Human Services, Labor, and Economic Development Committee 6/5/2026

Good morning.

The Human Services Labor and Economic Development Committee meeting of the Seattle City Council will come to order.

It is 9.33 a.m.

June 5th, 2026. I'm Councilmember Alexis Mercedes Rink, chair of the committee.

Will the committee clerk please call the roll and let the record reflect that Council President Hollingsworth and Councilmember Juarez are excused.

Vice Chair Foster.

Here.

Councilmember Saka.

Here.

Chair Rink.

Present.

Chair, there are three members present and two excused.

Thank you.

We will now move on to approval of today's agenda.

If there is no objection, the agenda will be adopted.

Hearing no objection, the agenda is adopted.

Welcome everyone.

We have three items on today's agenda.

First, a vote on a resolution updating citywide parking and business improvement areas, or BIAs, then a briefing from King County Regional Homelessness Authority regarding the corrective action plan submitted by the agency to both mayor's office and the county executive, May 22nd, 2026, as required in response to the forensic evaluation.

And finally, we have a briefing from the city's human services department and public health seattle king county and DESC regarding public health approaches to substance use disorder and with that we will now open the hybrid public comment period public comments should relate to items on today's agenda or within the purview of committee clerk how many speakers are signed up for today currently we have one in-person speaker signed up and there are two remote speakers Thank you.

Each speaker will have two minutes.

We will start with in-person speakers first.

Clerk, can you please read the public comment instructions?

The public comment period will be moderated in the following manner.

The public comment period is up to 60 minutes.

Speakers will be called in the order in which they registered.

Speakers will alternate between a set of in-person and remote speakers until the public comment period has concluded.

Please begin speaking by stating your full name and item that you are addressing.

Speakers will hear a chime when 10 seconds are left on their time.

Speakers' mics will be muted if they do not end their comments within the allotted time to allow us to call on the next speaker.

The public comment period is now open and we will begin with the first speaker on the list.

Thank you.

The first in-person speaker is Michael Pickett.

Good morning.

I wanted to thank the council members for your sacrifice.

You have hard jobs, you get more complaints and criticism than you do compliments, and I appreciate the work you do.

I serve on the board of Fair Start as a community volunteer.

I live in the city of Seattle.

I am not homeless, and I never have been.

I had a career in management consulting where I helped organizations operate better.

I worked with companies like Microsoft and Starbucks, the city of Seattle, the state of Washington, King County, the Gates Foundation, and every single one of them had areas where they needed to do better.

I think the city of Seattle does some things really, really well, and I think they have some areas they need to do better.

as does KCRHA, right?

They've got some areas they need to do better.

But they're a five-year-old organization.

They were founded and started by a leadership team that was not terribly process-oriented and entrepreneurial.

Probably the right thing at the time, but that leadership team is no longer here.

We're now on to version two of KCRHA.

To expect flawlessness in their operations is not realistic.

They've got areas they need to improve.

What I would urge all of you to do is to help them, advocate for them, and hold them accountable.

But they need support, and they need a little more time to get things figured out.

If we're in the same spot in a year or two, I think a re-evaluation and a serious one is warranted.

But right now, our community, people on the streets, and everybody wants more results.

And KCRHA and the organization that is set up is best positioned to do that.

If you were to try and neuter them or make a change, it would cost millions and time.

And that's time that we don't have.

So I would urge you to support them, advocate for them, advocate for the folks who are homeless, and give it another shot and hold them accountable.

Thank you.

Thank you.

The first remote speaker is Alberto Alvarez.

Please press star six when you hear the prompt, you have been unmuted.

Thank you.

Good morning, Chair Rank and Vice Chair Foster.

Price increases due to tariffs, the Iran oil blockade, and federal burdens on trade manufacturing.

Inflating the price to consumers in our city would further push local shoppers and nearby residents away.

The majority of workers in hotel hospitality, food and drink, building maintenance, and more live far outside the boundaries of our city.

most of which would not benefit from the mayor's spending on transit.

As lines with majority Seattle stops would be expanded, the mayor will be taxing the remaining income after food, rent, utilities of the most struggling workers who can never afford to be our neighbor.

Express lines from nearby towns, the two to three buses a person takes into our city, or the 45-minute drive from Snohomish.

None of these would be alleviated with the Mayor's plan, yet she will be taxing their participation in our local economy far higher than any benefit they will ever see.

Please move forward with great caution on another sales tax.

Take into account that taxing vehicles and local parking are the best way to ensure an increase to ridership.

Thank you all and have a good day.

Thank you.

The next speaker on the list is David Haynes.

Please press star six when you hear the prompt.

You have been unmuted.

Hi, David Haynes.

We always needed King County Regional Homeless Authority to keep the service providers honest, forthright, and diligent with a constructive criticism that would improve the outcomes.

Instead, King County Regional Homeless Authority, the original starters of it, perverted the interpretations of policy and began running interference for criminals and prioritizing the most self-destructive, more profitable repeat offenders in partnership with some of the racist, woke, corrupt at the Human Services Department, imploding our society.

Ever since Brad Feingood took over, there's been a 331% increase in drug overdose fatalities, while King County keeps misleading about it only being a public health crisis, as evil predators are listed non-violent low-level, committing crimes against humanity, destroying their fellow man's life.

In fact, public health crisis for King County believes that they need drug kits, which are up to over 75,000, and yet we still have a plateau of a minimum of 600 over deaths while claiming that they've had success dialing it down 28% from a record of 1,350, which is still a significant amount, but yet we get these misleading words to be heard from these propaganda bureaucrats who are untrustworthy.

It's like you might be college qualified, but you are untrustworthy because your scoring lived experience gets in the way of real progress.

because I hate to say this folks but you need to understand that the foundational philosophical architectural approach to public health in Seattle is based on Brad Feingood being advised by his drug addict brother who he didn't even know was a drug addict but yet died of a drug addiction and yet Brad was told by his brother that drug addicts need a safe place to do drugs and Brad has shared with us his misery and forced all of us to be subjected to all these people dropping dead because he believes that they need a safe place to do drugs with the heroic answer of- That concludes our public comment period.

Hearing no objection, we're going to move on to our first item of business.

The clerk please read item one into the record.

Item one, resolution 32207, a resolution adopting updated policies regarding the establishment and management of parking and business improvement areas for the city of Seattle and superseding resolution 31657, briefing discussion and possible votes.

Thank you, Clark.

Colleagues, as our presenters get settled in, just as a reminder, we heard this item actually last week during our special meeting, and as we discussed, we are bringing this for a vote today.

The citywide BIA policies provide guidance for existing and potential BIAs.

This resolution will update and simplify that guidance.

We know that BIAs are a powerful tool that allow businesses and property owners in neighborhoods across the city to target shared resources to meet the specific needs of their own neighborhoods.

And so, excited to have this before us today.

I'll turn it over to the table if you want to take a moment to first introduce yourselves for the record and then proceed with the topic at hand.

Please go forward.

Jasmine Marwaja, Council Central Staff.

Isaac Horwath, Office of Economic Development.

Excuse me, Theresa Barreras, Office of Economic Development.

Yeah, thank you for having us today and for considering to approve the resolution.

I won't spend a lot of time recapping the legislation as Chair Rink described.

It makes many small changes to make the policies more user-friendly and easy to understand the roles and responsibilities of the city and of current or prospective BIAs.

The most substantive change is around reducing the barriers for renewing an existing BIA as long as they're not making any significant changes to how they operate or their boundaries.

We're available if there are any follow-up questions.

and I think Theresa had a little doubt.

I'll just add that the policies were last updated about 10 years ago and so it was time to take another look and try to make some improvements from things that we had seen and we worked closely with the directors of all of our business improvement areas in the city to go through the policies in depth and agree on what changes were needed and so it was a very inclusive process and I think we landed on a good result

Fabulous.

Colleagues, questions that you have on the resolution?

I am not seeing any hands.

I know we had a robust discussion about this last week and so unless there are any final points.

I think I'm just gonna keep us moving along then.

I move that the committee move forward with recommending adoption of Resolution 32207. Is there a second?

Second.

It is moved and seconded to recommend adoption of the resolution.

Any final comments?

All right, will the clerk please call the roll on the committee recommendation to adopt the resolution?

Vice Chair Foster.

Yes.

Council Member Saka.

Hey.

Chair Rink.

Yes.

There are three in favor, zero opposed and zero abstentions.

The motion carries and the committee recommendation to adopt the resolution will be sent to the June 16th full city council meeting.

Thank you colleagues.

Thank you all for being here this morning.

Have a great weekend.

With that, we will now move on to our second item of business.

Will the clerk please read item two into the record?

Item two, King County Regional Homelessness Authority, KCRHA Forensic Evaluation Status Update, Briefing and Discussion.

Thank you so much.

As our presenters sit down at the table, a note for my colleagues and for the viewing public, this item will have KCRHA speak to the corrective action plan that they were required to submit to the mayor's office and the King County Executive and the KCRHA governing board as a result of the forensic evaluation findings.

