 Good morning. This is Senate Health and Welfare Committee meeting and it is January 11th, 2023. So welcome everyone. We're, this morning our agenda's been sort of changed and that you have a fresh copy on your desks. We'll, we've been just a few minutes talking about committee priorities. So each of you maybe give one or two of your thoughts and then we'll come back to that discussion at 11 o'clock. We tried to accommodate folks who have other schedules. So we'll start with that. We'll just dive in and talk about what maybe your major goals are for bills or issues. So just speak to the specific issue and then we'll go from there. We'll come back to this as I said. At 11 o'clock today and we'll come back to it regularly during the committee process as we get bills up on the wall. Priorities change, interest change and we want to make sure we're staying current. So Martina, I'm going to start with you. I mean, Senator, look, hot seat. Okay. Very, you know, just a brief couple of thoughts about your interests. Well, I am bringing the thoughts that came out of the Burlington and Lusky meeting that you were at as well. I just thought I would share those because they seem really relevant to my constituency and just relevant in general. One of them, and I'm not exactly sure what this would look like, but one that got brought up was specialized care for violent individuals. You probably remember that. Improve access to medication for opioid use disorder. Contingency management for the growing meth use that we see, especially in our urban areas. Reentry support for justice-involved individuals with substance abuse disorder. Expanded residential treatment opportunities, including long-term residential treatment for mental health is just a huge part of a lot of what I'm talking about today, and I'm sure it will be. You are, I mean, you're totally going both in and out of the public safety realm. Yeah, yeah. Right. As it pertains to mental health and drug addiction. Just a few more. Removing barriers to overdose prevention sites. I'm very interested in shield laws. Mm-hmm. Reduce and streamline prior approval process with insurance. So you're talking about prior authorization. Yeah. Yeah. I keep hearing that from our medical professionals. Yeah. I really would like to learn more because I keep hearing about the guardianship issue. I would like to learn more about that, and I think maybe something that we want to try to fix. It seems like it's got some problems. Mm-hmm. And then lastly, I think there are already some bills that are being drawn up here, so I don't think I'm going to necessarily, but given that we are having this mental health crisis, I think we should look at legalizing therapeutic use of psilocybin. I think it is proven to be very helpful to folks suffering from PTSD, especially veterans and folks who are pretty tired from the military, as well as reducing anxiety and depression. So those are mine. A short list. We should be able to tackle all of those in the first, I don't know, next week. Many as we can. There are some very important issues in there. Thank you. That's a good list. Thank you. Okay, Senator Hardy, do you want to go next? Sure. All right. Well, I think I would agree on pretty much everything on Senator Vue's list. I'm on the Opioid Settlement Advisory Committee, so I've been working on substance use disorder legislation at a meeting today, actually with Commissioner Powell later to try to tease out a little bit more about what he's thinking. So I will, I'm working on a couple bills on that that are coming out of the work from that committee. And also work we did last year, but let's be told. So that's great to hear that you're interested in that. Senator Lyons and I are working on our Protected Health Care Bill, which would be essentially shield laws, both from the health and welfare stance and the judiciary perspective. I see for the second. So we have 11 people, our quota is 10. So I'm going to ask, and if you're sitting in a seat that's labeled staff, I'd like for you to allow for Rachel Feldman to please take one of those seats. And then that's good. Now we just break down the quota now. Oh, good. Yeah, thank you. Maybe we'll have Rachel sit down, it'd be great. Okay, sorry for the interruption, Senator. No, you're fine. Okay, good morning, Senator Vue. Good morning. I'm not sure if you can hear me. Okay, so we're just going through a short list of priorities. We've got only five more minutes and then we're going to come back to our priorities at 11 o'clock. Okay, very good. Okay, terrific. Sorry. So that's totally fine. So the Protected Health Care Bill, which would address shield laws from both the health and welfare and the judiciary perspective for abortion care and gender affirming care. Of course, childcare and early childhood education that we've been working on for a long time. And some follow up to some of the work that we did last year on healthcare reform, sort of an oversight, particularly right now with the meltdown of our ACO and really trying to get a better handle on the future of the ACO and whether or not it should be a thing. And... Please, can you share any acronyms with us? Oh, I'm sorry, yeah. The ACO is the Accountable Care Organization, one care. Yeah. And I'm sure we'll go into more depth about that at some point. And certainly mental health. We did some work in mental health last year. Peer support and work and primary care and shoring up our primary care. And I will have bills on that as well, so. I'm not sure it was. I also reintroducing the bill that I introduced last year that we never got a chance to get to on fertility care. Oh, good, okay. Right, and I know there's interest in that one, too. Yeah, and I can't remember what else, but those are the things that come with my head right now. That's helpful. Yeah, good. So... Manager William. Tools. Why don't you give us a thumbnail and then we will come back to this discussion at 11 o'clock and when we have our staff here. So just to get this started, we hope. Okay, I can be very brief. One concern I've got right now is Medicare change for retirees. I'd like no more about that. Okay, good. I mean, a lot of feedback from constituents. You're talking about the advantage? Yes, yes. Yeah, that, yeah. Sounds like it's a done deal, but I'd like to find out what it is. It can't be a done deal. So you, as you talk, well, we can talk about that. Okay, and then going, the guardianship issue, like I have a bill, I just need to get the legislative council with it. Basically, there are two different systems. There's voluntary guardianship and involuntary. There are, one is in probate cards and the other one is in the spirit court, as family court. And there are 16 differences between the two types of guardianship. So this has all been being addressed by a constituent who had a concern. It's not just his situation, but it could affect anybody who has a parent or a child that it could apply to. So it's an interesting subject. Yeah, it is. You're talking about guardianship, not just of children, but also adults, so adult protective services, yeah, okay. And that's good. That's good. That's enough, I think we'll find more. That's great, okay, good. Senator Weeks, would you like to just give us your initial thoughts? Go ahead. This is initial thoughts on the... On your interests and your goals, the issues that you'd like to see covered in here as we work together on legislation. Right, yeah, so in addition to the ones that we discussed last week, I would simply like to add the issue of pervasive obesity. I'm curious if there's anything that the state can do about addressing the prevalence of obesity specifically in our state culture, but that's the only new one that I thought of since we got together last week. Okay, and is there any others that you're specifically, I know even bringing in what we talked about last week, those issues that you are most concerned about would maybe introducing a bill or you would like to get involved with? No, the reality is that I'm not, familiar enough with the bill process to be in the, to be drafting at this point. That's the uncomfortable reality. Okay, well, that's just fine, we'll get there and you'll have fun doing it. Okay, good. So everything that you all have talked about are things that I'm interested in and hope that we can work together on. Just, is Jenny Samuelson in the hallway? Do we know? She's on Zoom. She's on Zoom. Oh, good, you're here. Okay, so I'll hold off and I can give you a thumbnail when we get to 11 o'clock, but I do want to make sure that the secretary has sufficient time to share with us the work of the agency, her perspective. So I wanna just, how many people have we got in the room? Oh, we're perfect. Okay, good. We're good. Okay. So Secretary Samuelson, welcome to Senate Health and Welfare. It's good to have you here. You're our first official witness. Why don't you introduce yourself for the record and our goal here today is to get an understanding of a little bit about the agency and the work that's going on there and then where you see the greatest challenges for us as we work together during the session. Well, thank you for having me and it's an honor to be the person providing first testimony for you this year. It's been exciting to see the energy with having everyone back in the building and I had been very hopeful to be there this morning but having woken up with a scratchy throat but it was prudent to stay put. So apologies for not being in person. Again, for the record, I'm Jenny Samuelson. I'm the secretary for the agency of human services and have been for the last year. I've worked with the agency of human services though for the last 17, almost 18 years. So my goal this morning is to meet your needs, please feel free, chair Lyons to interrupt and ask questions or other things as you feel fit throughout today. I'm gonna start off with a general orientation to the agency and its departments then we'll drop into what our priorities are for the next year. And it's nice to meet all of you who are either new to this committee or who are new to the Senate. Would you like for us to, I would like to have our senators introduce themselves because we have three new folks on the committee. That'd be great. We're gonna begin on the screen with Senator Weeks. Who you, your name and your district. Yes, good morning. I certainly understand, Madam Secretary, how you feel about not coming into the room when your throat's a little scratchy. I got hit pretty hard with the cold last night so I'm also remotely linked in. My name is David Weeks. The freshman senator from Rutland County. I live in Proctor, originally come from Wallingford. It's nice to meet you. And I hope you feel better. Ha, me too. Thank you. Hello, I'm Martine LaRocke-Hulick. I am a new senator from the Chittenden Central District. I live in Burlington. Hi, Secretary Samuelson. Nice to see you. Ruth Hardy from the Addison District. Nice to see you again. Morning, Secretary Terry Williams, Senator from Rutland. And I'm from Colby. And Ginny Lyons, chair of the committee and from Chittenden Southeast. Getting that straight. So do you have, I'm looking at a central office PowerPoint that we have on our webpage and I'm thinking that, is that what we should be looking at as you're talking? It is. It will give you kind of an outline of the direction that we're going today. Would you prefer that folks either have it on their own computers or on hard copies if that works better for you? Or Rachel can share it on the screen. Which works better for you, Chair Lyons? We have it on our screen. Committee, would you like to have it up on the, why don't we put it up on the screen? And then we can take it down whenever we feel necessary. Okay, go ahead. Thank you, Rachel, for putting that out. Okay, and we'll move forward at least a slide. So again, the agency of human services mission is to improve the wellbeing of remoners and to protect the most vulnerable. As you hear that, I wanna emphasize that the breadth of our work goes from prevention and wellness, which I heard many of you talking about in terms of your priorities this morning, as well as working to support for monitors who are in oftentimes in crisis. The agency does our work by working with a significant number of community organizations and providers to administer a broad range of programs and services that promote both the wellbeing as we talked about over monitors and to actually provide direct health care and human services programs. The agency really is dedicated to ensuring and working with individuals and communities to reach their potential. And I wanna emphasize the last component while we mount a significant number of programs and services, our goal really is to help individuals achieve a level of independence on their own as they move through our programs. You'll note that I wanted to make sure that we touched on the values and the approach to the work. Next slide, Rachel. The approach to the work that we do because I think it's important as we work with you directly this year that you can see these come forward. There are many good things, probably thousands of good things that happen at the agencies. And then there are also some really hard things that happen through the work at the agency of human services. But our value is really whether we're talking about the positive or the challenges and opportunities is to strive towards transparency and to do our work with integrity. We really have a strong focus on service both for the individuals that we serve but also service for the staff and other people across our agency because many of our staff work internally as well as externally. So these should really come forward as we do our work together with the legislature. The agency of human services also approaches our work with innovation not just change for change sake but recognizing that over time the needs of our communities and the needs of individuals are evolving. And so we're continuously looking for ways to ensure that we are looking for best practices and