Transcripts For CSPAN3 Discussion On Opioids Epidemic In Appalachian Region 20240713

The mayor of little rock, arkansas 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 when greg speaks. Our work that was done seems like aged ags 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 arc for your partnership. We partnered with each other. We partner with various agencies. This event is the culmination with a yearlong partnership to strengthen the local response on the opiates epidemic across the 13 state region. County leaders need the help and support of partnerships like the ones that a. R. C. Has provided and the resources that are needed to serve our citizens. We see the impact that Substance Abuse is having on counties across the entire region. County support over 900 hospitals. County owned, county supported hospitals. They over see sheriffs departments, other local Law Enforcement, emts, firefighters, other first responders. Investing over 100 billion in justice and Public Safety services each year. I want to repeat that. 100 billion in Public Safety services each year. Counties provide Child Protective Services and foster care and they need to teal with increases in case loads when parents are impacked 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 in courts and Legal Services annually. We cannot forget the way that Behavioral Health and Mental Health are aggravating this s Substance Abuse crisis and the resources counties are investing to help residents in this area. Unfortunately, too, county coroner and medical examiners end up 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 indigent b burials. Thats a line item in my county budget. So many times this work is done and you ask later what are the outcomes. The outcomes from this work is really focusing on solutions. Im excited to see that. We see the impact of Substance Abuse on counties and the resident and were focused on making positive change with this work. Were very proud of what we have been able to accomplish through this partnership. Together we produce a robust guiding document with findings, recommendations and case studies for appalachian county officials. We gather feedback from attendees. This event today brings together all of these efforts. Were proud to showcase what we have learned and to look forward to the future of appalachi together. We have two great Panel Discussions that will take place today. Our first panel will focus on key collusisolutions. Key solutions that county members have been implementing across appalachi and what solutions have been working the best. Our second panel will look to the future and focus on how we can help communities move beyond the Opioid Epidemic, looking long term, focusing on solutions to revitalize appalachi. 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 k cappado to join us at the 4 30 session and the key role for leaders to play on this work. 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 13 member 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 appalachi. Tim has more than 20 years of experience and the Public Infrastructure work force, training and regulatory issues. He most recently served with Mitch Mcconnells staff from 2015 to 2018 where he partnered 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 t iwelcoming 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. This latter part of developing local leadership is an over happen overlap in the mission of our organizations. Thank you so much. I want to thank any Congressional Staff and thanks to senator shelly moore. Also want to recognize my colleague, a. R. C. North carolina alternate. We will have some excellent discussions this afternoon on the state of the Substance Abuse epidemic and the steps that are being taken and can be taken to address it in a come prehence p. This is a tragedy on a human level that impacts in one way or another every person living in our communities throughout the region. Another thing i noticed from the moment i took office is 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 work force of healthy, ready workers, debroprives our govrernment of resources. A. R. C. Is an Economic Development entity. Thats our 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 ch challenge. We m 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 instances positive results are being realized where local officials are take on a more active role. Ensuring more of these officials ensure 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 those individuals in our communities struggling with Substance Abuse need help and like wise recognize the negative impact stigma plays in both individuals long term recovery and Community Efforts 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, nato 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 are leading by addressing the issue for multiple angles from treatment and Recovery Services to job training and employment. 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 communities can also lead the way in finding solutions to the problem. At a. R. C. Were also taking action. Last year we held listening sessions in six states, conve convening leaders from state and local governments 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 number of years now. Then we compile that data from those sessions and gave it to our Substance Abuse Advisory Council but members appointed by the governors and myself this is root 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 Community Based recovery eco syste systems designed to help individuals navigate the process and the work. Employment supports and sustains rekor recove recovery. We have been told time and time again. The report has been approved by the commission released publicly and serves as a basis for a. R. C. Now there are no easy or Quick Solutions to this epidemic but that doesnt mean we shouldnt confront it head on, use tools at our disposal and combine forces. The partnership were having today makes sure our friends and neighbors have hard data and proven strategies on which to model their own approaches. This challenge requires a whole of Society Approach but more it requires folks working together in aprehensive way to form innovative partnerships. Often working with people and organizations that doi not have a history of working with in the past. Local officials are in a key position to convene these entipties and develop the myriad of players into a structured approach fitting their community. I want to thank every one 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. I want to thank naco for partnering with a. R. C. In this important effort. Thank you very much. Pleasure to be here. [ applause ] you really cant talk about Economic Development without talking about work force 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. Had i is the 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 arc 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 4e89 funding, solutions to the ems crisis, county property tax reform, rural broad band 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 to i want to thank them as well for a Job Well Done 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 in 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 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 veg 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 environmenti 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 hope 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 Abuse 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 noloxone. 