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Agenda 12/10/2019 Item #16D 3 (CCSO After-the-Fact Grant Application)12/10/2019 EXECUTIVE SUMMARY Recommendation to approve an “after-the-fact” Combating Opioid Overdose grant application in the amount of $500,000 to the University of Baltimore, in partnership with the Collier County Sheriffs Office (CCSO), to provide Medication-Assisted Treatment (MAT), at the time of incarceration and for inmates transitioning back to the community. OBJECTIVE: To develop a medication-assisted treatment MAT Program for incarcerated, and soon to be released, opioid users within Collier County jail. CONSIDERATIONS: America’s correctional facilities are at the epicenter of the opioid overdose crisis. Nationally, nearly one in five people entering local jails have an opioid use disorder (OUD). The high prevalence of OUD in the jail population is especially concerning given the high rates of overdose post- release. Individuals with OUDs who leave jail untreated also may continue their drug use, which may contribute to recidivism and reincarceration. Implementing MAT in jails and enhancing collaboration between jails and community providers is required to change the course of the opioid epidemic. Through a competitive process, the Office of National Drug Control Policy awarded the University of Baltimore a grant to fund Combating Opioid Overdose through Community-Level Intervention Initiative (COOCLI). Through the COOCLI Initiative, the University of Baltimore is soliciting sub-award applications for the purpose of: 1. Undertaking research activities that entail implementing and evaluating community-based efforts to fight the opioid-involved overdose epidemic; and 2. Supporting and promoting the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing overdose and other harms of opioid-involved (mis)use. On September 24, 2019, the University of Baltimore issued a Notification of Funding Availability (NOFA) and applications were due no later than November 1, 2019. Preparation of this grant application occurred through a collaborative effort with the CCSO, Arm or Correctional, and the David Lawrence Center (DLC) through Collier County’s Community and Human Services Division. The focus of this application is to obtain $500,000 in funding to help CCSO take advantage of an opportunity to establish a MAT Program for inmates already receiving MAT prior to incarceration or those who wish to begin MAT at their release. CCSO would expand the use of MAT from only pregnant female inmates to all inmates wishing to participate. The program will include an Advanced Practice Registered Nurse (APRN), a Licensed Practical Nurse (LPN), a drug treatment counselor, a case manager and a peer specialist. New inmates who indicate they are on MAT in the community, or who are willing to begin using MAT while in custody, will be flagged by medical intake staff. The program would provide not only medication, but also oversee the inmate’s treatment, while in custody, and will link the inmate to services upon release. CCSO through its partnership with DLC link the inmate with DLC at the time of release to continue MAT. In addition, the project will have an evaluation component to evaluate the success of the program, recidivism and the overall decrease of OUD in the community. . Due to the unique nature of the grant and its collaborative application process between agencies, more time was needed to assemble the application. Collier County CMA #5330 authorizes the County Manager to approve the submittal of grant applications with subsequent Board of County Commissioners (Board) action at the next regularly scheduled Board meeting to ratify the approval as an after-the-fact application. 16.D.3 Packet Pg. 2166 12/10/2019 The County Manager approved the grant application on October 28, 2019. The University of Baltimore will convene the COOCLI Initiative Board (COOCLI Board) in mi d- November. The COOCLI Board will assess proposals and recommend funding levels to the University of Baltimore, who will then issue sub-awards based on the COOCLI Board’s recommendations to successful applicants in December 2019. Funding is for twelve (12) months and no local match is required. FISCAL IMPACT: If awarded, funds from the University of Baltimore will be appropriated into the Human Services Grant Fund (707) via a Budget Amendment at the time of the Board’s acceptance. LEGAL CONSIDERATIONS: The Board will have the opportunity to accept or reject the funds if the grant is approved. Accordingly, this Office has no issue with respect to the legal sufficiency of this request, which is appropriate Board action. This item requires a majority vote of the Board for approval - JAB GROWTH MANAGEMENT IMPACT: There is no Growth Management impact due to this request. RECOMMENDATION: To approve an “after-the-fact” Combating Opioid Overdose grant application in the amount of $500,000, to the University of Baltimore, in partnership with the CCSO, to provide Medication-Assisted Treatment, at the time of incarceration and for inmates transitioning back to the community. Prepared By: Hilary Halford, Sr. Grant & Housing Coordinator, Community & Human Services Division ATTACHMENT(S) 1. ATF 19-024 Combating Opioid Overdose approval (PDF) 2. UB Opioid Funding Information (PNG) 3. UB_NOFA -2019_FINAL (DOCX) 4. [LINKED] Collier County COOCI Grant Application FINAL 11.1.2019 (PDF) 5. CM Approval Memo (PDF) 16.D.3 Packet Pg. 2167 12/10/2019 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.3 Doc ID: 10664 Item Summary: Recommendation to approve an “after-the-fact” Combating Opioid Overdose grant application in the amount of $500,000 to the University of Baltimore, in partnership with the Collier County Sheriffs Office, to provide Medication-Assisted Treatment (MAT), at the time of incarceration and for inmates transitioning back to the community. (Net Fiscal impact $500,000) Meeting Date: 12/10/2019 Prepared by: Title: – Community & Human Services Name: Hilary Halford 11/04/2019 11:00 AM Submitted by: Title: Manager - Federal/State Grants Operation – Community & Human Services Name: Kristi Sonntag 11/04/2019 11:00 AM Approved By: Review: Community & Human Services Kristi Sonntag CHS Review Completed 11/12/2019 1:46 PM Community & Human Services Cormac Giblin Additional Reviewer Completed 11/18/2019 4:15 PM Community & Human Services Maggie Lopez Additional Reviewer Completed 11/18/2019 4:20 PM Public Services Department Kimberley Grant Level 1 Reviewer Completed 11/19/2019 12:30 PM Public Services Department Joshua Hammond Level 1 Division Reviewer Completed 11/20/2019 8:17 AM Grants Erica Robinson Level 2 Grants Review Completed 11/20/2019 8:50 AM Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 11/20/2019 8:58 AM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 11/20/2019 9:43 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 11/20/2019 11:41 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/20/2019 2:36 PM Grants Therese Stanley Additional Reviewer Completed 11/21/2019 4:30 PM County Manager's Office Sean Callahan Level 4 County Manager Review Completed 11/25/2019 9:38 AM Board of County Commissioners MaryJo Brock Meeting Pending 12/10/2019 9:00 AM 16.D.3 Packet Pg. 2168 REQUEST # OMB ASSIGNED FY17 v2. REQUEST FOR AFTER THE FACT APPROVAL OF GRANT APPLICATION Submit all requests to: OMB Grants Compliance Office FEDERAL/STATE AGENCY: PROGRAM NAME: CFDA# / CSFA#: DATE REQUESTED: DIVISION: REQUEST MADE BY: FUNDING ANNOUNCEMENT DATE: SUBMISSION DEADLINE: NEXT AVAIL. BCC MEETING DATE: The Board of County Commissioners must approve all grant applications, even those applications that do not require a signature and are submitted online or require an individual other than the Chairman of the Board to sign. The most common reason for an exception is when a grant application’s deadline precedes the agenda meeting deadline for Board approval. In this case, the project or program manager must contact the OMB Grants Compliance Office to request or discuss options for emergency submittals or an after-the-fact approval. Over usage or unjustifiable reliance on the after-the-fact process is not acceptable and the County Manager has the right at any point to disapprove the submittal of an application. 1.Choose one exception to CMA 5330 below. 2. Provide additional justification within this box (date you became aware of funding opportunity, etc.) 3. Attach a copy of the funding notification to this request. CMA 5330 Policy - (Check One) (a)The grant is announced and the application is due within one month or less and the deadline has been missed for the next available Board of County Commissioners meeting; (b)Division commitments to emergency situations or events beyond normal operations prohibit staff from having time to develop application in coordination with Grant Compliance Office; or (c)The Board of County Commissioners is not in session for a few weeks at a time (e.g. summer break). Requirements and Timeline Once the Grants Compliance Office receives your request and a copy of the funding notification, you will be contacted with an initial approval. No later than three business days prior to submittal, the Division must provide a complete application as will be submitted to the grantor agency and a draft Executive Summary, for review and County Manager approval prior to submittal. OMB will prepare the County Manager’s Memorandum of Approval (CM Memo) on behalf of the Division. The Division is required to obtain formal Board approval at the Board meeting date identified in the OMB written approval as well as attach a copy of the CM Memo to the Board action. Division Staff Signature I have read and understand the Requirements and Timeline Section of my After the Fact Request. I have included a copy of the Funding Announcement and any other accompanying information. OMB Grants Accountant Review OMB Grants Compliance Manager Approval 16.D.3.a Packet Pg. 2169 Attachment: ATF 19-024 Combating Opioid Overdose approval (10664 : After-the-Fact Combating Opioid Overdose through Community-level FY17 v2.  