looking for new opportunities to serve people and to serve them well. Throughout the pandemic you have seen or I have seen and I'm hoping that you also have seen the ability for us to come together and do teamwork. The agency of human services is often talked about as having multiple silos because we are such a large agency but what we saw during the pandemic is departments working closely together across organizational boundaries and also closely more closely together with our community partners and with other agencies in state government. And so that's a true approach that we're working to hold on to and amplify. Many of the staff that we have across the agency could be doing work in other places that was less stressful or more lucrative for them but they come to work with the agency of human services every day because they're really dedicated to serving Vermonters and serving Vermont communities and it's been a privilege to work with probably the most dedicated staff that I've ever worked with in my career and in my life. So for a general orientation I know that we've got a mixed group some folks who have either worked on this committee before or who are new to the legislature. So next slide, Rachel. I wanna do a general introduction. We are the largest agency in state government with a total budget of a little over $4.7 billion in terms of our appropriation. That is a significant mix across different fund sources, federal and state fund sources. We also have over 3,700 employees to carry out our work across our six departments and a couple of offices within the secretary's office the agency of human services. We do this work through six departments and I'm gonna go through each one of the departments in the general size and the mission of each. But I do wanna point out that we recognize that oftentimes individuals will end up at our highest level of acuity in hospitals in our correctional facilities and or through homelessness but that the root causes of why they get there really are held within the jurisdiction of each of the departments within the agency of human services. And so we really are set up by working across our boundaries to address mental health, substance use, trauma, violence, food insecurity, housing instability that really as we look further upstream prevent these outward high acuity and expensive levels of care that cause trauma for remonters. So across those departments we'll start with the department for public health. It's the Vermont department of health you'll often hear it referred to as VDH. It is our public health entity in Vermont as you've seen over the last two years. They have a little over 650 employees with a focus on protection and proving the health of remonters. They do this through partnerships with schools, businesses and communities and the activities that they generally carry out include surveillance, education, promotion of healthy lifestyles, activities to prevent, detect and respond to disease and injury from environmental factors and infectious disease. So they've got a significant breath across the prevention spectrum but also on that early detection and reaction. Moving forward to our department for mental health which you will hear sometimes referred to as DMH. They have nearly 300 employees and they're really targeted to provide access to effective preventive and early intervention and mental health treatment and supports to those who need it so that they can live, work, learn and participate fully in their communities. They do this through a range of services from prevention activities to community mental health services for people who need mental health supports, crisis supports and response to intensive residential treatment programs and then secure residential and inpatient hospitals. In order to do this work, they oversee the work of the designated and specialized services agencies in our communities. They also run Vermont's psychiatric hospital which you will hear often referred to as VPCH and a secure therapeutic residence which at this point is in middle sex but we'll be moving shortly to the Chittenden County area in a permanent space in April. I wanna note that they are because of their work at VPCH and their therapeutic residence and that they take direct custody of those who are in voluntary care that this is one of our custodial departments. In addition to the work that we've talked about already they have a range of partnership with other organizations and nonprofits from hospitals to residential care to the crisis hotline in order to carry out their direct mission. Rachel, can you move forward to... No, actually no, stay on the side please. The next department is the Department for Disabilities, Aging and Independent Living. They have approximately 320 employees. The focus of Dale is to make Vermont the best place in which to grow old or to live with a disability with dignity, respect, and independence. They do this by providing adult services such as Choices for Care which are a set of community-based services that prevent individuals from needing skilled nursing levels of care through adult protective services and adult day. They also support care for individuals with developmental disabilities. They provide supports for individuals who are blind and visually impaired and they provide licensing of long-term care and residential facilities. It's support to individuals who may have disabilities and need employment which is a really exciting preventive program often which you will hear often referred to as higher ability Vermont. Like the Department for Mental Health, the Department for Disabilities, Aging and Independent Living partners very closely with the designated and specialized services agencies. So you'll often hear that Department of Mental Health and Department for Disabilities, Aging and Independent Living referred to when we're talking about the DAs or the designated agencies. They work with long-term care facilities and the area agencies on aging along with many other organizations to carry out their mission. The next department is the Department for Children and Families. They are one of the largest departments within state government. They have almost 1,000 employees. They're focused on the health and well-being of children and families across Vermont. What folks don't often connect to them with them is that they also administer many of our economic services and supports and that they are the ones who provide support for early education through their child development division. In order to do their work, that typically folks are familiar with their child protective services work, but they also administer three squares, fuel assistance, emergency housing, known as the general housing assistance program or sometimes referred to as the hotel voucher programs. They support shelters and local offices of economic opportunity. They determine eligibility for disability services. They administer programs for child support. They do licensing for childcare programs and they determine eligibility and administer the childcare subsidy programs. Moving forward to the Department for Vermont Health Access. They have about 374 employees. They're mission is to prove Vermonters health and well-being by providing them with access to high quality and cost-effective healthcare. When most people hear the Department of Vermont Health Access, they think of Diva and their role with the Medicaid program, but I want to pause there to note the role that Dale, the Department for Mental Health and the Department for Disabilities, Department for Disabilities eight, sorry, just the Department for Children and Families that they each oversee a specific components of the Medicaid program themselves as a whole agency, the agency is the Medicaid administrator. That said, Diva plays a prominent role in the health insurance in Vermont. They help Vermonters access health insurance by determining eligibility and enrollment for Medicaid. They also run Vermont Health Connect, which is a place often referred to as a marketplace for individuals and businesses to purchase and acquire commercial insurance. They set rates and play and pay healthcare providers for healthcare services for the Medicaid program. And they also are driving much of the innovation in payment models and incentivize value versus volume in healthcare. So our last department is our corrections department. It has a little over a thousand employees and is the largest department in the agency of human services. I wanna note that it is unique to have Department of Corrections within the agency of human services. And this really speaks to Vermont's commitment for identifying the health and human services needs that often leads to incarceration, such as mental health, substance use and trauma. And as such, working to address those needs for individuals who are coming into custodial care and or community care through the Department of Corrections. Really taking a therapeutic approach and a rehabilitative approach in the state of Vermont. And I appreciate that commitment. The Vermont Department of Correction is committed to addressing these issues for those who are incarcerated or who are on probation and parole with a goal that through the services and support that they provide, individuals will achieve independence and will not return to our correctional system. And Vermont stands out in that way. By being embedded in the agency of human services, it provides them with a unique opportunity to partner with other departments across the agency to ensure continuity in the provision of services. They serve about 1,300 people who are incarcerated in six correctional facilities in Vermont. And it's worth noting that we don't have a jail system. We have a correctional system in the state and that is embedded within our correctional facilities. In addition to that, there are 5,700 people, a little more than that, who are supervised in communities through probation and parole. So those are our six departments. In addition to those six departments, it's worth noting that among other things, the Office of Healthcare Reform is embedded within the Secretary's Office at the Agency of Human Services. I heard you talking before about the Accountable Care Organization. And it really is the role of the Office of Healthcare Reform to set the vision, direction, and policy related to healthcare reform, including how we evolve the way that we care and then in support of that, the way that we pay. And the Office of Healthcare Reform takes a lead role in negotiating both with Medicaid and with Medicare at the federal level, the agreements and waivers that help them participate in Vermont's healthcare reform and also to set the direction. As we look at where we are right now coming out of the pandemic, the Office of Healthcare Reform is really focused on two things, providing provider stability and long-term sustainability for our healthcare system. In order to make that achievable and doable, they really are focused into four key areas right now, including integration of mental health and substance use into our systems of care and integration with each other. Looking at long-term care or what others will also refer to as skilled care, which includes our skilled nursing facilities and home health agencies, primary care, and then working in those two areas also with our hospitals, recognizing the important role that our hospitals play in the health and economic viability of our communities. And so there's been a lot of focus and a lot of work across agencies and within state government, but also with our healthcare providers to really focus on the stability and long-term sustainability of at least these four elements of our healthcare system. So I'm gonna pause there, tear lines to see if there's anything, any questions that you or committee members have and also kind of take a moment to take a breath before we head into our priorities that we have for the next year. Any burning questions, Vinny? I think we're good. I think it's been very clear and helpful. So why don't you go right ahead into priorities? I think you've got about seven or eight minutes left and it would be helpful for us to understand what your priorities are and how they might dovetail with our thinking in here. We'll sort that out as time goes on. I'm sure you will. I look forward to continuing to work with this committee on that. So I do wanna point out as we go into our priorities that the agency of human services while we play many roles, it's important to point out two particular roles. The agency of human services is the Medicaid agency. So that's the public insurance program for Vermonters who maybe have low income or a disability. And by doing that, we determine eligibility. We ensure payments and the provision of care for services for individuals who are enrolled in Medicaid. Across the entirety of the agency, and this should be a theme that you, and the Medicaid agency, it means that multiple of our departments are involved in administering the Medicaid programs and services. In addition to that Medicaid role, we also have a population health and human services role really to assess and monitor the needs of the health and the needs of Vermonters and to make sure that the systems who provide those services and support are appropriately sized and resourced as well as making sure that those services are available to Vermonters. I wanna reinforce the AHS facilitates these, the second rules through a significant number of investments in private non-profit health and human services organizations. And we often do not directly provide some of the services in ourselves. Do we definitely determine eligibility and enrollment and provide case management? So when I look at our priorities for the next year and in this session, while we've got many priorities, I wanna point out three. We're really working on strengthening and integrating the system of care for mental health and substance use disorder. I wanna point out the two components of that, really strengthening. So looking at the gaps, which