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 r 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. Thlkd 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 blue field 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. [ applause ] 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 as 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, arcs 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 had 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 arc 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 and 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 longest serving 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 leaders comments 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 moon shine county. Grew and smoked a lot of pot. Kids were eaten quaaludes. And there was some cocaine arounds. This was in the late 70s, early 80s. And those were serious, but it was different. And so, when we talk about root causes, i think weve done some work that arc 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 lay out of work. It may be to keep your life functional. Damn. 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. And yes, lets get ahead of it but were behind it and were trying to catch up. I was on the phone earlier today and this will get probably into the next question but root causes, i guess ill try to stick to the question for a minute, are that complex of issues, of the and i think drug use has always been related to meaning and purpose and something to do, but then the chemistry of how this affects and changes how people function and can function is a deeper cause and its why recovery becomes a lifetime enterprise. If i may, just i do want to take a moment and say lets all take a moment and just think about folks we know, faces and friends who we know, who are struggling with pain and loss about this right now. But lets remember the heroes who are getting up and trying to stay clean every day right now and lets help them too and that will come back to that. A dear friend of mine of many years lost her brother on Christmas Day two weeks ago. So, its live and were in the middle of it. And i dont pretend to have answers but i appreciate that were all here and were all here together to try to figure out how to Work Together to make a difference and bring our communities forward. I apologize for taking so long. Ill just say im humbled in many ways to be up here today and be a part of this. I work for a state oceassociati of county officials and i get the privilege of working with folks line commissioner puckett and commissioner snyder. Theyre trying to do all kinds of things. And in some ways i get to sit back a level removed from that and look at a 30,000 foot view and so many county officials have their heads down and theyre working as hard as they can and i think as this crisis began hitting everywhere, they didnt realize it was part of a national effect. They just thought whats happening to my community . So as we began hearing about this, as i began learning about it, we tried to do what we could through our Ocean Association and our meetings and our Educational Programs to raise awareness and let them know this is going on, youre not the only place, let them share their best ideas with each other, let them hear about whats going on in some other states but so many comments here have already kind of taken all my notes. But i think a couple of things that both commissioner puckett and snyder spoke about earlier was its not an opioid problem because were the same way in our communities in tennessee. We had something called a Meth Task Force that was going on for a long time and then suddenly overnight it was now the Dangerous Drugs Task force because it had to morph and deal with things like fentanyl and others, these chemicals now, its like three grains of salt, seshlg essentially, can kill a 200pound man. Its so much easier for people to overdose. But the communities were dealing with addiction in one way or another. Im going to give two examples of things ive heard from county officials. The first one is a bad one and the second one is a good one. When i first started working with the associations, i would get out and tour the counties and go to visit people and i talked to one of our rural county mayors and was just having a general discussion about the association and what can we do for you all and then at some point i always try to turn around to whats happening in your county, what are the Biggest Challenges in your county, what are the problems youre facing and this guy was notoriously blunt and very straight to the point and he just said, the biggest problem our county has are the people who live here. And my first thought was, and you got elected. Was that your Campaign Slogan . He did not get elected the next cycle around but as i tried to tease that out and he started talking about it and he said, look, we have employers here who are leaving, we have employers we try to get to expand, we try to recruit industry in, and these people are telling me all they want is somebody who can do eighth grade math, show up on time and pass a drug test and he said, we cant get two out of those three. He was frustrated with it. So, whats going on that weve got this addiction level . If you look at things about Mental Health issues in the rural areas, its not any as far as instances of things like depression and all that, its not any different there than it is in the urban areas, but were seeing higher levels of addiction. Were seeing higher levels of suicide. Were seeing a loft these different problems. I think theres, you know, well get into more of this a little bit later on. I think one of the things i dont know that theres not true opportunity there but i think theres a perception that there may not be opportunity. Naco did a lot of work on the economic recovery and how weve got two economies and some places took off and others are still stuck