AFTER THE FACT APPROVAL STEPS – GRANT APPLICATIONS  1.Complete an OMB After the Fact Request (ATF) 2.Submit ATF and required documentation to OMB 3.Receive approval from OMB 4.Division prepares Grant Application 5.Division prepares Executive Summary (ES) 6.Submit final ES and Application to OMB by deadline (3 days before grantor due date) 7.OMB prepares County Managers (CM) Memo 8.OMB presents application package, CM Memo and ES to County Manager for signature 9.OMB provides signed application package to Division 10.Division submits Application, with exception of grants.gov applications submitted by OMB 11.Division obtains Board approval by date identified in ATF approval 12.Division requests a Level 2 review of Board action 13.Division forwards fully executed copy of application to OMB 14.Division forwards any grantor communications to OMB including but not limited to notification of denial, notification of award, request for revision. 15.Division notifies OMB of application revisions prior to revision submittal 16.OMB reviews revisions and advises if Board action is necessary (substantial changes) 16.D.3.a Packet Pg. 2170 Attachment: ATF 19-024 Combating Opioid Overdose approval (10664 : After-the-Fact Combating Opioid Overdose through Community-level 16.D.3.b Packet Pg. 2171 Attachment: UB Opioid Funding Information (10664 : After-the-Fact Combating Opioid UNIVERSITY OF BALTIMORE FY 2019 Competitive Subaward Solicitation Combating Opioid Overdose through Community-level Intervention Notice of Funding Availability (NOFA) Application Guidance Center for Drug Policy and Enforcement Submission Deadline: November 1, 2019 Funded through: Office of National Drug Control Policy Catalog of Federal Domestic Assistance (CFDA) Number: 95.007 University of Baltimore Center for Drug Policy and Enforcement 1420 N. Charles St. Baltimore, MD 21201-5779 410-837-0191 Kurt L. Schmoke, President Roger Hartley, Ph.D., Dean, College of Public Affairs Thomas H. Carr, Executive Director, Center for Drug Policy and Enforcement 16.D.3.c Packet Pg. 2172 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant Getting Started Thank you for applying for the Combating Opioid Overdose through Community-level Intervention Subaward from the University of Baltimore (UB). The primary purpose of the Combating Opioid Overdose through Community-level Intervention Grant is to: 1. Undertake research activities that entail implementing and evaluating community-based efforts to fight the opioid-involved overdose epidemic; and 2. Support and promote the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing overdose and other harms of opioid-involved (mis)use. Applicants must use evidence-based approaches to implement or enhance community-based new or ongoing programs that aim to reduce opioid-involved overdose, particularly in the regions of the United States with the highest rates of fatal and non-fatal opioid-involved overdoses. Applicants must evaluate these community-based efforts to assess their efficacy in reducing opioid-involved overdose and other harms of opioid (mis)use, particularly in the regions of the United States with the highest rates of fatal and non-fatal opioid-involved overdoses. Proposals must support and promote collaboration between public safety and public health agencies to ensure that overdose reduction efforts provide and that communities benefit from a comprehensive and coordinated response. If you need application assistance, please contact: Sherae Lonick Associate Director for Finance Center for Drug Policy and Enforcement 301-489-1711 16.D.3.c Packet Pg. 2173 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant Table of Contents I. BACKGROUND/ SCOPE ...................................................................................................................... 1 II. ELIGIBILE APPLICANT .................................................................................................................... 2 III. ELIGIBILITY CRITERIA ................................................................................................................. 3 IV. APPLICATION PROCESS ................................................................................................................. 3 V. APPLICATION REQUIREMENTS .................................................................................................... 3 VI. FAITH-BASED/COMMUNITY ORGANIZATIONS ...................................................................... 5 VII. IMPORTANT DATES ....................................................................................................................... 6 VIII. PROJECT PRIORITY AREAS ....................................................................................................... 6 IX. FUNDING EVALUATION ................................................................................................................. 6 X. FUNDING SPECIFICATIONS ............................................................................................................ 7 XI. DISTRIBUTION OF FUNDS & REPORTING REQUIREMENTS............................................... 8 XII. MATCH ............................................................................................................................................... 9 XIII. SUPPLANTING, TRANSPARENCY AND ACCOUNTABILITY .............................................. 9 XIV. APPLICATION ................................................................................................................................. 9 XV. CERTIFIED ASSURANCES ........................................................................................................... 16 XVI. ENDNOTES ..................................................................................................................................... 16 16.D.3.c Packet Pg. 2174 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 1 I. BACKGROUND/ SCOPE For the first time in U.S. history, a leading cause of deaths—vehicle crashes—has been surpassed in likelihood by opioid overdoses.1 Americans now have a 1 in 96 chance of dying from an opioid overdose, with more than 130 Americans dying from opioid overdoses each day. Among the 70,237 drug overdose deaths in 2017, 67.8% involved an opioid. The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased by 45% between 2016 and 20172. Deaths involving synthetic opioids increased from 2016 to 2017 across all demographic categories. The highest death rate was in males aged 25-44 years, and the largest relative increases occurred among blacks and American Indian/Alaska Natives. While significant decreases in heroin-involved overdoses were observed in 5 states, twenty-three states and DC experienced significant increases in synthetic opioid-involved overdose death rates, including eight states west of the Mississippi River. The largest relative rate increases occurred in Arizona (122%), North Carolina (112.9%) and Oregon (90.9%)3. West Virginia, Ohio, and Pennsylvania were the three states with the highest observed drug overdose death rates in 20174. While the opioid epidemic justifiably dominates national and state priorities, another emerging threat deserves focus and attention: overdose deaths involving cocaine and psychostimulants increased by 52.4% and 33.3% respectively from 2015 to 20165. Deaths from cocaine sharply increased from 2011 to 2016, increasing by about 18% each year during the five-year period. Cocaine was the second-or third-most common cause of overdose deaths every year. Similarly, the number of overdose deaths involving methamphetamine increased from 1,887 in 2011 to 6,762 in 20166. According to the Drug Enforcement Administration (DEA), Mexican transnational criminal organizations (TCOs) have increased the production and trafficking of methamphetamine, therefore lowering its domestic price point while increasing its presence and purity throughout the United States7. The threat of methamphetamine is particularly high in the Pacific, Southwest and West regions of the United States, but its availability on the East Coast has also increased8. Similarly, the DEA notes that increases in coca plant cultivation in South America have contributed to the rise in global cocaine production, leading to increased prevalence and heightened purity of the product9. Poly-drug use introduces an additional challenge to the overdose crisis as it may place individuals at an increased risk of overdose, particularly with the introduction of fentanyl into the cocaine and methamphetamine supply. In 2016, nearly 40% of all cocaine overdose deaths also 16.D.3.c Packet Pg. 2175 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 2 involved a synthetic opioid, such as fentanyl10. Most overdose deaths involve more than one drug, with individuals who overdosed on benzodiazepines having other drugs in their system 96% of the time. Nearly 70% of fatal fentanyl-related overdoses involved more than one drug, as did 71% of fatal heroin overdoses. 