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PSCC Minutes 3/01/2024 DRAFT March 1, 2024 1 MINUTES OF THE COLLIER COUNTY PUBLIC SAFETY COORDINATING COUNCIL MEETING Naples, Florida March 1, 2024 LET IT BE REMEMBERED the Public Safety Coordinating Council in and for the County of Collier, having conducted business herein, met on this date at 9 AM at the Collier County Jail Muster Room, 3347 Tamiami Trail E., Naples, FL 34112, with the following members present: Chairman: Dan Kowal, Board of County Commissioners Vice Chair: Capt. Keith Harmon, Corrections Operations, CCSO (designee) Michael McHugh, Chief Circuit Judge (excused) Janeice Martin, County Judge, Drug Court James Stewart, Asst. State Attorney, State Attorney’s Office (designee) Rex Darrow, Supervising Assistant Public Defender (designee) Brad Rouskey, State Probation Circuit Administrator Jeff Nichols, Director, County Probation Nancy Dauphinais, COO, David Lawrence Center Carmen Henry, Disability Navigator, CareerSource SWFL Also Present: Lee Willer-Spector, PSCC liaison, Communications, Gov’t & Public Affairs Michael Smykowski, County Clerk of Courts (designee) Katina Bouza, Director, CCSO Corrections Support Division Mark Middlebrook, Chief of Corrections, CCSO Sgt. Dareece Canady, Corrections, CCSO Lt. Craig Demange, Corrections, CCSO David Lubas, Corrections, HSA Armor Health Bridget Corcoran, Legislative Affairs Coordinator, County Communications, Gov’t & Public Affairs Tami Bailey, Grants Manager, Community & Human Services March 1, 2024 2 Any persons in need of the verbatim record of the meeting may request the minutes from the Collier County Communications, Government & Public Affairs division. I. Introduction A. Call to Order Chairman Kowal called the meeting to order at 9 a.m. B. Introduction of New Statutory Member – Collier County Judge Janeice Martin [Replacing Judge Rob Crown] Judge Martin told the council: • She’s been attending these meetings since she was a private criminal defense attorney because she heard many important issues were decided here that impacted her clients. • She was elected in 2008, took the bench in 2009 and continued attending this council because of her problem-solving work in the courts. • The PSCC constantly discusses issues that matter to her work. • After 15 years, she prevailed upon Judge Crown to let her take his place because she was attending all the time. • She’s honored to be a part of this important group and is happy to be a part of it. Chairman Kowal said we’re proud to have you because he knows she has a lot of respect in this area and works very hard in the community. [Other PSCC members and attendees introduced themselves.] II. Approval of Agenda and Minutes A. Approval of Agenda Chairman Kowal made a motion to approve the agenda. The motion to approve the agenda passed unanimously, 9-0. B. Review and Approval of Minutes from March 29, 2023 Vice Chair Harmon moved to approve the March 29, 2023, meeting minutes. Second by Mr. Nichols. The motion passed unanimously, 9 -0. III. Old Business A. Update on MAT expansion in the jail [Katina Bouza] [Ms. Bouza detailed a PowerPoint Presentation on the grant, which will be in its final year and starts on Oct. 1.] Mr. Nichols asked what makes it work faster. Is it subcutaneous? Ms. Bouza replied: • It’s subcutaneous and it stays in there. The beauty of the injection is the longer you’re on it, the longer its effects are. • After 62 months, if you were to get off, you’re still protected from overdoses for a while. The longer you’re on it, the longer you’re protected from overdoses, if you were to get off it. • It’s a once monthly injection and it’s quick. March 1, 2024 3 • We had a MAT care coordinator and MAT peer specialists who work for DLC but under the new grant we just applied for, we are not partnering with DLC for the new grant cycle. We’re still going work with them hand-in-hand, but the MAT care coordinator and MAT peer specialists will be CCSO employees. • That’s because the grant is a reporting nightmare. Nobody likes to report the grant. For the amount of money DLC was getting, it was ridiculous for the number of DLC staff hours. We already put the time in, so we’re taking those positions. Ms. Dauphinais said it’s very burdensome. For every dollar you get for a grant, you have to show a dollar match, which adds a lot of administrative burden when there are other sources for opioid funding that don’t require a match. We continue to provide those services using a different funding source. Ms. Bouza told the council: • The grant goals are a reduction of detoxes in jail, reduction of overdoses in the community, continuum of care and treatment. • At intake in 2020, the start of this grant cycle, 14% of all people brought into our jail were already on MAT in the community. In 2021, it remained at 14%, and in 2022, it dropped to 9.6%. • We didn’t