uh meetings so far. We meet every single month um just talking around these matters. Um and then also the last thing that I'll share is that in December we were able to launch um Dorm Countyy's first opioid settlement RP process. Um and that was very intentional um you know that we we didn't have any caps on on this one. Uh but the reason why we wanted to do it in in a specific way um is that we wanted really we wanted to really better

understand the community needs. We want to we want we wanted to assess um community needs and also service gaps. And I think that we did that. We had 23 different applications and we also saw that there was about a $7 million request overall. Um and that's everyone coming to the table um from the community um and also the county um to try to address these opioid needs. So I think that this RP um even though it had it had its challenges, it actually did what our original intent was, which was really to essentially assess the needs. Um and so we were able to to do that and I'm grateful for um the outcomes of the RFP. And so, but and the last thing I'll share here is that we also continue collaborating with the state opioid settlement uh leaders um across the the state um throughout this position. Um the national uh county of of of commissioners uh the NCAACCC uh their technical assistance team were able to meet with them um um pretty consistently almost monthly, sometimes weekly. Um and one of the the positives or the benefits of actually having that in place is our ability to um share best practices and also to understand what's happening across the county. um and across North Carolina. I'm trying to move forward. All right. Um this is the the next slide. This the last slide here. And this is also part of our collaborative strategic planning which is our community um survey and also stakeholder feedback. Um we put out a survey about close to a month ago um around county staff, community stakeholders um just about future opioid settlement investments um and priorities. Um this something that we've been doing um probably of the last two to three years um to kind of get a sense of input um across the community and also county staff as well. Um and so we asked about community preference for funding allocations and also top committee priorities for FY27. Once again, this is

actually something that's mandated, something that we do through our public meeting. Um and NCMO actually asked us to do these type of things to receive input around how these funds are being utilized and we are to put out the community. So one thing that we that stood out is that most respondents supported either a balance, which is like more of a 50-50 approach um to spending um in county le and also community le programs. Um and then also uh we asked about top priorities for FY27 and recovery housing uh came at number one. Um addiction treatment also ranked pretty high as well followed by peer support services, youth prevention efforts and then also re-entry support for individuals returning uh from jail. So while this data data is still preliminary, it's also helping us to um inform conversations. That's one of the beautiful things about why we do these type of these type of surveys. But it helps us to inform um conversations around future funding strategies and also where the community sees the greatest um un unmet needs. And now we will move to I will pass this over to Sisa. Um but before we move into the FA2627 budget request, uh I just want to note that this is an important shift in our process. uh over the over the past few years um opioid funding recommendations were developed um and also presented by county staff. Um however um the launch of the OP7 advisory committee uh or OSAC this year's recommendation will actually reflect um the work and the input of the committee itself. Um so the recommendations that you're that you're about to you know you're here are OSAC's recommendations for the FY2627. Uh they are not intended to represent formal staff recommendations uh as well. So, at this time, I will uh pass this over to one of the co-chairs, Shalisa Howard Martinez.

Yeah.

Good morning, everyone. My name is Shalisa Howard Martinez. I am co-chair of the Durham Opioid Settlement Advisory Committee along with Britney um Price who um had to step out. We have a committee of a very um I would say um well-represented committee of different

folks who have different expertise around this topic. We currently have a vacant seat right now. Um Kay Sanford who's who occupied the social services seat, she resigned recently. We hope to have someone within that seat within um by July. Um the committee right now um after this process of developing the recommendations for the FY27 funding, um we are now currently heading into a debrief process about this um entire um last couple of months. And we've also identified learning priorities to improve our process for next year. So I'll go ahead now and offer the re recommendations from the committee around the FY um 2027 funding. So the first of course the collaborative strategic um planning that is as Jason has mentioned is mandatory is required under the MOA. So we are recommending $165,000. Um our second strategy that the committee um is recommending is a focus and investment on the lock zone distribution. Part of that is with um of course the Durham County Department of Public Health and also with together for resilient youth. Um there is a a slight increase for the Durham Department of um public health. Um and of course when we look at that we know that also the public health department is partnered with more than 40 different other organizations. Um, our third strategy that we are recommending investment in is around the syringe service programs again with the DRM department public health and also with the North Carolina harm reduction coalition. The fourth strategy is around addiction treatment for incarcerated persons and that includes the medical director position um at the sheriff department. Our fifth is the evidence-based addiction treatment that is offered at BART. And then our sixth um strategy is around post overdose response team which Jason has spoken about which is managed by the office of emergency services to increase

that funding. Um and then seventh is our recovery support services and this is again a um a continuation of funding but also an increase of funding to recovery services and also um a new um source of um funding will be to the justice services department for a position um to work with families who have been um referred to justice services through DSS. And then finally the eighth um um recommendation for investment is to recovery housing support through Southlight um health derm. So we're also and besides in addition to all of this we also are requesting or recommending a total of 2.2 um 2,296890 $689. This is a little bit over the initial amount that we expected to invest in this year. But these are our recommendations again from our um opioid settlement advisory committee. And I'm gonna go ahead and um ask if um Britney would like to share anything else as far as um our recommendations from the committee.

Um I did just want to point out and please forgive me if you've already covered this. um but that we um basically about 60% of our recommendation is going to county based programs, 40% is going to community based programs. All of these um strategies um as I'm sure y'all mentioned are evidence-based which is required um through the state the terms of the settlement. Um, and I did also want to note that, you know, Commissioner Valentine and Commissioner Jacobs mentioned earlier um when we heard from folks in social services that like there is this sort of organized abandonment um at the federal level of um people in our community and a lot of the systems really that we're investing

in here are also affected by that. So if you look at like the post overdose response team, their funding um in their budget is facing cuts from SAMA um and like syringe services programs um face cuts. Sama will no longer fund um fentinel test strips, silosine test strips or metatomdine test strips. um and I don't know what you all know about the drug supply but silosine and metatomdine are on the rise and um contribute to overdose um so every you know a lot of these programs do rely on this funding um and in some cases this is the only funding available for the services that they offer I

think that's the end of our presentation. So, if you have questions for us or comments,

we have one more thing too as well. I'm sorry. Uh if you guys have questions around the budget,

I'll let I'll let you guys finish your slides.

Do you have more slides or

just one more slide after this?

Yeah. Okay. Any questions about the budget? Commissioner

Burton,

I just wanted to um highlight the um the partnership with all the community organizations. Um it would be great to get a list if we have it of the 40 different organizations that public health does um collaborate with for the um nlloxxone distribution program. And um also I just you were just bringing up

Britney about um just the changes in SAMA funding. I I just I'm going to share it with everyone, but I just listened to a podcast yesterday about the new synthetic drugs that are entering our the streets and entering our jails. Very frightening. um coming coded on paper. Um and the conclusion of the podcast was that the most effective unfortunately the most effective strategy is still harm reduction. um in terms of which I think I'm so proud to see how Durham County is excelling at that um with all of the partners um in that's the most effective way to save people's lives is getting is getting the Narcan out there into the community and also the syringe program um is is really is it we're seeing it in the data it is it is saving lives So thank you for sharing that.

Madam vice chair could can I wait till the end of the presentation?

Absolutely.

Okay.

Just have one more slide here. Um these are just um one last slide and this just more so um just as we did with the budget here. This is like I said the recommended budgets for 2.2. Um our annualized number is around 1.1 uh one and it us typically goes up to around anywhere between 1.1 to 1.5. uh typically because we have investments around the open settlement funds that it kind of allows us a little bit of wiggle room. Um so but as we look ahead to uh future funding cycles, we want to just bring forth a few strategic questions to the board's for the board's consideration and the first is around funding allocation. Um, this has come up in conversation a few times, but specifically um, you know, does the board really envision a really stronger emphasis of county-led programs? Uh, more of a balanced approach between county and and community-led uh,

programs or a greater emphasis on uh, community based organizations moving forward. Um, this actually helps us in our collaborative planning as we plan out for three, four, five years. Um, the second question is more so around the structure of the recommendations. So once again, this year uh marked the first time that OSAC uh developed and also prevented uh presented uh funding recommendations as a part of the process. Uh and so going forward, we value guidance on whether the board prefers more of an OSACled uh recommendation model um community- based model or a staffled model with the OSAC input uh or more of a hybrid approach where both the staff and OSAC independently provide um recommendations. Um but really clarifying these two um um this clarifying this direction will really help guide future planning. It also help strengthen alignment and also support more consistent long-term investment strategy. So I don't know if there's any deliberation that would be needed for that or if that's something that could be something that could be um spoken with and deliberated around as we would certainly uh could really use that use that direction from the board and it has to come from the board uh from you guys for that for that type of thing to happen. Um, so leave that there for you all. And really quickly here, next Thursday, uh, really quick announcement. We do have our annual public meeting. Uh, that will happen next Thursday right here in this space. Uh, there will be some food available. So, if you're hungry and just want to learn more about, uh, what's happening across the OP settlement here directly from Morgan Culver. She'll be talking about the lock zone and harm reduction and um, the port and all that. We will have all of those details will be available as well. Um, we're also hear from uh, OSAC and have a more of a panel discussion. And so we want to invite you all out to come out to there if you'd like to hear and learn more. Here's some additional resources uh as well for you for uh commissioners for you all um to just kind of uh deep dive into what's actually happening with the opioid settlement work. Um and I believe that's going to be all for us. So thank you uh thank you for your time uh for all the commissioners, the OSAC

members, also county departments that has also been a part of this also my leadership as well. And so just thank you all for your time and support. Thank you so much Jason and to the entire team for this one quick question about the last slide. What would be required from the county like to do that? Is that just like the staff time to bring to going into those recommendations or what would be needed beyond the board's direction?

Oh, okay. Now, I was going to comment um first, thank you for the presentation and Jason for your leadership under director Jenkins and this is great information and uh it's exciting to see where our program is three years later and and so I I would say the framework for the strategic questions will coordinate with um ACM uh Joanne Pierce and um Dr. Jenkins to determine when we can come back to the board for a policy conversation so there's sufficient time to think about what's the best path forward considering where we are uh with resources as well as um what's best for the community and and with some reaction to how we've been doing it thus far. And so I'm thinking maybe uh in the fall we can have that discussion uh if if that's the pleasure of the board, but we can come back and give more direction on a timeline. But thank you for outlining the questions because that helps us think through what that next step looks like in evaluating where we need to be.

Thank you and cher and commissioner round.

Yes. Thank you so much. Um, and thank you so much for your presentation. And I I wish I could come June 4th. I got a meeting that evening. So, um, I think I have more of a comment. Um, looking at

the data about the number of men and fentanyl overdoses. That is sending a red flag to me because what that tells me is that men, there's something going on with men and you know, mental health, stress, things like that, trauma, aces, and how do we deal with that as a community, right? before we, you know, you turn to substance abuse and things of that nature and wondering and I like like from the survey, you know, support of youth and early intervention and I'm really glad that we have money in our budget to address youth. Um, so I guess my question is, is the opioid settlement money, can it be used for, I guess, mental health supports, prevention, or is it only used to address, okay, all right, we have people who now are have substance abuse disorder and now we're just trying to make sure we save their lives and make sure, you know, they don't harm themselves. ves even further which will lead to you know early death because seeing that it's letting me know okay there's something going on with our men and I think when I go around Durham and I'm walking downtown I'm seeing it's mostly men who are homeless you know I see I see it so there's something there and I think a lot of times you know and I hope no one takes me wrong when I say this you know we focus on women's issues which is important. Yeah. But when I see that number, I'm like, okay, there's something else happening as well. So, can the money be used for prevention or

is it only used for okay, harm reduction? That's my question.

Yeah, there there are three strategies um in the prevention bucket uh that we're able to use the funds for. The locks on SSP, which are the two that that we are currently investing in. The third one is early intervention uh which typically is individuals for more of the youth related um those that are might be suspected um to you know I want to use the word risk factors but maybe showing those signs um those early signs. So we do have funding around that there is an more of an open sense of of opioid funds which is under a different option which is option B um which we do not have that unlocked and do not have access to those options as of yet. But uh in terms of prevention outside of nlloxxone and um SSP or the syringe service program, the early intervention would be that bucket in which we would provide that um that education and and workaround for the youth um in that regard.

Thank you, vice chair. Thank you for your presentation. It's been quite a uh a number of months, Mr. Smith, since I've even seen your face. I need to get out more. So uh thank you for highlighting the 6040 split uh with regards to what the priorities are here coming from the advisory uh council. Uh I would be remiss if I didn't reiterate that I thought that best allocation would be to go to the community who are closest to the problem in solving this this ep epidemic. Um my good friend Commissioner Jacobs always says that this settlement fund is for uh us to actually um solve the problem. And so solving the problem in my estimation is getting as close to it as we can. You talked about RFP challenges. I'd like to to know a little bit about that. I'm sure it's not lost on you that I've received many phone calls about the opioid settlement funds

and uh and distribution, what that looks like. And so if you have some information about that, I'd like to have it. And also I commend my colleague again on mentioning the nonprofit list. And so to the extent that you can uh get that to us, I think that would be important. So So those challenges, please. With all due respect, Commissioner Valentine, I will say that those challenges were immense and uh we would be um we would be so grateful to provide you and this board with those challenges and successes in writing. Uh but for the sake of time, we certainly want to make sure that things continue to move on, but we I commit to making sure that you get that in writing.

I appreciate that.

That tell that tells me they're vast.

Absolutely.

All right. And the again, as I mentioned before, the committee is going to do a debrief of the process and so we could also um provide a report about the committee's experience through the RFP process.

Thank you so much. And can you give me your name again?

Shalisa Howard Martinez.

Okay. Thank you.