11 “The single and most important criterion of success is saving American lives, and achieving that objective requires the Federal government to work with partners at the state, local, and tribal levels; the healthcare sector; industry, foreign partners; and every concerned American citizen to advance our Nation’s efforts to promote and maintain healthy lifestyles, and help build and grow safe communities free from the scourge of drug use and addiction12.” Overall, these staggering figures highlight the need to implement and/or enhance community- based efforts to reduce overdose deaths. Actions taken under this proposal must align with related Office of National Drug Control Policy (ONDCP) and Centers for Disease Control and Prevention (CDC) projects. II. ELIGIBILE APPLICANT The following entities are eligible to submit subaward applications, providing the application includes a letter of support/commitment from the participating HIDTA signed by the sponsoring HIDTA Director. (See Section C-8. Letters of Support/Commitment) • High Intensity Drug Trafficking Areas Programs • Public/State Controlled Institutions of Higher Education 16.D.3.c Packet Pg. 2176 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 3 • Private Institutions of Higher Education • Nonprofits with 501(c) (3) IRS Status (Other than Institutions of Higher Education) • Nonprofits without 501(c) (3) IRS Status (Other than Institutions of Higher Education) • State Governments • County Governments • City or Township Governments • Special District Governments • Indian/Native American Tribal Governments (Federally Recognized) • Indian/Native American Tribal Governments (Other than Federally Recognized) • U.S. Territory or Possession • Independent School Districts • Public Housing Authorities/Indian Housing Authorities • Native American Tribal Organizations (other than Federally recognized tribal governments) • Faith-based or Community-based Organizations III. ELIGIBILITY CRITERIA • Applicants must have expert knowledge and extensive experience in conducting research and analysis • Applicants must have expert knowledge and experience developing or enhancing new or ongoing programs that aim to reduce opioid overdose through strategic, evidence-based approaches. • Applicants must partner with a regional High Intensity Drug Trafficking Areas (HIDTA) program, and applications must include a letter of support/commitment from the participating HIDTA and signed by the sponsoring HIDTA Director. IV. APPLICATION PROCESS Applicants are required to apply for subaward funding through the UB. The UB must receive the emailed copy of the application no later than November 1, 2019. V. APPLICATION REQUIREMENTS Sub-recipient Organization Eligibility Requirements The UB established criteria for the Combating Opioid Overdose through Community-level Intervention subaward that must be met by all organizations that receive these funds. Sub-recipients must: • Using an evidence-based approach, implement or enhance a community-based new or ongoing program that aims to reduce opioid-involved overdose, particularly in the regions of the United States with the highest rates of fatal and non-fatal opioid-involved overdoses; 16.D.3.c Packet Pg. 2177 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 4 • Once implemented, support the evaluation of this community-based effort to assess its efficacy in reducing opioid-involved overdose and other harms of opioid (mis)use, particularly in the regions of the United States with the highest rates of fatal and non-fatal opioid-involved overdoses; and • Support and promote collaboration between public safety and public health agencies to ensure that overdose reduction efforts are aligned and that communities benefit from a comprehensive and coordinated response. Each subcontract recipient organization shall meet the following requirements: 1. You must comply with the Government-wide Suspension and Debarment provision set forth at 2 CPR Part 180, dealing with all sub-awards and contracts issued under the grant. 2. Reporting Sub-award and Executive Compensation Information - This part provides guidance concerning requirements for Federal Funding Accountability and Transparency Act of 2006 (FFATA) reporting. ONDCP must report Federal fund awards of more than $25,000. Subcontracts also fall under reporting requirements but please note that the definition of "Sub-contract" does not include your procurement of property and services needed to carry out the project. (See 2 CPR Part 170) 3. Requirements for Drug-Free Workplace (Financial Assistance) - This part requires that the award and administration of ONDCP grants and cooperative agreements comply with Office of Management and Budget (OMB) guidance implementing the portion of the Drug Free Workplace Act of 1988 (41 U.S.C. 701-707, as amended, hereafter referred to as "the Act") that applies to grants. (2 CPR Part 421) 4. Non Discrimination Statement: The UB and ONDCP prohibit discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political belief, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Agency. (Not all prohibited bases will apply to all programs and/or employment activities.) 5. Compensation- Personnel Services: This part requires that charges to Federal awards for salaries and wages must be based on records that accurately reflect the work performed. (See 2 CFR 200.430) 6. Financial Management: This part requires that systems must be sufficient to permit the preparation of reports required by general and program-specific terms and conditions, and the tracing of funds to a level of expenditures adequate to establish that such funds have been used according to the Federal statutes, regulations, and the terms and conditions of the award. (See 2 CFR 200.302) 7. Technical Assistance: You must participate in scheduled telephone calls and meetings with technical providers. 16.D.3.c Packet Pg. 2178 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 5 8. As specified in this notice of funding opportunity, recipient must: a. Establish and maintain effective internal controls over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with the guidance in "Standards for Internal Control in the Federal Government," issued by the Comptroller General of the United States and the "Internal Control Integrated Framework," issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). b. Comply with Federal statutes, regulations, and the terms and conditions of the Federal awards. c. Evaluate and monitor the non-Federal entity's compliance with statute, regulations, and the terms and conditions of the Federal awards. d. Take prompt action when instances of noncompliance are identified, including noncompliance identified in audit findings. e. Take reasonable measures to safeguard protected personally identified information and other information the Federal awarding agency or pass-through entity designates as sensitive or the non-Federal entity considers sensitive consistent with applicable Federal, state, and local laws regarding privacy and obligations of confidentiality. Evidence-Based Practices, Promising and Proven Programs • Priority will also be given to applicants who propose to implement and/or evaluate an evidence-based, or promising program. • Applicants are encouraged to review national best practices and evidence-based, and promising program examples in selecting a program for implementation and/or evaluation. • Applicants should also provide details on how they will maintain fidelity to the proposed program. VI. FAITH-BASED/COMMUNITY ORGANIZATIONS Faith-based organizations applying for Combating Opioid Overdose through Community-level Intervention funds do not have to lose or modify their religious identity (i.e., removing religious symbols) to be considered an eligible applicant. However, Combating Opioid Overdose though Community-level Intervention funds may not be used to fund any inherently religious activity, such as prayer or worship. Inherently religious activity is permissible, although it cannot occur during an activity funded with subaward funds; such religious activity must be separate (in time and/or place) from the subaward funded project. Further, participation in such religious activity by individuals receiving services must be voluntary. Such organizations receiving Combating Opioid Overdose through Community-level Intervention funds must ensure that services are offered without regard to religious affiliation 16.D.3.c Packet Pg. 2179 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 6 and that the receipt of services is not contingent upon participation in a religious activity or event. VII. IMPORTANT DATES ➢ Deadline to Submit an Application: November 1, 2019. ➢ Sub-award Start Date: December 2, 2019 ➢ Sub-award End Date: November 30, 2020 VIII. PROJECT PRIORITY AREAS This Notice of Funding Availability will only give consideration to projects relative to the following priority areas: 1. Research activities that involve implementing and evaluating community-based efforts to fight the opioid-involved