[MaryAnn O'Connor]: So, welcome to the October meeting of the Medford Board of Health. Dr. Platt, I was gonna ask you to open the meeting.
[MCM00001745_SPEAKER_03]: Sure, let's open the meeting. First is the review of the minutes from September 19th, 2023, which were emailed to everybody by yourselves. We did a solid waste dumpsters. Motion to accept the minutes.
[MCM00001745_SPEAKER_07]: Motion.
[MCM00001745_SPEAKER_03]: And I second it.
[MaryAnn O'Connor]: Thank you for your time.
[MCM00001745_SPEAKER_07]: Yes.
[MaryAnn O'Connor]: Thank you. Motion passes. Kathy is emailing me trying to get into the green so hopefully she's able to do that. Motion passes. Minutes are huge, thank you. And Millie, thank you for doing such a great job of the minutes. Appreciate it. All right, I'm gonna ask that we move the agenda around just a little bit because we have Penny here. She's gonna give us an update on Medford's Opioid Settlement Fund. But I know she's on a little bit of a time constraint between meetings. So I was hoping Kathy would be able to get in.
[MCM00001745_SPEAKER_03]: Where does that Opioid Settlement Fund have its origin?
[MaryAnn O'Connor]: So this is from the Attorney General's Settlements with multiple companies who they claimed did marketing techniques and the steps that actually contributed to the opioid epidemic and caused the epidemic. excessive sales and use of opioids. So it's like with the- Tobacco. Yeah.
[MCM00001745_SPEAKER_03]: How much money are we talking about?
[MaryAnn O'Connor]: A pharmaceutical company. So Penny, I'll let you, where are you Penny? Did you leave it?
[Funaiole]: Hi, I'm here.
[MaryAnn O'Connor]: There she is. Hi. I'm trying to get Kathy and I'm gonna let Penny.
[Funaiole]: Dr. Ploditz, we have an estimated 1.5 million coming over 15 years. So the way that it's working out is there's multiple funds that the state went after, wholesalers, retailers, and then the actual makers, Purdue Pharma, right? The distributors and some of the pharmacies have done their payouts. And so all of these different payouts are coming in different schedules. So the best way for us to keep our head wrapped around the funds that are coming in is to just understand that in total will be 1.5 million, give it up or down just a little bit. And that over the 15 years, it's about 100,000 per year, we can roll forward the funds each year. In terms of budgeting, it makes most sense, I think, to lay it out in that format so that we can really create something sustainable in the city that is really consistent. So that's the fund situation. What we've done over the last year or so is a couple different things. One, we always collect data anyway. So we have youth data, we are now doing another round of the youth surveys will happen in November for the schools. So we'll be looking at that data to see what are the current pertinent issues needed for prevention intervention and and health promotion, right so that'll happen. Soon, but we are currently looking at the data from 2021. We also have opioid overdose death record data. We have a database that we communicate with police department on current overdoses that are happening. We look at EMS data runs from the States perspective. So typically it makes sense to obviously get primary sources of data, but also the state has done a good job of turning around the death record and the EMS runs in a very efficient way more recently in the last few years. So looking at those are very, that's what we look at. That's our quantitative work. Our qualitative work, we did interviews with nine or 10 people that work within the industry. people that have lived experiences or have a family member with lived experience with substance use as it was specifically opioid use disorder. And then we did a survey and I want to present the information from the survey so the survey was formatted. strictly towards what the state is telling us we can use these funds for, right? We can't just co-make, you know, Jamie's, you know, backyard into a fun place and say that's prevention, right? We have to have very diligently, you know, what are we looking at? And the majority of the funds or the primary use of the funds is to prevent death from opioid overdoses. So really talking to people with lived experience and really focusing our attention towards that. So if you're looking at the guidance document, which I have a folder that I can share with the board members. In there, you'll see that like the majority, almost, there's only three items that you can do prevent mention. Everything else is around response, connection to services and so on. So we put the survey out to the public. We got about 140 responses, 142, 45 responses. So I'll share my screen. I'm just going to present this survey and this is the like what we're, you know, in my mind it's like this is the community saying these are items that I believe this is a good use of the funds. The next level after this is taking all this information going to the promote prevent support. at Behavioral Health Commission and tomorrow we'll be