you'll see and can see and some identified in some of our proposals and RFPs for mobile crisis, alternative to emergency departments and implementation of things like the crisis call line. So real focus on making sure that we've got the right foundation across that whole system of care and also recognizing the interplay between mental health and substance use and ensuring that that's a co-occurring system of care. The second is making sure that the health and human services works for individuals who are at highest need. What we recognize is that many of the people we serve come to us at a crisis point in their lives. They're enrolling in multiple services at the same time. And that there's a lot that we can do to ease the burden on individuals who are interacting with our system, particularly given the federal pressures that we have related to data and other things that we collect. In this area, you will see us working on both the flow within the agency of human services through that collaboration partnership that I talked about earlier, but also through IT projects like integrated eligibility and enrollment and continuing to move forward with that vision and direction. And so really looking at how we can also financially braid and blend funds so that that's not necessarily apparent to the client but so that we can adequately support them and their needs. We also are looking to stabilize the health and human services system and do that with response financially in a financially responsible way. Following the pandemic, we are continuing to pursue our long-term healthcare reform goals. And so in this area, what you will see is that there's a lot of workforce, pressures on many of the systems within the agency. We've been providing extraordinary financial relief and we're beginning to look at with providers at how we might shore up components of the system or do our work differently given the fact that the demographic trends and others will continue to put pressures on our systems for years to come and that also we need to make sure that we continue to achieve our affordability goals for Vermonters for the services that they're enrolled in. So in addition to our priorities, there are some key pressures that you will see affecting the agency of human services this year. Those include the updating the system of care plan and continuing to provide innovation in the space for individuals with developmental disabilities. As with many of our other systems, we're seeing a higher level of acuity and need coming into our developmental services system. And as such, we're needing to assess and reevaluate the programs that are necessary. The system of care plan will be provided or has been provided that provides some updates, but we also know that we need to look at our crisis system of care and some other innovations. We also are finding facility pressures. We have, as folks have heard, our women's correctional facility, looking at where that will be cited in place. Our high-end system of care for youth is experiencing significant pressures and significantly higher acuity than we have experienced before. And so looking at where we might provide services to both provide immediate stabilization and treatment for youth who are in crisis. And then lastly, in the facilities area, we have seen an increase in the number of individuals who are adjudicated in the criminal justice system and need a hospital or a residential level of care and support as they're incompetent to stand trial and to really work towards competency. While I know that many folks may or may not be affiliated with this term, you'll often hear this referred to as looking really at our forensic system of care. And then lastly, housing. We've seen historic investments in permanent housing and housing opportunities across the state of Vermont over the last year, but we also see a significant need in terms of emergency housing needs and returning to a system where people get the care and support that they need if they are experiencing housing instability. And so really working with community partners to look at how we evolve from what our pandemic-related position has been to something that is a more permanent solution that better serves Vermonters. And so those are some of our key pressures. Generally, I hear individuals ask when to contact the secretary's office or when to contact departments. And I think to hear some basic groundings. We have constituent services for individuals, particularly who are having a hard time across multiple different departments and or navigating services. Please reach out to the central office for that. We take press and communication inquiries that may also be pertinent to issues in cross departments. The blueprint for health and healthcare reform sit at the secretary's office as does our office of refugee health and resettlement. And so inquiries related to that should come to the central office. And then oftentimes there's multi-department inquiries. Where do we start? You're a large agency. Individuals are complex. Or issues are complex. They cross department boundaries. That's a time to come and talk to the agency of human services centrally. And then the agency of human services does our budget that we have across the entire agency. It's not departments. We try to look at it not as department-specific budgets, but how we support the health and human services needs. And so agency-wide budget questions should come centrally to our chief financial officer. And then he has liaisons within each department who help administer the funds across those programs. So that's when to contact us centrally. And if you're trying to get a response immediately, right away, Shayla Livingston, who's our policy director, and Ashley Roy, who is our administrative coordinator. And then you have Rachel in the room, our great contacts who often provide immediate response to questions and queries. I'm always happy to take them myself, but sometimes it may take me a day or so to get back, whereas Shayla, Ashley, and Rachel really catch things in an immediate way. So that's the agency overview for the agency of human services in a nutshell. I'll turn it back over to you, Chair Lyons, to see if you've got any additional questions or inquiries. Thank you. That has been a really terrific overview. And even for those of us who are experienced in this area, it was helpful to hear that and some of the nuance that you brought. So thank you and thank you for staying within the time. It's terrific. I really appreciate it. So I know that there may be questions that I'm going to ask the committee if you have a burning question for the secretary, could ask it now. Otherwise, we can move on to hear from Dr. Levine and the Department of Health. But do you have any specific questions? I just, Ruth, go ahead. And Senator Weeks, do you have a question? Yes, no, okay. Senator Hardy. Thanks, Chair Lyons. Madam Secretary, you and I talked last week about the unwinding of the public health emergency at the federal level and the impact that we'll have on the Medicaid program. And I'm just wondering if you've been able to get any information on that. This is maybe just a reminder if you need to come back to us with that information. Yeah, no, we can dig that into more detail. For the other committee members, what we know now is that the public health emergency has been linked to a hold on redeterminations for Medicaid, which means that the Medicaid case load or the number of individuals enrolled in Medicaid is higher than it's ever been because no one during the last two years has been redetermined at whether they're continuing to be eligible. It continues to be my understanding, Senator Hardy, that in April, that had been linked to the public health emergency and that we would not start redeterminations. It is still my understanding that in April, they have separated those two things out that regardless of whether the public health emergency continues, they will be able to begin the redeterminations. That will have a significant impact on many Romaners but also the workload at the department for Vermont Health Access. If for any reason we come back and we determine that that's not the case and we're gonna need to hold on redeterminations, I'll let you know. Okay, I think it's mostly just what resources you may or may not need in order to do all the redeterminations and making sure people aren't falling through the cracks with that process. Yeah, what we have done is that the department for Vermont Health Access feels at this point that they have measured out the redeterminations over the period of time that the federal government will allow them to do in a way that is achievable through the department and achievable by asking other staff and employees and other departments to assist. And so right now they're feeling like they've got an achievable plan but they'll know more about that when they begin the process to see whether they can keep on track with their current status and plan. I mean, it is a great question. If you, it sounds like you have Dr. Levine coming in from our Department of Health. Next, I'm sure that some point during the year you'll probably have Department of Vermont Health Access but I will have Andrea reach directly out to you, Commissioner DeLabrio. Great, thank you. And we will get to having a more direct and specific conversation in particular about the results of the pandemic and the effects on not just Diva but other parts of the agency. Thank you. Senator LaRoy Rulik. Thank you. Thank you, Madam Secretary, for that presentation. That was great. This also might be a question that we can delve into on another date just because it may be kind of a big one but I am curious about the need for a women's correctional facility, why there is a need or a perception of a need and also if there's a plan for that facility to be publicly held or privately. So if we could talk about that at some point, that'd be great. Those are two easy questions to answer. So if it's okay with you, Chair Lyons, I'll go ahead and answer. Take a half a minute, go right ahead. Okay, so our correctional facilities in Vermont are public facilities there run by and staffed by the Department of Corrections and that will be true of the women's facility. Right now, our women's facility is in Chittenden County and the infrastructure for that is aging and while they have looked at what it would take to address the needs, for example, some sewer and other related issues, it would be more expensive to do that at their current location than to build a more state-of-the-art facility. Thank you. That really helps to facilitate both incarceration and that gives them an opportunity to have community transitions approach which is a state-of-the-art approach. Thank you. Okay, thank you so much. We appreciate your time and this has been very clear and I know that we'll be seeing bills that relate to some of the priorities that you've expressed. I haven't named my priorities, but one of them is blueprint and also mental health and substance use disorder and trying to integrate those co-occurring disorders into the programs that we have. So I look forward to having you back in or others back into as we discuss that. Thank you. It's been a delight. Have a great day, everyone. You as well. Thank you. Take care. Dr. Levine, welcome. Hello, Senator LaVine. So, you know, we have a new committee. I see. I think everyone probably knows who you are but you don't know who we all are so we're gonna go around the room yet again and we're gonna begin on the screen behind you and go ahead. Yes, good morning, doctor. My name is David Weeks. I'm the Rutland County Senator and I come from Proctor. Good morning. I'm Martin Marocchi. Look, I was in Burlington and I'm one of the new senators from Chittenden Central District. You know me. Ruth Hardy, perhaps the district is. Senator Terry Williams from Rutland District and I'm Paul. I'm surrounded by Rutland. This is why I'm here. We're surrounded by Rutland. And I also know you so it's welcome. It's great to have you back and have you here. We're interested in just getting to know about the Department of Health. Some of us are more familiar than others but and we have a PowerPoint. Are you gonna go through that? Yeah, we have the Department of Health PowerPoint. Yeah, so the way it was described to me I could come back for a broader presentation. Yes. And that's really the broader presentation. This is the broader, okay. But I also want to kind of satisfy your needs for today. Good. We really want to get our feet wet and really understand the Department of Health and where the priorities are currently. Good. The work that you're doing and how we might be working together going forward. I know we're gonna see bills on prevention, intervention, treatment, et cetera. Okay, so because there are actually more new members than old members, I think we'll start sort of at the beginning because I think one of the most common if you will areas that people confuse and conflate is healthcare with health. So I always try to begin with sort of understanding what health and mission of public health are because that's very different. I also want you to understand that the work of public health is broad and that we have a very passionate and skilled and professional workforce to carry out much of that. Never enough, but still. And third, I guess, take home message, if you will, would be that to work effectively, public health has to really work across sectors. We don't do all of the work of public health. It's really through partnerships and collaborations with legislators and governors, but also with all of the sectors of society, essentially. And that's where things like health and all policies becomes very important because to have a healthy community, one requires interaction with the agency of commerce and community development, agency of transportation, agency of agriculture, the list goes on and on and on. So those are sort of themes and take home messages. The other take home message is COVID is not our