A Pathway to Hope, Part 1: Poverty and the Opioid Crisis

Uncover the foundations of the Opioid Settlement, how and why they were established, the challenges they have faced, and what success looks like as community leaders move forward with their individual missions.

The opioid epidemic has devastated communities across the United States. The National Opioids Settlement and other settlement agreements have created a sense of hope for families and communities affected by the opioid crisis and provided a profound opportunity for states across the nation to begin to repair the damage the epidemic has wrought.

This event was the opening discussion at the University of Notre Dame’s Summit on the Opioids Settlement: A Pathway to Hope which focused on how to most effectively distribute the nearly $50 billion in settlement dollars to maximize the impact on our communities and citizens.

Held in August 2024, this summit brought together attorneys general from across the country to discuss best practices to proactively evaluate the efficacy of opioid abatement programs and develop strategies to best distribute the funds. Led by the University of Notre Dame’s Poverty Initiative, the summit explores how evidence-based practices can inform decision making and ensure that the Opioids Settlement best helps those victims it is meant to serve.

Speakers:

• Jim Sullivan ’93, director of the Poverty Initiative, academic director and co-founder of the Wilson Sheehan Lab for Economic Opportunities at the University of Notre Dame
• Rev. Robert A. Dowd, C.S.C., president of the University of Notre Dame
• Rev. Edward “Monk” Malloy, C.S.C., president emeritus of the University of Notre Dame
• David Go ’01, vice president and associate provost for academic strategy and the Viola D. Hank Professor of Aerospace and Mechanical Engineering at the University of Notre Dame
• Jonathan Board, Executive Director, West Virginia First Foundation
• Don Mason, Board Chair, One Ohio Recovery Foundation
• Alisha Nelson, Executive Director, One Ohio Recovery Foundation

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Transcript

0:06

Good evening. I want to welcome you all to the campus of the University of Notre Dame and to A Pathway to Hope, a summit on the National Opioid Settlement. My name is Jim Sullivan, and I'm a professor of economics here at Notre Dame and director of the university's Poverty Initiative. I'm also a co founder of the Wilson Sheehan Lab for Economic Opportunities, or LEO, which is a research center with a mission to identify evidence based solutions to poverty. We are so grateful that you all have taken the time to be with us focused on an issue that has devastated so many lives and communities across this country and to engage with us in a conversation on how to deploy the National Opioid Settlement in the most effective way possible. Poverty, and the opioid crisis are intimately connected. the tragic effects of this epidemic are widespread, it is the most disadvantaged communities that have been hit the hardest. Those without a high school degree are nine times likely to, face a drug related death than college grads. you know this from seeing it in your own communities and from the work you do. The University of Notre Dame is committed to understanding the root causes of poverty and advancing programs that improve outcomes for the most vulnerable. The opioid crisis and the recent settlement created urgency for a better understanding of how to improve outcomes for those afflicted by this epidemic. The lives of hundreds of thousands of individuals and billions of dollars are at stake. While there's a critical need for research to inform best practices, we also know that researchers by themselves are not going to provide the answers. This effort needs to be informed by those on the front lines. by state officials leaders of foundations and the social service providers who are working to address this crisis in their communities. that's why we're all gathered here tonight. Our goal is to provide a forum for conversation and planning on the most pressing issues faced by communities and families across this country. Our hope is to have in place a foundation for a research agenda that is informed by the feedback that you all give us. So our ask of you is to actively participate in all of the discussions over the next day. We need your voices in order to identify the solutions that are the most essential and that will help us build a path forward for an evidence informed response to this crisis. We want to learn from you. Now I'd be remiss if, I didn't recognize one person in particular. Paul Farrell. Paul, will you raise your hand? I'm quite certain you all are going to get to know Paul well over the next, 24 hours. Paul's a Notre Dame alum who embodies the university's call for a disciplined sensibility to the poverty, injustice, and oppression that burdens the lives of so many. Paul is a trial lawyer who played a key role in the National Opioid Settlement. And in particular, the pivotal case with Purdue Pharma. over the past year, I have had the good fortune of getting to know Paul a little bit. while I'm not a lawyer, I am certain I would never want to face him in a courtroom. Paul is passionate about his work. With relentless energy for him, this crisis is personal because he's seen firsthand the impact it has had on his own community. Paul has also been an amazing partner for Notre Dame as we work to build evidence around solutions to this crisis. he has played a pivotal role in the event, over today and tomorrow. please join me in thanking Paul for all he has done to bring to light this crisis and the needed solutions. it is my great pleasure to introduce Father Bob Dowd, president of the University of Notre Dame. Father Bob became Notre Dame's 18th president this June, and we are