►
Description
Briefing of the Buncombe County Board of Commissioners on September 19, 2023. The briefing is a chance for Commissioners to review agenda items before the meeting. No motions will take place during the briefing.
A
A
B
The
post
addressed
items
that
have
been
identified
as
common
administrative
gaps
in
collection
agreements
across
the
state,
and
he
offered
recommendations
to
address
those
common
gaps.
Recommendations
found
in
that
post
are
being
incorporated
into
our
Municipal
collection
agreements
by
an
addendum
to
the
existing
agreements.
We're
also
going
to
add
some
recurring
reporting
and
approval
processes.
B
The
school
of
government
recommendations
include
Municipal
appointment
of
a
tax,
collector
Municipal
tax
collector
delegating
all
duties
to
the
County
Tax
Collector,
the
County
Tax
Collector.
To
take
the
same
oath
required
of
the
municipal
tax
collector,
the
municipal
tax
collector
will
have
a
bond
each
year.
The
municipality
will
adopt
an
order
of
collection
for
the
municipal
tax
collector,
and
a
copy
of
that
adopted
order
will
be
delivered
to
the
County
Tax
Collector.
B
The
County
Tax
Collector
will
obtain
approval
for
refunds
and
releases
of
Municipal
property
tax
so
where
we
are
in
the
process
and
next
steps,
The
Collection
agreement,
addendums
have
been
provided
to
and
approved
by
each
municipality
we
collect
on
behalf
of
each
municipality
is
working
through
the
completion
of
the
recommended
actions
noted
by
Chris
McLaughlin
from
the
school
of
government,
and
the
last
step
is
County
approval
of
the
addendums
to
the
municipal
collection
agreements.
Those
are
on
the
con.
The
consent
agenda
today
for
each
municipality
I
would
also
like
to
add.
B
A
A
B
A
C
C
So
these
are
just
a
couple
of
pictures
and
images
from
the
reparations
Retreat
that
happened
on
July
29th
at
the
Harris
Cherokee
Banquet
Hall.
We
had
members
of
the
commission
who
were
there.
We
had
Venetia
Crawford,
who
was
bought
in
to
help
facilitate
the
conversation
to
help
them
narrow
down
their
scope,
focus
on
their
recommendations,
focus
on
defining
reparations
and
just
having
this
a
chance
and
opportunity
to
talk
across
ifas
and
develop
their
work
further
I'm
here
and
these
two
photos.
C
This
was
an
activity
that
they
did
after
lunch,
that
everyone
really
engaged
in
and
it
was
opportunity
for
them
to
go
around
to
the
different
ifas
and
look
at
the
recommendations
that
have
been
put
forth
and
to
use
sticky
notes
to
note
where
there
are
crossover.
So
their
crossover
between
education
and
housing,
crossover
between
criminal
justice
and
Wellness,
Health
and
Wellness,
and
they
really
did
appreciate
that
opportunity
and
activity
to
look
at
those
further
harms.
Look
at
how
that
could
be
repair.
C
Look
at
the
impact
of
past
harms
and
how
what
their
the
work
that
they're
doing,
how
it
could
develop
into
possible
repair
and
reparations,
and
then
to
close
out
the
retreat.
They
were
able
to
then
form
these
groups
and
working
across
ifas.
C
So
you
had
criminal
justice,
pairing
up
with
economic
development
and
housing,
and
education
paired
up
in
health
and
wellness
had
enough
people
present
that
they
sent
two
people
to
one
group
and
one
to
the
other
group,
and
they
all
had
their
flute
charts
and
they
were
writing
and
they
were
discussing
and
they
were
seeing
how
there
was
this
overlap
with
some
of
the
recommendations
and
with
some
of
the
harms.
And
so
the
goal
is
that,
through
this
process,
they're
able
to
put
forth
the
recommendations
as
a
whole
commission,
not
in
silos
by
ifas.
C
But
it
was
an
opportunity
for
them
to
see
the
hard
work.
That's
been
put
forth
so
far
in
the
year
and
a
half,
so
our
current
dialogue
or
current
progress
data
team
has
been
able
to
go
to
each
IFA
and
have
conversations
and
discuss
with
them.
What
is
going
on?
77
of
all
data
requests
have
been
completed
across
ifas,
19
has
not
been
completed,
and
10
of
that
cannot
be
completed
for
whatever
reason
we
don't
have
access
State
records
and
some
particular
ifas
like
health
and
wellness.
C
C
Special
collections
has
done
a
lot
of
great
work
and
put
data
in
journals
and
books
and
things
in
there
that
we
can
have
beyond
the
reparations
process
to
use
access,
County
department
experts
continue
to
visit,
they've
had
visits
from
permits
and
tax,
assessors
and
others
may
visit
as
well
to
provide
them
additional
information
that
will
help
them
in
this
process.
C
Currently,
County
and
City
are
in
the
review
process
of
the
first
slate
of
recommendations.
Those
will
be
given
back
to
the
ifas
for
them
to
hone
in
and
tighten
up
and
delete
things
that
they
don't
need
and
have
a
better
understanding
of
what
may
or
may
not
be
the
best
way
forward
with
their
particular
reparations.