Is it all right if I um Yeah. Thank you, Commissioner Valentine. I also I wanted to um just like offer my perspective on like the 6040 split and the um

it is mispriced. Correct.

Yes. Yes. Yeah.

So um I think truthfully before I was part of this committee I would have um I would have felt the same way. I think I'm I'm like a very, you know, I work um in funding um largely community- based programs to do um overdose prevention work. Um once I was able to see um first the way that the funds had already been spent at the county level, knowing that like for example the county harm reduction f program is exclusively funded by these

um opioid settlement funds and knowing that you know the county for example the county harm reduction program the port team. Those aren't things that exist like in a vacuum. You know, these are folks who are out in the community. The port team, for example, represents a crucial bridge to care for people who um need buprenorphine access. Um this is um you know these are programs that are that are in the community and that these are programs um in which the community is pretty inextricable from the clientele of these programs. And they're programs that, you know, were they to experience a big gap or were they to go away, community programs would then be faced with like picking up um all of the people that uh are falling would fall through the gaps um should these programs go away or reduce their um capacity. I think that like something else um that is important for us to consider is that like we know that there are people who rely on these programs um who also rely on other community programs but um for whom you know if if you're going to the county SSP for example and that program goes away the hours You may not know that, you know, you just show up, the door's closed, you need an lock zone. If the door's closed, like where do you go? You know, like if you had to take time off work, if you had to get three buses to get there. Um, so I think, you know, with full respect

and I think understanding that like it it would be wonderful to be able to allocate even more money to the community. Knowing that these programs play a crucial role in our community is really what drove at least my recommendations um or my push to really um continue investing in the county programs we already invested.

I don't think anything that you said is inconsistent with my with my position. Yes. So, uh I'm just looking my comments were directly related to how we budget.

Oh,

right. So I don't think anything you said is inconsistent with what I believe to be true. Thank you,

Commissioner Jacobs.

Well, I first want to thank all of you. I want to acknowledge our public health staff and Kristen who's been very involved uh with everything and I mean every meeting that I'm in, you guys are director Jenkins is there, Kristen is there. I I want to commend Jason who has worked very very hard um if it's not evident um how seriously Jason has taken this job and it's very difficult to come in and create a whole new program and doing something new. I also want to acknowledge all of the community members who have served on the opioid um settlement advisory committee. Um, you know, this was a very different role for me to, uh, be, you know, an elected official on the committee and, um, to be with, frankly, experts from all different parts of our community. It is, it's really pretty amazing. Um, this is something different. We've never had any kind of a structure like this. And so, um, I think that there definitely

were some growing pains and that's okay. I mean, it's the first time that this has ever been done. And so, I think just, you know, kind of working through things is healthy. And of course, when you have a group of people on the opioid services advisory committee who all take this very very seriously, I I just want to say for the rest of my of our board to really understand how much time the opioid services um settlement advisory committee members put into this. There were extra meetings added, plus there were three people who served with public health staff reviewing all of the RFP applications. I mean, people spent days of their time volunteering to do this. And so I I just again I I really want to lift up how much time and effort and how seriously everybody has taken this because people really really care. I mean th this is a life and death issue. It impacts families. It it impacts so many people. Um and I and I want to acknowledge all of the work that has been going on for the past 10 years by um you know Durham joins together to save lives. my co-chair Wanda Boon, all of the work that um group you know the education and prevention committee Durham Tri has been leading in the community um and also all of the involvement of a our um harm and harm reduction and treatment committee which involves a lot of community members and Durham County staff. So this is just all building on all of this. Um, and I'm sorry that Commissioner Burton just stepped out because I did want to address one of the things that um, Dr. Boon has talked

about in our derm joints together meetings is that um, there seems to be some correlation uh, looking at the data around um, disparities with af you know black males um, in Durham it's there. Oh, Commissioner Burn, I was just mentioning one of the things that Dr. Boon has talked about is um the correlation between um multi-ubstance use, so fentinyl with along with alcohol use seems to be what may be and please correct me Dr. Jenkins, but um that's something that I've learned from her in those meetings that there does seem to be something going on. she has conferred with people at the state level about what what is going on in Durham related to that. Um but um anyway, I we just have to keep on keeping on with with what we're doing. And I would say that you know what I think you're saying, Britney, is that we have created a very strong um system of care um in Durham. I think thanks to honestly the foundation of the work of Joint Durm joins together, but that if we're going to shift funding and not use the opioid settlement money for these programs, we're going to have to look to the Durham County budget. Um, so I think that's that will have to be a discussion for later with our board. Um, so that you know I think that'll be part of a bigger bigger conversation. So, but just again want to say thank you. This is the first time we've done this. It was very hard and I do hope our board will support the additional funding of the um to get us to the $2.2 million. And Jason, could you clarify? I know we've got had $7.9 million received, but we

have not spent all of that. Could you could you talk about how much money is available from the 7.9 so that we could put the extra money the extra like 5 million whatever it is 700,000 towards this year's budget to be able to fund more of the community organizations.

Sure. In the last three years we spent uh as you can see here maybe close to $ 1.5 million.

Say that again. close to about 1.5 million that we spent.

We do have s we certainly if we've had almost 8 million allocated in the last three years and we've we've only spent you said 1.5 is that

uh yes ma'am that that money is available but it's also supposed to be spread out mind that first slide it's supposed to be spread out across these 18 years and the sustainable number that we came up with is around 1.1 to$ 1.2 million. So this increase of funding of the 2.2 two is a is a one-time inc or a very temporary increase. And I think that we need to think about what does that look like at the 1.1 to 1.2 number because we can't live at the 2.2 number, right? So, we're going to have to figure out what is a sustainable approach at the 1.1 to 1.3. So I guess the issue is we have enough to do it for this year, but in terms of a bigger policy discussion, I think coming back with the board and thinking about maybe kind of what we do with the Durham County transit plan, we know we have es and flow of the sales tax revenue coming in and expenses and so maybe we as a board need to kind of have a conversation about um planning how much is available spread out over time, but I just want to make the point that we do have the money available to do the 2.2 for this year.

Thank you, Madam Vice Chair. I just want to make one additional comment. I'm glad that

you uh

um noted one of our community partnersh and uh Dr. Woon's work. In fact, uh there's some data out there that shows that uh the work that she's doing is is uh reaping benefits for our community in a way that a lot of our partners are are not. Not that they're not doing good work, but she's exceptional with what she does in our community. And so, I'm glad that you highlighted her work and uh I'm not sure that the proposed budget reflects that, but I'm glad that you highlighted that. Thank you. Well, thank you all so so much again for all your work and presentation.

We went a bit over with that item. Um, we do have lunch here. We'll do if everyone's okay with a working lunch to do 11:45 if everyone can grab their food. It's 11:34, so like 10 minutes. Everyone rush to the bathroom, get your food, come back, and then we will continue with the justice services presentation. Okay.

Rasha Humphrey and Oh, wait. Actually, we might need to wait for Clerk Wallace and her team to come back. There we go. Check on her.

um the the mental health services provided by justice services department in the detention center. So this morning well I am Rashana Humphrey director of justice services department and with me I have Dr. Patricia Canap who is our mental health director. I have um Mark Strange who is our clinical services manager and then we also have Tmaine Sawyer who is our mental health program manager. Um so I brought them with me this morning so you can hear from the individuals that are actually in the detention center doing this um very important work. I will start off by giving you a brief history of jail mental health and the services being provided. So this dates back all the way to March of 1997 when we had one clinician that started working in the detention center at in response to the need for some type of mental health care for detainees. Um as that position continued to work over the years we saw the increased need. So we added additional positions. So in 2012 two additional um full-time positions were added. Fast forward to 2026, our current staffing pattern for the um detention mental health services, we have a program manager, we have a behavioral health supervisor, we have three full-time clinicians, we have one um substance use disorder counselor/case manager, and then we have six PRN clinicians that are temp relief um type positions. So, we have definitely grown by leaps and bounds over the last few years. um while we kind of do um what we do and have the staffing that we have. Um back in 2017, we had an unfortunate event, a suicide that occurred in the detention center. After that event, we were then required as a county to provide 24-hour coverage or mental health co coverage in the facility. So, as a result of that, um justice services had to do an expansion of the of the um staff that we had. So, with that, we added a full-time week weekend clinician position. So that position worked Friday, Saturday, and

Sunday. In addition to that weekend clinician, we added the six um PRN clinicians that I talked about. So when the staff, the full-time staff leave at 5:00 in the afternoon, we have relief positions that come in in the evening that work from 5 until 8. In addition to the relief positions, we also have a mental health supervisor on call during the evening and on weekends to assist the staff that are on site with any um occurrences that may happen. In addition to the um part-time individuals, the full-time staff that we have, we also have a contract with Recovery Innovations to provide overnight teleaalth for mental health. So that's how we provide that 24-hour coverage, full-time staff, part-time staff, and then actual contract for overnight. So that's kind of the staffing pattern that we have for our mental health services. Um, with that, um, that's just a brief overview. I will pass it over to Mark Strange to talk a little bit more about the daily operation of the jail mental health services.

Good morning. Thanks for having us here. Um, briefly before I start, so I'm the clinical services manager for Justice Services. When our longtime program manager retired from Jail Mental Health, that was Kelly Agnosic. I've stepped in. I'm kind of the interim person there now. And Tmaine Sawyer will be our program manager. And I'll be getting him trained over the next however long it takes given how complicated the system is. Uh what I want to do is just give you a brief overview of what services we provide, how it is that detainees come to our attention. And just so you know that every every detainine who comes in the detention center gets screened by medical. Medical looks for any kind of underlying medical issues they might have, any ongoing medical treatments they have and they try to identify mental health issues. And there are a number of things on the list that they use that that generate automatic referrals to mental health. If it's an individual's first arrest, for example, if they come in saying they're they're in mental health treatment or they're in

mental health medication, if they come in uh obviously demonstrating some type of mental health symptoms, whether it's being overly distraught, being highly agitated, being delusional, whatever it happens to be. Um, they also will automatically refer domestic violence cases to us and they'll also automatically refer high-profile crimes to us simply because those latter two categories, there's a higher propensity for those people to have some kind of underlying issue or be highly impulsive or to need extra kind of hands-on and eyes on to see what's going on with them. Um once the referral is made then the general meal health clinician will assess the detainee and the assessment is based on what we see what we hear. We also request records from their previous treatment. We have access to do electronic medical records. If they've been in the jail before, we pull up their records from the jail before and so we can kind of see what's their history because we don't want to go in blind. We want to have as much information as we can and and go from there. The screening itself is designed to assess risk of dangerous themselves or others, any potential for victimization while in custody. Um to identify strategies to prevent decompensation or further decompensation of people coming into the jail, they're placed on the mental health case load once they've been placed on mental health medications, whether that's through Dr. Canad or Dr. Coway who work with us or it's through medical because that's what they were on last time they were there. We got records really quickly and and medical is able to start them but they become part of our case load. We also put people in our case load not on mental health medications but we have identified as need special assistance from us and need somebody to have eyes on them. Let's see. Once the detainine is placed on our case load we meet with them at least monthly. frequently, more often than not that, but once they're stabilized at least monthly, they have access to direct contact with the psychiatrist at least every 90 days. And

that depends upon the psychiatrist assessment whether they come back in two weeks or in three 30 days or 90 days if they've been there for a long time and they're stable. We will respond to any detainee who requests services through sick calls and we get a number of types of sick calls. So, we address them all and try to try to help these people meet their needs. with consent. The discharge planner also works with the detainees attorneys on court and detention related issues, on pre-trial release, on their competency, on community referrals and release supports. The moment someone comes into the detention center, we're working with them on a discharge plan. One of the first questions we ask is, do you have a safe place to go when you leave here? We try to identify how did you get here? How do we keep you from coming back? And what are the sources and the resources that you need? Um and I so among the services we provide and I'll talk about the therapeutic housing unit here in a second. Jill Moel provides weekly treatment groups and pro-social activities in the therapeutic housing unit and in the women's spot. We also meet daily with detainees who are on suicide precautions. We meet every two to three days with people on security observation and we meet weekly with detainees on disciplinary segregation and these are all very clearly laid out in policy about who meets what criteria. If someone is on suicide precautions, it means we consider them to be at active risk of harming themselves. And that could be a mental health call, that could be a custody call, that could be a medical call. Um, they're put in a suicide smock. They're in their cell. most of their items are removed so they can't harm themselves. They're on 15 minute staggered watches and they're assessed frequently to see do they need to continue on that. And they're also assessed to see what interventions can we help them with to help calm the situation down. And usually that that takes a just a matter of days for them

to kind of get acclimated and calm down a little bit and get medication in their system if that's appropriate and also to feel like they're being supported. uh we step them down to observation, security observation, which means they're not free and clear. They get their clothes back. They have most of their belongings back, but they're in a pod. They're in a cell very close to the pod officer so they can be under constant observation. Um because we've recognized that they're at risk, we want to make sure that their transition is as stable as possible to calm things down. There are also a number of individuals in the detention center who are placed in disciplinary segregation because of behavioral issues. Again, we round on those people to try to see is there an underlying mental health issue that's contributing to their behavioral issues and if so, how can we best help them address it? Within the therapeutic housing unit, we conducted daily rounds. Um, so let me talk a little bit about the therapeutic housing unit. The detention facility established a specific mental health pod or the therapeutic housing unit in October of 2017 for male detainees. We only have one female pod and so we try to treat that as the therapeutic housing unit for women even though some of the women in there wouldn't qualify for that but it's just the most efficient use of our of our services. The objective is to improve identification and monitoring of detainees with severe mental health issues who possess acute or high-risisk behaviors. And then there's some examples here of what what is an acute or high-risisk behavior. um severe persistent mental illness, having been act team involved in the past or currently. They need assistance with adult daily living skills. They have poor compliance with directives. They have low functioning. They're frequently placing sick calls. It may be their first episode of psychosis. They could be acutely decompensating from a from a mental health perspective. They could have engaged in some form of self harm. Statistically, the women the the individuals who meet most of those categories are at higher risk of being harmed than they are of harming other people. And so, a lot of what we do at