grateful for his leadership. A member of Notre Dame's political science department since 2004, he is a popular teacher. He is also the founder of Notre Dame's Ford Program in Human Development Studies and Solidarity. Specializing in comparative politics, his research focuses on how Christian and Islamic religious communities affect support for democratic institutions. especially in Sub Saharan Africa. Prior to his appointment as president, Father Dowd served as vice president and associate provost for interdisciplinary initiatives, overseeing a number of departments and institutes. He holds a bachelor's degree in psychology and economics from Notre Dame, An M. A. in African Studies and a doctorate in Political Science from UCLA. Ordained a priest in the Congregation of Holy Cross in 1994, Father Bob served previously as Religious Superior. of the Holy Cross Priests and Brothers at Notre Dame, and has ministered to students on campus for many years as a priest in residence. Join me in welcoming Father Bob. thank you, Jim. for that kind introduction. welcome to Notre Dame, everybody. It's wonderful to have you here. It's an honor. to host this summit on our campus and this summit is so important. It's core to our mission here. As Jim noted, in our mission statement, we espouse to a disciplined sensibility to poverty, oppression, and injustice that burden the lives of so many. we know that the opioid crisis has only added to the burdens of countless communities in our country and beyond. And also, it has disproportionately affected economically at risk populations. I know that many of you in this room have been on the front lines, as Jim mentioned. You've experienced this firsthand. And so it's wonderful that you're here to help inform, our efforts. This really is a joint collaborative effort. It's going to require all of us to work together, we know that. So thank you for being here once again. We really look forward to working together to deepen our intellectual capacity to study poverty. this summit is one way we are working towards that goal. I am grateful for the work of Jim Sullivan, Bill Evans, Heather Reynolds, And everybody at LEO, I'm also grateful to everyone working on our poverty initiative and the support provided by the provost's office here. Beyond just welcoming you here to Notre Dame, it's my great honor to introduce you to our first speaker, who is someone I've known for a long time, and someone who's no stranger to the search for evidence based solutions. To the ongoing substance abuse crisis in our country. He is my good friend and mentor, Father Edward Monk Malloy. he served as the University of Notre Dame's president from 1987 to 2005. He led Notre Dame at a time of rapid growth in our reputation, growth. in the equality of our faculty and the growth in resources to do good. He has an extraordinary legacy as Notre Dame's president. And Father Molloy has also played a major national leadership role in efforts to promote community service and to combat substance abuse. This Molloy, who we, affectionately call Monk around here. I know this is something that Monk cares about deeply, and he has been devoted to for so long. He's been a member of the National Advisory Council on Alcohol Abuse and Alcoholism, President Bush's Advisory Council on Drugs, the Community Anti Drug Coalitions of America, the Governor's Commission for a Drug Free Indiana, and he's currently a member of the Board of the Partnership to End Addiction at Columbia University. He has chaired a number of commissions, particularly dealing with substance abuse among adolescents and college and university students. He was co chair of a major study on college drinking for the National Institute on Alcohol Abuse and Alcoholism. Thus, I'm sure you'll agree that he is a most fitting speaker here this evening. So please join me in welcoming to the stage, Dr. Father Edward Monk Malloy. This afternoon in my office, I received an email from another named person, and she shared the story of her son, who became addicted, after, dental surgery. And, had an excess of pain reliever and, now has disappeared and they don't know where he is. I have a niece who went to Notre Dame. she is now a heroin addict. she's been in and out of rehab on multiple occasions. She started out, addicted to alcohol and Ambien. then she met somebody in one of the rehab situations. Who was a heroin addict, got back into it, and so on. These are the sorts of things that happen in families. Nobody wants these to happen. But what to do about it is the challenge. I think the Poverty Initiative here at Notre Dame has the right set of priorities. We're taking this on in partnership with all of you. We want to be a force for good in the world. We want to give a preference to the poor and to those who are vulnerable, and we want to do this in a way that takes advantage of the expertise of so many of us. As most of us know who are in the academy, you've got to find a focus to bring people together, otherwise they're in their little worlds. I've had a chance through these various levels of participation in matters related to substance abuse, to see some of the best research available. When I was at NIH as a reviewer of alcohol related research, my role was to make sure that the process was fair. For example, the question, how many women were part of the research as well as men. What were the ages in which people were being evaluated in the research that was being done? What about the ethnicity and race? I didn't have to know a lot about the particular proposals, but rather to make sure the dynamic between the various administrators in NIH was proper to serve the nation as a whole. I think that the fact there are people from multiple states here, Is a good sign for what the future has in store. I can think of a lot of questions that I have. For