where they were and we had counties in tennessee at the depth of the economy that had more than 25 unemployment. It really got hammered and it took them forever to come back from that. But theres there are opportunities and i think they saw themselves kind of falling behind when everybody else was recovering. They saw the Information Age and the gig economy and theyre dealing with dialup and they cant get broadband so its like how do we go there . They have to have different strategies but a more positive county official, i think, who had a passion for his Community Like these folks do, one time talked to my and said, local politics is really easy in a rural area. He said, 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 grandkids in the same environment. And he said thats got strengths and weaknesses to it because in some ways, we have parents of kids who have a lot of talent and ability and theyre scared of education. Theyre scared of them going off to college somewhere and getting a good job because they think they cant get it here and theyre not going to come back home and im not going to see my grandkids and i want to have that. So, its a place where our Rural Communities and the appalachian communities, their strength is also their weakness at the same time. Theyre a real small, Close Knit Community that can be a wonderful strength. But then theres a fear there of, like, but we dont want to lose our kids. We dont want our grandkids raised somewhere else. We dont want them moving off. But i think there are opportunities where they can make those communities flourish and they can stay there at home. Its taken some different strategies and i know arc does tremendous work on Economic Development, so something is happening thats causing people to turn to addiction. As you mention, we got moonshine at tennessee too. Sometimes we have it show up at our conferences but we wont talk about that. Theres been that. Theres been meth. Theres been bath salts and they morph and change and we have to figure out why is it that people dont feel like theyve got other solutions and theyre turning to something. One last thing and then ill turn you back to the question. I mean, i think one of the Silver Linings of the Opioid Crisis is the fact that it didnt discriminate. This is not a drug problem that was in that community or with that group of people or those troubled youths or those teenagers. This is now an addiction problem that is the farmer, who fell off his tractor, got back issues and started on prescription pain medicine. Or its the guy who had on the job injury or its the former College Athlete whos dealing with aches and pains and people started on things that they trusted their doctors and their pharmacists to say, yeah, this will help you with your pain. And the next thing you know, they were addictsed so it hit every family. It hit across racial lines, across socioeconomic lines and Everything Else so i think it has begun to change peoples attitudes towards addiction. I see that in our own membership where you used to get people saying, oh, theyre wanting to claim theyre aan addict, theyre just making bad choices. Now most Everybody Knows somebody struggling with this addiction and so i think its caused us to develop new compassion that we didnt have before and new understanding. Its slowly chipping away at the stigma that you all mentioned thats really such a crucial part of this. Thank you for that. Director mccleskey, arc is primarily an Economic Development agency so from your perspective, how has the Substance Abuse crisis impacts efforts in North Carolina to strengthen Economic Opportunity at the local level and then also, what are some steps that local leaders should think about taking to build economically resilient communities in the context of addressing this crisis . Well, i think 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 theyve been following docs orders and now things change and availability changes and what was legal becomes something you got to go find otherwise and its maybe got fentanyl in it and you could be dead. Its frightening. The i dont have a nice, neat answer for this question and i did some thinking about it before coming and i appreciate seeing them in advance. One thing that i think is happening i think you touched on it is a shift in attitudes around the disease as addiction and the this the polysubstances was the term i was on the phone earlier with our deputy secretary of hhs who will be testifying up here next week on this question with a panel of states in front of the energy and Commerce Committee on what are you using your federal money on and what works and what do we need to be focusing on. I think that question, and i know why were asking it, is what were augull struggling wi. If a part of the answer, as we believe it is, is meaningful jobs, and were in a region that is designated as a region of special attention by our federal government because of the need for meaningful jobs, and then this is layered on top of it, that it becomes the central question, and this is to tims credit. He has challenged the commission and he has successfully gone to the congress. He didnt tell you that. Im going to 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 back to work perspective and weve got some decisions to make about what that will mean and how that may work. Watch this space because we will shortly, as a commission, be taking up some proposals around making some funding available for Creative Ideas from the field around a recovery ecosystem, as tim talked about, and i highly encourage you to go to the website for arc. Gov and look at the report that the commission accepted from our task force at our september meeting and at the recommendations of this panel of a variety of experts, all around what might a recovery ecosystem look like, because it is about how we help folks to get and stay employed while in a Recovery Scenario thats a lifetime scenario. And so, parts of what it means and another website reference, everythings about a website, our North Carolina opioids action plan, i commend to your review and contemplation, includes some recommendations on what local officials can do and think about. Employment supports are a big piece of that. So, things that cost a lot of money and a. R. C. Doesnt have a whole lot of money, transportation supports and in Wilkes County, did you know that a drivers license is a plural . And we dont say yall. We saw y uns. So when i was in high school, the question everybody wanted to know was did yuns get them . And you can lose them too. A lot of folks in the Recovery Community may not have a drivers license. Theyve got to get to work and home and to the day care and to the store. So, thats an interesting conundrum