SPEAKER_25

All right, good morning, everyone.

The time is 9.32, and the August 14th meeting of the Housing and Human Services Committee will now come to order.

I'm Kathy Moore, chair of the committee.

Will the clerk please call the roll?

SPEAKER_24

Council President Nelson?

Present.

Council Member Saka?

Vice Chair Morales?

SPEAKER_20

Here.

SPEAKER_24

Chair Moore?

Present.

Three present.

SPEAKER_25

Okay, so we do have quorums, we'll be able to proceed.

So if there's no objection, today's proposed agenda will be adopted.

Hearing no objection, the agenda is adopted.

All right.

Thank you, everyone, for being here today for the August 14th meeting in the Housing and Human Services Committee.

On today's agenda, we have our central staffer, Tracy Ratliff, here to walk us through legislation to extend the sunset date for the multifamily tax exemption program by three months.

Second on the agenda, we have a presentation on the lead and co-lead from Purpose Dignity Action.

And finally, we have presentations from our Human Services Department, the Seattle King County Public Health and King County Department of Community and Human Services on our regional response to behavioral health challenges and substance use disorder.

We will now move into public comment.

We will open the hybrid public comment period.

Public comments should relate to items on today's agenda or be within the purview of the committee.

And just note that Councilmember Wu has joined us.

Clerk, how many speakers do we have signed up today?

SPEAKER_24

Currently, we have six in person and seven remote speakers.

SPEAKER_25

Okay, so let's proceed with the in-person speakers first, and then we'll go to the remote.

Would you please So each speaker will have two minutes.

As I said, we'll start with in-person and move to remote.

Would you please read the public comment instructions?

SPEAKER_24

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

The public comment period is up to 20 minutes.

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

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

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

SPEAKER_25

Okay, so we begin with our first speakers.

SPEAKER_24

The first speaker is Craig C. Werner, followed by Lindsey Christopherson.

SPEAKER_12

Hi, my name is Craig Werner.

I've been a resident here for about seven years.

I've watched the...

I've watched over the country the homeless problem turn from a crisis to an epidemic.

And back in June, I kind of became inspired about how to solve this problem.

It's radically different from what everybody has been doing over and over again that has basically changed our homeless crisis to an epidemic and spent maybe hundreds of billions of dollars or more than a trillion dollars nationwide, and nothing has been solved.

My solution is totally different, and I believe with about $35 million budget that I can help to totally clean out and re-home 100% of the homeless.

We're talking about maybe 500 of them being RV dwellers and car dwellers, the others being sidewalk dwellers, and the...

tent dwellers, and what I'd like to do is be able to have a 30 minute presentation with the city council and the city leaders to be able to do a PowerPoint presentation so that I can share my ideas with you.

This idea is going to be extremely applicable to every city across the states and the United States.

I want to see the city of Seattle being the first one to do it because I believe whoever does it first We'll be able to get a lot of political punch from it and also national notoriety.

I'd like to see the city of Seattle become the animal city again.

So again, with that, I just want to leave one last story with you that back in 87, I had the opportunity to buy an IPO stock for $21.

I didn't, I spent my $10,000 to a and I ended up losing that $10,000.

I left that $10,000 in that $21 IPO stock.

It'd be worth $58 million today.

I didn't believe my friend.

It was Microsoft.

So with that, I'm going to leave it.

And I'm going to leave my cards here.

And I hope to hear from you soon.

SPEAKER_25

Thank you.

And please feel free to leave any written comment here.

And also, you can email council at seattle.gov.

Thank you.

Council Member Saka has joined remotely.

Oh, okay.

SPEAKER_24

And I just want to note...

The next public commenter is Lindsay Christofferson, followed by Charles Hines.

SPEAKER_25

For the record, Council Member Salka has joined us remotely.

Thank you.

SPEAKER_08

Can you hear me now?

Can you hear me now?

My name is Lindsey.

I work for Low Income Housing Institute.

I'm a case manager.

And we recently opened a new supportive housing building called Jean Darcy Place in the U District.

We house about 63 tenants, and we take the previously homeless, and we give them free housing for one year.

They're under a lease.

And this gives them the opportunity to rebuild their life in a stable and safe house.

And Code Lead is the entity that helped us fill our units.

The outreach team was absolutely amazing.

And we had to fill it pretty quickly.

We filled it in about a month.

And these guys were just really, really supportive.

You can tell the people that do it because they love what they do and because they want to make a difference.

And I personally am pretty new to the whole case management thing, and they have been 100% supportive.

Every time I call, they answer.

The clients have had nothing but good things to say about them.

They also support us in the aftercare program, which is a legal supportive for our clients.

And...

We've been in it about four months, and I'm happy to say it's going really well.

We could not have done this without them.

I mean, they are, they're just amazing.

And it was a pleasure for me to come up and speak for them today.

Thank you.

SPEAKER_25

Thank you very much.

SPEAKER_24

Next speaker.

Up next, we have Charles Hines, followed by Jorge Antonio Lemus.

SPEAKER_27

Good morning.

My name is Charles Hines, and I am the property manager for the Jean Darcy Place.

And I work closely with CoLead.

That's our case manager that was just up here.

It is supportive housing, which I definitely believe in, especially for people dealing with mental issues, substance abuse issues, and homelessness.

I think it needs to start in supportive housing, and CoLead has been really supportive in that venture.

It really takes a team to meet people where they're at And I've worked in shelters before.

I've ran shelters.

I've ran drug rehabilitation programs and properties.

So I have a unique experience coming into this and being able to meet people where they're at.

We're having a, it's not a madhouse.

It's actually a really controlled environment.

And that's because we're engaged with the people that we have, the tenants that we have.

And I think having them come into this, As a tenant landlord relationship also gives them some responsibility.

We have a legal agreement and it and it holds them accountable to that.

So it's teaching them how to reintegrate into life and in a supportive way.

And I know this from experience because I am a recovering at it.

I've been through what they've been through.

and had to do a lot of the things that they're doing now.

And I just appreciate the support that we get, because whenever we have questions, see, everybody's plan is a little bit different.

Everybody's situation is a little bit different.

And that's what I mean by meeting people where they're at.

It's not just a one recipe fits all.

And that's where Co-Lead comes in.

They really give us a lot of information and background on how to how to target certain issues, and they help us with all of the support that we need to do that, especially with our case managers on site, too.

So everybody that comes in is assigned a case manager.

Although they're not required to meet, they're highly encouraged to meet so we can overcome barriers within this year period of time.

That's our main goal, and we've been able to be successful at that so far.

SPEAKER_15

Thank you.

Permission.

Excuse me, what organization did you say you were with?

I'm sorry?

What is your organization?

Oh, Lehigh.

Okay, thank you.

Didn't catch it, thanks.

SPEAKER_24

The next public commenter is Jorge Antonio Lemus, followed by Daniel Zargaradoni.

Sorry about that.

SPEAKER_30

Hi, my name's Jorge Antonio Lemus, and I'm one of the tenants for Coley.

I live in the Westwood building in West Seattle and they asked me to come and just speak about everything that's happened, like experiences.

And over the last year and a half, uh, my life has changed entirely.

I mean, I was sitting in a tent underneath the first setting bridge and it was horrible.

And it's just, just from meeting people from Koli, I started changing my life as far as like I got on my court stuff done.

I got, I'm trying to get back in my kids' lives.

Like, I'm doing a lot of stuff that just I wouldn't be able to do without that support.

I mean, it's a great program.

I've talked to all my neighbors.

They love it, but they just don't like talking, so they didn't want to come.

But, yeah.

I mean, I'm just really grateful for everything that they've done.

And, yeah, I don't know what else to say.

Thank you.

SPEAKER_25

Thank you.

Thank you for being here.

It's always a little nerve-wracking speaking in front of people, so we really appreciate you.

SPEAKER_24

Okay, our next speaker.

Up next is Daniel Zaragoni.

Followed by Sarah Eskay.

SPEAKER_23

Hi, my name is Daniel.

Thank you, Outreach, for giving me this opportunity to get my life back together.

This one chance comes once in a lifetime.

My experience with the staff was wonderful.

They were kind and made me feel like a human being.

If I was still living out on the street, who knows, maybe even overdose.

Thanks to this program, I was able to get my life back together and quit using fentanyl and quit drinking alcohol.

I was able to replace those habits with good habits by skateboarding and working out.

I started going to church and getting involved with the community more by doing outreach with the Mosaic Church on Tuesday nights.

As of now, I'm trying to get a job so I could stay busy.

That way I don't have too much free time on my hand.

Past experience, I learned that if I have too much free time, I tend to fall back to my old habits.

I'm looking forward to the future to see what it has for me.

SPEAKER_24

Thank you.

Our last in-person speaker is Sarah Eske.

Eske.

Eske, thank you.

SPEAKER_17

Good morning, everybody.

My name is Sarah Eskew.

Till this day, I've had only good experiences with Co-Lead, which I'm very grateful for.

Not only have they helped me grow, they've given me great opportunities to succeed.

I was in the first i2 Solutions four-week boot camp, which was a pretty good challenge, and it was really fun.

After I graduated top of the class with a huge amount of resources for finding work, I had a great opportunity to meet the governor.

And then I was blessed with housing.

And it's all been a great, great experience.

And without Coley, I wouldn't be here doing the great things.

Thank you.

SPEAKER_25

Thank you.

SPEAKER_24

Our first remote speaker is Kate Rubin.

Kate, please press star six when you hear the prompt.

Sorry, wrong one.

SPEAKER_06

My name is Kate Rubin and I'm the temporary co-chair of the Seattle Rentions Commission.

The fact that the commission is operating with only five of the mandated 15 commissioners is unacceptable.

This is now the third time I've testified before you to call for action on the overdue appointment, and the Department of Neighborhoods has been reaching out to Committee Chair Moore's office since the beginning of the year.

Let's be clear, this delay is not just an oversight.

It's a blatant disregard for the renters of Seattle who make up a majority of this city's population.

They're refusing to prioritize these appointments you are actively harming communities that are already marginalized and underrepresented.

The absence of black commissioners is particularly shameful, given Seattle's history of redlining, the ongoing gentrification and displacement of historically black neighborhoods, and the disproportionate rate at which black people, especially black mothers, are evicted.

You've been making decisions on critical issues that directly impact renters, like the transportation levies, the ongoing discussions around the comprehensive plan, and a proposed soda and soap zone, yet we, the very body tasked with advising the council on policies affecting renters, have been repeatedly ignored.

This isn't just about filling seats, it's about fulfilling your responsibilities as public officials.

Whether you like it or not, this is your job.

You are elected to serve all Seattle residents, not just those with economic power.

Your continued inaction is a direct affront to the renters of this city and a failure to uphold your duties.

Prioritize these appointments now and address any future appointments promptly to ensure the situation does not repeat.

Thank you.

SPEAKER_24

Thank you.

The next speaker is Irene Wall, followed by Gary Lee.

Irene, press star six.

Irene, are you there?

We'll come back to you.

Up next is Gary Lee, Gary Press Star Six.

SPEAKER_31

Hello, I'm Gary Lee, co-chair of the CID Public Safety Council and a member of the Chinatown Block Watch.

And I want to express my support for the continuation and expansion of the lead and co-lead programs in the CID neighborhood.

As a member of the Block Watch, I've made several referrals, which all have been acted on, and we greatly appreciate the work that they are doing to help make the CID safer and to help people who need serious help.

Thank you.

SPEAKER_24

Thank you, Gary.

Up next is Nathaniel Lyon.

SPEAKER_02

Hello, my name is Nathan Wyan, and I'm the senior manager of community advocacy and outreach at the Ballard Food Bank, and I wish to speak to you today about the importance and impact of the LEAD program at Ballard.

In my role at the Food Bank, I've worked with many different external organizations, outreach workers, and governmental entities in an effort to address the individuals with highest needs in northwest Seattle.

I have never seen any of these agencies be able to pull resources together and make real change happen like the LEAD program has.

In fact, in the last week, LEAD was able to enroll and start to support a client who has been on the street invalid for 15 years, a client who has shuffled out of hospitals, jail, and services without ever receiving more than palliative care.

LEAD was able to pull together resources from us, community members, and other service providers to get her into the program.

While there is no cut and dry solution for this client's needs, there now exists a passport when before all that was achievable was attempting to prevent their death.

We have seen LEAD work successfully with clients who have no other place they can turn, clients that have burned bridges and can't access traditional services, and there are taxing systems not designed to serve them.

Furthermore, LEAD recognizes the importance of community-based intervention in a way that truly supports not only the client but local community.

We have tried for years to find ways to make effective community referrals for our high-need clients only to be confronted by programs that are unsupported, have high employee turnover, and an unwillingness to meet clients where they are.

In our experience, LEAD has been the exception to this rule.

We have seen more progress in our community since engaging with LEAD than we have for years in a way that manages to respect the needs of the individual as well as the broader community.

We hope to have the opportunity to continue this partnership for years to come.

Thank you.

SPEAKER_24

Irene, we're gonna try you again.

Press star six to speak.

Okay, we're gonna move on.

Sarah Jane Siegfried is up next.

Sarah, press star six to speak.

SPEAKER_20

Good morning.

This is Sarah Jane Siegfried.

I'm here to ask you not to renew the MFTE program, the multifamily tax exemption program, at this time.

There's no value in not letting it sunset at the end of the year.

The program doesn't provide any affordable housing under the definition of affordability in House Bill 1110 statewide, which the city adopted is complying with.

that would be people with incomes less than 60% of area median income.

And the lowest in this program is 80%.

So more than half, the vast majority of the need is below 60% of AMI and the program doesn't provide any of that.

So there's no affordability.

It's not managed well.

There's no inventory of apartments Many of the apartments supposedly renting under this are renting for the same rent as others in the building that are supposedly market rate.

This happens.

The city has not done a good job with this.

We might as well wait for the audit at the end of the year to get a better take on it.

Meanwhile, the only thing that will happen is that the developers will rush to get in under the wire, and we don't want that.

So let's just let it expire.

No cost.

to any taxpayer and the taxpayers instead would bear the burden of any of these projects that take place because the tax exemptions then are spread over the rest of us.

So I appreciate your thinking about this and I have mailed my comments to the rest of the council as well.

SPEAKER_24

Thank you.

Up next is Dan Godfrey and we'll try Irene one more time.

Dan, press star six.

SPEAKER_20

There we go.

SPEAKER_24

Dan, can you press star six, please?

Okay, we'll try Irene again.

Irene, can you press star six, please?

SPEAKER_25

Okay.

Are those the remaining two?

SPEAKER_24

Yeah, those would be our final callers.

We're going to try one more time.

Dan, can you press star six?

There we go.

Are you there?

SPEAKER_05

Can you hear me?

SPEAKER_24

Yes thank you.

SPEAKER_05

Thank you.

I'm Dan Godfrey calling from the Seattle Renters Commission.

I've been on the commission for three years.

I was chair for one and a half years.

At the end of 2023 the SRC sent a letter to the city council requesting that commissioner approvals be delivered under three months or in a timely manner going forward.

We currently have four active commissioners and 11 open spots.