This corrective action plan requirement was also outlined in the resolution passed by full council on Tuesday of this week.

And this paper document was submitted by KSRHA and received by the three entities on May 22nd.

And today's presentation covers the content.

So presenters, if you can take a moment to unmute your microphones, introduce yourself by stating your full name into the microphone for the record, and then proceed with the presentation.

That would be great.

Thank you.

Good morning, Chair Rink, Co-Chair, Foster, Member SACA, members of the public.

I'm Kelly Kinison.

I'm the CEO of the King County Regional Homelessness Authority.

Good morning, everyone.

My name is William Towie.

I'm Associate Deputy Strategy at KCRHA.

We really appreciate the opportunity to be here to talk to you about our corrective action plan and answer any questions you may have.

As you can see, we've kept the slides streamlined so that we can get right to your questions or any discussion that you'd like to have.

I'd like to start with just some brief background for those not familiar.

KCRHA was started during a really tumultuous time during a global pandemic.

We really started operations in early 2021, and this evaluation period ran from April 2021 through July 2025. We've included a reference slide at the end of the deck with a brief timeline of KCRHA's operations.

The forensic evaluation that was conducted by Clark Neuber really revealed some very serious weaknesses in our financial systems, internal controls, and our reporting practices during the entire reporting period.

And as the evaluation points out, these really started at inception and kind of built and intersected with each other over the period of time that the evaluation covered.

We're very thankful there's no evidence of fraud or misuse of funds despite some of the reporting you may have seen.

The quote-unquote missing funds that are sometimes mentioned in news relate to funds that we paid out to homelessness service providers or other appropriate uses.

but our reconciliation on our back end for getting reimbursed frankly didn't happen or happened incorrectly.

We're still investigating that deeply over the course of those years.

I just want to, you know, emphasize that KCRHA is responsible for fixing these problems and we know that we have work to do with our partners to better collaborate and coordinate with our funders and make sure that these issues on our back end are reconciled.

So where we are now, we have submitted a corrective action plan that's very detailed, that walks through every evaluation finding in response to the evaluation.

It was submitted on May 22nd.

It acknowledges the seriousness as I have related to these issues and it has allowed us to move from response to the evaluation into really knowing our path forward for correcting the issues.

It's really what, as I joined the city, the region in 2024, I knew there was a lot that we needed to fix, but it's really hard from a bird's eye view to understand everything.

And I know those of you who have been involved longer than I have understand that.

And so this is an amazing tool that we have now to roadmap exactly how the backend governance needs to work.

So our focus is now stabilizing all of those operations, continuing to reconcile some of the unresolved issues that have come on our radar.

We've already strengthened controls, which William Towie will talk to you about in just a moment.

And we're doing much clearer reporting to the board, city and county where that's possible.

We still have some things we need to fix so that our reporting is accurate and timely.

We're approaching this work with accountability, transparency, and urgency.

We understand and have heard from you the urgency and the unacceptability of the situation.

And we hope that you will see our corrective action plan and see how we are trying to move in that direction.

William?

Thank you.

On slide four, We list out some of the items related to current status and operations.

I would note that the forensic evaluation covered the period of time from the beginning of KCRHA through to...

Apologies.

I think we're having an issue with slides.

Are you presenting slides right now?

Okay.

Can we address that?

Thank you.

One moment.

We'll be at ease, colleagues, just while we make sure the slides are up.

Apologies.

And while we're on those technical adjustments, William, if you can make sure that your mic is on.

I think we're having some trouble.

I believe it is.

I'll try to be.

I think you can also move it closer to you.

Thank you.

Perfect.

Great.

Please proceed.

Thank you.

There we go.

Thank you so much.

So the forensic evaluation covered the period from the beginning of KCRHA through to the June of 2025, and it uncovered really two or three key areas of focus.

Policies and procedures and practices for operations generally, as well as a couple of other areas.

This slide really relates to the first category of items.

and I would note that the bulk of the problems identified in the evaluation center on the years 22, 23 and 24. It's notable and the evaluation also notes that in 25 we switched to an updated contracts management system.

The original system was insufficient as it is apparent from the results of the evaluation.

and so we know that the year 2025 and 2026 are significantly improved from those earlier years.

So it's a little bit of a tale of two organizations in a sense.

The policies and procedures that you'll see noted on this slide are related to primarily the kind of activities that were centrally improved through the implementation of Salesforce.

There are still several items noted in our corrective action plan related to these areas.

However, we have had many of the control changes underway or in place.

Those are being codified.

Our monthly close is happening regularly at this point.

The finance leadership and controller level review is an example of changes that took place in 2025, right around when the evaluation was ending.

The ability to validate our receivables and basically perform reconciliations, which was one of the core problems from the early years, is largely resolved and functioning at this point.

and we're evaluating where we may need additional capacity or external validation and I'll speak to that a little bit more in the next slide.

And so where we're at now is we have implemented all the control changes in place for approvals, documentation, access reviews.

There was notable conversation around things like gift cards and purchase cards.

I would just frame that in the scope and scale of the financial implications from this evaluation, those items are very much at the margin, and of course it's important that there are appropriate and proper controls in place for those.

Those controls were largely in place, they just weren't as thoroughly documented as one might have liked.

The Phase 1 work for the Corrective Action Plan has really leaned into making sure that those policies and practices and procedures are fully documented and in compliance with 2 CFR 200, the kinds of requirements that we need to be able to show that we're not only that we're doing the right things, but that we're documenting and it's clear and the policies and procedures are clear around that.

The other part of it is this sort of secondary element of the evaluation which relates to some really pretty large dollar numbers.

And they fall into three key categories.

Unreconciled accounts receivables, which as Dr. Kinison noted, represent funds that we paid out to providers that we did not correctly bill back to our funders.

At KCRHA, we really have five things that we spend money on.

We spend money related to the HUD COC work.

We spend money related to our Department of Commerce Permits Supportive Housing programs.

And we spend money related to City of Seattle contracts and King County contracts.

And the fifth thing, we spend money for the administrative overhead of the organization.

And our initial review has focused in on clearly understanding those expenses and the income related.

And because we use the King County Treasury, we don't have our own bank account.

We use the investment pool.

We have 100% clean records on every penny we've spent.

and every penny that's come into the organization.

And we can identify that flow of cash across those five categories.

So we've already begun working through a cash analysis that we will continue in the coming weeks and have identified with clarity that the The vast majority of these unreconciled receivables reside in the relationship between the City of Seattle and King County and KCRHA.

That being said, there's kind of two levels of analysis there.

The top level cash analysis will give us the dollar amounts.

The pursuit of the actual detail relative to the particulars of each contract, each cash swap related to those unreconcilable receivables will take longer and require more historical evaluation, which is the sort of work that's anticipated in phase two.

Also in phase two, we note that the opportunity will continue to improve systems within KCRHA so that the status of the organization that we have today in this sort of 25, 26 frame of functioning and operating quite well is stabilized, well documented, clearly defensible, and operating smoothly moving forward.

Leaving the city, the county, and ourselves with the task of understanding what the final numbers are relative to the unreconciled receivables, any administrative overspend, of which there is also some notable items that show up on that, such as the expense of transitioning to Salesforce, and also the interest that is being accrued on the negative balance in the King County investment pool.

Noteworthy, is the role of program underspend each year that has been a opportunity over the years for the City of Seattle, King County, and KCRHA to reconcile additional expenses that were unanticipated during the course of the year, be they programmatic, administrative, or other related activities.

And that underspend allocations at times has been used to reimburse KCRHA for unbudgeted administrative overspend or other programmatic expenses that were out of the original budget.

And so that is an important note in this area, but ultimately the task over the coming months will be to determine what that final number ends up being.

and understanding how the city and the county partners wish to proceed with reconciling that number.

And that number is important because it is embedded into our negative balance with the investment pool.

So once we know what that number is, we can have confidence that the remaining amount in that negative balance is related to normal operations.

So I'll stop there.

Council, we'll turn it back to you for questions and more deeper discussion on any areas of interest.

Thank you all for the presentation today and coming for this discussion.

I imagine my colleagues will have a number of questions.

I know many in the public have been engaged in discourse on this topic, and so just to get us warmed up, colleagues, I'm going to start with a couple of questions and then invite you all to to chime in with yours.

Just starting us off, KCRAJ says in the Corrective Action Plan that external stabilization support is needed in order to fully address forensic evaluation findings.

Can KCRAJ explain what this means in plain language?

Does this mean more funding is needed in order to pay for additional staff and or consultants?

Does this mean in-kind support from King County or City of Seattle finance teams or some combination?

Thanks for that question.

I think we are very open to some combination of those two solutions.

Our finance department is understaffed at the moment.

We've had a couple of recent losses.

And in addition to just needing more regular staff time to do our regular business, we lack some of the expertise that is needed to complete the corrective action plan internally.

So we would very much appreciate some of that expertise coming in.

It could come in in a number of ways, through a consultant, a small team, or an interim CFO role.

But that, we believe, is important for fully implementing the corrective action plan.