working through how do we want to bucket the money in terms of are we helping people, are we going to put more funds in the harm reduction, wraparound supports, recovery initiatives, are we going to put more money in prevention, whatever that is, we need to basically look at that and say this is the sort of the scheme in which we think is an appropriate use of the funds, send that to the mayor, then send that off to the city council for final approval. Once they do that, we would come back to the table with this commission and identify very specific targets and funding towards each of the program. directions, right? Prevention direction. And then, you know, we're of course been doing a lot of work on outreach and engagement for people with substance use disorders. So we're hoping that people will agree that the work that we're doing is viable and it's also being given permission by the community to do so. So in the survey, we did reach out, we had multiple methods in which we reached out to people. We got 145 responses back. I'm just going to skim this we had you know concerning community member was the number one type of respondent. And some of the questions are answered a little bit differently. So it looks like there's a lot of people here. It looks like the reason their primary involvement in the survey is X. But when you come down a little bit further, you'll see that 50% of the respondents said that they had a death of an offender or family member. So people were impacted that were filling out this survey for sure. So we asked about their concerns with substance use this was an open ended question and the majority of the people said that the, I'm sorry. Oh, you want to do that now. Um, Lack of knowledge, resources, people needing help, not providing enough resources, difficulty accessing or knowing about resources. We did We did host a in-person session to have a discussion and the folks that showed up, they were concerned that not enough people knew about it. So there's some sort of like fundamental breakdown of like, how do we get information out to the public? And this is not related to opioids, it's related overall to the work we're trying to do in the health department. We're doing many methods to get information to people, but people still say that they don't know enough about what's going on. So that's a huge struggle that we need to keep thinking about as we're going forward. People were concerned about neighborhood safety and homelessness, overdose, and harm reduction for those people. Okay, so there was also, if you come down here too, we asked some more questions. There was definitely conflicting Ideas, there's some people who are saying like we need to do more public safety, more law enforcement attached to this issue. Other people were saying harm reduction works, go towards harm reduction. So there was a sort of a split notion there with some of that, some of those comments that we had. But mostly people just really want to see connection, support and care, reduce stigma. So, if we're here we're looking at one of the questions that we asked is one of the buckets that we can fund to get to get work done is to pay treatment facilities. From our bank account to the treatment facility on behalf of the resident, so we just asked outright, like, do you think this is, you know. Do you believe the city should be paying operating costs outside opioid treatment. So, we did get a good amount of people said some said yes and some said maybe and some said I need to know more. So that's that's sort of on the table I didn't, I didn't know that that I didn't think that would be on the table be some like the community, the level at which we are doing our work. But this is what they're authorizing, right? They're authorizing treatment for individuals and their family members, provide mobile interventions, treatment and recovery services. So those are definitely opportunities to look for new programming and ways to do that, should that be something that we choose to spend the money on. On supportive service and fund uses, so they're saying wraparound services, which is fantastic, because that's what we're already doing. We're doing wraparound support services, providing people with treatment to their appointments, getting them basic necessities. for job interviews, getting them connected to mass hire. So we're doing a lot of work around that. Increase the number and capacity of recovery programs, access to recovery housing. Great news, we're already doing this. We're doing sober housing through a fund that we have called the Rise Foundations Fund. So we would like to continue to do that work. All the systems and the protocols are all in place and they're moving and they're operating. So that's not something new for us. Um, but down here it says these are the least popular support for bereaved families and frontline workers, fund outside agency to rebuild, rehabilitate properties. So they don't want us to do that. So we're not that's something that seems like it's low favor. Here we have connections to care. So