C
And
then
the
commission
last
night
agreed
to
the
parameters
of
defining
reparations
for
Ashland
local
County,
so
they
invited
vernisha
Crawford
back
and
she
was
able,
through
a
series
of,
prompts
to
get
them
to
help
compose
a
more
Collective
through
the
commission
idea
of
what
reparations
is
and
she's
going
to
get
that
typed
up
and
send
that
back
to
Christine
so
that
it
can
be
on
their
branding
and
can
be
on
their
agendas.
It
can
be
a
part
of
where
they
move
forward,
so
they
have
a
Direction.
C
C
Why
is
reparations
important
that
had
they
all
went
around
the
room
and
shared
out
just
random,
then
she
asked
them
what
would
reparations
be
defined
as
and
then
she
gave
them
a
prompt
that
asked
them
to
look
at
what
would
they
want
to
see
continued
and
what
would
they
want
to
see
enhanced,
and
so
they
were
able
to
share
out
around
the
room
and
she
collected
that
data
and
is
going
to
put
it
all
together.
So
we're
excited
about
that
process
from
last
night
and
then
evaluating
the
timeline
and
progress
toward
completion.
C
April
2024
is
the
initial
deadline,
but
we're
assessing
that
as
we
go
to
see
where
they
are
and
what's
coming
up
and
how
we
can
help
support
them.
Then.
Lastly,
finalizing
the
plans
for
our
reparations
Summit,
our
community
reparation
Summit
on
October
7th,
we're
excited
about
that
and
I'll
share
a
little
bit
more
on
the
next
slide.
C
So
for
a
community
and
public
engagement,
we
have
a
series
of
events
leading
up
to
the
reparations
Summit.
The
community
reparation
Summit
on
October
7th.
The
first
one
will
be
on
Monday
October,
2nd,
where
we'll
be
showing
the
documentary
black
in
Asheville
by
Mr,
Todd
Gregg
and
then
on
October
5th,
we'll
be
showing
The
Big
Payback.
That
highlights
the
reparations
process
and
work
that
was
going
on
in
Everson
Evanston
Illinois.
Both
events
are
free
to
the
public.
C
D
C
10
a.m
to
3
P.M
we're
not
going
to
stay
there
all
day
on
October
7th
at
the
Cheryl
Center
at
UNCA.
Asheville
registration
has
closed
for
that
event,
but
we're
excited
that
we
met
our
goal
and
we're
looking
forward
to
those
events.
We
have
vendors,
we'll
have
music
playing
we'll
have
people
from
the
community
who
will
be
out,
and
this
will
be
another
opportunity
for
the
ifas
to
share
with
the
larger
Community.
C
The
work
that's
been
done
since
the
beginning
of
this
process,
where
they
are
the
recommendations
and
they'll
also
have
a
chance
to
pull
and
talk
to
the
community
and
get
feedback
directly
from
the
community
on
what
the
community
would
like
to
see.
So
they
can
add
that
into
their
recommendations
as
well,
so
transitioning
a
little
bit
to
the
cease
to
harm
audit
which
has
been
developed
out
of
the
community
reparations
Commission.
C
The
sisterharm
audit
was
voted
agreed
on
a
contract
between
Carter
Development
Group,
Dr,
Carter
and
Dr
Lashana
Wiggs
came
here
on
August
21st.
They
met
with
key
stakeholders,
they
attended
the
were
in
September,
so
they
attended
the
August
reparations
meeting
and
got
to
talk
to
the
Commissioners
and
share
a
little
bit
about
them
and
their
goals.
C
They
launched
a
kickoff,
they
talked
to
stakeholders
in
the
city
and
the
county,
those
that
will
be
collecting
data
from,
and
so
that
has
officially
started
and,
as
you
can
see
from
this
image,
there
are
10
people
who
will
be
working.
There
are
two
people
assigned
to
each
IFA,
so
there's
a
researcher
and
then
there's
an
assistant,
so
they
are
honed
in
on
collecting
data,
asking
questions
and
then
they're
going
to
schedule
cohort
meetings
with
those
who
cohort
members
and
with
the
apartment,
heads
and
subject
matter,
experts
to
get
the
narrative
piece.
C
So
this
first
half
has
been
the
quantitative
data
of
just
getting
the
numbers,
getting
questions
answered
and
then
they're
going
to
follow
back
up
with
the
qualitative
side
and
have
conversation
and
develop
the
narrative
to
complete
that
in
the
hope
of
the
aim
is
that
they
will
hopefully
have
a
preliminary
update
aiming
for
December.
Realistically,
it
might
be
January,
but
definitely
by
January.
We'll
have
a
preliminary
result
of
the
sea
storm
audit.
C
So
looking
ahead,
where
do
we
go
from
here
from
the
community
reparations
commission?
They
want
to
expand
Community
Education
and
seek
additional
input.
They
are
really
engaged
and
hone
in
on
talking
to
the
community
and
want
to
make
sure
that
the
black
community
in
Asheville
feel
like
they
have
a
say
in
this
process,
and
so
they
want
to
expand,
what's
being
done
and
said
and
taught
and
seek
additional
input.
Some
of
that
will
start
at
the
reparation
Summit
and
we'll
continue
to
refine
and
finalize
recommendations
at
the
Timeline
Milestones.
