 And just to let the committee know, I had a discussion and conversation with the Department of Mental Health yesterday, and they have sent some information in on S197. And I've asked them for some language that would improve the bill in terms of simplifying the grant process and the role of AOE versus DMH. So we will be seeing additional information on that. And as you, I think you remember, Laurel Ormond was the person who spoke with us earlier about the bill as well, as well as Emily Haas. All right, welcome to our two folks. Lance Mateir is here from Northwest Counseling Support Services. And also, Ann, you're here. Ann Paradiso, thanks for being here. So Lance, why don't you go first? We have about 15 minutes total for your testimony from both of you. And we look forward to hearing it. And have you sent something in? So Lance, have you sent a written testimony in? I have not, but I can do that. That would be great. After our time together today, absolutely. And Ann, did you, I think Ann was going to provide a bit of an overview of our system. So if it's okay. No, that's perfect. We like coordination. We tried our best, thank you. Ann, please introduce yourself for the record and we look forward to your testimony. Sure, I'll get started first and then turn it over to Lance. Thank you for having us. My name is Ann Paradiso. I am the director of school programs at Howard Center. I wanted to share a little bit about the DA system and our history with school mental health services. We have been in this business for nearly 30 years. It's hard to believe the length of time that we've been able to provide these and develop these supports and services. And the success of this model has relied on strong partnerships with schools and districts. While many are aware of the school-based clinician services, a number of designated agencies also provide one-to-one student services and specialized schools. So our system has a really well-developed expertise and skill set to effectively provide supports and interventions to children and youth experiencing emotional behavior challenges. We've accomplished this through provision of direct student services, as I just referenced, but also a lot of team and school consultation and targeted training. Our partnerships supporting children's mental health extends into the community. And in many counties, DAs are working with child care programs, providing early intervention and prevention to highlight one specific relationship in Chittenden County. Howard Center is working with the Sarah Holbrook Center to provide mental health consultation and training for Burlington children and youth who received their after-school vacation and preschool services. So with adequate funding, and we're well-equipped to contract with partners to bring needed mental health services and supports into the community and really encourage the committee to consider the existing system of care and the successful models that we've developed over the years. So that was the overview I wanted to give. And then I think Lance is going to get a little bit into more of the specifics of the service delivery. Thank you. All right. Thank you. And thank you just for the opportunity to be here as well. I think this discussion is incredibly important. So my name is Lance Mater. I'm the team leader of School-Based Clinical Services at Northwestern Counseling. And there we have a team of 14 master's level clinicians who provide support over 400 students in Franklin and Grand Isle counties. I wanted to talk a little bit more about the role of a school-based clinician and about the services that they provide daily in an ongoing way to the schools that they're embedded in. First of all, I just want to take a moment to highlight the importance of school-based clinicians because they're different than just mental health, but I don't want to say just a mental health provider, but they're different than a private mental health provider in the school. They really are embedded within the fabric of the school. They're part of the school community. A lot of the clinicians on my team have been working in their schools for the past 10 years. So the connections that we build to the community and the relationships that we build with our schools are incredibly powerful and it's really the basis of the effectiveness of our work. So the role of a school-based clinician is to provide individual therapy care coordination with families, pediatricians, and medical providers with DCF and then just any other people who are involved in the lives of young people. School-based clinicians provide mental health consultation to school staff, crisis evaluation, not only for our clients, but also for the general population. Student population, when a young person is struggling, they can come to our school-based clinicians to receive a crisis evaluation and direct support in that moment. So in addition to that, we also provide general population we would call them community level supports to the entire student population. So some of those things include groups, individual check-ins when non-client students are struggling, and we also provide regulation breaks and then also coaching in classroom push-ins. So not only supporting the students, but we're also supporting school staff as well. And this has definitely been a shift for us or something that our team has moved into more within the last two years over COVID. So we have noticed some really big gaps in school resources and educators and school staff are needing different things from us. So we've really shifted a lot more of our time to be focused on providing consultation, coaching within the classroom, providing trainings as well around social-emotional learning and really just best practices to create trauma-informed classrooms. So that's a shift that we are working to lean more into that it's really serving to fill some of the gaps that we're noticing and some of the increased needs of students as well. So we're seeing that the students who have underlying mental health conditions are far more acute, they're struggling so much more than they were two years ago. We're also noticing these struggles just across the general student population. We recently completed a time study in January. So this was for all school-based clinicians throughout the state participated in this time study. And what we found for one week in January it was just a random week but we found that we were spending over eight hours a week providing just that general consultation, training, classroom push-in and support directly to educators and school staff. So we're doing a lot of this within school and I hope that we can increase and get more creative around the supports that we're providing to schools. So I think the reason