 Good morning. This is a joint hearing between Senate health and welfare house human services and house health care. It's January 14 and welcome everyone are three committees will be taking testimony today on how the outcomes from the CRF funding that we received in 2020 and trying to understand the effect of what we've done in particular on our in areas of human services, but then also with our provider stabilization fund. So we have a long list today, and we'll get to that in just a minute but first I I'd like to let vice chair of human services Teresa would introduce herself, and then chair bill leopard of house health care to introduce himself. Good morning. Thank you, Senator lions. I'm Teresa would represent representative from Waterbury representing the Washington Chittenden district. And on behalf of chair q she is otherwise engaged for the first part of this meeting this morning but she will be joining us just a little bit late so thank you all for being here. Good morning. Representative bill leopard chair of the house health care committee representing Heinzberg. Again, I look forward to hearing from our witnesses today and maybe I will just telegraph that we're looking to hear about new CRF dollar new. We're not going to be able to turn this CRF anymore but the new federal dollars and we'll be scheduling that again with a joint meeting of these three committees for next Wednesday morning. Stay tuned for the specific time and witnesses. Okay, thank you and thank you all committee members for being here we're not going to introduce ourselves anymore than than we have today, but we want to move forward into the testimony and before we do that to two things of course please keep yourselves muted when we are in committee and hearing testimony. And then secondly, we're asking that you not use the chat. It becomes distracting. If you do need to communicate with the chairs, then you can communicate directly with us about a concern or a question you have about your, your testimony, want to make sure we have time for everyone. So we're going to move as quickly as we can without losing the important words that you have for us today and we truly are looking forward to this we know. It's been an unbelievably difficult time for every person who's with us today in a particular those of you who have been working out on the ground for helping people. We get that. And so we're very interested in hearing your stories, hearing how the CRF funding has helped you, how any of the policies that we've put in place have helped you. And then where are the gaps that exist and how we might systemically improve as we go forward. So that's more or less our goal and we're going to start out with Sarah Clark, the chief financial officer for the agency of human services. And I believe we have testimony from a number of folks on our web pages and Sarah I think you're included in that list. Presenting your testimony for this is for witnesses. Let us know if you have testimony submitted and then we'll be able to go and find it. And some of you want to share screen and we can allow for that I think Commissioner squirrel has already asked for that so we'll we'll try to be as efficient as we can going forward and I thank you again for for being here. Looking forward to hearing every all the wisdom that's coming to us today. Truly, thank you. So, Sarah, welcome, and thanks for being here. Good morning. Thank you for having me. I am going to share my screen. We get oriented. Can you see my screen. Perfect. Welcome back. It's good to see everybody. Today I'm planning to give you an update on the status of the coronavirus relief fund programs as appropriated by the legislature to the agency of human services. At one point in time when you last left at the end of last session. We just had approximately a half a million dollar, excuse me, $500 million, a half a billion dollars appropriated to us for coronavirus relief funds that included some of the funding related to the early relief efforts that the agency of human services had provided to our provider networks, as well as the legislatively created programs that we developed in collaboration. At that time, as, as you are aware, through the joint fiscal committee process, there have been adjustments to our original coronavirus relief fund appropriations, or we now probably roughly have between 400 and $450 million of CRF appropriations at the agency of human services. So I'm going to build off of the testimony that I provided to you last session to give you an update across the roughly 20 CRF programs that have been established at the agency of human services. There is a lot of information in this presentation and so I'm prepared to move quickly because I know you have a pretty lengthy list of folks scheduled to testify today, as well as commissioners hut and squirrel. An important piece of information that kind of changed our world at the end of the calendar year, we have been targeting over the last 10 months that the coronavirus relief fund was set to expire on December 30. So all of the action all of the relief that we issued to our various networks was targeted with being complete by December 30. And what what that means is not necessarily that all of the cash had to be out of the door, but all of the services all of the expenses had to be incurred by December 30. This required us to move at a very quick but effective pace. As you know, right before December 30, the US Congress extended the coronavirus relief fund for another year. I mention this to