connecting individuals to care was the more broadly supported category. So EMS and post-overdose response teams to connect with individuals, post-services. So we currently, or we have been doing this since 2016. We fully intend to keep doing this and to do it in an equitable way. services training to encourage early identification intervention for those struggling with drug use. I think that there is some work that's done at the schools. They have some programs we'd like to look at. Maybe we want to put money behind doing that a little bit, making sure that it's working well and adding to it if it needs to be added to. Harm reduction fund uses, so Narcan availability, we're distributing Narcan as is, we're giving Narcan at our door knocks, so that's good, let's keep doing that. Continue to provide education and training regarding naloxone, we're doing that. And continue to fund post-overdose outreach team, which again, kind of loops back to the previous question, post-overdose door knocks are critical. They do not want to have a fund, fund a center range program in the city that's the lowest of all the selected here for that. So then in the criminal justice realm they're saying create a co responder model to address. We do have a co-responder model in the city of Medford for mental health. This is something we can look at how that would work or be expanded, connect individuals involved in the criminal justice system to, so effectively we are doing that again, cause we're doing our door knocks and then post incarceration supports. So anything that we can do to continue to connect with the programs that are coming out of the sheriff's office and the, um, prison system, we should be looking at that as well. Finally, they have some, well not finally, they have some support questions around supporting pregnant and parenting people use. So recovery to support programs for parents and recovery. This is something that we've always kind of been hoping to do. So I'm looking forward to maybe doing an expanding program around that. And then here we have for prevention. So prevent misuse, implement prevention, education funds, greater access to mental health services, There's some work that's going on at the schools called Care Solace. It's this platform to help you get connected to a provider. That said, the provider needs to be available to get connected to. There's a low capacity for providers in this area. And then practices that demonstrate effectiveness in preventing. So that's what they said. There's a lot of practices. It's not as spelled out. There's obviously a lot more to dig into that question, but it's exciting that people believe in it. They don't want to fund our survey or any health assessments. That's OK. I think we have other funds. But it is something that we had anticipated to continue to use, to continue to monitor the issues and be on top of it. So here you have the five most popular programs that we should be looking at with the commission, the Behavioral Health Commission. And we'll sort of start analyzing that over the next few days. We hope to have a decision to the city council by the end of November about what to do. These are the least supported programs, bereaved families, syringe service programs, music care survey. And then in priority ranking support people and recovery is the highest priority connecting to care prevention. These are our 3 top highest categories, and I expect that those buckets will likely be funded by the commission. And then, in terms of most popular programs, this is the order in which it's coming and then that's it. That's the presentation.
[MaryAnn O'Connor]: Thank you, Penny. So, this has been kind of prescriptive from the AG's office and from the state as to the approach we have to take to get community input to make sure that was certainly a part of our decision-making process. And with that being said, I'm interested to hear from the Board of Health members if they agree with what they saw for the findings, if they have any other ideas or thoughts on the best way to use these funds, or is there anything surprising that they saw?
[MCM00001745_SPEAKER_03]: I like the initiation and helping facilitate the care, the tie in with existing organizations. The other question I have is, did we have some program with the police department?
[MaryAnn O'Connor]: So yeah, we have a couple of different programs. Penny said that We had helped them get a grant from DMH to have support.
[MCM00001745_SPEAKER_03]: We may be able to tie some of this back to that, where it's already existing. I forget the office's name. He had come a couple of times.
[MaryAnn O'Connor]: Yeah, that probably was Rory Lockowitz, who had now moved on. Oh, okay.
[MCM00001745_SPEAKER_03]: But something like that, that may be worthwhile of some of the money.
[MaryAnn O'Connor]: And that's tied to the doorknobs as well, when we do doorknobs.
[MCM00001745_SPEAKER_03]: Yeah, right, exactly.
[MaryAnn O'Connor]: So most, you know, overall, you agree with the findings that we saw so far?
[MCM00001745_SPEAKER_03]: Yep.