only business. Though it seems to never go away, it's still not at the level where we can't do other work and that's really, I think, what we've arrived at of late. When it comes to, I'll say a few things from the slides, just to get us all on the same page and then we can get into some of the priorities. Basically, the definition of health is really meant to be a definition that takes you off of the course of disease and illness. As a doctor, I try to deal with all of them, but at the same time, public health is really far more focused on the prevention theme, far more focused on mental, social, physical well-being as the state that we want to achieve. And that's really important. In public health, to me, our mission statement is really like the reason to get up every morning and go to work, to protect and promote the best health of all Vermodgers. And so that's what we try to do, which is not an easy task when you think about the spectrum and intensity of public health problems across the country, never mind in our little state. So I think that's a really important thing. The traditional definition of public health really focuses on preventing outbreaks and epidemics, working on environmental hazards and trying to have healthy lifestyle choices to prevent chronic diseases, which as you know, occupy the biggest part of a healthcare budget. The more modern definition doesn't ignore those, it encompasses those, but it also includes really working across sectors to achieve these common goals and have healthy communities throughout. And that's a broader definition, which I think is very useful to keep in the back of your mind. So with that as sort of the framework, the structure of the Department of Health has a number of divisions in it, some of which evoke the words I've just used in the definition. So we have laboratory science and infectious diseases. Needless to say, that was intense during the pandemic, but there are plenty of infectious diseases to keep them busy, even if there were no respiratory viruses in the world. And there's plenty of laboratory work that's not all infectious, much of it is environmental and other spheres to keep our public health plan busy as well. But needless to say, the immunization section is under that and there are more immunizations than just the bivalent vaccine for COVID. We also have an environmental health section and this committee and others work very closely with that and us to achieve what we've achieved with school led in the drinking water testing. They're also concerned about things like cyanobacteria, PFOA, PCBs at the schools, et cetera. We also have a section of health promotion and disease prevention, which I described earlier as how do we have healthier lifestyles, prevent chronic diseases or enhance self-management of prevention and chronic diseases to have a healthier society. Opioids are always a big issue. So we have an entire division of substance use programs, but opioids is not their only business. Business is very broad and we would not wanna forget the impact of alcohol in our state. We would not wanna forget the fact that teenage and middle school brains get affected by a host of substances on the way to some of the very bad things, not the least of which is nicotine cannabis alcohol, sort of the big three. We also have a section on maternal child health and maternal child health is exactly what it says. It's trying to keep that family structure as strong as possible in Vermont. From a physical health standpoint, from a mental and emotional health standpoint, from a substance use standpoint, from all of the things that cause what we call ACEs, adverse childhood experiences, that conspire in the very earliest parts of life to really set a child on its destiny, if you will. And the goal is that destiny be bright and wonderful and not severely restricted by some of the events of early years. So a lot of our work there goes on from very early life, prenatal, just after birth, to middle school, to high school, and to, again, involving the mother and family, whether it's breastfeeding issues or what. You'll be happy to know that we have a proud new grandfather sitting in the show. Ah, I know the feeling. Get a good note. Good. The other divisions would involve the newest one, which is health equity, and everything we do in the department is on a platform or a foundation of health equity, because health equity is so critical. The definition, if you will, is everyone should have the same fair and just opportunity to be healthy. And when we look at health data, which our department is all about, and we have an entire division called Health Statistics and Informatics, the data says that many Vermonters are doing just fine. But when you start to look at who the Vermonters are that aren't, you find that there are areas where there are severe inequities. They generally fall along lines of race, gender and sexual orientation, disability status, socioeconomic status. And a little bit in Vermont on rural versus, I'd hate to say urban, but rural status. So these are all really, really critical things. So that's kind of how our department is structured. And I'm sure you could talk for a long time on priorities. And I can do that when I come back or we can start it today. Well, you know, I'm thinking that it would be helpful, I think, to have you come back. Because I know there are a lot of questions that we've wanna dive into. And my particular interest will be to come back and have a discussion initially on prevention and the prevention council that's in place, the chief prevention officer, all the work that's been going on for the past several years. And then how that intersects with the Opioid Substance Use Advisory Committee that Senator Hardy is on and what recommendations we might see coming from there. And then, so yes, there's a lot. Just in that area, and Senator Weeks pointed out his interest in obesity, which is one of those problems that we see, particularly in adolescents that some of us have been trying to work on prevention for too many years. And yeah, so what progress, if any, can we make? Adolescent issues are particularly have been really exacerbated during COVID as well as others. You've taken all the words out of my mouth that I would have come up with. We would love to have you come back. I think that just the tip of an iceberg, right? Right, and there are some of those that are higher priorities than other, but they are all priorities. They're all priorities. And post-pandemic, they have become even more of a priority because lots suffered during the course of the pandemic. I'm happy to give you a COVID update at that time as well, just to put the perspective, but good to see that you've restricted the admission to the room because it is a tight room for sure. And wearing masks when you feel that's appropriate is fully endorsed. Well, we're the Health and Welfare Committee, so we try to be somewhat cautious. I am with you, believe me. That's good. But yeah, so I mean. Good, well. Prevention was the theme you raised, and that's it, whether it's chronic disease, whether it's substance misuse, whether it's the development of a youth brain from nicotine to onward to opioids and stimulants. Ashes. Whether it's. Social determinants. Right, and whether it's early childhood programming that will actually set the mother child or family child dyad in a better direction from the very earliest days. All of those things are very high on our priority spectrum. And so it may not show up as much. Obesity and childhood obesity being such critical problems. Less in Vermont than elsewhere, but our trajectories are still all the same. That's something we have to tackle in the midst of everything else. And I know you have mental health coming in on my tail, but I don't want this committee to think that we are divorced from mental health. That's their turf. They have enough to do, by the way, in mental health. But the whole issue of integration of mental health is a council that I'm chairing with the deputy commissioner for DMH. The whole issue of how mental health and substance use disorders get addressed. Isolated versus comprehensively. All of these are really big issues that our department is working on with them. Suicide prevention being the other really hard statistic compared along with opioid overdoses. These are the realities. So they are all on the priority spectrum. And just to say, we will have you back. And the whole area of prevention is so difficult for people to understand when you look at appropriations and revenue. Because the longer term goals. So you don't see the results for many years, but it's so critical. Right, but Bravo to the last session where governor and legislature got together and $3 million appeared for really prevention coalitions around the state to have more equity in that arena than we've had. That is a longer term strategy, but caution you to realize that some of the returns occur within a couple of years. So it doesn't mean you have to wait a decade every time you do a prevention coalitions. So good, I'm gonna suggest that we move on to mental health. I know that there are about a million questions sitting around this table and on the screen, but we will look forward to having you back. And maybe we can talk a little bit about what you see as the topics that you'd like to present. I know we're gonna have bills. We're gonna see the tobacco bill back again and so on. So we'll know we'll hear that. We're gonna have substance use disorder, mental health. So, but we'll work together as much as we can. Well, thank you for having me today. We greatly appreciate your time. I'm sure most of you, but maybe not all of you know David Englander who's the senior policy and legal counsel for our department. And so David will not be a stranger. I'm afraid not. Oh, that's great. I know. I'll go ahead and get back. It's great. Thank you. Thank you, doctor. Yeah. Sure, I have to excuse myself. Okay, yep, that's fine. And thank you for, you know, just thank you for your work. Yeah. Just before you leave. Oops, he didn't hear. That's okay, but I wanted to say thank you for Dr. Levine for the work he's done. Chair, we're gonna take a five minute break. We're gonna be 15 minutes behind and then it comes out of our hide. You don't have to. Okay, welcome back. This is the Health and Welfare Committee meeting of January 11th. So we are meeting today with members of the Agency of Human Services and we have with us the commissioner and deputy commissioner of Department of Mental Health. So why don't you, before you introduce yourselves, I'm gonna have the committee introduced because we have three new members and we're gonna start on the screen behind you. Hey, good morning all. This is Dave Weeks, Senator from Rutland County. I hail from Proctor. Good morning. Senator, look. Hello, I am Martine Malakka, I live in Burlington and I am a new senator. This is Chicken Central. Oh, great. Yeah, nice to meet you. Nice to meet you. Terry Williams, Senator from Rutland County, I live in the home. Oh, great, nice to meet you. So I'm, when Senator Weeks is here, I'm surrounded by Rutland. I'm not gonna let him forget it. Senator Hardy will be back in. She went out to chat with Dr. Levine, I think. So why don't you introduce yourselves for the record and then give us an overview of DMH and maybe some of the priorities that you have and how we might be working together going forward. Sure. Good. So good morning for the record. Emily Haas, commissioner for the Department of Mental Health. And for the record, Allison Cromp, deputy commissioner of Department of Mental Health. And we have a PowerPoint that eventually, Nicole, do you wanna introduce yourself as well? Oh yeah, so my name is, for the record, my name is Nicole Sazio, I am the director of policy for the Department of Mental Health. I'm disabled from free sharing, so I keep kind of asking. Okay, so once we get that, you have your PowerPoint here, so go right ahead. Okay, sounds good. So we'll all start off just framing out the mission and vision for the Department of Mental Health. So the mission is to promote and improve the health of Vermonters. And the department resides under the agency of Human Services, has the same critical mission, which is to improve the conditions and wellbeing of Vermonters and protect those who cannot protect themselves. Our vision is that mental health will be a cornerstone of health in Vermont. People will live in caring communities with compassion for and determination to respond effectively and respectively to mental health needs of all citizens. We also want Vermonters, and they will have access to effective prevention, early intervention, and mental health treatment and supports as needed to live, work, learn, and participate fully in their communities. So I'll run through a few of the things that DMH focuses on. So we're responsible through statute for the mental health system of care. As a department, we're comprised of around 265 staff of 200 of those folks are within our facilities. The Vermont psychiatric care hospital and currently Middlesex therapeutic community residents. The DMH budget operates around $287 million to support the mental health services to over 25,000 Vermonters. Additionally, we oversee the 10 designated agencies as well as two specialized service agencies. I'll highlight quickly for you all the Vermont psychiatric care hospital. That is a 25-bed adult facility located in Berlin, the top of the hill. Folks there are under the care and custody of the commissioner. Can I ask you very quickly for how difficult would it be for this committee to take field trip to that facility? We love field trips. That sounds great. We'll coordinate that with Alex and the VBCH team. So we're happy to do that. Currently, we also have the Middlesex therapeutic community residents that is in Middlesex. For folks to be aware, we are in the process of moving that program to Essex. That's the other one we wanted to visit. Yep, that's a new name. We'll be River Valley therapeutic community residents. For