that i think well probably see some ideas coming our way, tim, around what does supportive transportation look like and can we, should we help to what degree, in partnership. Everythings got to be other peoples money too, right . What about housing . What about Supportive Housing that doesnt put folks right back where theyve been and helps them stay in a Supportive Community . Intentionally. And expertly supported. Those are workforce issues and its absolutely where a. R. C. Should be spending time and attention, but we dont know what were going to do. Were going to figure it out with you. We need you. We need ideas from the field and a. R. C. Cant fund private. We fund public and we fund nonprofit and we love it when its public and nonprofit together. So watch this space. Did i go too far there, mr. Chairman . All right. Mr. Connor, do you have anything youd like to add on to that . I love the term, recovery ecosystem. I do think that is something thats critical. In getting ready for this, i was doing a Little Research and looking into some issues, and i guess one thing im going to take a moment to do real quickly is help add into this chip away at stigma thing. I dont have an addiction problem but i have Mental Health issues. I have depression that i take medication for and spent a significant amount of time seeing a counselor, but i live in our state capital, in nashville, im in an urban area, ive got good health insurance, its easy for me to get to places if i needed to take off and go to a counseling appointment over lunch, that was a simple thing to do. If youre living in a rural area, if youve lost your job, maybe youve lost your license, probably dont have a car either so youre stuck having to, like, ask somebody for assistance, youre trying to stay clean and sober, but it may mean you got to get somebody who will drive you 90 minutes to go to another town to go see a counselor if you cant figure out Something Else. Thats the ecosystem, i think, we talk about, we definitely know we dont have enough broadband out there. I dont think we dont realize were missing a Mental Health infrastructure. Looking at some data on rural Mental Health issues and rural addiction issues, they estimate that more than 90 of all psychiatrists and psychologists who are licensed to practice are located in urban areas and masters of social work, its over 80 . So, theyre not out there. And its almost like we need a how sometimes we try to encourage teachers to go teach out in the Rural Communities or, you know, lets get a chemistry teacher out there, lets get a french teacher out there, whoever that we can, we may need Something Like that to help recruit those Mental Health practitioners out into the communities that dont have it. Because that is, i think, part of the reason why the addiction problem and the suicide problem and some of those things have worse outcomes in the Rural Communities, its because they cant get the resources they need for treatment. Telemedicine can play a role in that. Its interesting looking at some strategies around that, that a lot of times they say its best if you can get that to try to integrate it in with normal type of Family Practice in a setting, because i could take off at lunch and drive to my Counselors Office and not run into anybody i knew, but you know, in a Rural Community, it may be that if im going to go see my therapist, people are going to see my truck parked out front and know whats going on. Theyre going to say, whats happening with joe . So, theres some issues there that theres sigma not only around addiction but theres stigma around seeking Mental Health treatment that we need to breakthrough. So i think thats part of this culture that employers are going to have to be ready to take on as well but i think we cant expect them to do that on their own. There needs to be the Community Support of providing that ecosystem. Because Something Else that has occurred to me and ive got friends who are theyre in their 60s, know the couple, both of them, theyre both recovering alcoholics, both have been sober a long time. The husband had some Health Issues back this last year, and just a number of Different Things kicked in, and after 15 years of sobriety, he had a relapse and over the Christmas Holidays had to go through residential treatments. Like you said, this is a long haul issue. Its not, lets run them through a 90day program, get them back out there, theyre going to be fineme fine. Weve got to recognize that these problems they have been burdened with, these Wicked Problems that have hit and changed the way their brains work and Everything Else, theyre going to struggle with that the rest of their lives. The thought that it brings back to me and it occurred when you were speaking a moment ago, we all hear, you know, somebody will show up on time and can pass a drug test. Well, what about employers who are willing to hire people who arent clean . Puds, people who use drugs. Thats one of the acronyms in our state action plan about ways to think about this. We, at our listening session, we had a panelist there who and it wilkes is a big enough county but its a small county and this is a fella who was a couple years ahead of my in high school and i went to the prom with his cousin. And he hes a businessman in town, and operates a restaurant creamery. Hes in recovery. And he makes a point to hire folks who are trying to make it. Not everybody can do that. Weve been to some other tim took a tour with us down in North Carolina visiting some really interesting, fairly hightech operations and they have a very different attitude on substance use, and so you know, none of this is mandatory. Its all got its got to be what can work with somebody who is in business to do business. I believe that this evolution of attitude around these are just good folks who need to be able to be able to be good folks for all of our sake. What does that mean in trying to provide the kind of ecosystem this can support it is the challenge of our time in this space. Thank you both for that. I could spend the entire time i feel like talking about that issue. Im sure you all could too. Well move on. Mr. Conner, in addition to the Economic Impacts and economic issues, health and Justice System costs are two issue of significant concern for local leaders. How can addressing issues in the health and Justice System strengthen appalachian communities and help them address the root causes of Substance Abuse . Whats amazing is more and more were hearing that linkage between criminal justice and health. We started earlier hearing about that with healMental Health. Somebody has heard somebody say our jails have become our Largest Health facilities by default. This doesnt come from an appalachian county, but theres a