you for context, because even though we do have an initial year. The majority of our programs were really almost at the point of completion, because we had been hard charging for so long. So, I'm going to just start going through the inventory of CRF programs. In this office, there were three different CRF programs to grant funds to legal aid. Focusing on providing access to justice services, providing access for legal and counseling services for those who are at risk of or experiencing homelessness, as well as some funding for information technology needs necessitated by the COVID-19 pandemic. And across all of those funds, a little bit more than a million dollars, the agency has executed those grants with legal aid and paid out or have expenses incurred for that full amount. In addition, I do want to point out to you that as it relates to providing assistance to Vermonters with electronic judicial filing fees, we are planning to amend that contract with legal aid to add an additional $75,000 of support. The first program I'm going to talk about is an original appropriation of $2 million to AHS to distribute to vulnerable populations. The original appropriation was for $2 million subsequent to that the joint fiscal committee approved in early December, excuse me, in mid December, an additional $1.3 million. We distributed those funds through the departments for children and families and the departments for disabilities, aging and independent living. The funds through DCF, $2.6 million was provided as stipends to families in the reach-up program. They received two stipends. Dale issued $700,000 to the DS Family Support stipend program. The funds have been put out the door. The next program I'm going to talk about is $700,000 in grants that were made to two refugee organizations, $350,000 to the Association of Africans Living in Vermont, and $350,000 to the U.S. Committee on Refugees and Immigrants Vermont Refugee Resettlement Program. Those grants have been executed and the funds have been paid out or encumbered through December 30th. Now I'm moving fast, so if you need me to slow down, please just signal as that. The next program I'm going to talk about is $3 million that was provided to EMS and ambulance service providers for both a training and a stabilization program. Of the $3 million to date, roughly $2,873,000 has been issued. $300,000 for training purposes for paramedics and EMTs. And an additional almost $2 million for stabilization to EMS and ambulance service providers. AHS worked with the Vermont Department of Health to stand up the stabilization program, also working with the various organizations to make sure that we receive their input in terms of the development of that program. I'm leaving a legislative report on that tomorrow with some more details about providers that received funds through that program. There was another program related to EMS providers that was an additional $2 million to provide workforce stabilization funding to EMS and ambulance service providers. AHS through the Department of Health issued roughly 73 grants to providers totaling $1.9 million. You will also receive additional details on that program in the legislative report tomorrow. The next program I'm going to talk about is one of our biggest at AHS and that is the hazard pay for essential employees program. If you recall, there were various stages of appropriation to support this program. For the two tranches of funding that were appropriated by the legislature, as well as additional funds that was provided through the JFC process, that program grew to be $60,600,000. AHS partnered with Department of Financial Regulation to administer both the first and the second rounds of this program. If you recall, the first round focused on health and human services providers who allow those frontline employees to receive hazard pay for their efforts in the early phases of the pandemic. The second round expanded the eligible employers to include a more broad array of employer types where employees were working on the front lines during the heart of the pandemic. That is the round where the Department of Financial Regulation were amazing partners to the Agency of Human Services and allowed us to execute this program. To date, 1,192 employer organizations have received grants from this program. Roughly 3,240 former employees received payments. I should pause for a moment to reflect that during the second phase of legislative appropriations for this program, it was determined that we wanted to provide these hazard pay payments to individuals that may at one time during the heart of the pandemic worked for an organization. Perhaps they no longer did, but we still wanted to be able to reward these employees for working through a very challenging time. And so we expanded the program to allow former employees to be able to receive either the $1,200 or $2,000 payment. The table at the bottom gives you a rough sense of the $60.6 million that was appropriated kind of where we are from an accounting perspective. It's important to note that we are still finalizing this program and that these numbers will change over time. We've issued roughly $54.7 million in grants to covered employer types to distribute to their employees. We've also issued $5.3 million in hazard pay payments to former employees. There have been $335,000 of administrative costs. As well as in addition to those amounts, there are some employers who received awards that subsequently returned those awards to the state of Vermont. And