The SRC has screened, interviewed, and recommended enough commissioners to almost fully staff the commission, and those citizens have been in limbo for up to a year.

The city council and the mayor's office have failed to approve or respond to commissioner recommendations, and we are totally hamstrung.

It is very confusing to read news articles about the city council considering making serious changes to renter protections.

While this renter commission that the council staff is functionally defunct.

The SRC used to enjoy a healthy working relationship with the council and I myself enjoyed collaborating with council member Morales' office last year.

The SRC was able to get things done in the past.

We are asking the council to approve or respond to appointment recommendations promptly in the next month or two.

or to notify the SRC that the council will no longer oversee our commission and doesn't have the staffing to support us.

I'm available for questions and I appreciate your time.

SPEAKER_24

Okay, let's try Irene Wall one more time.

Irene, at the prompt, please press star six.

SPEAKER_25

Okay.

Irene, apologies for the technical difficulties.

Certainly feel free to email us your comments for today.

So that does conclude our list of speakers from the general public.

There are no additional registered speakers.

We'll now proceed to our items of business.

To those of you who came to testify on behalf of Lehigh, I just wanted to say thank you for being here and for all the good work that you're doing and congratulations on on doing so well and being here to tell us about it.

Really appreciate that and kudos to you.

So clerk, if you could read the title of the first agenda item into the record, please.

SPEAKER_24

An ordinance relating to the multi-family housing property tax exemption program amending section 5.73120 of the Seattle Municipal Code to extend the program's sunset date to March 31st, 2025 for briefing, discussion, and possible vote.

SPEAKER_25

And just like the record to reflect that Council Member Salka has now joined us in person.

All right, thank you, colleagues.

Today we have with us Tracy Ratliff from Council Central Staff to walk us through Council Bill 120817, which is extending the Multifamily Housing Property Tax Exemption Program.

Tracy, I'm going to turn it over to you.

SPEAKER_11

WONDERFUL.

THANK YOU.

GOOD MORNING, COUNCIL MEMBERS.

TRACY RATZOV, COUNCIL CENTRAL STAFF.

SO YOU DO HAVE IN FRONT OF YOU PROPOSED COUNCIL BILL 120817. THIS BILL WOULD EXTEND THE SUNSET DATE FOR THE MULTIFAMILY TAX EXEMPTION PROGRAM FROM DECEMBER 31ST, 2024, TO MARCH 31ST, 2025. THE PROGRAM, AS YOU MIGHT REMEMBER, WAS AUTHORIZED, PROGRAM 6 WAS AUTHORIZED IN OCTOBER OF 2019 WITH A SUNSET DATE THAT WAS ACTUALLY, I THINK, ACTUALLY IN 2023. Because of the pandemic, because of a lot of what was going on last year in terms of the housing levy, and then the challenging rental market, I think it would be fair to say, coming out of COVID, OH deferred one year the formal evaluation and full evaluation of this program, They are very much underway with that evaluation today.

They are very, very hopeful and anticipate that they will, in fact, get us legislation at the very beginning of 2025, but they are still in the process of doing a pretty robust stakeholder engagement.

They have some work that they are doing with the University of Washington regarding the program, as well as looking at some of the data that they are also collecting separately from providers to add to that evaluation.

So we do anticipate we will see that legislation, hopefully very much early in 2025. And that's why they're asking for an extension of the program to March so that it allows the program to continue and not to expire in December.

And I'm happy to answer any questions that you have.

SPEAKER_25

Committee members, any questions?

Yes, Council Member Morales.

SPEAKER_21

Just what might be an obvious question, which is if we let it expire and we wait for the new legislation, what's the impact of that?

SPEAKER_11

It's just that some developers may not be able to take advantage of the program.

Now, I would suggest to you that if the signal gets sent that we're not going to be extending the program, that those who are most interested in participating in the program will probably come in and apply before that expiration date.

But I couldn't tell you that that could be a lot of folks who might miss out on that because they didn't get the notice about it ending versus those who would.

SPEAKER_25

Any other questions?

SPEAKER_14

Yeah.

So there should be no doubt by now that I believe that the MFTE program is an absolutely crucial component of our affordable housing strategy.

It allows us to meet the goals of on-site performance and it also It can be said that given what we learned at one of these past meetings, that how long it takes an affordable housing, a completely subsidized affordable housing project to get off the ground and out the door, where the Office of Housing is carrying large balances year to year, and there's a lot of complexity with braiding sources and finding the right lending.

So here's my point.

I realize that there is a revenue hit by giving the developers or owners of these multifamily facilities a property tax break.

However, they're getting housing built fairly quickly, and I think that we have to keep our eye on the ball.

So that's my preamble for saying I'm very invested in making sure that there is high participation in this program.

And so I was hoping that—I considered an amendment, basically, to this bill saying, If there's any way to inform how the work is going so far before they come out with a complete package, that would be advisable.

You and I spoke in the hall when I asked about, what is this?

Because I was really looking forward to seeing what the plan was going to be.

So is there any mechanism beyond putting it in this legislation that we can be, we can get a preview of what they're thinking because of the importance of this program?

If they're taking three extra months, what's going on?

SPEAKER_11

Right, so the reason why we chose March 31st, 2025, just to be really clear, is that when we heard from OH that they just didn't feel like it was possible that they were gonna be able to get us the legislation transmitted before the end, we said, we wanna make sure that, one, you get it to us promptly in 2025, but we also wanna make sure that you, we, have time to look at what the mayor proposes and the analytics, all the data, all the information that they're going to be doing, the modeling they're going to be doing, to support their proposal, that you have time, we have time, to look at that and decide, do we want to make any changes to that?

Because I will tell you, in the past, we have.

Now, have they been major changes?

No.

But there have been some changes, and we've had to have some meeting on the minds between the mayor's office and the legislative branch about that.

So that's why we chose that March date, was to say, you may do well in terms of getting us what we need in January, but we want to have time as a council to be able to consider what you've done and the data that you're collecting.

I wish, Councilmember, that I could tell you that we could get some early indication of the data outcomes and the stakeholder engagement.

I think what we might see is some further conversations that are had with stakeholders that we might be able to be privy to, to see what it is that they are hearing from the stakeholders, what they might even have as some preliminary ideas about what they might be looking at in terms of changes.

I am in conversation with the Office of Housing about whether we might be able to hear some of that early on.

But it's not gonna be in a format where you all can hear, oh, here's formerly what they were proposing early on in terms of their recommendations.

It would be early indications of maybe some early ideas and proposals, but not anything formalized.

And so, again, it's helpful, but what's really going to be helpful is for us to see all of the data, all of the modeling that they've done to understand, because fundamentally, a lot of where the conversation is had is, what's the affordability levels that are required?

What are the other conditions that we put on their participation in the program?

And that modeling and that other data that they collect is really what helps us inform that.

And that's what we want to see.

And that's what I don't think we're going to get and that they will have ready for.

SPEAKER_14

So will this be the typical, they send something down, we have two or three weeks to vote it out of committee?

I mean, is that how fast you're thinking this is going?

What I'm hearing you say is that January they could be done with their work.

So maybe we could see...

the draft plan before we have to, and then we'll have at least a month or two

SPEAKER_11

And that's why I said we wanted to go with the March deadline was if they don't get us something formally until January, then we have that time to be able to not have to rush through.

We would still have till March 31st to approve a new program.

So that's what would give us the time.

We can ask, council member, we can always ask the executive, could you give us an early briefing about what you're finding and what you think, where you might be heading?

We can always ask.

SPEAKER_14

We don't always get...

Well, it sounds like they're going to get us something in January, so then we'll have some time out.

SPEAKER_11

Yeah, and they are very well aware of everybody's interest in this program and wanting to move on with this program, so I think they are doing their due diligence to get the work done.

It's just that it is a process, and they've got contractors who are doing some part of the work, and then they themselves are going out and doing...

What I think OH is pretty good at, which is engaging stakeholders legitimately in multiple ways to try to get their input on the program.

This is a big evaluation.

We have probably not done this kind of a robust evaluation of this program for many, many years.

So we want them to do it well and to get us what we need, what you all need to decide and to feel comfortable with whatever you approve in terms of that new program in 2025. Got it.

SPEAKER_14

That help?

Yeah.

Would it be how about it?

So a little suggestion in the in the legislation.

This should be transmitted by the end of January so that we it is extended through March.

I we can let's talk later.

Yeah.

OK.

Yeah.

OK.

Thanks.

Good.

Happy to do that.

SPEAKER_25

Any questions?

OK.

I have a question and a comment.

So.

So any extension that we do through the end of March, how many new developers do we anticipate are gonna be applying between now and March 25th?

Is it possible to say, and also those people will be grandfathered into the current program, right?

SPEAKER_11

They will be applying to the program six, yes.

On the provisions of the program six, excuse me.

No way of knowing in this current environment that we are in right now in the development world.

what projects might be looking at coming in.

I can get an update from OH to see what they've seen in terms of any new applications and kind of what they have in terms of the flow.

But, you know, it's a dynamic time in our real estate development pipeline.

And because this is a primarily market-driven program, what's going on in the private market development world has implications for this program.

SPEAKER_25

Yeah.

And...

The corollary program is the MHA, and we know that that's being evaluated by the mayor's office.

Do we have any update on when that report might be coming?

SPEAKER_11

I knew you were going to ask that.

My understanding is that we're going to have that in 2025. I don't staff that issue, but my understanding is that that's when that evaluation would be complete.

SPEAKER_25

In early 2025?

I don't know about early 2025. I think I heard 2025. I'll confirm that for you.

Okay.

I'm just thinking, because there's been some discussion about maybe looking at how we can utilize them in tandem to sort of accelerate the value or the bringing online, I guess, of affordable housing.

Yes.

SPEAKER_11

And I believe...

I believe that's being looked at as part of the MHA program because that's where the prohibition on the ability to layer MFTE and MHA resides.

I do not believe the MFTE.

I think that it is silent, that program is silent about the ability to layer.

SPEAKER_25

Mm-hmm, yeah.

Okay, any questions?

No?

Okay.

So this was set for vote, but I think given that we've had some discussion about additional information and perhaps bringing an amendment to this extension bill for some clarity about when we're going to get information regarding the new bill, I'm going to hold it off for vote until our next committee meeting sometime in early, mid-September.

Okay.

Okay, thank you.

Yeah, thank you very much for your overview.

Appreciate it.

Okay.

SPEAKER_24

Clerk, if you could read the next agenda item into the...

Law enforcement assisted diversion and lead and co-lead 2024 overview for briefing and discussion.

SPEAKER_25

I don't have that on my...

Oh, okay.

SPEAKER_13

Got it.

SPEAKER_25

All right.

Thank you.

So, colleagues, today we have an update on LEAD and COLEAD's work.

LEAD stands for Law Enforcement Assisted Diversion, and we have a team of presenters with us here today to walk us through a presentation of their work.

And I will turn it over to the august table in front of us.

If you could please all introduce yourselves.

Thank you.

SPEAKER_04

Brandi, would you want to start?

Just go talk to her.

SPEAKER_16

There's two Brandis.

SPEAKER_04

Right.

SPEAKER_16

Is my mic on?

SPEAKER_04

Very much so.

SPEAKER_16

Hello, my name is Brandi Flood.

I'm the Director of Community Justice for REACH and Evergreen Treatment Services.

Hello.

Thank you for having me.

SPEAKER_01

Good morning.

I'm Lorenzo Gray.

I am the lead supervisor for Ideal Options in the Northgate.

SPEAKER_19

Hello.

Good morning, council members.

Denise Perez-Lawley.

I'm the co-lead program director.

SPEAKER_22

Hello.

Good morning.

I'm Nicole Alexander, Director of Special Initiatives and Outreach with CoLEAD.

Hello.

SPEAKER_26

Good morning.

I'm Chris Porter.

I'm actually the Human Resource Manager stepping in for Ernest, but with POCAN.

SPEAKER_03

Hello.

SPEAKER_04

I'm Sam Wolf.

He, him with PDA.

I'm the Seattle LEAD Program Director.

SPEAKER_03

Hello.

Good morning.

Brandy McNeil.

I am one of the Deputy Directors at PDA.

SPEAKER_25

Hello.

Well, welcome.

Go ahead and turn it over to you.

SPEAKER_99

All right.

SPEAKER_04

We'll get into it.

I'll start with a brief overview.

LEAD is a public safety program.

Our goal is to work with people whose unlawful behavior is driven by poverty and or unaddressed behavioral health issues, things like substance use disorder and or mental health.

Our goal is to work with our clients towards change, and we do this via long-term intensive case management.

Lead case managers act as the golden thread for clients, brokering access to resources, things like housing, as well as helping them to navigate the often complex paths ahead of them.

LEAD is designed to be complementary to the rest of the public safety ecosystem.

We take referrals from first responders, and then as we do our long-term care, we actively coordinate with criminal legal system partners to make sure that we're able to support our clients as they walk through those systems.

For clients, there are a few ways to get into LEAD.

When LEAD started in 2011, the only way in was arrest diversions.

At that time, the LEAD policy coordinating group laid out a series of divertable offenses upon which diversions could be made.

Right now, we're receiving a lot of diversions related to public use, but there are actually a number that are eligible for diversion, things like misdemeanor theft, property destruction, prostitution, and more.

Officers exercise discretion when making diversions.

That means even if somebody's eligible per lead protocols, they're not required to do so.

And so fundamentally that means that every arrest diversion that we receive starts with a decision by the officer to make the diversion, and then of course a decision by the diverted individual to participate in the program.

We opened up to what's called social contact referrals.

Essentially, this is a referral to lead that a law enforcement officer can make when there's no immediate need for arrest, but when that individual is known to law enforcement to chronically engage in law violations.

Then during the pandemic, the policy coordinating group directed us to open up to community referrals where anybody can make a referral.

We operate this referral system when we have capacity after law enforcement referrals.

When we have capacity issues, the community referral system is the first system to shut down and we've done this multiple times over the years.

But when it is operating, the community referral system can be a really robust way to reduce the burdens on the emergency response system.

Essentially through community partnerships, we're able to work with community and identify individuals who are likely to be generating 911 calls.

and then hopefully be able to preemptively work with them and do so before those 911 calls are generated.

Due to not having capacity to work with all potentially eligible individuals throughout the city of Seattle, we're currently only able to take community referrals from what's called focus impact areas, which are specific geographic regions scattered throughout the city, as defined in our city contract, where we are focusing our resources to make enhanced impacts.

And although we aren't able to take referrals from everywhere in the city for the community referral system, we can do so for law enforcement referrals.

And we do still have offices and teams throughout the city.

Reach was joined this year by Pocan and Ideal Option, our two new lead service providers.

Pocan is based in South Seattle, Ideal Option's in the north, and actually they just opened a new office near Northgate this year.

THIS COLLECTION OF TEAMS AND OFFICES THROUGHOUT THE CITY OFFERS INCREASED ACCESS TO SUPPORT FOR LEAD CLIENTS AND OF COURSE AS OUR TEAMS COORDINATE TOGETHER TO TRY TO WRAP AROUND SUPPORT AND OUTREACH ALL OF OUR LEAD CLIENTS IT JUST OFFERS US THAT MUCH MORE CAPACITY TO DO SO.