overdose epidemic 2. Efforts that support and promote the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing opioid-involved overdose and other harms of opioid-involved use and abuse Funding Specifications: The UB will use a tier system when making subcontract awards. Tier 1- up to $150,000 per award designed to support small, innovative projects. Tier 2-$150,001 to $350,000 per award designed to support medium sized, innovative projects. New Tier 2 projects are encouraged to have an evaluation component (either an evaluator who is a member of your staff or a subcontractor hired to conduct an evaluation of your project); however, projects funded through the Combating Opioid Overdose through Community-level Intervention subcontract in the prior year must include a built-in evaluation component. Tier 3-$350,001 to $500,000 per award designed to support large, innovative projects that have a built-in evaluation component (either an evaluator who is a member of your staff or a subcontractor hired to conduct an evaluation of your project). IX. FUNDING EVALUATION The UB will assess the worth of each organization's overall project based on the following: • Problem Statement/ Needs Justification (10%) • Project Description (5%) • Project Priority Area (5%) • Evaluation, Goals and Objectives, and Outcome-Based Performance Measures (40%) • Strategy and Timeline (5%) • Organization Management Capabilities/ Cooperating Agencies (5%) • Project Sustainability (5%) • Budget (25%) 16.D.3.c Packet Pg. 2180 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 7 Additional factors UB will consider in making a funding evaluation are: • Performance history with previous Combating Opioid Overdose through Community- level Intervention awards • The degree of innovation in the project • Whether the project addresses the needs of the community where it will be implemented • The use of evidence-based practices or promising and proven programs • Geographic size and location of the project • Whether new staff are required to implement the project and, if so, how quickly new staff can be hired • Whether the project will require approval of an Institutional Review Board (IRB) and, if so, whether steps have been taken by the applicant to prepare for the IRB review process. • Audit Findings The Combating Opioid Overdose through Community-level Intervention subaward includes a competitive application process. Applicants should ensure they address funding evaluation factors in the appropriate section/s of the narrative in their application. The UB will conduct a review of each application submitted in accordance with this Notice of Funding Availability. X. FUNDING SPECIFICATIONS A. Funding Cycle Awards funded under the Combating Opioid Overdose through Community-level Intervention will commence on December 2, 2019 and end on November 30, 2020. This is a twelve (12) month award. Funds are paid on a reimbursable basis. Note: Cost extensions for sub- recipients’ projects will not be granted under any circumstances. B. Budget Budgets must be clear, specific, and tie directly to performance measures. Budgets must reflect months of spending and, where applicable, be adjusted to reflect start date, state furlough days, and holidays. The UB reserves the right to reduce budgets. The prioritization of line items is required for all applications having multiple line items. Applicant requirements will be taken into consideration should budgets need to be reduced. The justification sections must contain brief statements (1 to 2 sentences per line item) that explain each line item and their relevance to the project goals and objectives. Do not state "See Narrative, Goals, or Objectives". C. Allowable Costs The following is a listing of services, activities, and costs that are eligible for support with Combating Opioid Overdose through Community-level Intervention funds. Before these costs can be supported with Combating Opioid Overdose through Community-level Intervention 16.D.3.c Packet Pg. 2181 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 8 funds, the applicant must agree that direct services cannot be offered without the support for these expenses; and that the sub-recipient has no other source of support for them: • Personnel and Fringe Benefits • Facilities • Travel • Contractual Services • Services • Supplies • Equipment • Indirect Costs D. Unallowable Costs The following services, activities, and costs, although not exhaustive, cannot be supported with Combating Opioid Overdose through Community-level Intervention subaward funds: • Overtime • Lobbying and Administrative Advocacy • Perpetrator Rehabilitation and Counseling • Audit Costs • Property Insurance • Food/Beverage for program staff • Vehicle purchases • Trinkets (items such as hats, mugs, portfolios, t-shirts, coins, gift bags, etc.) E. Indirect Cost Rate Applicants that intend to charge indirect costs through the use of an indirect cost rate must have a Federally-approved indirect cost agreement. Please provide a copy of a current, signed Federally- approved indirect cost rate agreement. Non-federal entities, other than State and local governments that have never received a Federally- approved indirect cost rate, may elect to charge a de minimis rate of 10% of modified total direct costs. If chosen, this methodology, once elected, must be used consistently for all Federal awards until such time as a non-federal entity chooses to negotiate for a rate. Line item justification must include the agency/ organization's direct cost rate illustrating how the indirect cost rate was determined as well as the costs associated under this heading. F. Consultant Rates The limit for consultant rates is $650 per day or $81.25 per hour. XI. DISTRIBUTION OF FUNDS & REPORTING REQUIREMENTS The UB will distribute awarded funds to sub-recipients in conjunction with the timely submission of corresponding Fiscal and Programmatic Reports. These reports must be emailed to the UB. The programmatic reports are due within 15 calendar days following the end date of the quarter; a financial report is due within 15 calendar days following the end of each month. All reporting activity occurs through email. 16.D.3.c Packet Pg. 2182 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 9 Electronic Funds Transfer (EFT) – The UB encourages the use of electronic funds transfer (EFT). To obtain the appropriate form, the address to submit the form, and a general overview, including FAQs, refer to the following website: http://compnet.comp.state.md.us/General_Accounting_Division/Vendors/Electronic_Funds_Tran sfer/ XII. MATCH There is no match requirement for this subaward. XIII. SUPPLANTING, TRANSPARENCY AND ACCOUNTABILITY Federal funds must be used to supplement existing state and local funds for project activities and must not replace those funds that have been appropriated for the same purpose. There are strict federal laws against the use of federal funds to supplant current funding of an existing project. Jurisdictions must provide assurances and certifications as to non-supplanting and the existence of proper administrative/financial procedures. A strong emphasis is being placed on accountability and transparency. Award recipients must be prepared to track, report on, and document specific outcomes, benefits, and expenditures attributable to the use of subaward funds. Misuse of subaward funds may result in a range of penalties to include suspension of current and future funds and civil/criminal penalties. XIV. APPLICATION Notice to All Applicants: The information collected on the subaward application form is collected for the purposes of the UB. Failure to provide all of this information may result in the denial of your application for funding. The UB is a government entity; upon submission, this application is considered public information. The UB does not sell collected subaward information. Under the Maryland Public Information Act (PIA) (MD State Government Code Ann. 10-617 (h) (5)), you may request in writing to review subaward award documentation. Please send those requests to Margarita M. Cardona, MS, CRA Assistant Provost, Sponsored Research University of Baltimore 1420 N Charles St. Baltimore, MD 21201-5779 410-837-6191 A. COVER SHEET INSTRUCTIONS 1. PROJECT TITLE The project title should be brief, precise, and reflect what is being funded. 2. APPLICANT AGENCY 16.D.3.c Packet Pg. 2183 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 10 The organization or government agency that is eligible to apply for subaward funds (See Eligible Applicants). If the Government, Township, or Board of Commissioners mandates that the County Executive, Mayor, or Commissioner sign all subaward award documents (for all subordinate agencies) then the Government, Township, or Board of Commissioners MUST be the APPLICANT Agency. DUNS/SAM Registration: Provide your DUNS number and SAM.GOV. In an appendix, submit proof of your agency's current SAM registration from www.sam.gov. Include a screenshot of just the page that lists your DUNS number and SAM.GOV expiration date. Please do not include any additional pages (i.e., those containing banking information). Access to SAM.GOV: https://www.sam.gov/portal/public/SAM/ Access to DUNS (D&B): http://fedgov.dnb.com/webform/displayHomePage.do;jsessionid=81407B1F03F2BDB123DD47 D19158B75F . 