Transcripts For CSPAN2 Discussion On Opioids Epidemic In Appalachian Region 20240713

Task force on opiates that was done across the u. S. We had 20 elected officials at the city and county levels, intensity officials intent county officials. The mayor of little rock, arkansas, it was a cochair on the city side and i was a cochair on the county side. Youll be hearing from one of those Panel Members today when greg speaks. Our work that was done, seems like ages ago. Well be talking about that. I want to thank those of you here in person as well as those of you that are here virtually. We know this is being broadcast live stream and a special thank you to a. R. C. For your partnership. We partner with each other. We partner with various agencies especially great partners like aoc, we are thankful for that. This event to the combination of a year Long Partnership to strengthen the local response on the opiate epidemic across the 13state region. Irc is a unique federal, state and local partnership and where they, go we make it are privileged to work alongside with them. The Appalachian Region as one of the hardest hit regions in the country. County leaders in the region need to help and support of partnerships like the ones that aoc has provided and the resources that i need to serve our citizens. Today, we are focusing on the Opioid Crisis but we know that the issue reaches beyond that, to Substance Abuse in a broader scale. Many local leaders from all sectors are working together to address Substance Abuse and we see the impact that Substance Abuse is having on counties across the entire region. Counties deal with these pressing issues every day on the front lines. Think about some of these numbers. County support over 900 hospitals, county owned, county supported hospitals. They oversee sheriffs department, other local Law Enforcement, emts, firefighters, other first responders. Investing over 100 billion dollars in justice in Public Safety services each year. I want to repeat that. 100 billion dollars in Public Safety services each year. Counties provide Child Protective Services in foster care and they need to deal with increases in case loads when parents are impacted by Substance Abuse. Counties are also heavily involved in the criminal Justice System, supporting 91 of all local jails. 91 of all local jails. And investing over 20 billion dollars in the courts and Legal Services annually. We cannot forget the way that Behavioural Health and Mental Health are aggravating this Substance Abuse crisis and the resources counties are investing to help residents in this area. Unfortunately as well, county coroner and medical examiners and that being the ones who need to process the dead bodies and in some cases, like us in kentucky, counties are providing the funding for those indigenous barrios. Indigent burials is a line item in my county budget. Nikole and a. R. C. Are therefore focusing on solutions. So many times this work is done, and you later learned the outcomes. The air comes from this work is really focusing on solutions, and im excited to see that. We see the impact of Substance Abuse on counties in the residence and we are focused on making a positive change with this work. We are very proud of what weve been able to accomplish through this partnership. Together, we have produced a robust getting document with findings, recommendations and case studies for operation county officials. We partnered with a 13 appalachia state associations of the county to bring direct resources to the county leaders in the states through ten educational sessions. We also gathered feedback from attendees and foster discussion through the polling on many of these sessions. This event today brings together all of these efforts. We are proud to showcase what we have learned and to look forward to the future of appalachia together. So, we have two great Panel Discussions that are going to take place here today. Our first panel will focus on key solutions. He solutions that county leaders have been implementing across appalachia to address the opioid misuse and what types of solution i have been working the best. Following that discussion, our second panel will look to the future and focus on how we can help appalachian communities move beyond the Opioid Epidemic, looking long term, focusing on solutions to revitalize appalachia. Well have time for questions for all four of the panelists after the second panel finishes. After the questions and after the panels, were excited to have u. S. Senator Shelly Moore Capito to join us at the 4 30 session and the key role for leaders to play on this work. So right on cue, im going to introduce a special guest we have with us today. Tim thomas. Tim serves as the federal cochair of a. R. C. He works directly with a. R. C. s 13member governor, their alternates and Program Managers with a network of local development districts. Together they help create Economic Development opportunities and address Opioid Crisis across appalachia. Tim has more than 20 years of experience in the Public Infrastructure work force, training and regulatory issues. He most recently served with u. S. Senator Mitch Mcconnells staff from 2015 to 2018 where he fostered partnerships with Community Leaders to support economic and Community Development initiatives. Tim has a bachelor of science degree from marie State University and a law degree from the university of louisville. Join me in waccing the ingwelcoming the cochair of a. R. C. Tim thomas. Thank you for that kind introduction and the good work youre doing back in northern kentucky. We have known each other for a number of years. Welcome to all of you to this capstone event that marks a year of collaborative effort between the Appalachian Regional commission and the National Association of counties. Im glad to be here with the director of an organization that helps to broaden understanding of common issues among its members and in his leadership capacity. This latter part of developing local leadership is an over happen inoverlap in the mission of our organizations. It has been a pleasure to collaborate with you. Thank you so much. I also want to thank any Congressional Staff and thanks to senator Shelly Moore Capito who you will hear from at the conclusion. I also want to thank my colleague, a. R. C. North carolina alternate. We will have some excellent discussions this afternoon on the state of the Substance Abuse academic in the appalachians region and the steps are being taken to address it in a comprehensive and most importantly in a local way. The aoc nicole report, open opioids in appalachia, released this past may, shows that the rate of opioid overdoses was 72 higher in appalachia counties compared to nine appalachian counties. Overdosed threats in several states of the region are among the highest in the nation. This is a tragedy on a human level that impact in one way or another every person living in our communities throughout the region. But another thing i noticed from the moment i took office as the federal cochairman of a. R. C. Was the toll these grim statistics take not only in lives lost but also the impact on Economic Opportunity. Substance abuse robs our workforce of healthy, ready workers, deprives our local governemtns of resources. A. R. C. Is an Economic Development entity. Thats our congressionally mandated mission, but i realize we couldnt address the economic challenges faced by many in the region without giving attention to the Substance Abuse challenge. It was the elephant in the room requiring us to think hard about how we as a. R. C. Could help communities respond. Our partnership is a part of that and the may report yielded important recommendations. Most essential being local leadership. Every community is different, each with a unique array of resources and assets. Some may have assets that may not be readily apparent as having a bearing on this chaj challenge. We moe its critical and it is the basis for this partnership that local leaders have the tools and facts in hand because they are the ones making the policy decisions and directing the resources that are most impactful on this issue. Many instansces positive results are being realized where local officials are take on a more active role in leading the response, ensuring more of these officials have the tools to affect leadership ensuring best practices to be implemented on the local level will be critical in helping communities impacted by the Substance Abuse epidemic. Also we need to recognize that those individuals in our communities struggling with Substance Abuse need help and likewise recognize the negative impact that stigma plays in both individualss long term recovery and Community Effort rs to address this challenge. While people in recovery can ultimately be assets to their communities, too often, stigma can serve as a roadblock that hurts us as well as them. In an effort to provide local leaders with information and best practices they need, naco has helped sessions in ten appalchian states based on reports and submitted articles to statewide leadership in other states discussing key recommendations for local action and showcasing case studies of effective initiatives. Many communities in the Appalachian Region are leading by addressing the issue for multiple angles from treatment and Recovery Services to job training and employment, and we hope with the efforts of this partnership and others, appalachian communities will continue to be out front in fighting this crisis, one that impacts the nation as a whole. Unfortunately, the Opioid Epidemic first showed itself in the Appalachian Region and i believe appalachian communities can also lead the way in finding solutions to the problem. At a. R. C. Were also taking action and focusing on visiting the difficult transition from Substance Abuse recovery to the workforce. Last year we held listening sessions in six states, convening leaders from state and local governments, Treatment Recovery services and employers, among others to better understand effective strategies and the pitfalls that can strain well meaning efforts. We learn from those who have been dealing with this issue on the ground for a number of years now. Then we compiled that data from those sessions and gave it to our Substance Abuse Advisory Council with members appointed by the appalachian governors and myself, including Law Enforcement, treatment experts, employment specialists and the like. The council met several times and worked very hard to produce 14 recommendations for creating communitybased recovery ecosystems designed to help individuals navigate the process from the beginning of treatment and ultimately to work. Employment in fact supports and sustains recovery, we have been told, time and time again. The report has been approved by the commission, released publicly, and served as a basis for aocs limitation that works, how during Substance Abuse and Building Local recovery ecosystems. Now, there are no easy or Quick Solutions to this epidemic, but that does not mean we should not confronted head on, use the tools at our disposal and combine forces. The partnership we are happening today next year we have hard data and proven strategies on much to mueller and approaches. This challenge requires a whole of society approach. But, more it requires folks working together in a more comprehensive way for partnerships, including treatment providers, not profit nonprofits, but this is a community colleges, private businesses, civic groups and others, often working with people and organizations that do not have a history of working with in the past. Local officials are in a key position to convene these entities and develop the myriad players into a