C
So
this
process
of
sending
their
recommendations
for
review,
city
and
county
reviewing
getting
input
from
the
community
going
back
and
forth
at
certain
intervals
of
time
and
then
continue
to
evaluate
the
timeline
and
progress
towards
completion
again
looking
at
where
they
are,
where
they're
coming
from,
what's
been
done.
What
may
need
to
be
done
and
addressing
those
as
they
as
issues
or
conversations
arise?
And
then
our
next
commission
meeting
will
be
October,
16th,
6,
8
pm
at
Harris,
Cherokee,
Banquet
Hall,
any
questions
or
discussions.
E
I
have
a
question
I
I
guess
without
this
is
going
to
put
you
in
a
hard
spot
without
speculating
too
much
about
what
the
recommendations
will
be.
Is
there
anything
that
we
could
do
to
prepare
for
the
general
tenor
of
what
it's
going
to
be
expected
of
us,
because
I
know
a
lot
of
the
changes
that
are
being
considered
from
what
I've
heard
or
a
lot
of
the
audit
on
ceasing?
The
harm
is
kind
of
hinging
on
us.
C
That's
a
great
question:
I
think
from
the
conversations
that
we've
had
a
lot
of
the
assessment
of
the
current
recommendations
is
looking
at.
What's
already
there
I
think
there
are
a
lot
of
things
that
the
county
is
doing,
and
it
may
be
that
we
need
to
expand
what
we're
doing
or
highlight
how
we're
doing
it
and
offer
more
opportunity
and
access
to
the
community
to
get
those
resources.
So
I
don't
know
that
there's
anything
to
plan
for
I
honestly
believe
from
our
conversations
in
multiple
hours.
C
Reviewing
the
recommendations
and
talking
through
there
are
a
lot
of
pieces
in
place,
and
so
it
might
just
be.
How
do
we
expand
those
pieces?
How
do
we
get
more
people
out
to
know
about
those
pieces
and
how
do
we
get
them
to
build
that
trust
between
city
and
county
and
community,
so
that
they'll
utilize
what's
there
and
then
whatever
is
missing,
find
a
way
through
collaboration
on
how
to
build
through
that?
Thank.
F
So
today
we're
providing
a
brief
update
on
our
fiddle
overdose
response
efforts.
Earlier
this
year,
the
commission
asked
that
staff
become
laser
focused
on
reducing
fatal
overdoses
as
a
result
of
the
opioid
epidemic
and
as
a
reminder,
these
were
recommendations
developed
through
planning
for
the
use
of
opioid
settlement
funds
and
aligned
with
the
focus
to
reduce
fatal
overdoses.
We
will
be
providing
updates
on
where
we
are
and
implementing
these
strategies
on
the
right
side
and
so
I'm
excited.
F
We
have
Dr
Ashokan
Shukla
with
Shukla
Health
Consulting,
who
we
contracted
with
as
our
medical
substance
use
professional
to
help
us
with
data
collection
and
understanding.
What
are
those
important
metrics
to
Monitor
and
measure
our
impact
and
to
also
work
with
our
community
paramedicine
and
our
sheriff's
office
around
being
that
bridge
for
folks
from
the
hospital
and
the
Detention
Center?
H
Hey
everyone
so
I'm
going
to
go
over
some
data
from
the
of
course,
I
turn
off
the
screen
from
the
North
Carolina
opioid
and
substance
use
dashboard.
There
has
been
some
discussion
amongst
County
departments
about
the
quality
of
this
data.
I
would
say
pretty
straightforward
that
this
data
is
consistent
with
the
way
the
CDC
and
other
big
Health
agencies
collect
data.
So
no
data
is
perfect.
H
There's
unlimited
ways
to
dissect
data
and
say
what
it's
missing
and
what
it's
not
but
I'd
say
this:
the
highest
quality
that
makes
sense
for
us
to
pay
attention
to,
and
also
the
thing
that's
most
important,
rather
than
the
perfect
number
of
the
number
of
deaths
or
the
number
of
overdoses.
Number
of
er
visits.
It's
more
about
the
trends,
and
so
here
you
can
see
this
is
data
up
to
2022.
H
They
usually
say
on
this
dashboard
that
the
last
six
months
of
data
is
a
little
bit
more
questionable,
because
death
certificate
data
sometimes
has
a
three
to
six
month
lag,
but
you
can
see
that
Buncombe
for
several
years
really
mirroring
the
presence
of
Fentanyl
and
then
the
the
pandemic
has
diverged
from
the
state
status
in
terms
of
the
overdose
rates,
and
so
this
is
deaths
from
all
causes,
but
you
can,
if
you
looked
at
opioids
specifically,
would
be
the
same
Trend
and
you
know
you
could
see
during
the
pandemic.
H
The
states
try
to
catch
up
with
the
county,
but
things
have
worsened.
Nevertheless,
this
one's
a
little
busy,
so
you
can
start
by
showing
that
the
the
first
bullet
points
showing
that
rate
for
Buncombe
versus
the
second
bullet
point
the
rate
for
the
rest
of
the
state.