story about how a couple years ago in the middle of the afternoon on a workday at the International Airport a man in his 40s walks 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. Theyre holding him there. He had no alcohol in his system, no drugs in his system. Typically you dont think a 40yearold man is going to walk into an airport stark naked unless hes high or on something or mentally ill. Our responses is thats messed up. Call the cops. Even in a place like an urban area with all kinds of services. Rural community its even harder. Weve done crisis intervention training with Law Enforcement to help sort out if were dealing with drug addiction or Mental Health. The Law Enforcement community is like, thats great, you can help me identify if its a criminal justice issue or health issue, but now that ive identified that where do i take them . Thats where we need good communication between Service Communities that may not have been crossing lines before. Thats the Mental Health community, the counselors and Law Enforcement. Thats a partnership we really need to forge. If theyre already starting off with that maybe they have committed a criminal behavior as a result of the Mental Health issue, putting them in jail will worsen whatever Mental Health issue they have. In some cases they may be dangerous and others we may be creating a worse problem locking them up. Thats a very difficult piece of the puzzle that we need to determine. Our jails are dealing with that. Ive had county mayors talk about our jail is growing and are overcrowded and when people show up theyre in much worse shape. Theyre so strung out and high and dont know whats going on. The other issue is a lot of them are women and theyre not equipped to deal with that. If you planned a jail, you didnt plan an entire wing for women. That in many of our counties is the fastest population in the jail. They have to reconfigure their structure and keep the genders safe and secure from each other. With female prisoners comes along the fact that they were probably the primary care giver of children and this gets to your issue of grandparents raising the Second Generation because mom is in prison or in jail. Those changes have been a huge burden on the criminal Justice System. Tennessee has been bad about incarcerating a lot of women are just strictly drug offense, possession offenses. Studies have shown that many times women who have addiction and are caught in criminal behavior probably have been victimized in the past. Were taking someone who may be getting high to get over the fact that theyve been raped or who knows what else. Were taking them now away from their children. Unintentionally were repeating patterns that are really difficult and require shifting in sentencing, shifting in prosecution, shifting in Law Enforcement training, correctional training. Theres a lot of good work being done in the juvenile space. Just getting tough on a kid who has grown up with physical or emotional or sexual abuse isnt going to work. Theres so many different places where all throughout the whole spectrum on the criminal justice side as well as the health side theyre trying to redo that and work with those populations. Its a tremendous challenge that takes a big coordinated effort from a lot of different players. I have a story. Some years ago before i joined the state i worked in d. C. As a local government advocate. I worked for counties and cities trying to fix what the feds were doing to them or for them. One day downtown i was walking somewhere. A fella who worked in the bush one white house who had been a local official on long island in new york had his dry cleaning. Had it over his shoulder. I said bill i have mayor smith coming to town next week. Would love him to see you. He said bring him. That was either trite or brilliance. I really appreciate more and more over time that the power of an elected official or an elected leadership body is the power to convene, to bring people together to talk about things. It plays out in so many ways, right . These listening sessions, we had folks from hours away in North Carolina came to Wilkes County. There were people minutes apart who didnt know each other. Thats not anybodys fault. Thats the world we live in, right . You werent just running for reelection when you talk about getting people to talk to each other. Nothing happens if they dont. Its easy for me to say. I deeply respect and admire and thank you for taking on public leadership and sticking with it. Bringing people together we had a listing session in Madison County before we started the official listing sessions when we had tim in North Carolina. We decided to have an opiods conversation. It was folks who by and large knew each other. They have a pretty strong perspective from the courts. They dont have a drug court per se. The d. A. s office is woke. Is that what we say . The sheriff was terrific. This guy is bigger than me and hes tough. He needs places to take folks besides the jail. He knows once theyre there its not going to go so well and there needs to be alternatives. Their Health Director is a pistol. They got to get together regularly and its all about dealing with cases and its all about being present on an ongoing basis as folks struggle with the long sequelae i heard that from a friend of what this complexion of issues brings. Sorry, no filibusters. Following up on that question, mr. Connor, have you seen any best practice approaches in tennessee to address or mitigate some of the issues when it comes to the Justice System . Yeah. We were hearing a lot of stories. Thats whats rewarding is seeing some of our communities. Weve worked on things and were able to get a little bit of grant money to help counties. Weve had some that have been doing that for a while. Its the sheriffs, its the Law Enforcement guys, from some of our in southeast tennessee is about one of the most rural places you can get. Weve had them talking about what they were doing. So many people were like they can do that with the resources they got . We should be doing this. Weve seen counties doing Reentry Programs. They almost always have a recovery element of it. Some counties have specialized on programs for women to try to manage that population. Those have tended to be successful. One of the most encouraging things to me is counties heard quite a lot from people who work with different counties on recentuentry programs that s weve yet to go into a community there wasnt a willing business. It may be they believe in Second Chances and redemption. They say some of those folks may have a person screw up every now and then, when they dont and even when they do, you get one of the best employees youve ever had. That was very encouraging that people in the Law