3. IMPLEMENTING AGENCY The name of the entity that is responsible for the operation of the project. 4. PROPOSED START/END DATES Start and end date are determined by the parameters of the NOFA. Projects may not exceed twelve (12) months or commence before the NOFA defined start date. 5. PREPARER INFORMATION Enter the name of the person completing the application, their mailing address, phone number and email address. 6. PROJECT DIRECTOR Select the person who will be responsible for oversight and administration of the project on behalf of the applicant. Enter the name of the person, their mailing address, phone number and email address 7. FISCAL OFFICER Identify the person who will be responsible for financial reporting and record keeping for the project. Enter the name of the person, their mailing address, phone number and email address. 8. CIVIL RIGHTS CONTACT Select the agency's point of contact for handling internal civil rights violation complaints (usually a Human Resources or Personnel Manager). B. SUMMARY INSTRUCTIONS 16.D.3.c Packet Pg. 2184 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 11 The Project Summary should provide a concise summary of your proposal and be limited to 150 words or less. Be sure to include the name of the implementing agency, the project’s main function, and a brief explanation of the budget for the subaward. Note: UB may use your summary for press releases should your application receive a subaward. C. NARRATIVE INSTRUCTIONS Provide a description of the project timeline, and potential for information sharing. The contents for the narrative are explained below. The Narrative must be in an outline-styled format (retaining all numbering, lettering, and headers). The Project Narrative may not exceed 10 pages, excluding the Cover Sheet and Appendices. Applications that are incomplete and/or improperly formatted will not be considered for funding. ➢ Use a New Roman typeface and a font size of 12 points ➢ Use standard letter size (8 ½” x 11”) sheets of paper ➢ Use at least one-inch margins (top, bottom, left, and right) for all pages ➢ All page limits specified refer to double-spaced format using the above formatting requirements 1. Problem Statement: Include a description of the nature and extent of the problem to be addressed, target population, and geographical area served. Provide the latest statistical data to document the problem. Describe past effort made to address this problem. Explain how this project will address the identified problem. 2. Project Description: This section of the application should contain a general description of activities that justifies and describes the project to be implemented. The project description should include specific services that will be provided and explain what the project will accomplish. 3. Project Priority Areas and Evidence-based Categories: This section must identify the Project Area Priority area/s and Evidence-based Category that the proposed project/ activity will fall under and specifically detail how the project relates to the priority area and evidence-based category. Combating Opioid Overdose through Community-level Intervention priority areas: 1. implementing and/or evaluating community-based efforts to fight the opioid overdose epidemic 2. supporting and promoting the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing overdose and other harms of opioid use and abuse 3. Both 1 & 2 above Evidence-based categories: • Drug misuse prevention • Drug misuse early intervention – such as Adverse Childhood Experiences (ACEs), Trauma-informed responses for children and families (e.g. Handle with Care programs) 16.D.3.c Packet Pg. 2185 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 12 • Treatment for substance use disorders/drug misuse • Recovery programs for substance use disorders/drug misues • Harm reduction programs • Drug policy reforms • Healthcare systems interventions • Criminal justice interventions • Drug-related innovative technologies • Polysubstance misuse • Methamphetamine and other stimulant misuse 4. Evaluation Plan, Goals and Objectives, and Outcome-Based Performance Measures: Each applicant must submit an evaluation plan that describes how the applicant intends to maintain records of services provided, how services are provided, and how the desired or intended changes and effects will be measured. Each application must include clearly defined goals, objectives, and outcome-based performance measures. Goals: Provide a broad statement that conveys, in general terms, the project’s intent to change, reduce, or eliminate the problem described. Goals identify the project’s intended short and long- term results for the anticipated funding year. Explain how the project will accomplish the goals. Objectives: Objectives are specific, quantifiable statements of the project’s desired results, and should include the target level of achievement, thereby further defining goals and providing the means to measure project performance. Outcome-based Performance Measures: The UB encourages projects to focus on delivering products and services and show their efficiency and effectiveness via outcome measures. 5. Strategy and Timeline: This section details any planning process that was undertaken in developing the plan of response. Further, it should provide an overview of the strategy to be employed and the timeline for implementing the strategy. Include linkages to other programs, organizations, and stakeholders that will be involved in or impacted by your program. Applicants must submit a detailed timeline/work plan. This timeline/work plan must include: • Key tasks that must be carried out to implement the project successfully • Person(s) responsible for seeing that each task is completed within the proposed timeline • Target dates for task completion 6. Management Capabilities: Qualifications and Experience: Provide a brief description of the experience and achievements that qualify the organization or agency to conduct the project. Present and Proposed Staff: List the name of the project director and in an appendix provide a resume or curriculum vitae (no more than 3 pages) for this individual. List the names and provide a short professional biography of the key consultants, financial officer, and other professional staff members. Clearly identify, by name and title, requested personnel. Indicate 16.D.3.c Packet Pg. 2186 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 13 how all requested staff are currently funded (i.e., name subaward fund or state that personnel are line items in the existing agency budget. If funded by more than one source, list percentages for each funding source). 7. Project Evaluation & Sustainability: Also include what prospects exist for continued financing of the project when subaward funds are terminated: What efforts have been or will be made to continue the methods, techniques, and operational aspects of the project when the subaward funds are concluded? Indicate planned future sources of funding or proposed jurisdictional planning efforts. 8. Letters of support/commitment In an appendix, provide letters of commitment by partners who will participate in the execution of the project or whose cooperation and support are necessary to its success. Letters of support/commitment are not optional. The participating HIDTA must provide a letter of support/commitment signed by the sponsoring HIDTA Director for this subaward application to receive consideration for funding. D. BUDGET INSTRUCTIONS BUDGET – GENERAL REQUIREMENTS You must complete a detailed budget for your proposed project. All 'Total Budget' fields must be rounded to the nearest whole dollar. Budgets must be clear and specific. Budgets must reflect twelve (12) months of spending and where applicable, be adjusted to reflect start date, state furlough days, and holidays. The subaward cycle will reflect twelve (12) months, December 2, 2019 to November 30, 2020. Each budget line item must include a justification entry. The justification sections must contain brief statements (1 to 2 sentences per line item) that explain each line item and their relevance to the project goals and objectives. Do not state "See Narrative, Goals, or Objectives”. PERSONNEL AND FRINGE BENEFITS List the personnel/positions, salaries and fringe benefits for staff required to implement the project. Consultants must be listed in Contractual Services. Either Time and Effort reports or Timesheets must be maintained for all personnel included in the subaward project. If you are paying an employee directly, they should be entered in the Personnel category. For each position, list salary and fringe benefits on separate line items. - The ‘Description of Position' field must contain the title of the position. - Position line items (salary and fringe) are grouped via the ‘Description of Position' field. - After completing the first Position's line item, use the dropdown to add additional budget items to the position. - The ‘Description of Position' is used to select existing positions and to add new positions. - For multiple staff in the same position, use a suffix (i.e., Position 1, Position 2, etc.) - Multiple positions with the same hourly rate may be grouped. Note: For each line item entered, you must include a justification that ties that item to the activities described in your narrative. Example justifications based on the Personnel category: 