anticipate not having enough participants. We had to look at induction, because we weren’t spending the money. • 66 inmates have been served on that in the jail during this grant cycle. • There are 33 on the waiting list for Sublocade. Of the inmates here, 33 want to start Sublocade. To start Sublocade in our jail, medical staff has to do a full physical and EKG to ensure they’re physically well enough to start the program. Then they have to start induction with buprenorphine for seven days, and after that, they’ll do the injection. • We give them 10 people’s inmates’ a week, so they can start working on those but we don’t know if they’re going to get sentenced to prison or get out next week. There will be people who start Sublocade who go to state prison and won’t get it there. • There’s pending legislation to start forcing state correctional facilities to offer MAT in prisons and the Department of Corrections (DOC) was trained on Sublocade. When they came to train us, they said they’d already trained the DOC. The DOC is just waiting for the green light. • Detox. In 2020, 24% of all intakes were on withdrawal protocol. In 2021, 26% were on it, and in 2022, 21% were. In 2023, it rose to 52%. • She received those numbers yesterday and hasn’t determined why it rose. It may be that someone pulled statistics incorrectly. It’s hard to believe that 52% of our population came in and needed detox protocol. A reduction of 11% on withdrawal protocol from 2021 to 2022, and then an increase of 31% could be as simple as our medical company, Armor, changing its policies on who is placed on withdrawal protocol. • Drug overdose information comes from HIDTA (High Intensity Drug Trafficking Area). In 2021, we had 1,203 overdoses and in 2023, it dropped to 797. This also shows Narcan deployment in the county and whether it was single deployment or multiple deployment. • Unfortunately, Fentanyl does not react to one dose of Narcan. There’s a new Narcan that’s three times more powerful, but drug dealers are always one step ahead. • It’s nice to see our overdoses decreasing. • We give Narcan when inmates are released if they’re at risk of overdosing or being present when someone overdoses. • The hospitals provide Narcan when people get out and she believes CVS offers it free. March 1, 2024 4 • More people are getting Narcan, which is not a final solution, but it will stop the overdoses. A discussion ensued and the following points were made: • Ms. Dauphinais noted there may be many more overdoses stopped by Narcan because some people may have done it themselves in the community. This only tracks EMS, hospital use, the jail – the official uses. • Ms. Bailey said fatal overdoses are going down. • Chairman Kowal said many don’t want to call 911 because they’re using illegal drugs and administering to each other. • Judge Martin noted that there are Good Samaritan laws to protect them from that. Ms. Bouza told the council: • There are plans for the county to push treatment out countywide to stay on par with Gov. DeSantis’ program. • We’re constantly working on that with the hospitals. [Mr. Smykowski joined the meeting at 9:15 a.m.] • The PSCC subcommittee met on January 29 and all the measures for the grant had been met. • The medication fund is not being spent as anticipated, which is why we pushed for Sublocade. • We pay roughly $1,600 per injection per inmate per month. • When you use buprenorphine or something else, it’s just a couple of dollars so this will help her spend the money. She’s not worried about what she’ll do when the grant money runs out because she has the county Opioid Relief Settlement funds. Ms. Dauphinais suggested a new injectable, Brixadi, which is sold for a similar price. If you’re not having complaints about pain, Sublocade is muscular and Bruxadi is subcutaneous. Ms. Bouza said she hasn’t looked at that yet but please send her the name. If it’s in the arm, that would be better because that could be done in the Sally Port and she wouldn’t have to bring inmates out of their cellblocks. Ms. Bouza continued: • We all agreed the expansion of the MAT program and the use of Sublocade was something we had to do so we wouldn’t lose this grant. • Today, we have nine people on Sublocade. We had a few people on methadone who wanted to move to Sublocade, which surprised her. • It’s a very long process to detox someone from methadone and start Sublocade, but we’re doing it. She discussed this briefly with Judge Martin. We have a meeting with the county about this, but she now has inmates who want to start Sublocade. They get a full physical and an EKG and we go through all the steps and start them on buprenorphine, which they have to be on for seven days before they can start Sublocade. Then right when they’re going to start Sublocade, they change their minds. • The issue for us is does that affect our grant numbers? If that’s