The
third
and
fourth
bullet
points
are
also
noteworthy
because
those
the
first
two
are
overdose
rates.
This
the
last
two
are
ER
visits
for
overdose,
and
this
doesn't
show.
Oh,
it
does
show
the
trend
in
the
the
middle
graphs.
H
You
can
see
for
Buncombe
that
overdose
rate
has
sort
of
been
consistently
bad.
However,
the
ER
rate
has
actually
improved
or
or
studied
in
the
last
several
years
and
sort
of
there's
a
few
theories
of
why
that
is.
One
theory
is
that
people
are
dying
before
they
can
reach
the
ER
because
of
the
potency
of
drugs
in
the
drug
Supply.
So
before
a
paramedics
or
Community
bystanders
can
provide
naloxone
to
someone.
They
are
succumbing
to
their
overdose
and
I.
H
Think
the
other
Trend
here
is
that
especially
in
Buncombe,
County
folks
are
choosing
natsco
the
ER,
whether
or
not
they
were
resuscitated
or
a
paramedic
was
involved
because
of
the
perceived
quality
of
those
services
in
the
ER,
and
so
folks
are
not
appearing
in
the
ER
for
overdose
and
thus
not
being
captured
in
that
data.
You
can
see
on
the
right
hand,
side
again.
The
top
one
is
the
death
rate
in
the
ER
visit
rate.
H
Buncombe
is
you
know
not
the
worst
in
the
state,
though
worse
than
than
the
average,
but
you
can
see
a
lot
of
the
other
counties
that
have
this
worse
are
often
rural
counties
on
the
borders
with
other
states
as
well
as
you
can
see,
Mecklenburg
and
the
Raleigh
Durham
area
and
other
counties
with
big
municipalities.
So
I
would
say,
there's
nothing
terribly
surprising
here.
H
The
other
thing
that's
not
noted
on
this
data
is
that
our
rates
are
prescribing
buprenorphine,
which
is
the
gold
state
standard
for
saving
lives,
improving
outcomes,
reducing
criminal
justice
recidivism,
all
the
all
the
good
things.
That
rate
has
also
increased
in
Buncombe
County,
and
particularly
amongst
Medicaid
and
uninsured
beneficiaries,
who
are
at
highest
risk.
H
We
just
heard
this
one
focuses
on
the
the
racial
breakdown
of
Overdose
and
Buncombe,
and
you
can
see
the
numbers
are
quite
small
and
so
like
this
doesn't
really
reach
statistical
significance,
but
you
can
see
they're,
comparing
2015
and
2020
in
terms
of
Overdose
rates
for
biracial
category
and
though
across
the
board,
things
have
worsened
and
for
white
non-hispanic
things
to
worsen.
H
The
165
increase
over
those
five
years,
see
for
black
citizens
of
Buncombe
County,
that's
worsened
by
566
percent,
and
so,
though,
most
overdoses
are
accounted
for
amongst
white
non-hispanic
citizens.
It's
worsening
faster
for
black
members
of
our
community
and
you
can
see
that
represented
in
the
the
graph
on
the
right.
You
can
see
there's
a
lot
of
dots
missing
on
the
bunkum
line
and
that's
because
the
state
is
not
reported
regularly
through
the
ways
the
state
collects
this,
but
the
trends
are
nevertheless
a
little
concerning
a
lot
concerning.
F
Yeah,
so
speaking
about
that
part
of
our
response
is
adding
a
position
into
the
office
of
equity
and
human
rights,
and
we
have
titled
this
an
inclusive
connection
and
healing
coordinator.
So
we
are
well
into
that
process
for
hiring
this
person
is
to
really
help
connect
with
those
communities
and
understand
what
they
need.
Just
as
some
of
our
efforts
in
naloxone
distribution.
F
Our
Equity
team
is
also
continuing
to
work
with
our
joint
information
center
on
awareness
and
marketing
materials,
which
our
director
of
communications
will
be
sharing
next
Lillian
govis,
and
then
we're
also
really
starting
to
meet
with
some
of
our
Behavioral
Health
clinicians
in
the
bipod
Community
to
really
again
understand
what
are
those
opportunities?
I
So
August
31st
was
a
overdose
awareness
day,
and
that
was
when
we
did
our
big
splash
to
kind
of
kick
off
and
have
something
notable
in
the
community,
but
leading
up
to
that.
We
got
with
other
organizations
other
municipalities,
other
agencies
who
have
been
in
this
work
to
find
out
their
best
practices
so
that
we
could
learn
from
those
really
focused
on
making
sure
that
the
language
is
positive
and
constructive
and
intentional
about
reducing
stigma.
I
Regardless
of
what
community
you
come
from
and
then
working
with
our
bilingual
information
and
communication
Specialists
to
make
sure
that
the
messaging
that
we're
developing
resonates
into
our
Spanish
language
information
as
well
as
Russian
and
Ukrainian.
So
we
kicked
things
off
on
opioid
or
excuse
me:
overdose,
Awareness,
Day.
What
you
can
see
with
that
image
is
the
current
advertising
that
we
have
going
at
gorilla
movie
house
if
you
go
to
moving
any
time
between
now
and
the
big
Christmas
rush,
you'll
see
these
slides
ahead
of
those
movies.