structure the player approach, putting their community. I want to thank everyone for being here today and i look forward to hearing what our expert panelists have to say. More importantly, my hope is that this report will serve as a helpful resource for local leaders like you as you work to address this challenge in your own communities. And i want to thank naco partnering with aoc in this important effort. Thank you very much. Pleasure to be here. As tim said, you really cant talk about Economic Development without talking about workforce and you cant talk workforce without talking about Substance Abuse, addiction, and the things that were confronted with. Counties are on the front line, and i think were going to have a great discussion today, talking about some solutions and some ideas and the results of the work thats taking place. So, to facilitate, moderate the first panel, im going to bring up hadi. Hadi is i say bring up, hes going to do it from there. He was the we worked very closely, he was the staff person with naco that really staffed the city county Opiate Task Force work and has been involved in this now for a number of years. Im going to turn it over to you. Thank you. Thank you, judge moore, and cochair thomas for your remarks and your leadership of this project throughout the last year. And it is my pleasure to introduce our panelists and to moderate this first conversation about county solutions and how county leaders throughout appalachia have stepped up to lead the charge in reversing the tide of the Opioid Epidemic. Before doing that, a couple of quick housekeeping items. We will hold off on q a until after the second panel and take all questions at once. And also, we are Live Streaming this event, as judge moore mentioned, so please make sure to wait for a microphone before speaking or asking questions so those following virtually can also hear you all. So, with that, its my pleasure to introduce two great appalachian county leaders who will help lead this first conversation. Commissioner puckett, who needs no introduction amongst the naco audience but is a native southern West Virginian who was elected as a Mercer County commissioner in november 2014. Alongside serving as the county commissioner he also serves as executive director of Community Connections, which is Mercer Countys Family Resource network where he continually reaches across county and state lines to help guide the prevention and Community Building process. Commissioner puckett has been a key partner with naco for a lot of our work around addressing opioids misuse and along with judge moore, i think, have been our really key champions in this effort over the last several years. His county is featured as a case study in the opioids in appalachia report, which naco published with naco and arc and which we have many copies of outside as well as on the naco and a. R. C. Websites, and he has also served on the naco nlc task force on the Opioid Epidemic. Representing the great state of pennsylvania, were glad to have commissioner snider, a Clinton County commissioner since january 2012. Commissioner snider currently serves as president of the county commissioner association of pennsylvania or ccap and he has five priorities as president. Behavioral health funding, solutions to the ems crisis, county property tax reform, Rural Broadband expansion and adult probation funding, and as our opening speakers commented, all of these issues are part of the discussion today. And lastly, prior to his election, commissioner snyder owned and operated the chatham run feed mill for 30 years and was a member of the Keystone Central School board for 20 years so please join me in welcoming our great panelists. And with that, our first question to both panelists is a broad one. Can you speak to how the Opioid Epidemic has affected your county and your state as a whole and why is it important for county leaders in particular to be on the front lines of your efforts . Commissioner puckett. Thank you, hadi. Before we begin, i want to thank cochair thomas as well, judge moore, matt chase and i certainly want to thank all of the amazing staff at naco. With any good organization, it all comes from the staff so i want to thank them as well for a Job Well Done in putting this together. For us, its really about everybody working together, and i think as long as youve got a Good Community collaboration, you can have great solutions. But without that, you also have just the opposite. So i think from our standpoint, working together with our local community coalition, working together with all of the different resources that we have in our communities, really what kind of sets us apart. We start off different programs, different objectives, but we try to be as diverse as possible. One of the things that i think weve been able to do is really focus on understanding where our statistics are, not being so good, but also trying to come at it from the other side and saying, okay, we understand where our overdoses are, we understand how bad the situation is, but yet weve started Quick Response teams that go in and address those overdoses individually. Weve also gone back into our School Systems and worked on prevention based programs, weve worked with our Law Enforcement to start l. E. A. D. And weve really tried to focus on getting into those hard to reach areas of our Rural Communities and do as much education as possible, even getting out into our local Convenience Stores to capture as many people as possible so again i think what chairman thomas had reached out to say was that its all about partnerships and i think partnerships exude from everywhere from the local level, state level and certainly up to the national level. Thank you for all being here today. Clinton county, pennsylvania, most people ask me where Clinton County is. Were between center county, which is penn state, which most people recognize, and little league, which most people recognize so were right in the middle. A population about 40,000 people. Pretty rural. We have one precinct where 12 people live, so to get Voting Machines there and get them to vote sometimes is a little bit difficult. The Opioid Crisis has hit our Community Just like it has everyone elses community. And we got on the ball real quick. Part of the problems with rural county is funding, so i want to thank our governor, tom wolf. He took this Opioid Epidemic very seriously. Got together and put out 110 million worth of grant money. So, its helping filter down. We have a local group called the. Ill come back to that. I am not an expert, ill tell you. We have a local drug and alcohol commission, west branch, thank you, west branch drug and alcohol commission. They are so vital. Unfortunately, most of the people that we deal with that have problems with Substance Abuse end up in our local prison. But you know, thats not always a bad thing, because 60 to 70 of the 567 individuals that went through the system last year also had Mental Illness issues, so while they were in our facility, not only did we get a chance to help them with the opioid issues, the Substance Abuse issues, and unfortunately its not always the opioids. We have a big problem in our county with alcohol. And unfortunately, were now seeing a swing away from the opioids to meth. Bath salts. And some things i cant even pronounce. Weve got to look at the whole picture, and weve got to Work Together with the teams that we have. Were very fortunate. Our courts, our president judge, has, under his umbrella, the probation department. We work with our probation department, our west branch drug and alcohol commission, children and youth. You know, one of the things that legislation that Governor Wolf passed that i thought was the saddest of all was for grandparents to have the ability to raise their grandchildren because the parents were incarcerated because of Substance Abuse. But we have put some really good teams together of all the entities, and thats why county government is so important, to bring the teams together, to get treatment for these individuals, whether its opioids, alcoholism, bath salts, but i spent a lot of time as an advocate with the children and youth because theyre our most important. Weve got to educate, and were doing that in our elementary schools. Weve got to educate and work harder on prevention. And then maybe we wont have so much trouble with the cure. Thank you, commissioner snyder, thats actually a perfect segue to the next question for commissioner puckett. Broadly speaker, we have broken down the roles for county leaders and so prevention and education and treatment and recovery and Economic Development and employment. Can you speak to that first piece, prevention and education and specifically how youve worked with youth and Mercer County to advance efforts. Sure. Well, first of all, i think one of the things that we have discovered as county elected officials is that we not only have an opportunity to lead, we have an obligation to lead, and in doing so, weve got to try to put all the different sectors together and part of the prevention strategy is working with our community coalition, which has 12 identified sectors. You work on certain strategies to try to make sure you change not only the individual but the environment to that individual. And i think thats one of the things that we can do more as county commissioners is that we focus on that environmental based strategy. We know that if we do a lot of education up front, we can reach the individual, and thats not a problem. We do all the health fairs, we can, you know, get out and do curriculum in the schools, thats fine. But in fact, its the environment that that individual lives in is whether that dictates their personality, and we know that without that good positive environment, we are not going to be able to change the society. We may be able to change an individual but we cannot change the entire community. So we focus a lot of different ways. We focus on not only the programming but we focus on what other policies that we need within our communities. We look at the data. We decide, okay, what are our alcohol policies, tobacco policies, where are we reaching out to our young people and saying, how can we get them to effective opportunities for not only them but their families. You know, if youve got a society of addiction, how do you change that addiction so that everybody benefits . And again, Economic Development, everything goes along the same way. Former one of our congressional members, evan jenkins, our former congressman had once said, you can change a loft social ills by a good job and thats very true. A good job can change a lot but unfortunately we have to provide the environment where those jobs can effectively come in, especially into Rural Communities so youve got to be able to do both simultaneously. You cant do one before the other. Youve got to do both at the same time and i think one of the things were doing in prevention is really looking on that community and doing those assessments and is saying, okay, are we having good access to treatment . Are we having good access to anything . Is it grocery scores . Where are we going to get our young people to where they can have a good quality source of life and so those types of issues that were working on are extremely important. I also think part of that prevention side is really focusing on if you have people in active addiction, how do you get them the treatment and the help that they need . Within the state of West Virginia in the last three, four years weve had a Great Program calls help and hope wv. That is a website that we can go to, all the resources throughout the state, not just in my community. We also have a website