We have some other needs that are a ramification of just being a little bit understaffed in sort of core infrastructure, such as IT and HR, and would very much like to continue discussions that we have been having for some time about how we streamline getting those resources to KCRHA, given our partnerships with the city and county.

So that's the ask we've made in the Corrective Action Plan.

And thank you for that.

And building on that point, understanding that there's some identifying lacking expertise internally and a need to try and bring in additional support.

So does KCRHA have an estimated cost for the amount of external stabilization support needed and over what time period and what might happen or what would you do if you cannot receive external support?

Do you have thoughts on that one?

Sure, I'll lean in on that a little bit.

To build on Dr. Kinison's remarks a little bit, an element I think that is important in the request for this external role centers on the fact that there's going to be this number that emerges that the city and the county and KCRHA are going to grapple with and the allocations of that expense and the history of those expenses will be important and I think that it would be Likely, all parties would seek to have essentially a third party reference relative to the efficacy of those numbers, so to speak.

So I don't think if we produce them just on our own, there may be question marks around that.

And there'll need to be some balancing out between the county and the city on how these become resolved.

The question of the expense, the way I view it, would be when Dr. Kinison asked for this evaluation quite a while ago, it was clear to her that we needed a higher level of capability in that area.

and we chose to hold off, or she chose to hold off on pursuing a person for that role until the evaluation was completed.

What we know today is that the organization would benefit from a CFO type role with the correct level of capability and experience relative to the complexity of our operations.

For me, the way to proceed here would be some sort of external consultant or temporary professional in that space who's acceptable to all three parties that acts as essentially the interim person in that role and acts as the source of truth for what the resolution is on these matters.

and then ensures that the organization's finances are stable and operating well so that a following employee in that role has a clean starting point.

And for cost, you know, so just thinking about the cost of an external CFO and maybe including a year of an accountant, I think we could think about $500,000 over the next 12 months.

Thank you for unpacking that a little bit more.

I want to continue that discussion on what's needed.

Um, I'm going to shift gears a little bit, uh, just to move into some of the points about federal funding requirements.

Um, how is KCHA addressing any findings related to federal funding requirements?

For example, the forensic evaluation specifically, noted that KCRHA is out of compliance with those requirements by not having an internal control framework, yet the corrective action plan does not appear to address this piece, so I'm wondering if you can expand on that.

William, you've been working with our compliance team on that issue.

Yeah, the corrective action plan is lengthy and covers a lot of different areas.

You'll see references in there to COSO framework and other matters.

We feel strongly that we are in good shape there.

It's an example of the changes from when Clark Neuber were evaluating an organization and calling out activities in the 22, 23, 24 frame.

We had our own controller actually come in in 2025, early 2025. We also had results from other evaluations and audits that were informing the need to improve many of those practices.

we have currently in our corrective action plan dashboard a section specifically covering what I've called HUD readiness.

So we are making sure that by the August 26th deadline that we have irrefutable evidence of all of those requirements being met, implemented in place, and documented properly.

And the August 26th is when we will submit our application to HUD.

And so when we submit that, we want to be able to say at that time that all of those, any issues that might affect that finding are resolved.

Thank you for that.

And I know in Clark Nuber's evaluation, there was identification that some of these findings, in order to resolve them, there's a sequential order that should be in place in order for them to be successful.

I'm wondering how KCRHA integrated Clark Nuber's recommendation that some of these actions have to happen in a specific order to be successful.

Again, the overall corrective action plan encompasses over 70 different milestone components, and many of them are interrelated and sequenced.

And I would say we also used a risk framework, so addressing the highest risk items first and prioritizing those.

So while sort of smaller in impact, the high risk areas that the city and county you know, asked us to address first were around those cash equivalent items, so the business card or purchase card, gift cards, and how we reimburse employees.

We were able to do that fairly quickly because many of those practices were in place.

Again, not well documented or people had, because we had vacancies, people were straying outside of the policies and procedures.

So we've locked that down immediately.

And so that was an important step just in mitigating any risk there.

And then as William said, this issue of the unreconciled funds I think is at the center of our corrective actions.

And so that has been a priority for some time.

I want to take a step back just around the internal control framework, noting that we're in the midst of a federal funding cycle.

Will we have an internal control framework developed by August?

Yes.

We have an internal control framework active right now.

The thorough and complete documentation of that framework is being completed in the coming weeks and months.

So most of the core documents are already in place.

The framework outline is in place.

And as I noted, that's of particular importance and focus because of the fixed runway relative to that.

And I just evaluated the dashboard on that yesterday to see what we're doing.

And I feel good about where we're at with that.

Understood.

That part being critical for HUD compliance.

Thank you.

Colleagues, those are just some of my warm-up questions for this discussion.

I want to open it up to you all and also recognize Councilmember Rivera joining us as a guest in today's committee discussion.

Welcome.

Thank you.

Wonderful.

Going to committee members first, I'll start with Vice Chair Foster.

Thank you so much, Chair.

And thank you so much, William and CEO Kenison.

I really appreciate it.

And as a governing board member, I appreciate your responses to many of our questions and our engagement over the last several months.

And I'm looking forward to our conversation today in committee.

I wanted to return just as I was taking some notes on your responses to Councilmember Rink's questions.

I have a few of my own, but I first want to make sure I got clarity.

CEO Kinison, I think I heard you mention 500,000 around the external CFO role.

I wanted to make sure I heard you correctly.

Can you just share that thinking again?

That's not necessarily for that internal hire approach, right?

Can I just hear a little bit more?

Yeah, so that's a sort of back of the napkin approach.

It would depend on which firm we contracted from, how long we wanted to bring that kind of expertise in.

But in thinking, you know, what we, the agency has had a CFO, a temporary or external really CFO for almost all of its tenure.

and that cost from Robert Half is in the report.

It would be about the same.

And then we do have some additional accounting team needs some of which are in our budget, some of which are not.

So just sort of a ballpark for you, because I know Clark Neuber was very generous in providing an estimate of what it might cost to bring forensic consultants in to do this work, but also acknowledge that may not be the level of assistance that we need.

Got it.

And I appreciate that.

That was a good segue sort of into my next part of this question.

You mentioned the sort of the potential need for the forensic evaluation to kind of understand this.

And I know, William, you spoke to this a little bit as well.

But what I thought I heard from you, William, was in regard to the account receivables and the resources that have been paid to providers but have not been billed correctly to the agency.

And what I believe I heard you say, William, is your understanding right now is that the vast majority of those receivables sit between the city, the county, and KCRHA.

But it's my understanding that it would take significant time and expense in order to accurately reconstruct those.

And I thought I was hearing something different from you all today, so I want to ask for a little bit more clarification on that point.

Yeah, deeply, deeply appreciate that question, and it kind of segues into CEO Kenison's response to around the cost.

As I was describing earlier, there's two ways that you can come at this receivables issues.

You can do a cash accounting, which is going to tell you specifically of those receivables, which ones accrue to King County and which ones accrue to the City of Seattle.

And that is an exercise that can be completed, in fact will be completed in the coming weeks.

because it's rather just like looking at your bank statement.

You can see the expenses listed, you can see the income, and we really only have five bands of operational flow for those funds.

So we will know pretty soon in the coming weeks what those numbers are.

And this speaks to the note that...

Mike Nurse from Clark Neuber made during the presentation relative to the question of how much would it cost to figure this out?

And Mike noted that if you hired his whole team to come in and do it, it could be very, very expensive.

He also noted that's not how you would go about it, though, but his point was salient.

in that if you're trying to go back into the 2022 or 2023 and determine exactly why this $35,000 rollover from one contract to another that somebody agreed to move didn't get billed, it'll be very expensive to try and track down to that level of detail the particulars of those.

But from a cash analysis, we'll be able to tell in the coming weeks pretty clearly what those numbers are and I think then it becomes a decision.

We will probably be able to have most of those clearly identify the majority of those funds but if you wanted to really pursue it down to the very finite dollar it would be time consuming and expensive and potentially not fully achievable given the history of the early years.

Yeah, I appreciate that.

And one thing, and I think this may be work for us to follow up on our end, and let me say I appreciate you making the distinction between the cash basis and going back and looking at the accounts.

I think one of the remaining questions that I have is whether or not the information that we have in a few weeks will be sufficient for our needs at the city or the needs at the county in order to sign off on those payments.

So making sure that we have sufficient information that meets our contracting standards to go back and do that.

I'm looking forward to getting the results of the work that you all are doing because I believe it will provide necessary additional clarity especially around the 8 million because as we've stated the communication about that is really important and so having that understanding is certainly useful but I'm not sure whether or not it will be sufficient for the billing purposes.

So I look forward to seeing that when it comes to us, and then we can answer that question of whether the information is sufficient.

Happy to take a comment on that if you have one, but that's just the concern I wanted to work out there.

I think we're exactly aligned on that, and the goal will that hopefully this will be a good decision support tool relative to that conversation.

That's very helpful, thank you.

And yeah, and I think we'll have to see with that if it, how do I say this?