there are a variety of reasons why that that may have happened to include either a closer review of eligibility of their employees that cause these employers to return the funds to Vermont. So as of today, and though these these figures as I said will change, we have spent in this program $57.5 million. The next table is probably very hard for you to read when you get the report tomorrow you will see a report on the hazard pay program you will be able to see more of these details clearly, but this just gives you a flavor by employer type. So how much was issued. It's important to know in this table that it's duplicated, meaning it's not going to equal the total on the slide previously, because employers had the ability to self select their employer, their employer type and so they may have selected more than one, but it's, it's good to understand, you know, where the dollars flowed as part of this program. So I'll just pull out a few numbers for you a little bit more than $12 million went to grocery store employees. $10 million went to healthcare facilities. And 13.3 million dollars went to retailers. So again, you will receive this report tomorrow and certainly happen happy to have a more in depth conversation about that important program. So the next program I'm going to talk about is the biggest one that the agency of human services administered and that is the healthcare provider stabilization program. As you know, even before this program was established in collaboration with the legislature, the agency of human services moved quickly to provide supports to our critical providers to ensure that the healthcare system was sustained through the pandemic. Our focus was on preserving the healthcare system and Vermonters ability to access healthcare services during the pandemic commissioners squirrel and hut are going to give you a little bit more detail. Later in this presentation about some of those early relief efforts to critical provider groups. So this slide gives you a kind of a sense of the appropriation history for this program. So if you recall, we originally started at a $275 million program in Act 135 Act 154, which was during the fall session. We actually reduced that overall appropriation by $27.5 million. In addition to that reduction, there were some key set asides to allow the agency of human services to cover some other critical areas, such as testing, the EMS workforce stabilization program that I've talked about. And a round three that was targeted for the DA's and the ssa's to provide them continued relief from September 15 to the end of the year. That left available in the program when the legislature adjourned at the end of September $238 million roughly. As you know, with the deadline of the coronavirus relief fund being December 30 agencies and departments across state government were working really hard to ensure that we were maximizing our use of this federal revenue, leading up to the deadline. As such, as AHS move through the administration of this very important program. It was clear at that point in time that there was funding available that could be reallocated through the joint fiscal process to other important needs in Vermont. And so you see the $78 million reallocation by the joint fiscal committee that was done on November 5. In addition, at that meeting there was funding pulled out for more testing as you've I'm sure seen the capacity of testing in the state has really been enhanced over the last couple of months. And we got approval to use some of the funds in this program to pay for our administrative costs, leaving available for grants in this program, a total of a roughly $156 million. And we've talked about this I think at last session but I'll maybe kind of quickly remind you of the process that we went through for this program. AHS stood up an online application via Salesforce. This is a essentially a grants application system that was used not only by AHS but by a variety of programs across state government, most notably the economic recovery programs at ACCD. Our process was a need-based assessment where we looked at multiple factors to determine what an award amount would be for a provider. This includes the fiscal impact of business disruption for various revenue sources, increased expenditures related to COVID, any sort of mitigating actions that an organization may have taken to control costs, as well as looking at fund sources that they could have received from other sources. So for example, the federal government, there was a lot of aid that was provided direct from federal health and human services to providers. All of those were factors that we considered in terms of making awards. In addition, in this sphere, some of the providers are eligible for FEMA funding. If a provider was eligible for FEMA funding, they needed to pursue that FEMA fund source. And our grant program would issue them the 25% state match that would be needed for that FEMA award. It was a very labor intensive review process. The team at AHS spent significant amounts of time reviewing the information to be able to make grant determinations. We did outreach to make sure we were communicating with all eligible applicants. And you can see I've included a link here to further information if you want the details of the grant programs. At that time, it was all geared to be completed by December 30. And these grants are subject to the requirements of a single audit, which is important for the recipients to understand. We administered two cycles. The first cycle