folks who aren't aware Middlesex was one of the response efforts of the state from a tropical storm Irene. It was a temporary facility and so we're moving into a permanent facility and expanding that program. And it is the state's only secure residential. Additionally, we manage several contracts and grants to peer organizations. We have contracts for forensic psychiatry. We do psychiatric consultation with primary care and then also a beach of contracts to conduct analysis of population level that related to mental health. That's a small, those are a small sample of contracts. We have many, many grants and contracts to support reminders. Additionally, we partner with local hospitals, our community providers, police departments, courts and pretty much anybody you can think of we're partnering with them. Let's see. It was hard to know if you went through those different points behind me. Did you? Oh, great. Yeah, it's going great. Great, all right, I'll take it. So I'll turn it over to deputy commissioner Croft to summarize this slide. So I think when it comes to where our priorities are and how we're talking about how we're identifying gaps in the system and the vision we have or where we wanna go, we're putting things into the category of someone to prevent, someone to call, someone to respond and somewhere to go. And so at the department, we've over the past couple of years we've been trying to build up the summer to prevent. You'll see that in the resiliency and trauma prevention position that was provided to agency of human services but is situated at DMH, that position has been, we've just been so lucky to see how well it's gone and they are really well respected in value but serving so much broader than just the department. You're talking about the position for trauma prevention that was in the secretary's office and then has been moved to DMH and that's actually something that we would like to hear about in here, not necessarily today, but have greater depth to understand the role that plays and linkage with other prevention pieces. That'd be great. Yeah, I know we would love to talk about that. I think the big news is also that we now have a partner for that person in the prevention world and it's our director of suicide prevention. That was a role that was put through last year and they were hired and they started last week and we're very excited. So you'll be welcome to meet them and talk about how maybe that role connects with KAC and Google's role. Excellent. Someone to call. We've had a lot of efforts to bolster someone to call. 988 is probably the most public and that was to bring more of the centralized, we have this wonderful crisis system in Vermont where that's localized, but if you are just a regular person in Vermont and you may not have known that number, you may not know the exist. So 988 was a way to say, whoever you are or if you are in the state, if you were in a crisis or your child was in a crisis, here's a number to call. That went live as a three-digit number in July and we've had great success. That's something we could talk more about and show data at another time. But in addition to someone to call, we've got the pathway support line and the crisis text line. Someone to respond. This has been a piece where, obviously staffing crisis has impacted, but we've also been building over the past few years to stakeholder engagement asking, we meet with families and say, what aren't you getting? How would you like your services to be received? And so many of them have said, we really want someone to come to us. In my old job, it was a crisis clinician for kids and when the parents would call me, if I had to say, well, you have to put them in a calm and take them somewhere to get them to me, it was incredibly overwhelming for them. So this was them saying, we really want you to come to us. So we're building or you'll see a request for proposals that the department put out for mobile crisis response. And that's what this is. And it's also a benefit that we could tap into for Medicaid to get a higher reimbursement rate so that something the state's really interested in building and sustaining. In terms of others, someone to respond, obviously there's a great need to sustain and stabilize the designated agencies and special services agencies. So we have data on how much funding has gone out. And I think that's a very top of mind conversation for both of us on how we can make sure that if they're stable and we have a less need for higher levels of care. So that gets to someone to respond. And then lastly, somewhere to go. So you may have seen, and I'll just alert you to, if you request for proposals that the department has put out. One is for a youth inpatient facility. We have the Brown River Retreat. They're the only youth inpatient facility in the state. And we are one of our big initiatives and visions, and this is also coming from AHS, is integrated care. Meaning that if you call and you're a human being and you have a mental health need, it's quite possible and likely you also might have a substance use need or a medical condition. And right now, with it being the only place to go for youth being a place that has no medical care, that's been a barrier to some youth being placed there. So we're looking to diversify and we're asking for a more integrated space for youth inpatient. Additionally, you'll see an RFP for, we're looking at community-based adult residential facilities. That's something we've been interested in. We put out an RFI for that, so let me just clarify. The RFP was for Psychiatric Urgent Care. So that's something that we're personally really excited about. It's a space in the community to go. That's an alternative to an emergency department. And we're very interested in the response we've gotten from across the state to stand something like that up. And then lastly, children's residential and micro-residentials, those are of great interest. Right now we're talking about it with our partners at DCF and other departments to make sure that youth have a space to go if they reach a point where they really need something more intense. So hopefully I know that was real good. That was great. You hit so many different things. And a lot of the issues that we hear about all the time. I do have a question, but I'm going to open it up for the three senators who are here. So we'll start with Senator Murat Gulak and then we'll go to Senator Williams. And then Senator Weeks, if you have a question. And I'll go last, so I'm going last. Thank you very much. This is great, really appreciate that. I would imagine that the hospital workers, healthcare providers are really happy to see kind of a focus on facilities, creating places for folks to go. Do you feel confident or somewhat confident that if and when we're able to build and refine these structures that will be able to staff them? And if not, is there a plan for staffing? Yeah, I would look at it as us needing to focus on staffing all of our levels of care. And so I guess we've targeted some inpatient or facilities, but we also have numerous openings around our system and it takes all of those entities to be fully staffed to have the system be working like a well oiled machine. So we've done some great work of partnering with our dozen news agencies around community staff. I think Vermont as a state has plans and thoughts of how to bring workforce into the state as well as potentially utilize folks who may not be in the workforce yet. And so those are all on our radar for future planning to staff. So we understand that there's a balance of growing programs and facilities and we also want people to work in them and also get services in them. So I think there's a long road ahead to solve our workforce crisis and we're all on board to figure out the best path forward for that. Senator Waves. I love mental health issues and this is local, so I've heard about it. Sure. We were invited to a medical society meeting and the biggest theme of that meeting was emergency room was overwhelmed with children that I have mental health issues. They were filling up all the rooms on the fifth floor of hospital. Is there any plan to expand treatment facilities to the other parts of the state? Sure. Do you want to talk a little bit? I think there's sort of a different prong, there's maybe three prongs approach to supporting folks. So we currently, Deputy Prompt talked about investing in mobile crisis support so that folks aren't having to necessarily go to the emergency room if they don't need to. So meeting people where they're at. We also discussed our RFP for inpatient psychiatric care but then also Deputy Prompt has been leading some great work around alternatives to EDs and you can talk a little bit more about that. Yeah, so those mental health urgent cares I spoke about before, some regions of the state are looking to develop them specifically for a population. So you'll hear the word Puck. There's one down in Bennington. Puck means psychiatric urgent care for kids. And so there are some who are saying, you know what, we're gonna start with children and youth because for us that's what's pushing the limits of our emergency departments. Others are using their data to say, we actually think we're in a decent place with youth. We're gonna start with adults. So those conversations are happening and thankfully we've seen a lot of communication between hospitals and the community mental health to try to figure out how you can target those resources. I think it stemmed from the COVID, but they were all along. They were, you know, the staff was leaving and they got control given nurses and emergency room tests and I told them I'd address it. Yeah, you know COVID exploited all of the things that I think needed to be exploited in a lot of ways. More people are acknowledging that friends and neighbors are experiencing symptoms of mental illness and they're open to talking about it. And people are also seeking treatment and we want people to seek treatment and treatment is available. So I guess COVID is part of where we're at right now and I can see that from a positive and a negative. Senator Weeks, did you have a question? No, I just wanted to thank both of you for the overview. It's very informative. I look forward to working with you over the future but I have no additional questions. Thank you. Terrific. All right, thanks. A question, but I think probably it'll be a time when you can come back and we can talk about the identification of the needs in the community and I know that the work, but I don't know that you are but I know the agency is looking at Act 167 and trying to understand what the needs are and then where the services are. So are you working with the agency? We're working closely with the agency on all issues. We don't need to. Do you work with higher ability at all? Oh, do down from you? Yeah, yeah, do it. Okay, that's a great program. They've done some great work over there for sure. I know, amazing. Okay, anyway, good. Thank you. Thank you. This is, I'm telling people, this is the tip of the iceberg. Yeah. So you've just given us food for thought. Great. And we'd love to have you come back. Yeah, we'd love to. Thank you. That's good. Thank you. And to thank you. Yeah, nice to see you. Good, so now we can find Dr. Chen and Catarina. And we'll try to scoot along. Keep our time somewhat with the agency. We have, yeah, we take away time from us, okay. That's mine. Thank you. Yeah. Oh, I appreciate it. Oh, please. Okay. Okay. Morning. Morning. You can come on in. You're good to go. You have a seat right there. Okay. Good to see you. All of us. Good to see you. Yeah, we've got plenty of room now. I think we're over, we're a quota of 10. Oh, okay. Good. Very good. And now I did share the presentation. Yeah. You're welcome to sit there or you can sit over there. If you're going to be speaking, you want to stay over there. Yeah. Put it right up on the screen. I think Alex, you too. I can put the slides up. Okay, great. I prefer two webinars. We're going to skip some because we know we sent you a pretty long presentation. Yeah, but I don't want to have the control of it because then I don't want to show up, okay. If you have the Zoom information, I can let you in. Perfect. Oh, I see, I can do it. We can do it for you. Yep. And I made the abbreviated one, so I can keep up. You know, while you're getting started, with people go around the table and have the members of the committee introduce themselves, because they don't know you and you don't know them probably, except me. We're going to start behind you with Senator Week. Good morning to both of you. I'm Dave Weeks from Rutland County. I come from Proctor and I apologize for not meeting you in person, but I went to bed last night with a slight cold and woke up with a full blown cold. Surely not appropriate to be in the room today, but thank you. So good to meet you, Senator. Hi, I'm Martina Rock-Eulich. I live in Burlington and I am a new Senator from the Chittman Central District. Great. I'm Terry Wands, I'm a new Senator from Rutland. Good to have you. I thought you were calling. Great. I know you. I'm Senator Kibbe, the alliance. And Senator Ruth Hardy is out talking with someone and she'll be back in hopefully. She's off to London. Sure. Okay. So thanks for being here and also being patient with our schedule. We're getting used to legislative time all over again. Yes. We're looking just for an overview of PCF and some of your priorities and where we'll be working together because I know that's going to happen. Sure. Okay. So good morning, Senator Madam Chair and Senator from the Health and Welfare Committee. We have a lot of ties. I live in Burlington. I spent 30 years at Rutland Mutual Medical Center in the births department. And he was a great evening. I see. He was a great evening. Yeah. Yeah. I was a frequent flyer. So there's a lot of connections here and so it's just for mine, isn't it? Yes, it is. And so I'm here with Catarina Pazias, my legislative task master. I like that name. Yeah, absolutely. And