example, is poverty in urban settings better or worse than poverty in rural settings? Or is it the same? we heard that statistic about what percentage of people get a chance to go to higher education and what a difference that makes. I think in West Virginia about the coal industry and all the people that suddenly were out of work. And you can think about the Rust Belt cities of this country. One of the areas of expertise that I have been involved in is police ethics. And just think about the role of police today relative to substance abuse. and the challenges they face, what role should they play? Mental illness, what role should they play in terms of intervention? And there's a lot of proposals out there, but when you become the enemy, and when there's violence and nobody will testify to who did it, then you have so many obstacles to trying to have a positive impact. can we solve the problem by sending more people to prison? Not myself, to what extent do we believe that the research we're engaged in the academy is designed to have a positive impact in the real world, not just discussions among academics about rarefied issues. I'm a moral theologian by training, and the reason I went in that direction as a theologian was because I felt that the reflection we made could be helpful to people in a wide variety of fields. One of the great things about the Catholic intellectual tradition, which we represent here at Notre Dame, is that it tries to find common ground with everyone. It's not just within the community of faith. It tries to reach out and it means that you have to find language that people can understand. You need to engage in discourse, that not only can be understood by those with high degrees, but also the average person. There's so much human pain that we're talking about here, that, I know if I said to the broader NerdAim community, who among you has dealt with this issue? We'd be overwhelmed, even though we don't know about it in general. It's the sort of thing that slips out. And when somebody contacts you, you want to help try to make a difference. So we're very proud that we are trying to focus on evidence based solutions that people of goodwill can rally around and that we can get financial support. I know in the tobacco settlement, a lot of money got squandered in covering state deficits and all that sort of thing. I understand you want to solve the state deficit problem. but not at the risk of dealing with cigarette, which was another kind of addiction. In some of the groups I belong to, we've tried to pursue the relationship between different types of addiction. Is there a relationship between alcohol, marijuana, and other substances? If people wait to a certain age before they take any of these substances, does that make a difference in whether they become addicted or not? What is the role of advertising? Just think about how much money gets spent. In the other direction, all the time, on television and elsewhere. So people are being encouraged to use substances by advertising, and we're trying, in a sense, especially for those that can't deal with that issue in their life. we've only had three presidents the last 72 years, and now we have four. And he's the man and he's going to make it happen. they asked me to say a kind of opening prayer, but before that, I'd like to ask you for silent recognition of all those who have died. and all the families who mourn their loss and all that this entails for the level of suffering in the world. Dear God, we ask your blessing in those here assembled and for the meal we share. We gather together to take on one of the most perplexing and tragic issues of our day, opioid addiction. We seek to understand its causes and support structures to pursue on the basis of the best evidence available, possible routes of further research in the long range quest for ameliorative programs. at the local, state, and national level. May our interaction at this meal open us up to the expertise and experience of others. We know that only a spirit of cooperation and mutual commitment will lead us towards sustained progress in the face of this great scourge. We pray this in your name who live and reign forever and ever. Amen. Let's enjoy our meal. Hopefully you all have had a chance to get to know some of the other summit attendees and you will get more opportunities to do so throughout this evening and tomorrow. I wanted to Introduce our panel for this evening. tonight's panel will focus on the settlement foundations, how and why they were established, challenges they've faced, and what success looks like as they move forward with their missions. And we are honored to have three panelists join us tonight for tonight's discussion. I'll introduce the panelists and then our moderator. Alicia Nelson is the Executive Director of the One Ohio Recovery Foundation. Alicia is a longtime advocate for improved behavioral health services. Prior to joining the Foundation, Alicia served as Director of Behavioral Health Strategy for a managed care organization, led Recovery Ohio in the Governor's Office where she oversaw mental health and addiction related work across the state, and served in Ohio Attorney General's Office offering statewide technical assistance to communities fighting the opioid epidemic. We are thrilled to have Alicia's voice in this conversation. Jonathan Borde? is the executive director of the West Virginia First Foundation. Jonathan has served as a policy advisor for state and federal agencies. His consultancy work in health policy spans the Veterans Health Administration, Department of Defense, CMS Innovation Center, and the Government Oversight and Accountability Office. He previously held roles as Director of Public Policy and VP of External Affairs for healthcare entities. He is a well published author on topics including