opened on July 17. The deadline was August 15. It was for the time period, March 1 of 2020 through June 15 of 2020. We received 351 applications and ended up issuing 190 awards. Those awards totaled $85 million from the Agency of Human Services. However, in addition, we partnered with the Agency of Commerce and Community Development because their economic recovery program was actually open and available to applicants before the healthcare provider stabilization program. As they had healthcare providers that came in through their door and were issued in a grant through the ACCD program, AHS agreed to reimburse ACCD for those healthcare providers. So we reimbursed roughly $1.9 million of grants to ACCD. I've included a link to the report on cycle one of the program. You will receive the updated legislative report tomorrow. It's been a busy week for legislative reports at the Agency of Human Services. Cycle two of the program opened on October 19. The deadline originally was November 6. The time period for eligibility was March 1 through September 15 of 2020. We did reopen the application from November 17 to November 24 so that some providers who had started applications but didn't have a chance yet to finish them, we wanted them to come back through over that week to be able to finish their applications. We received 272 applications, and we issued 128 awards as part of the second cycle. AHS issued $57.9 million of awards, and then there was an additional $797,000 that was issued on behalf of the ACCD program. In addition, as I've mentioned briefly earlier, there is a cycle three of sorts that's targeted to the DAs and the SSAs to total $3 million. We are in the process of working with our partners to complete and administer those grants. I want to bring to your attention an emerging issue that we have experienced at AHS with the kind of November, December surge in COVID cases in Vermont. And that is we do have some long-term care facility and other residential facilities that when they are dealing with an outbreak have needed some quick and relatively small infusions of cash to help them have the resources to be able to deal with the COVID outbreaks in their facilities. We have some parameters for that program that we've developed. For example, there has to be a COVID positive patient. There has to be a financial need, and it has to kind of be immediate and quickly needed. We've issued to date roughly $332,000 to about five providers. Again, some slides that are probably hard to see from your screen. You'll see more detail in the PowerPoint that I provided to the committee assistant as well as in the report that you will get tomorrow. But this just tells you by provider type, the amount of awards that were received in cycle one, cycle two, and then in total. So in total across all cycles of this program and including the transfers to ACCD, $145.7 million has been issued as part of the healthcare provider stabilization program. This is just another way of looking at that same information, but it tells you the count of awards by provider type. And then just another breakout of information by hospitals, you can see who received awards in cycle one and cycle two. So hospitals received together about $110 million across cycle one and cycle two. For your information, we were notified, I believe in November that the state auditor's office was going to be doing a risk assessment for the healthcare provider stabilization program. They've actually now moved from the risk assessment to they're doing an audit of the healthcare provider stabilization program. This is something that they're also doing for the other major coronavirus relief fund programs in state government. I know they are doing them for the economic recovery programs that ACCD and PACS administered as well. We actually have our entrance conference with the auditor's office this afternoon. And their preliminary objectives are to assess whether and how the agency of human services ensured that those providers that we issued awards to met state and federal requirements as part of our grant program. And they're also very focused on ensuring that there was not a duplication of funding provided. So, more information to come on that. And that's the, that's the healthcare provider stabilization program. But you will probably at some point want some more information on that. Yes, I think each each of the committees will with your acceptance will invite you in I think for greater detail so we can ask some more specific questions I really want to thank you for the work that you've done I do understand this is a day before the report is due. I'm appreciative to that when we invited you so we're very appreciative that you're here. So thank you. Of course. I just have a one. I don't want to ask questions now, but something to think about is, as you were looking at need. Obviously you were communicating and working with a CCD on all of this but also, there were other funds available to certain providers, particularly healthcare providers that was outside of the money given to the state and did you take that into account. Okay. Yes, we did it was very important part of our methodology. We actually the Department of Vermont health access oversight and monitoring unit went on a weekly basis pull down that information from the federal government it's it's publicly available by provider type. And so we would reconcile, you know what an applicant had input in terms of the other forms of relief they received with what we are seeing from the