SPEAKER_03

LEAD is a framework for tackling law violations and problematic behavior that have consequences for self and others.

That includes law violations involving economic activities, including sex work, by those who struggle with substance use disorder.

LEAD does this work using best practices in recovery services and care coordination.

The model is closely aligned with the Substance Abuse and Mental Health Services Administration, or SAMHSA's framework for recovery.

LEAD is organized around core competencies in substance use disorder counseling as defined by RCW 18.205.020.

Some key elements of LEAD include intensive case management, and this type of case management, as Sam spoke about, is a golden thread that sticks with the person over months and often years.

It helps participants achieve actual progress even through setbacks.

Case managers help participants navigate resources like outpatient treatment, medication treatment, inpatient treatment, housing, legal services, job training.

The list really does go on and on.

Case management involves multi-system navigation to tackle impediments to recovery across the four realms that SAMHSA identifies as key to recovery, health, home, purpose, and community.

Another key element is the framework for information sharing that includes and involves the Seattle Police Department and prosecutors at both the King County Prosecuting Attorney's Office and the Seattle City Attorney's Office.

Legal system coordination is a key element which is dependent on our partnerships and agreements with our prosecutorial partners.

LEAD also includes neighborhood-based case conferencing, and finally, project management, which ensures public impact is mitigated and the program operates with fidelity to the evidence-based model.

The LEAD framework has evolved and continues to evolve to meet the needs of the community.

LEAD originated in Seattle and has now been replicated in over 60, that's six zero, jurisdictions across the country and the world.

It is the most widely replicated diversion framework in the United States.

Within Washington State, LEAD has been replicated since 2019, starting with demonstration projects in Snohomish, Whatcom, Thurston, and Mason counties.

In 2021, the Recovery Navigator Program began, which is based directly on the LEAD framework.

In 2020, CoLEAD was developed to support more rapid stabilization and healthcare connections through the use of temporary lodging, and you'll hear more about the CoLEAD program later in this presentation.

Finally, we have the Third Avenue Project or TAP.

The Third Avenue Project was developed in 2022 at the request of downtown businesses that were struggling to operate in dangerous and disorderly conditions downtown.

The project utilizes the We Deliver Care or WDC Street Team, which provides de-escalation and milieu management, immediate troubleshooting, and LEAD provides sustained case management for high priority individuals as capacity allows.

SPEAKER_22

So as most of us know, recovery is not linear.

We will all follow our own journey.

What we have found is that bringing folks inside gives a foundation for them to work on their recovery.

Throughout every part of CoLEAD, our participants are on their own journeys.

Last week, for three days, we worked with a participant who was in crisis.

Upon entering into our program, this participant had already suffered a traumatic brain injury, and moments before walking through our door, a horrific loss.

This participant came in on methadone and wanted to continue.

Unfortunately, as in most prolonged crisis, this participant had gone into withdrawal.

Our team that it was detrimental to get this participant to dose on methadone.

Due to the nature of the crisis the participant was experiencing, this took hours to achieve these simple steps.

To replace soiled clothing with clean, some needed hygiene, transportation to a clinic, obtaining the carry box for this participant's Sunday dose, getting the participant to dose, and then transporting back.

In the end, the participant was able to dose and continue to work with their case managers to come out of crisis.

On Monday, while at the Jean Darcy, our permanent housing project, It was brought to our attention that five of the aftercare participants there were ready to start methadone.

Unfortunately, there was no transportation that they could find to get participants to dose.

We were able to work quickly and work with our partnering transportation company to get our folks to dosing.

In fact, if it's close to 10, they're dosing right now.

Yesterday, our outreach team was able to bring in a pregnant couple they had been working with for weeks.

Tomorrow we work on getting them both into detox.

Everybody's recovery looks different.

Co-lead is the foundation in our participants' lives.

Our participants have reunited with family.

They have gained their children back.

They have gone to school and entered into trades training.

They've gained employment, have been housed, and continue to grow.

I would be remiss if I didn't share one staggering data that we have.

We have had zero deaths by overdose in any of our lodging facilities through our whole time of operating lodging.

We can and do recover.

I'll pass it back to Sam.

SPEAKER_16

You guys dump it over to me.

I feel like that Olympic basketball team, that was a really good game.

Okay, my name is Brandi.

I work with REACH.

So REACH, Evergreen Treatment Services, has been the service provider for LEAD since 2011. We provide long-term case management services to LEAD participants.

REACH utilizes the principles of motivational interviewing, harm reduction, street outreach, and radical hospitality to do our work.

We embrace a client-centered approach that creates an environment of belonging through trust and engagement.

Our participants are able to focus on their goals and really develop a sense of autonomy with that approach.

Our overall purpose in this work is to build bridges between the systems that our folks encounter and the participants.

And in a way where our clients have dignity and a shared humanity through the experience.

It's often hard to navigate through systems and The folks that we serve, drug users, folks who have been homeless a long time, people engaged in the sex crate, are not always respected when they walk into those systems.

And so our job is to really build that bridge and create an environment where they can improve their lives.

I only have so much time, but I always love to share a story and help connect those dots, because LEAD is quite massive in the work that we do.

And so one story I want to share is about one of our clients who is part of the Third Avenue Project, young black queer man in his early 30s.

He was encountered on the street through We Deliver Care WDC that does the milieu work on Third Avenue and the ambassadorship work.

They identified that this would be a good lead participant, and they made a referral to Joseph Jackson, our downtown street and outreach services, our screening and outreach coordinator.

As soon as he met him, he did the referral.

He did the intake process.

He connected him to our lead case manager, John Nelson.

In working with this young man, he was identifying his goals with...

Yvonne, one of those goals was treatment.

So we have our treatment and Evergreen treatment services has our treatment in motion program right here in Belltown.

It's been there for over a year and we just started in Pioneer Square.

It's our methadone program that they brought downtown.

We were able to enroll this gentleman into the methadone program.

And right now, through the Third Avenue project and our access to housing through that project, we're working on housing with him.

We're finishing the paperwork up now.

So hopefully by the middle of September, this person will be off the street.

And it's remarkable because our treatment and motions program has enrolled about 125 folks this year total in the entire year since 2023. we've been able to roll 2,300 folks from Belltown.

And that's all of Belltown, that's Third Avenue, all those places where we're seeing a lot of fentanyl use, drug use.

And believe me when I say it's miracles to get somebody to stop what they're doing on Third Avenue and make it down to the Thames van.

But our street outreach workers, they use a lot of radical hospitality, a lot of motivational interviewing and meeting the person where they're at and creating the opportunity for the person to just be themselves and access treatment in the way that they want to.

Thank you.

SPEAKER_26

Thank you.

Again, my name is Chris Porter.

Pronouns are he, him.

And I'm with POCAN.

And for those of you who don't know, POCAN's been around since 1987, and its work will always be rooted in HIV prevention, whether it's treating those living with HIV and preventing HIV infection, particularly in communities of color.

Since that time, POCAN has really expanded its programs, and I can't remember them all from my memory, but for instance, Connect2, which is an HIV case management program, CURB program, the Trans Economic Empowerment.

We have HIV mobile testing units so folks can come to office as well as we have a medical mobile van that can go to various sites and test people not only for HIV but other STIs as well as blood pressure checks, glucose checks, cholesterol checks as well.

Best Starts for Kids, addressing homeless prevention because of course it costs far less to prevent someone from losing their housing than when they lose to try to regain a housing somewhere and be stable with that.

We have a senior medical mobile program where we have essentially a mobile clinic that goes to senior centers and out in the community to provide health services for seniors as well as other community members as well.

So we've really just been expanding our services, and of course we're part of the LEAD program.

Now one of our, and I'll make this brief too, success stories.

A 25-year-old male, goes by the initials of AA, who is East African, had lived in Canada and came to Seattle.

He had a tremendous amount of anxiety and fear, from past traumatic events in his life and really struggled with crowds and people and just being around others.

And the notion of going to a shelter was just not an option based on his severe anxiety.

So he was living in a tent in CID and, of course, found his way to self-medicate with various substances.

Anyway, he came into our program And I think the success behind this is having a case manager who was culturally sensitive, nurturing, and very patient to try to get him from where he was, you know, very isolated and very non-trusting of systems as well and structure, to a point where he could accept housing.

And this really required the case manager to just take the time to meet him where he was and take these steps that he could take to agree to a certain plan as he moved along and finally accepted a housing situation which was a very small housing unit.

This happened to work extremely well for his anxiety because The notion of going to a large facility or a multi-living facility where there are lots of people just only perpetuates and heightens this anxiety.

So he's settled in well and is adjusting and has finally, with the nurturing with his case manager, agreed to consider treatment for his anxiety.

Obviously, by addressing that, he would be far more open to many more things in stabilizing his life.

So it's just a story about how powerful this program is. and the work that the case managers do to bring about that stabilization for those at risk and their lives, you know, centered or overwhelmed by substance use, and in this case, mental health disorder, severe anxiety.

Thanks, Chris.

Lorenzo?

SPEAKER_00

Hello, I'm Lorenzo, supervisor for the lead program for Ideal Options.

We are a medical assistant provider.

Like the lead work frame now surrounded, Ideal Options core value is meeting people where they are in order to help move forward as medication assistant treatment providers.

Ideal Options is able to provide immediate access to support and treatment for people who are ready to engage.

These services are offered supports for people struggling with substance use disorder.

As a new lead service provider, Ideal Options is taking on the new clients from the 3rd Ave area, but also supporting lead services provision in the North Precinct.

One of our clients is a 27-year-old woman who we received a recent law enforcement referral from the North Precinct SPD officer.

When we first met her, she was living in Northgate in an encampment that was set for removal.

We learned that she's been homeless for over a decade and struggling with mental health and SUD.

Although she was ready to get off the street, she was scared and overwhelmed.

and unsure how to begin the next steps.

And her situation made her an ideal candidate for co-lead placement, but due to the co-lead pause on placement, we had to make other arrangements.

She was apprehensive about losing her belongings in the encampment removal, so we helped her store her items.

and various needs that she needed.

Although building trust needed her where she was at, we were able to assist her and Connecting to Reach Treatment and Motion Program, which offers suboxone and methadone treatment and also connecting her with sound mental health.

We set transportation up with her to get to appointments, work, and numerous, get her ID and documents needed for her to get housing, to be housing ready.

She is now currently working and getting...

getting the support that she needs for housing and to continue to engage with our case management and scheduled appointments.

This client has made significant accomplishments since her time with the LEAD program and continues to grow in a positive way in the team engagement.

This is a great example of the LEAD case management not only working with clients' accessible resources, but also working alongside of the difficult trials and often overwhelming work that completes the change required.

Thanks, Lorenzo.

SPEAKER_19

Co-lead.

Co-lead is comprised of three phases, outreach, temporary lodging, and housing aftercare.

Everyone who comes into CoLead is vetted, and most are known to have ongoing law violations and are placed with us with the objection of stabilization, recovery, and crime reduction.

Our staff are highly skilled, working on site 24 hours a day, seven days a week, to provide intensive case management that includes connectivity to medical and behavioral resources, getting participants to their medical appointments and into treatment.

Staff also provide legal criminal support that navigates a very complex legal system and daily nominate individuals into housing referrals.

Once placed into housing, we continue to work with each individual for up to 12 months to ensure their stabilization.

I'm sure you can imagine individuals living on the street and outdoors for five, 10, at times 15 years and more.

When they come into temporary housing, you can imagine their medical condition, their mental state, and basically their overall needs.

We work with each individual and you can also imagine it isn't easy.

At times, it's very difficult and very challenging work, yet each of us are committed to each of our participants and aim to get them housed.

A summary of what we provide.

Safety and de-escalation, overdose prevention services, housing placement, Aftercare for those in permanent housing to prevent further return to the streets, connectivity to medical care and overdose prevention.

Staff are trained to respond 24 seven.

SPEAKER_22

So unfortunately what we have seen over the last few years, in 2021, we were serving with 240 beds.

And as of July of this year, we are down to 106 beds.

Unfortunately, with the decrease in those beds, we are serving less people.

At this time, we do have multiple funding sources and Seattle does contain 50 of those rooms.

As we were scaling down recently, we went from three buildings to two.

This was found on our final walkthrough written by a participant in our program.

This place was a home.

It took care of us, played as first base for many great adventures.

And for most of us, it was the first time in a long time that we could feel we belonged.

Thank you, Belltown.

Off to the next adventure.

SPEAKER_04

All right.

We often make the distinction that LEAD is not a program but is a framework, and this flow chart is what we mean.

So PDA, although we project manage the program, we don't self-authorize or unilaterally make decisions.

We take direction from LEAD's Policy Coordinating Group, or PCG, which is a consensus-based governing body whose stakeholder members are listed at the bottom of the slide, most notably including the Seattle City Council, as represented by Councilmember Kettle.

PDA takes direction from the policy coordinating group, and in carrying out that direction, does a variety of tasks, including subcontracting to organizations like REACH, and as of this year, after a competitive RFP process with a panel including the city attorney, the mayor's office, and SPD, our new service provider's ideal option, and POCAN.

PDA also houses CoLead, a lodging-based lead service provider, as well as the lead legal team, which is a very small but mighty team of attorneys that assist case managers when needed with lead client situations.

King County BeHeard contracts to DESC for the COAT team, the Community Outreach and Advocacy team, which is a specialized clinical team that assists with lead clients who are True Blood class members, essentially lead clients whose competency has been raised in court due to having higher level mental health issues.

And then finally, LEAD funding goes to support legal coordination in the form of prosecutorial liaisons.

We have teams at SCAO and KCPAO who coordinate with other operational partners about non-diverted criminal cases that LEAD clients have.

SPEAKER_03

So now we get into what is either the most or the least exciting part of this presentation, depending upon who you are, which is funding and the budget.

And so first we'll start with a breakdown of Seattle LEADS 2024 funding.

And this is inclusive of, you know, the funding that goes toward to our service providers, right?

ETS REACH, as well as our new service providers.

And it's worth noting, by the way, that those new service providers were selected RFP process with the city attorney, the SPD, and the mayor's office on the panel.

And so that really goes to what Sam was saying about how we don't self-authorize, we take direction from our stakeholders.

So with regards to lead funding, we project that we will be serving nearly 1,400 clients total this year.

Funding is between $15.3 and $16.5 million.

With an estimated 1,400 clients, that comes out to a cost of around $11,000 to $12,000 per lead client.

Now, we're showing the full program budget, even though nearly half of LEAD's funding comes from non-city sources, because all of these participants come to us due to impacts they're having on public order and safety in the City of Seattle.

State funds are increasingly being sourced for both the LEAD and co-LEAD's programs, The city's legislative agenda last year prioritized additional funding for LEED from the state budget to support continuing to accommodate increased referrals through the first half of 2025. Of that $15.3 to $16.5 million, only 10.5 of that is ongoing funding.

The funds in the yellow tone slices of the pie chart are one-time funds and represent a funding cliff for next year when it comes to ensuring continuity of care and the ability to keep taking new referrals.

This is a breakdown of co-leads 2024 funding.

Co-leads funding is approximately $11.6 million, most of which comes from funders other than the city.