public health, alternative dispute resolution, and historical legal theory. We are grateful to have you here tonight, Jonathan. Don Mason. is the Chair of the One Ohio Recovery Foundation Board of Directors and the Mayor of Zanesville, Ohio, where he has served as Mayor since 1983. Previously, Don worked for the Ohio Department of Natural Resources and served as Commissioner of the Public Utilities Commission of Ohio. He sees his service on the Board as an opportunity to address one of the most pressing issues in his community, Thank you for being here with us, Don. our panel will be facilitated by David Go. David is Vice President and Associate Provost for Academic Strategy, as well as the Viola D. Hank Professor of Aerospace and Mechanical Engineering. His major responsibilities include implementation and execution of the academic elements of the University's Strategic Framework, including the University's Poverty Initiative, opioid crisis and national opioid settlement. We are thrilled to have David with us tonight to facilitate this discussion. And with that, I will turn it over to David. Thank you very much, Jim. I'd like to add. My thanks to all of you for taking the time to come and spend the next 24 hours with us to address this incredibly important topic for our nation, our families, our communities, and especially from our perspective, one that's at the heart of who we are as an institution and the mission. we've had the opportunity to hear from Father Malloy and Father Dowd, and we're grateful they spoke about the framing of this conversation from the Notre Dame perspective and our poverty initiative and the effort that we are bringing to, use research and use evidence based research to address issues that those who are, in the most economic disadvantaged positions face, right? But tonight we want to transition that conversation from what Notre Dame is thinking to how states are approaching this. particularly with the National Opioid Settlement. I'm extremely happy that Jonathan Alicia and Don are all here, to have us start that conversation and that will lead into tomorrow when we really start thinking about the nuts and bolts of things. I'm going to start with you, Alicia, as the Executive Director of OneOhio Recovery Foundation. What is the charge of this foundation? I think the charge started a long time ago with Ohio being one of the first, or one of the largest states to file a lawsuit. at that time we knew we had a case and we needed to do something about what was happening in our communities. And from just even those very first steps of that lawsuit, we needed to know what we were going to do with the funds should we get the opportunity we knew it was an opportunity to bring hope and solutions to our communities. from that the idea has come to fruition and we are now a fully operationalized, non profit, a public charity in our state receiving 55 percent of all opioid settlement dollars for Ohio. really thinking about through our many counties, 88 to be exact, how we can come together and talk about solutions collaboratively, understanding that dollars for the solutions are coming from all over. What's the role of philanthropy and how can we take a long range look at solutions to this? I come from state and local government, as you guys mentioned, and we always had this kind of four year grind I've always said if we had more time, the foundation has given us a little more time to think thoughtfully about what we can do next and we're excited to be a part of it. That's wonderful. Jonathan, I turn to you with the same question, for the West Virginia First Foundation. Yeah, we're charged with fundamentally changing the trajectory of the state of West Virginia. It's a daunting task. We have had some strong advocacy. We would be remiss without thanking Paul and all these others who've done so much work in this space, but the stage is set. Thank you. I don't think it's any secret that West Virginia, is three times the national average in overdose, rates. The next closest to us is two times. So we're an entire factor more than the closest state, which is not a race that you want to win. West Virginia is a very small state. If you think about it, I think we're what, 7 million in that range. My hunch is in, in this state. They're probably counties that have more population. And because of our size, we now forfeit the right to be complacent. we can't fail anymore. despite the incredible efforts of so many who work in this space. We're talking about the entirety of the continuum of care from prevention all the way down to recovery and re entry. And that's a huge task in a state like West Virginia where you don't have a lot of people and you have a lot of service area deserts. we've got to get tools in the hands of doers. We're not going to run things, we're not going to get in the way, I think we need to look for opportunities to be a little disruptive in the best of ways. We have incredible expertise in this state. I see mayor Williams here. you look at Huntington, they're not alone, but you look at Huntington. they were the epicenter of this, one of the epicenters at least. we can get frustrated and disappointed, but the reality is that's where innovation is occurring. The challenge is the birthplace. Of success. And so we've seen the challenge and now we've got to infuse those tools into the hands of the doers to be successful and push back against this. maybe we're not triple the national average anymore. I just want to point out something that resonated with me is that you talked about the entire continuum of care, right? And that there's no single silver bullet, right? You have to pay attention to all of it. it meshes well with what Alicia said a lot of times in government, you're in the two year, four year cycle. It's a really rapid turnaround, but this is a