[MCM00001745_SPEAKER_07]: Yeah, I thought the presentation was very well laid out and I love that we reached out to community I do wish more people responded, but I think 145 is still a good sample group to get a sense of how to use the funds a couple questions. What's the timeline for implementing? Is there opportunity to get more funding beyond the 1.5 that's already allocated to the city of Medford for the 15 years? And there was a third question. It'll come to me. I'll stop.
[Funaiole]: I apologize. I leaped right over your first question. I'm going to go to the second question. The funding. So the Purdue settlement is still out. We're not sure how that's going to work or when that funding will come in or how much it will be or what it will look like. So that's a possibility for that. There may be other settlements that the DEGI's office is working through that we're not aware of. So there may be additional funds coming in that regard. In addition to what we are getting for this opioid settlement dollars, it's important to know that we also have two grants from the Bureau of Substance Addiction Services in the prevention unit. One is a regional underage substance use prevention grant. It's really trying to get even further back from just looking at substances, really looking at root causes and stuff like that. So that work's happening. It's currently being paid out, it's $250,000. for this year, next year, and it was 250,000 for the previous year, they're probably not going to sustain that. The original grant was 125 per year. So currently we have a little bit of a surplus of work that's happening on that. The other grant that we have is an evaluation grant. So not much of the dollars that come off of that grant really go towards the bottom line of helping people, but it helps us to see that our work is being effective, helping us to clear up our data collection systems and making sure that we're, you know, monitoring what we're doing and that it's effective. So that's also good news sort of adds in and plugs into the program. The other fund that we have right now is from the RISE Foundation. And so we received in 2020, 25,000, and then we received 25,000 subsequently until this year. And it looks like this year, it'll be the last year that they'll fund us. So we've built an set up these connections, these programs over the last three years, where we're working with the police department, tapping into what they do best, what we do best. We have a regional, sorry, we have a hub meeting where all of our providers, DCF comes, Mystic Valley. So we have like a lot of different people coming in and supporting. So getting more closely to what you were saying, Dr. Plato, it's about Working with existing organizations to further the mission that we're trying to do here. And then the only other thing that wasn't mentioned here is that we have had a recovery coach since 2017. And we would like to continue to sustain that position, look at that position and make sure that we're still like up to industry standards. Cause a lot has changed. We were the first municipal, one of the first municipalities to have a recovery coach working for the municipality. So we wanna look at like, what are the best practices right now? The entire field of recovery coaching has sort of continued to evolve over time. So we wanna look at that a little bit closer. So what was your first question again?
[MCM00001745_SPEAKER_07]: Timeline for implementation. And I just remembered my last question, which is more broadly, you mentioned people feel like they're not getting the communications. Did they happen to share any suggestions on how to get communications out so that more people are involved?
[Funaiole]: No, you know, they express their frustration and it's so warranted, right? I think that what I'm starting to understand is that we don't have a newspaper that we put information out anymore, right? We have newspapers and five different media sites, social media. And within that social media, we have five different accounts. And so it's like, it's almost like we have too many places. And so then it's like, Who are you paying attention to? So one of the things that I've suggested recently, and I think might be effective, is to really pull out some money and put it towards paid ads. Because if you're not engaging with the City of Medford's Facebook page, you may not be getting notifications about the City of Medford's Facebook page, just the way that that's all been set up with this algorithm and that algorithm. So I think we need to pay for these announcements, for surveys. I think we need to put in a budget for that. So that's one thing. That I think might be more helpful, but we need to continue to look at it and I'm working closely with our communications department overall. Making sure that our content on the website is going to be clearer and more of simplified so that it makes more sense. So we're working on that. We're getting a plain language training coming soon. So there's a lot of stuff we're doing towards that regard. that hopefully will start to sort of help with us. In terms of implementing and getting going, like I said, we're already going on the harm reduction and recovery work. Nothing stops. We just keep moving. And then we just work to switch the fiscal code to this one, to that one. That one's fine. But the other work, you know, I think that we're hoping that we get approval to start using the fund in January. And then from there, we would want to do a little bit more detailed planning around the prevention work and anything that, you know, hopefully over the next few weeks, as we're going through the planning process, we'll sort of suss out any changes that we need to make to the harm reduction and recovery initiative that we're working on.