the therapeutic housing unit is try to separate them from the general population so that they're not that vulnerable and not that exposed. The THU offered initially 24 beds and created a more controlled and safer environment and allowed clinicians to make daily rounds to support custody staff and address the needs of this population. We're trained to manage mental health issues. Custody staff by and large is not. And so we offer a lot of support, a lot of guidance about how can you help with this person? And what happens is as the custody staff get familiar with that and familiar with the detainees, they give us a heads up. So and so is not doing that great today. Can you check on him? You know, something has changed and that's the input that we need in order to have an effective intervention. Once the individual in the THU is stabilized, we can then talk with custody and classification about do they need to remain in the THU? Are they okay going into the general population now? Because we want this to be a seamless kind of thing for everybody in the jail and for the custody staff to be comfortable with how we're operating things. Initially, there were three officers assigned to the pod per shift. There was to be one officer direct supervision at all times. uh these officers were to be trained in mental health first aid and in CIT. Then COVID hit, everything changed. Um upon release, what Male Health thrives to do is we when we know the release is coming up, we've been working with them at discharge planning. We've been trying to get them hooked up with community providers. We help to supply a brid a 30-day bridge of their mental health medications so that then their outside provider can pick it up. Um, if they're on injections, then we make arrangements with their outside provider. When's your next injection due? And we talk with different community providers about who's going to provide transportation to get them to their next shot because we need to make sure that that continues to happen. We also provide a warm handoff to the jail to the GST jail transitions program or to an outpatient provider or another transition service provider. Ideally, I mean, we do this especially

with the jail transitions program which we operate. Those people will come into the jail, meet with the detainee through visitation, be able to talk with them, establish relationship with them, meet them when they're discharged downstairs, take them to their housing, take them to their outside provider that somebody they know it's a familiar face that then they can come into the JSD outpatient building and see that same person. They have a relationship with them. And you know, research has always shown that that makes the best compliance with outpatient transition is they have a relationship established before they come out of the jail. We

I'm sorry. I was

say can I interject? Um just to add to what Mark is mentioning about the warm handoff to the jail transitions program. Um in our JSD budget request, the mental health um the human services clinical counselor will help to enhance this role. Currently the jail transitions program consists of a case manager and a case management assistant. But what we found with the um level of need of the individuals being released from mental health in the jail, we needed to add a clinician to that team. And so that's why we requested that human services clinical counselor to help to bridge that gap with a clinical person, not just the case managers. Just to add on to that because historically what's happened is when we have someone in the building who really needs extra assistance beyond what the case manager is trained to do. They come find me or they come find Renee and if we're out of the building doing other things then there's no clinical person there to really help and we need a lot more structure to the program that as Bran was pointing out. Let's see. So, we put together some numbers for you just in terms of who's coming into the jail. And this is just raw numbers. It's not broken down any demographic way. But you see from 2021 to 2026, the steady increase, there was a dramatic drop off during COVID because of a lot of very um hard work done by

the DA's office and and by the sheriff's department to try to get people out of the jail. And since that time, the numbers have gone back up. And what we have found though is that the numbers for our program continue to go up. The acuity level, and I'll let Dr. Canat talk about that in a minute, but the acuity level of the detainees has gone up and up and up over the years. Part of that is because during COVID, a lot of the outpatient programs shut down and so you have a lot of people that that are not receiving services anymore. Other reasons for that are longer term about North Carolina's decision to deinstitutionalize long-term mental health care. And so over time, what has happened is indigent and underserved people get most of their mental health care through the emergency department and through the jails. And so we see that continuing. And if you see the the yellow line up there is who's who of the new detainees is referred to mental health. It's consistently between 50 and 60% now of everybody that comes into the jail is referred to to general mental health and that's because we've gotten better with medical recognizing the need but also because the population that we see is a much more acute population and the needs are much higher. The next slide shows you what has happened with psychiatric visits and care in the jail and that number continues to climb because all the same reasons. Um, I think at this point I'm going to turn over to Dr. Canal to talk about more the psychiatric version of what's happened this year.

Okay. Hello. Good morning. Um, I'm Patricia Canal. So, um, I want to kind of, um, reflect a little bit on the what was just presented about the origin of the program and then also the acuity increases over time. Um, my first job out of residency in 1999 was at the Durham County Mental Health Center, which as we all know, community mental health centers were all dismantled in 2024 to privatize the community meal health system. And at that time, we had

one clinician in the jail so that when people who were stable in the community went into jail, they didn't lose that stability, that the services would be continued. And because by by and large people's needs were met at that time only six hours a week of psychiatric you know care and one clinician was sufficient to meet that goal. But over time, both with the privatization and the fracturing of the system that we have seen occur and then also the closing of Dorothia Dixs in 2012 and then with COVID, we've had an abrupt unplanned decimation of state hospital beds to where now we're at 500 for the entire state of functioning beds. We could have 900, but because they can't retain nursing staff, they can't open 600 beds across the state. So all of that was just kind of thrust upon everyone in the whole entire state and we've I feel like have done a good job responding to it to keep our community safe and to keep our patients with chronic psychiatric disability healthy. Um, and I feel like the way we've been able to do that is because we have grown as needed when, you know, it's presented to us that things are changing um, in terms of what's available for people in the community or with hospitals. So um in terms of my work, I am a I own psychiatric services and consultation and so I staff the psychiatric um care and then justice services provides basically all the support so that that's as efficient as possible to really minimize the need to just hire more people, hire more people. And part of what also makes it efficient is because of the coordination with mental health court that they also um operate. So there is this more of the seamless transition back into their outpatient

care. Um but for the work that I do in the facility um right now it's two and a half days a week either myself or Dr. Kawei who also works um with psychiatric services. Um we do most of that is one-on-one just direct clinic visits and we're in person which I want to emphasize because most jails and prisons are shifting o into you know teleaalth telea medicine which isn't a terrible thing but there is a a big strong um there's a lot of ways that inerson care is you know advantaged um we can better coordinate with detention staff with wellpath and medical staff we can better problem solve things as they arise by being in the facility. Um so that's about 25 to 30 um contacts patient contacts of direct patient care and then also I'm available not as a on call emergency services provider but just on a as needed in between clinics available to start medicines when someone comes into the facility or um make sure that um anything that arises in between clinics doesn't have to wait until the next clinic day. And that's where again the team, you know, they do the screening and the reviewing of sick calls to then triage people for um as needed. Um and then how frequently we follow up with patients depends on how ill they are basically. So someone who comes in with untreated schizophrenia who has acute psychosis will need to be seen at least once a week probably several times a week by a combination of the clinicians and the psychiatry team um and the medical team. So that's a very high need um detainee. Whereas someone who has a long-term stable condition, they might be seen just once a month by um the clinicians with justice services department and then once every three months by the

psychiatry team. So um so that's that piece. Then also I wanted to point out that in 2017 we um partnered with Duke to help train their residents. Um I started that program because you know we were seeing this need for more and more um patients to get into clinic and we didn't have at the time it wasn't two and a half days a week it was like one and a half days a week and so um Duke you know I worked with Duke and we got a contract in place with the county so that we could um bring residents in and they we've had like between two and five a year since 2017 and And they see about five patients a week, which you know can result in anywhere from like 50 to 100 or actually 50 to 500 additional patient contacts per year of just free services essentially, but I supervise all the residents. So they're not, you know, just playing, you know, playing doctor like they're well trained. They're already third or fourth year residents and then I'm also providing direct supervision in person. Um the other thing is the reason that we wanted to have that program is because you know unfortunately since there are more and more patients being treated in these facilities as opposed to in the community we need psychiatrists to understand you know how to help someone who's justice involved and to maybe spark more interest in coming into these facilities and working with this population and it has resulted in that. Several of the people who've done that rotation have gone on to do forensic fellowships and um and now that we have Dr. Kawei, she also was someone from the Duke um residency program. Um okay, let's see. Thank you. Um, so yeah, this speaks to just some of the work that's done outside of the direct

one-on-one um, clinic with patients, but basically to support the jail mental health staff um, and medical staff when someone comes in that they're just not sure what's going on with them. And, you know, I can do an assessment sometimes because I've been doing this for, you know, since 1999 and I actually know the members of the community very, very well. Sometimes I already know a person that someone else has never seen before and I can give background information and history. Um, I also have a lot of connections with other doctors in CR, UNCC, Duke, and we can just kind of discuss patient care between facilities more, you know, quickly and expediently. Um, which will reduce any kind of gaps in care or delay in getting care. Um then that's part of you know if a patient is new to us because sometimes people come here I feel like because we have a lot of services in Durham like the rescue mission we see a lot of folks from other counties being kind of sort of migrated over here for some services and then we're trying to manage something that we don't we've never met the person before. So that's where we have to like get old records and really dig up the history and get collateral information and all that. Um and then of course prescribing and monitoring and part of that interaction is sometimes motivational inter interview interviewing helping people who have ambivalence about getting care kind of weigh the pros and cons and reflecting back on what the care has helped them obtain or how it's helped them feel better even if there are some things that maybe make them hesitant. Um and then working with uh the discharge P planner to coordinate and make sure that when someone leaves all the work that we've done to help stabilize a person doesn't just get lost because that um you know years ago we didn't need a discharge planner because everyone went to one place which was the derm center but now there's so many

different places coordinating that is a very big part of um the job for our case manager Um, so yeah, that covers that. Yeah, and I did want to I have a few slides here just to address this um question about long- acting injectable medicines because I do realize that they are expensive and we have had a change in what's available um and how we're using them. And what's what's changed is we have five as opposed to for years and years and years we only had two. We had doll and prixen and now we've got inveilifi um and uh risk consta and the older medicines are very cost-effective held and prolixen and a lot of patients are on those but if someone comes into our facility on a different medicine that is more expensive that costs per injection about $2,000 an injection um you're faced with a decision to try to convince them to change medicines, which most people don't want to change, or put them on oral meds. And when you start them on oral meds, the whole reason people get on these long acting medicines is because it helps with the day-to-day ambivalence or mixed feelings or just kind of apathy about their own care, which will result in some interruption in treatment. And the medicines are really important in helping people maintain um remission. So even if someone's in a in a facility like this, if they miss 5 days of medicines a month, you might see a change in their behavior. And then sometimes because half of people with schizophrenia, for example, don't understand they have an illness, those five or six days of not getting the medications bring up some thoughts about, I don't have an illness. I I just realized I don't have an illness. And now they're on zero medicines. and then you're kind of starting from scratch with something that was already like,

you know, working really well. So, so I've personally not chosen to stop them and put them on um oral medicines, but it turns out in doing a deep dive into the research, the research supports that. And I already knew that from, you know, keeping up with CMEs and all that good stuff. Um basically in the 2022 and 2023 a lot of um a lot of studies were done that kind of looked more in more detail and um could you go back a couple slides? I'm sorry. Um, so yeah, basically the what one of the big things that's happened with those landmark studies is the AP the American Psychiatric Association as well as like the VA and the Department of Defense have issued guidance in support of using LIIS in um variety of settings um and it's now kind of established a standard of care. And then and part of the studies that supported those changes are looking at real world studies, not just um not just um randomized clinical trials. And those and those studies have shown benefit across like sex, age, whether you do it early in their treatment, late in their treatment, and whether or not they have comora substance use. Um and they've also shown that the higher pharmacy costs are offset by lower medical costs and overall they're at least costneutral. Okay. So in and then there's not that much studies in correctional settings but this study was done a while back that looked at people who were either recently released from a correctional setting or were still in a prison setting and they were randomized to either a long acting injectable or an oral medicine of the same type. And um their outcome measure was treatment failure, which I know sounds very pessimistic, but that's just kind of how

they wanted to look at this. And um they definitely showed that people with Lis had a lower rate or you know lower um incident of treatment failure than if they were using oral antisycchotic medicines. And the most common reason for treatment failure was a rearrest and that also was different the difference. So, long story short, it helps to prevent recidivism, which I feel like is part of of the community goal and the community best interest, even if it may not be part of um the budgetary, you know, goals of the facility itself, if that makes sense. Okay. Um Okay. So, the key takeaway, sorry, I don't want to go on too long. Um so there's robust evidence for it um in schizophrenia. There's there's some evidence emerging for bipolar one. Um there's studies now in correctional populations and um that there's less evidence specifically for um in jail settings, but um there's more and more of that. And then the other piece is the monthly ones are about 2,000 a month. the they have now some that will last three months or even six months and those are like eight to$10,000 a month. We don't use those because I think that the benefit that you get if if someone's on that in the community and we cut them down to monthly, we're still doing what we need to do without paying $10,000 um when they may only be in jail for a week. Um so that's one way that we do try to keep minimize the expense around those medicines. So thank you.

Thank you, Dr. Canal, we're going to move forward now to talk a little bit about the inter agency collaboration within the program and how justice services works directly with um Wellpath and the um detention center to

collaborate on the services needed to for this population.