called stigma free wv and as cochairman thomas alluded to, we have to destigmatize the issues around addiction. We dont have a drug problem. We have an addiction problem so we have to focus on addiction as a whole. And if we can do that collectively as our communities, were going to have a way to solve the problems. Thank you. Thank you, commissioner puckett, and commissioner snyder, again, kind of picking up on where commissioner puckett left off, arc certainly is a great leader on the issues of Economic Development in appalachia and connecting folks to jobs and part of any longterm solution to addressing opioid misuse is ensuring that residents in recovery have those employment opportunities. Can you speak to your work in Clinton County about jobs and housing opportunities for residents in recovery and what has proven most effective . Yes. If only it were that easy. Many fires sometimes have to be put out before you get to that point of housing and jobs. Those who are not in the system that we are trying to help, they have babysitting issues, transportation issues, rent, bills, so we have to find ways to help them get past that. There are they are out there wondering where they start. We have worked partnerships with businesses in our communities that will hire these individuals. We and if its a housing problem, we do through our Housing Authority have places that we can find rent, affordable rent, for them, and one of the things that we worked very hard in our county is we did not have Public Transportation until just a year little over a year ago. That has helped us tremendously. But if the person who needs the treatment doesnt have that babysitter, doesnt have the support of the family, so theres a program that the commission started and its called being a loving mirror, and its a oneyear comprehensive webbased curriculum designed to bring families hope and to help them regain their peace and calm despite whats going on around them. It also teaches participants how to contribute to being their loved ones best chance at recovery. Research shows when a family gets well, and stays well, the loved ones have a better chance of getting and staying well and one of the components of the comprehensive program is a 12 principles which are taught through 12 weeks, facetoface class, family recovery coaches, certified, are there to facilitate the course. The course has been held in both counties and its been very successful. Jobs, housing opportunities, theyre so critical to this conversation. How have yall been tackling that in Mercer County . As with any community, its a challenge but one of the things weve tried to do is reach out to our local Housing Authority so we understand how to get in and not only to get the people adequate housing but try to educate them on the hazards associated with addiction within those particular properties. A lot of times when youre dealing with the Housing Authority youre dealing with a lower income population and they may not have had the opportunities to understand the addictive world and so we try to get in and educate them as much as possible. Again, getting and changing the local environmenting local environment, looking at policies and making sure that whatever we can do to help send those protections we try to do that the best. When youre looking at the jobs, it kind of comes into understanding of how broad you can get in an economy like ours which unfortunately in southern West Virginia, if anybodys been to the great state of West Virginia, we dont have a lot of zoning. We dont have a lot of things that are really active and needed within communities. And unfortunately, a lot of times, thats not seen as something that our community wants. Although we understand that its something that we desperately need. So as we look forward as communities, as coalitions, as commissioners, we need to look at policies and whatever we can do to not only protect our communities but give our businesses opportunities to thrive in those communities as well. Zoning is a perfect example. If youve got a trailer park next to a Million Dollar Housing Development and youve got other things where businesses around major metropolitan areas and you dont have zoning, its very difficult to protect those businesses. So, we have to go at it from a protection standpoint, not a punitive standpoint so i think thats one of the things that were working on certainly over the next few years, thats what im going to be working on. Thank you, commissioner puckett. A word that came up, i think, in both of our introductory remarks and some of your comments is stigma. And in the report that we published with arc, we spoke about the role of county officials as local leaders who are able to chip away at that stigma in ways that facilitates recovery for folks in the community. Can you all speak to how you have used your position as elected commissioners to help chip away at that stigma . In our county, we have three courts now. We have a Treatment Court. We have a va Treatment Court and the most recent is a Behavioral Court that deals mostly with Mental Illness. These courts are structured so that these individuals have structure and they need structure. And the judge, judge salisbury, in the beginning, was not an advocate, really, of the first court that we formed with the Treatment Court. He really was one of those judges, and hell tell you this, who thought that there really was not a lot of hope. But you ought to hear him talk today. And im smiling because i really like what judge salisbury has done for this program. He works them through. They have wristbands that are different colors that they work through, and the thing that he says to them every time that they show up in court is, they have to tell what theyve been doing and they cannot lie. No matter what. Even if they went backwards, they cannot lie because if someone does not have selfvalue, what do they have . And he makes them feel like they should feel as a human being through what he does through his Treatment Courts. And his success rate has been phenomenal. We are turning these individuals back into productive citizens and im very proud of what Clinton County is doing through our Treatment Courts. I agree, and the thing is, when youre talking about stigma, it goes back to my earlier comment that we have to treat addiction as a brain disease and not necessarily as a cultural failing. And so as long as we can understand that and we can try to educate our Community Better on that, we have a greater opportunity to overcome the problems associated with a stigma. Several programs that were working on, one of the programs were very unique and very blessed to have the program called camp mariposa and theres only 13 camps nationwide. Mercer county is very blessed to have one. Its children age 9 to 12 that are understanding and dealing with addiction in their lives. And it doesnt necessarily have to be them or their parents. It could be a relative. It could be just a family friend but its allowing these young people to come forward and understand that its not their problem. That its the cultural problem that theyre living in and how to overcome and be resilient to those particular issues. That program is working very well for us and were constantly trying to perpetuate that into sort of a new generation of understanding addiction and moving forward. The other thing that weve been trying to do is theres a program that was actually allotted by naco a couple years ago called keep mercer clean. We know if a Community Looks a certain way, it will feel a certain way and it will act a certain way and so one of the things that we were doing is getting a volunteerbased program where we can get people from march 30th to april im sorry march 20th through april 30th to come out and clean up their community. And they can take ownership of that community. The only way that the community will change is with that ownership. And so, by having them volunteer to clean up the highways, you know, clean up their own properties, and really feel a sense of pride and hope, we talked about hope earlier, to feel that pride and hope back in their communities, thats what will make a community change. Thank you, commissioner puckett. Next question, looking towards the future, what are you all as appalachian county leaders need to strengthen your communities and prepare them for future growth and development . Tough one because it never stops moving. As i said earlier, were not just dealing with the Opioid Crisis now. These synthetic drugs, its ever changing. So, you know what . I guess the best thing we can do is stay flexible, keep in mind what the end goal is, and keep working with the partnerships that we have and never give up. I dont know what else to say about that, because its ever changing and we have to be flexible enough to change with it and try, if we can, to stay one step ahead of it. And the only way to do that is there are a lot of people that i work with that are a lot smarter than me and i tell them that every day. We need to keep working together to help these individuals get back on the path but i am absolutely committed, 20 years on the school board, im still recovering from that, but 20 years on the school board, its an education. Thats where i truly believe it lies is in education and the sooner we can get into those schools, and we have a new superintendent that were working with and shes absolutely fantastic, the sooner we can get into those schools, the earliest stages we can, thats where it is. I truly believe that. I concur and i would also like to say that, you know, over the last two administrations, we have seen a dramatic shift. We know that this problem did not start ten years ago. It started 23, 24 years ago. And when it first came into West Virginia, we didnt know how to deal with the problem. Thankfully, through Funding Resources over the last 6 to 8 years weve seen a shift where we can get into that education and work on those policies that really help protect our communities the most. Theres four basic things that we can do. Work on prevention. Prevention is going to be the key and that means Early Education as you alluded to as well as the policy development and working forward. The second thing we need, we need to have adequate treatment. If we cannot get people who are in active addiction now into treatment, we are not going to be able to solve the problems and in treatment thats in a good environment. If you do treatment and you put somebody back out into the same environment, that person will relapse and it will be the same desired result. Its going to happen. The third thing is research. Really focusing on the data within the particular community. Know what your data is, know where the problems are and know how to fix them. Know where your overdoses are handling, where theyre out in your community. And start looking at it and putting resources into those communities to start pushing that down. Law enforcement should be where your overdoses are the highest. Thats the only way youre going to stop that particular problem. And the last thing is going to be hope. If you cant, as an elected official, provide homepe to your community, you dont need to be an elected official. You need to make sure your Community Knows that you care, youre out there and working as hard as you can to solve this problem. Thank you both. My last question, i think, you all have covered somewhat but would love to hear your further thoughts. One of the things that i remember being discussed in our original Opioid Task Force was that even if a Community Feels now that they are avoiding an epidemic of opioids or whatever type of addiction it might be, it can really hit any community at any time, so