Enforcement side are saying can we get a Reentry Program and the employers are just there. Some are back to the fact that theyre struggling to find people who are out and can pass a drug test and show up to work. If you put them through a program, im sure they havent been on anything in the last nine months and ill take a chance on them. Can i mention one other thing . A little bit of money can go a long way. Microphone. Sorry. A little bit of money can go a long way in getting folks attention. Were five years in with the a. R. C. On the power initiative. Partners ships for opportunity workforce and economic recite la revitalization. In this last year the quality and range of proposals in power that have come forward focussed on Substance Abuse recovery and return to work has been striking. So i think 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 who want to stay home doing it, want to stay in that county, hopefully well be in a position to help you. Thats what i get my metamessage is. Were in this together and were not leaving. We appreciate you coming here today. I want to give a lot of credit to the elected officials who have been taking a lead on this. Everybody is already pissed off on how much were spending on jail. If you say were going to start new programs and invest money and do things for those people you were mad at and were locked up, its tough. It takes keeping the faith for a few years until you start seeing it paying off. Then they start telling the stories where people are landing in jobs and they turned their lives around and the tears of joy and Everything Else that happen at those graduations, its really worthwhile. Its the right thing to do, but its a hard thing to do. We have been trying to work on gathering data to help make it easier if your county is wanting to take that step. Youre not crazy. Here is 20 others doing it in the state. Heres the outcomes theyve had. Heres the people graduating. Heres the residism rate and how we can get them into housing because theyre going through the return to work program. It takes courage on behalf of elected officials and as you mentioned convening, getting a lot of people talking around this and having the right advocates in the community. Sometimes the Faithbased Community may be critical to get them involved in advocating for this being the right thing. This wasnt planned. Kind of feeding off what both of you all talked about, 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, you know, people plugging people in recovery who have overcome this crisis back into the workforce . Something that i thought of when you were discussing this earlier, we found out its very under utilized. We discovered our state has a felon bonding program. If youre an employer and you hired a felon, you can get a bond thats paid for by the state that helps cover any potential liability as a result of some malfeasance by that employee. Theres a federal tax credit for hiring recently convicted felons. Theres also returning veterans and all sorts of people. Theres a class for felons. I think we need to be aware of things like that, help promote programs like that in places where you may have reluctant or even an employer who is willing to take a risk, make sure theyre getting all the credit and protection they can for helping us. There are some programs out there and that may be something we need to expand. Maybe we dont need to link it strictly to convictions, but go to a point like can you get a tax credit for hiring somebody in recovery. Thats interesting. Just a couple things ill mention. These are early stage in North Carolina. In a few counties and were hoping to grow them to other places as resources are available. I just learned about some of this today and dont know it chapter and verse. Supportive services to give an employer some sense that there are other folks in this too that are going to help an individual stick with it. I dont know if thats data driven. It maybe stands to reason. A couple things i thought were interesting that i heard about today and ill be getting read up on. Hospitals looking at bonding to provide housing in partnership with our North Carolina Housing Finance agency. Thats interesting. We need Affordable Housing in a lot of areas around our states, particularly down east around hurricane recovery. But, we need Supportive Housing in communities to give employers and everyone a sense certainly for the individuals involved that theyre in a good place and can stay in that good place while they continue their journey. Another one you mentioned thats a little less about employers directly, but relates, is the training of both Law Enforcement and judges and perhaps that means somebody doesnt end up as an offender per se, but may be able to access some of the resources and hopefully get the attention of employers. The tax piece is really interesting. You mentioned, hospitals and their role in housing, weve got a group in Hamilton County tennessee which has been working on a project called f. U. S. E. The idea is that when you look at the same people who are cycling repeatedly through the criminal Justice System, theyre also in our Emergency Rooms, in our hospitals. The cost to hospitals is astronomical to the point where there are hospitals that are building supportive houses because its like if we can get the people out of the Emergency Rooms and into a stable place, maybe they wont keep coming back here. Theyre doing a unique partnersh partnership to try to say lets identify that population that is cycling the most through both systems. Get them in Supportive Housing with wrap around services and we can deliver that a heck of a lot cheaper than what were paying for treating them medically in the Emergency Rooms and through the jails. We talked about some of that earlier today in conversations where i was prepping for testimony this week. Its called moving upstream towards prevention. However yeah, thats probably more effective money to spend over time and education is key and prevention is key. Its a tradeoff in real time when, yeah, your dearest dollar, your most expensive care is at the highest point in the crisis, but you got to do it. Its life or death. Thats why you get paid the big bucks to make the hard decisions. Weve got 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 appalachian leaders to keep in mind as they try to prepare their communities for future growth and development . Ill take a try at this. It sounds trite. We have to believe it though, right . This year Governor Cooper was the states cochairman for the a. R. C. We hosted the annual summit. We had it in nashville. It was a great event. Our theme was appalachia strong. We had the question what does appalachia strong mean . I think people are strong. Thats what i would say to anybody, to a leader, to a person, by golly to an american. Weve been through worse. 