I
What
we
found
with
our
messaging,
that
was
that
those
with
the
connection
to
resources,
Narcan
test
strips
those
were
the
ones
that
had
the
greatest
stickiness.
So
those
are
the
ones
where
we're
really
trying
to
invest
in
the
community,
because
we're
seeing
people
take
that
information
and
turn
it
into
behavioral
change.
I
We
also
put
money
behind
a
paid
social
media
campaign
working
on
a
Spotify
campaign
focusing
on
those
demographics
and
age
groups
that
Dr
Shukla
was
referencing,
so
that
we're
being
very
intentional
about
the
work
that
we're
doing
connecting
to
the
communities
who
are
seeing
the
greatest
impacts
from
opioid
and
polysubstance
use.
We're
also
looking
into
YouTube
advertising
and
one
of
the
great
things
that
we're
doing
is
partnering
with
the
wnc
health
network.
I
A
lot
of
our
messaging
can
be
utilized
outside
of
Buncombe
County
and
tailored
to
meet
those
other
communities
needs,
so
we're
working
with
them
on
a
regional
collaborative
in
that
space.
We
also
made
sure
that
we
rolled
this
information
out
to
our
employees.
First,
we
have
more
than
1400
employees
who
need
to
know
this
information
so
that
they
can
help
not
only
be
connected
to
resources
but
connect
their
friends,
their
family,
their
loved
ones.
I
To
these
resources,
as
well,
like
I,
said,
we've
been
working
with
our
bilingual
information
and
communication
Specialists
to
make
sure
that
what
we're
doing
is
culturally
competent
and
we're
in
lockstep
with
our
Equity
committee
who's
also
doing
this
work.
At
the
same
time,
we've
brought
our
community
paramedics
out
to
our
community
engagement
markets,
helping
to
have
those
conversations
meet
people
where
they
are
we're
Distributing,
the
materials
out
at
community
events.
We
were
recently
last
week
actually
at
working
with
the
Mexican
consulate,
and
so
we
were
set
up
there
provided
information
and
Rocio
Quintero.
I
If
you're
coming
to
the
October
7th
reparations,
Summit,
don't
worry,
we'll
have
materials
there
test
strips
and
Narcan
available
to
attendees
we're
going
to
continue
advertising
on
Urban
news,
making
sure
that
we
have
information
in
depth
in
detail
in
in
regular,
speak
on
wres,
helping
to
demystify
and
destigmatize
this
information
so
that
people
can
have
it
and
have
it
available
when
they
need
it
most
I
know,
I
was
impacted
in
my
family
by
the
use
of
opioids,
so
this
is
I
know
firsthand
how
having
that
call
would
have
helped
change
outcomes,
we're
Distributing
materials
at
all
of
our
community
festivals
and
continuing
to
have
them
out
at
our
community
engagement
market.
I
F
It's
almost
wrapping
it
up
and
obviously,
if
you
all
have
questions
we'll
welcome
that
as
well,
but
just
some
of
our
last
updates,
as
you
just
met,
Dr
Shukla
has
been
onboarded
and
has
started
meeting
with
our
various
departments
and
is
starting
to
begin
meeting
with
some
of
our
Community
Partners
that
provide
medications
for
opioid
use
disorder
to
again
better
understand
their
process,
opportunities
that
we
can
get
people
to
the
right
place
at
the
right
time.
Our
community
paramedicine
expansion,
we're
excited.
F
We've
identified
new
staff
to
staff
that
four
person
I
mean
not
four
person,
but
we
will
have
four
Community
paramedics
on
staff
24
7
and
we
anticipate
them
to
be
all
up
and
running
in
early
October
and
they
will
be.
The
new
supervisors
and
team
will
be
working
closely
with
Mission
Hospital
Emergency
Department.
F
They
have
been
slowly
working
on
implementing
their
medication,
access
to
medications
for
opioid
use
disorder
for
those
that
are
presenting
to
the
emergency
department
in
hopes
to
really
align
with
the
community
paramedics
to
make
sure
we're
able
to
get
people
given
that
support
in
between
from
leaving
the
emergency
department
to
getting
connected
with
their
ongoing
provider,
and
this
expansion
will
allow
our
current
teams
to
be
based
out
of
the
Swannanoa
and
West
Asheville
area,
and
this
is
just
to
help
kind
of
re
increase.
F
How
do
we
utilize
our
Sheriff's
Office
Community
paramedics
and
mental
health
clinicians,
and
so
it
was
an
exciting
opportunity
to
just
start
exploring?
What
would
this
look
like?
What
is
the
community
open
open
for,
and
what
we
really
learned
is
that
one.
This
is
something
that
the
community
wants.
F
They
want
that
alternative
response
and
we're
also
noting
that
we're
getting
some
better
outcomes
by
being
able
to
spend
more
time
than
maybe
a
patrol
officer
would
be
able
to
do
and
again
having
some
specialized
training
with
our
crisis
intervention
team,
and
so
that's
just
been
exciting
to
see
that
someone
who
needs
help
that
maybe
on
the
Forefront,
it's
not
clear
but
able
to
have
different
perspectives.
So
you've
got
your
law
enforcement
perspective.