Once we have that information, I think we'll better know what additional information is needed and if it is possible and if we have the cost to go down the road to get the remainder of the information needed to then complete the billing process.

So thank you so much for that.

I wanted to So I want to return now to things I was going to ask before.

I heard Council Member Ring's fantastic questions.

So I know that in the Corrective Action Plan, there's these targets for the 30, 60, and 90 days.

But we also know that at the end of the 90 days, not all of the findings will be completely addressed.

And we just talked about some of the complexity related to that.

So can you just share a little bit more about why the agency believes that we'll need more time after the 90 days to resolve the actions?

And obviously you can leave out the one that we just dug into.

I'll start that one and then I'll ask William to add.

So there's different levels of findings.

And I think one is sort of historical cleanup.

And those are tangible accounting procedures, policies, things that we need to, in case CRHA is basically solely responsible for implementing corrections to those things.

Many of those things will be done in 90 days just for capacity reasons.

It might move into phase two to really make sure all of the documentation of having done those is complete so that we can present that to the board because that, as you know from the Corrective Action Plan, we won't consider the findings closed until the board considers the findings closed.

The other set of things is really about how do we move forward because there are some things with our funding model and how we're doing business with our funding partners that need to be addressed to keep us from continuing to struggle with some of the financial issues that we're having as an organization.

Those things require a real dedicated partnership over time to do things like streamline and come to a baseline understanding of how the invoicing should work and work on that together and implement those next steps.

We anticipate that will take, you know, maybe up to nine months to do with our partners, depending on their capacity and our capacity.

Yeah, what would you add to that, William?

I think that's really an appropriate overview, perhaps sort of painting a little bit of, like, what does that detail look like and mean.

Earlier I mentioned every year there are many millions of dollars of programmatic underspend, and that underspend becomes this opportunity for all three parties, the county, the city, and KCRHA, to better understand how to activate the homelessness response system, to roll over funds that weren't used into the next period, to maybe balance out different needs between the county and the city so for example the city might have a fund source that is expiring and they want to use quickly and so they will maybe pay some of the things that the county typically would have paid but because they want to move the money through quickly they'll pick that up and then the county will kind of consider that as like a quid pro quo that gets returned later.

So it is a really important component of the system and central to the project, to the KCRHA project, which is this idea that the funding between the county and the city and the other partners relative to the homelessness response system is optimized in partnership.

and that there's opportunities to perhaps rebid some of the areas that should be optimized or updated over the years.

And in the past, in the entirety of KCRHA's operation, that goal has never been engaged or realized because of the structure that we have now.

So I think that is sort of an example of that phase two opportunity.

Yeah, thank you.

And Chair, if I may, just one more question here.

I want to sort of ask just a clarifying question on that point because I think what I hear in your response in regards to the 30, 60, 90 days and the work that will be remaining is a bit of an indicator of there are some components of response to the corrective action plan that are under the control of the agency.

And I hear that there are some that require decision-making and input and addressing from partner agencies and funder agencies.

But I do wanna make sure that I'm clarifying this and please understand my intention here because I do think that while there is a role certainly for the funder agencies, I wanna make sure you're not suggesting that that's the sole component here.

Cause I know as that's come up and yeah, I know that as that has come up and as we're trying to discuss some of the, complexity of these audit findings that there have been points in time where we've heard from the agency information about the funder practices.

And I want to make sure that I'm understanding correctly that you are trying to point to that as a component, but not as the whole.

and it's my belief and my understanding that even after the 90-day period, there are still gonna be certain items that are within the agency's control that will need to be addressed outside of that 90-day period.

So I wanna make sure that I'm both correct in that and that we're clarifying that, the responsibility.

Yes, that's correct.

There will likely be some of our work that continues past 90 days.

Again, only having maybe five staff who have the skills to work on this, there's only so much they can accomplish, even though they're working quite a lot.

and there is a sequencing, as Council Member Rink noted, and so some of this, we have to reconcile the $8 million of funding that needs to be resolved so that we can understand our negative cash balance then we need to work with our KCIP partners to address that negative cash balance and the operating model and how we participate in that model, how our funders participate in that model, so we can really shrink down the time between us paying our providers and us getting reimbursed for that.

There's some opportunity for optimization there if we want to shrink down the interest payments that are required by the KCIP when we to enact our cost reimbursement model, starting with zero.

So you're exactly right.

And again, many of the things in the Corrective Action Plan sit wholly within KCRHA to address, and we are serious about addressing those with as much urgency as possible, working with our board and councils to make sure they understand the progress we're making and that there's documentation of that progress.

and I think there are some opportunities for partnership that we've pointed out very specifically in the Corrective Action Plan.

That's very helpful.

Thank you.

And okay, Chair, actually, this is my last question.

So I think that's very helpful in terms of just delineating the agency's role, the funder partner's role, and then we have obviously the governing board role, the role of the two councils that approve the funding.

And so I wonder how you're anticipating, you know, the sort of phase two component.

So we have the end of August kind of deadlines coming up, and then do you anticipate communicating back to the governing board or to the funding body sort of recommendations for the what needs to happen next in order to address what won't be covered in those 90 days?

So those parts that you've just sort of indicated, whether they're city role or agency role.

Yes, so one of the things that we decided early on was we couldn't wait for sort of incremental deadlines to share progress.

And so one of the things we have internally and are developing for external use with the board and potentially council is a dashboard that's showing progress on a weekly basis for what we are achieving and where we've got blockers.

And then we can specifically work with our board to say, this is a resource issue.

This is an expertise issue.

We hit something that was done wrong and so we have to redo it.

I mean, there's any number of reasons why there may be delays.

and we wanna be really clear with our partners about why, if there are delays, why there are delays.

We wanna make sure those high risk items are fully addressed as soon as possible.

And then in terms of the sequencing, rate limiting step needs to be addressed first.

So those are the kinds of things that we felt we needed a dashboard to do.

As mentioned in our plan, that is nearly complete.

And then that will be, I think, an ongoing tool for us to use about where we are and what milestones we'll hit by which dates.

and then what will continue into phase two.

And then there's opportunities to intercede.

If the board says, actually, we think you need to put more resources here, leave that for later, that's the kind of thing that we've had to do since the beginning of the organization, as is obvious.

And maybe there's an opportunity to hear the funders' priorities and make sure those are reflected in the sequencing.

Thank you so much.

Thank you, Chair.

Thank you for those questions, Vice Chair.

Councilmember Saka, you are recognized.

Thank you, Chair.

And first off, I want to thank Dr. Kenison, Mr. Towie for being here today and reporting on current progress, findings, next steps, remediation, all the things.

Also appreciate the opportunity to connect with both of you in my office a few weeks back and learn more.

Now it's time to continue the conversation as we're doing here.

and also want to thank the chair, vice chair for your excellent questions.

Earlier ticked a few of mine off my own list.

So, but just curious if you can help us better understand You alluded to the fact that the organization won't be able to fully respond in a comprehensive and defensible way to specific findings of the forensic evaluation.

and some of those things might not be fully resolved.

Can you provide a little more detail about that and just talk a little bit more about that?

Question one, I'll get both of my questions out here.

But you mentioned, so question two is, How will KCRHA ensure that the corrective actions implemented now and are planned are truly sustainable after that initial stabilization and reconciliation phases are complete?

So in other words, how do you plan to make sure that those actions and solutions are truly durable, if that makes sense?

Thanks so much.

Those are a great pair of questions.

And it really boils it down to the core of many of these issues is the maturity of the organization.

and the amount of money that was handled by the organization at a really nascent time in its development.

And what folks did is prioritize getting money out.

We all remember putting providers in a really difficult position, not being able to pay them.

and so that became the priority.

And when that is prioritized with the size and resources this team have, other things like documenting PCARD policy are not prioritized.

And it was in that state when I arrived.

Again, I've mentioned coming from federal government where there's like a form in triplicate for everything, including getting something hung on your walls.

the lack of policy and procedure that was available to me as I onboarded.

And so now we're fixing that.

And again, that's sort of how I am used to doing my work.

So we have implemented many policies and procedures formally.

We've developed signature policies, worked with the board to understand how those workflows should go over time and have adjusted with new boards.

And so I'll turn it to William to get into some of the details of the historical reconciliation problems we are likely to have.

but I think fundamentally a government organization that's handling public funds, you have got to have your policies and procedures documented and have ways to regularly ensure that they are being followed.

And so that is what has been underway since I arrived, continues to be underway in our finance space, and that is the way that we sustain best practices and ensure they're being followed.

Thank you.

Yeah, I would just add, I appreciate the question specifically relative to a question Chair Rink centered in on as well, relative to the policies and procedures, documentations, HUD readiness, if you will, to CFR 200 compliance, COSO compliance, The Clark-Newberg evaluation highlighted those things and from their perspective reviewing 22, 23, 24 and the beginning of 25, those were really clear areas of improvement.

The organization began rectifying most of those during 2025 with the arrival of a controller and continued that to present.

where we are now in the place of really focusing our activity is on making sure that we have the compliance frameworks documented, that we have the ability to demonstrate those practices and policies as being not only in place but functioning properly.