problem that's going to take much longer attention. it actually brings me to my next question, for you, Don, Both Alicia and Jonathan are leading non profit institutions set up by states and that's a big lift to set up an entire non profit institution, both legally, but also practically, operationally, organizationally, and I'm curious. In your role as the board chair, how have you seen that process play out in a very practical sense and what could other states learn from the experience that Ohio's had in going through this process? thank you very much for the question. I want to thank Notre Dame for being a leader in this capacity by having us all here. Let me just say this. We've had great leadership at our foundation from the entire state. This is one of the few times where regardless of political background, regardless of whether someone's in the House or the Senate, Republican or Democrat, Attorney General's office, the Governor's office, County commissioner, representative of one of the various agencies in Ohio. Everybody is really coming together very well to work together. We've had consensus on literally every key vote, which is important because You want to continue to build, a synergy, an energy. And by having everybody in agreement as you move along, it's the best way. as indicated, we have 19 regions across Ohio serving on this. one of the difficulties, which was identified before we were set up, and this is wonderful, from our Governor, Mike DeWine, and Attorney General, David Yost, is that each region's priorities might be slightly different. One region, is Hambleton County, Cincinnati. Another region is Franklin County, Columbus. Another is in Cleveland, Ohio, Cuyahoga. I represent an area along the Muskingum River, about eight counties. Very much, Appalachia. what we need, where I live, or even further to the east, might be completely different. Then what is needed in Columbus, Ohio. the attorney general and the governor, having recognized that what each area needs is going to be different was very prudent in setting up a board. I'll say this 19, regions with a total of 29 members on the board, the difficulty is I feel like I'm steering an armada, and not just a ship. we're going slow enough that we're all staying together. if I would advise a person setting up a foundation, don't be scared by the size. And again, don't be scared by the different differentials between the various regions or board. That's just good. Cause that leads to having, every area of your state served. I think your job really is to try to do what you can to stimulate conversation between everyone. I want to make sure the talents of all 29 board members are brought to bear. Some are county commissioners. Some are legislators. some have a long background in pharmaceuticals, but each one brings a different talent. that's why I think we're working well together. There's a great deal of respect amongst the board members. And we're excited to be moving through this process. I want to thank one of the prior board members who, we were going through our executive search and had some very good talents. towards the end he came to us and said, I think I've got somebody for us to interview. And it was Alicia. halfway through the interview, and most of you who've sat through executive interviews, you're like, Don, this is it. This is who we want. I was so pleased. A heavy burden was lifted off of us when Alicia said yes. Thank you. It's funny, you talk about steering an armada. Here in academia, we like to call it herding cats. So I feel your pain a little bit. this next question is going to foreshadow a more challenging question down the line. But I'll give you the softball first. I'll start with you, Jonathan. What do you feel your foundation is doing really well and what it's set up to do? Yeah, I would say being the voice for a lot of folks who don't have a voice now. the challenge of being a small state actually benefits us here because everybody knows everybody. This has touched everyone in our state. we've all had to bury family members, We understand that every dollar we have is because someone suffered and died. there's a gravity to that, and there's an understanding to that. I applaud, the folks who were involved in the founding, who created something unique, They had the wherewithal to say, Alright, we're gonna create, a private foundation, and then publicly fill its board with elections regionally. similarly, now I don't have as many regions, we've got six which is more manageable. Well done, Chairman. that's impressive, and then of course we had five appointed, so we have eleven members, but they all have their own experiences. They all have their own lived experiences. And so that doesn't set us apart. everyone has that, but a camaraderie and understanding of who we're actually representing the other side of that is true too, and we get to the challenges in a minute, I don't want to get ahead of you, but, yeah, it's about being the proper voice. Excellent. Alicia, How about you I think I reflect and relate to a lot of what Jonathan said that camaraderie, is going to be necessary understanding the solutions is going to be necessary. Meeting people where they are, is going to be one of the things that we do well alongside listening to those folks who have been impacted because we all, have been impacted in some way or other. Thank you. but really thinking about how can a foundation be technical assistance, support, and bringing solutions to bear where folks have a problem or a challenge. a lot of times in what we're experiencing, our first grant round, RFP went out and we got 1, 400 applications for over half a billion dollars. and what we saw in that is a lot of passion, a lot of community mom and pops who are rolling up their sleeves and saying, we want to do something about it, but maybe