16.D.3.c Packet Pg. 2187 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 14 Justification (line 1): The Community Outreach Coordinator helps prepare, schedule, and develop trainings targeted for hospitals and other medical facilities. Annual salary is $60,000. She will be devoting 33% of her time to this project. We are requesting $60,000 x.33 = $20,000 in subaward funds to support her time on this project. Justification (line 2): Fringe benefits @ 10% of salary. $20,000 x .10 = $2,000 Justification (line 3): The Community Outreach Trainer makes presentations at hospitals and other medical facilities. Annual salary is $40,000. She will be devoting 25% of her time to this project. We are requesting $40,000 x.25 = $10,000 in subaward funds to support her time on this project. Justification (line 4): Fringe benefits @ 10% of salary. $10,000 x .10 = $1,000 FACILITIES Facilities refers to costs associated with leased space and rent. For each line item entered, you must include a justification that ties that item to the activities described in your narrative. TRAVEL AND TRAINING Travel expenses may include mileage and/or other transportation costs, meals and lodging consistent with the local jurisdiction's travel regulations and cannot exceed the State of Maryland reimbursement rate specified below. Training includes, but is not limited to, such costs as registration fees or tuition. For each line item entered, you must include a justification that ties that item to the activities described in your narrative. Mileage maximum: $.58 cents/mile as of 1/1/2019. Maximum Per Diem/Meal Allowance is $47/day ($10 Breakfast, $12 Lunch, $25 Dinner). *Lodging Per Diem must follow the GSA rate: https://www.gsa.gov/portal/content/104877 SERVICES Services include, but are not limited to, costs associated with telephone, copier, and utility services. For each line item entered, you must include a justification that ties that item to the activities described in your narrative. CONTRACTUAL SERVICES Consultant contracts for training or evaluation should be included here and shall be consistent with federal guidelines. If you are paying an outside agency for an employee, they are Contractual. For the line item description, enter the agency (Consulting firm, temporary agency, etc.), a dash and then the nature of the service to be provided (e.g., Consultants ABC – analyze evaluation data). For each line item entered, you must include a justification that ties that item to the activities described in your narrative. A copy of all contracts associated with items listed in the Contractual Services category must be provided to UB within 30 days following receipt of subcontract award. 16.D.3.c Packet Pg. 2188 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 15 Construction projects are ineligible for funding under subaward projects and expenses for construction may not be included. SUPPLIES Supplies include those items with an expected life of less than one year and that cost less than $5,000 per unit. Supplies include, but are not limited to, items such as lap top computers, telephones, recorders, projectors, cameras, calculators, pencils, paper, paper clips, staplers, and folders, etc. For each line item entered, you must include a justification that ties that item to the activities described in your narrative. EQUIPMENT Equipment is defined as having a useful life in excess of one year. Property Inventory Report Forms (PIRFs) will only be required for equipment that costs $5,000 or more per unit cost. Costs include taxes, delivery, installation and similarly related charges. The procurement process used must be consistent with your written procurement guidelines. For each line item entered, you must include a justification that ties that item to the activities described in your narrative. Maintaining internal inventory records for equipment procured under this subcontract is mandatory. INDIRECT COSTS Include the indirect costs and computations illustrating how the indirect costs were determined. E. APPLICATION STATUS INSTRUCTIONS After completing and reviewing all sections of the application, email your application to OSR@ubalt.edu, return receipt request. If the email is received by the UB, you will receive a receipt for your submission. Be sure to retain your receipt. Your Application will be placed in a pending file while it is considered for funding. After the UB has considered your application, you will be notified by email whether your application was selected for funding. F. DOCUMENTS INSTRUCTIONS Included required forms (e.g. Letters of Support) and other required documents in an appendix to your application. G. SIGNATURE PAGES The Certified Assurances and Federal Anti-Lobbying Certification must be signed by the appropriate agency representative and included with the application. Both forms may only be signed by the Applicant Agency's Authorized Official or their duly assigned alternate signatory. H. AUDIT FINDINGS / CORRECTIVE ACTION PLAN Applicants must submit copies of any Audit Findings and Corrective Action Plans with the application. Do not send a copy of your audited financial statements; ONLY the applicable audit findings and/or corrective action plan is required. 16.D.3.c Packet Pg. 2189 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant 16 XV. CERTIFIED ASSURANCES A. Certification Regarding Lobbying B. Assurances – Non-Construction Programs XVI. ENDNOTES 1. https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/ 2. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis). 3. https://www.cdc.gov/nchs/products/databriefs/db329.htm). 4. https://www.cdc.gov/nchs/products/databriefs/db329.htm). 5. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w 6. https://www.cdc.gov/nchs/products/databriefs/db329.htm). 7. https://www.cdc.gov/mmwr/volumes/68/wr/mm6817a3.htm?s_cid=mm6817a3_w 8. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf 9. https://www.dea.gov/documents/2018/01/11/2017-domestic-methamphetamine-threat- assessment-key-findings 10. https://www.dea.gov/documents/2018/01/11/2017-domestic-methamphetamine-threat- assessment-key-findings 11. https://www.businessinsider.com/farmers-in-colombia-relying-on-economic-benefits-of- cocaine-production-2018-3; https://www.dea.gov/sites/default/files/docs/DIR-040- 17_2017-NDTA.pdf 12. https://www.whitehouse.gov/wp-content/uploads/2019/01/NDCS-Final.pdf 16.D.3.c Packet Pg. 2190 Attachment: UB_NOFA -2019_FINAL (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant FY 2019 Competitive Subaward Solicitation Combating Opioid Overdose through Community -level Intervention Cover Sheet Form 1. Project Title: Collier Co. COOCI Grant Application 2. Applicant Agency: Collier Co. Board of County Commissioners DUNS NUMBER:_ 076997790 Address; 3299 TamiamEIN NUMBER: t Troll E., Suite 303, Naples, FL 34112 59-6000558 _ 3. Implementing Agency: Collier Co. Sheriff's Office Address: 3319 Tamlaml Trail E., Naples, FL 34112 4. Start Date: 12/2/19 S. PreparerInformation: Address: End Date: 11/30/20 Marien Ruiz 3319 Tamiami Trail E., Naples, FL 34112 6. Project Director: Address; Katina Bouza 3319 Tamiami Trail E., Naples, FL 34112 7, Fiscal Officer: Maggie Lopez Address: 3339 Tamiami Trail E.,Bldg. H, Naples, FL 34112 g. Civil Rights Contact: Chief Chris Roberts Address: 3319 Tamiami Trail E., Naples, FL 34112 i�u woras or less: Marien.Rulz@colliersheriff.org Phone, 239-252-0852 Email: Katina.Bouza@colliersheriff.org Phone: 239-252-9645 Email; maggie.lopez@colliercounlyfl.gov ---. 239-252-4274 Email: Chris.Roberts@colliersheriff.org 239-252-9541 The Collier County Board of County Commissioners requests $500,000 in funding that would allow the expanded use of Medication -Assisted Treatment (MAT) to all inmates within the jail who are receiving MAT prior to incarceration and to those seeking MAT prior to their release. Currently, only pregnant inmates receive any MAT while incarcerated. The program would provide not only medication, but also oversee the inmate's treatment while in custody and link inmates to services upon their release. The program would provide for the hiring of an Advanced Practice Registered Nurse (APRN), a Licensed Practical Nurse (LPN), a drug treatment counselor, a case manager and a peer specialist. In addition, the jail would collect MAT data for analysis by a third -party consultant to examine the usefulness of MAT within the county corrections system and, if appropriate, use the findings as a catalyst for ongoing MAT efforts in the jail. 1. Problem Statement The Collier County population estimate in 2018 was 378,488, with most residents concentrated along the Gulf Coast, Collier County includes the incorporated cities of Naples and Marco Island as well as the agricultural and fishing communities of Immokalee and Everglades City. As can be expected, our population increases during the winter months with returning seasonal residents and tourists from around the world. A sharp contrast in population characteristics exist between the city of Naples, on the Gulf Coast, and Immokalee, a largely migrant farm worker community located inland. In Immokalee, 45% of the residents are at or below the poverty level, while in Naples, the poverty level is 8.9%. Collier County overall has a high number of uninsured adults at 21.6% compared to state population of 15.4% (US Census Estimates, 2018). During the 2018 calendar year, Collier County documented 173 opioid overdoses: 31 were fatal and 142 non-fatal. hi July 2018, Collier County Sheriff's Office (CCSO) deputies began carrying naloxone. There were 98 deployments of naloxone by CCSO through December. In 2019, January through September 30, Collier County documented 316 overdoses, 20 were fatal and 296 were non-fatal. There were 218 deployments of naloxone by CCSO and EMS. Collier County has two area hospital systems, NCH Healthcare System and Physicians Regional Medical Center (PRMC), which treat overdoses. Collier County only has one nonprofit addiction treatment facility which serves the uninsured, David Lawrence Center (DLC). In addition, Hazelden Betty Ford is a nonprofit addiction treatment center; however, they do not serve the uninsured. Other treatment facilities in the County are for-profit and expensive. Collier County lacks a locked detox facility and is currently pursuing the construction of such facility with local government surtax funding. 