why you had us here is to really answer that or maybe to help you answer the question or to give you some perspective on how do we best support students? So I see this as the dilemma, right? Do we create new systems to support our youth or do we invest in the infrastructure that's existed for decades, right? There's a lot of experience and a lot of connection in a relationship that's already been built in our community. And the designated mental health agency services are really embedded. They're enrolled into the fabric of our schools and of our communities. And to help you all take it to answer this question I'll refer back to testimony actually from a superintendent Lynn Kota in my area where I live and work. She said, the best way to support Vermont schools with mental health is to support the systems schools rely on to support children and families in crisis. If we can work to ensure that families have access to necessary resources to meet their basic human needs fewer students will require more intensive interventions. Specifically Lynn was talking about and recommending providing the support to Vermont's designated mental health agency system. So I'm grateful that you all are having this conversation and we have resources to provide to students however we're providing that to schools and students their desperate need right now. I would encourage us to definitely look at the resources and systems and infrastructure that we have in place and see how can we work to sustain that and also expand that as well. There's a lot of knowledge and just a lot of resource there so that I feel can benefit so many more students. Thank you. This is very helpful. And so in my conversation yesterday with the commissioner of mental health we talked about increasing the flexibility within the bill so that it would allow for you who are associated with Vermont care partners and the DAs to have greater involvement. The issue also is that we're seeing tiered needs and so some of those needs obviously are being met through the masters of mental health and the folks that you've been talking about and some of those needs might be at a level that require don't require a master's level trained psychotherapists. So there in lies kind of the, and we've heard that there are just needs across the state. I guess my question as you looked at your January study did you identify that all the needs are being met across the state? So that the 8.6 hours a week is that, is your, sorry, just to clarify. Are there sufficient resources right now to cover all the needs for kids? No, no, I mean, this is about, sorry. But I would say no. A silly question, I think. Well, this is clinicians balancing a caseload and then working to meet the ongoing needs that schools are having. Yeah, I think. Yeah, no, it's a conundrum. So we wanna be sure that we're covering the variety of needs from, I will call it lower level tier to the higher level, master's level tier and ensuring that maybe we'll have to evaluate what we have in that bill and we'll be working with the agency of education and the education committee as well to ensure that the services that we can cover a multitude of services through the grants process. I'm not hearing that having additional resources is a bad thing, but it's how they might, how accessible they are to you who are currently doing such excellent work in the community. Yeah, and I'd like to add that while there certainly are targeted interventions that our school services across the board provide, there also is school community supports that the clinicians offer to students that are in a lower tier. And then certainly in our contracted partnerships, I referenced in a whole book, there are many others, that isn't about like the highest level intervention. That's not a tier three intervention. That really is around helping to equip staff with the knowledge and skill set to be working with those students that are present in, whether it's after school or vacation services that are presenting with behaviors that exceed the training and knowledge that they have. So we bring in that specialized information, share it with them, consult, give feedback, train, and then they're better equipped to manage those kids that still have needs but don't need to be in the one to one intensive mental health service or support. Yeah, we've been talking a lot in this committee about certification for support staff. So it sounds like it's that kind of training for people to be more engaged. Yeah, it doesn't result in a certification, but it certainly expands their knowledge of trauma-informed interventions, behavioral supports that are effective. And I think it better equips them to work with students in a variety of needs. Okay, thank you. Senator Cummings, Senator Cummings, you are muted. Just getting hit in my drawer. Tying it all together though, your first, well, I know my local mental health agency is having trouble hiring master's level because of the wages they're able to afford. And I'm assuming Northwest isn't in any better financial shape. And I think I heard you say that if we have extra money, that you have the systems in place that you already are working with after school programs with school staff, and then if there's extra money, you could put it to good use. Is that, I think that's what I heard. It is true, we are in unprecedented times and everybody has experienced a workforce shortage, so we can't deny that. There are no guarantees next month. We are looking forward to the day when we move out of this. As you all are aware, the DA system has requested a 10% increase for this upcoming year to help move the wages and get more people able to consider working for designated agencies, seeing that as a viable place to provide services and earn a living. So it is correct at the moment, there are extreme workforce shortages that has not gone away, but we are prepared as that starts to lift to take that expertise in the system we have and bring that into the community. But funding certainly is a part of it. Okay, questions for the folks? Senator Hardy. Thank you, Madam Chair. Thanks, Anne and Lance for being here and for all of your work. I know personally how important school-based clinicians are. So, sorry, I'm just curious, your work during the summer, do the school-based clinicians continue their work in connection with students and potentially staff during the summer? Either one of you. Sorry, I am, if you wanna talk a little bit more about a statewide or correct me as well, feel free to jump in. So I think that depends on the agency and the way that their projects are built in the school. So I can only speak specifically for NCSS and what we do. And yes, we do continue to work about 20 to 25 days over the summer. And a lot of that