And then relative to things that will transcend into the phase two, the deeper reconciliation of unreconciled receivables is likely to take longer depending on the level of detail that one wants to go into there.

Also the ability to work more closely with funding partners on cash flow analysis, contract management, payment timing, payment receipts, those sorts of things are a little more operational that will be in more of the phase two, but the real important goal for us is that as we move toward the HUD submission in August, we have all of those core COSO-related policy and procedure pieces in place and functioning.

Thank you.

No further questions, Chair?

Thank you, Councilmember Saka.

Vice Chair Foster, is that a new hand

It wasn't, but I actually have one question I wanted to ask, and I don't know.

It's apologies, council members.

William, thank you for wrapping up on that point around the HUD submission, and only because I know Council Member Rank and I have heard a lot about this as governing board members.

Could you just speak as briefly as possible to the significance of that HUD submission the resources that come into our community because of the role of the continuum of care and the 4,000-plus people that are housed in our region because of those resources.

Absolutely.

The use of the HUD-COC funds for WA500, which is the name of our continuum of care local here, have been significant anchor components undergirding the development of permanent supportive housing investments in the King County region for 10 years.

They have represented a solid and stable flow of funds that are a core part of the overall funding stack that providers put together when they place these buildings into operation.

In 2025, over 500 units of permanent supportive housing came online.

It represents the tail end of what will be a peak production period.

High interest rates, other economic factors, and uncertainty around the future of HUD are impacting the ability to continue to develop those at the rate that we have in the past.

And they're centrally important to the overall homelessness work in King County.

because they represent a housing outcome of a type that is the only real pathway for folks who are chronically homeless with co-occurring behavioral health, mental health.

So to get into permanent supportive housing, you have a condition, you have a diagnosis of some type that qualifies you as a disability to be in that building.

and most of the population that is sort of the most difficult for us to resolve into housing, permanent support of housing is the pathway for that.

So for me that's how I tend to think of the importance of the HUD COC funding into our community and it's about 70 million a year, 68.

Thank you, Vice Chair Foster.

Next, recognizing Council Member Rivera.

Thank you so much for joining committee today.

You are recognized.

Thank you, Chair.

Appreciate you having me, letting me sit in today or just welcoming me.

I know we can all attend each other's meetings and I always like to make sure that Chair knows.

Obviously we all very much care about this issue.

I want to thank you both for being here and also especially for scheduling a meeting with me I think next week.

I do have a lot of questions.

We just got this corrective action plan last week and it is sizable.

I really appreciate you high level presenting today.

I was watching some of it in my office.

I do have just two questions and one is Obviously Clark Neuber's forensic assessment had many items for correction in there and I think William you said earlier there were like 70 pieces to that that need to be addressed.

And from your presentation today and what I've heard you say is you're tackling in the first 90 days the most priority of those and then obviously you have to keep working through.

My question is what is the overall cost that you think it will take to make all the corrective actions, not just the first 90 days.

So that is not just hiring the CFO.

Obviously we all know Clark Neuber had with their recommendation and it's going to cost and it was a very large number.

to put these things into place that we're recommending as part of that forensic assessment.

And I've also heard you say, Director Kenison, that there's a capacity.

I heard you use the word capacity restraint multiple times in this presentation.

So what would be a fair assessment of how much will it take to actually get to correct all of these items moving forward?

Thank you for that question.

The shorter version is we're not sure.

Part of that is because of the sequencing of needing to address the findings.

So as Vice Chair Foster alluded to, we know we need to do a high-level cash analysis to understand which funder we may have misbilled or underbilled for that $8 million or so.

the work to get down to a level that may be required by the city and county would cost more money.

And so that's an option that we would frame out once we get that first step done to say, here are the options.

We can stop here or we can proceed and this is about how many hours we think that would take.

And I think we have a couple of recommendations that require that kind of sequencing.

understanding how far we can get with internal existing resources and then articulating a need for additional expertise beyond just a CFO type leader or someone to come in and really bring expertise and project manage that for us.

It will cost more than that $500,000 for just the basic capacity staffing.

I think that we need to implement this.

But I think you all and our funders have choices about how much information needs to be had about 2022. when we're working in spreadsheets and in journal entries and it's metaphorically in shoeboxes.

How far do we wanna go there versus in 25, 24, we've got much better records.

So those are some of the things I think I need to lay out for you to be able to understand the kind of resource requests we may have.

And what's the timeline for that?

I think we'd have a good grasp on that within our 90-day period of work, potentially sooner for some pieces.

What about the full picture?

I think at 90 days we'll have a real sense of how far we can get with current resources, what we know by then and what we don't know, and then based on your input about what you still need to know, like how much more investigation is needed.

We will by then have things like policies in place and Our processes, like our hard clothes at the end of every month, you know, institutionalized and documented, and the board will have seen that documentation.

It's some of these more historical pieces that we need to uncover that I think are the place where we need to make a choice about the resources we spend there.

Thank you for that answer.

I guess I'm going to ask you something you may or may not know, and that's okay, and that is I'm not sure if in the contract with Clark Neuber there was an opportunity for them to review your corrective action plan and give feedback on it.

Do you know if that's happening, if that was part of the...

I don't know.

I haven't seen that contract.

What do you think they'd say if they reviewed this corrective action plan and sort of what you've laid out as a path forward

I think largely they would perceive it as an appropriate serious document that took their recommendations very seriously, highlighted what we are able to do, what we need help doing, and laid out some pathways forward.

You know, I won't speak for them.

I'm sure they have things they would have done differently.

But I think it's very, we took all of their findings as and it was resonating.

There were a few things around the edges that we maybe felt like we had more information about that wasn't in there, but they're an excellent firm.

I think they did excellent work and we took that as a very valuable tool.

I mean, it's kind of what I was hoping to get to be able to figure out how do we move this agency forward.

And the corrective action plan I was looking through it.

Does it address every single item that the Clark Neuber forensic assessment raised as corrective, needing corrective action?

You just are not quite sure yet how you get to solve for each of those.

For some of the historical pieces, I think there are levels of resolution.

So are we comfortable knowing generally our failure was not correctly billing our funders over a course of a couple of years?

As William said earlier, we feel confident we'll get to a high level amount because we have those King County Treasury, what we got and what we paid out.

So we'll get a balance.

What Vice Chair Foster asked and is absolutely true is, You know, there are rules that the city and the county need to follow to reimburse us for those funds through pathways they have available.

And so what level of additional information would be needed for that to happen?

And what are the alternatives?

And I think that is where we need to provide good decision support to you all to say, this is what we know at this level, how much further or do we need to go?

And then we need to understand that, especially in those very early years, the records are not great.

And so there's a trade-off between how much money we put in and what the ultimate ability of the agency is to provide the records that would be needed.

And what was Clark Neuber's recommendation on that?

Because I thought they said that that was missing and that it was something that, you know, industry standard and what we should be doing, we should have.

So when I hear you say, well, it depends how much you want to know, it's not exactly aligning with what I read in the Clark Neuber report.

So what I'm hearing you say is, well, how much of that back information do you want?

And I guess my reaction is, well, industry standard is that we should have all of it because just because we're at 2026 doesn't mean our books shouldn't be in order from 2022. So that is of concern, I guess, was what I'm trying to say.

Absolutely.

And I wish deeply that I could go back and do it differently.

Thank you.

I have other questions, but we're going to meet.

Thank you so much.

Thank you, Chair.

Appreciate your...

And you all asked a lot of questions that I had as well.

I appreciate the opportunity to ask mine.

Thank you.

Certainly.

And thank you for your participation today in committee, Council Member Rivera.

Thank you all committee members for your thoughtful questions.

I appreciate the seriousness that everyone is bringing to this topic and deeply appreciate the engagement in our discussion today.

Thank you to our partners at KCRHA for coming into committee.

I'm not seeing any additional questions, so I am going to move us to our next item of business and thank you again for your time.

Thank you.

Colleagues, as we move into item three, I'm going to have item three be read into the record, but then I'm going to put us at ease for just a couple of moments.

We're scant on quorum, and I have to step off very briefly, but I'll be right back.

But I will move us at least to read it into the record.

So we will now move on to item three.

Will the clerk please read item three into the record?

Item three, public health approaches to substance use disorder in Seattle and King County.

Briefing and discussion.

Wonderful.

And I will have our presenters come and get settled down the table, but I will put us at ease and I'll be right back.

Yeah, yeah, yeah.

Rob's holding down the front.

Great, and we are back.

Thank you everyone for that brief break.

Before going into today's presentation, I want to take a moment to first and foremost address a comment that was made during the public comment period from Mr. Haynes towards one of our presenters today, Brad Feingood, just to note for the record that what was said was wholly unacceptable and inappropriate and downright hurtful.

So I wanna apologize to Brad.

I have appreciated your vulnerability in sharing your family's story, your brother's story.

It has given me strength to talk about my own family's story.