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 a country in a hard wilderness. We can and will thrive together. I think my message would be that appalachia needs to embrace what it is and not try to be somebody else. Its got incredible natural resources, incredible beauty. A lot of communities are try to focus on tourism. Its frustrating when i see communities thinking about, like, we got to get some employers in here. Well build another building and throw it up and see if we can bring a plant in and hire 350 people. Youre 60 miles from the nearest interstate. You dont have rail or barge. Youre not even making a lot of those cut offs for those types of jobs. What do you have . Look at those resources. One of the things it requires solving the broadband piece. 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, whether its software or data entry, employers can pay them much less to live a higher standard of living in a rural area than in silicon valley. We need to think outside the box what services can we deliver remotely . Instead of the Old Solutions like we lost a manufacturing plant. We need a new manufacturing plant. You might not get there because of where you are. Embrace where you are. Its a beautiful place. You dont have traffic or noise. Youre five minutes away from hiking through beautiful places and lots of people want to live there. Look at what your strengths are. Well, gentlemen, that concludes our panel. I want to thank you all so much for your contributions and for the work that youre doing in your local communities on this and various other issues. We really appreciate your time today. So with that, im going to ask commissioner puckett to come on the stage. Well do q a later. I have to give a shout out for senator capito. Thank you for your support and leadership. We appreciate you. [ applause ] good afternoon. Thank you so much for all the great questions. Look forward to joining you back on the panel. Its my great honor to introduce our senator from the great state of West Virginia. I have known her longer than before she was even a member of the senate. She was not a congressional member of mine. Yet, every time i went to d. C. And came to this place, i would always visit her office. Although i was not a c constituent, she always took time to meet with me. There is not, in my opinion, a greater bipartisan supporter of the opoid issues and all substance issues than senator Shelly Moore Capito. At this time please give her a great round of applause. [ applause ] thank you, commissioner. Its great to be here today. Excuse my voice. Who else has had it . Its going all around. We had 11 people for dinner on Christmas Eve at my house and 8 of us got it. We think ground zero was my 2yearold grandson. I dont know, greg, others from West Virginia here . Is agnes here . Later. Phyllis . No. Jonathan . No. Well, welcome. Its great to be here with tim thomas. He was really kind to come as the head of the a. R. C. To West Virginia where we did sort of a swing on Economic Development issues, which obviously go hand in hand with the issue of opoid addiction and health in general. Thank you, tim for your dedication. Hes done two swings through West Virginia. We really appreciate your great attention to our state. All 55 counties in West Virginia are part of the a. R. C. I want to thank what you do in the association of counties. My experience in West Virginia and our clollective experience has been the best solutions are from the ground up. Theyre not generated in our office or Mitch Mcconnells office or rob portman has been a great advocate from ohio. Hes been wonderful getting legislation going from kara and 24th century cures and the support act we just recently passed. Its a bipartisan issue as you know because its cutting across every part of our state in a pret pretty tragic way. I contend as a West Virginian that the Solutions Coming from our state, from any county in our state, are now the solutions that found their way into the support act. The crisis Response Teams originated that idea originated in cable county. Where i live in charleston, theres a program called handle with care. Thats where the local police and the local deputies are you doing handle with care in mercer . Yeah. Its if a child has an intervention in their home where someone has had a Drug Overdose or someone is getting arrested and johnny has to go back to school and is behind, hasnt slept, hes hungry and starts acting out in a classroom which you would do too, before johnny gets to the school, the deputies or city Police Called the p principal and said johnny has had a rough night, handle him with care. It can really help. These are the solutions we see coming from different counties. We have Community Connections program. Theyre working with the seed lift program and a lot of other programs that are Economic Development. This is onthejob training working with treatment programs in the area to try to get people back to work. You can treat people and they can be in recovery. The senate and the house in general has done i think a lot in this area. We did just pass a program in the a. R. C. Last year, a Pilot Program to help combat the opoid epidemic. Weve got dedicated funding to go towards that as well. Thats the off shoot of not just the report that was done, but also the coordination and the partnerships developing. So if you think about the whole breadth and depth of the issue, think about Law Enforcement, the court systems. Ive been to drug court graduations. We have them in West Virginia. It works well for some people. Our Health Systems are overrun. Theres fatigue in our Health Systems. There are repeat flyers. Theyre coming into your Emergency Rooms, your ems is going out all the time to the same people. At some point you think about the Mental Health of your health worker. Recovery centers, we have a variety of those. Our foster care system is totally overwhelm in West Virginia. Your tate is probably experiencing the same thing. When you listen to the Radio Station and theyre advertising for foster parents, thats a big problem. We have 7,000 more children in foster care. 80 of the new children are as a result of opoid addiction. We have grandparents raising kids and in some cases great grandparents raising children. I cant imagine i cant imagine being a great grandparent, but i cant imagine trying to raise a new generation. Most of our grandparents have planned for their retirement. They didnt plan to have a 2 to 5yearold all the way through high school in their home. Everything has been impacted by this. A lot of programs were looking at, the solutions, but the way to fund this are very expensive and expansive. We need to look at a. R. C. Does this and i think its a big part of what the solutions got to be. Yes, we can try this solution here and that solution there. You know what, if its not working get rid of it. Dont keep funding it or trying it. Dont keep thinking its going to get improved. Get rid of it and start on another community where youve got solutions that are working, that youve seen them tried and true in other areas. One of the other things i did in West Virginia on the funding issue, when i found out what the formula funding was for West Virginia initially it was 7 million. Right, dana . Dana, is my guru here. Shes a champ on this issue. 