not have met the academic side of things or an evidence based practice. And so how can we connect people to make sure that not only are you using that passion, and making a difference in your community, but we're force multiplier. I learned from the law enforcement community, the term force multiplier making sure that we're giving them the boost they need. to learn some of those evidence based practices to understand, population health models and really making sure that they're serving the people they intend to serve in the best way possible. And so we're really excited to partner with them from a grants perspective, but also from that technical assistance perspective. And I think we're going to try to do that well, bringing universities together, bringing community providers who have done things well, that are near them or neighbors to them to show them, the path for impact. I think that the clear message that all three of you have already hit on is that. There's the unity of purpose, right? And that's really critical, whether the board, all the members, or the different communities that you're engaging in West Virginia, there's a clear unity of purpose. But before we move to Q& A, I do want to flip the script and say, what are the practical challenges for both of your foundations as you move forward? we'll start with you, John. Oh, sure. West Virginia has done this before, like some other states. Our friend, mentioned the tobacco settlement, I think we all recall that. In West Virginia, 3 percent of the total went to abatement. Now, you could argue, that was 3%. I can assure you, at least for the West Virginia First Foundation's perspective, 4 percent to abatement is not going to be a success, We know what the floor is, and we're not going to do just a little bit better. We have to do substantially better, right? And our makeup is a little different, I think it was 24. 5 percent from the Qualified Settlement Fund goes directly to municipalities. And, to counties, 72. 5 percent goes to us and then 3 percent to the Attorney General for ongoing maintenance. it gives us a lot of opportunity to do good and I think we have to now. Other challenges, West Virginia, has a lot of providership deserts. We have counties, that don't have urgent care, let alone a primary care doctor. Let alone, God forbid, a licensed hospital. We have counties who are paying EMS to drive around in anticipation of receiving a call so that they can go and get Narcan or some recovery to those folks. So the challenge is massive. The chairman pointed out another issue, which is solutions in one place in one community are very different than in another. And so that's why we have to be really mindful. Our approach. We can't just say everybody gets a thousand dollars. that won't work. we've tried that in the past. It certainly won't work here. the challenges are evident. I said, and I've said it before, and I don't know if it flies or if it plays well, but, This is not our Alamo, right? This is our Apollo 13. we know that there are great challenges, but we know that there are solutions. And so we have to listen to that local voice to drive solutions forward. Otherwise, we'll fail. and I would suggest just to build on the analogy that failure is not an option. you also raised a good point that, with the dynamics within a state, there's a lot of, differences and heterogeneity, and I think we'll learn over the course of the next 24 hours, that's true state to state as well. And so there's no single, silver bullet. Alicia, what are some of the challenges you are facing in a practical sense? I think it's the focus on these really big numbers. really making sure we stay focused on the mission has been the goal of some conversations we've had, we can't give a thousand dollars. we have to be thoughtful, planful, and understand how we can use these dollars to bring new opportunities to the table. As a foundation, I think one of the things we've been talking a lot about here in Ohio is these resources are finite, when you spread something that thin in a state as big as Ohio, that number becomes smaller and smaller, but there's opportunities for collaboration and leverage and bringing other philanthropy to the table. Thinking not only about grants, but loan programs and outcomes based payment and pay for success models. How can we catapult behavioral health into a new stratosphere of thinking around how our contracts are built and things of that nature. really trying to get folks not focused on. where's the money? Where's my money? for Ohio, it's an important resource, but how do we make the most impact is going to be the turn of the tide, for us. when you throw around numbers like 50 billion, people's eyeballs get very big, right? But when you talk about impacting individual lives, it's a much different thing. My name is Pat Brown. I'm an executive director here on the Recovery Cafe. About an hour south of where we're all seated. How do you vet evidence? Do you have university partners? how do you reach consensus on what evidence? You will support and enact. I can start with this one. we're going through this right now. the way we're structured we have an expert panel. not only does Don chair the 29 member board, but the board has also selected several members from across our state to serve on an expert panel, and they've laid out a quick guide to evidence based strategy. it really talks about the things that you all are probably more versed in than I, but really talking about evidence based, practice informed. It goes down a spectrum, of evidence. now that we're in our grants process, we're having a lot of conversations about that Practice Informed, has been a lot of the discussions we've had as of late, and how can we support academic Universities and some of the folks to study these very important programs to making