what is your message for county leaders in and outside of appalachia who may not have dealt with an epidemic of Substance Use and addiction as they look forward . I think youve got to look not only what you have now in terms of that addiction but whats coming. And i think if you look at especially appalachia, the next wave of problem is going to be the hiv epidemic. And all the other problems associated with hepatitis c and the Public Health crisis that were going to have following the Opioid Crisis. In my state alone, we have 28 communities out of 220 that have been identified by the cdc that are at risk for an hiv outbreak. One of those is mine. Were not testing enough. Were not getting out there ahead of this in a Public Health crisis enough, and so i think to the administration, to state officials and everybody else in between, focus on whats coming and not necessarily what is. Were dealing with the opioids but were shifting to meth, heroin problem, the needle problem and with that comes the Public Health crisis. So being aware of that, knowing whats coming and how to deal with it. One of the benefits, if you want to look at a benefit of the Opioid Crisis, is what happened in our community is the fact that all of the different entities that now have naloxone. How i feel about naloxone is this. I dont think its the end all. It gives someone a Second Chance but weve got to move past that. But what has happened is all of these agencies, police, schools, we have it in our county buildings, have come together to be prepared for an event if it happens there. So, theyre training, theyre communicating, theyre collaborating, those are some of the words i used when i was running for reelection, by the way. But you know, thats what its all about. People in your Community Working together and that is one of the benefits if there is any benefit to the Opioid Crisis is that people have come together as a community. Theres one more thing i want to tell you that weve done in our county that im proud of because people in recovery need support, and i really want to mention this. We have theyre called crss. Theyre certified recovery specialists. And they are individuals in a longterm recovery from a Substance Abuse who are trained to provide peer support. And i know commissioner puckett talked about it. You really need to support these individuals, and some of that support with this question comes from the community. Get behind each other and support each other. It goes a long way. Ill tell you an interesting story along that. He mentioned naloxone and hes 100 right but we have to teach our community to not be scared. This is something that we can deal with and we can Work Together in our communities to fix this problem. Its not something thats insurmountable. One of the things that we had in any community is we started doing naloxone distribution on a broad based level and started reaching out to our ems personnel, if youre dealing with this, youre an ems personnel, doesnt matter if youre trained or not, if youre dealing with addiction, youre ems. I will tell you that one of our major communities said absolutely not, we do not want naloxone in our cars. We are not going to have it. Were not carrying naloxone. Were just not going to do it. After about a year of coercing and really talking about the issues and really talking about the need for it, and selling it from the standpoint of, hey, this could help an officer. This could help your drug dog, all these other people, please carry it in your cars, just have it. It wasnt about a month later and all of a sudden i got a text from our city manager in bluefield that said, hey, your naloxone just saved one of our officers. He had pulled over somebody, had exposure to a particular substance, and had gone into cardiac arrest. Naloxone that was in his car at that moment saved his life. I got a call from the city chief. He also said, hey, sorry we didnt listen sooner. Weve got to be more diligent on that. Weve got to be open and if theres a solution in our communities, be open to understanding it. Commissioner snyder, any closing thoughts . I make myself available to the community. I put my cards everywhere, with my cell phone number on. I want to get to a christmas when i dont get a phone call from a grandparent. Thats where i want to get. I think as commissioners, certainly you exude that well, you tearing up is not helping me right now. I think youve got to care. I think youve got to be in those communities. You cant be disconnected from this problem. Like any other problem, but this one in particular, you have to care. Youve got to be able to get in, youve got to get dirty and you got to go solve the problem. There are resources there. The federal government is putting a lot of money out there. Naco, arc, theyre providing resources, theyre providing education. Understand where you can get it. Find those resources. And make it available in your community. Thank you both for your remarks and lessons and your passion and for exhibiting why its such an honor for us to work with county officials here at naco. Please help me give a round of applause to commissioner puckett and commissioner snyder. Before we move to our next panel, just want to, again, remind you all that the report that is a culmination of our partnership with the Appalachian Regional commission is on the naco website. Encourage you all to read it and also here at naco we make ourselves available to all county leaders, appalachian or not. You can always reach out to us at research naco. Org and our resources are available to you. So, as a reminder, well wait to take questions until after our Second Panel Discussion. So, it is now my pleasure to turn it over to andrew howard, a. R. C. s chief of staff, and our close partner in leading this project over the last year, and andrew will moderate our Second Panel Discussion and the q a time following it. So, lets give him and our panelists a round of applause. I hadnt planned on giving any opening remarks so ill go ahead and ask our panelists to go ahead and come to the stage and well jump right in. Thank you, hadi, for that introduction and i want to thank everyone again for coming out today, again, to introduce myself, my name is andrew howard. I serve as chief of staff to the federal cochair at the Appalachian Regional commission, and i have been fortunate enough to work on some of these issues in the past and you know, being a being from Eastern Kentucky and seeing the impact, it really is rewarding to be up here with these gentlemen and having this important conversation. So, thank you all again for being here today. And without further ado, were here today for our second panel to talk about beyond opioids, fortifying communities to sustain future growth. So really looking at looking to the future and i think commissioner puckett and commissioner snyder really did a good job of leaving off on that conversation, but looking towards the future of some things that we need to be thinking about, you know, from federal state level but also as local communities to address this issue, which is why im really honored to have joining us today two individuals who work very closely with our local communities to ensure to address the challenges that are presented to them and obviously Substance Abuse is one of those significant challenges. We have jim mccleskey, who serves as director of the North Carolina washington office. In this role, he serves as he works and collaborates with various federal entities on behalf of the state of North Carolina and local communities in North Carolina, and he also serves as governor coopers a. R. C. Representative on the commission as well. And then directly to my right, we have david connor, who serves as executive director with the Tennessee County Services association, so gentlemen, thank you all for joining us again, and well go ahead and jump right into it. But to just go ahead and set the table, if yall dont mind, talk a little bit more about your role in your respective states and then also what you see as the root causes of the epidemic that local leaders should be thinking about moving forward. Sure thing. Is this on . There we go. First of all, thanks to naco and thanks to tim and to the arc team for bringing us together today and for the work that this report represents. I am a child of the Appalachian Mountains on both sides of my family. Going back, honestly, to the days before North Carolina was a state. Ive come to know, through work that other relatives have done, how deep those roots run. Ive been honored to serve a succession of governors and am presently the longestserving alternate to the arc and its a an entity near and dear to my heart. We call ourselves the arc family. That means we know each other well and like each other anyway. And i want to affirm that to my friend, tim thomas. Tim has taken this issue on in a really profound way, and im going to say that its so far showing some promise and well get to results a little later, mr. Cochairman, because were not there yet and i think thats the spirit of this event today too. I appreciate that this is a capstone, but we are all in the middle of this crisis. And we are all looking for things that matter and make a difference and give us all some hope. I really appreciate our leaderscomments here today, deeply. When i was coming through my dads a retired now methodist preacher and in the Methodist Church your preacher is like your governor. If you dont like him, just wait a while, youll get a different one. But one of the churches that daddy served, and it was when i was in high school, in Wilkes County, North Carolina, the great state of wilkes, wilkes by god county and this was 40 years ago, yall, and i would say were a little deeper into this crisis than 20 or 30 years. 40 years ago, in Wilkes County, manufacturing was strong. Mirrors, furniture, and textiles to a degree. Certainly agriculture. But manufacturing was strong. Northwestern bank was headquartered in Wilkes County. We had some strong holly farms chicken in Wilkes County. Strong employers, gave folks a place to go out of high school. When i was at wilkes central high school, folks wanted to get out, get a car, get married, get a job, probably in that order. Or close to it. And the issues then i said this when tim mentioned these listening sessions and tim thomas is a listener, and this listening tour that we put together, the second of the succession of them was in wilkes so i was able to be back there this past winter, going on a year ago now, and it struck me then and ive been back since for some other reasons and heard the chairman of our commission in wilkes talk about what was different 40 years ago. He was really talking in the Economic Development realm, but these things all relate. Jobs were strong, folks had a place to go. The issues then, as i recall them, we were probably still are but always been a moonshine county, grew and smoked a lot of pot. Kids were eating quaaludes. And there was some cocaine arounds. This was in the late70s, early80s. And those were serious, but it was different. And so, when we talk about root causes, i think weve done some work that a. R. C. Has helped to finance with significant foundation support around the diseases of despair, but these chemicals are different, and as you all know better than me, im no expert either, commissioner, but these change your brain. And they change how you process and work on things, and you get sick if you dont get these drugs again. So, to maintain yourself, to try to go to work, you may be looking for getting high. Its not necessarily to lay out of work. It may be to keep your life functional. Right . That is a wicked problem. The director of our Wilkes