Black Hawk County public health outlines priorities for opioid settlement spending; subcommittee to refine funding plan

Black Hawk County Public Health presented an update March 25 on how the county might use opioid settlement funds, including data on prescribing, treatment demand and recommended priority strategies drawn from a community subcommittee.

Russ (county public health) and representatives from Pathways Behavioral Services summarized available local data showing Black Hawk County’s opioid-prescribing rate is slightly higher than the state average and that fentanyl and opioids figure prominently in recent overdose deaths. They also noted data limitations and urged caution interpreting small-cell counts.

The county’s settlement-subcommittee — convened through the Cedar Valley Substance Abuse and Overdose Prevention Coalition and involving roughly 20 stakeholders — narrowed 26 eligible “core strategies” from the settlement exhibit to 11 and then to five priorities for a two-year focus. The five short-term priorities (across prevention, treatment and recovery) were presented as options for board consideration; key current contracts and programs were also summarized.

County staff said there are existing contracts supported in part by settlement funds: Pathways implements school prevention and jail-based services; a contract for “One City United” provided wraparound employment supports (about $125,000 per year for two years) and had been fully spent as of January 2025. Public Health holds an Overdose Data to Action contract (about $160,000) and other state and federal grants funnel services to the county through Pathways and other providers.

Michelle (county staff) projected the county’s settlement receipts will slow but estimated roughly $1.2 million in cash by the end of the fiscal year and projected future payments over multiple years possibly totaling nearly $4 million (estimates depend on remaining settlements and timing). The board asked for updated, clarified projections and a revised gap analysis that reflects pending state behavioral-health realignment and remaining funding uncertainties.

Vicki Miller of Pathways described evaluation methods already used by providers — pre/post testing for prevention programs, client-level outcomes and electronic health records to track treatment goals — and noted typical treatment success and relapse patterns: roughly one-third of clients achieve success on the first treatment attempt, another third require multiple attempts, and a third do not achieve lasting recovery, she said.

Supervisors asked for additional detail on recommended evaluation metrics, sustainability risks (grants vs. recurring funding), how state-level administrative-service-organization (ASO) decisions could affect continuation of county programs, and whether the subcommittee should draft a request-for-proposals or funding-opportunity structure.

The board directed staff to update the gap analysis to reflect any new state rules or funding shifts, to circulate the full committee minutes and to return with evaluation recommendations and a proposed community funding process. The subcommittee will continue its work and can assist with drafting application or evaluation materials if the board requests.

"Things we could look at would be like, what — how many people you’re reaching, what their outcomes are," Vicki Miller said, describing typical program metrics used by service providers.

No new contracts were approved at the March 25 meeting; supervisors said they want the committee to refine priorities and provide a funding structure before any new awards are made.