federal databases. Thank you. That's that's helpful and we'll keep that in mind as we go through the report that you send us. Okay, I, I think a bill or Teresa do you have a single question for Sarah. I think we're all set right now thank you manager. Okay. Yeah I think I think what you just said in terms of for particularly for new members understanding why we initially appropriated $275 million in fact we thought that wasn't not going to be enough. And some part of. So we'll hear more in our committee but what we learned was that hospitals in particular and other entities were eligible for FEMA dollars and for some other dollars and so the total amount was able to be reduced and reallocated. And I don't think we can overemphasize the complexity of the work that has an ACCD, all folks in the administration have done. And also, I do thank you for your emphasis on the collaborative process between the legislature and the administration. This has truly been that and we appreciate that. I think we'll move on and I want to thank you and good luck this afternoon. So I do I do have and I know that commissioners squirrel and hut are scheduled after me I do have, but for other departments some updates on their CRF programs. I think I can, if you want me to go through them or we can go right to commissioners squirrel and hut I'm fine either way you've got the information. I think we should just move ahead if, and I don't know what your schedule is we can we can come back. We can circle back to this either today or another day and get into greater depth but so I think we should move on to the two commissioners. And I'm actually asking you Sarah if you agree with that decision. Yeah that's fine I can I can come back at any time to talk about the other programs. And you've got the materials so whatever works best for committee. Good. Why don't we do that. We don't want to overload ourselves this morning we can do that tomorrow. Okay. All right. And so we do have two commissioners with us today, Commissioner Sarah squirrel from Department of Mental Health. Commissioner squirrel welcome. Morning. Good morning. I'm just going to move right along into testimony. And thank you for being here. Of course yes thank you sender lions good morning everyone for the record. This is Sarah squirrel the Commissioner of the Department of Mental Health and joining me this morning is Commissioner hot so I will allow her to introduce yourself. Good morning everybody and happy new year it's lovely to see you all. Monica hot I'm the commissioner at the Department of Disabilities aging and independent living and it's a pleasure to be here this morning. Thank you for being here. We greatly appreciate it both of you. Thank you. So I think if it's if it serves the chair, or the chairs, I will also share my screen to continue the presentation where Sarah Clark left off. Okay, can everyone see that okay. Yes, yes. Wonderful. Okay, well I will just jump in in the interest of time. I just want to thank the committee for your time this morning again to reiterate Sarah Clark comments about the collaborative efforts here. I also know that there are many providers that you are waiting to hear from so we will try to move through this as quickly as we possibly can. Certainly the areas that we wanted to cover today was just an overview of some of our relief efforts specific to the mental health system of care, and the developmental services system of care, in addition to older Romaners and long term care facilities, an overview of some of the CRF funds that we've provided to the designated agencies and specialized service agencies, an overview of other CRF initiatives, the Department of Mental Health has supported. In addition to Dale, and then per the chairs requests, some thinking about some of the impacts that we've seen related to the pandemic and opportunities that we see as we go forward. So, first and foremost, when the pandemic hit the state last March, our primary priority was stabilizing our essential mental health and developmental services providers and other services across the state. So it was absolutely essential that we ensure that those critical services for Romaners could continue. So we worked diligently to ensure that we had a strong and stable system for both mental health and developmental developmental disability service system, our long term care services and support system, and our older service system. We know that this network of services and providers is absolutely essential to keeping our community based human services system intact. Our focus on stability of providers throughout the pandemic was always our North Star. And without these systems without these individuals without these direct care workers. We know the pressure that that would have put on our emergency departments hospitals and public safety. And I do just want to take a moment and thank all of our leadership across our network of providers, some of whom we will be hearing from today. And of course, all of the direct care staff across the system of care. They have truly been essential showing up every day to ensure that vulnerable of our monitors are still receiving care. So I just want to highlight a little bit of our early relief that we provided specifically to the DA's and ssa is develop our designated agencies and our specialized service agencies. So when the pandemic first hit, you know, we really stepped back and said what can we utilize or leverage within existing resources to create stability. So many individuals are aware