And I know many other folks across our community have stories just like yours.

Thank you so much.

I would never wish the experience that my family's gone through on any member of our community or any other community.

Thank you so much.

Thank you for your graciousness and I just want to note that I'm ashamed that your story was weaponized against you.

I will be double checking to see how these remarks may be in further violation of council rules and so clerks if you're listening I'll be swinging by to talk about this moving forward but I thought it was important to really start us off on that note and again get all of that on the record so thank you.

Thank you.

And thank you for your courage and your voice also in speaking out.

Thank you.

With that, I'm really eager to dive into today's presentation on this topic that is so close to many of our hearts.

And so in terms of formalities, I am going to ask everyone to introduce themselves and then invite you all to go on to today's presentation.

I want to thank you again for making time on this Friday morning to talk about this important topic.

Thank you committee chair and thank you members of the committee for being here with us today and engaging in this conversation with us.

We all look forward to it.

This is a difficult subject and it's one that really we look honored to do the work.

My name is Brad Feingood.

and I get the honor of working in Public Health Seattle-King County.

My formal title is Strategic Advisor.

I oversee our overdose prevention efforts for Public Health in Seattle-King County and I'll pass it to my fellow panel mates.

Thank you, Brad, and thank you, Council, for having us.

My name is Chris Clayson and I work at Human Services Department overseeing our department's homelessness and public health investments.

Thank you so much for having us today.

My name is Rachel Marhill.

I'm DESC's medical department senior operations manager.

Good morning.

My name is Kaelin Folkley.

I use she, her pronouns, and I'm an emergency medicine and addiction medicine physician.

And I'm the senior medical lead for the ORCA program.

Please proceed with the presentation.

Thank you so much.

A little bit of an overview of our conversation today.

We're gonna give a little data overview because I do think it is important to take a look at what we've been experiencing in our community, both the really terrible scourge of overdose deaths that we've experienced due to a really toxic drug supply, and then also some successes that we've been able to experience recently and we'll hear firsthand from colleagues about it.

We're gonna talk about, with that, evolutions in medications for opioid use disorder, how our care has evolved over time because we've really been able to do some real innovative work here that really leads the country in being able to get care to the people who are most in need and who is the most vulnerable.

Chris will talk about the City of Seattle investment and then we'll hear about the amazing work that DESC has stood up at the Overdose Recovery and Care Access Center just down the street.

And then we'll have time for questions at the end.

So a little bit, a little overview of what we've experienced as far as overdose deaths.

The caller was right.

We have seen, we saw from basically 2018, 2019 to 2023 just a huge, tremendous increase in overdose deaths.

When I started with the county in 2015, we were averaging around 350 overdose deaths per year, approximately one a day.

In 2015, we had three overdose deaths in the county that were due to fentanyl.

And so that's less than 1% of our overdose deaths in 2015 were due to fentanyl.

and we had this awful concurrence of seeing a drastic change in the drug supply that we've experienced, not only in the county, but in the whole region and across the United States, overlapping with COVID.

And so that had many, many, many challenges that came with it.

And in 2023, across the county, we had over 1,300 people that died of an overdose death.

And out of those 1,300, over 1,000 were due to fentanyl.

So in 2023, we really reached, in the third quarter of 2023, the apex of a really terrible situation.

And at that point, about 80% of our overdose deaths were due to fentanyl.

So changing, you know, over the course of eight years from 1% of overdose deaths due to fentanyl to 80%.

And that really, you know, forced us into some real looking at the tools that we had.

The tools that we had, I would say, were really difficult and substandard.

and really trying to evolve our model of care.

The good news is that overdose deaths that peaked in 2023 are on a huge decline.

In the city of Seattle, over the past two years, we've seen a 44% decrease in overdose deaths.

Now, that's still unacceptable.

and extremely large number of overdose deaths.

But it is great that we've seen a decrease.

And in the first quarter or the first five months of this year, we're continuing to see a substantial decrease.

Matter of fact, across the county in the first five months this year, we've seen another 30% decrease in overdose deaths.

So we're continuing to see those numbers come down.

So that gives us a lot of hope.

Important to note that there is a huge overlap in the people who are living outside, living in supportive housing, and overdose deaths.

We know that, as was discussed earlier with the King County Regional Housing Authority, The people who are the sickest are the ones that we're trying to get housed and that's imperative and we need to continue to evolve our model of care to reach those people because we know that it's paramount that they have to be housed.

within our permanent supported housing system.

And when people close their doors, that also presents risk.

And so we continue to work with partners at King County Regional Housing Authority and our housing partners to evolve models of care to address overdose risk in supportive housing.

Also happy to note that proportionally to the overall decrease in overdose deaths, overall overdose deaths amongst people living outside and in supportive housing also continue to decrease.

So as you can see, over half of the people in 2025 who died in the city of Seattle of overdose were within that housing or that unhoused and permanent support and housing continuum.

We also have seen huge disparities.

We know that black and African-American individuals have disproportionate impacts from overdose and overdose deaths.

We also know that our Latinx population is continuing to see increases in overdose deaths.

So this continues to be a focus of the work that we do trying to address the disparities in overdose deaths in the unhoused populations and in our in our communities of color.

So pivoting a little bit to some of the things that we know works, and this is gonna also dovetail into what our friends at DESC are gonna talk about today, is one of the best tools that we have, without a doubt, is medications for opiate use disorder.

Time and time again, medications for opiate use disorder.

are shown to decrease overdose deaths by 50%.

We also know that fentanyl has been difficult to get people started on medications for opiate use disorder and continued on medications for opiate use disorder.

I also want to be really clear and very careful and very clear to say that it's not a golden ticket.

When somebody gets started on medications for opiate use disorder, when somebody is able to continue and stabilize on medications for opiate use disorder.

There are so many other things that people are struggling with in their lives that are also important to address and need to be addressed.

medications for opiate use disorder are just that, medications for opiate use disorder, and we also know that there's a lot of people who are using stimulants out there, and specifically methamphetamine, and there's no lightning rod of an intervention that we have.

There's different tools that we have, but there's no medication that has the impact that medications for opiate use disorder have.

Important to note in this slide is that methadone has been fairly stable with the number of Seattleites who have been able to start and get access to methadone.

We've also been able to pivot from fixed-site methadone clinics to more mobile medication units, so we have some vans that can get closer to where people are at, more easily accessible for people who are wanting to get started on methadone.

Oral buprenorphine, we saw a huge increase in availability and access to oral buprenorphine prior to 2020, and the amount of people that have accessed oral buprenorphine continues to grow, although not at the substantial rate that we saw from 2017 to 2020. And lastly, I'll talk a little bit about injectable buprenorphine because that really provides a hope that we didn't have a couple of years ago An injectable buprenorphine is another form of buprenorphine, but it comes in a couple of different doses that someone can get an injection.

And so that injection allows them to stabilize, it allows individuals not to have to worry about daily medication regimens, keeping their medication safe, or accessing their medication on a daily basis.

I'll let Dr. Folkley talk more about it as an addiction medicine doc.

So a little bit about the evolution of care through public health.

So we know we've really tried to lower the barriers in access to care.

We know that people out there are struggling.

They have a lot of complexities.

They're very sick often.

And the more that we can make it easier for people to get into care, the better, the more likely that they'll start in care and that they'll be able to retain in care.

When I first started, people had to make, the only option really was methadone, and people had to trudge across town, make an appointment, go for a psychosocial assessment, and then come back days later for their medication.

we've really been able to flip that system on its head and lead with people having access to medication because we know that that's life-saving.

We've been able to collaborate across multiple different organizations and systems to address the complex health needs, and there's still a long way to go.

Kudos to Executive Zahalai for the Breaking the Cycle workgroup, which was just chartered.

to be able to think about how do we do better work across systems.

And we're starting to see those impacts, not to mention the investments that the city has made really around access and linkage to care has really been able to pay off to link people from systems like the hospital and jail to community-based settings where they can get care.

And again, the increase in long-acting injectable buprenorphine has really provided us, it's not a, whether it's a game changer, just like a really great tool that we have at our disposal now that we haven't had before, just a new opportunity.

And lastly, for me, just noting that in public health, we have a couple of different...

Within our strategic plan, we have two goals.

One is to make sure to reduce harm to people.

We know that people aren't always in a position to access treatment or be able to receive treatment.

but we need to be able to reduce the harm to people and be able to provide treatment to people when they want it, in a way that they want it, and both with focusing on equity and the community's most marginalized.

I'll just end and transition to Director Clayson with the statement that in King County, Public Health fills this role, but our partners in DCHS also fill a really significant role around access to treatment.

And so often, harm reduction can be the shiny thing.

But in reality, the treatment system that the county stands up hundreds of millions of dollars a year really focuses on providing access to treatment and treatment services for people when and where they need it because we know that people want to get better and that we have to be able to give them the opportunity to get better when and where they need it.

And with that, I'll turn it over to Chris.

Thank you, Brad.

Much appreciated.

And as Brad mentioned, my portion of this briefing is going to focus on how and why Seattle invests in public health and just where that funding goes.