[MaryAnn O'Connor]: So we're hoping to go to council by November, get approval for the account. It's a restricted account with these funds that then we can just start planning and doing a program at work that we're doing. So we definitely want to expand our recovery coaches role and really look to bolster both communications, but also definitely the prevention work, continue the work with what we're doing now with scholarships for the sober homes. and expand on what we can do. I mean, this funding will be really helpful. It's going to be great. It's going to be a game changer for knowing that we can continue our programming and also build upon it. So we're excited about it. And there may be more settlements, like Penny said, coming our way through the AG's office in the future. So that's also exciting. But it's necessary work. I mean, it's obviously necessary work. And what we're seeing, you know, the opioid issue is certainly been in the forefront lately. And it's definitely, you know, that's way back to being one of the primary issues that we need to deal with. So thank you very much, Penny. Thank you. Thank you for the help, I appreciate it. Moving forward, we have only a, minutes left so we do have some variance requests and I do want to also give Jill some a quick update for what we're seeing at flu season and what our plans are going forward both flu and COVID but we do have some variance requests to the prohibition on the use of polystyrene based disposable food containers. We have requests from the Conte Taqueria restaurant. Are they on? I don't know if they're on with us. We also have from the Medford Senior Center, Mystic Family Elder Services is their caterer. They have advised them, but they need time as well to switch the Medford Nursing and Rehab. is also saying that they need to, they would like to be able to finish with what they have through January of 2024. Rose's Chinese restaurant is asking that they continue to use what they have as far as takeout containers and cups through December of 2023, and a more pizza as well through December of 2023. Are any of the restaurant representatives on the call? On the meeting right now? I saw Pam was here at some point. Kelly's in the senior center, but she might have to drop off.
[SPEAKER_05]: I see Carol Barbarosa. She's from Medfor Rehab and Nursing Center, but I don't know if she can hear us.
[MaryAnn O'Connor]: Okay. Carol, can you hear us? You're not muted, so.
[SPEAKER_05]: She's on the chat. She said, yes, I am here. Yes, I can hear you.
[MaryAnn O'Connor]: OK, great. OK. So are there any questions? Would anybody want more information or do we want to move forward with a approval for these establishments? to use, it looks like most of them, other than the Medford Nursing and Rehab will be done in December, the Medford Nursing and Rehab, they will be complete and done in January of 2024. So can I get a motion to approve these variance requests? There's no questions. Motion to approve. Second, Jen, was that you or Kathy? Kathy. Kathy, thank you, Kathy. Okay, we'll take a roll. Dr. Plattowitz?
[MCM00001745_SPEAKER_07]: Yes.
[MaryAnn O'Connor]: Jen Vitale?
[MCM00001745_SPEAKER_07]: Yes.
[MaryAnn O'Connor]: Thank you. Kathy Schabonina? Yes.
[MCM00001745_SPEAKER_07]: Thank you.
[MaryAnn O'Connor]: Okay, motion passes. Variance request for deferment of the polystyrene BN is approved. And we may still have some triplets coming in over the next meeting or so for folks. may still be looking to have a variance. And now quickly, Jill, wanna give a quick update on what we've been doing and what our plans are going forward and maybe get some input from the board on what they think.