But again, we're showing the full program budget because these participants come to us due to impacts they're having on public order and safety in the city of Seattle.

and those other funding sources are scheduled to end in early 2025. It's important to note that this chart doesn't include facility costs, such as the city's $2.85 million lease of the Civic Hotel.

We are exploring a plan to reduce the cost next year with the building purchase, and we've received a $7 million contribution from the legislature for that purchase.

We are exploring whether the city can match that, and there are ongoing discussions with the mayor's office about how that might happen.

Again, similar to the previous slide, the yellow slice shows one-time funding that represents a cliff for 2025. An evaluation of CoLead conducted by a University of Washington research team found that when CoLead had access to housing resources, more than 70% of chronically homeless participants with substance use disorders and legal history moved into permanent housing.

Peer-reviewed Evaluations of lead from 2017 to 2019 showed a 58% reduction in recidivism for lead clients for all criminal activity, not just diverted crimes compared to a control group.

What this means is that compared to people who are matched as a control group, same criminal history, same age, same race, et cetera, the lead group's propensity to engage in criminal activities leading to arrest was very different.

It's not that the overall environment was becoming more permissive.

In fact, the control group was arrested at a slightly higher rate year over year.

Rather, the lead program made a difference.

The lead group's arrests year over year went down considerably.

The King County auditor for 2022 found the LEAD framework leads local diversion models and commitment to rigorous evaluation and using data to make program adjustments.

Speaking of data, I'd like to highlight some of the lead outcomes in 2023. I'll note that these are duplicated outcomes, meaning one client could have multiple outcomes per category.

With that said, for lead, with 870 active participants in 2023, there were 815 mental health engagements.

Mental health engagements include connections to mental health providers, attending mental health counseling, mental health medication, and completing a crisis plan.

There were 1,231 substance use disorder or SUD engagements.

These kinds of engagements include SUD assessments, attending a medication assisted treatment or MAT appointment, detox, inpatient or outpatient treatment, attending a recovery support group, and harm reduction education.

There were 605 finance and benefits engagements.

These sorts of engagements include attending finance or benefits appointment, completing paperwork for SSI, SSDI, ABD or unemployment benefits, job training programs, employment and budgeting, and there were 2,840 legal outcomes.

Legal outcomes include resolving a legal haste, very often with input and direct involvement from our prosecutorial partners, resolving warrants, again, often with the assistance of our prosecutorial partners, coordinating and connecting with a participant's lawyer, and a case manager providing information to the court.

SPEAKER_04

Denise and Nicole.

SPEAKER_19

Excuse me, 2023 co-lead data.

These are also duplicated outcomes for 2023. We had 255 participants.

The 255 participants, 95, we had mental health engagements connected to mental health providers, attended mental health counseling, mental health medication, and crisis plan completion.

520, substance use, substance use disorder engagements, assessment, attended MAT appointments, detox, inpatient outpatient, attended recovery support groups, harm reduction education, 174 finance and benefits engagements, attended appointments, completed paperwork for SSI, SSDI, ABD, unemployment, job training programs, employment, budgeting, and payee, 717 legal outcomes, legal cases resolved, warrants resolved, lawyer coordination, connection, and court advocacy.

SPEAKER_22

As we're moving folks in, I think that there's a very large number here that we would love to actually share.

From January to June of this year, 88 out of 157 of our participants moved from co-lead into permanent lodging.

That is a huge number and it was a huge success as we were downsizing, our folks were not exited to the street.

They were found to be placed into permanent housing.

Currently right now, there are five additional placements.

There's a couple more.

We added some yesterday to our list.

And we are actively pursuing matches daily in multiple areas to find locations for our folks to move into permanent housing.

Once our folks move into permanent housing, our aftercare team, it works as stabilization.

As we all know, things are transitional and moving is very scary.

We want to make sure that as we have partnerships with our programs like Lehigh and Plymouth and so forth, that folks don't lose that housing or that it's an appropriate fit.

70 people at high risk of losing their permanent housing received stabilization and housing retention.

And a few of those we've actually moved into a more stable environment and a stronger set of permanent supportive housing that were in scattered sites.

We were also awarded the Washington State funds to support the stabilization work as well.

SPEAKER_04

All right.

Thank you.

With whatever time we have remaining, we're happy to answer any questions you might have about anything we presented on.

SPEAKER_25

Thank you very much.

Questions?

Yes, Council Member Wu.

SPEAKER_09

I have a comment and a question.

And then I'm so sorry, I have to run to a funeral.

So don't be alarmed if I get up and leave.

I'm a huge fan of your program.

I've seen your effects.

I've seen people who were in need of services and were able to attain those services through your organization and they come back and they're They're part of the community.

It's been amazing and so I would love to see the expansion of your programs Especially on to 12th and Jackson because I think that would really help what's happening on tap but my question is What does capacity look like I mean we talked you talked about downsizing from three buildings to two But what does that look like going forward?

And what what's that look like for lead especially?

SPEAKER_03

I think, I mean, capacity is, of course, always dependent upon funding.

And so we are, you know, through 2024, able to continue to accept referrals, arrest referrals, and prioritizing arrest referrals and social contact referrals from officers first, and some community referrals through the end of this year.

But with that funding cliff in 2025, what that means is that, you know, we have the very real possibility that we will then have to figure out how to, you know, shrink, how to, you know, reduce accepting new referrals.

So it's something that we are giving thought to, preparing for, but right now our capacity, we are able to continue to operate through the end of the year at our current sort of clip, so to speak.

So that's our plan as of right now.

Thank you.

SPEAKER_04

I will add some, I mean, with the potential, you know, for a funding cliff in 2025, we are trying to be very considerate of how we are ramping up referrals.

So for example, we're in very close coordination with SPD leadership around when and how to do things like roll call training, because the thing that we are trying to make sure we avoid is, you know, setting up a ramp of a lot of momentum for referrals that we may or may not be able to serve depending on the funding situation.

So we are moving a little bit more considerably than we might otherwise, given the uncertainty.

SPEAKER_03

And one other thing I'll add as well is that, as we've mentioned a couple times, we do prioritize referrals from officers, whether that be in arrest referrals or social contact referrals.

But, you know, community referrals do...

hold a really valuable role in that they actually do reduce the burden on the community, the ability of the people in the community, whether that be business owners, whether that be neighbors, whether that be service providers, out seeing folks that they're like, this is somebody we can help.

That reduces the burden on officers to respond.

We were really able to come in before possibly somebody is causing a public safety or order problem.

And so community referrals, again, though we prioritize them sort of last to make sure that we can make sure we can always accept officer referrals, they really do actually, they're a valuable addition and they're really part of being responsive to public safety.

So I wanna make sure we highlight that.

And that is a loss if we have to shut, curtail that or shut that down.

SPEAKER_16

If I could add one more thing, the community referrals that weigh the heaviest are the ones that are in our focus impact areas.

And for me, I live in Rainier Beach, so it's a priority for me.

But through the Recovery Navigator funding, it's allowed us to expand LEAD in that area in which there really are no services serving those populations that are drug using and homeless in that area.

So we're thankful that we could do that through the LEAD programming in that area, in that focus impact area.

SPEAKER_26

I'll add that POCAN is expanding its services by looking for larger office spaces, more central in Seattle, a little further south in federal way, working with those populations that have been pushed out because of housing inaffordability and access to.

SPEAKER_09

Thank you.

And your services are desperately needed.

And so I thank you for all the work that you do.

And I've seen firsthand from community referrals how that burden and that stress is taken away and helpful for our communities.

So thank you so much.

And I have no further questions.

SPEAKER_25

Sorry, any other questions?

Yes, Council Member Saka.

SPEAKER_29

Thank you, Madam Chair.

And thank you all for the work you all do every day and you and your respective teams.

Really important and impactful stuff.

So just want to shout out and acknowledge and appreciate that.

Express my sincere gratitude.

It's hard work, but it's important.

Also, just as an aside, it's really great to see some District 1 constituents and neighbors and residents of District 1 here, and Denise Perez-Lally, and of course, Mr. Christopher Porter.

Chris, in particular, you've been a great, I've had the pleasure of partnering together with you on any number of strategic initiatives and community activities and efforts in our various shared communities outside of this context.

And you've been a terrific thought partner.

and leader in any number of spaces.

And so really great to see you here.

And it sounds like you're with Pocan in this capacity, wearing a Pocan hat.

I'll just say that Pocan is lucky to have you.

So in any event, thank you all again for being here today and sharing out this important work.

I'd be curious to follow on to Councilmember Wu's question.

I would be curious to better understand the referral process, intake and engagement process, particularly with respect to our newer care department.

Is our care department, are they empowered to make referrals?

Under which of these sort of buckets would that come in if they do?

And how many referrals do they typically make?

SPEAKER_04

So far yeah at the moment care would be in the community referral bucket But we're in conversation with them knowing that they're offering like immediate response for first responders essentially ongoing conversation about how to make these systems fit together, but Care is does great work, and we're committed to trying to complement their their addition to the system

SPEAKER_29

Yeah, yeah, absolutely.

And our care department and our civilian response, alternative response is a capability that I'd like to see.

And I think it's a sentiment that's broadly shared.

I don't purport to speak for any other of my colleagues, but I think it's a sentiment that's broadly shared.

We need to grow and expand and scale our care department such that they are a 24-7, 365 citywide response capability, alternative response capability.

And so- If we're able to get there, well, we will, just a matter of time and resources.

But regardless, we can expect their referrals to ratchet up.

So we need to make sure that all the systems are connected and talking to each other.

We have capacity within reason, given the constraints that we're all facing.

How many community referrals do you typically get?

SPEAKER_04

guess on an annual basis whatever period and what percentage of those are accepted of those referrals are accepted that's a great question I can we're more than happy to follow up with exact numbers I will say one of the mitigating factors on the community referral that we receive is that because we've had to shut it off at multiple times we've never fully advertised the availability of this system to the broader community because since opening up to community referrals have never been able to accept all eligible ones submitted to us.

I will say since the public use ordinance was signed into law last October, law enforcement referrals have comprised the large majority of the referrals we receive, but we are still, I think in 2024, we have received a steady trickle up of community referrals.

Though again, you know, law enforcement referrals as an aggregate are still the majority of the referrals we receive.

Off the top of my head, I'll say right, I think in the month of July, because we just finished reporting, we received something like 30 something community referrals from various focus impact areas throughout the city.

SPEAKER_29

Any initials, so 30-something or so, thereabouts?

Any initial sense of, like, how many of those were actually accepted?

SPEAKER_04

I don't have that number off the top of my head.

I need to follow up with exact referral volumes and how many were accepted from each source.

SPEAKER_29

Yeah.

Well, that speaks to demand, and, you know, we need to make decisions based off of data and including that.

So, yeah, I would appreciate...

learning more about that.

But anyways, thank you all.

No further questions or comments, Madam Chair.

SPEAKER_25

Thank you.

Council President Nelson.

SPEAKER_14

I'll start with the easy money questions first, and then I have a follow up on what you were saying.

So clarifying question on page 13. It notes Seattle lead 2024 funding in the total.

So but then there are sources on the right side of that slide.

Could you put that slide back up?

So when it says Seattle, does that mean the people being served in Seattle are being...

But that does not mean Seattle money, does it?

So...

Here, I'll phrase it as another way.

Is the city of Seattle providing $15.31 to $16.56 million, and some of it's going through these other agencies?

SPEAKER_03

So the city of Seattle is not.

Okay.

the full amount, basically.

We are receiving...

The city of Seattle does pay for some.

Right.

And it's, I believe, a little less...

I think a little less than half, right around there.

Right.

But as I alluded to earlier, all of this funding goes to people who are having an impact in the city of Seattle.

SPEAKER_14

Okay, got it.

That's good to know.

Thank you very much for clarifying that.

And then on the next page, I assume the same is true for the 11.6 million.

The pie chart shows how much is coming from Seattle.

And I would be interested in knowing the facility costs and the COLA adjustments as well.

At some point you can provide that, or at least what Seattle funding is going for that.

Yes.

Thanks.

So it's been about a year since we have adopted that public use law, and I'm glad to hear that there are—and the intention was always that diversion with the goal of incentivizing people to get into treatment was the goal of that.

what happens when someone is referred to you, an officer calls up, you come, and then what happens to those people?

Do they go to treatment?

I've heard anecdotal accounts that once they're now in your care, then what do you do?

And sometimes you have to release them, obviously, and then it's hard to track them down to get them into treatment.

So can you please explain that?

What happens after you're called to one of those stops?

SPEAKER_03

Absolutely.

So I'll hand it off, actually, to Brandy Flood.

But before I do, I'll highlight, you know, something that Council Member Saka highlighted about the care team, which is we similarly right now are working 24-7, 365. So if an officer in the middle of the night calls our green light phone with an arrest diversion, somebody will respond and go out there.

There are limited resources at 2 o'clock in the morning, right?

So with that, I'll hand it off to Brandy Flood.

SPEAKER_16

Thanks, Council Member Nelson.

So, you know, we get the referral in the middle of the night or whenever.

We show up in person.

Our screening and outreach coordinators show up in person, do a screening and intake in the moment.

And like Nicole mentioned earlier, treatment is not linear.

It's kind of a wiggly, wobbly journey.

And so...

We do a lot of engagement to sit down with that client and identify their goals.

Not all of them are treatment at first.

Some of them might be other things.

And in that conversation, you might hint that, hey, reducing your drug use might help get to that goal.

And so there might be a plan for that.

But we sit down with those clients and create individual service plans and help them hit their goals.

And, you know, for a lot of them, it does take a lot of street outreach.

And we utilize all of our resources that are in LEAD.

We utilize our REACH outreach team.

We utilize We Deliver Care, you know, Ideal Options in Pocan.

We've had a great relationship so far.

So we collaborate together to find clients and things of that nature.

Some clients are harder than others.

Some, especially our clients who are in our True Blood member class members are a little bit harder to reach.

but it's an entire process that takes a minute, which is why long-term case management is useful in that process.

SPEAKER_26

And if I may, I want to echo everything that Brandy has said, and also to point out that that contact and coming out of whether they're just being held or being released from incarceration, housing resources couldn't be a higher priority, that without that, it just makes the job that much more difficult.

So that's one of the highest priorities.

into contact with one of our case managers, and at the top of the list you find out that they do not have a housing option and that they've got to do that.

So housing resources still remain one of the highest priorities that makes this program a much bigger success.

SPEAKER_16

I will say, Councilmember Nelson, with the fentanyl crisis, like our participants, they're tired.

Even the ones who are still engaged in drug use, they're tired.

They're tired of seeing their friends and family members overdose and die.

And a lot of them do want treatment.

And so we do our best to access that for them and kind of walk this journey with them.

I can't think of the number right now that the auditor put out there, but the highest number of overdoses right now have happened in our 3rd Avenue corridor all through Belltown.

That's where our office is.

And so we see that impact all day long with those clients there.

And so I would say just in my anecdotal, just from experiences, from my 15 years of experience, I see more clients wanting to access treatment now than ever before because of this fentanyl crisis, which it actually makes it a little easier for us to...

engage on that side of things of treatment.

SPEAKER_14

Thank you for that response.