certainly she could be a resource to this committee on an on-home basis. I'm delighted to present to you what we're about in terms of the Department for Children and Family. And a couple of things I want to just start with. Just some numbers. Just state your name for the record. Sure. Definitely. I forgot that. Dr. Harry Chen, Interim Commissioner Department for Children and Family. And let's start off with our mission. I'm moving too fast. I'm scared to go back. So just kind of some numbers to remember. We have 1,000 employees. We touch roughly 200,000 Vermonters a year. So that's almost one in three Vermonters. And we are all over the state and it's really about reducing poverty and homelessness, proving the safety and well-being of kids, creating permanent connections for children and youth and financial assistance for children, individuals, and families at a time of need. So you included that, the Reach Up program. Yeah, it's all there. It's all there. And we'll go through some of that. Yeah, good. Our vision is a place where people, kids, families are prosper, they're safe, have strong relationships and individuals reach their potential. Our mission is to foster healthy development and safety, well-being, and subsufficiency for Vermonters. So I think it's always important we're here to talk about the what, but I think it's also important to understand the why. And what we know is we traditionally talk about health and well-being in terms of hospitals and doctors, but we also know that there are things called what call them the social determinants of health. And these are the things that ultimately provide the foundation, which I think we're very clear that how people thrive and are healthier based on these social determinants, whether it's the house of your head, whether it's a job, whether it's a place for you to recreate, whether it's freedom from violence and racism. All of those things are vitally important to our health and welfare of our populations and we'll see that we touch a lot of those in terms of the services we provide. Next. So here's just a brief overview. Again, 1,000 employees, six divisions and offices across the state, 200,000 Vermonters. There's family services, makes sense. That's where we take care of kids and families. That's where both in terms of child safety, child welfare and an environment for kids that is conducive to development, permanency and wherever possible placement with their families. We have a child development division which is all about the early child space in terms of childcare, in terms of early child dedication, in terms of early intervention and services. I think all of those things are vitally important obviously for what happens later. The Office of Child Support providing a program which helps ensure that kids and families get the support they need from non-custodial parents. Economic services division is our biggest division. That's where the LIHEAP, the three squares, the housing, home energy assistance and housing, emergency housing come from. The OEO, which is really an agency which primarily purposes to push out funds to other partner agencies. So it's the CAP agencies throughout the state. It's a huge effort in terms of weatherization and it's working and partnering with all of our homeless service agencies throughout the state. Office of, and then there's the DDS, Disability Determination Services which really is an offshoot of the federal government. So it determines eligibility and redetermines, recertifies individuals who are applying for a disability. So in terms of the Family Services Division, it's actually our largest division. It has 407 employees and it's really, it focuses on child safety and law abidance for children and youth and emerging adults. It's working with families, foster parents, partner organizations to achieve the best outcomes we can for children and youth in our care custody. Senator Hartley. Sorry. That's okay. We try to keep, we foster, we try to achieve a mission by working with families to keep children and youth safe, to keep them free from harmful behaviors and understanding that sometimes that's not possible. We try to find other safe and nurturing placements for them while we work toward reunification which is our ultimate goal. And then even in a smaller proportion, we know that sometimes that is not possible. And then we find, we search, find and develop placements that are permanent though because we know permanency is really vital to development and children going up to be successful adults. So our four key outcomes, obviously safety comes first in terms of family services and our kids, permanence, finding the right place for them but ideally return home if not guardianship or adoption that we wanna measure and ensure that there's well-being for our kids in our custody and that the youth, children and youth are free from unlawful behavior. Just as a, in terms of a number, there are probably 1,091 children and youth that are in DCF custody right now. So I tell my kids, I have 1,000 other kids. How many of those are out of state? Do you know or is it, that's a discrete question. Yeah, that would be a question like that. What I can say is that most of the out of state ones would be in that kind of high end system of care. And that's probably maybe about 100 to 200 kids but some of them are here in the room opposite where you are outside the monitor. And then one other question because there's an interest in this committee on guardianship and so how many of those kids are in some type of guardianship. Some alternative kind of custody. I guess we'll have to get you there. Yeah, we can look that. We'll get to that because I know we'll be talking about it at some point. Yeah. So in terms of our structure of the family services, it's district offices, there's statewide units in terms of child protection in terms of residential licensing of our care facilities. And then there's a central office that oversees practices. Next is child development division, 49 employees. Again, really all about the early child space, all about licensing about child care, child early education, licensing, technical assistance, early intervention with our children's integrated services, trying from birth to five to trying to again ensure that we get to them quickly and early and to best ensure their success on which. Head start collaboration, universal pre-kindergarten oversight with the agency of education. And again, all the child care programs we serve, child care providers, understanding that Vermont is a very kind of diverse state in terms of the providers, the early professionals, early education, after school professionals, and then families receiving what we'll call child care financial assistance and then families of serve through children's integrated services. We have multiple projects and programs through the child development division. So we have a quality program, a few lists or stars. We have our information system that really are able to track both the providers and the programs. We are building capacity, understanding of, I think of nothing else we saw during the pandemic of what happened and how important vital child care and the early child's system is. And then understanding that most, we do not actually provide the childcare, but we support the organizations that do. So it's technical assistance, both in terms of the business side, but also in terms of the professional development side. And it's licensing regulation and a revision of that that's ongoing now. So important kind of the regulatory piece of that, but also the technical assistance piece of that. And I won't go through this, but just to give you an example, we spent or pushed out $108 million to providers and the system in response to the pandemic. Understanding that they're really the needs that were. Well, it was important stabilization. Yes. I did look at this one yesterday as well. So in terms of office of child support, our mission is really to ensure that promote the wellbeing of families by strengthening their financial safety net and really making that link between non-custodial parents and ensuring that they provide payment and support for their children. And primarily we know that we see that child support increases independence of the parents, that it reduces child poverty, reduces the reliance of public assistance. So there's certainly a link between, so as an example, sometimes the payments will actually go up to economic services where the family may receive benefits to actually kind of repayment for those benefits. Reduced reliance on our benefits encourages parents to exit and remain off public assistance and increases parental involvement of the paying parents. So it's really a way to keep kids connected with their family but also support them financially. And in terms of child office of child support, we serve the parents who are paying support. We also serve the guardians who are caring for children and the parents who are actually caring for kids. So there's just that kind of link in terms of providing, making sure that they get the support. They're all over 15,000 cases benefiting over 16,000 children. So you can see here that we work with our partners, economic services, family services, Department of Corrections, Department of Labor, employers, the judiciary, domestic violence network, and associations of business industry. So all of that is kind of connecting parents with families, with businesses, creating mechanisms whereby we can ensure that the kids are getting the support that they are due. And it's a difficult system to be in. It's what? It's a very difficult system to be in. Yes, yes. Economic services is again another very large division of DCF and it really provides the economic benefits to providers in need. So this is the safety net in terms of families and individual providers who may be experiencing unemployment, single parenthood, aging, death of a family member, or other life-changing events. And there are again, 350 staff throughout 12 district offices. We have a central office and we have an economic service benefit call center. And then we have an application and documenting process center. All of this connecting to Vermonters in need, a lot of those 200,000 Vermonters are those receiving economic benefits. And I think truthfully, this is an area where we see a dramatic change in the way we work because it used to be pre-pandemic, you walk into the office, you sat down, you filled out a form. So now we're really seeing how that's changing, but also stressing this system because whereas before you have people could wait in the waiting room, now they're waiting on in the queue for the phones. So understanding that we have challenges there and we have work to do to actually try to improve the timeliness of our response. And the connectivity. And the connectivity, yes. So economic services, most of these are actually federal benefits. And so the advantages we're using federal dollars, the disadvantages we actually have to go by federal rules. So just as an example, we were thinking about changing, trying to use a contract to help us with our call center. But the federal rules say we have to wait 120 days to do that. So as you might expect it's the pace at which the federal government accepts change. It can be challenging. So the benefit programs, everybody knows SNAP or Three Squares, which provides food in terms of on the table for reminders, the general assistance program, which helps individuals of family meet their basic needs, personal needs, housing, medical dental, medical supplies, baro costs, the Vermont Rental Assistance Program as part of the GA program, in terms of short-term rental subsidy, subsidy, LIHEAP, which actually, as you might imagine, people are worried about the cost of fuel to heat the homes. And this year we've got a couple bumps of funding, which should help with that. And then ReachUp or TADF, which helps to stabilize families experiencing poverty to help them get out of poverty. So again, we had a lot of transition related, a pandemic-related programs, transition housing, I'm sure we'll talk a lot more about that. The pandemic EBT, the maximum allotment, which is actually going away based on the on the spill and will be a challenge. So people will receive considerably less in their SNAP benefits come March. And also ReachUp, rental assistance was a, I think a program, trying to really address a certain population, which are families that are homeless, trying to get them into permanent housing. OEO, again, administers grant funding, core funding for the CAP agencies, community action providers, provides training, technical assistance, develop resources for communities. A lot of the next, the main areas really are homeless assistance. They support all of the homeless providers, service providers, weatherization, financial empowerment, and the core funding for the community action agencies. And again, I won't go through all this, but OEO was able to push out tremendous amount of money to their organizations. Again, they don't do the work. They're called the small but mighty operation because they're really focused on working with community partners, funding them, providing the technical assistance, and obviously making sure they're held accountable for the dollars that go out. DDS, in short, they provide applicants with medical eligibility in terms of disability, governed by Social Security and federal statutes. It's recognized as a national leader in terms of accuracy, timeliness, and public service. Again, they work for the four federal programs. We have to abide by the federal rules, but we've done that, again, the very bottom line, 98.6% accuracy in terms of this termination. So we're very proud of the work that they do. So that's GCF and a whirlwind nutshell. I hope that, I'm sure we'll have time. So we know everything we need to know. You know, and in terms of priorities, I think we're focused on the end of the transitional housing program and how we transition the greatest number of reminders to permanent housing