County Health Department at our listening session described this as a wicked problem and its because of all the ways that it changes how folks can approach their lives and really have to approach their lives. So root causes. We need Northwestern Bank is gone. Holly farms is tysons but its smaller than it was, and lowes was there. I didnt mention lowes. Lowes is not headquartered in Wilkes County anymore. It started as an employeeowned one of the early Employee Stock ownership plans was Lowes Hardware in Wilkes County. Theyre not there anymore. And the furniture and the mirror plants are gone. So, its just a very different place to think about raising a family, making a living, and having stuff to do that makes your life meaningful. And good folks are working hard on that right now. I dont sell any of it short. But that pattern is all over the region were talking about. And so, jobs and hope and a sense of purpose and connectivity are crucial as pieces and the absence of those as pieces of root cause, but tree and so the governor was on the president s commission on opioids that did its work in 2017, and into early 2018. And we heard really powerful testimony and presentations from a range of different perspectives in that process. But the the medical communitys decision to treat pain as a disease that had to be fixed combined with the chemical the biochemistry of opiates, opioids, and i know our friends and colleagues are upstairs talking about next steps and what the third branch has to say about this whole phenomenon right now, and the lawsuits that are going on, but the fact that the companies were marketing the way they were and at the volumes they were into the communities where it was just completely out of whack. I mean, theres your root causes. And here we all are. There is your root causes. We are behind it and we are trying to catch up. I was on the phone earlier today but root causes are that complex of issues and drug use has always been related to meaning and purpose and something to do but the chemistry of how this affects and changes the way it can function is a deep cause and is why it is a lifetime enterprise. I want to take a moment and say lets all take a moment and think about folks we know, faces of friends we know who are struggling with pain and loss without this right now but lets remember the heroes who are getting up and trying to stay clean every day right now and come back to that. A dear friend of mine of many years lost her brother on Christmas Day so it is live and i dont pretend to have answers but appreciate that we are all here together to try to figure out how to Work Together to make a difference and bring our communities forward. Im humbled to be part of this. I get the privilege of working with folks like commissioner steiner and commissioner puckett who are trying to help keep kids off of drugs into all kinds of things. In some ways i get to sit back a level removed from that advocate a 30,000 foot view and so many county officials have their heads down and are working as hard as they can. They didnt realize it was part of the National Impact based on what is happening in my community. As we began hearing about this we tried to do what we could through our association, meetings and Educational Programs to know this is going on, you are not the only place, let them share their best ideas with each other. So many comments have taken all my notes but a couple things commissioner puckett and snyder spoke about earlier, its not an opioid problem because in tennessee we had something call the task force that was going on overnight and now it is the Dangerous Drugs Task force picketed had to morph in dealing with things like sentinel, these chemicals, it is like three grains of salt to kill a 200 pound man. It is different, so easier for people to overdose but the communities are dealing with addiction one way or another. I will give two examples of things i heard from county officials, the first is a bad one in the second is a good one. When i first started working with associations i talked to one of our county mayors and having a general discussion about the association, what can we do for you all and somehow tried to turn around what is happening in your county, what are the Biggest Challenges in your county and the problems you are facing. He was notoriously blunt and straight to the deck and said the biggest problem our county has is the people who live here and my first thought was and you got elected, that is your campaign slogan, did not get elected the next cycle but as i tried to tease that out he started talking a about it and said we had employers who were leaving, employers we try to get to expand and recruit industry and they are telling me all they want is somebody who can show up on time and pass a drug test. He said we cant get two of those three. He was frustrated with it. So what is going on . We got this addiction level. If you look at Mental Health issues in rural areas, as far as depression and all that it is not any different than it is in urban areas but we are seeing high levels of addiction, higher levels of suicide, a lot of different problems. We will get into more of this later on, one of the things, i dont know that there is not true opportunity there but i think there is a perception that there may not be opportunity. Mako did a lot of work on economic recovery and how we got two economies and in some places it took off and others are still stuck where they were and we had some counties in tennessee at the depth of the economy that had more than 25 unemployment, really got hammered and took them forever to come back from that. There are opportunities and i think they saw themselves falling behind when everybody else was recovering, they saw the Information Age and are still dealing with dialup and cant get broadband. How do we go there so they have to have different strategies but a more positive county official who had a passion for his Community Like these folks do one time talked to me and said local politics is really easy in a rural area, people want two things, they want to be able to raise their kids in a safe environment and they want their kids to stay there and raise their kids in the same environment. That has strengths and weaknesses because in some ways you have parents of kids with a lot of talent and ability and they are scared of education, of going off to college and getting a good job because they think they cant get it here and they wont come back home. They think in Rural Communities their strength is their weakness. They are a small closeknit community, that can be a wonderful strength but there is a fear, they dont want to lose their kids, dont want grandkids raised somewhere else but there are opportunities they can make those communities flourish and stay home and take different strategies and they do tremendous work on Economic Development. Something is happening that is causing people to turn to addiction. We have moonshine in tennessee too. We will talk about that. There has been myth and all the things you mentioned before in those communities and they morph and change. Why do people not think like they have other solutions and are turning to something. I think one of the Silver Linings of the Opioid Crisis is it didnt discriminate. Its not a drug problem that was in that community or that group of people. It is an addiction problem, the farmer who fell off his tractor had back issues and start on prescription pain medication and cant get off of it or an onthejob industry, a College Athlete dealing with aches and pains and people started on things they trusted doctors and pharmacists to say this will help you with your pain and then they are addicted. So it hit across racial lines, socioeconomic lines and Everything Else. It has begun to change peoples attitudes towards addiction and i see that in our own membership, we used to get people saying they want to claim they are an addict and making bad choices. If they straighten up and turn around they will be okay. Now most Everybody Knows somebody struggling with addiction so it has caused us to develop new compassion we didnt have before, new understanding slowly chipping away at the stigma you all mentioned that is a crucial part of this. Thank you for that. Director mccleskey, aoc is primarily an economic developed agency. From your perspective how is the Substance Abuse crisis impacting efforts in North Carolina to strengthen Economic Opportunity at the local level land what are some steps local leaders should think about taking to build economically resilient communities in the context of addressing this crisis . Those are really important questions for the reasons you just stated, that this is insidious and persistent for folks and hard to come back from when they have followed Doctors Orders and things change and availability changes and what was legal becomes something you have to find otherwise and if it has fentanyl in it you could be dead. It is frightening. I dont have a nice answer to this question. I did some thinking about it before coming in advance. One thing that is happening that you touched on is a shift in attitudes around the disease of addiction and polysubstance as was the term the secretary of hhs will be testifying here next week on this question with a panel of state in front of the Energy Commerce committee on what are you using federal money on and what works and what do you need to be focusing on . That question and i know why we are asking it is what we are all struggling with. If part of the answer as we believe it is is meaningful jobs and we are in a region designated as a region of special attention by the federal government because of the need for meaningful jobs and this is layered on top of it, it becomes the central question into tims credit he has challenged the commission and successfully gone to the congress, he didnt tell you this. I will give you a little bit of tomorrows news today. The congress in the recent appropriations package endorsed the Commission Getting much more active in the opioid space from a recovery perspective and we have some decisions to make about what that will mean and how it may work. Watch the space because we will shortly as a commission be taking up some proposals around making funding available for Creative Ideas from the field around a recovery ecosystem and i encourage you to go to the website and look at the report the commission accepted from our task force at our september meeting and the recommendations of this panel, a variety of experts all around what the recovery ecosystem might look like because it is about how we help folks to get and stay employed while in a Recovery Scenario that is a lifetime scenario and so part of what it means, another website reference, our North Carolina plan, i commend to your review and contemplation, includes recommendations on what local officials can do and think about, employment supports are a big piece of that so things the cost a lot of money and arc doesnt have a lot of money, transportation a drivers license is a plural and we dont say yall, we say unions. The question people want to know is did you get them . You can use them too. A lot of folks who have been and are in the Recovery Community might not have their drivers license. Theyve got to get to work and home too and today care and the store so that is an interesting conundrum that we will see some ideas coming our way around what does supportive transportation look like and can we, should we help, to what degree, everything has to be other peoples money too. What about housing . What about Supportive Housing that puts folks back right where they have been and helps them stay in a Supportive Community