So before getting into it a little bit, I just wanted to say that our partnership with Public Health Seattle King County is governed by the 2011 interlocal agreement.

County is responsible for promoting public health throughout the region.

and HSD executes annual contracts to support Seattle residents with enhanced access to services, ensure we're responsive to Seattle's needs, and also to test innovative models and hopefully scale them across the region.

With that, in 2026, HSD is investing over $35 million in public health efforts.

Over the next few slides, I'm going to highlight some of those programs which address the basic needs of community members who are, as Brad shared, experiencing disproportionately poor health outcomes, really to support their pathways to stability and sustained well-being.

Of this, $35 million, $20 million is allocated to Public Health Seattle King County, with the remainder going directly to service providers.

And just a note here as well that the budget does come from a variety of sources.

General fund, opioid settlement dollars that the city receives, and the public safety sales tax.

So there are a variety of programs within HSD's public health portfolio, and this gives a bit of an overview of those.

So first wanted to mention healthcare access for homeless and low-income individuals.

That does include physical healthcare and dental care.

And this work is really led by community organizations through the Community Health Partnerships Program and the Healthcare for the Homeless Network.

Alongside that, we also fund programs that are focused on expanding access to reproductive healthcare, oral health, and community-based responses to behavioral health crises.

And then, finally, our investments in overdose prevention and substance use disorder, or SUD treatment, and those are noted here in orange.

They make up, actually, 39% of the budget, or $13.6 million.

Wanted to, on this slide, key in on those investments and just note that it's important to share that Seattle is investing across an entire continuum of SUD response, ranging from prevention and early intervention to harm reduction, treatment and management, all the way to recovery and healthcare system support.

and this really recognizes that recovery from SUD is not a linear path, but for many individuals it requires multiple attempts to care and highly individualized support as well, which is why we fund this continuum.

In addition, Seattle's funding is focused on expanding services, again, to addressing existing inequities, bridging service gaps, and meeting people where they are to support more equitable outcomes.

and on the next slide, I'm gonna highlight several of these investments in a little more detail.

First up is the prevention of fatal overdose through training on overdose response and also the distribution of naloxone or Narcan.

Calling out here, there's $2.5 million that is allocated for community-based organization prevention and MOUD programs.

Next is post-overdose stabilization support, which includes efforts like the Health 99 team that offers case management for those experiencing an overdose, as well as funding for Orca Center operations, which DESC will be sharing a bit more on in a few minutes.

Connection to services funds programs that provide healthcare linkages for people using substances, which includes care navigators for those exiting the hospital to ensure they receive continued care, as well as $881,000 for transportation and case management needs at the King County Sobering Center for Seattle residents.

Low barrier access to MOUD supports people where they are, whether that's at the Pathways Clinic at the Downtown Public Health Center, or at permanent supportive housing and shelter sites that's possible with the expansion of the OrcaPod program.

And finally, this funding supports inpatient treatment, and just wanted to call out there the $4 million that's been allocated for the Thunderbird Treatment Center.

These investments in low-barrier services support our efforts to address overdoses and SUD that Brad has mentioned there.

Next slide.

And again, 2025 saw the lowest number of deaths from fatal overdoses since 2022. We do know that we need to build on that progress and keep it going, and really, how do we do that?

through these bullets here, continued partnerships with teams that are working on the ground that include our own city of Seattle departments, such as first responders at Seattle Fire and Care, working with the county and also community organizations to reach individuals that are most impacted by fatal overdose and also least connected to services.

The second way through connected low barrier services for people wherever they are, that includes mobile services and also targeted investment in public health services to meet the needs of our Seattle residents.

And with that, I'm going to turn it over to DESC.

Yeah, thank you so much again for having us this morning, and we're excited to share about the Opioid Recovery and Care Access, or ORCA, programs.

And again, my name is Rachel.

And my name is Kaelin Folkley, and just first to say thank you so much for your support.

As was highlighted earlier, this work would not have happened without the city and without council, so thank you for that.

And I'm really excited and privileged to be able to tell you a little bit about what's been happening this last year.

So what is ORCA?

Other than a really cool acronym that stands for Opioid Recovery and Care Access, it's really two things.

It's an umbrella that includes the ORCA Center, which is our brick and mortar, located just a few blocks away at 515 3rd Avenue, and our ORCA Patient Outreach Division, or POD Team.

So the ORCA Center, there's really two ways that you can get in the front door.

One is through overdose response, so 24-7 access for overdose survivors to receive medical stabilization, and also same-day access to medication for opioid use disorder.

So this is the Orca Center.

It's all spick and span before we actually opened the doors.

Now there are actually curtains that create some more private spaces in between the recliners.

But this offers a place for people to recover safely from an overdose event.

There are providers, nurses, 24-7, medical assistants during day shift, milieu specialists at night to help support clients wherever they are.

The other way that people can get through the front door is there are walk-in hours.

So from 9 a.m.

to 11 p.m., every day of the week, every day of the year, patients can come in and start or continue on medications for opioid use disorder.

And as Brandon mentioned earlier, medications for opioid use disorder, namely buprenorphine and methadone, reduce mortality for patients with opioid use disorder by 50%.

That's a number you need to treat of two.

So you need to treat two people to potentially save one person's life.

I previously worked in the emergency department and there was not a medication that I could prescribe or administer that was more effective than that.

It's just truly a privilege to be able to work at the Orca Center and provide that access.

We have sublingual and importantly long-acting injectable buprenorphine that we're able to also provide in the moment to a lot of patients who are interested in initiating on medications.

and also we are one part of a larger milieu of providers for medications for opioid use disorder in our community and that's allowed us to be able to initiate people on methadone using something called the 72-hour rule which allows us to initiate and continue medications for people for a certain period of time and actually do a warm handoff in the opioid treatment program or methadone clinic in our community.

We're agnostic to that clinic partner but we actually have evergreen treatment services co-located with us Monday through Friday.

We have a care navigator Monday through Friday and a provider often two days a week in order to do medical intakes as Brad had mentioned years ago would have taken days can now happen in the moment and the warm handoff can happen just around the quarter to the mobile van where people can continue to dose.

We also have access to showers, snacks and laundry and other services because we're co-located in the Downtown Behavioral Health Clinic which the DSC runs and also is able to offer other behavioral health services there.

So we're able to provide connections to behavioral health, other shelter and housing navigation and just namely the Star Center which the DSC also runs just down the street as you may know that offers lots of shelter beds, I believe 90 shelter beds for people up to 90 days.

The Orca Center is able to provide and manage five of those beds so those who are able to initiate on medications can stay there for a short period of time in order to stabilize before we do a warm handoff elsewhere.

and the ORCA pod team is a team of providers and nurses and peers who will be able to bring clinical care directly to patients in permanent supportive housing and shelter.

And it's really providing care that works best for that individual.

And maybe eventually that means coming to the ORCA center, but we will repeatedly knock on people's doors and just let them know that we're there for them.

Awesome.

And then want to highlight just a few of our metrics.

As Brad said earlier, people want to get better.

And as our services have expanded, we've seen a really huge demand.

So the ORCA Center opened in September 2025. And then in January of this year, we received funding from HSD to expand the ORCA pod team, which is now just about fully staffed.

So we do expect these numbers will keep growing.

At the Orca Center, we've served 451 post-overdose patients.

Between the Orca Center and OrcaPod programs, we've had nearly 8,000 encounters, either people walking into the Orca Center or OrcaPod staff outreaching clients at their residences.

and then we've had 713 unique clients start on medications for opioid use disorder and 380 clients start on a monthly long-acting injectable buprenorphine medication.

and then we just want to close out with one client story that really highlights, I think, the partnerships that are happening across this community.

So this client was a woman with a long history of opioid use disorder.

She had been treated with methadone in the past and had an overdose in her apartment.

Seattle Fire Department's Health 99 team responded to that patient, and they offered buprenorphine in the moment.

That patient was really hesitant to start that medication.

She had experienced precipitated withdrawal in the past, but the Health 99 team was able to spend a lot of time with her, do some motivational interviewing, and she did end up starting buprenorphine.

and after more conversation, the patient came to the Orca Center.

She stayed with us overnight and during her stay, she started a monthly long-acting injectable buprenorphine.

As well as working really closely with Health 99, we also work really closely with the Pathways team and handed this patient off to them to provide ongoing outreach.

She had mobility limitations and needed care delivered at her home and the Pathways team was able to meet that need.

If I can, before we close, I just want to acknowledge how transformational the Orca Center has been for us in our system of care.

One of the questions that I used to get often is, what did we learn from COVID?

We were able to operationalize and stand up services so expediently.

And one of the things we did learn is that people, if given a safe place to be, would be really interested in having treatment for their opiate use disorder and reducing their risk of overdose.

And so it really was a total community effort to get started with the ORCA Center.

It was the city, it was the county, it was our partners at University of Washington, obviously our partners.

at DESC.

Our partners at Health 99, for years, our fire department has said, and our first responders have said, give us somewhere else to take people besides jail and hospital, and we'll take them there.