As mentioned, um individuals who come in the facility with a multitude of needs between psychiatric and substance use and it's not isolated to just one department. So a lot of our collaboration is as mentioned with medical wellpath and relying on detention staff. Um so these are real-time situations where we have to collaborate during that time to make sure the stabilization of the individual is met whether it be getting records as mentioned before or identifying I guess in some additional needs. Um the early identification helps prevent crisises that happen in the facility and helps for long-term stabilization. Um here's just another emphasis on the the collaboration and stuff as we talked about because as individuals come in with a multitude of needs we have to again address it and meet them where they are far as with the different levels of services. Um so we work closely with detention staff identify individuals that may need involuntary commitment or safekeeping and those are just levels of interventions if it exceeds what we can manage within the facility. Uh we work closely with medical staff. Um again getting front line is our detention staff who identifies different behaviors. Individual stops taking medications. Then we are able to address it early before things escalate. And then being able to address like case management needs and other collaborations with the courts as well whether it be the low bond meetings and things like that to help people get transitions out of the facility. And this just reiterates some of the things just said. Um but the collaboration with our detention staff is very important. But as you mentioned before is that we have to collaborate, we have to talk, we have to share information with everybody that is in the facility so that we can help minimize some of the crisises, help stabilize individuals and help them get connected back to the community. A lot of individuals are going to return back

to the community and so we have to make sure they get those resources and services and become um safe and stable. These are some additional interventions that are used. So it's not only the screening parts that we do, but it's also again this different interventions to help stabilize individuals and help them connect with different auxiliary services that we have within the facility. Although the jail is not made to be a psychiatric hospital, it is as mentioned the increase of acuity is increasing and the needs are increasing. So we want to make sure that each individual is tailored to I guess the needs that they have clinically and safety wise. So, I just want to take a second and talk about the obstacles and challenges we face, but I think I'd like to to give you an example of that. Um, that speaks to both what Dr. Canal was talking about and the inter agency cooperation that Tmaine was just talking about. We have an individual in the jail right now, and this is not unusual, who came in actively psychotic, not on medication, um not able to take care of their daily needs, dangerous to themselves and to other people, has been locked back on suicide watch until we can get that individual into safekeeping, which takes there's always a wait for the bed. There's a wait for the court order and we've been waiting for the bed for a while now. In order to get this individual to safekeeping, medical has to be able to come in and take their vital signs. That's not safe for medical to do. The spirit team comes in, physically restrains the individual so medical can take their vital signs to make sure they're medically stable enough to transport and go to safekeeping. All this happens on a routine basis in the jail because we're getting people that don't belong in jail and there's no place else for them to go. And so, as Dr. Canal talked about, the bed space is very limited. And so, we're having to wait to get them to a safe place where they can be forced to take medication so they can stabilize and they can

function. Their quality of life is zero right now while we're holding them. And that is routine, not just in this jail, but in every jail across the country. And so, that's something that we try to ameliorate. Mental Health works very closely with medical, works very closely with custody for people like this about how do we keep them safe? How do we get this process through the system as quickly as we can even though we have no control over what happens? How do we coordinate stuff? How do we share information? How do we make sure that we're treating this person as humanely as possible given their situation? That is one of the big obstacles that we face almost on a daily basis here. I'm, as I mentioned earlier, you know, custody has been short staffed ever since COVID. A lot of people retired then. Nobody wanted to come work in the jail and be exposed. And so the pods are still often understaffed. Regardless of what the sheriff does with recruitment and training, he's still short staffed. And that that presents a problem for us in terms of if we if health staff or if medical goes to a pod to see somebody and there's not an officer because they're on an indirect or the officer get called away for an emergency, we can't be in the pod to see the person. And so that that interferes with our operation and medical operation and it really creates a high level of stress for the detention officers. Until recently, this affected the THU quite a bit. More recently, the sheriff was able to hire someone to get them trained to be dedicated to the THU. We have one officer who's in there every day now who knows the detainees in that pod who frequently seeks me out to say so and so is struggling with this today. That's what I need to know and I can talk with him about here's what we're trying to do with this person. And so that has helped tremendously in terms of how the THU operates. Um, as I mentioned earlier, the acuity level of the detention facility population keeps going up over the years. I don't think that's going to change. I think it's actually going to get worse as we see more of the effects

of Arena's law. Um, but the average daily case load that Jal Health deals with right now is between 165 and 210 detainees. That's the people that were responsible for on a daily basis. the long-term weights I already talked about. It's it's difficult to get people into these programs where they need to be because again that's a state funding question about we have not prioritize it as a state and so on the local level we're trying to deal with it. Um and this is just the same thing over and over again. There's very limited alternatives to arrest and detention for individuals with serious mental illness. There's a lack of community based housing options for these people when they come out of jail. There is there continues to be a lack of assets of services for uninsured and underinsured persons. We've been working a lot with alliance to try to address this. Alliance has created a forensic act team. They've helped us create a forensic community support team through Carolina outreach. Those address a small number of individuals, but it's a very important resource that we have now and we're trying to develop more resources like that. Um, there's, as I mentioned earlier, a complete lack of long-term inpatient mental health and substance use treatment options for our population. They leave us, they go to temporary housing that we can pay for for a short period of time, and then they're back on the street. If we can't make some radical changes to how we they're treated in the community, there are always issues of continuity of care between the detention facility, outpatient providers. But as we've worked more with our job transition services and forensic community support team and the heart team, we've been addressing those gaps and trying to make sure that people get to where they need to be and are able to stay where they need to be. Um I think I'm going to turn it back to Rich for the rest of this.

And just as we wrap up, um one of the things we wanted to mention is about future needs for mental health. Um definitely adequate staffing. We feel

like we have adequate adequate staffing right now, but one of the needs is going to be around specialized training, especially for custody staff to be able to work with this population around um CIT training and um mental health first aid. Also, we feel like there needs to be a better data sharing um arrangement for community- based providers, hospitals, and the detention center around being able to quickly share information about detainees. Housing options. This is definitely a challenge. Um we talk about having vendors in the community that we work with and that we provide short-term housing for um the individuals that we work with, but it's a need to have more structured housing placements for individuals with mental health challenges. Because what we find when we place them with just a normal housing vendor, that tends to not last long because the staff at that vendor may not be equipped or trained to work with people with mental illness. And then as Mark and Dr. Canal both said is just a need for the long-term residential care that we no longer have because of the institutionalization of mental health. So that's some of the things that we have noted as an agency um that we will need to see in the future. But um in addition to that, we wanted to highlight what we are already working on as it relates to mental health because we have made some really good strides as it relates to what we have done. Our criminal justice advisory committee continues to work on um issues related to providing adequate mental health services in the community. Um our local re-entry council does the same as we uh is that my cue to wrap up, Monica? The the local re-entry council also um works with the facilities um through the department of adult correction in identifying individuals who will need additional support as they um enter the community. Our stepping up initiative continues to work. We have an event coming up on June 8th around the sequential intercept map. And this bullet is placed in the wrong place, but

our access to care um subcommittee would fall under the stepping up initiative as well. Um the familiar um faces initiative continues to work around how we work in the community around um services and support for individuals with mental health. Mark mentioned our contract with Alliance to provide a forensic community support team. We've also done work with the council of state governments uh and been enrolled in their um justice and and safety and justice challenge um equity cohort. We also continue to do work through Durham joins together with their mental health and substance use treatment committee. So, that's a lot of work that um not just just the services, but Durham overall has committed to working to address the needs of those with serious and persistent mental illness. But there's still a lot of work to be done. And so, we are excited about the work that we have done in the past and continue to do. Um we're excited about the partnerships that we have um with medical and with the sheriff's office for our um jail mental health, but we're also excited about our ability to um connect those individuals as they come out with some community- based work that we're doing as an agency as well around mental health. So with that, we will take any questions you all may have. Thank you all so so much for all the work that you're doing and all the ways that you're providing care and service to some of our most vulnerable neighbors. I had a few questions. Um, but I want to see if the colleagues um I wanted to know like have you all so I the program you have with Duke for the residents. I know that it's different because they're studying medicine, but has there been any like talk about partnerships with also like NCCU for their counselor like non doctor counseling program? Yeah, we work with um North Carolina

Central Department of Social Work. So, we do take interns and we've also had different interns for different social workers from different um universities as well.

One more. Now, it's slipping my mind. Um, if anyone else has Oh, Commissioner Jacobs, I just had a uh a follow up to the example that you provided and you uh made a salient point about uh the detention center not being a mental health hospital. Am I to assume that that example is um someone who been on the other side of the law in some kind of way? Like they didn't just end up at the detention center because they were on the street because of their status, maybe being homeless or something justice involved led to them being at the detention center. Otherwise, I'm going to be very troubled. They're in the jail because of they they came into conflict with the legal system in some way.

All right. Um, and unfortunately the way the laws are set right now, this individual would qualify to be involuntarily committed to a psychiatric hospital. But in order for that to happen, their bond has to be has to go away. Has to be unsecured. And because of the level of charge, that can't happen. So they have to wait for safekeeping either at Central Regional or at the women's prison. So there needs to be a legislative fix it sounds like around the issue with with the bond.

Yes sir. Okay. It's it's it's part of the population that has been marginalized in terms of state priorities and so it's left again it's left to the counties to try to figure out how do we want to manage this within the the constriction of what the law says. Okay.

All right. Thank you. Um one additional question if if if I could

could could I help answer that? I mean that was a great answer as well but just to add a little more context. Um, so when the Ireina's law comes in, because part of it's in effect now, but the rest of it's going to come into effect next December, it's going to be even harder to get people out on bond because that's part of what they're um mandating is that anyone who's had any IVC history in the last right now it's reading in the last three years, which they're trying to make some changes, that's why they delayed implementation, but anyone who's had any IVC in the last three years is not going to be eligible. for unsecured bonds. So that means we can't get anyone out under IVC. And then the other piece is because we don't have any state hospital beds, even when we were able to get someone out under IVC and we send them to a regional, well, they're under a tough situation as well because they can't hold people in their ER for 30 days waiting for a CR bed. So sometimes they'll let people out that really need a hospital. So, it's from I guess just to make the point that it's from all sides that we just aren't getting people the level of care they need in the right setting. And then the default because if if you aren't able to care for yourself and if you are responding to internal stimulation that says that maybe people are trying to hurt you, it's very, you know, the chances of you running into some kind of a legal charge is very high. You know what I mean? So, just to underscore that point. Thank you. Uh thank you for that additional uh detail Dr. Canalt and also just to uh lay your concern about 1999. It wasn't that long ago

with regards to the uh positions um through justice services. What are what are what where are they credentialed? Like we talked about social workers already. the uh vice chair talked about

NCCU and the answer was that you know some of the students from the social work program are involved as interns but people that are employed there uh through the program what are what are they credentialed as licensed clinical social worker or a licensed clinical mental health counselor to to actually be a part of the mental health team they have to be licensed

thank Thank you,

Commissioner Jacobs.

Well, thank you so much for this very, very detailed presentation. Um, this came up because we have recently had to allocate additional funding for uh medications and for this program. And you know, so the question was, you know, what's going on? So, I really appreciate um I think Commissioner Burton, you asked for this. Uh I really appreciate this really deep dive. I think this is an example of how there are amazing things, amazing work happening inside of Durham County government that frankly most people do not even know about. and also just the very challenging work that you all are involved with and everybody who's a part of the jail mental health team and frankly justice services in general. I I want to just thank you all so much for your dedication and your care. Um, and I want to recognize Tmaine is also the head of the STAR program in the detention center, which is our, you know, educational, preventive, um, substance use treatment program. And also Lacy Scoffield with public health and Tmaine are the co-chairs of the DURM joins together, um, harm reduction and treatment program. So folks and you know Mark and Roshanna also would do a lot of

work outside also around familiar faces and other things. I just want to recognize that you all do a lot of other things too that go above and beyond. Um, you know, it's just um I I hate to feel like our whole uh budget work session today really has, you know, when you're talking about opioid, DSS, public health, now this is just um it feels very overwhelming. Sorry to get emotional about it.

Take your time, Commissioner.

So, one of the requests I had was the and also I appreciate the collaboration. It's so important and also the work you're doing is helping our detention center staff because they are not trained and equipped to deal with this. And so I really see this as how this is just really helping everyone. Um and um and I totally support the use of the long acting medications when necessary because you know it is going to be cost effective in the long run. So related to the future needs that you identified Roshanna I guess what I would like to ask is that in in the fall you know after the sim the sequential intercept map update which is we've been invited to um which is going to look at our system and what are the gaps um but related to the issues you raised maybe coming back collectively with some solutions or recommendations of things that we should look at. Um I'm on the um access to care stepping up initiative um

committee. And so one of the things that we've talked about because ultimately we don't have enough places for people to go for who need much more long-term care. So, for instance, one of the things we've talked about is could our recovery um our 24-hour 24-hour recovery response center is the way is there way to designate some of those beds um for long-term care. Like we we're going to have to come up with some kind of creative innovative solutions um here. And so I I think things like that that maybe you could bring forward some things. And then also this really ties into the homeless strategic plan because um I've also been involved with the f familiar faces with also Mark and Marshana. Um that these are the folks that cycle in and out to your point on the street in the emergency department. You know you said Dr. canal, you know, these people, they come in and out. Um, so the way our system is working, like it is tied to ending our, you know, achieving functional zero for homelessness and and I think it ties back to that position that we're going to need to have internally. Um because some of the points that you raised around data sharing like that's the kind of thing that this position could help with how we have a better inflow of sharing information inside and outside of our system. Um so I think that we're going to have some I think we have solutions and some opportunities and some some things that we can really do um because it's it is going to fall on us um to try to solve these problems. So um again um just and then could you just also define what is safekeeping and that

compared to the um capacity restoration and are some of those people that you've talked about would they be eligible for the capacity restoration program? So, um so safekeeping is when uh the our our county um sends someone to the uh state prison hospital, central prison. Well, there's two kinds. There's safekeeping for custody, like if someone just doesn't have a mental illness, but they just have some behavioral management issues that the um sheriff feels would be better managed in central prison. And then for mental health safekeeping, it's like a literal psychiatric hospital within the prison system. Is that And then for capacity restoration, um when someone uh their attorney requests a an evaluation to see if they're capable to go to trial, if that um forensic evaluation determines that they're not capable to go to trial, then they're ordered to right now Central Regional Hospital. So they go in the weight list which is right now about a four to five month weight list and they eventually get transferred out there and then they get um it's it's not just medicine treatment it's like education so that they can understand what's going on in court and also further assessment and they get a reassessment and then they hopefully will be able to go to trial at some point. Um do you want to talk about this jailbased is that the jailbased capacity restoration or

sure if you want to mention that. Um well just that so the state has come up with a um an alternative to going so because to help with the bottleneck at CR they want to look at allowing people to get restored um in jails and right now they have a program in Meckllinmberg County and PIT and it used to be Wake it but Wake's dropping it and so um the

idea would be there'd be three regional centers and people would be transferred from other counties to utilize those if if it's an appropriate transfer because if someone um needs more support or maybe needs um doesn't want to take all of the treatment that maybe would be recommended um by the court or by individual um clinicians um they have to go to CR. But for people who are kind of sort of more engaged in treatment, they can get restored in the community um in the the jails. And they also even have community based ones, but that's harder to that's been a little more of a struggle.