intentionally and expertly. Those are workforce issues and it is where arc should be spending time but we dont know what we are going to do. We are going to figure it out with you. We need ideas from the field and arc cant be private, we fund public and nonprofit and we love when it is public and nonprofit together so watch this space. Did i go too far, mister chairman . All right. Do you have anything to add . I love the term recovery ecosystem. I do think that is critical in getting ready for this i was doing a Little Research and looking at some issues and one thing i will take a moment for quickly is add the stigma thing. I dont have an addiction problem but i have Mental Health issues, take medication and spent a significant time seeing a counselor but i lived in the state capital. Im in an urban area, i have good health insurance. It is easy for me to get to places. I needed to go to a counseling appointment over lunch it was a simple thing to do. If you are living in a rural area, lost your job, maybe lost your license, you dont have a car either so youre stuck having to ask somebody for assistance but trying to stay clean and sober but it might mean you need somebody to drive you 90 minutes to another town to see a counselor if you cant figure out Something Else. That is the ecosystem we talked about him we dont have a broadband out there. We dont realize we are missing a Mental Health infrastructure. Looking at some data on rural Mental Health issues and addiction issues they estimate more than 90 of all psychiatrist and psychologist licensed to practice are located in urban areas and social work is over 80 . They are not out there. It is almost like we need, sometimes we try to encourage teachers to teach in Rural Communities or get a chemistry teacher out there, a french teacher, whoever we have difficulty recruiting we might need some help recruiting those Mental Health practitioners in the communities that dont have it but that is part of the reason why the addiction problem in suicide problem and other things have worse outcomes in Rural Communities, because they cant get the resources for treatment. Telemedicine can play a role in that. It is interesting looking at some strategies around that but a lot of times they say if you can get that try to integrate it with normal Family Practice in a setting because i could take off lunch and drive to my Counselors Office and not run into anybody i know but in a Rural Community it may be if im going to see my therapist people will see my truck parked out front and know what is going on and say what is happening with joe so there are some issues, stigma not only around addiction but also around seeking Mental Health treatment we need to break through. That is part of this culture employers have to be ready to take on as well but we cant expect them to do that on their own. It needs to be Community Support providing that ecosystem because Something Else has occurred to me. I have friends in their 60s, they are recovering alcoholics, both have been sober a long time. The husband had some Health Issues this past year and a number of things kicked in and after 15 years of sobriety he had a relapse over the christmas holiday, had to go the residential treatment. This is a long haul issue, not just run through a 90 day program and get out there and they will be fine. We have to recognize these problems they have been burdened with, Wicked Problems that hit and changed the way their brains work, they have to struggle the rest of their lives. The thought that brings back to me that occurred when you were speaking a moment ago, we all somebody will show up on time and pass a drug test. What about employers who are willing to hire people who arent clean . People who use drugs, one of the acronyms in the state action plan, we had a panelist, wilkes is a big enough county, he was a couple years after me in high school, and he was a businessman in town and operate a restaurant, he is in recovery and he makes a point to hire folks who are trying to make it. Not everybody can do that. Somebody took a tour visiting some hightech operations and they have a very different attitude on Substance Abuse and so none of this is mandatory. It has to be coalition of the willing and somebody in business to do business but i do believe this evolution of attitude around these are just good folks who need to be able to be good folks for all of our sake. And what does that mean, trying to provide the kind of ecosystem that can support it over the longterm is the challenge of our time. Thank you both for that. I could spend the entire time talking about that issue and im sure you could too but we will move on real quick. Mister connor, in addition to the Economic Impact and economic issues, health and Justice System costs are often two issues of significant concern for local leaders so how can addressing issues in health and Justice Systems strengthen appalachian communities and help to address the root causes of Substance Abuse . More and more wearying the linkage between criminal justice and health. We started earlier hearing about that with Mental Health, probably everybody in this room has heard someone say our jails and correctional facilities have become the largest Mental Health facilities by default. I have an interesting story, this doesnt come from an appalachian county but the sheriff tells a story about how a couple years ago in the middle of the afternoon on a workday the National International airport a man in his 40s walked in stark naked. What do you do, somebody calls the cops, they arrest the guy, figure out something to charge him with, he goes to the county jail, they are holding him there, they do a drug screening, he has no alcohol in his system, no drugs in his system, typically you dont think of fouryearold man is going to walk into an airport stark naked is mentally ill but the responses we have had our thats messed up, call the cops. Even in a place Like National Davidson County with all kinds of services, Rural Community is even harder and we have a lot of efforts going on, crisis intervention training with Law Enforcement to try to sort out or are we dealing with recovery or Mental Health or Something Else but when you talk to Law Enforcement and Rural Communities their frustration is that is great, you can help me identify this isnt so much a criminal justice issue as a Mental Health issue and then what do i do with it . Where do i take them and that is where i have to get the good integrated communication between Service Communities that have not crossed lines before, crisis stabilization units and Law Enforcement, that is a partnership we need to forge because if they are starting off with that and maybe they have committed criminal behavior as a result of these Mental Health issues and addiction issues. Putting them in jail will worsen whatever issue they have. In some cases they may be dangerous and that the best place to happen and others we are creating a worse problem by locking them up. That the difficult piece of the puzzle to sort out and determine where we go on that and im glad its not a choice i have to be making but our jails are dealing with that. I had county mayors talk to me before, not only is our jail growing, not only is it overcrowded but when people show up at the front door they are in worse shape, so strung out and so high they dont know what is going on and the other issue is a lot of them are women and we werent equipped to deal with that analysis city, both from segregation, if you want to jail you did not plan on having an entire wing of cells for women but in many of our counties it is the Fastest Growing population of the jail. We have to reconfigure the structure, to make sure they keep genders safe and secure from each other but with female prisoners often comes the fact that they were probably the primary caregiver for children and having a lot of grandparenting communities that are raising a secondgeneration because mom is in prison or in jail so those changes have been a huge burden on the criminal Justice System, tennessee has been bad about incarcerating a lot of women on drug offenses, position type offenses because studies have shown many times women who have addiction and are caught up in criminal behavior probably have been victimized or Something Like that so were taking somebody who may be getting high because they are trying to get over the fact that been raped and abused and whatever else and we have locked them up and taken away from their children, unintentionally we are creating generational repeating patterns that are really difficult and require shifting in pretrial, Law Enforcement training or correctional training. There is a lot of work around Adverse Childhood Experiences in the juvenile space and Law Enforcement understanding what these kids have gone through is a big indication of what is happening. Getting tough on a kid who has grown up with physical, emotional or sexual abuse isnt going to work. There are so many different places, on the criminal justice side and the house side they are trying to figure out how to redo that at work with those populations but it is a tremendous challenge that takes a big coordinated effort from a lot of players. A yogi berra story. Some years ago before i joined the state i worked in dc as a local Government Advocate for counties and cities, trying to fix what two of them are for. I was walking somewhere in the fellow who worked in the Bush White House who had been a local official on long island and new york in a governmental office, i said weve got mayor smith coming to town next week, he said bring him. It is good to meet and gives people a chance to talk and that was either trite or brilliant. I appreciate more and more that the power of an elected official leadership body is the power to convene, to bring people together to talk about things and it plays out in so many ways. At these listening sessions we had folks from hours away in North Carolina, there were people minutes apart who didnt know each other and are working on the same stuff and that is not anybodys fault, that is the world we live in and so you are not just running for reelection when you talk about getting people to talk to each other, nothing happens if they dont. It is easy for me to say and i deeply respect and admire and thank you for taking on public leadership and sticking with it but bringing people together, we had a protosession in Madison County before we started the official session with tim in North Carolina and we decided to have an opioid conversation and it was folks know each other but they have a pretty strong perspective from the courts, they dont have the drug court per se but the das office is woke, is that what we say . The sheriff was terrific, this guy is bigger than me. He needs places to take folks besides the jail because he knows once they are there it wont go so well in their need to be other alternatives, their Health Director is a pistol. But theyve got to get together regularly and it is all about dealing with cases and being present on an ongoing basis because folks struggle with the long circle i of what this complex of issues brings. Following up on that question have you seen any best practice approaches in tennessee to address or mitigate those issues when it comes to the Justice System . We are hearing a lot of stories. That is what is really rewarding, seeing our community, we worked on some things and are able to get a little grant money to encourage counties to start reentry programs, we have been doing that for a while and it is those Law Enforcement guys from burlington county, one of the most rural places you can get, we talk about programs the Sheriffs Office is doing