I was very invested in the passage of that.

And as we know, the previous version failed.

Treatment to me does seem the only path.

Yes, housing.

Yes, everything else.

But they're being stopped by officers because they are oftentimes now, smoking fentanyl in public.

And so therefore, they're in a very dangerous situation.

And if when you are called to intervene instead of them being taken to the precinct, I would hope that getting help for people so that they aren't back on the street immediately and then taking perhaps their last hit would be the top priority.

So...

And then where do you suggest that they go, et cetera?

But maybe I need to, I'll work, I'll ask for more information to see what the pathways are to get people help.

SPEAKER_26

I just want to add that I agree with you about the treatment option and to say that even if they get the treatment option, if we can't satisfy or address their housing needs, then what you have is treatment that may upend and not do as well without the housing resources that go from emergency housing to temporary, certainly to stable housing.

So those two have to work in tandem.

SPEAKER_14

Totally, yes.

People have to have somewhere to live.

And if they are accessing treatment, it would be beneficial if they had someplace to live that is recovery-based so that they have an environment to continue down that journey.

Thank you very much for, sorry.

SPEAKER_25

Any more questions?

SPEAKER_14

Nope.

SPEAKER_25

I know you're next, but I just have one quick question.

Just to follow up on that where you're saying you're available 24-7, we both just came from a meeting earlier today where one of the issues that was identified was the fact that people are being discharged from jail or from the ER, the hospital, you know, at 2 in the morning or 3 in the morning.

So I'd like to hear...

It sounded like you would be, somebody would be available.

So can we be making a better coordination between jail and the hospital discharge so people aren't finding themselves on the street?

SPEAKER_16

Oh, certainly, Madam Chairperson.

We have to do better at that system with all systems to have better opportunities for discharge to go to services.

you know, that really doesn't even exist in terms of having some player to take somebody at 3 a.m.

right now.

And so that's what I hope we continue to be in conversations with the city about how do we make that system better, you know, between, you know, REACH, Ideal Options, Procan, Coley.

We only have so many options and like with only 50 beds left on Coley, I mean, that could get sucked up quickly.

And so that is a place where our whole entire care system needs to be better at that.

There is nowhere to go in the middle of the night, even shelter sometimes.

So, um, which is why Brandy McNeil said, there's only so much we could do in the middle of the night when we have those referrals, other than referral and intake and assure you that, um, we're going to work with you through that process.

You have a little bit of somebody to go to in that moment.

SPEAKER_25

Yeah.

So that sounds like that's a big gap in the system that we really need to work on.

SPEAKER_16

Like actually a gap.

I think we've all sat up here and talked about for 10 years working with conversation with city council and the county and every place we could yell it at the mountaintop.

So it's a frustration that we have that you guys have.

We share the same frustrations in trying to fill that gap.

SPEAKER_26

And I want to say as a seasoned ER nurse, when you discharge someone at 2 a.m.

in the morning, there's what I will call this holding period from that time until services are really available.

Even if you could get the case manager, let's say at 2.30 a.m., services aren't really available until the sun comes up and people answer their phones, etc.

So no one's willing to do a sort of holding in that gap time.

And that's, I think, the thing that really makes this a bit of a challenge, I'd say.

SPEAKER_22

Yeah, thank you.

I would like to just share one small.

For Denise and I, we actually are that location.

We do have that success.

So for our folks in co-lead, when they are in crisis and the crisis team calls, we are that person that responds 24 hours a day.

When our folks do get released at 2 o'clock in the morning, sometimes our staff are there with them inside.

So we are that operating factor that does have that success.

Unfortunately, as we shrink, that becomes more of a constraint, right?

But we do have that program and it is available.

It's just a matter of being able to grow to the size needed.

SPEAKER_25

Okay.

And are the providers, like the ERs and the jail, are they aware that you exist and that they can make that sort of warm handoff?

SPEAKER_22

It's for our co-lead participants.

So our participants that are in our program, we do case care and case management with them.

So if somebody's in crisis and it's in the database, they will know to call us.

If not, our clients will usually...

let them know that they do have case managers or they are connected.

We have lots of crisis nurses that actually know our program.

So if someone is admitted in the ER and they say that they're with co-lead, they actually have some of our work phone numbers and main lodging site numbers to call us and let us know what is going on and to connect.

SPEAKER_25

Great, thank you.

Council Member Morales.

SPEAKER_21

Thank you.

Thanks for identifying me. that particular challenge for us.

I wanted to talk a little bit about the scale of the challenge.

Given the funding that you have, you indicated that it is You're running out of beds.

We know there's a lot of folks on the street who could benefit from your services.

You're already limited to receiving referrals from law enforcement rather than from community.

So I'm interested to know a few things.

What is maybe the percent of need, if you know that, that you are able to fill?

What's What are we missing in terms of the resources that would be needed for you to feel like you could have the capacity to address the need?

That's one question.

I'm interested to know what opportunities you have for funding from the state or from the feds to try to bolster the funding that you have, or even philanthropy, private dollars.

And then when you're talking about the housing resources that are needed, are you specifically thinking about permanent supportive housing or is there a range of options?

Because we know that what we hear a lot is that folks don't want to go to congregate shelter.

I have a lot of questions about for those shelters that we do have that have regularly have vacancies.

Why do they regularly have vacancies?

And my assumption is that people don't want to go to places that have congregate shelter that are congregate shelter because there is they get their things stolen.

You know, what we hear is that the places have bedbugs, they might get assaulted.

And so people want to go to a place where they have their own door, their own space.

Um, so I'm interested to know, you know, when you're saying that one of the important criteria for, um, solution or for, for supposing what kind of housing does that mean?

Um, And then the last question is, what kind of treatment options are available?

So if you receive folks and then they need to go to treatment, where do they go?

And do we have enough?

I don't think we have enough treatment places for people to go.

And so there's a whole ecosystem of need and an ecosystem that lacks sufficient capacity to help handle the problem.

And so I just want to be really clear about what some of those gaps are.

SPEAKER_03

So I'll start and then I'm gonna toss it to other folks.

I'll say as far as the percentage of need that we feel like we're able to address with our current funding level, that's very difficult to assess.

I think in part because, you know, the population that we serve moves, right?

They don't necessarily stay in the same area within the city or even moving in and out of the city, so it's very hard to assess.

I don't know if anybody else has a better estimate on that, but I can get into a little bit as far as the funding question.

So, you know, philanthropy started LEAD with an understanding that as a basic system, it needs to be publicly funded, and we've continued to pursue...

different funding sources, as you can see by the slide we presented.

We have continued to receive funding from the state, whether that be for co-leads, a possible permanent site, state funding just generally, or also federal funding.

We've met with multiple Washington congressional offices who are interested in helping, and we've received funding previously through federal funds as well.

We're not turning any funding down, I can assure you.

And we're always pursuing as many avenues as we possibly can.

With regards to the housing options and the treatment options, Council Member Morales, I'll turn to perhaps our service providers to answer that question.

SPEAKER_22

Yeah, so for clarity, can I get the housing question again?

Specifically, are you asking what housing options will work for individuals and what resources we are using?

SPEAKER_21

Yeah, well, when Chris was talking, it just sounded like if you're saying that, you know, treatment is important and also people need stable housing.

My assumption would be that if people are needing treatment, perhaps permanent supportive housing is the housing option that works best for them.

But if I'm wrong about that, it's important to know.

SPEAKER_22

So currently we utilize multiple levels of housing, right?

Of course, there's a scarcity.

So we are trying to fit a square peg in a round hole sometimes.

What we have found is that most of our participants do need a level of permanent supportive housing.

There's different levels.

There's a light touch.

You have just...

case manager on site and you're checking in and they're helping you learn your dailies, right?

And then you can move up to the levels where DESC you're having, you know, medication management and so forth.

Um, the key factor is that folks do need their own place.

They need their own door.

They need safety.

We've worked with multiple entities to find that our folks feel successful when they have trust and safety where they are at.

And, um, Even though we have utilized scattered site placement, I do feel that it is better when our folks are all within, especially in new and recovery, that we're working together with them to have that support, specifically if they are in new recovery and understanding that There is some hurdles in recovery and sometimes you do need a little bit of acceptance as you're moving through that journey and that the folks there do support you.

One of what we do see in recovery is that it can take a couple times.

And so if you lose everything that first time, you lose faith in that system.

And many of us who work in the encampments find that folks do not want to engage with you at first because they think that there's going to be very strong perimeters around what is black and white.

So we do encourage that folks are able to find housing in places that understand part of what is going on.

SPEAKER_16

Councilor Morales, I'll add to that and talk about treatment as well.

One of the biggest gaps that we often never talk about, we know that drug use and chronic drug use causes significant health issues.

And one of the biggest gaps where permanent supportive housing staff and resources are not enough, and then it's hard to put somebody in individual housing, is that, you know, our nursing homes, our adult family homes, those facilities, they won't even take people who smoke, much less people who have been drug users.

A lot of our people actually need that level of support to be housed.

And, like, when you walk down there, the people who are still outside are probably the ones with the highest health issues where they can't leave alone.

They need some assistance.

They have some major, major health issues because of that drug use.

And so that is probably our hardest...

Gap for lead, co-lead, all of us to even house are those people.

There's nowhere for them to go.

So I just want to put that.

I was a respite case manager for many, many, many years, and I'd have to do my best to keep people alive on the street until they could be housed, and sometimes it just never happened because they had too many needs for the staffing at some of those places.

In terms of treatment, we're trying to use everything.

We're trying to use Valley Cities, Evergreen Treatment Services, therapeutic health services, ideal options, you know, Inpatient, if possible, you know, research, there's no really difference in inpatient and outpatient other than inpatient costs more, but the results are still the same.

We just try to customize our treatment plans for the client where they're going to have the most success.

And, you know, they go through withdrawal so fast, it's been a little bit harder, but we really try to customize that plan for the most success.

So it depends on what that client needs in terms of treatment, but we're going to access every opportunity.

SPEAKER_04

Nicole, would you want to address a little bit the role of aftercare in housing stability?

SPEAKER_22

Yeah, so as we move folks from co-lead, which is temporary lodging, into permanent housing, be it permanent supportive housing, scattered sites, single residency occupancies, we pair our participants with an aftercare support specialist.

And that person is there to really help walk them through the transition of going from temporary lodging into living in your own apartment with your neighbors and a landlord and a lease.

And also being able to continue to work on everything that has piled up over the years.

A lot of our folks come inside with a lot of legal issues.

As we all know, that takes a long time to resolve.

And so there's still access to the team to be able to resolve warrants, to be able to file your first family order so that you can actually visit your kids again, to be able to work on guardianship, your LFOs, your legal financial obligations that have piled up as well.

Something else that our aftercare specialists really work on is being able to access your own daily needs.

You need to be able to know where the laundromat is, to be able to wash your laundry or to get to your mental health appointment, to get to your legal appointments.

Where's the DSHS that's in your neighborhood?

Who is your case manager?

How do you get a new EBT card?

Where is a grocery store that you can make those EBT purchases last all month, right?

Because a lot of our resources are in food deserts.

And so we want to make sure that we're setting folks up for success and for them to be able to feel like they're doing it and being successful on their own as well.

We work with folks for about 12 months.

Now, some of our folks are like, I got employment.

I've started my own business.

I'm doing amazing.

It's great chatting with you.

Three months is good, right?

And then some of our folks who have been outside 10, 15 years This is a long, long process.

And we have to work on being able to keep our apartments so they're not a fire hazard.

Understanding that as we come inside, we process things, we keep things, we throw things away, right?

And that we answer the door to our landlord every once in a while when they need to come in and do a fire check or like your annual review.

because there's just not trust in that system or knowledge.

And so as we work through that, last year alone, 70 folks were actually on that capacity for us to be able to keep them into housing.

And some of them transferred into a little bit stronger PSH or a little bit more structure and to be able to keep them inside and not return to homelessness.

SPEAKER_26

And I wanted to add that both Brandy 1 and Brandy 2 covered, I think, everything quite well.

But also, and she touched on it briefly, was the mental health component.

In the story that I gave about the success program, The case manager is staying with this individual until they can receive or have contact with a mental health counselor.

We know that King County and the city of Seattle have told us time and time again that mental health resources have been limited for quite some time.

So that ends up being still a crisis that we have to navigate with limited resources that without that component, even after, let's say, they've gone through drug treatment, they're going to need that additional resource, but there just is simply not enough of that.

SPEAKER_22

Can I flag one more thing?

We actually developed our aftercare program because of need.

We were placing folks into permanent supportive housing and into scattered sites, and our participants were coming back to our lodging facilities, back to our case managers, needing resources, asking questions.

At one point, we had a PSH that almost every door had 30-day notices on them, and people just didn't even know how to respond to them, right?

And so...

It was out of that that we really like we love our people.

We can't let them go.

Right.

But we want our folks to be successful.

And so we developed a team that could walk through that.

So there wasn't that gap in services.

It wasn't like an emergency response.

So we see the issue and we plan for that.

And so that's how come we developed our aftercare program.

As we look at PSHs, I really want to point out that we've had tremendous success with our right-of-way project where they have stood up their own supportive housing units.

The Jean Darcy who is here today with Lehigh, they are one of those units.

And the ability for us to work together and really be successful with our clients in those facilities and to partner so that everybody who has the resources, each provider has scarcity, right?

We have a legal team.

They do not.

We have transportation.

You know, all these different things that we can piece together really creates a continuum of care that we're hoping in the future could be the golden threat.

SPEAKER_25

Okay.

Any questions?

Not seeing any.

You probably want to close it.

SPEAKER_14

I know, I know.

I'll just make it more of a statement then.

When I hear 15, 20 years people are out on the streets or wherever, that is heartbreaking and, in my mind, inexcusable on the part of the city because that represents a complete system breakdown, failure.

And I understand that there is mistrust about getting people into certain kinds of housing, etc., I think that the health and safety of people living outside is more important than even trying to find the perfect lodging because, as we know, people living outside are vulnerable to violence, et cetera, and they will fall deeper into addiction and a chronic situation that will make it harder and harder for them to put their lives back together.

So I really want to hear next year's not 15, 10, five years.

SPEAKER_22

We have a wonderful success rate for bringing folks inside.

And as Brandy's team, Rich's team knows, a lot of our folks are just in areas where there's not enough workers to get to these folks and to engage and continue to engage and to build that trust.

And the reason why we have a success rate high into the 90s of acceptance into the program is because I'm going to see you every morning.

I'm going to come with muffins.

I'm going to know your name.

And by the time we have the discussion about coming inside, my hope is that I know your mom's dog's name and everything in between.

And I think that's the key when we're looking at our folks is that this is somebody's father, their mother, their sister, their uncle.

And unfortunately...

people try to rush projects.

And for us, you can tell me no, and I'm gonna follow you to the next camp.

In fact, I'm gonna help you, and we're gonna continue to build that trust.

I'm gonna figure out that you really want pink socks.

So we will do it.

SPEAKER_16

Just so you know, we don't take a lot of time.

There is no perfect housing.

There's not enough housing.

But the reason we try to get the best fit because the way the housing system is set up, if I put somebody in the wrong place and they get evicted three months later, they don't qualify for any more housing for over a year.