What
are
those
considerations?
F
How
can
we
mitigate
further,
maybe
Justice
involvement
that
could
prevent
them
from
getting
into
a
treatment
facility
or
to
get
those
resources
that
they
need?
How
are
we
looking
at
their
medical
well-being
and
making
sure
that's
being
taken
care
of,
and
also
their
mental
well-being
and
helping
to
really
get
folks
into
the
treatment
that
they
need
as
soon
as
possible?
So
this
was
just
an
initial
and
again
what
I'm,
just
kind
of
sharing
with
you
all
is
that
it
is
welcomed.
F
F
And
so
just
thinking
of
what
our
next
steps
will
be,
one
obviously
with
Dr
Shukla
on
board,
he's
really
looking
at
different
programs.
What
are
the
what's
the
information
that
we're
collecting?
As
you
all
may
know,
a
lot
of
times.
Our
programs
have
been
born
out
of
Grants
and
there
are
certain
requirements
that
might
be
needed
and
so
really
looking
across
the
county.
What
is
the
information
that
we're
Gathering?
How
can
we
assess
our
impact
and
being
able
to
do
this
consistently?
F
He
is
diving
in
and
already
as
of
today,
coming
up
with
some
ideas
so
more
to
come.
Another
thing
that
we'll
start
looking
at
and
talking
about
is
just
what
are
opportunities
to
support
strategies
that
address
the
systemic
root
causes
with
our
Wave
2
funding,
and
so
we
will
work
with
Commissioners
to
prioritize
the
use
of
potential
Wave,
2
Funds,
so
look
forward
to
some
future
conversations
with
that
and
then.
Lastly,
it's
never
too
early
to
begin
our
conversation
about
sustainability.
F
As
you
know,
Wave
2
or
opioid
settlement
funds,
both
waves
or
any
waves,
will
eventually
titrate
down.
There
may
be
new
initiatives,
things
that
we
want
to
look
at.
So
what
is
our
plan
to
continue
to
sustain
some
of
the
services
that
may
need
to
continue
in
a
long
term
versus
an
immediate
response?
So
we
want
to
start
having
those
conversations
and
figuring
out
what
is
a
plan
to
make
sure
that,
as
opioid
settlement
funds
reduce
that
we
are
able
to
continue
to
meet
the
needs
of
our
community,
and
so
with
that
we've?
J
Good
to
see
you
all,
thank
you
so
much
for
these
updates
and
and
obviously
a
lot
has
been
happening
since
June
when
we
last
heard
from
y'all.
So
thank
you
all
for
the
very
hard
work
and
Leadership
and
welcome
Dr
Shukla
to
the
county
team.
A
J
Glad
you're
here
I
had
a
couple
questions
just
to
go
a
little
deeper,
particularly
on
the
operational
piece
and
sort
of
within
those
sub
strategies.
I
think
it.
It
seems,
like
the
Opera.
J
The
the
ways
we
create
bridges
into
mat
access
and
ongoing
clinical
care
is,
is
really
one
of
those
key
difference
makers
in
terms
of
live
saved
and
wondered
if
there
are
some
any
additional
updates
that
could
be
provided
just
around
sort
of
what
what
we
can
look
for
moving
forward
in
terms
of
access
to
mat
really
starting
to
increase.
J
It
look
looks
like
this
is
sort
of
the
hiring
timeline
for
the
new
staff,
but
sort
of
if
we
have
any
updates
at
this
point
around,
when
there's
additional
protocols
might
be
online
either
at
the
Detention,
Facility
or
or
the
emergency
room
or
if
there's
any
other
settings
that
are
under
consideration
around
how
mat
could
be
made
available
and
accessible
to
more
high-risk
folks,.
F
Yeah
I
think
in
terms
of
any
timelines.
Definitely
getting.
The
new
team
on
board
is
a
big
piece
of
that.
To
really
then
work
with
the
hospital
to
identify
who
are
those
folks
that
would
be
best
served
and
then
again,
as
Dr
Shukla
is
starting
to
reach
out
to
Community
Partners,
who
are
other
partners
that
folks
could
go
to
when
needed.
We
know,
mayhec
has
been
meeting
a
huge
need,
and
yet
no
one
provider
can
do
it
all,
and
so
how
do
we
get
people
to
the
right
service
at
the
right
time?
F
So
beyond
I
believe
really
in
that
early
October
having
that
team
once
they
get
onboarded
which
again
they
are
identified
and
even
backfill
folks
have
been
identified.
I
think
we'll
really
see
some
updates
and
really
able
to
give
some
kind
of
timeline
of
we
are
running.
We've
we've
got
to
start
I,
think
even
Mission
Hospital
is
going
to
be
starting,
very
slow
and
the
numbers
that
we
are
getting
started,
but
no
specific
timelines.
At
this
moment.
K
J
The
other
question
I
have:
is
it
it's
great
to
get
that
sort
of
high
level
data
update,
but
is
maybe
Dr
Shukla?
If
you
could
speak
to
us
a
bit
about
what
we
know
about
folks,
the
folks
in
Buncombe
County,
who
are
at
highest
risk
of
imminent
overdose
death
like?