And we we've had you all have identified some people that could be

Yes, we we have like three people on the wait list right now for CR who are taking their meds. And so it's just a matter of getting access to that um um educational piece which can be done in a jail instead of at CR like as long as there's a program in place. So yeah,

and it appears that the sheriff is in conversation with the state about potentially picking up the program that is being terminated in Wake. So if it is going to be moved to our jail, what does that mean for how our jail functions and our capac thinking about you all saying that we have vacancies and things like that and we're already at I'm just wondering how is that going to impact the functioning of our jail with that?

I'm not quite sure. Um I have just learned that the sheriff is in conversation about the potential of bringing that um program to Durham. So, we haven't been involved in the conversations between the sheriff and the state. So, we will have to follow up with him about, you know, what that potentially looks like as far as is it a pod, is it more staff? I'm just not sure because I haven't been involved.

I mean, so just as a followup, and I had heard that information. Um, I guess the

the question is, do we have the capacity? Like, do you have a thought about that? Dr. Canalt, I see you shaking your head. I'm not 100% sure. I mean, I def I think it's so I would like our detainees to have access to some kind of jailbased capacity restoration program so they don't have to wait um for months and months. Right now we can use Meckllinburgg if you know they would have to go through the process and the sheriff would have to agree and all that you know has to get ironed out. This is a new this is new information for everyone. Um, no one knew that Wake, what happened is Wake doesn't want to take detainees from other counties and that was kind of a deal breakaker with the state. So, this is all new for for all of us. And so, I think that is an important question like because we would have to also take it's I think capped at 10. So, that means right now we have three, we would have to potentially take seven other people who are, you know, higher than average acuity to transfer into our county. and get their care here. But I guess you would the state sponsoring the the staff that provides those services. So I just don't know exactly how it would look with just we just need to kind of like all get together and discuss it. I think

county manager, do you have a thought about this?

Yeah, I was going to say we can follow up with the sheriff to get more insight and um share that information with the board.

Yeah, and I would say you all definitely need to be involved with this. um jail mental health services needs to be in the conversation. Absolutely. Um and I just want to say something that um from my own experience um my daughter is a uh assistant federal public defender representing people who are on death row. Many of them I would say um from what I've learned from her who suffer from severe mental illness. And also my daughter-in-law is a psychiatrist at Central Prison. And

I will just say what maybe would be unsaid is that it is very important the role that you all play um jail mental health because you are also advocates. You are advocates for the people in our detention center and that is very important. Um, and I know that from even my daughter-in-law and my daughter that, you know, it is often that people who, and it's to no fault of their own, but people who are running facilities are they they are not trained or nor they are very under a lot of stresses and they are not necessarily going to be um attuned to the these issues and needs. Um, and it often takes advocates saying that somebody needs that their mental health issues need to be addressed and need that advocate. And I appreciate the fact that that's is an important role that you are playing is making sure that um people who have severe mental illness are getting the care that they need within a system that is not a it is a broken system. Um, you mentioned the closing of Dorothia Dixs. You know, that's something that I've really learned a lot about is is how we've completely deinstitutionalized a system and didn't replace it with anything. And um, you know, Dorothia Dixs, if you go there now, it's a beautiful place. And when it was a wonderful place for people to live who needed long-term care and people lived there with their families, there were children. People spent their whole lives and they could come and go except for one building was, you know, they people were not free to leave. Um but people it we don't have anything like that for people anymore. And so now we see what

we're dealing with here in our county. So thank you all so much for the work that you're doing.

Thank you all so much. And I remembered my second question now um all this conversation. How I know it can be difficult with also like access to the counselors and their therapists, but how well do you think that we've been able to implement like a cultural matching and like background matching of the therapists and counselors um with the patients that they'll be seeing with individuals in the jail because we know that has a significant impact on also their responsiveness and you know participation in counseling and therapy. I think we've done a really good job. We have a very diverse team. Um many have been there for many many years are very familiar with the inner workings of of the detention center and also with the detainees that have tended to come in and out over the years. So um right now we have one new full-time person but the other staff season have been there quite some time.

That's really great to hear. And Tmaine um is stepping into the mental health program manager position and he is very familiar with detention has worked and supervised the star program for the last 12 years and now he'll be moving into that role. So the detainees that come in and out are also very familiar with him.

Wonderful. Congratulations. Yes. Well, thank you all so so much again. Appreciate it.

And I just want to thank this body for the continued support. um jail mental health would not have been able to grow as it has over the years without the support of this board and we we don't take that lightly and we definitely appreciate it. So, we are proud of the work that we're doing to show you that your support is is worthy and that we appreciate all all that you've done to help us grow the programs to support the community need. Of course,

that brings us to the end of our discussion items that we have. Now, we have our add and delete list is a

we have one more.

Yes,

that's the one thing we need to be able to get.

Yes.

All of these things funded. And as um Director Dole is about to share, I heard great comments about the conversations he had yesterday with um city council and their budget uh discussion. So excited to hear um the information. I didn't hear anything about those discussions, county manager. So, that must be a good indication that they

That is a very good indication. you know, um, Director Dole has done a great job over the last 18 plus months, it feels like, um, sharing with the community what our appraisal process is. And, um, getting to the end of this cycle has caused a lot of questions and I know that's part of the reason you desired additional conversation so our residents could hear further about the topic. So

uh good. It is good afternoon. So good afternoon everyone. Uh commissioners, county manager, and um the collective. I appreciate the opportunity for coming doing another update. Uh have some information here. Some of it may have been mentioned before, but I feel it was a good opportunity to u add some information and bring up some very

important points that may have been touched on over the past few months. Um, thank you all for the support and the um, partnership in regards to making sure that we had opportunities to get these messages out to the taxpayers and property owners over the past 2 years. The January 1, 2025 reappraisal was a very, very, very big increase um, unlike anything Durham County had ever seen before. So, the messaging was very important and I appreciate your support and making sure that that was um, a priority. Uh the general overview in regards to this particular update uh is just again about the reappraisal. I'll touch on the appeal process. I'll touch on some of the impacts post the appeal process and um just speak to some of the concerns or uh questions that have come about over the last few weeks. Um Durm County Department of Tax Administration conducted a 2025 reappraisal that led to a historical increase in real property value. That increase led to record number of residential and commercial appeals. Those appeals led to a record number of hearings scheduled before the board of equalization and review and the property tax commission. The reappraisal process in general, local real estate market data is collected and analyzed during the two years preceding the reappraisal date. So in this particular case, it was January 1, 2025. Um, of course, with a 2029 reappraisal scheduled, we will begin this particular process again, uh, going into January of 27 to prepare for the 29 reappraisal. Um, that particular second year of a reappraisal or the final year of the reappraisal is when the land and improvement pricing begins usually by that February of that final year. Building the schedule of values very important that particular process property data is used for model

specification model calibrating and establishing the schedule of values which we are usually doing that particular process between July and September to have that uh schedule turned in to the board of county commissioners by October is usually the date we are shooting for. This is an illustration of the market. very important illustration of the market that was being analyzed for the previous reappraisal. So we touched on the two years this would be starting January 23 up through December 24. This is the market that was that we were a part of during this particular analysis. that particular mark market started off somewhere around 383 and by the time the year was closing out of 24 the market was around 416 it peaked about 460 uh midway through 24 that peak is during the time period where most of the market information is being taken into account and used for the work that's being done we had to have that schedule values turned in. So a lot of the data that comes after this time period is not captured in the way you would like if the market is doing something whether it's going up or down. If it's steady, this doesn't really take into account or have any impacts. But if there's a rise or a fall, it will have some impacts. Appeal details. During a typical year, the Department of Tax Administration receives anywhere between 75 to 200 appeals. That's a typical year. Um, not based on any reappraisal, just a basic year-to-year. And keep in mind, property owners have a right to appeal every year. Whether they appealed last year or not, they can appeal every individual year if they see fit. Although the value

that they are challenging will always be the reappraisal year value. So if they're appealing in the first year, second year, third year, fourth year, it doesn't matter. They're appealing January 1 of the reappraisal date. During a reappraisal year, traditionally, Durham County has received anywhere between 4,500 appeals to 7,500 appeals. Reappraisals, of course, you see an uptick from a normal year and a reappraisal year. Barely anything over 200 in a normal year. And we are showing these types of booms or spikes during a reappraisal year. January 1, 2025 reappraisal brought a different type of appeal. We got 10,533 appeals. That led to some impacts, but it caused a lot of things in regards to value as well as budgeting processes. And some of that is due to our decision to hold the appeal deadline out to June 16th. We did it again this year. I believe this is the last time we will do this. It's a good thing, but it causes a lot of complications. Um the appeal deadline was set for June 16th which was after the budget figures were needed from the department of tax administration. Require estimates to be made regarding how many appeals would be received. Total received appeals are used to assist in projecting holdbacks. 7,500 were estimated May 19th, 2024. There were a total of 5,436 appeals received at that point with two weeks left for the deadline of June 16th. We ended up receiving 10,533 about 200 slightly over 200 of those five that uh

10,533 were received after June 16th. Ultimately, the board of equalization and review has the power to accept late filings. More than 3,000 appeals were unaccounted for during the budget process because of the difference between the 7 7,500 and the 10,533 that were ultimately received. the importance of the holdbacks. Holdbacks for potential appeals, exemptions and any other kind of uncertainties. So hold backs are not specific to appeals. Holdbacks are based on any types of uncertainties that could exist from year to year and it's not based on reappraisals alone. So this is a basic practices done annually. tax relief, tax exclusions, any types of programs that we can't necessarily predict or track. It's just a matter of a person filing an application, whether they're approved or denied. Those types of things are things that we can't really account for. So, holdbacks are a annual process that's done every year regardless of a reappraisal or not. Holding back too much reduces budget revenue, budgeted revenue, and overestimates potential loss due to appeals. Holding back too little puts significant risk on meeting budgeted revenue and underestimates potential loss due to appeals. The commercial appeals this particular reappraisal. The volume and timing of appeals this cycle were influenced in part by the complexity of commercial property valuations. Commercial appeals typically involve significantly more data and analysis and are often filed later in the process. It is not uncommon for a single tax representative to submit a large number of appeals at once or request continuences to receive additional

information. In this cycle, those circumstances were amplified. The board of equalization and review increased its meeting frequency from once per week to as many as three times per week in an effort to try to keep pace of the unprecedented number of appeals. The uh the board did everything they could to get in front of the amount of volume that we received. The goal was to be done by January 5th. We did not achieve that particular goal. But I do not believe that that was because of any lack of effort from the board or staff. Even with those proactive measures, the volume of cases extended the timeline for final decisions beyond what is typical. There are plenty of counties in this particular area, our neighboring counties, and further further away that are experiencing some of the similar issues that we we experienced this particular year. This is an example of the difference between impacts when we're talking about residential properties versus commercial properties. This is a very important slide. It puts things in perspective in regards to the importance and value between residential and commercial. Typical issues found during a mass appraisal. This did happen this particular reappraisal, but it is not um a one-off. These types of things are discovered during reappraisals. properties were identified that had their incorrect year built from a particular neighborhood. These properties were moved in the 80s. They were 1950 yearbuilt homes and they were moved in the 1980s from one part of Durham to another part of Durham. When that took place, the year built was changed in era. It shouldn't have happened. The year built should have stayed what it was. But this particular situation took place in the ' 80s. It was an error that was found through

people appealing their property values. Neighborhoods got together and discussed this particular transaction or occurrence and they brought it to the tax office. This particular situation calls for 96 parcels to be reanalyzed and some adjustments needed. 40 parcels actually received reductions. 40 residential homes that were moved from one part of Durham to another part of Durham had their year built adjusted which calls for an adjustment during this particular reappraisal. That total adjustment equated to $1,460,000. Properties that needed condition adjustments that could only be observed internally received adjustments that total Keep that in mind. We're talking about 40 individual properties totaling $1 million in adjustments. 1.4 Four, commercial sales challenged based on income values impacted by dramatic vacancy issues. The two property types that commercial properties were impacted most were apartments and and office buildings. Value change. The total commercial properties appealed was 1,165 commercial properties appeal. Total residential was 9,235. So we see that difference in regards to what made up the total appeals. The budgeted amount total appeals reductions to budgeted value was 3.1 billion. If you account for what was held back prior to ever being budgeted, the total would be 4.3. That 3.1 is a part of that 4.3. Of course, those aren't separate figures,