and 70 other counties, if they can do that with the resources theyve got we should be doing this but we have seen quite a few counties doing reentry programs, they almost always have recovery because most folks are dealing with something. We had some counties that specialized on programs for women inmates to manage that population but those tended to be successful, one of the most encouraging things to me is counties, heard quite a lot from people with different counties on reentry programs that said we have yet to go into a community where there was not a business ready to be a willing partner because either somebody in the business, maybe they come out of the Recovery Community or it may just be people believe in Second Chances and redemption and all of that and they say to some of those folks you may have a person screw up every now and then but when they dont or even when they do, you will get one of the best employees you ever had because you are willing to reach out and that was very encouraging people on the Law Enforcement side saying can we get a reentry program, who do we want to work with as an employer. Some of that is back to the fact that they are struggling to find people who are out that can pass a drug test and show up to work so it is like if you put them through a rigorous program i know they havent been on anything the last nine months so i will take a chance on them. One other thing. Elaboration and focus goes a long way. Out in the real world. A little bit of money can go a long way in getting folks attention and get them around the table and it has been striking to me. We are five years and with the irc on the Power Initiative and they helped us on that. Partnerships for opportunity, workforce and revitalization it is about economic diversification. Especially in this last year the quality and range of proposals in power that have come forward focused on Substance Abuse recovery and return to work. The continuing relationship of that and the little bit of money that we can put in some places to hopefully afford local leaders and spark plugs who want to lead, who want to make a difference and want to stay home doing it, stay in that county, hopefully we will be in a position to help. My made a message is back where we started, we are in this together and we are not leaving. And we appreciate being with you today. Followup comment on that. I give a lot of credit to elected officials, county commissioners out there who have been taking a lead on this because everybody is pissed off how much we are spending on jail and if you say we are going to start new programs and invest some money to get more treatment for those people you were mad at and that is why they are locked up is tough. It sometimes takes keeping the faith for a few years to see it pay off but they start telling stories of those graduations from those programs were people are landing in jobs and turn their lives around and the tears of joy and Everything Else when people are united with kids and families is really worthwhile and is the right thing to do, really hard thing to do and we have been trying to work on gathering data about ways to make it easier if your county is making that step, youre not crazy, heres 20 others that are doing it in the state, some of the outcomes they have headed people graduating that program and how much it reduce the recidivism rate, how much to pay off the court fees and how to get them in housing and save up some money as they go through the return to work program. It definitely takes courage on behalf of a lot of elected officials and you mentioned getting a lot of people talking around this, having the right advocates in the community and sometimes the Faithbased Community may be critical to get them involved in advocating for this being the right thing for our community to do. This wasnt planned but feeding off of what both of you talked about about engaging employers, do you have any suggestions or recommendations for how local leaders should engage with or talk to local employers about this issue when it comes to getting people, plugging people who are in recovery who have overcome this crisis back into the workforce . Something i thought of when you were discussing this earlier. We found out it is very underutilized, our state has a felon bonding program. If youre an employer and hired a felon who recently left prison and has come into your employment you can get a bond paid for by the state that helps cover any potential liability as a result of some malfeasance by that employee. There is a federal tax credit for hiring recently convicted felons are one of the classes of people that can be hired, returned veterans, all sorts of people but i do think we need to be aware of things like that and help promote programs like that in places where you may have reluctant, even an employer who is willing to take the risk, make sure they are getting all the credit and protection they can. There are some programs out there and that may be something we need to expand and maybe we dont need to link it strictly to convictions that go to the point of can you get a tax credit for hiring somebody in recovery. That is interesting. Just a couple things i will mention and these are earlystage in North Carolina, in a few counties, we are open to growing them to other places as resources are available and i learned about some of this today and do not know it chapter and verse, housing, Supportive Services to give an employer some sense that there are other folks in this that are going to help an individual stick with it and i dont know if that is datadriven but it stands to reason from my perspective. A couple things i thought were interested that i heard about today, hospitals looking at bonding to provide housing in partnership with the Housing Finance committee which administers low income, that is interesting. We need Affordable Housing and a lot of places for a lot of reasons particularly down east but we need Supportive Housing in communities to give employers and everyone a sense and certainly the individuals involved the sense that they are in a good place and can stay in that good place while they continue their journey. Another one you mentioned that is less about employers directly but relates is the training of Law Enforcement and judges and perhaps that means somebody doesnt end up an offender per se, but maybe access the resources and hopefully give attention to employers. The tax piece is really interesting. You mentioned hospitals and their role in housing. We have a group in hamilton county, tennessee where chattanooga is working on a project, frequent utilizer systems engagement. Joked about how they need a better acronym but the idea is when you look at the same people cycling repeatedly through the committal Justice System they are going to Emergency Rooms and in hospitals. We have to miss cost on the kernel justified, the cost of hospitals are astronomical to the point there are hospitals across the Country Building Supportive Housing because it is like if we can get these people into a stable place maybe they wont keep coming back in here but they are in a unique partnership with the city of chattanooga, hamilton county, the Sheriffs Office, Blue Cross Blue Shield and local hospitals to try to say lets identify the population that is cycling through the systems, get them in Supportive Services and we can probably deliver that a lot cheaper than what we are paying for in the most expensive way possible treating them medically in Emergency Rooms and from the committal justice standpoint to the jail. The conversation i was prepping for for this testimony next week, call it moving upstream towards prevention. However, probably more effective money to spend over time and education is key and prevention is key but it is a tradeoff in real time when your dearest dollar and most expensive care is the highest point in the crisis but that is why you get paid the big bucks, to make hard decisions. A couple more minutes here. I want to pose one more question to both of you all. Looking forward to the future and thinking of issues coming down the pipeline for appalachia what would you consider most important for local act, leaders to keep in mind as they seek to fortify their communities and prepare them for future growth and development . I will take a try but we all have to believe it. We hosted governor cooper, 2019 state code chairman, you get to host the annual summit. We had it in asheville because i was there. It was a great event and the theme was appalachian strong and we had a question from one of our moderators, what does that mean . I think it is manifest. I think people are strong. That is what i would say to anybody, a leader, a person, to an american. We have been through worse and we can get through this too. This is a great nation of strong people who came here to make something and in this part of the country in a hard wilderness and we can and will thrive together. My message would be appalachia needs to embrace what it is, not try to be somebody else. It has incurred natural resources, incredible beauty, a lot of Rural Counties are trying to work on developing tourism rather than manufacturing. They may have lost the chicken mills and textile mills. It is frustrating when i see communities thinking about we got to get some employers in here so we will build another spec building and throw it up and see if we can bring in a plant and higher 350 people. You are 60 miles from the nearest interstate. You dont have rail, you dont have barge. You are not even making a lot of the cut off for those types of jobs but what do you have . Look at those resources. One of the things, it requires solving the broadband piece but one of the things that can happen is there are a lot of things that can be done remotely and People Living in a Rural Community if they get the skills, software or data entry or all kinds of Different Things employers can pay them much less to live in a higher standard of living in Rural America then they could in silicon valley. Think outside the box about what services you can deliver remotely, how can we train our workforce to be doing that instead of just trying to do the Old Solutions a we lost a manufacturing plant and we need a new manufacturing plant, you might not get that because the logistics of where you are. Embrace where you are, you have a strong community, beautiful place, you dont have traffic, dont have noise, you are five minutes from hiking through beautiful place like that and lots of people want to live there. Look at what your strengths are. Gentlemen, that will conclude our panel and i want to thank you for your contributions and the work you are doing in your local community on this and various other issues, we appreciate your time today and with that i will ask commissioner puckett to come on stage and we will do q a later. I got to give a shout out to senator capito. I love wild West Virginia. Thank you for your support and leadership for the Appalachian Regional commission, we appreciate you. [applause] good afternoon, thank you for the Great Questions and look forward to joining you in a moment. To wrap up the session right now it is my honor to introduce our senator from the great state of West Virginia. I will go off notes on this one because i have known her longer then before she was a member of the senate. She was not a congressional member of mine. But every single time i went to dc and came to this place i would always visit or office and although i was not a constituent she always took time to meet with me, all the different people we worked with, we have great coalitions. Amy from Jackson County does a phenomenal job. There is not a greater bipartisan