that we can, understanding that that's not a number that will be, those that are left over, obviously, we also need to address in the most kind of beneficial and humane way we can. So housing, the high-end system of care, the kids that are now, children and youth that are now going out of state, certainly it is our preference to, where we can keep them in Vermont. I think additionally, this system is struggling everywhere. And you know, I've talked to New Hampshire, talked to Maine, everybody's really feeling the same pressure. So it's really part of my major effort is to ensure that we're thinking ahead in terms of the facilities and the programs that we need in terms of family services. And then economic services, I think I mentioned that, the new way of doing business, how do we best deal with that in terms of in an efficient manner? Yeah, good, thank you. There's so much there. And then the linkage between judiciary and here on some of these issues, just compounds everything. And so we're gonna continue our interest, particularly where PPR might be in termination of their own rights and guardianship and those things that are so really important. They're important issues, and they're emotionally charged issues too. They're emotional issues. Senator. Thank you very much, Chair Lyonsk. I was wondering, the number that you gave, the 1,091 children who were in DC of custody, how does that compare to the national average in terms of like per capita, you know? I wouldn't have done that. That's a good question. I'm curious. I believe we're actually above average per capita, but we have made strides in the last few years to be more aligned with the national average, but we can follow up. Okay, thank you. Great, and then my other question was just, we have three folks here who are also on education. So I was wondering, in terms of the departments, which ones work most closely with AOE? And I'm assuming it's CDD and FSD, is that right? Definitely CDD. Yes, definitely CDD. Of course, there's overlap with FSD when a kid is in our care or may become in our care. ESD of course has overlap because, you know, in our REACHA program, that also serves families and as well as the Three Squares program works very closely with AOE on the school meals programs and the various pandemic food assistance programs. Okay, great, thank you. Okay, so I guess a lot. That's my figure, yeah. We got time, we have two minutes. Go ahead, Senator. I thank you, Dr. Chen, and I'm sorry I was late. I know you can't provide specifics, but you did list this in your priorities, and I'm wondering, will there be anything in the governor's budget or proposals about childcare? Oh, and that's one of our priorities. Yes, and I neglected to mention that obviously there is, related to what we saw during the pandemic, I think everyone acknowledges that there's stresses and challenges in the early child system. And so there are quite a few initiatives based on that. Okay, great. Coming up. Well, we look forward to working with you guys on that. Thank you. Right, he did mention it before you came in, but so it's good and glad you asked the question again because it's nice to put a little exclamation field. Yeah, it's a good work. Any other questions? All right, Senator. Thank you. Small question. I might have missed it. Do you have anything to do with the foster child care program? Yes, yes. So that's Family Services Division. Okay. And it's, obviously it's a very valuable resource in terms of being able to place children and youth at our custody in a kind of safe nurturing environment, hopefully temporarily, but important nonetheless. We also have a very strong program with how you transition out of foster care when they're aging out of the system called the youth development program. And that's something that, similar to your question, Senator, about how it overlaps across the department is, you know, when a youth is in foster care for a big portion of their life, they're often using other programs that do CF as well. Great. Thank you. Okay. This has been terrific. We will have you back and we'll dive deeper into some of the departments because there's so much here in particular. We are going to do that on the CCFAP this week. And then get into areas that are gonna, we need a baseline to understand the work that's coming up in childcare and other places. Thank you. Great. Thank you. And welcome. Hey, great. New members. Welcome to you. Yeah. Good. Senator Weeks, did you have a question? I'd like to ask that. No, no, given the time constraints, no question. Certainly we'll follow up when we see, we see this group again. Thank you. I hope you feel better, too. I have to remember, we've got a little high. It's not very healthy. Yeah. Thank you. Take care. Bye-bye. Okay. So we have Monica White and Dale. All right, Alex. Ah-ha, nice to meet you. All right. We're behind schedule. Highly unusual in this building. We do have- Is that sarcasm or what? How are we doing for people? Jeff talked over there. One more. Yeah, we can do one more. I think we can come in. Welcome. Are you going to share up on the screen? I will, yeah. So I need to turn my camera off. I don't know. Have you given her the- I think you should help us. Everybody knows- Please don't. It's awesome to us. And I can't remember where share screen is. Let's see. Oh. We have it. We have what you've got. I can't remember. You may have to. Breakout rooms. No, I don't know. Okay, it's only been a few months since I've had to do this. Share screen, the big green button at the bottom. Here we go. All right. You love this. Well, the fluency, because the state primarily uses teams. So it's like, oh yeah. Yeah, but you're the same thing when we get on teams. How does this work? Why are they using me? I do have- I'm getting used to it. If anybody wants paper. We do have it. I did- Alex did it well. I'm good. I'm good. Thank you. There's a color. Oh, this is a color. Oh, wow. Borders are expensive. Beautiful. We don't use paper in here, but cases like this, it's important because we need to have this bottom floor. Or we can start. Oh yeah. All right, you can let me know when it's okay to hit the share button. All right. Well, we're going to introduce ourselves first and then I'll have you introduce yourself for the record and then we'll move from there. So we'll start with Senator Weeks who's behind you. Good morning. Dave Weeks from Rutland County. I live in Proctor. I apologize for not being with you in person, but I went to bed last night, not feeling well and woke up feeling pretty darn bad. So anyway, my apologies for not being in the room. Nice to meet you. Nice to meet you. Well, that I said, hello. I'm Martin LaRocchio, I live in Burlington and I am the new Senator in the Chittenden Central District. Nice to meet you. Congratulations. Hi, it's nice to see you guys. I'm Senator Ruth Hardy from Alston District. Great to see you again, Senator. Senator Terry Williams from Broad County, and I live in Baltimore. Nice to meet you. Senator Jerry Lyons, welcome. And I'm from Chittenden, South East. And I see more of you on screen than in presence. So this is glad we're finally getting together. So why don't you go ahead, introduce yourself for the record, give us a little background on Dale and then maybe some of the priorities and the issues that will be coming here and we can work with you on which we can work with you. Use my correct grammar. Great. So for the record, my name is Monica White and I'm the Commissioner of the Department of Disabilities, Aging and Independent Living, also known as Dale, and I am joined today by my principal assistant or our principal assistant, not my personal principal assistant, Rebecca Silvernegel, who is also our legislative liaison. So in terms of timing, the presentation that we have is very, very robust and I won't have enough time to go through that in detail, but my intent was just kind of skim through and do an overview of the high level points orientation for the new senators and refreshing for the two of you who've been here in the Senate for a bit. So would you mind firing that up, Rebecca? Firing away here. Okay, is that, all right, there we go. So the mission of the Department of Disabilities, Aging and Independent Living is to make Vermont the best state in which to grow old or to live with a disability with dignity, respect and independence, and that really permeates everything we do across our five divisions, across the commissioner's office. We have, well, in the next slide, please, maybe I'll just kind of page that. Okay, there we go, all right. We're good, yeah, here we go. So the mission is that's what we do as a department, but it really is a statewide priority, I think, for all of us, and I know for all of us to really fulfill the commitment that we have made as a state to persons with disabilities and to older Vermonters, enabling folks to receive supports and services that they need in their home to support living independently and fully included as members of their communities. Vermont is a leader across any number of metrics as it pertains to older Vermonters aging well, as it pertains to persons with disabilities, persons with developmental disabilities, intellectual disabilities, employment for persons with disabilities, and that sort of thing. And that's something that we are very proud of, recognizing that especially post-pandemic, there's some work to do to really stabilize and strengthen our systems of care generally across the board. On this slide too, I'm not gonna go through them, but the commitment that we all as a state have made is governed by a number of state and federal mandates to include the Americans with Disabilities Act, the Developmental Disabilities Act here in Vermont, Older Vermonters Act, and Nationally Older Americans Act, and so on. So I'm not going to go into great level of detail in the interest of being crest. Next slide. Okay. I wanna, could you use mine? Okay. Okay. All right, so that's kind of the very broad spectrum of our department's goals and targets, but for our department itself, we have about 300 employees, and those folks are statewide. We have about a third of our staff have quartered in Waterbury at the State Office Complex, and then the remainder across our 12 district offices and also home-based and pre-pandemic home-based performing functions out in the community to include Adult Protective Services and Survey and Certification, among other things. So that's kind of who we are in terms of numbers and where we are statewide. We have about, we have over a half a billion dollars in our budget across all of our programs, and I'm not going to break into the specifics on this slide here in the interest of time, but so we have our commissioner's office and our work is comprised or split between five divisions and I would like to spend a bit of time just orienting to kind of the high level where the programs sit in the divisions and what those are at the very high level. And so our five divisions are our Adult Services Division, Developmental Disability Services Division, Division of Licensing and Protection, Higher Ability Vermont, which in statute is known as Division of Vocational Rehabilitation. We underwent a rebranding initiative last year to support like a fresher, crisper, and more relatable name. So we refer to that division as higher ability. Are you interested in having that statutory change? You know, I'm not sure that that's something that we have contemplated, given that there are federal regulations with the federal. So it's better to keep it as hope we have. I think so, but that's something that we can certainly talk to make sure. And then the sort of the criteria and principles that are under higher ability is I know how successful it is right now. Really terrific. Yeah, yeah. So, and then the division for the blind is visually impaired. So those are our five divisions and in the next slides we'll do just a bit of orientation to those divisions. Actually you can go back up to the next one please. Thank you. So commissioner's office, this is the kind of who's who at a really high level in the commissioner's office. You can expect to see and hear from most of the folks who are listed here, depending on testimony topic. And at any time that there's a question or issue or needing more information, certainly reach out to myself, deputy commissioner Megan Tierney Ward, Rebecca as our legislative liaison. And other folks here kind of helmed within the commissioner's office. And to the next slide, please. All right. So getting into the division. So the adult services division, the division director is Angela Smith-Jang. She's been in that role for a few years and is just absolutely a fantastic champion for the work that occurs within ASD as it's known. And ASD's primary focus is managing long-term services and supports for adults with physical disabilities and older for monitors. There are 43 staff in that division. And the scope of that focus includes several units. So long-term services and supports unit, also known as overseeing the choices for care Medicaid program, which provides Medicaid services for folks who are nursing home level of care in the setting of their choice, either in a long-term care facility or at home and in the community. And also the brain injury program is housed here as well. Our quality management unit, which provides a quality oversight function for adult services programs. State unit on aging works to, works in concert with the five area agencies on aging around the state and other partners on a number of issues focusing on older Vermonters and to include the Vermont Action Plan for Aging while at work on that front. And that's something that is also in strong partnership with the Vermont Department of Health on a number of metrics there. And we also have the Money Follows the Person Project, which is an initiative granted by the federal government focusing on helping individuals who wish to transfer their care from a skilled nursing facility into the home to help tackle some barriers on that front. And