but the budgeted amount is what we budgeted for. The 4.3 is if you are accounting for what was held back prior to ever being budgeted. So there's the totals. The total tax exemption loss included 320 million, slightly over 320 million. The Durham office buildings and the Durham apartments were the two biggest impacts to our commercial value. I'm about to run through what it looks like from our side and what the BER the board of equalization and review had to assess and um make some very important decisions based on what they see and what they saw. So this is an example um I believe Commissioner Jacobs helped me get some of these properties over the past few months. Um, so this is a a news clipping from a property that just is just showing you an example of the type of things that are taking place in the market. Um, this is not a one-off and it's not to pick on any particular companies. This is just news. These particular properties are the types of properties that we're seeing being impacted. We have sale prices here. This property, this is a property that sold for $35 million. back in 2016. It's not odd to see over a 10ear span that that particular value appreciated to a taxable value of 44 million. It's another property we had a sale for 35 million. This particular property had a cost value a cost approach of 42 million and an income approach of 35 million. It's pretty tight. Here's another property 81 million.7 sale

price. The cost approach value was 103. The income value is 71. Here's another property. Sale price 85. Income value came in at 778. cost approach supported the sale price at 85. And these are just examples of the ranges. In a in a very strong market, these values are closer. You're going to have a sale price, a cost approach value, and an income value that are pretty tight. When you have some of the things we have in the market during this time, hopefully they don't still exist, but during the time of the reappraisal, the income values were showing drastically less than what the sales and the costs were showing. future approach to data collection to try to hope and tighten up the data that we are paying for, the data that we are getting from our own records and our own work. We want to make sure that we communicate throughout the cycles, not just during a reappraisal year, but throughout the cycles. We want to open up communication with property owners, be that residential and commercial, so that we have more current information and they aren't bringing information that we don't have and that we didn't pay for from market information to a board hearing. Attaining the most recent property characteristics from owners through multiple communications should improve timely data collection. Continuously collected market data supplemented by direct property owner data input will decrease information gaps. In summary, the number of appeals and

and resulting valuation changes were higher than prior years. They reflect the operation of a statutory process responding to rapid shifts and market conditions following a significant reappraisal. Appeals are an inherent part of the property tax system and serve to ensure the property assessments remain fair, equitable, and align with current market realities. This revaluation reflects growth in our community. Real property valuations increased close to 70% from the prior re-evaluation with the values rising from 43 billion to 72 billion. And that's just real property. Value adjustments resulting from the appeal process is better understood not as a sign of economic weakness but as a recalibration within an otherwise strong market. I am available for questions as long as you have to ask you. Commissioner Burton.

Yeah.

Thank you so much Mr. Doyle Kar for your wonderful work. your leadership through this whole entire process. Um, we knew this was going to be a tough year because property values went up a lot and we knew that it would have a great economic impact. And I also want to say for the many of people who are listening to us um this is state law. This is state law. So commercial property owners, you know, you you all did a great job of explaining the difference between the sales approach, the cost approach, the income approach, and commercial property owners could use the cost and income approach. And so I don't want because I think there's some communication that there's some kind of I don't know collaborate about corporations and collaborate and all

this kind of stuff which is total nonsense. You are upholding the laws of North Carolina. These are state decisions. So I just want to put that out there. So thank you for everything. Um thank you for explaining things. Well, the question that I have was of the amount of money that we had to refund percentagewise, what percentage of that went to commercial versus residential and refunding that amount that we had to give back to property owners?

I do not have that exact figure, but I will definitely get it for you.

Um, but it is overwhelmingly commercial in regards to value loss. So, I would I don't want to throw out a bad number or percentage, but it is definitely overwhelmingly commercial.

Okay. Thank you so much. And with the high number of residential owners who appeal, they they were feeling the strain of the high reevaluation because of how much they would have to pay in property tax. So, thank you so much. And uh Commissioner Burton, just want to uh to your point, I want to reassure reassure the board as to the strength and diversity of our tax base still even after appeals. So, you're hearing a lot about commercial properties, uh the adjustments that were made during the appeal process. So, one thing I want to be sure to point out is that in Durham County, we have uh 7,343 improved commercial and industrial parcels. Still some vacant land out there. Those are improved with a building on the on the land. 5.5% of all properties are commercial industrial. That 5.5% of commercial industrial property contributes 35.9% of the total tax levy. All right. When you add on uh the vacant land that's commercial industrial 2, it's about 37% of the total tax levy. So even after

these adjustments, we're still in a good place from a tax base uh strength and diversity standpoint. Um and another thing is that so when you're appraising property, the the owner or or the appraiser really doesn't get to selectively choose the approach to value based on property type. That's what dictates the type of approach you use. Right? So when when you buy a residential home, you're buying it to live in. And um as as an appraisal best practice, you use the sales approach. What did other properties around that property that are similar to that property, what did they sell for? You don't buy a residential property to produce income. Commercial properties you buy to produce an income and that's why you use the income approach um predominantly for that. And the challenge as Mr. Doyle has pointed out, one of the challenges, especially on on this side from the tax office standpoint is the data that you need to do those commercial appeals is hard to come by. That's what makes this process so challenging. And then the other approach, the cost approach to value, that's that's for some of your properties out in RTP, right? Somebody's not going to buy them and rent them out. You're not going to buy them and live in them. So the other approach you have is to value it as if it were new and then you just back out the depreciation that's occurred on the property. Okay. So so so every property type kind of has a leading a guiding uh approach to value that you already use. It's just how how how can we get the data that we need? That's that's the most challenging part. Uh especially with mass appraisal. when you go out there for a bank loan and you're praising the property, it's a much easier process. But, uh, when tax office goes out there, it's it can be challenging getting the information we need to be, uh, successful. And I just want to say thank you for mentioning that about how much revenue

commercial properties bring into Durham County because when we're making decisions around economic development and incentives, we're thinking about, okay, if this potential company builds a commercial property and how much that will generate in tax revenue so we can do the things that we need to do for our residents. Um, I appreciate you saying that. So, thank you both so much.

Commissioner Brown.

Yes. Thank you, Vice Chair. Mr. Doyle, thank you for your willingness to engage uh members of our community right where they were this this cycle. Uh, the many churches, community centers that you went to, it didn't go unnoticed. So during your presentation, you talked about uh June 16th being uh the deadline for the appeals and you said moving forward that wouldn't be something that would be we would be uh doing in the future. Uh can you speak to that a little bit?

It would be my recommendation. I would definitely be willing to continue if that's what the board would would suggest. Um, historically we usually have a deadline date somewhere around the first two weeks of May. That's typical. Um, normally anything beyond that, you are endangering other processes, but because of the reappraisal and what we were expecting for January 1, 2025, we thought that it was important to try to extend it. Where is there a soft spot somewhere in the middle? I I don't know. Um, I know that the typical date is safe um, in regards to knowing how many appeals you have at that moment and it's still time to be able to make certain types of um, decisions that need to be made.

Uh, thank you for that. So, it's safe to assume that the June 16th date that was set for this year was primarily based on

the facts and circumstances of this particular cycle.

Yes.

Okay. Um, I've taken some criticism in the community about the the board of equalization review and one of the criticisms was is that Commissioner Valentine didn't know anything about this obscure board, which we know is is not true. In fact, we marshaled them into this very chamber because of the heavy lift that they provided during this uh particular cycle. Could you speak to the makeup of that board for our residents?

Yes. Um, I've been with this particular tax office since 2007. I've been a part of residential appeals, commercial appeals, and in management. Um, this board is one of the most experienced boards that I've seen um, in my time. Um, I'm sure um, ACM Brenson could speak to some of the boards he's seen over his years, but I believe that Durham County is lucky to have a board that has the level of experience this particular board has. We have real estate agents and appraisers on this board. Um, all boards don't have real estate experienced members making these types of decisions. I do not agree with every decision made by the board of equalization and review, but I respect it cuz I know their experience. I know who they are and I know what they are looking at. Um, it's very hard to get three appraisers in the room and we all have the same same exact number. So there's going to be some disagreement. There might be some differences in regards to perspectives, but um having this the experience of this particular board in my opinion is a value. I definitely think we have one of the best boards that I have ever been a part of. Um we lost a very important member. We were able to replace that member with somebody that some of the um current members had experience with and served on other boards with. Um we have a lot of people who are members of the real estate the local real estate um association. Um these are things that

are very important. I value the fact that we have experienced real estate people on our board making decisions. I think that is very important.

Uh Mr. Doyle, continuing on that that theme, why is this expertise so important in this process relative to a further appeal that exists at the state level? I believe that the average decision made on this level, whether I agreed with it or not, if it's going further to the property tax commission, which some of these values are, we have about 230 to my knowledge um that are scheduled for the property tax commission, which means they went through the board of equalization and review and they received a value. So, the property owner felt that they wanted to continue that fight. We definitely feel comfortable with whatever that value is and our staff is probably hoping to get it raised some because it's going back to the arena for further discussion. So, um, the property tax commission, we would like to make sure that we are taking advantage of an opportunity for a property to be challenged again, but more than likely the board of equalization and review has given them a value or judge decided and established a value for that property owner. Nine times out of 10, that value is not going to be reduced further. And that's because I think we have a pretty solid board. Um, our office usually is trying to see if we can get it raised a little bit by the time it gets to that arena. But it's very important that um, precedent is set prior to going to the property tax commission. We do not want a board setting arbitrary values and then that value makes it to the property tax commission. So the value that makes it

to the property tax commission is important.

Uh lastly, you talked about this being a recalibration and so I mean I know projections are a difficult thing. Um what what should we sort of look forward forward to um during the next cycle? What's that what do you think that's going to look like? We'll be watching the market to establish a very strong um understanding and opinion of what the value is going into 29. That starts at the start of 27. Um we'll probably cheat a little bit and start a little earlier, but the data um we're just hoping what we're hoping for is a steady two years. We need it to be consistent throughout that last 6 months. Any type of rise or fall impacts the ratio. again uh Mr. Doyle, thank you for the work uh in your office um and also for uh the work of the board of equalization review. And so we depend on people in our community to serve and uh to the extent that people are willing, we we are very thankful for their participation in this process. Thank you.

Thank you,

Commissioner Jacobs. I just want to echo a lot of the comments that have already been made. Um I think it's really important that we try to address some of the inaccurate information that is being um put out. Um, and we heard some of it at our public hearing that uh we our we did not have a situation in Durham County government where corporations evaded their taxes. That is false.

We did not have a situation where um we had businesses that were we had giveaways. That is false. We have we have state laws that govern our tax system in North Carolina. Uh we have to follow the laws and as you have very eloquently um you know described um Kar and all the examples that you gave um the reality is is that commercial properties are valued differently. That is just a fact. That's the way the system works. Um, and commercial property owners have a right to show what their losses and that impacts their values. And so we need we are not doing a service to anyone in our community when we are putting out information that is not true. Um, and I also appreciate you saying that we still we do have a strong economy and but the fact is that values go up and down. That's that's the reality of how the market works. And what you showed in that first chart is that, you know, property values are actually going down and there's always going to be pros and cons in that of that. If you're somebody who's buying, that's a good thing. if you're trying to sell your property, you may not be happy about that. And that again, that's we live in a capitalist market economy. And that's the way it works. Um, so um, and I also want to lift up our staff, our budget staff, and our tax staff because they do their best to try to make estimates of where things are headed based on the data. at a certain time it is not a perfect science. It's human beings

um who are trying to do their best and um and again same thing with as you acknowledge our board of equalization and review. I mean I was thinking about them the opioid advisory kitty members people who are really I mean they are nominally uh given some compensation but the amount of time and effort that they put into this um so um and you know a lot of you you hear a lot of people saying I don't understand we have so much growth in Durham why is it not why do we why are we having these um challenges with funding is it's a very complex issue you. But as you have more development, you have more costs for expenses and services and the cost of everything's going up. So if your household budget is going up, so is the county's budget. And so um so I think it's really important that we all try to speak the truth and educate our community. Um, and just like every, you know, families are having to really make hard choices, we are having to make hard choices because we we have to weigh all the different needs that we have in our community and we have to be good stewards of the of the dollars that we have. So, um, thank you again. Um, appreciate you. Um, you have very difficult job. Nobody likes to talk about taxes. Um, and thank you for going and and and presenting to the city council. I didn't know about that, but thank you for doing that. And thank you for your support as well. Um, ACM Brinson, appreciate it. We get to have the additional benefit of uh of you as well.

So, thank you. Thank you, Commissioner Jacobs. Um, thank you so much. Sorry for almost skipping over you. Uh, but we appreciate all the work that you do to make it possible for us to even have the programs and services that Durham County provides. Um, and being so willing to be out and open in the community, even though, as Commissioner Jacobs mentioned, is not a conversation people like to have, but it's one unfortunately we got to have because in the state of North Carolina, this is the only revenue generating source that we have beyond sales tax and it's the only one we have control over. So, thank you all so much. And JG, did you have

No, I just have one comment. Um when we develop our budget each year, we have a guiding principles document and we sort of talk through areas we'll focus on um strategies and looking at revenues, expenditures. One note that I would say that we consider as we think about future years as it relates to our reappraisal that we make a a minor adjustment to our guiding principles to note that during a reappraisal year, the recommended budget aligns more closely with the general statutes to allow for increased time to evaluate the appeals. And I say that because by law, the county manager has to present a recommended budget to the board by June 1st. We typically do it early May so there's more time for deliberation. So, if we're in a cycle similar to this current year where we have unprecedented growth, we allowed our um residents and businesses to have extended time for the appeal process, which was the right thing to do. Um, however, it did mean that we had some timing issues with when

the budget was recommended. And this is why we are having this conversation now. Budgeting is an art and I've been doing it for a long time and I've been fortunate over the years whether I was in the budget director role or some other capacity that um did not have this scenario but it happens because it's budgeting and so um but I I um will say lesson learned that may be something for us to consider for future boards so that they can think about it in future um leadership but that uh may be a way to make sure there's enough time. It will compress the time that the governing body and the manager talks about the budget, but it takes away some of the risk that's there if you're allowing an extended appeal process if it's decided, it will work that way. So, just a a place for us to think about in the future. We have a few years but um lessons learned are important as we continue to move forward um the organization. In response to what you just sess suggested, I guess it's kind of in different than what Kar suggested because he suggested having a shortened

yeah he deal right so I think

the question is right well and so we could frame it um that the board would consider

a shorter period or if it's extended the recommended budget is presented at a I think it has to be

based on more what activity you're seeing in the market.