1 Our local community behavioral health treatment center, David Lawrence Center had over 700 treatment admissions for heroindopioids across the treatment continuum (including detox and residential but not including Drug Court), in 2018. The Collier County Jail collects data at intake on irmiates' drug use, based inmates' self- report. During the 2" d quarter of 2019, the Collier County Jail admitted 2,328 new inmates. Five percent (5%) of those inmates self-reported to using opioids. The Collier County Jail currently administers medication -assisted treatment (MAT) for pregnant inmates who are established with MAT at the time of their arrest. Additionally, inmates enrolled in the Drug Treatment Court, who are at a very high risk for overdose upon release, can receive a Vivitrol injection, up to 30 days prior to their expected release from custody. Due to lack of funding, fewer than 1% of the defendants enrolled in Drug Court are able to receive Vivitrol prior to release from incarceration. Due to lack of resources for MAT, apart from pregnant inmates and those few inmates enrolled in Drug Court, we are not able to offer evidence -based MAT in jail for treatment of substance use disorders and management of withdrawal. 2. Project Description The Collier County Sheriffs Office tracks overdoses in Collier County with our partner, Highway Intensity Drug Trafficking Area (HIDTA). With this information, we would like to begin assisting the drug -addicted population with medication -assisted treatment; specifically targeting those who have a substance use disorder and are already on MAT at the time of their intake, or those who wish to begin MAT prior to their release fi•om incarceration. It is common for incarcerated individuals with substance use disorders to overdose post -release, due to a diminished tolerance during incarceration. This new program would provide not only medication, but also establish a select group of dedicated staff members who will oversee the inmate's K treatment, while in custody, and will link the inmate to services upon their release. This program will include an Advanced Practice Registered Nurse (APRN), a Licensed Practical Nurse (LPN), a drug treatment counselor, a case manager and a substance use recovery peer specialist. New inmates who indicate that they are receiving MAT in the community, or who are willing to begin using MAT while in custody, will be identified by medical intake staff: • An LPN will verify the inmate's medication and treatment in the community. • The inmate will provide a urine drug screen. • Designated staff member will complete a standardized substance use disorder screening, using the Texas Christian University Drug Screen (TCUDS-5). • The inmate will be referred to the APRN for an evaluation and treatment plan. • The inmate will be offered buprenorphine (Suboxone/Subutex/Sublocade) as appropriate. • The inmate will be screened for the jail's substance use treatment program, Project Recovery. • The inmate will attend regular Alcoholics Anonymous/Narcotics Anonymous (AA/NA). • A case manager will work with the inmate to create a plan for continuing services in the community that address substance use and medical care through the public health system. • A peer specialist will be assigned to the itunate to provide mentorship and support for the inmate, not only while incarcerated, but post -release. • The inmate will receive education regarding the use of naloxone for opioid overdose and will receive naloxone at the time of their release from custody. This program will increase the number of inmates who are receiving MAT prior to release from jail. CCSO anticipates that this program will assist in decreasing the number of opioid overdoses in Collier County. 3. Project Priority Areas and Evidence -based Categories The Collier County Jail's first priority would be to focus on inmates who are already receiving MAT at the time of their arrest. The second priority would be inmates identified as having a substance use disorder who wish to begin medication -assisted treatment while incarcerated. We do not anticipate any difficulties, with sufficient resources, in providing at least two forms of MAT (buprenorphine, Vivitrol/naltrexone) in the jail setting. We work closely with our medical contractor (Armor Correctional Health Services) and the David Lawrence Center who are aware of the challenge in providing MAT due to resource constraints. Approximately 50% of our irmiate population suffers from substance use disorders. While not all of them are willing or ready to go into a treatment program, with the addition of MAT, we believe at least half of those identified as appropriate for services and offered these specialized services will participate, based on our most recent three-month arrest data. a. Evidence -based Categories: i. Standardized Assessment: Texas Christian University Drug Screen (TCUDS-5) identifies individuals with a history of substance use disorders (based on the DSM and the NIMH Diagnostic Interview Schedule). It is particularly useful and widely used as a tool in criminal justice settings for identifying offenders eligible for treatment services and recommended by SAMHSA for screening of SUD n criminal justice settings. ii. Substance Use Counseling through Project Recovery: This program includes Twelve - Step Facilitation (a manual -guided therapy based upon the 12 -step model outlined in the Alcoholics Anonymous "Big Book." The intervention focuses on the patient's acceptance of his/her use as a disease, using 12 -step tools, and connecting with recovering persons in 2 the fellowship), as well as individual and group counseling interventions designed to replicate as closely as possible the treatment approaches most routinely delivered in the community. Interventions focus on direct problem -solving to initiate abstinence, identify triggers and prevent relapse, and facilitate 12 -step group involvement. The program also incorporates principles of cognitive psychology and social learning theory and teaches patients to develop new cognitive and coping skills for substance use behaviors. Cognitive - behavioral therapy has been effective in reducing alcohol and ding use and in supporting improvement in other life domains. v. Motivational Interviewing: Motivational interviewing is a directive, patient -centered counseling approach that aims to help people change problem behaviors. Motivational interviewing has been found to reduce substance use among individuals with DSM -5 substance use disorders. vi. Medication -Assisted Treatment: Buprenorphine is a partial agonist, semi -synthetic opioid analgesic. Buprenorphine is currently available to trained and certified physicians and pharmacies. In addition, it has been shown to have a high affinity for the mu opioid receptor. It is safe, long acting, and has a mild dependence potential. Vivitrol/naltrexone: Vivitrol (naltrexone) blocks the effects of opioid medication, including pain relief or feelings of well- being that can lead to opioid abuse. An opioid is sometimes called a narcotic. Vivitrol is used as part of a treatment program for drug or alcohol dependence. ix. Criminal Justice Interventions: Naloxone counteracts the life-threatening effects of an opioid overdose. Since most accidental overdoses occur in a home setting, it was developed for first responders, as well as family, friends, and caregivers—with no medical training required. 