on these committees we did, we have implemented payment reform for the Department of Mental Health. So all of our DA's and ssa's are paid under a case rate. And so they get a monthly perspective payment to provide services. We've been able to leverage that model to provide flexibility to adjust the reconciliation on the back end, so that they can continue to provide those services and receive that funding. And we also moved quickly in partnership with Diva to ensure that telephonic services were approved for Medicaid billing. We expedited the payments for the EMR's that the DA's were also providing and Dale implemented flexibility within their billing, which enabled agencies to bill consistently on a daily rate, and then monitor again to create that stability for our providers across the system. We also knew that quickly we needed to stabilize the workforce. So we immediately put into place in collaboration with AHS some efforts to provide hazard pay to the DA's and ssa's. So specifically we were able to provide $7.6 million specifically for hazard pay and incentive pay for the DA's and ssa's. This also included family difficulty of care stipends and stipends for shared living providers for the Dale providers. In addition to that we provided $3.2 million and additional COVID relief. So our total early relief specifically for the DA's and ssa's was $10.8 million. And again these funds were provided to cover prevention supplies, increased costs related to IT and telehealth expenses, hazard pay, and other COVID related expenses. And Monica, do you want to talk a little bit about that last bullet in terms of the conversion of underutilized respite dollars. Sure. I think one of the one of the most important tenants as Sarah or Commissioner Squirrel has already spoken to was trying to stabilize our providers. We also recognized that what that the pressure that the pandemic was putting on individuals and families. And so one of the early things that we did was initiate flexibility within the individual funding providers for families and individuals, which enabled agencies to work with those individuals and families to convert dollars that weren't being drawn down into stipends for individuals families and shared living providers and that flexibility has continued throughout the pandemic. I'll speak to that a little bit more a little bit later in the testimony but just wanted to make sure that people recognize that as we were working to stabilize and support our providers so that they would exist safely through the pandemic and be available on the other end. We also recognize the kind of pressure that that put on individuals who were receiving services and counting on those. So tried to mitigate that as we could. So that was a quick overview of some of the early relief that be provided specifically to the DA's and SSAs and then Sarah Clark gave an overview of the health care stabilization program. Both rounds one and two, which are DA and SSA system were able to apply for as well. Sarah Clark already reviewed some of those cycle periods and in total in round one and two. In addition to those early relief dollars. We've provided an estimated $5.8 million to the DA and SSI network. Again, same source of funds related to COVID related expenditures, revenue losses and demonstrated on that need. I would also note as Sarah Clark outlined in her presentation that the DA's and SSAs were also authorized by the legislature $3 million of CRF to be utilized for a third round of health care stabilization through the time period of September 15 and December 31. Again that $3 million has the same source of funds of the same expectations in terms of how it can be utilized. The status of that is that it is in process and the final application is due January 22nd from those DA's and SSAs. And Commissioner Hut, do you want to speak to the second round of family difficulty of care stipends. Yes, I think that that was the end it. There is a merge between what Commissioner Squirrel and I are sharing and what Sarah was able to share at the very beginning. So that second round of stipends Sarah Clark spoke to, as she was talking about the very specific legislative time that was created that was distributed both through DCF and reach up and through DALE. That was where those funds came from to enable us to do that second round of direct family stipends. So you will see throughout the rest of this presentation, and certainly on the DALE side, the health care stabilization, the legislative appropriations for CRF and programs that the agency were able to do, sort of jumbled together and spoken to more specifically in terms of response and results. But Sarah Clark is the, is our North Star in terms of the dollars and where they came from. So we will always defer back to her when that comes up. Thank you. Next slide is just an overview of the total CRF for our DA and SSA network specifically. It's inclusive of the early relief that I noted, estimated awards for health care stabilization round one and two, and health care stabilization round three for a total of $19.7 million. And again, our community mental health agencies, specialized service agencies have done a tremendous job in focusing on retaining their staff, maintaining safety, transitioning to telehealth, and really working on establishing more mobile and nimble service delivery. So again, hats off to our community providers and leadership for their incredible work over the past several months. I want to talk a little bit about some of the other CRF