sure that our communities, our families stay in long term recovery through our recovery infrastructure. we're having those conversations now, it's still an art, not a science. we have coupled with it, evaluation metrics, I'm looking at my partner who does our evaluations at Mighty Crow, to really think that through, it'll be, an art not a science, but it's gotta be thoughtful because there's passion there in our recovery programs. there's not a one size fits all when it comes to evidence I don't have the answer to that today. So Don, if you don't mind me asking, to build upon this question, how's the board thinking about the role of evidence and the importance of evidence in decision making? The role of the board, that you oversee, how are they thinking about it? And, emphasizing, de emphasizing the importance of evidence in how you distribute the funds and administer them? if you think about it, the General Assembly, The Attorney General and Governor gave up power. When you give up money and decision making you're giving up power. And what you're relying on is trust, and to a great deal of faith. So I believe that thought process has translated to the board level. In other words, if we've been empowered by elected officials from, I'll just say the State House, to carry about this mission, then we also have to be, ready, willing, and able to trust our process, trust our experts. Recognize, for example, in my region, we have 29, members of my board from eight counties. the people reviewing the grants to serve my eight counties are also part of the process in total, we have 365 people from across the state involved in the 19 regions. it's interesting. I hate to call it a very democratic way of approaching an issue, but we have really socialized this or, Democratize this so that everybody's involvement that it takes political and business maturity to make sure you're willing to trust somebody in another county at another agency, another state on how they assess. The grant applications coming through the system. I'm very pleased and we have our rounds of grants being awarded over the next probably six to eight weeks. this will be a real test. Wonderful. I'm Joanne Cogdell, I'm the CEO of Naxos Neighbors, and we're all about innovation, and I found that, a lot of times foundations in the states or municipalities are not that interested in innovation. So I hear there's obviously a lot of talk about evidence based. how do we break out of that? How do we try something that's never been done and find support from people like you? one of the issues that we brought up, we brought the team together and did a workshop very early on. one of the things we recognized, and I would imagine that West Virginia is not alone, but I will speak for West Virginia. is we have for many years done the same thing and wondered why we're getting the same results. so we baked into our founding principles, this notion of a sandbox. We're going to look for opportunities where people are innovating in this space. maybe we fail, but we fail fast. we find ways to solve these ongoing problems and engage intentionally. In spaces that haven't been done before. We're new, but there are a lot of other folks doing new and innovative things. So we have to support that. I think creating a hierarchy or some sort of scoring rubric. out there in the ether. It's really important that we build it up, to your point, with evidence based. But, then the question is, what is evidence based, and how do you rely on it? back to my colleagues here, you have to have that local voice. I think bringing these things together is vitally important. a special attention to coming up with solutions that maybe are a little different than what we've done before. I love the entrepreneurial language you use there of failing fast and that's something you often see in the non profit sector or in these types of sectors because, the impact of failing weighs so heavily on people, But at the same time, we need to find the best solutions. And so you need to be creative. Mark Phillips with Catholic Charities West Virginia. My question is about partnering with, especially state government, but local governments, municipalities, and counties as well, so that those folks feel like they have some part of this process, so it's not just your job the legislature, can focus on whatever current social issue they want and the drug thing, you folks have to take care of. So how do you make sure to educate them about their continuing role in this? I'm happy to start with our structure, because we talked a little bit about it, but I think it answers some of what you're referring to, and it's really a participatory structure. We really leaned into participatory grant making as a model, which is a foundation for awarding grants, but it also bode well to the local input that we knew we needed to drive these conversations. we have 19 regions. that, represent over 365 people who serve on those regional boards making the decisions about those grants. So we got 1, 400 grants in, we split them up between the regions, and we've asked them all to review and provide that community input to you all's point about decisions aren't just around evidence based, but that community experience with these organizations. But while we're doing that, while we have this structure, 365 folks at the table across the state, we're also in a process of engaging them on evidence based practice. We're talking about the continuum of care. We're bringing experts and connecting folks that may have never been a part of the conversations before. our regional boards represent folks who are mayors, who are township trustees. they cover zoning. the issues that we're seeing the stigmas that are being broken down from these conversations are really exciting bringing folks to the table that may not have had