I mean, we had, you know, I guess the final number a 68%

um growth in our our base and we've

never experienced that type of activity.

So, uh naturally, you're going to have a higher percentage of appeals. And so

if in March you're still

sensing there's going to be some appeals,

you may have to um reconsider if that earlier date is the is the right timing based on what you're experiencing in the market. And again, based on that time frame, it looked like we were still doing the right thing, but the patterns turned out to be different. And so, so it's a it's a um a good lesson for us to um to sort of think about and we have opportunity to to visit it further. Well, I agree that we should think about what policy change might make sense to as your to your point for both of your points, lessons learned

and maybe something that gives the flexibility of either approach in the future. But I think that's a good idea.

Manager, Commissioner Jacobs, one thing that K Mr. Do and I have been talking about, um, we can we can have the same almost the same amount of time for the appeals process. we can start it earlier and end it earlier. So, traditionally, we've started the appeals process and tax. You have to start it between the first Monday in April and the first Monday in May. And we've we've aired towards the first Monday in May. Traditionally, we could advance that and start it uh towards the first Monday in April. still allow a very ample amount of time for appeals and still have uh a a good uh thorough guide projection for the budget process if we need to make adjustments at that point because you think about I mean today's May 28th right so June 19th you think about 3 weeks from now if we got 5,000 appeals three weeks from now that would be a

real impact on what we had done from a budgeting projection standpoint so if we advance that and make it earlier, still giving the same due process, still giving the same amount of time. Uh that would help us from a a budgeting uh stability standpoint, too. So, we're looking at several options.

Thank you all so much. Appreciate it.

Now, that brings us to David Ades and manager Hager on add and delete.

Yes. So this is the time in the conversation that we will entertain um board um questions. There are a list of questions that we are following up on and you may or may not have um comments at this time. Uh we do have a meeting on Tuesday and one tenatively on um Thursday of next week. uh because of our um sort of our budget this year. It's not the same number of conversations that we've had in the past because it's it's pretty much a flat budget from county operations perspective or actually it's a a reduced budget from the county um operational um perspective. So we are uh finalizing the list of departments that are uh that we'll share on Tuesday. We'll give some highlights on next steps on various areas there in the fall. There are conversations that need to occur about our capital improvement plan and where we're headed. We need to adopt a CIP as we plan for the next several years. Um we did get affirmation from standard and pores and Moody's that we uh were reaffirmed as a AAA um bond rated entity. So thanks for everyone's support in that and it's great we're in a

community that is growing and businesses and residents desire to be here and based on our practices with our financial management we remain solid. So, we're excited to share that information. And so, again, we'll entertain any comments or questions from the board. And I'll turn it back to Commissioner Long,

Commissioner Pr.

All right. So, uh, thank you so much for that great news, um, Manager Hager, that it's important for our residents to understand that for Durham County to have a AAA bond rating is very significant in order for us to be able to build these largecale projects and that we are on good financial ground. So, that's really, really great news. So, so I wanted us to have a discussion. I think the biggest thing that's on my mind with regards to the budget is around Durham public schools and the classified staff and as a former DPS um employee. Um I was a school media coordinator as many of you all know. I worked for the public schools and also I served as DAE president. I think about the situation with the classified staff and I know we're DPS, the superintendent and his budget wants more to get their wages up and I begin to think back to my time in the building when I was in leadership with DAE and I began to think about this has been ongoing now for about a good eight to 10 years about how do we raise classified pay and I think it's unfortunate that the state has abandoned its um responsibility

um to the schools and we listen to justice services about mental health. They've abandoned their responsibility to people with mental health um issues and place that burden on the counties. Um, and here we are, right? And I begin I think in timelines. And so I was thinking about, okay, in 2018, the classified staff, the custodians were on contract with DPS and they wanted to bring them back in house and school superintendent school board asked for the money to bring them back in house. brought them back in house as employees, regular employees, right? I remember all of that. I think when they were on contract, they were making $9 an hour. When they start working for being official DPS employees, it went to $14 an hour. They got sick leave, medical insurance, things like that. Then we go to 2020, 2021. I was DAE president at the time trying to push to get them to $15 an hour. We pushed, we got that to 15, right? Then in 2022 2023 the previous superintendent did a salary study try to figure out how do we get the classified pay to this level did the salary study came to the county asked for the money. Okay you see the pattern right and then in 203 24 you had the pay debacle. Okay go to the county we need this amount of money. I think that was 27 million. You see the pattern? Okay. So, now we here two years later, we need 25 26 million because we got to get the classified staff paid up, right? And

this is going to be tough because I believe that all workers deserve livable wages. But on the other hand, I'm seeing this pattern that we're trying to use the property tax to buff to get it up to fill the gap because the state won't take on the responsibility and we're holding the bag, right? And what I'm clearly am seeing is that in it's going to be every year we're using the property tax to try to get workers up to this livable wage. The cost of living goes up, things like that. So I'm saying that to say I don't I want to give something because I recognize that they work hard. that hold up the schools, the operations, but I don't know if we can continuously raise the property tax. We need DPS. We need to work on this together to figure out how are we going to get these wages to livable wages. How are we going to do it? Right? And one of the things going back, I'm going back to 2017, 2018, DPS had a budget advisory committee where we looked at the budget and it was Ellen um former commissioner Ellen Recal was on there. You had um Fred Raven, former school board member Steve Unrew, several people from the community, myself, the previous president of DAE. We were on there trying to look at the budget, things like that. I don't know if something DPS needs to go back to something like that. But I also know that this is not sustainable where we continuously raise the property tax every year. But I do think we need to

contribute something. We need to figure this out. So I'm willing to hear from my colleagues about how do we solve this? Because I believe all of us up here believe that we value workers. We want people to have a livable wage, but I think we got to come up with some sort of solution. It can't be reactive anymore. So, that's all I want to say.

Thank you, Commissioner Burton. Commissioner Valentine. Okay. You want to go first? Okay. Um I was going to go last, but I'll go.

Madam Madam Chair, if you want to go last, I I'll I'll

go in the line. Yes.

I I will honor that. Yes. Um, thank you, uh, Commissioner Burton. I think that, uh, you're spot on with respect to this not being something that is sustainable over the long run, um, based on how it's being presented to us. Um, I think the question is, you know, one of, you know, placing a further burden on our taxpayers and are are we willing to do that? My concern is is that we do that this year. Next year is going to be the same. We're going to be the same place that we uh the same place that we are today. We'll be there next year. Right? So, we need DPS to tell us, you know, and we because we can't direct them, right? So, we say we asked for the classified pay increase, which is $10 million they're asking for. Let's say we granted that today, right? Say we all got together and we agreed that we would do that and we put the burden on on the taxpayer. What's the plan for next year with respect to DPS? In fact, I'm still waiting for, you know, where they're finding some money

in their existing budget. I hadn't got any information on that just yet. So, it'd be hard for me to to make a decision about how to move on this. Do I think that it's unfair for our classified workers to be in the position they're in? Yes. But a lot of that burden is on the state and they're not doing their job. they're not doing their job. Now, I'm hoping that uh a budget is forthcoming and they'll do something, but in terms of the the county continuously filling the gap, it's just an impossibility. It's an impossibility. So, um I will take what you have said under consideration with respect to what it is that they need in this regard. Um, but I'm not I'm not sure that I'm prepared to to put it on the taxpayers that additional burden. So, I I'll have to think through that when I sit and I think about this board. So, we have the former ch uh head of the teachers union. He's not here today. We have the former school board chair. We have former DPS parent. I'm a former DPS teacher, parent, and current parent of a DPS educator. And we have a parent of young children who will be DPS students one day. You could not have more pro- Durham public school board here. Um, you know, I I agree with what both of my colleagues have just said. Um, I I I would like to hear, you know, I sent a list of questions. Uh I would like to hear about what um

the Durham public schools what kind of funding that they first of all can commit to within their budget to go towards the classified staff. Um we have done the hard work in Durham County. Our our 32 departments have made sacrifices. We have tremendous needs. We have to be prepared for what's coming down. this year at any time related to Medicaid and SNAP. Um, and we have to have the ability to be able to fund those things as well. Um, what you know, as as you said, Commissioner Burton, what what is happening is not sustainable. So, I think we have to look at kind of short term. I agree with you. I absolutely feel like this should be a fullcourt press um meaning in partnership with Durham public schools about making tough decisions and realigning priorities and the priority should be on the classified staff salaries. I would hope that they're looking internally on some of their initiatives that are expensive to implement and maybe putting a pause on some of those things like the growing together initiative. I don't know what the costs are associated with that. Um but the truth of the matter is that in the manager's recommended budget is two over $235 million of funding that is being allocated to Durham public schools. They ch they can choose to use that money however they want and anything that we say we don't have control over that. Um, and I'm really concerned when I hear some of our DPS staff,

the comments that I heard, some of them on on Tuesday night, make me feel like people are not getting accurate information about how things really work and who makes the decisions. uh we don't get we don't decide about classified pay and year to your point I appreciate your history because every year that I since really 2016 um when I became chair of this board it was one of my priorities to be able to redirect more funding to Durham public schools and I'm very proud of that and the county has contributed more than aund $100 million in new money to Durham public schools over a time when the enrollment has dropped. And so when you have declining enrollment and you keep increasing the locally funded positions, that is just not financially sustainable. So um I agree with you, Commissioner Burton. there. We need to as soon as we get through this budget, I will we we turn to the county manager and ask about how we can set up a process where we are consing out ASAP a strategy going forward. And I agree with what um we heard the DAE um president share about a plan. I agree. We need a plan because this is something has to change and part of that plan needs to be getting us in line with benchmarking on locally funded positions. Um, so yeah. So my concern is is number one, I really want to hear from Durham public schools about what money they can come up with within

their budget just like we have. We heard three to4 million the other day, but we didn't get any real commitment on how that could be used. If there is the additional $1.7 million that gets freed up of M's pay, are they willing to um dedicate that to classified pay? Um we asked for a breakdown of the positions um and what the pay categories were for those positions. Um is there way for us to focus on again on the on really the people who are the lowest paid? Um, and then you know, I'm just going to throw this out there that we've done this in the past is is there a way for us to be creative in terms of um looking at because the only place we we have no room in our budget right now except maybe the vehicles. Is there a way to look at reallocating any capital costs in a way that it would free up some um operation funding for for DPS as a contribution or as a match towards them putting money towards classified staff u and that would be a way to be able to create some additional revenue without raising taxes. We've done that before creatively. We did it back in um 2425 with some ARPA capital funding because you know we know capital can only be used for one time. So it would just take some creative outside the box thinking but um because I do want to honor what you said about um property tax there people in our community are suffering. We can't just say that it doesn't matter and that people can you know handle it when you know the cast the price of gas,

food, everything is impacting people in our community and we can't ignore that. Um so those are my thoughts at this moment. I'm still hoping we can figure out a way between creative thinking on our side and also some um getting some answers from DPS by Tuesday on those questions.

And I'm sure they will get them to us by Tuesday.

Yes. So, I don't want to be redundant, but I I definitely want to shine a light on the fact that uh we talk a lot about student outcomes in this in DPS and we talk about uh placing conditions on DPS to spend money a certain kind of way, but Commissioner Jacobs is correct. Once we appropriate that money, no matter what conversations that we have around this DAS, DPS is free to spend that money any way that they desire. And so I am going to be um patiently awaiting to hear from our partners about uh what they're willing to do even before we talk about being creative on this side of uh the equation. um to to see what we can do potentially um with this particular issue. But it's going to be tough. I mean, we're in a tough uh budget cycle and uh we'll just wait to to hear from them.