And so we do take the time to kind of make sure we find the best fit.

But there's not a perfect fit and there's just not enough housing.

That's the one thing we need to do.

We need more of it.

SPEAKER_15

Noted.

SPEAKER_16

Thanks.

SPEAKER_25

Okay.

Well, thank you for the presentation.

I learned a lot.

Really, really informative.

Great work that you're doing.

It was helpful to identify the gaps as well.

And I hope that we can continue the dialogue around how we can work together to fill those gaps.

And I think we all agree we need more housing and we need appropriate housing and we need more...

sort of wrap around services as well and tailored to the spectrum of need.

So thank you again for the work that you're doing.

I really appreciate it.

Thank you.

Okay, we are gonna move on to our last agenda item.

Madam Clerk, if you would read agenda item three into the record.

SPEAKER_24

Agenda item two, addressing substance use disorder for briefing and discussion.

SPEAKER_25

And just a record to reflect that Council Member Rivera has joined us.

We don't, no, she's coming back.

SPEAKER_18

She's still here.

SPEAKER_25

She's still here.

SPEAKER_18

But I think you have to wait until she gets back.

Yeah.

SPEAKER_99

I don't know.

SPEAKER_25

Okay, we've lost quorum.

Council President, can you come back please?

Okay, we're gonna take a brief recess to hopefully regain quorum.

Five minutes, we'll be back.

11.28, thank you.

SPEAKER_99

Thank you.

SPEAKER_25

Looks like we have quorum.

Thank you.

All right.

We have presentations from our Human Services Department, the Seattle King County Public Health and King County's Department of Community and Human Services on our regional response to the behavioral health challenges and substance use disorder.

I want to...

Oh, turned over.

I want to congratulate HSD for their recent announcement of investing $2.6 million to expand substance use disorder detox and treatment beds.

Congratulations.

Fantastic.

That is a vital step to addressing this pervasive issue.

Thank you for doing that, and congratulations, and looking forward to even greater investments as we go forward.

So with that, I will turn it over to our presenters.

Would you please introduce yourselves?

Thank you.

SPEAKER_02

Hi, Kevin Munn, Strategic Advisor at the Human Services Department.

SPEAKER_07

I'm Tanya Kim, Director of the Human Services Department.

Good morning, Susan McLaughlin.

I'm the Director of the Behavioral Health and Recovery Division at King County.

SPEAKER_28

Good morning, Brad Feingood.

I am a Strategic Advisor with Public Health Seattle, King County.

SPEAKER_10

Welcome.

Well, I am thrilled to be here and to this one where we're gonna get into quite a great deal of substantive information.

And you will soon see, we've talked about this ecosystem, some of the greatest players in this region to be at the table.

And so we have all stars here.

And with that, I'm gonna move swiftly through my presentation because you have access to me on a regular basis, but to be here with our colleagues from the county is really important.

And so in the HSD presentation for the Human Services Department, I'm gonna start with an overview.

We'll do a little bit of context setting.

share more, absolutely, we're thrilled to bring on some beds and so we'll talk a little bit about that as well.

We'll talk about our role with the county, specifically with public health that comes up often in terms of the department, what is our role in general in this space and what is our relationship with public health and discuss next steps.

then I'm gonna hand the baton in the spirit of the Olympics that just closed.

I'm gonna hand it off to my colleagues at the county to really get into the body of work since they have the leading role in our region.

Great.

For the viewing public, I always love to start with the department.

I'm at committee often, and so I like to remind folks of the breadth of services that we do cover for people.

And the Human Services Department mission is to connect people with resources and solutions during times of need so we can all live, learn, work, and take part in strong and healthy communities.

We have six different impact areas that we address.

it's soon to be budget season, you'll see that our budget is also organized in this way and so it's really helpful.

Today, we're going to be highlighting some of the work around our public health investments.

Some context setting first, before we get into some of the good news, some of the immediate work that we've been doing.

I wanna first thank the mayor.

Mayor Harrell was very clear with his directive to say that we need to align our city investments and work with urgency to address the priorities.

And of course, behavioral health and substance use disorder, opioid, fentanyl has risen to the top.

We've just heard that from our previous speakers and we'll discuss that a little bit more here.

With that, the mayor gave us a directive to move swiftly and his executive order on 2023-04, the mayor took immediate action.

And today we'll go through three updates and a teaser of what's to come.

And what's to come too is long-term partnership and planning with our county colleagues, as well as more resources come online, some partnership that we'll do with you as well.

So thank you.

The progress.

I'm gonna outline these, but the following slides are gonna go into them a little bit deeper.

You're very familiar with HealthONE, what the Seattle Fire Department is doing.

They're fabulous.

We've expanded that to Health99, and HSD is very much a part of that partnership.

We have awarded, through a very aggressive request for qualifications, capital dollars, and so we'll give you an update on that, so we can support facilities to continue doing the important work.

There's a portion that's been ongoing, it's been in the works, but we've been able to add millions of dollars to that to get it across the finish line.

where there was a gap in the system, as well as another agency who is doing some important outpatient treatment.

We've got these set asides.

We'll speak more to that.

And I want to give a nod to our council president.

We are working quickly now that we have more understanding of implementation for CBA HSD 813B.

That's $300,000 for additional treatment reimbursement.

And so that is forthcoming.

But I wanted you to know that we know we're working on it.

SPEAKER_15

Thank you.

SPEAKER_10

All right.

Health 99, which is really an expansion of Health One.

Also, there's all these names.

The mobile integrated health team, so you know the chief and John are just their leads with this.

Through the executive order, and the opportunity to spend some opioid settlement dollars.

We were able to expand this so that this team is equipped specifically to address the opioid crisis.

And really, there's just, as you know, and I believe, Brad, you're going to share some of the data around overdoses.

And so they're out there responding.

The case managers on this team, they co-respond, our HSD employees.

And so we're proudly a part of that.

I wanna highlight for you the work to date.

So since July of 2023, a little over a year ago, we've already responded to 441 overdoses in the Seattle area.

And we had 97 post overdose follow-ups since its launch.

This is, there's, get ready for some more acronyms.

So with the post overdose recovery RFQ that we had, we had some capital dollars through the Community Development Block Grant.

We were able to have an expedited funding process With that, we were able to award two agencies.

Capital dollars are, while it's amazing to be able to access that, they also come with a lot of restrictions and guidelines.

And so I wanted to give you an update on one of the awardees with DESC.

They're doing what I just shorthand call post overdose facility.

It is an extensive partnership, I will say.

Brad's gonna get into that a little bit more.

He, UW, others have been partnering on this for some time.

HSD was able to come in and offer up to 5.65 million to get this facility off the ground.

If the timing works, we're currently under environmental review.

This is a requirement with the fund source.

We plan to develop the contract and have the services come online.

In quarter one of twenty twenty five.

And with that, I will say they've been working in partnership.

We're already going to contract with them this year to get some of the hiring and ramp up going.

And that's really important so they can start the critical work.

So then they are again operational in the first quarter of twenty twenty five.

And this is the press release that just went out.

And so I wanna, again, thank Mayor Harrell for his vision around this.

With Valley Cities, and we'll note this with Dr. McClellan, that we are working with Valley Cities.

They also have a significant agreement with county around their Medicaid work.

This expansion is unique in that we're able to offer about 2.6 million or 2.55 specifically where we can have set aside beds for the city of Seattle.

So we talked about where can people take folks if they are ready for detox or ready for treatment.

We are entering into an agreement with Valley Cities after much deliberation in order to have a place where we can take people 24 seven.

And it is again, they will hold 13 beds for us.

That's new, we're gonna pilot that.

And that doesn't take away from, that's additive to their work that they're doing with the county.

We anticipate that we'll be in contract hopefully within the month.

We're negotiating that right now and we're going to start referrals soon, quarter four of this year, which is just right around the corner.

And so we're very excited about that as well.

One of the things that we talk about, it's breathtaking.

Those are just some examples of the work that we're doing, but the Human Services Department, while we've had those six impact areas, we do touch public health.

A lot of these other components that we're highlighting now are new books of business for us.

And it's because these issues have been evolving.

They've increased.

And so, you know, and the demand is great.

And what we know for the data is that it's disproportionately impacting the city of Seattle.

We also have opioid settlement dollars.

We have an opportunity a new council partnership and the leadership of the mayor.

So we've been in this public health space role and just generally speaking, we do as a city have over 24.5 million in this space.

Now, I think about public health just as a general term But the contract that we specifically have with the county, public health, Seattle King County as a department, is for this year about $20 million.

And so those are distinct, right?

So some of the other things that I talked about, Health One, that's ours.

Those are investing in our own personnel.

The contract that we have with Valley Cities, that's our contract.

with them, but we also have a contract with public health to enhance and expand upon some of the services that their subject matter experts in and where we can align our priorities.

In addition to that, with the public health contract, we do have an opportunity and I understand that.

So given the priorities and given the real crisis that we're dealing with, we know that lives are important, is that we do want to also address the system gaps.

And so that's something that we'll be embarking on in the near future.

Some of the elements of the 2024 contract are listed here.

I'm actually not going to get into it so much because, Brad, again, we have our SMEs here from the county.

But it's everything from treatment to health care and also some services that we offer through the mental health court.

So it's a range of investments that we currently have in our public health contract.

And we do monitor the contract.

We have regular quarterly reports.

and we do that reimbursement.

Next slide, please.

Excuse me, Chair.

SPEAKER_15

I have a question on that page.

SPEAKER_10

This says next steps, but it's first a look back to the next step.

How did we get here, and then what's ahead?

SPEAKER_25

Excuse me, Director Kim.

I'm sorry, I think we had a question from the Council President.

SPEAKER_14

Quick question on that last page.

So how much of the $20 million that we're paying in our contract to public health is going to these programs?

SPEAKER_10

The majority of the funding goes towards programs.

There's a very small percentage that goes to administrative costs.

I do have the breakdown of the different budget program areas, and I'm happy to provide that to you as a follow-up.

SPEAKER_14

Because I had been informed by...

I think it was the mayor's office that only about 18% of the funds that the city pays into...

King County Public Health for supplementary services goes toward...

Treatment?

Treatment and anything associated with mental health, et cetera, but the things on this list.

And that, according to a community needs study, was the highest need for municipalities to be addressing.

So I am wondering where does the rest of the money go?

SPEAKER_10

Yeah.

Yeah, happy to provide detailed information.

I will tell you off the top of my head, I do know that a significant dollar amount does go to clinics, community clinics.

And there's a whole reason behind that where if people can have their basic needs met, that they could also deal with some of the other substance use disorder needs.

But happy to have that breakdown for your office and for committee after this meeting.

SPEAKER_25

Thank you.

If you could provide that to everyone, that'd be helpful.

You do have a question?

Okay.

SPEAKER_18

Is that okay?

Yeah.

I know.

Thank you.

Thank you, Chair Moore, for letting me ask questions.

I don't sit on this committee, but everyone's tired of hearing me say all these issues are super important to me, so I attend and I super appreciate the ability to ask questions.

I know that Public Health Seattle King County also oversees the school-based health clinics, but that investment is with FEPP levy dollars, not with these dollars, correct?

I just want to make sure that when you say community clinics, they're separate from the.

Correct, they're community based.

SPEAKER_10

That's right.

I'm only reporting today on the Human Services Department investments, but thank you.

Yes, DEAL does have investments as well.

SPEAKER_18

So the city has investments via DEAL for the school health based clinics and then HSD has all the other public health Seattle King County investments.

Correct.

Thank you.

Thank you.

SPEAKER_10

Thank you.

Excellent.

So we've done extensive research and this goes a little bit to what council president was just asking.

So of all of the program areas that are in our contract with public health, how much are we investing in each of the programs?

I will admit that this is a contract that we have inherited over the years that I picked up as a director And it wasn't, I think, it was built off of council ads throughout history, different executives saying, oh, we want to invest in X, Y, and Z, all worthy things at that point in time, but it was important for us to do a refresh.

and take a look to ensure that there's alignment.

And so just want to note that with that, in 2023, we worked with the mayor's office innovation and performance team.

They conducted extensive literature review.

We always start with literature review, but because, again, this was a new book of business for us.

We wanted to get out of the business of just passing through dollars and be intentional.

We got additional support from IP.

They did extensive review, gave us that information, and then HSD could overlay our analysis of our current contract.

And I want to thank Brad and team in advance, or I guess post.

We met several times.

SPEAKER_99

Yeah.

SPEAKER_10

very complicated Excel spreadsheets and really understanding what are we investing, what's the percentage, what are the outcomes, how many people are we serving, what clinics were the geographic locations, and so we did that deep dive.

And I will give you a preview that in 2025, so you know we're coming upon budget season.

And so as soon as the executive's budget drops, we're able to transmit that.

That's when HSD as a whole is able to start contract negotiations with all of our providers, with all of our awardees.

That includes our partnership with public health.

At that time, we will engage in contract negotiation.

That's the opportunity where we will align with the city priorities.

And further in 2025, once we have that contract, we're also going to reset some expectations where we wanna be partners.

I think we have some shared goals.

They also have a new strategic plan.

And so we'll be able to have some mutual expectations.

We're gonna finalize performance metrics.

Dr. Khan, I've spoken to him.

We're both excited about having the metrics visible and available.

And we'll have some clear reporting structures so we can report back out what the impact is of our additional enhanced dollars.

And I know this is a nod to you, Council Chair Moore and others who serve on the Board of Health that I do know that there's interest in strengthening our interlocal agreement.

And so we'll do a look at that as well.

SPEAKER_25

Thank you.

Um, I'm just asked to jump in on two quick questions.

So following up on that, the interlocal agreement, um, is that, would that require council review and sign off or?

SPEAKER_10

That's a great question.

I don't know what the mechanics is of that, but I am certain that there would be some level of collaboration, if not a formal, but I'm happy to get back to you on that.

SPEAKER_25

Okay, that'd be great.

Thank you.

And then I'm just curious to talk about that in 2024, you developed a theory of change.

And could you explain a little bit more about what the new theory of change, if it is new, whatever the theory of change is?

SPEAKER_10

Yeah, we were very careful with our word choice.

We are still developing a premium change.

Part of that is we need sign-off from the mayor.

Once we have that signed off, that's really going to lead us into our contract negotiations as we engage in that with public health.

And so it will outline what our priorities are.

and what we would like to invest in.

So it's not the scaffolding contract that we currently have, but that we're very clear about the budget and alignment to the city's priorities, which will be outlined once we have approval of that theory of change.

And that's our public health investments as a whole.

And so it's a good question, Council President, asking about what percentage of this contract is going towards substance use.

But I also like to take a step back and look at all of our investments as a whole and going to, and perhaps even with DEAL, what is going into the public health universe, and then how much of that, you know, including our federal dollars, including our opioid settlement dollars, is going towards which different priorities?

And we'll be able to answer that at the end of the year for 2025. It'll be refreshed.

SPEAKER_25

So what are you relying upon to develop a theory of change?

What's the source of information?

What are the conversations?

Because you're saying you're doing your theory of change to ensure investments are meeting our greatest needs.

Who's identifying what the needs are?