How
would
you
characterize
that
population
and
and
as
you're
thinking
about
how
we
prioritize
ways
to
get
life-saving
interventions
to
them?
Sure.
H
And
I
would
base
my
answer,
one
on
sort
of
the
National
Data
Trends,
which
has
been
published
pretty
widely
and
consistently
over
these
years
and
then
two
on
data
that
we
collected
when
I
was
at
mayhec
and
we
did
the
collaboration
with
the
EMS
for
bunk
conversion
care
which
we're
starting
patients
on
buprenorphine
in
the
field.
Post
overdose,
sometimes
immediately
overdose,
I
post
over
to
sometimes
Days
Later,
sometimes
weeks
later,
as
well
as
data
from
Sarah
gate
and
her
team
in
the
sheriff's
office.
H
So
the
majority
of
folks
who
are
experiencing
overdose
have
pretty
high
levels
of
being
unhoused
being
uninsured.
It's
more
men
than
women.
It's
ages,
20
to
40.
However,
folks
in
the
geriatric
range
over
65
are
very
much
under
recognized
as
a
a
group.
That's
not
getting
access
to
treatment
or
not
getting
screened
for
substance
use
words,
but
before
I
go
and
down
that
Wormhole,
so
20
to
40
more
men
than
women,
unhoused
I
was
surprised
in
some
of
that
data
at
the
levels
of
employment.
It's
not
as
unemployed
as
you'd.
H
Imagine
but
being
employed
in
Buncombe
County
can
be
very
still
consistent
with
being
on
house
and
uninsured
and
not
having
your
social
determinants
of
Health
needs
met.
Yeah
and
transportation.
Challenges
were
very
high,
at
least
in
that
post
overdose
cohort,
and
so
that's
consistent
with
big
cities
in
rural
areas
throughout
the
country,
particularly
in
areas
that
have
rural
Pockets,
like
Buncombe
County,
has
and
in
terms
of
access.
I.
J
Just
that's
really
helpful
part
of
what
I
ask
is
also
the
the
more
insight
we
have
there,
the
more
it
intersects
sort
of
with
the
Nexus
of
work,
we're
doing
around
increasing
emergency
shelter
options,
bringing
more
housing
online,
Supportive,
Housing
and
addressing
sort
of
mental
health
needs
in
our
community.
J
So
I
hope
as
we
move
forward,
and
particularly
as
more
kind
of
congregate,
shelter
settings
come
online
that
where
there
would
seem
to
be
a
very
high
overlap
of
people
fitting
into
exactly
the
demographics
you're,
describing
that
there
might
be
some
opportunities
for
us
to
think
about
how
that
intersects,
with
the
way
mat,
screening
and
and
those
kinds
of
things
are
happening.
So
thanks
for
kind
of
shining,
a
light
on
that
and
and
our
ongoing
policy
work
across
the
criminal
justice
space,
opioid
response
space
and
ending
homelessness.
J
You
know,
there's
there's
a
lot
of
dots.
I,
think
that
be
can
be
connected
as
we
think
about
how
to
integrate
services
for
folks,
yeah.
H
And
I
do
have
a
bias
here
because
I'm
on
I'm
a
board
member
for
Homeward
Bound,
but
we
had
on
Friday
an
event
to
recognize
the
opening
of
Compass
Point
Village.
And
you
know
those
folks
are
the
exact
demographic
I
just
described
that
high
risk
of
of
Overdose
and
substance
use
issues,
and,
unlike
some
of
the
other
providers
of
shelter
and
housing
support
in
the
county,
Homer
bound
subscribes
to
housing,
first
policies
of
not
requiring
sobriety
or
agreeing
to
treatment
in
order
to
be
housed.
H
And
so,
even
if
you
didn't
provide
someone
with
treatment,
having
someone
housed
in
some
ways
decrease
their
overdose
risk
but
also
potentially
increases
it.
When
people
are
using
a
loan
but
as
I
understand
it,
amchc
like
Dale
fell
will
be
providing
Services
there
on
campus
and
then
Sunrise
will
be
providing
peer
support
and
like
a
Pure,
Living
Room
on
campus,
so
I
think
that's
going
to
mitigate
all
those
dots.
You
just
mentioned
great.
L
With
questions
just
to
clarify
just
for
my
own
education,
what
I
heard
you
say,
maybe
you
can
you
can
clarify
repeat
that
the
demographic
data
you've
seen
suggests
that
the
people
that
we're
targeting
or
should
be
targeting
are
largely
unhoused
20
to
40,
but
also
perhaps
kind
of
in
the
50
50
range
of
of
employed
versus
unemployed
is
that
yeah.
H
H
You
know
I've
been
bouncing
these
numbers
around
my
head
and
saying
in
some
meetings
that
the
the
national
rate
of
opioid
use
disorder
is
about
two
percent
of
the
population,
so
at
Buncombe
County
it's
about
280
k,
that's
about
5500
people
with
opioid
use
disorder,
let's
say
about
half
or
so
want
treatment.
You
know
might
be
more.
But
let's
say
half
that's
about
2
700
people
with
the
current
infrastructure
we
have
I
know
at
mayhack
we
had
about
seven
or
eight
hundred
unique
patients
on
some
form
of
mat.