initiatives that the Department of Mental Health specifically was worried was working on. Working in collaboration with the legislature we were provided with an additional 500 K to focus on suicide prevention. Recently we know the pandemic has significantly impacted the well being of Vermonters. When we worry about increased unemployment, social isolation, fiscal instability, and family stress are all increased risk factors for suicide. We wanted to make sure that we had a comprehensive approach and implemented several strategies to support suicide prevention efforts across the state. We included expanding our zero suicide efforts, expanding our national suicide prevention lifeline, developing targeted suicide prevention resources that are culturally informed, expanding our mental health first aid, and of course expanding our elder care clinician programs across the state to support older Vermonters who we know are also at very high risk. In addition to that, we were also able and thank you to the legislature for additional funding to support pathways warmline, which is a peer run support line. They were able to expand their hours to be 24 hours a day, seven days a week. I was just reviewing a report yesterday on an update on that just tremendous work on behalf of pathways. They exceeded their targets for calls on averaging over 1000 calls per month and expanding their outreach efforts. We are also happy to report that we'll be able to continue that expansion by leveraging some of our SAMHSA emergency grant dollars as well. And I will turn it over to Commissioner hot to talk a little bit about some of the Dale specific programs. Great, thank you Commissioner squirrel. Before I jump to this I do also want to just express Dale's gratitude to Sarah and her team, because in addition to those CRF dollars that are supporting the elder care clinicians. The Department of Mental Health also found general fund dollars to support that program so it actually ended up being in $100,000 of an increase to that elder care clinician program. We're very grateful for DMH's continued support around that and you all know how valuable that program is as it is really provides clinical supports to older homeowners who are homebound and who can't access typical outreach or typical outpatient work. So more and more critical I think as the world turns and this progresses on and just really grateful to Sarah and her group for for being able to do that. From a perspective we had agreed that Sarah would really cover our designated agencies and specialized service agencies. But we, I wanted to make sure that we spoke to the different networks that Dale touches across the rest of our department, not in as much detail as Sarah Clark was able to offer even as much detail as we just offered on the designated agencies and specialized service agency system, but knowing that these you are three committees, particularly really look across all of these systems. I wanted to at least give you a small flavor for each of the networks that we work with in Dale, and what we've been able to do. Commissioner squirrel stated at the very beginning, you know the goal at the very, the very, very start of the pandemic was to create stability and sustainability for service provision and for these providers. And so that became a component and a track where we were working with what services were able to be delivered, but also recognizing that we needed our system to come out the other end of this pandemic. They needed to be stabilized financially in order to be available to Vermonters when the world becomes a little bit more normalized again. And so that became a primary focus for us across all of these different systems. And to all of the funding and the conversations that we're having today, it would be wonderful, a little bit later on in the session to be able to talk with you about some of the flexibilities that we created some of the changes in practice that we utilize to sustain these providers and to sustain services in really creative ways. So it's a lot to cover. And I know we wanted to stay focused on CRF for today but I want to make sure that we recognize that our support, hopefully was experienced by our networks is not only financial, but as as flexibility and what we were asking from them and how we were asking them and enabling them to work. So just covering really quickly through some of the networks that Dale supports adult day programs as most of all of you know, were required actually to close they were asked to close at the very beginning in in March, and actually they were working towards opening at the very beginning, or the end of the summer in the beginning of the fall, but had to close once again as the as the surge in infections and COVID-19 made it untenable for them to operate safely. So in addition to healthcare stabilization dollars that they were able to apply for, there was specific CRF funding supported through the legislature and through the Dale budget to ensure that they could operate completely. So that was their operational costs, based on what they gave to us as needs. So that has been tremendous. So July through September, they were there was $2.5 million to maintain the adult day programs in October through December, an additional CRF dollars that covered their full operating costs so that they could sustain their staff and and work to be available to families and individuals, both during the pandemic and afterwards when they can finally fully reopen. Thinking about our area agencies on