an opportunity to be at the behavioral health table before. And so we're really excited about how this will evolve. it's not a perfect system, but it's one that I think, has been in that regard very successful in actually bringing the, whatever's happened at the federal level to the state level to the local government, and then bringing all of the good news up from those local communities, our people who are living and breathing this every day, Influence what needs to be done next. So I'd like Jonathan, if you don't mind, to actually answer that question for the West Virginia perspective. Yeah, for sure. I think the last thing any state needs is for some body or group of individuals from, a high castle to look down at these local communities and say, this is what you need to do because this works every time. There is no such thing. Ohio, really led and we appreciate that creating these expert panels, I think I actually have an expert panelist in the room this evening, if she wants to say hello. There you are. we doubled down on that model. So we have a statewide expert panel of people that are truly boots on the ground and have regional understanding, each of our regions also has, the same mirrored style of expert panel. now you have a linear approach where they can truly be boots on the ground back to your original question where we're trying to gain knowledge from a distance. But we need that local wisdom so it'll come up from the regional expert panel to the statewide expert panel to the board and the board, of course, was elected publicly. So we've almost tripled down on that local feel because otherwise, we'd be treading water forever. Great question. I think it's clear, right? Going back to the heterogeneity issue, you need local engagement. You need local involvement, it's hard for me to say this being in the ivory tower, right? If it can't be some way up high, just spewing what others should do you really need that involvement. So we have time for one more question and Paul Farrell. perfect timing. So Paul Farrell, I live in Huntington, West Virginia. And for anybody that's read the book Dreamland by Sam Quinones, I live right at the cross section of West Virginia, and on one side of the river is Ohio, Portsmouth, Ohio, and right across the Tug River is Kentucky. if you draw any epicenter that exists, it's where I grew up. I'm hoping that this is another step on this strange journey I've been on, and so I'm gonna toss you a softball. to my two friends that have talked earlier, evidence based to me is what the Johns Hopkins School of Public Health is all about. so where's Jan Rader? Go see Jan. She ran a program with Steve Williams in the city of Huntington that went to the, followed up to the people that overdosed 24 hours later with faith. mental health, social, that follow up made a difference. So here's my question to the panel. What role do you think and how do we measure what's going to work in the future so that we can invest our dollars wisely and not repeat the mistakes of the past? Maybe not link, a stay in a medical facility to a billing cycle of 28 days. Maybe start there. Maybe actually look to healing people and what it actually means, not 30 days later, but three or four years later. And that's the kind of stuff you're talking about. we have to start thinking generationally, right? I speak for West Virginia, but I'm sure, others agree. We have massive issues and we're on a cliff that very few people, at least in my state, are talking about. West Virginia now, over 50 percent of all West Virginia's children are being raised by someone other than their parents. I have a county where 82 percent of all children are being raised by someone other than their parents. the primary reason for this, is the opioid crisis. the issue there is babies are having babies. They're 18, 19, 20 years old now. So now I've got great grandparents who are doing this. If we don't get upstream into the tributaries of prevention, our first foundation money is going to have to go to orphanages, success is, such a tricky question, but, maybe we're not the worst in America with overdose rates. Maybe we don't have 50 percent of our kids being raised by someone other than their parents. This is the stuff that we have to think, but this is way upstream. We gotta stop drinking out of the waterfall's edge. I'd have to agree with that. I think so much of what we've been thinking about is how do you measure success? and I think depends on who you ask and how that family feels. I know from my personal experience growing up, success for me looks a lot different. as a person who grew up in poverty, who saw this firsthand, success for me was opportunity. how do you translate that into what we can do as a foundation? we won't have all the answers, but I think we'll be a part of multiple solutions. we're thinking, prevention in getting out of this, reactive state. We are in a reactive, state right now and we know, there's population health and all the science We know some of the things that work and we still won't do them. We won't wrap our arms, whole person care. We won't get to the things that really have the return on investment. for the first time, our foundations, will be able to have that opportunity to say, Let's stop doing these little things. Let's do the big things that make a difference from poverty, from, mental health, from trauma, from lifelong experiences into what those things matter for whatever person that is. and I think that we need to do a lot more understanding from different perspectives to figure that out. but I think we're here for it and that's what we'll do. I think that's a wonderful way to close this conversation. please join me in thanking Don, Jonathan, and Alicia. Thank you, David, for facilitating. Thank you, Alicia, Jonathan, and Don for a fantastic conversation.