viewed as unsuccessful, then that’s a problem because we won’t meet our grant numbers. She’s March 1, 2024 5 going to reach out to other jails that do this to see if they have the same issue. She doesn’t know why they would go through all that for seven days of feeling high. Judge Martin said your population lives only for this moment. Ms. Bouza said we started looking at that today. She wants to speak to legal to see if you don’t do it for non-medical reasons, will it pay for the physical, EKG and the medication? She was told there were a handful of inmates, but she doesn’t know the exact number so she’ll look into it to see what we can do to dissuade that. Chairman Kowal asked about the question from the subcommittee meeting a few weeks ago. St. Matthew’s House asked about injectables. Did we get clarity on this? Ms. Bouza said the sheriff has been out of town a lot and she needs to speak to her chief to get to the sheriff to see if he’s willing to sit down with them because if it’s Sublocade they don’t have it. The issue they’re going to have is that the urine test will be positive. Judge Martin said it’s a huge speed bump to ramp these people up on best-practice medical care, release them to the community and drop them off a cliff. Our No. 1 recipient for housing of that population is not going to accept it, so we’re at cross-purposes. She doesn’t have an easy answer but is happy to stay in the conversation. Ms. Dauphinais told the council: • There’s strong opposition. It’s not just about diversion or other illicit uses. They don’t want people to be on partial agonists. They feel it’s somehow impairing their openness to treatment. • They want an abstinence-only treatment program, so it’s philosophical. • David Lawrence Centers is developing a 24-bed men’s recovery residence on the same location as our six-bed men’s recovery residence, so ideally that could be up within two years. It won’t get us right today but it would be great because one of the goals and reasons for the need for that is to have housing that accepts all forms of MAT. • After that we can do a female school but we’re not going to build because we’re done building. We’ll try to find a home that we can work with. Ms. Bouza said it’s difficult. A lot of the places we reach out to for our homeless population won’t take you either if there are a lot of stipulations to be there. Was St. Matt’s going to expand more, or is the expansion that they had what was already built? Do you know? Chairman Kowal said the property across the street is on the books, the little community. A Miami developer started a building and he just left it. St. Matt’s acquired that property, which is like a gated community. They have plans to put several apartment buildings there for Justin’s Place. Judge Martin said it’s going to be family housing for graduates of Justin’s Place. Ms. Bouza said if the sheriff agrees, she can be involved. It’s not an expansion where it’s treatment program. We can always use more treatment programs in the community and they can start a treatment program. Chairman Kowal said the property has been approved since last year but it hasn’t broken ground yet. Judge Martin said she believes they’ve secured the funding they need. March 1, 2024 6 Ms. Dauphinais said that will be really helpful. Ms. Bouza said even if they just said it’s OK if you’re on an injectable because you can’t divert it. We had our first and only (that we know of) diversion in the jail and it took us a while to catch the perpetrator. He detoxed after that. That’s something we’re very concerned about, diversion back into the jail. That’s why we’re really excited about the injectable because you can’t do it with that. IV. New Business A. Review of the Latest Jail Occupancy Snapshot [Katina Bouza] [Ms. Bouza detailed a PowerPoint presentation.] B. County Adult Felony Drug Court Memorandum of Understanding [Tami Bailey] Ms. Bailey reported that: • This involves the county Drug Court. • Ultimately, one of the requirements is being able to have a memorandum of understanding of those who participate in this activity based on your organization. • If you see an MOU that comes out in the future, she believes we’ve collected the majority of them for the grant because we’ve been awarded the grant for the next four years and are just tidying up paperwork. • The MOU will show we’re in compliance with all the grant requirements and everybody is on board to participate. • Once the MOU comes, we’ll explain the why, who, what, where and connect the dots. We’re just finishing our paperwork to ensure we remain compliant. C. Discussion of Last PSCC Subcommittee meeting [Katina Bouza and Nancy Dauphinais] [None. Covered in the above presentations.] V. Member Comments Ms. Corcoran reported that: • There’s legislation going through the final approvals involving probation for low-risk, technical violations