Who's identifying what the theory of change should be to meet those needs?

SPEAKER_10

We started with the literature review from IP.

We're working with public health.

There's a ton of data.

In fact, we actually fund part of an epidemiologist, and so it's going to be data-driven.

And so based on that, it'll be a clear, here are the issues, here are the needs, here are the gaps.

So one of the things that I've been learning throughout the past couple years is what is foundational?

What is mandated for public health to provide the county?

What is the role of King County Department of Community and Human Services and the treatment that they provide through Medicaid and the system that they have?

And then what is the role or opportunity that the city can have through the enhancements.

And so collecting all of that information is going to be articulated in this theory of change to say, okay, so based on the data, here's what exists, here are the gaps, here's what the city is going to invest in.

SPEAKER_25

And you anticipate having that done by the end of this year?

Yes.

Okay.

Okay.

That would be great to bring that to committee.

I think that would be helpful for us to see that roadmap.

Thank you.

Did you have a question?

SPEAKER_14

Well, wouldn't your theory of change follow the needs assessment that says what is, you facilities around the region are saying is happening out there in the real world.

My understanding is that the most recent needs assessment identified greatest need mental health, well, substance use disorder, greatest unintended injury, overdose.

I mean, it's really clear what the need is.

So how closely is the theory of change tracking what the community needs assessment says?

SPEAKER_10

Closely.

SPEAKER_14

Great.

SPEAKER_10

I don't think you will be surprised.

So, and we'll have all the citations and happy to come back and share that background information.

Thanks.

Okay.

So if there are no other questions.

I don't, I think there are actually.

SPEAKER_25

Council Member Salka.

SPEAKER_29

Oh, go ahead.

Yeah.

No, thank you, Madam Chair.

And thank you for this presentation.

Director Kim.

And thank you for walking through the exercise on this last slide here about how you approach aligning city investments with current priorities of the city.

That is exactly the type of boring, routine, but highly impactful work that we need to be doing more of as a city.

Because what we know happens is, I mean, you alluded to this a moment ago, is that, you know, Executives, council members, any staff in the department, everyone, you chain on one well-intended idea on top of another well-intended idea on top of another, another, another, and then you just end up, the end result is this Frankensteinish, monstrous, unwieldy set of values and priorities and programs and principles.

Some are consistent, some are totally inconsistent.

And so simplifying and streamlining and aligning to current priorities of this city is very, very, very important.

So thank you for undertaking that work last year.

Just curious to better understand, and it's, It's an iterative process, of course, and since that work was undertaken, as you know, a number of things have happened in the city, including unprecedented turnover in city council.

There's two-thirds net new members here, and we all have our own priorities, newer members and ones that were here before.

So just curious to better understand, how are you prepared to ensure that the public health priorities are aligned to the council's priorities, in addition to, obviously, the executive and any number of things?

How are you prepared to do that?

SPEAKER_10

Well, I think we're a lot closer than we're far apart.

I know that safety is important.

I know that addressing homelessness and the needs of our unsheltered neighbors are important.

I know that substance use disorder and opioid and fentanyl specifically and the intersectionality of crime and homelessness and others, that's important.

And I also know that going upstream and having health and wellness access to that is important.

And so, again, I think with the launch of the Theory of Change, we really listened.

There's a lot of community engagement that's already occurred.

We don't have to do more.

people have told us, generally speaking, what they need.

We also have a rich level of research that's been done, and so I didn't go into this, but even with the opioid settlement funds or the abatement funds, there's a council, there was some research, community engagement on top of that that said, here's how we're going to ask the various organizations municipalities to implement their funds.

There's some guidance on that.

And so we're leaning on that as well.

I have heard what your priorities are.

I don't think we're far apart.

There are many ways to get there.

And so for me, it's about coming back and being accountable to our metrics and really listening to also being in, you said iterative process.

Are we accomplishing what we're set out to achieve?

And if not, what do we need to do to change that?

There's some other things that are in play.

I had mentioned Council President Nelson's CBA that we have 300,000.

In order to stand up these resources online, there's more work that's being done in the background.

How do we do those referrals?

Is it working for people?

So there's all this behind the scenes collaboration as well.

So just wanted to note that there's a lot of opportunity, but certainly me coming back to council and giving you updates is another way that we can hold each other accountable and make sure that we have alignment.

This is something that I feel is not controversial.

We want to save lives and we want to give people the opportunities to be well.

SPEAKER_29

I would agree, definitely not controversial, just a matter of which specific lines of businesses and programs made pursuant to this broader public health mission that we all share.

Thank you for that.

I have a question now about Health 99. So you mentioned that this is essentially an expansion of the Health 1 program, and colleagues, many of you all have bragged about your ride-alongs with Health 1, and I will admit I have my own FOMO from that, and so I've already reached out to our partners and colleagues at SFD to get my own Health 1 ride-along.

But So Health 99, new line of business.

What is its specific relationship to Health 1?

How is it an expansion or not?

How is it related or not?

What are the differing characteristics of each?

SPEAKER_10

So HealthONE is really going out and doing responses where there's medical.

And then 99 is laser-focused on substance use disorder.

And I'm going to get this wrong, so I'm going to look to my friends.

I'm not even going to attempt to say this.

But they are also equipped.

with the medications to support people.

So it's not only just naloxone, which is readily available with lots of responders, but now they, and I don't want to speak for FIRE, but they have been able to launch some medications that they're able to administer for some longer-term treatment for the immediate response, which is important to help decrease additional overdoses in the aftermath and death.

And so that's very important where we can buy some time to get folks into referral and treatment options.

And so they're very specialized specifically around substance use disorder and overdoses.

SPEAKER_29

Got it.

So health one is high level, more more kind of health-focused, including potentially just broader behavioral health issues, which, of course, substance use disorder would fit within that.

And then Health 99 is more laser-focused and targeted on, you know, the substance...

use disorder aspect?

SPEAKER_10

I would say that that's a general.

So it's where, and if Chief Smith was here, she would be able to say when she gets those calls and then refers the calls over to the, you know, the fire system and then they deploy.

If they know what the issue is, is it related to overdose or not and then they would deploy is it more appropriate for health one or for health 99 and just as a reminder to with those they don't just accept the calls but they do the follow-up which is really important and so they know that it's specifically around a crisis response or is it more specific of course it could be co-occurring there there's a lot of things happening with the person but if it's more geared towards the substance use issue, then it is going to be health 99 that's deployed and follow-up response.

SPEAKER_29

And health 99 includes the like case management, follow-up response element, not necessarily like frontline direct case, but, but, uh,

SPEAKER_10

They do.

They can follow up.

The goal is to be able to, for example, when ORCA is stood up, the DESC post-overdose facility called ORCA, for example, we would envision that HealthONE, once they've administered naloxone, the person at that moment then needs to go to a place to stabilize and be monitored for up to 23 hours.

they can drop that individual off at the ORCA center.

And so there's gonna be a system of a response for overdoses and that's how that would work in that case.

SPEAKER_29

Thank you.

SPEAKER_25

I know you have questions, Council Member Rivera, but it's 12 and we have a lot of material left to get through.

So if you wouldn't mind holding that, thank you.

SPEAKER_10

So if it's okay, I'd love to hand the baton over to Brad Finegood and we're gonna start with public health and then we'll go to Dr. McClellan for the King County Department of Community Human Services specific division on behavioral health and recovery.

SPEAKER_28

Good afternoon.

Brad Finegood.

I am with Public Health Seattle King County, and I'm joined by my colleague Dr. Susan McLaughlin, who's the Director of Behavioral Health and Recovery Division at DCHS.

Anything else you want to introduce?

Okay, great.

We can keep going.

So recently, public health announced and rolled out its strategic plan for the next five years with five priorities, overarching priorities, climate and health, emerging threats to community health and well-being, partnerships, innovation, impact.

uh and information workforce and infrastructure with the underlying um tenants of anti-racism and equity and within that emerging threats to community health and well-being is a priority specifically around overdose prevention and care for people with substance use you can forward the next slide And so that goal is around making evidence-based, culturally appropriate decisions and making services available for people on demand, reducing stigma and providing access to services.

So there's basically four overarching objectives.

The first objective is around ongoing evaluation of our programs to ensure that the programs are working, to ensure that people are getting access to services and that we're doing the right work.

The second objective, we do a lot of community-based trainings for folks, both in response to community need and assertively to organizations, agencies, and community spaces where training is needed on overdose prevention, stigma reduction, best practices for people with substance use disorder.

Objective three is around harm reduction resources and supplies.

We do a tremendous amount of distribution of harm reduction resources and supplies in the community.

It's really important in order to get people into treatment, to keep people alive and provide access to life-saving supports and services like Naloxone, fentanyl test strips, wound and abscess care in order to give people the best chance of getting access to services and achieving recovery.

Objective four, the tried and true gold standard for treatment for people with opiate use disorder is access to medications.

And so we're doing a lot of work in conjunction with Susan and the Department of Community and Human Services that we'll talk about in a second around improving access to medications for opiate use disorder, both buprenorphine and and methadone, and that's in public health in coordination with all the other treatment access, both outpatient and inpatient, that is happening in DCHS.

We can keep going.

I think it's really important to always take a look at the data.

And especially right now, it's something that we can really feel good about, which is something that when I was at Seattle Council last year, the trends weren't looking in the right direction.

This is starting in basically quarter three of 2023. We plateaued at an extremely high amount of overdoses.

And since March, Quarter three of 2023, our overdose rate in King County and in the city of Seattle is decreasing.

So the numbers that you see here are year-to-date numbers as of August 6th, so beginning of the year in 2023 to August 6th of 2023. The amount of overdoses decreased in 2024 countywide, 15%.

So, I mean, that's still higher than 2022. and much higher than, I mean, zero, one overdose is unacceptable, and so, but it is nice, it is a little bit, it gives us a little bit of hope that overdoses are starting to trend down on a month-by-month and quarter-to-quarter basis, and that you can keep going, that it's It's also true in the city of Seattle where overdoses have decreased by 18%, so a little bit higher decrease rate than countywide since year-to-date of last year.

We can keep going.

SPEAKER_07

Thanks Brad.

Thank you again for having me here today.

So we're going to talk specifically about some of the programs and responses that we're doing across King County and within the city of Seattle to help support people with mental health and substance use needs.

But it's important to be reminded that there is an ecosystem of behavioral health services that exists and an infrastructure to support people along the continuum of recovery from both mental health and substance use needs.

And so one of the important reasons for the partnership between HSD Public Health and our Department of Community Human Services is so that we can complement because we have different responsibilities for different parts of The continuum and the ecosystem.

So, for example, public health is very focused on prevention, early intervention services and harm reduction.

My division is responsible for the system of treatment and recovery services, both outpatient and inpatient treatment for people on Medicaid and other low income individuals.

And then the continuum of crisis service response for all individuals in King County who are in a behavioral health crisis.

So earlier this year, Executive Constantine rolled out 13 action responses to get in front of and try to address the opioid crisis.

Brad and I are going to go through each of these priority areas, five priority areas, and what's been happening within it since this announcement earlier this year.

SPEAKER_28

Yeah, and I just want to reiterate what Dr. McLaughlin said, which is that we operate in a full continuum of services, and although harm reduction sometimes gets a lot of the press, it really...

is the goal is to get people access to the services they want and need.

And so when people want treatment, the goal of our system and the work that Susan and I do respectively in our departments is to get people access to the treatment.

Because if people want access to services and they can't get access to services, then we're not doing right by those people.

And that's our best bet.

So our first priority is that, around providing access to treatment and community-based recovery support.

So in order to do that, one of the things we're...

Well, we're trying to close gaps where people may want services and are having trouble accessing services.

So buprenorphine, which is one of the two medications for opiate use disorder that is proven tried and true, We've expanded access to over 160 fixed-site locations around the county where people can get access, but we know that might not be enough.

So with the change in federal rules, we launched in January this year a 24-7 buprenorphine hotline.

So anybody can call 24-7, get access to a doctor on demand, when they're ready to receive, get medication to start that recovery journey and have a prescription called in for them.

We're also working to make sure that buprenorphine is available at every behavioral health location.

So every outpatient facility, residential facility that's ran through the Behavioral Health Division and Department of Community and Human Services to make sure that medication is available.

It's not something that people have to partake, but we know that it does cut overdose rate risk by 50%.

And so we want to make sure it is available when people want it.

We're also, and Susan can talk more about it and probably will, I think we'll talk more about it when we have, if we have time at the end, increasing mobile crisis response, and making the number of mobile crisis programs available both to adult and youth in a 24-7 manner.

And lastly, With CDC funding, we are investing in six community navigators at high-risk community organizations that serve people at high risk to make sure that people get access to treatment and harm reduction services, so ensuring linkage to care.

You can keep going.

SPEAKER_07

The second priority area is putting online behavioral health beds and facilities, places for people to go to receive treatment when they need that longer term care.

And we are working with one of our partner organizations, Pioneer Human Services, to open a 16 bed residential treatment program.

specifically for individuals with co-occurring mental health and substance use disorder needs.

This is huge.

There is significant and substantial overlap between mental health and substance use disorders, and this will be the only facility in King County that is designed and set up to treat both in a co-occurring manner.

That is scheduled to open in October of this year.

Those beds will be online.

We also, in partnership with the City of Seattle, we've had a longstanding partnership for the operations of a sobering center.

This operates 24 seven and is again a place for individuals who are on the streets and intoxicated to be brought and there's staff on board to safely watch them as they detox.

And then also it's a point of engagement to hopefully move people into treatment.

We have been working on finding a permanent site that the siting of the sobering center has been in flux for several years now since its original site, the building was sold.

So we're working on a permanent site for that.

And because of the temporary site that it's in, it's not open.

operating 24-7 right now and at full capacity.

So when we do finalize the new site, it'll be able to function 24-7 and with greater capacity.

And then Tanya spoke earlier about DESCs.

OPIOID RECOVERY AND CARE ACCESS CENTER OR ORCA CENTER AND IN ADDITION TO THE CITY AND THE STATE KING COUNTY IS ALSO A FUNDER CO-FUNDER IN CAPITAL DOLLARS FOR THE RENOVATION FOR SPACE AND THEN OUR THROUGH OUR DIVISION WILL BE PAYING FOR OPERATIONS FOR THE SERVICES THAT HAPPEN AT THE ORCA CENTER

SPEAKER_25

I was like, can I just ask for clarification?

What's the difference between a sobering center and then the post overdose recovery center?

SPEAKER_07

Yeah, that's a great question.

So the sobering center traditionally is kind of like it sounds, and we're actually going to be evolving the model.

But historically, prior to heroin and fentanyl and some of the drugs that are on the streets now, it was really your traditional safe place for somebody to go who is severely inebriated, intoxicated, mostly on alcohol in the early days.

They're picked up by our emergency services patrol, which I...

we'll talk about later, and brought there, they are watched so that they are safety.

They usually sleep it off and then are transported back home or wherever in the community that they need to go.

The model, as we are getting ready to find a permanent site for it, will also be evolving the model for the current landscape.