supporter of the opioid issues and all Substance Abuse disorders than senator shelley capito. Please give a big round of applause and welcomed the senator from West Virginia, shelley capito. [applause] thank you, commissioner. I call him greg, but thank you, commissioner. It is great to be here today. Excuse my voice. Who else has had it . Is going all around. We had 11 people for dinner on Christmas Eve in my house in eight of us got it so we are not sure. We think ground 0 was my twoyearold grandson but we are not sure. Others in West Virginia here . Tell us now. Great. Now you are greg obviously, jonathan . Know. Welcome. It is great to be here with tim thomas who was really kind to come as head of the arc to West Virginia where we did up swing on Economic Development issues which go hand in hand with opioid addiction and health in general but thank you for your dedication, he has done two swings through West Virginia so we appreciate your attention to our state because our state is the only state where every single county, all 55 counties are part of the arc and i want to thank what you all do in coordination with the association of counties. My experience in West Virginia and our collective experience has been the best solutions for this problem are from the ground up. They are not generated in my office, Mitch Mcconnells office, or rob portman has been a great advocate from ohio, he has been wonderful and in terms of getting legislation going, 21stcentury cures. It is a bipartisan issue as you know because cutting across every part of the state in a pretty tragic way, but i contend as a West Virginia and who has statistics that are not only most glaring that the Solutions Coming from our state from cattle county or any county in our state that deeply affected are now the solutions that found their way in the support act, license Response Teams originated in cannot county where i live, charleston there is a program called handle with care. Thats where police and local deputies, where if a child has an intervention in their home or somebody had a Drug Overdose or getting arrested or something tragic happens in the middle of the night and little johnny has to go back to school, and is hungry and starts acting out in a classroom which you would do if you were little johnny too then before johnny gets to school the deputies or city police call the principal and said johnny had a rough night, handle him with care, doesnt cost anything but it can help in these are the Solutions Coming from different counties. We had the Community Connections program and camp mariposa in Mercer County working with children that had unfortunate byproduct of a lot of opioid addiction that we see. And worked with arc, the seedless program and a lot of other programs that are Economic Development but this one is working for on the job training for local opportunities, working with treatment programs in the area to get people back to work. You can treat people and people can be in recovery but if you cant get a job the likelihood of falling right back into it is just glaring and in a lot of places too much to cope with and people keep repeating and repeating so the senate and the house in general has done i think a lot in this area. We did just pass the program in the arc this year or last year, a Pilot Program to help combat the Opioid Epidemic and got dedicated funding to go towards that as well. Im sure that the option of not just the report that was done but also the coordination and partnerships that are developing so if you think about the whole breadth and depth of the issues, Law Enforcement, the court system, we have them in West Virginia, Drug Court Works for some people and works well for some people. Our Health Systems are overrun and there is fatigue in our Health System too where repeat flyers, coming to your Emergency Rooms or ems going out to the same places all the time with the same people at some point you have to think about the Mental Health of your Health Worker who is dealing with this, recovery centers, varieties of those, job training, foster care system is totally overrun in West Virginia. Your status probably experiencing the same thing and when you listen to the regular radio stations and they are advertising for foster parents, that is a big problem we are having. We have 7000 more children in foster care, 80 of the new children who have gone into foster care are result of opioid addiction, grandparents raising kids and in some cases great grandparents raising children. I cant imagine being a great grandparent because im just a grandparent but i cant imagine trying to raise a new generation when most of our grandparents planned for their retirement didnt plan to have a fiveyearold in their home. Everything is been impacted by this but a lot of the programs we are looking at, solutions but also the way to fund this are very expensive and expansive and we also need arc does this, it is a big part of what the solution has got to be, we can try this solution here and that solution there but if it is not working get rid of it. Dont keep funding it, dont keep trying it, dont keep thinking it is going to get improved, get rid of it and start on the solutions from another community, huntington or charleston or wherever your states are, louisville where you have solutions that are working, that you have seen them tried and true in certain other areas. One of the other things i did that is probably impacting West Virginia more than the other states, on the funding issue what i found out was formula funding for West Virginia initially, 7 million, danoh is my guru, dan richter, she has been a champ for us and for me in this issue but one i found out 7 million it sounds like a lot, cant even touch a drop in the bucket when you go through Law Enforcement, healthcare, treatment centers, job recovery, transition, foster care. How in the world and so because it was funded by population, smaller states like mine and New Hampshire to have one of the largest problems per capita, we are number one, vermont is in the top five, smaller states are where it is ground 0, we were really losing out on the funding issue so i was able to carveout the money in the appropriations bill to say if you have a highly effective state the 15 we carved out to be able to go directly towards the highly effective states, it meant 50 million more dollars to my state and that i think is something. Nothing against i asked rob portman to you have this problem in ohio . We really dont have a problem in ohio because we have a population that dropped funding and we dont have the problem is intensely everywhere in our state so its not the whole population so he they have been able to work around it the same way with a Larger Population so with smaller states, what i tell my large state friends is this is fair. We dont solve this problem and dont learn what works and what doesnt, when it comes because it will be coming to your state you are not going to have a solution to find the solution so that is why it is important to drive the funding where it is needed the most and that was one of the things we were able to do so our statistics are improving but they are still shamefully high and scary. One of the other things i know you all want the we did build into this last funding measure across the board because funding comes from arc and hhs and Law Enforcement, doj so theres a lot of different funding, hida out of the white house, drugfree communities out of the white house. We decided because of that funding stream, we needed to make sure we take more flexibility because the problem in lewis county, West Virginia, probably different than they are in ohio. We are having an influx of synthetic math so our Health System has been driving a lot of the funding to medication assisted treatment. You know the problem, medication assisted treatment doesnt help the meth addict. Im not a professional here but it has to do with the mechanism of medication assisted treatment doesnt stop an overdose and doesnt help the meth addict so we are seeing a lot of that so we are seeing more flexibility to use dollars the way they think they should use them and what will address the more intense problems so i thank you for everything you are doing. My kids went to high school in West Virginia and my youngest child is our daughter and i was speaking in front of her and like any motherdaughter combination she tells me every time i speak that i always exaggerate because mothers exaggerate, that is what we are supposed to do. I was trying to be very careful with her when i said my daughter is here, she graduated in 2004. She can name at least we ten people in the class of 212 that have either lost their lives or had a sibling who lost their lives. I got back to her and said is that right . Probably closer to 20. That is 10 of the high school class. They didnt all lose their lives but had somebody they know in their family that has been deeply affected by that and it is tragedy after tragedy. A big snowstorm in dc which is a total joke for those of us in appalachia, it snowed half an inch and everybody is freaking out but i thank you for letting me thank you for everything arc does every day to help all our states, particularly my state and all of yours, be a better place to live, the other thing i will say . The Economic Development that comes along with the arc has to go handinhand with this recovery issue, dont have a job, dont see opportunity, dont have optimism, you can do something with your life after you have gone through all of this then your propensity to fall back or remain hopeless is so much greater. Good luck in the snowstorm. What an exciting time it has been together and because of time, i do want to close at this time by saying every time we get together i learn something and the work that has been done through this effort is remarkable and thank you for all the time and energy and partnerships that have taken place in getting us to this point today. Recovery ecosystem, that sums up what we heard about needing to come together. When our county officials and others spoke they talked about the importance of being leaders, bringing groups together and that is the key to what we are talking about here. The passion they showed, the compassion, the heart that they have and we elected officials across the country now the when you are elected by the people of your community that is what it is about, being leaders, whatever the issue might be in bringing people together and making our community a better place. To senator Shelley Moore capito, i have to work the more in there. We think we may be cousins, we are not sure but thank you so much for your leadership to all of congress and the bipartisan way they have worked on this issue, this is an issue that touches all aspects of our community and it is a bipartisan issue. To arc, thank you for being with us today and for your work and investment and partnership, to the governors of the arc, you have done as well for their partnership. Focusing on solutions is the key to what we are talking about and again, a key component to all of this and to the staff, all of you for everything you do each and every day and for bringing us together. Thank you and i wish you well and be safe in the winter weather. [applause] campaign 2020 coverage continues live today at 1 00 pm eastern with andrew yang in bedford, New Hampshire and on sunday live at 3 00 pm eastern with senator Michael Bennet in bedford and at 4 15 eastern mayor Pete Buttigieg from las vegas. On tuesday live at 8 00 pm eastern on cspan2 donald trump in milwaukee, wisconsin at a keep America Great rally. Watch our coverage on cspan2, cspan. Org or listen with the free cspan radio apps