so they can have alternatives instead of being confined again and returning to jail. • They could extend community service or offer other alternatives. • She and Brad are trying to get details to see if it’s something new or if it’s tweaking a previous program. • It would provide other solutions, instead of re-offending and having to do jail time. They’d be able to continue their lives, including not paying restitution for technical violations. • It’s good legislation that could help out with the daily population. Judge Martin noted that it involves a large chunk of our population. The state legislative session should be ending like this week. Ms. Bailey reported that: • Collier County was selected to be a year two recipient of CORE (Coordinated Opioid Recovery Network) but it hasn’t been made public very well. • The proper channels that needed to be notified, like the County Manager’s Office and March 1, 2024 7 the County Commissioners probably don’t know that we were awarded the CORE designation. • It involves a big push by Gov. DeSantis for the treatment of opioid disorders through the national Opioid Settlement Agreement. • She worked hard to get it because EMS, David Lawrence Centers and Healthcare Network were the three entities that will receive funding. • The challenge for EMS was that it’s not on paper and it doesn’t say we’ve been awarded, so it’s hard to substantiate that to people. • We received formal notification and EMS now has that, so she’ll let them tell the Board of County Commissioners that we’ve been formally designated. Ms. Dauphinais said you’re splitting $875,000 and the second year is 60% of that. Ms. Bailey said that’s correct and explained: • She hasn’t done the math yet but received the documentation. • There’s a potential for rollover. She requested that because they asked her to write what she’d like it to say. She didn’t believe the money would be spent by June 30th because we’re already in March. That’s unrealistic, but that’s sometimes how things work. They put the cart before the horse. • She wanted it in writing to say any money we have left could conditionally be rolled over into the second year. It also will include whatever was left that wasn’t spent by the three entities. • She now has it in writing so it’s official. • That should provide some breathing room so we can allow it to roll over. • The official announcement should come out soon. Usually, Gov. DeSantis and his wife, First Lady Casey DeSantis, come here to celebrate that we’re implementing this program in Collier County. Ms. Dauphinais reported that: • There was a lot of work behind the scenes to make this happen. • The funds come through the managing entity, the state Department of Children & Families, which is why there are a lot of layers of requirements. • They’ve been doing these CORE implementation rollouts in different counties throughout their regions, which is how those agencies are selected. • In each county, they try to identify areas where MAT may not be getting implemented in a community and they identify EMS, where there can be leave-behind programs and more follow-up programs, a federally qualified health-care center. The need is to begin identifying MAT opportunities in the federally qualified health care center and then with the treatment provider to receive any other needs for new people they may encounter from EMS and the federally qualified health care facility. [Ms. Henry joined the meeting at 9:30 a.m.] • We’ve heard contradicting stories about whether the money can be used for capital, but yesterday we received a form we can fill out that could potentially buy a vehicle for EMS, a vehicle for community-based outreach. Other communities have used it for a mobile MAT clinic and similar things. • There are some innovative uses, but it’s interesting because you get all this money right away and then it goes down by half. • It’s meant to be seed money and we’re trying to figure out what’s feasible for March 1, 2024 8 deliverables, etc., Working with the managing entity is challenging. We meet weekly with the implementation team. • EMS Capt. Tony Maro, who heads the Community Drug Response Team, is part of the community coalition that helps determine how this will roll out communitywide. Judge Martin said it’s mostly MAT and Narcan focused because we can push out MAT all day, but those folks have no place to live on that. It’s like telling the: “Enjoy this best practice and go live behind the Publix.” Ms. Dauphinais explained: • You could use these funds to build a recovery residence. However, when you see the restrictions, obligations and that you have until June 30, you can’t build something by June 30. It takes five years before something comes up out of the ground. • Even if you can use some funds for rent or offsetting rental housing costs, there’s nowhere to put people who will take it. • It