7 million that sounds like a lot. It doesnt make a drop in the bucket. How in the world . Because it was funded by it was being pushed by population smaller states like mine and New Hampshire who has one of the largest problems per capita. Were number one. New hampshire is number two. Vermont is in the top five. The smaller states where its ground zero we were losing out on the funding issue to be effective. I was able to carve out some money in the appropriation bill to say if you have a highly affected state its about 50 million more to my state. Nothing against i asked rob portman do you have this problem in ohio . He said we dont because we have the population to drive the funding. Its not the whole population. Hes been able to work around it. North carolina is the same way with a larger population. Is this fair . This is fair . If we dont solve this problem in appalachian, when it comes to your state, you wont have the solutions to find the solutions. Thats why its important to drive the funding where its needed the most. That was one of the things we were able to do. Our statistics are improving. Theyre still shamefully high and scary. One of the other things you want and we built in the last funding measure across the board it comes from Law Enforcement, doj, theres a lot of different funding, drug free communities out of the white house. We decided that because of that funding stream that we needed to make sure that we gave you more flexibility. The problems in lewis county, West Virginia are different than in ohio. Were having an influx of synthetic meth. Our Health System has been driving the funding to medicationassisted treatment. If you know the problem, that doesnt help the meth addict. Im not a professional here, but it has to do with the medicalassisted treatment doesnt help the overdose. Were giving more flexibility to the states to use the dollars the way they think they should and what will address their more intense problem. I want to thank you for everything youre doing. Its important to me. My kids went to School High School in West Virginia. My youngest child is our daughter. I was speaking in front of her. Like any mother daughter combination she tells me i exaggerate. Mothers exaggerate. I was trying to be careful with her. That was a joke. I was trying to be careful with her when i said my daughter is here. She graduated in 2004. She can name ten people in her class of 212 that have either lost their lives or have a sibling that lost their lives. I went back to her and said is that right, is it ten . She said its probably closer to 20, mom. Thats 10 . They didnt all lose their lives, but they have somebody in their family affected by that. Its tragedy after tragedy. Its a big snow tomorrow here in d. C. Which is a joke for those of us in appalachia. It snowed half an inch and everybody is freaking out. Tim, thank you for everything the a. R. C. Does every day to help all our states, particularly my state, and all of yours be a better place. The other thing i would say i asked greg what do you hear . He said the Economic Development with the a. R. C. Has to go hand in hand with this recovery issue. If you dont have a job or have opportunity or have optimism or youre not hopeful that you can do something with your life after youve gone through all this, then, again, your propensity to fall back or remain hopeless is so much greater. That i think is where the a. R. C. Can help us in a lot of different phases. Thank you very much. Good luck in this snow storm. [ applause ] what an exciting time its been together. Unfortunately because of time we have to forego q a. I want to close at this time by saying that every time we get together i learn something. The work thats been done through this collaborative effort is very remarkable. Thank you for all of the time and energy and for the partnerships that have taken place in getting us to this point today. New phrase today im going to take back home is recovery ecosystem. I think that really sums up a lot of what we heard about needing to come together. When our county officials and others spoke, they talked about the importance of being leaders, convening others, bringing groups together and to me that is the key to what were talking about here. The passion that they showed, the compassion, just the heart that they have and we elected officials across the country know that when youre elected by the people of your community, thats what its about. Its being leaders, whatever the issue might be and bringing people together and making our communities a better place. So to senator Shelly Moore Capito ive got to work the moore in there. We think we may be cousins. Were not sure. Thank you so much for your leadership to all of congress and the bipartisan way theyve worked on this issue. This is an issue that touches all aspects of our communities. To a. R. C. , tim, thank you for being with us today and your work and your investment and your partnership. To the golf tovernors of the a. Thank them as well. Focusing on solutions i think is the key to what were talking about and, again, a key component to all of this. Finally to the staff, matt chase, hadi, all of you for everything you do each and every day. Thank you. I wish you well. Be safe in the winter weather. [ applause ] announcer our Live Campaign 2020 coverage continues thursday 7 00 p. M. Eastern with President Trump in toledo, ohio. Watch live on cspan 2 or listen on the go with the free cspan radio app. The house will be in order. For 40 years cspan has been providing america coverage of congress, the white house, the Supreme Court and Public Policy events from washington, d. C. And around the country. Created by cable in 1979 cspan is brought to you by your local cable or satellite provider. Cspan, your unfiltered view of government. Professor sarah binder back for a discussion about war powers and congress. Professor, President Trump said sunday that his tweets should serve as sufficient notice to congress of a possible military strike on iran. Where does that obligation come from . Well, the president is roughlyer