And so there will be some parallels in terms of what is offered at the Sobering Center as the Orca Center as well, drugs that are being used on the street are changing so okay so that those sort of be an overlap of services between those two or centers or potentially i think they'll complement each other the orca center is set up will be set up to um for longer stays than what is traditionally happens at the sobering center okay thank you

SPEAKER_28

Our third priority is, as we mentioned earlier, really around keeping people alive and ensuring that harm is minimized to people so that they can access recovery and start on the recovery journey.

Myself, as a survivor of a brother who died of a drug overdose, I can tell you that if somebody dies, they don't have the opportunity to access all these recovery services.

So it's extremely important that we keep people alive and that We also recognize that keeping people alive often is not enough and that we have to provide access to all these other low-barrier services, as we've been talking about.

Within that third priority, The lead behind naloxone and also the buprenorphine initiation in the field is something that we're prioritizing right now because when people are in that moment, we call it in counseling that moment of decisional balance, when they have had contact with first responders and maybe they've had an overdose reversed, then it's really important to provide them with the health services to be able to stay alive and to be able to help themselves.

We started an overdose fatality review process with our medical examiner's office so that we can take a deeper look at deaths that are happening and ways to prevent that.

We are also doing some community drug checking, and so making sure that, and in conjunction with our medical examiner's office, testing drug samples so that we can be aware when there are new, unique contaminants in our drug supply, so that we can help keep people alive and be on the front lines instead of being years behind reactive-like drugs.

Unfortunately, our system has been.

And then we are continuing to distribute naloxone kits and fentanyl test strips so people can know if fentanyl is in their drug supply.

And we know that people who are using opiates are the closest to reversing an overdose.

And so making sure that naloxone gets in the hands of people who use it.

Just an example real quick of the efficacy of the test strips.

We know that the drug supply is changing rapidly and continues to change.

When we first saw fentanyl come into our community, it came in the form of blue counterfeit pills.

We're now seeing fentanyl come in the form of white powder and rock.

It's not cocaine, but it looks like cocaine.

So people who may be intending to use cocaine who have no tolerance to opiates, may be taking it unbeknownst to them, and they're at greater risk.

And so letting people know that we just had a communications campaign that came out to let people know more about what's in their drug supply, and it's really important for people to be able to test their drugs.

SPEAKER_07

So priority number four is about the behavioral health workforce.

This is probably the greatest challenge that faces our behavioral health system today, which is the lack of skilled and trained behavioral health workforce to meet the capacity demand that we have.

In some cases, we sometimes have programs that are funded and we can't get them started up because we can't find the workforce to operate the programs.

So we are, this strategy is making investments to both retain and stabilize the current workforce while at the same time drawing more people into the field.

And one of the More significant investments that are being made is in a behavioral health apprenticeship program.

This is in partnership with the SEIU 1199 Training Fund and offers three tracks, a behavioral health technician, a substance use disorder professional, and a peer counselor.

So individuals can choose one of those tracks.

and go through training.

It's like a true apprenticeship program where it's on-the-job training with some paid course time as well to get the certifications that are needed to fully operate in those positions at the end of the apprenticeship program.

SPEAKER_28

And lastly, in our priorities, priority five is really working with entities like the city and Director Kim around the use of our opioid settlement funds, which Director Kim talked about earlier.

The city and the county have separate funds for opioid settlement, and we are working closely to ensure that the funds go towards disproportionately impacted communities.

but don't overlap each other, but really complement in each other's use.

I wanted to throw some information out for you all because, as Councilmember Sacca said earlier, the data is really important in understanding what your investments go for.

So these are just three pieces of the public health contract that you invest in with public health and the community.

And I wanted to inform everybody about what some of the outcomes from that funding is.

So the first is around the needle exchange treatment engagement.

From the investments that you all have made, 41 clients were enrolled in methadone treatment, which equated to 925 months of treatment.

and also folks getting enrolled in Medicaid so that their Medicaid can then pick up the tap because Medicaid fully funds methadone.

We started a low barrier buprenorphine program, which is one of the hallmarks across the country for low barrier access to buprenorphine.

It's funded through a number of different funding sources, but the funding of the city makes it possible to have this program.

And you can see the vast majority, the vast number of clients that we serve that are high risk in order to stabilize with buprenorphine.

And it just goes to show that if you provide the services in a way that people are willing to receive it, that they'll come in for the services.

And then community-based harm reduction supports, which is a newer funding.

You can see the amount of help that has been able to be made, including over 100 referrals or warm handoffs to medication for opiate use disorder.

SPEAKER_25

I believe we have a question from Council President.

SPEAKER_14

Yes, I'll repeat the question that I asked last year at that meeting that you referenced.

Well, first of all, is the distribution of harm reduction supplies, is that title encompassed under the needle exchange treatment engagement, and does that include the distribution of pipes to ingest fentanyl and other inhalable drugs?

Or does public health distribute those supplies, and is our money going toward that?

SPEAKER_28

I do not know what the city funds, if those funds go towards the distribution of smoking supplies or not.

I can get back to you on that, but I don't know the answer to that offhand.

SPEAKER_14

Okay, because they're...

My impression is that the answer is yes.

And if that is the case, my question last year and again is, what is the harm that is being reduced by the distribution of particularly those items?

Because I understand needle exchange reduces the possibility or the likelihood of the transmission of HIV.

But what is the harm that's being reduced by helping people, making it more convenient to smoke fentanyl, crystal, et cetera, meth, et cetera?

And how does one measure the performance of that investment?

You said previous that the idea is to engage people and get them to want to go to treatment.

That doesn't seem like a good enough reason, especially when I see a number like 41 people are enrolled in a treatment program.

The numbers that we are giving of people that we're giving those supplies to is much higher than that.

So I asked last year for those numbers and I did not receive them.

SPEAKER_28

Yeah, sure.

We'll get back to you on that.

Absolutely.

My apologies about not circling back on that exact question last year.

What I can say is that when fentanyl first came into our community, which was around the time of COVID, we saw a drastic decline in people coming in for syringe services because, as you've mentioned, people are smoking fentanyl primarily.

And so we had to pivot really quickly and try to figure out how to engage people because if people don't come in for services, they don't get access to naloxone, they don't get access to wound and abscess care, they don't get access to HIV and hep C treatment.

And so by providing access to services that people will come in for, we've seen a huge increase in encounters, access to naloxone, all of those type of things.

So from a logic perspective, that's how we've approached it, and we've seen that in people coming back in for services.

I'll absolutely get back with you on the data that you're looking for.

SPEAKER_14

All right.

Well, I'll just say that I believe that it is irresponsible and almost immoral to be relying on an engagement such as that when there are so many other ways of engaging people.

You know, the muffin that the woman mentioned earlier today, the socks, et cetera.

There are ways of engaging people on the street besides providing the tool that could aid their death.

Thank you.

SPEAKER_18

Can I just...

Yes, Council Member Rivera.

Just very quickly, because taking off on what Council President is saying, what does public health do in these needle exchange sites?

Because I know we have one in the D4, and the concern is folks are...

empathetic and it's not so much they don't want it there it's that their needles left behind and then folks are there it's creating another unintended public health consequence so what do you do to mitigate for that because then surrounding neighbors and small businesses need help And so does public health have personnel there that are outreach and trying to get people into services?

It doesn't sound from my conversations, particularly with the surrounding small businesses, that that's happening.

And so then it creates this other public health issue.

How do we manage for that or what are you doing to manage for that?

SPEAKER_28

Yeah, great question.

I think what would be best is if we have folks who operate the needle exchange come in to talk about the full array of services, possibly at a future presentation.

All of our needle exchange offices take, do needle, they receive needles, and they actually receive needles on behalf of the larger community.

So often groups like LEAD or CoLEAD We'll bring needles in all the people who come in for services will bring needles in other community-based organizations We have a needle drop box right out in front and we also manage the area and the blocks around it so but again

SPEAKER_18

But it's not happening.

So I guess what I'm saying is we need to do better in that space because these things, you know, it's just creating, like I said, the secondary public health issue.

SPEAKER_28

Sure.

And we also work with the city to...

I know the city tracks the needle utilization.

All that I can say is that needle use is continuing to decline.

Intervenous drug use is continuing to decline.

And...

And so, we've seen a decrease in the amount of needles that are sort of in the sphere.

And so, but we're continuing to work on it.

We worked with the city and we did a needle, sort of an assessment of needle pick up and take back and stuff like that a couple of years ago.

It's something that we can revisit.

But, yeah, we continue to monitor the situation and try to help manage the situation wherever we can.

We work with the MID on it also.

SPEAKER_10

And can we follow up with your office to get the specific location, and then we can work together to see what we could do to mitigate some of the at least, you know, immediate concerns and work on some longer-term strategies?

Thank you.

SPEAKER_25

Thank you.

SPEAKER_10

That's great.

SPEAKER_25

Councilman Saka, do you have anything?

No?

Okay.

Go ahead.

SPEAKER_07

Okay, so similarly, I was just going to share some of the ways the city is partnering with the Behavioral Health and Recovery Division on some of our interventions.

I mentioned the Sobering Center and Sobering Center Services earlier.

We also have the Emergency Services Patrol.

And I should say the Sobering Center itself is...

has been and continues to be in the downtown Seattle area, and primarily services for individuals in downtown Seattle.

The Emergency Services Patrol as well.

This is a team of folks that are in vans, both patrolling and outreaching to people who look like they might need assistance out on the streets, but also partner with Seattle Police and Seattle Fire.

They will respond to calls from the police department the fire.

And if first responders are engaging somebody in need, the emergency services patrol will come pick them up, meet them, engage the person, and if necessary, deliver them to the sobering center or another safe place, depending on the situation.

So I wanted to, I didn't have some data when we had to have these slides done, but just share with you a little bit about the scale of the impact there.

So just in the first half of 2024, from January through July, the emergency services patrol responded to almost 15,000 requests for assistance.

They transported over 4,000 people.

This might be a transport to the sobering center, to a shelter or another safe place.

And they initiated just about 11,500 contacts just being out there and patrolling with individuals and engaging them.

The Emergency Services Patrol also administers life-saving overdose reversal medications and have had to do that.

And again, partner with the care teams, the mobile integrated health teams, as well as our mobile crisis response teams on the streets.

City of Seattle also invests in some youth prevention and intervention strategies that we are implementing.

Family intervention and restorative services or FERS is one of them.

This is particularly for Families where there is escalating violence, domestic violence within the home, it's a place for the youth to go and separate from their parents for a bit and then get some mediation and family engagement so the youth can return safely to their home.

And we've served, so far this year, 33 youth through that program.

And then multisystemic therapy is an evidence-based, intensive, treatment program again for youth who are struggling with mental health and substance use issues also may be as a result engaging in illegal activities and to date oh I'm sorry I backwards that 81 youth have been served in the FERS program and 33 youth in the MST multisystemic therapy program to date.

Next slide.

So I wanted to just talk a little bit more about the county's Behavioral Health and Recovery Division just so you can see at a level of scale the system that exists and that can be leveraged versus duplicating activities or setting up parallel systems.

One of the things that we're able to do within my division is braid together federal, state, and local dollars to help invest and build out that continuum of care.

So we have an annual budget of over $465 million.

Again, federal, state, and local dollars that come in specifically for mental health and substance use disorder.

treatment services.

We have just over 200 people on staff.

Annually, we serve about 60,000 people across our continuum of care.

We are the lead division for the new crisis care centers levy, which I'll talk a little bit more about.

We oversee something that's called the MID, which is the one-tenth of one percent behavioral health sales tax.

Again, local resources that we can braid into the system.

And then we have oversee and partner with a network of over 50 community behavioral health providers within the region to support care to people in need.

Next slide.

SPEAKER_25

So thank you.

We are running really short of time.

So I'm going to ask if you could skip to the mobile rapid response crisis teams slides.

And then we'll do those and finish.

And those will be all our last two slides.

Thank you.

SPEAKER_07

So we have operated for many years now mobile crisis teams.

With the crisis care center levy, one of the early investments while we're awaiting crisis care centers coming on board is an expansion of mobile crisis teams.

Kind of in parallel, the state is shifting mobile crisis to a new best practice model called mobile rapid response crisis teams.

So that's what this slide is about.

gives you a little bit of information about what those teams look like and do.

And it's usually a multidisciplinary team that includes certified peer counselors, mental health providers, other mental health professionals that are involved.

They are mobile and outreach to individuals, kids and adults, wherever they are in the community and provide a face-to-face Crisis de-escalation, they will spend time within intervention.

Sometimes it's crisis planning.

Sometimes it's just stabilizing and identifying what other supports or resources the individual needs.

If they're not linked up to services, they might link them to resources in the community as well.

If you go to the next slide, this is the most recent update on this transition and expansion of the teams.

So we are adding teams and locating them regionally.

So there will be a Central West team, which is the city, not a single team.

the primary service area, City of Seattle and Vashon, which is kind of central west, and then northeast as a region, and then South King County as a region.

The goal here is to locate teams out in the community so that they can get to people quicker and faster.

We just finished our request for proposal process.

We now have two providers that we are in contract negotiations with, DSC, which will service the central area, and then Sound, which will service the north, east, and south areas of King County.

These mobile response teams will be dispatched through our regional crisis line that is operated by Crisis Connections.

And then we also have the YMCA of Greater Seattle operates our Children's Crisis Outreach Response System, or CORS for short.

And we are looking to expand their contract to add more crisis teams for youth and families as well.

The contracts will be executed on September 1st of this year.

Then there will be a 90-day transition and ramp-up period to allow DSE and Sound to hire the staff that is needed to add the additional teams.

And we'll begin to transition on December 1st of this year and through early 2025 to different populations that the teams will start to take over.

SPEAKER_25

Thank you.

I have a question.

So you said it's going to be run through the Dispatch Crisis Connections, which is the regional center.

Is that the 988 number?

SPEAKER_07

So we're very lucky in King County because Crisis Connections operates both the 988 line and what's called the regional crisis line.

So no matter which line you call, they will be able to work and dispatch mobile crisis as necessary.

SPEAKER_25

So is that something that like somebody, if you're driving or walking along the street, you see somebody who's in crisis clearly and a fentanyl crisis that you could call the regional crisis line or 988 and make them aware of that and they would dispatch?

SPEAKER_07

Yes, yes, they would talk through the caller with around the circumstances and if the mobile crisis team dispatches the appropriate response, they could dispatch to that community outreach.

SPEAKER_25

Excellent.

Very good.

Thank you.

Okay.

Are there any questions?

All right.

I'm going to have us end there.

Thank you so much for the presentation.

I've just really learned a tremendous amount of information, and I would really hope that we could get you back again next year and not so late in the year, because this information This work and this information is absolutely critical to all of the issues that we're dealing with in our city.

And being aware of the work that's happening is really important for us to be strategic in our investments and that we're not duplicating.

But anyway, thank you for your patience for being here today and the presentation, very, very helpful.

And thank you again to HSD, Director Kim.

Again, for your information, presentation, and being always available to answer our questions.

Really appreciate that.

Thank you again.

Thank you.

All right.

That concludes the August 14th meeting of the Housing and Human Services Committee.

The time is 1236. The next meeting is scheduled for September 11th.

And we are adjourned.

SPEAKER_99

Thank you.