[MCM00001812_SPEAKER_07]: Yeah, so for flu clinics, we've done about 300 flu shots so far between the senior center, homebound residents, police, fire and employee clinics. We still have a few upcoming clinics left. We're doing a big citywide one on November 8th, West Medford Community Center, and we're still kind of doing more homebound vaccines that are coming in as well. So beyond that, we're thinking about COVID as well. We did actually place an order for 200 vaccines today. So this year it's a little different. We don't get the vaccine from the state, so we have to private purchase it. So we got the 200 doses we're planning to do, senior center COVID clinics, West Medford Community Center, and then do the homebound residence as well for COVID. And then beyond that, we're thinking about utilizing some of the state program to get state supplied vaccine. We can only use that for underinsured or uninsured people or for children. So there's kind of some strict limitations on who we can get the state supply vaccine for. So we're thinking through those logistics. And then a question we had for the board as well was the 15 minute wait. So in past years that was kind of required after the vaccine to do the 15 minute wait. This year the requirements say to consider it. Obviously it's more logistically challenging to do the 15 minute wait. You know, we need more staffing, more space. So we're curious on, you know, your thoughts on that as well.
[MCM00001745_SPEAKER_07]: Is the 15 minute wait for COVID blue or both?
[MCM00001812_SPEAKER_07]: Just for COVID.
[MCM00001745_SPEAKER_07]: Just for COVID.
[MaryAnn O'Connor]: And I think they're saying it's a consideration now because obviously this is what the third or fourth shot.
[MCM00001812_SPEAKER_07]: Yeah, for people that, you know, have had potential issues in the past, we would still do a wait, but for people that don't have any history of any issues.
[Unidentified]: And also the slow way of doing it for if you've never had it before. So I guess it would probably be the same from COVID, if you haven't had a vaccine, you should wait 15 minutes.
[MaryAnn O'Connor]: Yeah, if you've never received a COVID vaccine prior. Yeah, makes sense. And we're just we're starting with the 200 doses to see you know what kind of response we get if folks are really interested in and I know some vaccine has been slow arriving to even like the CBS and Walgreens and the states. program as well, but the vaccines are starting to be readily available at this point is what I'm hearing. So, you know, it wouldn't, it wouldn't take us long if we can, if we go through those 200 doses really quickly and there's certainly a demand for more, we can, we can look at doing that as well. But it'd be interesting to see, you know, what the, what the demand is. We have gotten calls and a lot from the homebound as well. Jill's done a great job doing the homebound flu vaccine program. And we have gotten calls from folks who are looking for the COVID vaccine as well. So the state also has a homebound program, but as of right now, they don't have the vaccine. So they're waiting. So they're not, that state program isn't in effect as of right now. So we're looking at that with our two lemon doses as well to get out there so they don't have to wait.
[MCM00001745_SPEAKER_07]: What's the volume for the homebound
[MCM00001812_SPEAKER_07]: We've done about 40 flu shots so far for homebound, and most of those people are also interested in COVID, so we would circle back.
[MCM00001745_SPEAKER_07]: I think to Kathy's point, you know, if you've never had the COVID vaccine before, probably should implement the 15 minute wait or anybody who has had a reaction in the past, maybe do the 15 minute wait, but for others, yeah, after you get your vaccine, you could go. Of course, you know, if you have any reactions, symptoms to contact your primary care provider or go to the emergency room.
[Unidentified]: What is CVS doing when they go in there?
[MaryAnn O'Connor]: It's a good question, I don't really know, honestly. I know the past they have, because they have those chias in the aisles, but I haven't seen those. So honestly, that's a good question.
[MCM00001812_SPEAKER_07]: It varies a little. The last time I went, they said, if you want to wait, you can. If not, you can go.
[Unidentified]: So there's no regulations on CDC that you have to wait?
[MCM00001812_SPEAKER_07]: No, it just says consider a 15 minute wait.
[Unidentified]: Yeah, OK.
[MaryAnn O'Connor]: Okay, so I have less than one minute left on the Zoom. Any closing thoughts or can I get a motion to adjourn?
[MCM00001745_SPEAKER_03]: Motion to adjourn.
[MaryAnn O'Connor]: Thank you, can I get a second? Second. Thank you, Kathy. I have a roll. Jen Vitale?
[MCM00001745_SPEAKER_07]: Yes.
[MaryAnn O'Connor]: Kathy Chabonet? Yes. And Dr. Platts? Yes. Thank you. All right, thank you so much and we will see you next month. Thank you. Thank you.