5 4. Evaluation Plan, Goals and Objectives, and Outcome -Based Performance Measures Table 1: Proeram Tasks Task Responsible Party Maintain electronic records and data of inmates in Collier County Jail the MAT program (demographics, drug use history, % Of inmates continued on MAT overview of criminal history, TCUDS-5 assessment inmates on results, participation in MAT, participation in incarceration Project Recovery, AA/NA meetings, continuum of inmates positive screen not on MAT care plan, Naloxone education and receipt) Assessment and evaluation of inmate, urinalysis, Collier County Jail's Medical prescribing and administering the medication Contractor LPN APRN Provide Substance Use Treatment Program (Project David Lawrence Center Recover TCUD screening for all arrested Research criminal history once a year to track Collier County Jail recidivism for MAT participants those interested Review overdose data (once a month) and compare Collier County Jail with previous year screening Table 2: Proeram Goals and Objectives Short -Term Goals Objectives Outcomes Provide MAT for inmates who Continue % Of inmates continued on MAT are on MAT at the time of inmates on participating in Project Recovery vs. % of incarceration MAT inmates positive screen not on MAT who are positive on screening participating in Project Recover Provide MAT to inmates who Successful Decrease the negative withdrawal test positive for opioids at arrest withdrawal symptoms b administering MAT TCUD screening for all arrested Initiate MAT for % of inmates showing success with SA those interested recovery while incarcerated= negative drug in MAT screening Educate inmates on Naloxone Number of % Decrease in the number of overdoses in and provide MAT inmates with Naloxone the community Naloxone at time of release issued Long -Term Goals Objectives Outcomes Start MAT for imnates with Number of inmates % of inmates that transition to substance use disorder who wish who begin MAT community tx and MAT post release to begin MAT while incarcerated while incarcerated who are positive on screening tool Opioid involved arrests Decrease # of drug % of imnates using opioid or positive related arrest in TCUD screening for SA at the time of arrest Reduction in opioid use Reduce the number Percent decrease by month compared of opioid overdoses to prior year in Collier County Reduction in IV drug use Management of physical health Engage participants Overall improvement in physical iu health care 5. Strategy and Timeline: CCSO, David Lawrence Center, and other community partners collaborate in the Criminal Justice, Mental Health and Substance Abuse Community Reinvestment grant (CJMHSA) through the State of Florida's Department of Children and Families. This grant combines community treatment providers with jail staff to facilitate a smooth transition to the community while providing treatment services to reduce recidivism. Collier County is currently participating in a planning initiative to establish a local comprehensive criminal justice continuum of care for individuals with opioid use disorders through the `Building Bridges between Jails and Community Based Treatment" grant affiliated with the Bureau of Justice Assistance (BJA) and the Comprehensive Opioid Abuse Program (COAP). Collier County is one of sixteen communities in the country participating in the BJA Technical Assistance Program. As part of this initiative Collier County receives ongoing technical assistance and guidance for program implementation. Collier County has established a Mental Health and Substance Abuse Ad Hoc Advisory Committee that provides recommendations and input to the Board of County Commissioners. The Advisory committee is composed of representatives at -large with experience or a demonstrated interest in mental illness and substance use disorders. This advisory board has prepared a countywide strategic plan to address mental health and substance abuse issues. The County has 7 taken a proactive approach and is actively engaged in seeking alternatives and approaches to address substance use and the opioid epidemic while engaging the public health system. Table 3: Community Partnership Board of County State Probation Collier County Emergency Commissioners Evaluate program Communications Responders Chief Circuit County Probation National Alliance on Collier County Judge Continue stakeholder Mental Illness (NAMI) Health Dept. performance meetings meetings Public Health County Court David Lawrence Center Hospitals meetings Judge Begin identification of Begin administering Begin State Attorney Southwest Florida Medical Practitioners administering MAT identified inmates Workforce Development Project Recovery who to new intakes who Public Defender Court Administration Universities want to start MAT Table 4: ILnplementation Timeline Quarter 1 Quarter 2 Quarter 3 Quarter 4 Conduct stakeholder Evaluate program Evaluate program Evaluate program and meetings performances performances performances Establish baseline Continue stakeholder Continue stakeholder Continue performance meetings meetings stakeholder measures meetings Begin administering Begin identification of Begin administering Begin Buprenorphine to hates participating in MAT to inmates in administering MAT identified inmates Project Recovery who Project Recovery who to new intakes who are interested in starting expressed interest in want to start MAT MAT starting MAT Begin education and Continue administering Begin identification Complete program disbursement of Buprenorphine to new of new intakes who evaluation. Begin Naloxone intakes on MAT in the are interested in tracking recidivism community and starting MAT Naloxone 6. Management Capabilities The Collier County Sheriffs Office (CCSO) has long-standing relationships with partners who play a role in a defendant's treatment and/or sentencing structure. These partners include, but are not limited to Judges, prosecutors, defense attorneys, medical providers, public health, E hospitals, mental health and substance abuse treatment centers. These partnerships allow for special treatment plans for imnates who suffer from substance use disorders and/or mental health illnesses. The Corrections Division has extensive experience in the development of inmate programming and currently offers inmates a variety of inmate programs, which have been proven to reduce recidivism. These programs include the substance use treatment program Project Recovery (a twelve -week program serving approximately 45 inmates at a time), GED/Workforce Program, the Travelling Classroom, Second Chance Cell Dog Program, Domestic Animal Services and the Culinary Arts Program. Inmates who complete these programs have a greater chance of success post -release than those who do not participate in innate programs. The Corrections Division members work closely with its criminal justice and community health partners to develop treatment plans for inmates returning into the community, through the Reentry Section. The Univ of Baltimore/COAP grant will allow for a much-needed medication - assisted treatment program, which will assist inmates with their substance use disorders. This program will enable defendants to live successful and productive lives post -release from incarceration. These services will include access to medication -assisted treatment, specialized treatment services, case management to assist with linkage and referral to community-based care, and recovery peer support. The partnerships within the community, especially with the sole community behavioral health service provider (DLC), will be beneficial to the program and to the defendants returning to the community with wrap-around services and access to a comprehensive continuum of care. Collier County Community & Human Services (CHS) Division will provide the grant oversight. CHS is the management entity for all grants received in the Public Services N Department's seven divisions. CHS prepares and administers approximately $30M in grant funding annually across all 7 divisions. The division maintains a robust grant administration component with seasoned staff with over 20 years of grant administration, a fiscal team and a compliance team responsible for regulatory conformity. While CHS provides grant administration, the Division is also responsible for delivering services to citizens that meet their basic health and social needs when there are no other resources available, such as prescription reimbursement to those in need, senior services, and managing various affordable housing opportunities in the community. 7. Project Evaluation and Sustainability The Collier County jail will engage an evaluator throughout the term of the grant to evaluate the effectiveness of the program and to study the long- and short-term outcomes using qualitative and quantitative measurements. We have obtained and secured BJA qualified evaluators who have expertise and education in the area of MAT and opioid use. The evaluator will conduct pre and post evaluations as a means of measuring success of the project and provide on-going feedback for project improvement. This will give the Collier County Jail information as to the successes of the MAT Program and if it should be continued. This grant will provide the much needed data to support future funding requests, refinement of program objectives and data on the designs effectiveness in combating opioid addiction. The Collier County Jail plans for financial support of the MAT Program, once this funding source ends. Funds will be earmarked with each budgetary cycle, The Collier County Jail will also continue to seek grant funding to assist in the costs for the MAT Program. This grant will provide much-needed funding for the Collier County Jail to implement the MAT Program in the Jail. 10 APPENDICES Appendix A — DUNS/SAM.Gov Registration Appendix B — Letters of Support Appendix C — Budget Appendix D — Certified Assurances & Federal Anti -Lobbying Certification Appendix E — Audit Findings and Corrective Action Plan Appendix F — Management Capabilities & Qualifications (including proposed position descriptions) APPENDICES APPENDIX A DUNS/SAM.GOV Registration 16.D.3.e Packet Pg. 2191 Attachment: CM Approval Memo (10664 : After-the-Fact Combating Opioid Overdose through Community-level Intervention grant application)