And that's what's happened, and this proof of concept has really proven just quite amazing.

So just huge appreciation to the collaboration, and thank you, council members, for your support, and thanks to DESC for all the hard work that they do on a daily basis.

And with that, any questions?

Thank you so much.

Colleagues, what questions do you have for our presenters today?

I'll start with Vice Chair Foster.

First of all, thank you all so much for the work that you do every day and making, sorry, and making our city just a safer and a healthier place.

I deeply appreciate it.

I want to, I'm first going to ask sort of a, it's not a technical question, but it's an explainer question.

And I don't mean to ask you to go into vivid detail, but I do want to ask if you can explain a little bit about what precipitated withdrawal is. and I think it's important.

I learned a lot over the last year about the challenges that people have when they're seeking treatment and some of the things that really keep people from seeking treatment.

And the thing I heard a lot about was the withdrawal symptoms.

And if you can just speak to it briefly, I don't mean to ask you to be too vivid, but I do think it's an important fact.

Luckily we have an addiction medicine doc here on the panel.

Yeah, my pleasure.

Thanks for that question.

Yeah, if it's okay, I'm gonna talk a little bit about receptors or cups in our body.

Great.

So these opioid receptors or cups are kind of throughout our body, and opioids bind to them.

So fentanyl is a full opioid.

It fully fills up that cup.

Other full opioids, methadone, oxycodone, heroin, full opioids completely fill up that cup.

It all depends on the half-life or how long it sticks around in the body of how long that cup is full.

So it empties depending on that half-life.

So fentanyl, super short acting, so fills up the cup and then wears off, fills up that cup and wears off.

So often folks are just trying to keep that cup full so they don't feel sick, because every time that cup is empty, people feel withdrawal and cravings.

So if you can imagine, you're kind of constantly trying to fill up that cup, especially in this era of fentanyl.

So the two medications that we use in order to combat not just the withdrawal and cravings, but also reducing mortality are buprenorphine and methadone.

So methadone, full opioid, can completely fill up that cup, help with withdrawal and cravings.

Some of the negative side effects of methadone though are when used with other sedating substances.

it can cause increased sedation, problems breathing, those kinds of things.

The other bummer is that methadone needs to be slowly increased over time in order to be at a therapeutic level.

So sometimes that can take weeks, months for people to eventually get that cup completely full and people can feel well.

Buprenorphine is a partial opioid agonist, so it partially fills up that cup, just enough to help with withdrawing cravings, but doesn't cause some of the negative side effects because it doesn't fully fill up that cup.

It only partially fills it up, so it doesn't cause some of the negative side effects like sedation, respiratory depression, other things, especially when people are using other potentially sedating substances.

The issue is, is that how do you get from that 10th floor of that building to the 5th floor of that building?

Because if you're at the 10th floor because you're actively using fentanyl or have other full opioid agonists kind of in your system, you need to get to that 5th floor without going too fast because that drop from the 10th floor to the building to the 5th floor makes people feel sick.

So if you can imagine you're in the elevator and you drop to that fifth floor, that can cause nausea, vomiting, unfortunately in this situation, diarrhea, anxiety, irritability.

People sometimes say the worst flu or infection of your life, but I would say it's much worse.

So we have to be tricky about how to get onto that fifth floor.

And historically we've done teeny tiny little bits of sublingual oral medication, buprenorphine, to kind of get people up to that level.

But with the advent of long-acting injectable buprenorphine that come in different formulations and different doses, we can get someone up to the first floor on day one, the third floor on day two, and then the fifth floor on day three, and ease people onto that medication slowly to minimize the risk of precipitated withdrawal.

and the importance too is that folks have to continue to have full opioid agonists on board to not feel sick and it's been nice at the ORCA Center where we have access to methadone and other full opioid agonists to help address people's symptoms to hopefully also reduce the risk of precipitated withdrawal and also what we say is protracted withdrawal, withdrawal that would just continue because of abstinence or abstaining from opioids.

Hopefully that answers your question.

It fantastically did, thank you so much.

And I think it, and I'm gonna now have this cup analogy, so I feel like you're speaking to my learning style, so thank you for that.

But the thing I guess I just wanna reiterate is how important it is, as you talked about, the ability to get onto the right floor in a more rapid way, easing those withdrawal symptoms.

What I heard when I was, I got to visit the Orca Center last year before it opened and do a tour, and talked to some treatment providers.

And what I heard really clearly was, how important that is for supporting people, not just with the experience, but with the uptake.

And I feel like we're seeing that in the numbers that are in the slides that you shared with us today, just seeing how many encounters you've had and how many patients that are now participating in the program.

So thank you for that.

My follow-up question is, it's sort of a question to you for us, which is what does it take to continue to scale our investments so that the ORCA Center can continue to have success.

When we think about the ORCA Center and the STAR Center coming online and the impact that they're having, and when we certainly see and feel the impact of the opioid epidemic, excuse me, the fentanyl epidemic in particular in our community, how are we thinking about sort of scale and need to make sure that we can continue to see success?

Yeah, I think, I mean, first thought is the demand certainly continues to exceed our capacity.

So more investments with providers certainly are always, always helpful.

And then, you know, as Brad mentioned earlier, the medications are so important, but so is everything else.

So increasing access to shelter resources is certainly super helpful and other resources to help address other social determinants of health.

Anything you'd add, Kaelin?

I think what we also saw when we had the privilege of being one MoED provider for the Seattle Fire Department and some of the pop-ups that they have done, specifically at Halton Jackson over the last year.

And again, the demand far exceeds the capacity to be able to serve.

And I think what we also saw in that setting is that the folks who were housed or who we could find the next day and outreached, we were able to support through the process.

So I think that has been so invaluable, especially with the Star Center being just around the corner, to be able to house folks because we can start someone after an overdose event.

Actually, this just happened.

We started someone on a medication after an overdose event, an oral medication.

uninsured and couldn't be insured in our city.

So that person was sent to the Star Center.

Health 99 brought them to Pathways afterwards and they had been in our city for three years and unengaged in all services and not because of, not for want, is just impossible for them to be found in a way to help support them.

So I think just that connection of medications and housing and being able to outreach them and be able to link those two things, because really the special sauce when we first started, even prior to ORCA opening, was the outreach.

to be able to show up for someone repeatedly and without an agenda and not necessarily for medications, but just to show up for them, to know that I'm on your corner and I will help support you in the goals that you have.

And sometimes that doesn't come through in the numbers because it takes 10 or 20 outreaches to help support them and to maybe one day wanting medications.

So I think just acknowledgement that maybe the numbers will be slightly less on the medication from a much larger on the outreach front.

Just wanted to say quickly as well, I wanted to thank Mayor Wilson and the council as well for just the emphasis on the shelter acceleration strategy as well and I think the focus as mentioned and just making sure these services can come to folks at those new sites and wanted to thank Public Health and DESC and other providers who have had conversations about how we can grow and expand that in the coming year.

Yeah, I think as been mentioned, a key partner in this is Health 99 and the Seattle Fire Department, work that they're doing around pop-ups, around getting folks into care and triaging, case management and follow-up.

One of the things that Dr. Folkley was talking about with the multiple shots is that DESC has really been a forerunner in this country around going straight to injection and proving that that works and developing this multi-day three-shot regimen and really transforming our system of care based upon that and what we're trying to do.

So anything that we can do to continue to support people to especially get to that third day and then how do we do follow-up in a month?

As we showed from our dashboard with the medication indicators, it's really about getting people started and then keeping them on medication to be able to stabilize and stabilize some of this other care.

I'll just say real quick is the medication's super expensive.

And luckily right now Medicaid covers the medication, but when people do not have Medicaid, public health is spending a lot of time, energy, effort, and resources on trying to make sure that agencies have a fail-safe to be able to provide the medication to people right then and there without Medicaid being a barrier.

And we know that the Medicaid work requirements that are coming around the corner could have a really detrimental effect on this population of people.

And so I think it's gonna be really important that we continue to invest in things like the medication and getting the medication to people, because as folks know, if somebody shows up and we can't give them treatment when they want it, they might not show up tomorrow, right?

Because of their living complexities or the behavioral health conditions or medical complexities or homelessness, but they might also die and be an unfortunate person that shows up in our fatal overdoses.

And so we want to do as much as possible to provide treatment right then and there, and the medication costs are something that we're spending a lot of time and effort to make sure our insurer

Thank you all so much for coming and presenting on this work.

I would love to have more time with you.

Unfortunately, we're gonna be losing quorum, so I do need to stop our conversation here, but hoping we can continue this conversation again.

Thank you so much for sharing, especially the work about the ORCA Center.

It's incredible.

So we'll continue to be in dialogue with you all.

But colleagues, we have reached the end of today's agenda.

Hearing no further business to come before us, the next Human Services, Labor and Economic Development Committee meeting is scheduled for Thursday, July 2nd at 2 p.m.

And hearing no further business, we are adjourned.

Thank you, everyone.

Have a good weekend.