work actually over the last two years has shifted to supporting some of the summer programming because schools had an incredibly difficult time over the last few years, having educators and support staff come back very understandably because they worked so incredibly hard during the school year. And that's where we've used school-based clinicians to fill in some of that support. Yes, it is providing a very skilled person. It's a master's level person doing that. But I think the benefit of that is that they can provide so much more to that programming. It's such a valuable resource. And do you, sorry, go ahead, Anne. I'm sorry, I was just gonna reinforce what Lance was saying, that I do think it varies across the state, how the programs, it's part of the beauty of the system is we kind of respond to what the need is. I know in Chittenden County, our school-based clinicians, the majority do not work over the summer, a few do, but the majority don't. But I'll remind you, our school programs are just like one faction of our children's services. And so there's like family and community support services that have one-to-one staff that provide respite and living skills support throughout the summer, family engagement. So we work in tandem that if children's mental health is children's mental health and so some are housed in schools and some are housed in the community and some are housed in homes. So there's an array of providers available that may step up in the summer and cover for meeting the support needs of students during their summer break. Okay. And do you know, you may not have the statewide, but staffing shortages aside, I know that's a real thing, but do you know how many schools do or don't have school-based clinicians? What percentage of schools have them? Do you know in the state, you're not? I can, we do have that information as a system of care and I can just listening to Senator Lyons requesting that we submit a written statement at that time I could pass that information to the committee for you to have that for consideration. That would be helpful. Yeah, I mean, it's such an important service and not all of our schools have access to it, I'm sure and if we have money, I'd like to be able to beef up the program around the state rather than start something new. And there is consideration underway right now about how we, and you probably are aware the more equitable distribution and I think it's really been based on individual schools and districts over the years and who's decided to step up and partner and so that consideration is underway. Great. Thank you. Thank you both. Senator Cummings and then Senator Hooker. Yeah. The other thing that we don't know because this bill calls for summer programs and I'll probably look to Lance, I know Washington County to the best, I think there is some program in the Barry rec center and Montpelier's rec center runs a summer camp. My grandsons from Barry come to Montpelier. I don't know of any other summer program. So are there summer programs up near you that keep kids off the streets or, you know, how extensive is that coverage? Yeah. So I can, I mean, I can only speak for our area and again in Grand Isle, but there definitely is summer programming available to young people either through the schools or through local rec departments as well. So school-based clinicians historically have supported the summer programming that's embedded within the school or what the programming that the school provides, but both could be options for young people. Okay. Are they free or is there a, there's a pretty hefty charge for Montpelier? I don't, I can't answer that really. I think most are not free because they've got to, you know, be paying their staff or whatever. And it all depends on where you sit on the economic letters to whether that's something you can or cannot afford. And I think there's a real range and there's definitely a need there. I mean, I think the difference is we are mental health providers and our funding is to be delivering mental health services. And so, you know, there's capacity to bolster that within the summer programs, but it's, that's more of a recreational aspect. So that would vary as far as what involvement the designated agencies have. So what I'm going to suggest is that the, we did hear from the after-school folks and they did provide some of the answers to the questions that are being asked. And we're, we are very pleased to have your input on this because it'll help us restructure the bill in a way that is more inclusive of you and continue the system that you have. But it also provides for additional funding that is so key for out-of-school activities. So they're, and if we, right now, there's a minimal drop in the bucket in the bill. If, as we work through the Education Committee, we can add resources that will allow for you to have additional money and it will also allow for after-school to expand geographically, all of which is good stuff. So we do want to get it right and we do appreciate your coming in and clarifying the work that you do. Well, thank you very much. Yes, thank you. And I know time is limited today, but if there's a point where you'd like to have any us back to hear about the breadth and array of school services that are provided through the designated agencies, would you be more available? We will, you know, we'll try to reach out. I've got some recommendations coming in from the Department of Mental Health, the Agency of Education will have its comments and we'll try to sort this out and use your expertise as well. So this is very helpful. Thank you. Thank you so much. Senator Hooker, quickly. Just before you go and you've mentioned after-school programs a couple of times and I'm just curious to know if the school-based clinician is on staff for the after-school programs as well as the regular day of, you know, the regular school day. As Lance has mentioned, this is different across the state. In Chittenden County, our clinicians, their predominant services are during the school day but there is a lot of care coordination. So if there's students with special emotional behavioral needs heading into an after-school program, they would be coordinating with the providers of the after-school program to make sure that they understand the breadth of needs of a particular student and potential behavior intervention plan or crisis plan. So it's more about kind of an informed hand-off and then a back and forth communication about what may or may not be working. But again, it could be handled differently in different parts of the state but for Chittenden County, that's how it's handled. Okay. Thank you. This is great. Thanks for coming in. Thank you. All right. So committee, yeah, that was great. That was good, very helpful.