can be used to pay for rent in a recovery residence, but what if you don’t have a recovery residence? So we’re trying to think long-term, but these are meant to be short- term CMI (Contingency Management Initiative) funds and are not meant to address the long-term program. • There are other communities using this for public service announcements, marketing and communications. You can offer a unified community helpline so people can call one number. • There are many ways communities are using the funds. We have regular meetings to see whether there are any other communication campaigns, prevention or other aspects of CORE than just MAT, but MAT is what we focused on. Judge Martin said we have a special seminar just for judges. We have some violent opposition to MAT on the bench. She won’t name any names, but our best efforts to educate them are falling short. [The two agreed to discuss it later and possibly hold a meeting to allow people to air their concerns and get some information.] Ms. Bailey continued her report: • Ultimately, the opioid money seed money is meant to be the sustainability component behind the things that we get started in this community so there’s a lot of action. • County Manager Amy Patterson has been getting the sheriff involved and David Lawrence Centers for the treatment perspective involved and is working to try to expand so we can get more treatment options available, as well as trying to connect the customers with fire departments because sometimes they get left out in the periphery. • Over the next 10-18 years, as the money is projected to continue to roll in, that’s the intent of the county manager’s vision and Community & Human Services’ vision on rolling this out. • Continued identification, such as housing, is definitely something to bring attention to for the future of what we’re looking to do with this money. • Lots of planning is still involved because it’s been like building the plane as we fly it. We’ve done the best we can in trying to guess, but we continue to receive many compliments that Collier County is ahead of the curve. • We are much further ahead than many other counties statewide and the message we March 1, 2024 9 continually hear is that we’re taking a very aggressive approach and have done some very proactive things before this even happened to address opioid. • Kudos to everyone in this room who tries to address it. Judge Martin provided a Drug Court update: • One of the biggest barriers we face is housing. As we evolve and bring on more best practices, our numbers in Drug Court are down. She believes inmates are reluctant to sign up for an incredibly intensive program of supervision and accountability if they don’t have stable housing. • Because of opting into a best practice medication, what used to be our best option at St. Matt’s is foreclosed. • For women, there’s almost nothing. For men, there are a couple of places we can help with rent for a few beds, but housing has been a major barrier. • The majority of those people are parents. Many have lost custody of their kids and are working to get them back, so it’s a ripple effect, a blast radius. • A lot of lives are being impacted and she’s seen many parents doing great work. They’re working toward getting their kids back but cannot get the housing they need. They might be able to get into a sober house, but to get their kids back, they need a place where they can have their kids, so that continues to be our biggest barrier. • May is National Problem Solving Court Awareness Month. She may be in touch with Commissioner Kowal’s office to see if he could sponsor a proclamation. We typically bring our folks in and it’s really a powerful experience for them to step into the seat of government, a place where they’ve never been and wouldn’t have imagined they’d be welcomed as a group with felony convictions. • Addiction is isolation and recovery is connection and community, and that physical act of stepping into the town square with county government is powerful for them. • This year marks 25 years of Drug Court. Judge William Blackwell founded the county’s Drug Court in 1999. She’ll be putting something together that invites the community to come in and celebrate its great history. • Collier County’s Drug Court is in its second consecutive term as a National Mentor Court, a national model, which it was in 2020, 2021 and 2022 through 2024. • We decided to apply again, but she doesn’t know how often they give out a third term. We have nothing to lose, and our application is almost complete so we’ll pursue it. It’s been a huge honor and huge benefit. It gives us a tangible benefit and funds to help train our folks. • This past year, we hosted teams from Guam and Honolulu, who came here to observe our practices, procedures and how we run things. We learn as much as we teach them doing that. Her bailiff told her that