the next slide lists some of the priorities within the Adult Services Division. And the, I'm just, I'm not sure how much time I have and how in depth you want to go, because I do have other divisions. Yeah, take another 10 minutes or so, yeah, you're good. Okay, all right, so the priorities as listed here, I think I spoke to some of them briefly, but conflict of interest in case management, Vermont has not been in compliance with federal requirements with regard to having conflict of interest in case management for home and community based services. And that is a priority at the agency level across all of the programs to include those held within adult services and our developmental disability services as well. Also development of quality measures in alignment with federal regulations and the renewal of the global commitment waiver, which occurred this past summer. Workforce, workforce, workforce and providers. We haven't heard that before. Have you heard that? That's news, new news, right? Nobody else has mentioned it. Right, so that is a significant issue. Our state plan on aging, we actually just renewed in October for a three year period for a state unit on aging and the focus on that front, I won't dive down that here, but that's a significant body of work. And the Vermont action plan for aging, well, I mentioned that previously. Money follows the person. And also maximizing the use of one time ARPA, now for the life of me, I can't remember that acronym, but the federal funds, yes, the enhanced funds that came to us through COVID, specifically for home and community-based services as enhanced funding opportunities at the agency level, maximizing the use of those strategically to best impact the lives of Vermonters. Next slide, thank you. And we're gonna define FMAP in here. Fairly sure. That's an answer. Right. Hey, excuse me. So developmental disability services division. So the division director is Jennifer Garabedian. She's been in this role for about a year and is fabulous. I'm sure she will be in this committee at some point this session. And the primary focus of DDSD as it's known is managing home and community-based services for Vermonters with intellectual and developmental disabilities and providing court-appointed public guardianship services. 51 staff through that division in three primary buckets, the program specialist team to include a inclusive but not exclusive to focus. We have a position for children's services, public safety and geographic units there. Similar to the adult services division, we have a quality management unit focused on developmental disabilities, services, quality and our office of public guardian, providing public guardianship services to about 750 folks across the state. Next slide, please, thank you. So the priorities here align greatly with ASD in conflict of interest in case management, quality measure development. One focus for DDSD in particular is the crisis continuum of care, expansion of clinical support. So finding that the clinical acuity level of folks in crisis in developmental services has reached a point that we have this sort of unprecedented. So focusing some energy on that front to improve that segment of that system of care. Again, workforce provider stability. Last year, H720 slash Act 186 was passed and that was really landmark legislation for persons with developmental disabilities landmark, I'll just put it that way. And part of that was inclusion of a limited service position, which we have filled and creation of a focus advisory committee on developing residential alternatives or housing model pilots for persons with developmental disabilities. Recognizing we've heard loud and clear that the current housing options in the system are not meeting the needs of everyone. So what would be better? What are those options to consider? And so H720 put in place that the framework with which to develop pilots so we can evaluate data and really make some decisions as a system for what we will have moving forward. And that work is underway. That bill was actually fun to work on. I know there was a lot of controversy behind it and everything else, but the outcomes, we would love to hear what the outcomes are and the direction you're going with pilots and how that's all sorted out. Great, yeah, and we're happy to come in. We'll actually get house human services tomorrow with an update on that and happy to come in for a larger targeted discussion of this group. Yeah, and if that's part of the bill, they have the bill, the same bill that we have. So we'll maybe have some replication of the information that you're taking there. So yeah, that'd be great. Yeah, great. And then we are also, we have worked over the past couple of years to roll out a standardized independently administered assessment tool, SIS A payment reform is a focus as well as, and it's not on the slide, but we recently implemented a new statewide system of care plan for developmental services as of January 1st. And some of the priorities included in that include a mindful focus on supported decision making and Ombud support for persons with intellectual or developmental disabilities. Right, so, Division of Licensing and Protection, also known as DLP. A division director is Joe Nussbaum. You absolutely will be hearing from and seeing Joe this year to jump ahead. One of our large priorities this year is an update to the Adult Protective Services statute, which is decades old at this point. And so Joe has been leading that effort. So I'm getting, but I'm getting ahead of myself. So I'm just really excited about that. That's great, we like updating. Yes, yes. And so DLP's primary focus is protective services for her mentors. And the scope is 54 staff statewide comprised of the Survey and Certification Unit who provides regulatory compliance and licensure for over 200 licensed long-term care facilities, hospitals, home health agencies. And so that sphere of work. Adult Protective Services who investigate reports of abuse and neglect or exploitation of vulnerable adults. Restorative Justice Services, which is a relatively new pilot to engage, engaging alleged victims and perpetrators in a restorative justice process for successful resolution of APS matters. Service Navigators also a relatively new pilot where we have folks embedded within Adult Protective Services that can help to make some connections for some really thorny situations for reports that come in that might not meet the statutory definition of abuse and neglect or exploitation, or the person might not meet the definition of victim in statute, but they need services. And there really have been a dynamite resource to be able to connect to community resources that will help in those situations. And also we have two limited service positions known as the COVID strike team. We Dale took a very outsized role in the heat of the pandemic, particularly given the focus of preventing COVID-19 in long-term care facility settings. And a significant body of work reallocating people from their normal day jobs to focus on that. And coming into the endemic phase realizing that COVID hasn't gone away and we still do need to support long-term care facilities. We were able to leverage some grants, funding through the Department of Health to fund two positions to continue that work so that it's in supporting our partners at long-term care facilities and others with COVID specific supports. So next slide is the priorities for DLP. As I mentioned in my side, state of great excitement, the update to the APS statute and very grateful to Senator Lines among others for support of this work and my understanding that is currently being worked on by the Ledge Council. We're going to get the bill in here and it's going to be there. Then we're going to discuss who takes the first. That's going to be an interesting part of the work. I think everybody wants to do it, so that's good news. That's good news, that's great. Right, and that is sort of an everybody, I think that as a recently fair assessment is we had a very robust group of stakeholders involved either the APS or the committee and it's universally understood that the statute as currently written is locally out of date for today's world. So that's great. We also last year, we received additional positions like four or five, I'm going to try and put a blank on the number right now, but positions for survey and certification to enable us to provide annual surveys at state licensed facilities. So in the long-term care facility world, skilled nursing facilities are governed by federal regulations and requirements through the Center for Medicaid and Medicare Services where state licensed facilities to include assisted living residences, residential care norms and therapeutic community residences are governed through state regulation. And so the resources we had did not enable us to get out on an annual basis to state licensed facilities until last year when we were able to get some additional positions through that. And we, I believe now are almost, have almost all of those positions filled and prioritizing getting those people onboarded and trained and boots on the ground out there to do that work. Again, some pilot funding on the restorative justice project is a priority finalizing update on state survey regulations to, specifically for the state licensed facilities, working to focus on adult protective services, substantiation rate, and that is, so I lost my space here. And then we submitted a legislative report over this summer on self-neglect as a problem. So focusing on self-neglect and then striking positions, continuing those for that work. Higher ability to remote, as mentioned previously, Diane Demos is the director of that division at focusing on helping Vermonters with disabilities to prepare for, obtain and maintain meaningful careers and helping employers recruit, train and retain and promote employees with disabilities. And so that's an important point. It's maintaining meaningful careers, it's not just get a job, it's working with each individual person to learn strengths, learn what folks want to do, what are their educational goals, credential attainment, that sort of thing, to really help put people on the track that they want and will be successful. And there are about 145 staff across the state focusing on career counseling, so working with folks, working with employers in the area is the big focus, providing assistive technology support for folks who need a device or a gizmo or a gadget or some really, really great equipment to help folks be more able to live and live and work successfully. And we also, with an higher ability, have the Invest EAP Employee Assistance Program, which is statewide. And priorities for this division include the Vermont Career Advancement Project and Relatively New Initiative. We've now had two years worth of a summer career exploration program born out of the pandemic that has been extraordinarily successful and powerful in working with high school youth who have a disability and want to do a deep dive on career and educational focus, including paid internships. And it's really just remarkable work. And we also are working on pilot, also born out of last year, legislation on last year, on employment supports for persons with substance use, opioid focus. We're also really targeting efforts on diversity, equity, inclusion, and access to ensure that we are truly walking that walk for all the monitors and performance management of how can we do things better. And our last but not least division is for the Division of the Blind, Visually Impaired, directed by Fred Jones, who focuses on much of the same as High Ability Vermont for specifically for persons who are blind, visually impaired. It's our smallest division with 11 employees and the services listed here, vision, rehabilitation, employment, high school transition services, assistive technology, business enterprise program, older blind program are different than higher ability, but I'm realizing that I'm being very, so I'm trying to talk very fast. We can do anything we want. That's okay. It's pretty clear. I'll share. We're getting it. Yeah, we're getting it. All right, good. And then a few next one, please. So priorities, the expanded LEAP program, that is the Learn, Earn and Prosper program to include apprenticeship opportunities. That is a fabulous partnership with, that provides some fantastic opportunities to youth and high school students, college students who are blind, visually impaired over the summer. There's networking, there's education. It's just done some in person days with folks and it's really, really fantastic work. Getting a consumer driven conference off the ground, specifically as it pertains to blindness related assisted devices, the technology is incredible, what is out there and making the connection for people who are blind, visually impaired to the incredible amount of technology that's out there to actually make that difference is a big focus for us. And also a targeted focus on persons who are deaf-blind. So who are both, you know, deaf and blind, really really got to focus on the needs of our populations. It's small, but it's important. So I think that is the end. That's a lot of me talking and really excited about the work that we have on our way and the work that is yet to do and working with you this afternoon. That's terrific, thank you. I think what we'll do is we're gonna hold our questions if someone has a question you need for their information, maybe just send it along, okay, just send it to them. Will you come back in or members of your, a day will come in and we start diving into bills or we'll get more, yeah, I think so. Really appreciate your time. Well, thank you for the invitation and again, congratulations on your elections or re-election as the case may be. Looking forward to being back and I hope you enjoy this sunny, but really cold day. You know, we have to be sunny tonight. It's well, they kind of take the way said, right, right, right, right, right. That's great, thank you very much.