H
In
a
year,
I
think
Dale
fell
and
Lester
Clinic
Bay
MCHC
clinics,
it's
maybe
close
to
that,
maybe
a
little
less.
And
then,
if
you
look
at
the
otps,
each
of
them
maybe
have
a
hundred,
maybe
50,
maybe
150..
So
that's
of
the
folks
who
want
treatment.
Maybe
half
of
them
have
access
to
treatment,
but
that
leaves
a
gap
of
maybe
about
a
thousand
people.
These
are
the
folks
who
are
the
hardest
to
reach.
These
are
the
folks
in
tents.
These
are
the
folks
on
Ann
Street.
H
These
are
the
folks
interacting
with
the
criminal
justice
system
and
I.
Think
the
I
mean
I'm
saying
this
is
now
an
Insider,
but
even
when
I
was
an
outsider,
I
felt
the
the
structures
that
the
counties
pursued:
The
Paramedic
program,
the
jail-based
services.
This
is
exactly
what
the
county
needs
and
really
what
the
country
needs
to
address
the
overdose
epidemic.
L
D
And
I'd
like
to
give
Lillian
some
feedback
good
feedback
from
this
weekend,
I
was
in
barnardsville
at
the
celebration
for
the
pool
Saturday
and
then
yesterday,
I
was
in
fundraiser
for
w-r-e-a-s
and
in
barnardsville
a
lady
walked
up
to
me
when
I
was
leaving
and
thanked
me
and
said
you
know,
the
county
is
finally
doing
a
good
job
of
keeping
us
informed
even
up
here,
and
it
really.
You
know,
I
looked
and
said:
oh
great,
you
know
whatever
and
of
course
yesterday
at
wers
you
know
they
were
singing
your
Praises.
E
I
just
had
just
kind
of
a
quick
plug
as
we
go
forward.
I
know
that
it's
difficult
to
project
the
timeline
for
when
we
see
results.
What
results
look
like,
what
what
are
Metro,
measurables
and
deliverables
are
going
to
be,
but
I'm
excited
by
this
and
given
the
number
of
areas
where
there's
intersection
across
our
systems,
I'd
love
to
see
if
we
can
kind
of
plug
in
the
work
that
y'all
are
doing
into
the
different
committees
that
we're
already
having
these
conversations
and
I
know
you're
already
plugged
into
every
one
of
those
groups.
E
So
God
bless
you
for
having
to
send
like
50
meetings,
but
I
I
would
I
think
that
would
be
really
helpful
for
all
the
parties
involved.
All
the
stakeholders,
including
those
Beyond
necessarily
County
staff,
to
hear
some
of
the
data
that
we're
hearing,
because
I
think
it's
going
to
inform
some
serious
changes
here.
F
M
F
F
You
know
they
really
have
made
a
network
of
folks
and
providers
that
are
out
there,
helping
people
and
so
I
think
that
is
increasing.
Those
likelihood
that
an
individual
that
might
be
ambivalent
doesn't
have
the
transportation
to
figure
out
where
to
go,
to
know
that
a
paramedic
can
come
meet
you
under
that
bridge.
F
You
know,
wherever
you
might
be,
and
give
them
really
what
I'm
noticing,
as
I've
as
I'm,
working
on
our
opioid
impact
report
to
the
state
that
a
lot
of
the
feedback
is
like
you
saved
my
life,
you
gave
me
hope
that
there
is
an
opportunity
to
get
recovery,
and
so
yes,
I
would
expect
that.
That
is
the
fact
that
we'll
have
more
people
a
lot
of
times.
Our
community
paramedics,
just
like
law
enforcement,
will
have
a
couple
stacked
calls,
and
so
some
sometimes
we're
having
to
follow
up
later,
can't
find
the
person.
F
J
I
guess
I
actually
had
one
more
thing,
which
was
the
co-responder
piece.
I
think
that
some
of
us
may
remember
in
the
height
of
the
pandemic,
doing
a
call
with
kahoots
out
in
Oregon.
Some
of
us
in
this
room
were
on
that
call
and
to
my
knowledge
this
is
sort
of
the
first
real
steps
we've
seen
within
Buncombe
County
of
an
integrated
response
model.
So
that
seems
really
significant
that
that's
happening.
J
You're
laughing
was
it
it
feels
like
it
was
decades
ago,
yeah,
but
I
think
that's
really
notable
and
worth
kind
of
worth
kind
of
just
recognizing
the
big
lift,
also
underway
there
and
how
you
know.
We
don't
always
take
the
time
to
connect
the
dots
but
the
consolidation
of
9-1-1
Services.
You
know
the
the
just
ongoing
kind
of
deep
work
happening
at
the
collaborative
level
between
County.
J
Are
all
the
kinds
of
things
that
are
making
this
possible
so
exciting
to
see
these
these
marks
of
of
progress
as
we
move
forward.
A
G
You
pursuant
to
143
318-11
A5.
We
need
request
of
motion
to
go
into
closed
session
to
hear
real
property
matter
regarding
price
and
other
material
terms
of
opposed
real
estate
contract,
and
we
anticipate
the
board.
Second
May
come
back
later
and
address
the
issue.