Collier County must have the best Drug Court in the country because those teams literally flew across the country to see what we do. It’s been fantastic to be part of that. • Next month, we’re going to host Broward County, whose Drug Court is bigger and older than our is, but they’re bringing in a new judge and want to see what we do. • This year, the Supreme Court has finally finished what we’ve been putting before them since 2019, a statewide certification process for Problem-Solving Courts. These are all grassroots. Judge Blackwell had almost nothing to work with when he started Drug Court in 1999, but the first one in Florida was in Dade County in 1989, so that’s 30 years of data, studies and figuring out what works and what doesn’t work. • A fun statistic shows that if a law enforcement officer is a member of the Problem- Solving Court team, he has an 80% increase in outcomes. It might not be intuitive but March 1, 2024 10 many years of being able to study our Drug Court helped us figure out what does and doesn’t work and create standards. • Now, certification will reward courts for adhering to best-practice standards. What’s important for this group and what flows from that is a stable, recurring source of state money. The state has already provisioned a big pot of Problem-Solving Court money. As certification stands now, that will be the benchmark for pulling down those dollars. • There will be six teams selected this year for a pilot program. We’re pursuing that. Being a Mentor Court may help, but they have a matrix. They want a big court, a rural court, a diverse group of six, so that could help or hurt us. We will pursue that aggressively and try to get out in front on the certification. • She hopes it will start to stabilize that grant funding and possibly cut down on some weird admin tasks you all have to navigate to keep us going. The following points were made during a discussion between Ms. Dauphinais and Judge Martin: • The federal grant for this quarter cycle has a 25% match. • It’s administratively burdensome to have to demonstrate match expenses with regular ones, write all the grants and change all the enhancements. • If there’s something the judge needs for these best practices that doesn’t require you to redemonstrate your wheel every four years to improve things, that would be great. • The funds for the county’s three FTEs come out of that, $33,333 for the county and $83,333 a year for the David Lawrence Centers. It’s split based on that ratio every year. • It’s for four years this time, rather than three and that helps. • The county gives the Drug Court three FTEs, which helped with that headache so good things are happening. • Drug Court is enjoying great outcomes, family reunifications and good stories every week. • There’s a confluence of P2P meth and Fentanyl. Most Drug Court participants are heavily addicted to both – a depressant and a stimulant – and it’s more powerful than anything we saw 10 years ago. • We have to evolve quickly to figure out how to serve people with that double addiction. • Our Drug Court team is amazing and it’s a privilege to be part of it. • It’s great this group supports that. A discussion ensued and the following points were made: • The sheriff says the P2P meth and Fentanyl are coming through Mexico out of China. • They used to have to grow poppies but now it’s all synthetic. • It’s incredibly plentiful and cheap and makes cocaine and heroin look old school. You had to grow something to create those. • What P2P meth and Fentanyl do to the human brain and how much longer it takes for somebody who’s been using that regularly to even function at a very basic level, it’s tricky. • We’re leaning more lately on Justin’s and Jill’s Place, which makes MAT impossible. • Because it’s a one-year residential program, we’re finding fewer people truly capable of a community-based recovery because of how powerful those substances are and what they’ve done to them. • We don’t have an effective medication for those but we want them to get from probation across the street to David Lawrence Centers. That’s harder than a lot of Drug Court March 1, 2024 11 defendants can do in the first 90-120 days so it’s challenging. • We’re having to evolve, but we’ve got the team and support to do it. • Just when you think you’re getting traction – getting MAT and people and the community starting to wrap their heads around it – then we get substances that don’t respond to it. It’s intense. VI. Public Comments None VII. Adjournment-Next Meeting Date (Meetings will be called as needed) There being no further business for the good of the county, the meeting was adjourned by order of the chairman at 9:47 a.m. COLLIER COUNTY PUBLIC SAFETY COORDINATING COUNCIL Commissioner Dan Kowal, Chairman These minutes were approved by the council on , (check one) as presented, _______, or as amended _______.