Thank you. I want to add in that I share uh the same sentiments of all of my colleagues and it is a testament to how difficult of a budget season that we are in that each and every one of us cares deeply deeply deeply about our public school system, our students, our educators, the buildings that they are in. And also we're living in this time

where at the federal level we're seeing cuts. At the state level, we haven't had a budget in a year and people's cost of living are rising and they're also seeing unprecedented amount of job layoffs and job loss um in this in Durham County and all across the state and country. And I say all that to say like it is difficult because yeah, it's been nice to be you know the past four years where it was like yeah we had unprecedented growth. you get a car, you get a car. Really felt like it we were able to do everything. Um, and we're not in that financial state anymore. I know when we talked with that had the last joint meeting with DPS, I would like to hear and I know Commissioner Jacobs asked a follow-up question or email about that 3 to four million, it seemed like, you know, that um, Mr. Teter said that they could be able to find operationally. I would like to see that more solidified of like where is that going to be coming from? What can they allocate that towards? Um I also think you know moving forward when there is that like type of operational possibility of 3 to four million why is it not incorporated into the budget beforehand um before coming to the county. Uh, I think we need to set and have those standards for DPS as well that if they know this is a possibility, it shouldn't be, well, we'll come to the county, see what we can get, and then find our cuts. It should be, let's try every single thing we can internally first and then go to the county. So, I'd like to see that 3 to four million um information shared with us of where they operationally will move it around from, what will it cover? Um can it be moved to um salaries? Because if it isn't already salaries, then we have the whole charter school situation. So like how much would it actually be to be able to um tackle

the classified staff keep these C these classified and certified the classified staff salaries and then I'd also like us to look at so I've been recently like seeing a lot of articles it was actually in Granville County I think it was Associated Press maybe Washington Post just did a story about how Granville County just did like a study where they've had um days at their school that are screenfree which are including also laptops and iPads for students and how they've seen a drastic improvement in students learning and how even schoolisssued laptops even though they know that you know initially a big push for having school issued was to provide that equity access but there is a detrimental impact of it too of having kids constantly be on their screens in the classroom they're getting distracted their attention span is just shorter even in face-toface conversations. And I would like to hear from DPS like if they've been tracking and seeing any of that in our classrooms because I'm sure they have. I personally am concerned about the long-term impacts that has on our children's mental health and well-being to have them constantly on a screen in school as well as, you know, when they come home, whatever they're doing. And I think like the $3 million increase that they're asking us for for the replacements of those laptops, that's another area that we should look at. Is is there ways to find savings there that in the classroom there's shared computers like shared library time the laptop carts that we had like you know when we were kids that came around for each class shared those because yeah I don't I personally don't believe that we should be having a singular laptop or Chromebook for every single student to be learning on. Yeah, I think that's

something definitely to discuss. I will say being in the buildings with I know one of the issues is with testing now all the ELGs are on testing the Mitchmark testing, the I Ready testing. Um so you have to have an individual laptop for all the kids. But I think maybe thinking creatively around that. I will say the bright links are old. They they're old. But I think that's something that, you know, talking about with DPS about, okay, maybe just get the bright links, thinking about, okay, how many Chromebooks should we get? When I was in the media center, I did try to limit the kids using them. Like I didn't have K through um K through one bring them to the library. There was just some things you had to show them, right? But yeah, I think that's something that, you know, bringing that up. Do we have to have maybe we don't do a whole refresh, maybe do a half refresh or something.

Yeah. And like transitioning, I know obviously we can't just, you know, go cold turkey on everything, but yeah, having a transition period and also transitioning to what are other ways. I know that with the testing it makes it difficult, but especially with like the homework and the things that we have control over of the way that we're instructing in the classroom, what adjustments can be made? Um, and so I think it's 12 or $12 million is the ask for classified increases, correct? Or is it

because we did the the manager's recommended budget is 10 million for the continued funding,

right? Because that includes the 3% pay raise and there's the in that's the other thing that's going up is the pension cost and the insurance cost. So I think that that's in the six million.

Thanks. Uh I was looking as you all were talking the total request for the classified staff for DPS is 13 million classified staff. What they're saying is 2.7 of that is already covered in their continuation funding. So the expansion

portion of the classified is 10.6 million I believe is what they've asked for.

Then that 10.6 six and then if you take away that four million that if DPS is able to find within savings there's a remaining six million I don't know I know the state's budget is average 8% but for classified it's looking at 3% and that's not even all that doesn't cover the locally funded classified staff

and then you got to is that figured in the charter search charge part

I would doubt that that 10 million includes in the charter search charge so let's say I I think they were saying a number in the 27% I think is what they're projecting for next year with a couple more charters. So you've got another that 6 million that Vice Chair Long just came up with. We've got to add another two and a half million to that to where you're now at another cent essentially.

Yeah.

Yeah. A cent just for everyone's um education is 8.5 million this year. And I wanted to also say about how, and I know we talked about this, Commissioner Jacobs, about having charter schools present before us because they're getting a nice chunk of local dollars and wondering, okay, what are the outcomes for those students who attend their schools? Um, I I think that's something we could do, I guess, starting, you know, in the next fiscal year, how we would work that out. Um, I think that's really important. County Manager Hager.

Yeah. And I'll just add we probably about 10 years ago or more than that we did do that and we had a forum. I think that could be very easy to organize. The only problem is now we have so many that we would you know have just have create some kind of a framework certain questions and requests for information and have invite them to come or request

that they come to present the data. um and just spend, you know, a whole day doing it, but and invite the public and I think it's a great idea to have that accountability and transparency around the use of Durham County funds. The only comment I was going to add is in the budget document on page 9.5, we do have the student proficiency data for um the charter schools as well as for DPS. So for me, I say all of that rambling to say I also would like to see us, yeah, think creatively, get DPS to come up with that 4 million that they've already said is possible, but also looking within the technology, other areas that they're spending in to find additional savings. Um because yeah, I know Commissioner Valentine and I were able to attend the town hall, but also all the other commissioners were able to watch it afterwards um on their own. You know, it is I think all of us see and hear like how heartbreaking it is, especially for our EC educators um who are working with our most vulnerable students. Um our students, many of the educators, EC classroom um instructors were talking about how they are essentially like nurses in the classroom having to change diapers, feeding tubes. Um, and for me, so it's very difficult because I hear that and I do like all of us believe that they should be paid more and I know that it's the state responsibility and me personally I'm just like I know it's the state responsibility and also the state is not doing their job and I don't see them getting to do their job anytime soon and so I personally can't pull myself to say like, well, we have to we'll keep fighting for the state to

do it while not bringing it up. And I know that all of our colleagues care about that, but I think I would really really like to see us with DPS close that gap for the classified staff.

Yeah. And I also wanted to say um vice chair alum about this planning, long-term planning. I'm very, you know, with this constitutional amendment going on the ballot and we're going to really, we may potentially will not be able to do this next year. And so we really have to have these conversations about how do we move the needle with the potential that we will not be able to do this because the state is will probably restrict us, right? So, um I'm hopeful that we will get to some solution because um you know they work hard. So anyway, thank you.

And I think also to add on my last piece, another thing that I know I've brought up and I've talked to manager Hager about I've talked to Superintendent Lewis briefly about it of us looking in the future of what are roles and positions like with budgeting figuring out that could possibly be better served within Durham County. Um we did that in 202 with the a lot of the nursing positions that moved under public health.

Yeah. But I think there's other position areas that we could look at. Um

yeah, the challenge with that I mean we did it for efficiency purposes and we can discuss further the complexities of that. Yeah.

Thank you. And I did have two other things I wanted to see. Um I apologize if this was at the budget retreat that I had missed, but are we gonna have presentations from uh APS and the libraries during the budget work

sessions?

We had not planned for um for them to present. Um we can look to see if we can schedule them. I will say that uh based on the list of questions that came up from the board because we did not have an expansion budget and typically we focus the conversations on areas where there are expansion unless there are some questions. So we can see if we can invite them if not we can bring them back to the board for updates in um in during the summer. Uh or we can also give written information beyond what's there because we we have a lot of departments trying to isolate which ones um may need to present when they're not um having an increase has is is a little unique this year. So, but we can definitely see what we can do.

I much appreciate it. Thank you,

county manager. Even in in light of that, I would be in favor of having them come. I I really would like to hear from them.

The library. Yes. Yes. I definitely would be in favor of that.

Yeah.

And APS.

Yes. Hear from the library. Yes.

Thank you. Anything else? So, I actually have a an item

and so uh we've heard from the community and uh about provisions of social services and I want to put a couple things to rest about uh Commissioner Valentine's position on uh social services particularly as it relates to child welfare. There is a movement in our community to defund uh social services. I am 100% against that. Let me say that again. I am 100% against

that. And so I believe in the mission of DSS and child protective services as it relates to the safety of our children. Is it a perfect system? There are no perfect systems. There are no perfect systems. But I believe that that system is in place for the protection of children and I will support that. I will always support that. But to the extent that the community uh is concerned about reunification efforts actually came to this office um with that being one of my priorities. And so to the extent that we can uh direct staff to find some additional money within the the existing budget um to help support um reunification and preservation efforts, I would like to see if we could uh increase uh that appropriation. And so what that looks like, I mean I 50,000 100,000 we could have that sort of discussion offline. Um but within the existing budget uh if I can direct staff to to to do that and uh certainly um there was a an outcry from the community to to do 1%. I don't see how we get to that. That's that's uh not a number that we can even entertain that that would be to the tune of about $10 million. And so we just don't have that from a budgetary standpoint. But to the extent that we can um put some money into reunification and I've actually talked to the director, this actually been an ongoing conversation that we've been having over uh the course of a number several months. And so this isn't something new with regards to the discussions we've been having. But to the extent that we can direct money uh in the existing budget that way, I would hope that we we could find some. Yeah. Commissioner

Valentine, we will follow up uh with um Director Clap and also clarify ways that we support families who are in this circumstance with um resources that are already in place and and I'm not sure how easily um Director Clap can share that because whether it's rental assistance, eviction diversion funds, or other types of funds that some who may be in the situation that they're getting access to them. I think this is important for us to also bring context to what we are doing and then where there may be gaps in in this season trying to do the best that we can um to move the needle forward. Uh I absolutely uh agree with that but to the extent that we can uh I would definitely be in favor of that. Uh did any of my other colleagues have any thoughts about that?

Mr. Jacobs.

Yeah, I yeah I think it's important that we establish what what funding is there. I know a lot of time um and then also what kind of state and federal funding which is often restricted. So whether and it you know we can do something that is provides local you know local funding usually has flexibility. So whether there are some even if it's a small fund um that gives the staff some flexibility um to do things. I remember when I was on the DSS board, we had this source of funding that it was small, but it really made a bit big impact uh for kids like to buy prom dresses and do school photos and um you know, just

different things that they didn't necessarily cost a lot of money, but they also had a big impact on people's lives. and they were flexible sources of funding to support children and families. So, you know, whether there's something that the DSS staff have identified that could really help um you know, make the difference in terms of taking the edge off a lot of the strains that that people do have. Um and I you know I had asked for the whatever from community intervention support services from Crystal to get any of the data and reporting around the hey ty reborn because that is a place where we are still providing a high level funding that may be a source of uh redirecting some funds to things like what you brought up. Um, and I think I had mentioned also I am concerned the food security we're doing and whether we have the ability to add a little bit to that. Um, and then I was concerned also about um the early ch childhood action plan. We normally have money allocated for grants for that and I didn't see that explicitly in the budget. Um maybe it's actually in there or it just wasn't. Um

so we're following up on those questions. They are

um I know we will have some responses sent tomorrow. Okay.

And then another uh wave of responses um on Monday.

So

one item I can hopefully quickly clarify there is funding. I think it's a little over 300,000. Thank you Shannon and our team for pulling this together. um 300,000 in the early childhood great fund center for the ECAP.

Fantastic.

I think we're moving on to the implementation stage of ECAP versus more

of the study of what we want to do.

Right.

There's some other quirky looking funding in that area that we're going to try to explain in the in the questions that we respond to you. Okay.

It's basically related to some longer year commitments that are going to be handled in the rollover process as opposed to creating new money next year to handle them. But in the excuse me, in the end they'll have approximately the same amount of budget once the rollover process.

Awesome. Thank you. And then I guess pro it would be helpful to have we don't need a report on the vehicles, but just even just a writ some more detailed information about the vehicles. I know there's stuff in the budget book.

Yes.

But well, we we will definitely give you that information. And I know one that sticks out is um the the vehicles that are replacement for the sheriff's office. We we had probably twice as many that were eligible well um maybe closer to 58 position 58 vehicles were eligible for replacement either based on age or mileage or the number of repairs. Uh so for us our cycle has always been to replace a certain number so that we aren't in a situation where we aren't able to respond timely because of not having adequate um vehicles or equipment. But we will provide additional information on that as well. the the areas such as EMS where we need probably what 24 months for them to or is it longer than that now to actually um build a a a vehicle for us? Those are the ones that we are most concerned about and uh and we're trying to be creative as well in in those areas. And so some of these we may even come back next year to think about strategy

considering supply chain issues and then the demands with a growing population and how we are responsive. Yeah.

Yeah. Just to confirm the sheriff's office requested around 53 or 54 this year and managers Hager Manager Hager's elaborate process to come to a recommendation. Some of those were reduced to their normal amount, which I believe is 37 to 38. I would be remiss from the budget office perspective, and I I hope manager's okay with this if I didn't mention if we postpone a significant number of vehicles, we're kind of punishing our future selves because it's unlikely, unless a wholesale change occurs, that we're going to reduce the number of vehicles that the sheriff has. So eventually they're going to get behind and we're going to end up having to kind of instead of one year replacing 38, we're going to have to do that 50. So from the budget perspective, we kind of like the stability and the actual amount this year. Um Jonathan Yman may or may not nod at this. I think last year we replaced around 7 million of vehicles. I think we've actually reduced that a little this year with some of the recommendations from the manager already trying to trim things. I just had another thought which was you know in terms of coming up with a plan of how and thank you for the information about the vehicles. I know it's not a very sexy topic but um we I know the goal is of course to get classified up to at least 1922 which is you know what our minimum is which is still not enough. Um but if we can think about a phased plan where you know let's say we can get them up to 1820 this year or 1810 and then 1920 next year so over two years. One of my questions is what

is the cost if to get them up to that let's say 1810 um is that half of the request? I'm trying to understand and then if you know if DPS can do four million at least you know does that leave another two million like what what is a way to look at also a phased um strategy which I think is probably more realistic um based on things you know the realities that we have but that would be helpful to know also Thank you all so much.

With that we are adjourned. See you all on Monday.

All right. Great.

Thank you all. Great meeting.