aging, which all of you again are all very familiar with, and considering that one of their most critical functions throughout the pandemic has been nutrition supports and meal delivery. The CRF dollars were available to them. Again, April through June and then September through December to enhance the funding that we were able to receive through title three C the older Americans act. So there were dollars that went to senior centers and meal sites through our area agencies on aging. So first to address the gap in the enhanced rates that the older Americans act created for meals for meal preparations. There was still a gap in terms of costs. So those first $600,000 from CRF filled that gap for our meal programs and our senior centers. And then the second tranche of dollars the $565 actually created the ability for the area agencies on aging to continue the enhanced rates that the older Americans act had set through the pandemic. Again, I'll speak a little later in testimony about what we are anticipating coming back down through title three C and the older Americans act, but just important to know that we were trying to supplement for the area agencies on aging and our meal preparations. We certainly saw increases in the in the number of meals that were happening and tremendous creativity across provider communities in terms of how those meals were delivered. Obviously from congregate meals, but some real interesting workarounds to make sure that older Vermonters and Vermonters with disabilities were receiving meals. We did also reach out just as an aside to Vermont Center for Independent Living. As it turned out the federal government was very, very supportive and generous to them, and they ended up not needing any additional dollars, but were able to enhance and accelerate the meals that they were providing to individuals with disabilities across the state. So you want to jump to the next slide for me. Great. Thank you. So, some of the other networks that you know that we are engaged in involved with at Dale skill nursing facilities in our long term care facilities so not only our nursing homes but our residential care, our assisted living facilities and the therapeutic community residences that are licensed across the state. They were all eligible to apply for healthcare stabilization dollars throughout the, the different rounds of the HCS program. But additionally, for skilled nursing facilities in particular, there were some really significant hits at the very beginning of the pandemic. And so we created a sort of shortened version of our normal emergency financial relief program for nursing homes we call it EFR that works through the department of rate setting or the division of rate setting that sits now in diva. And we did push out some CRF dollars to nursing homes that were an immediate jeopardy at the beginning of the pandemic, not only because of increased costs, but because of the cost of staffing. The personal protective equipment that folks needed to buy and loss of revenue and again I'll speak to that as a systems issue that we saw that that sort of stalling of the ability of admissions to happen across that system. But that that was a really critical component of an initial response. Our home health agencies were eligible to apply for healthcare stabilization. And I believe were and also were able to apply for the hazard pay program. They certainly had to modify much of what they did. But they, unlike most of our other providers needed to continue to deliver face to face services and did so in the midst of a pretty challenging time and continue to do so. They really weren't able to pull back from that direct essential service delivery in the way that other providers really had to pull back, because the services that they were delivering were medical services and were critical. And I'm sure that they will speak to that a little bit later on in the testimony, but they really continued on in terms of service delivery and more typical billing. Long term care facilities outbreak response Sarah Clark referenced it, we are seeing now a need for some emergency response to some of the smaller facilities as outbreaks occur. So to date there have been five residential care homes that had that had outbreaks and for a residential care home it can be a large but can also be a very small facility. So five or six or seven or 10 residents and 10 staff. And in some of those facilities we saw outbreaks that literally took over the entire building where everybody was positive with COVID-19. And so the ability and the necessity of supporting them quickly with funding to pay for supplemental staff to get meals catered for the personal protective equipment that they needed to maintain prevention, infection and control procedures. They needed fast relief, they needed it to be quick, they needed it to be simple. And we were able to do that through CRF, which we're really grateful for. Additionally, the state of Vermont and Dale created an emergency staffing pool in a contract with TLC so that we've got 40 staff across the state, 20 in a staffing pool and 20 per diem that are deployed as necessary to any outbreak that occurs. If there are no other staffing options. That's happening on a very regular basis. We are still seeing and consulting on outbreaks. I literally can look back at my calendar there are seven or eight calls every day for the last several weeks where we're consulting immediately with facilities and have been deploying that staffing pool as part of the response which I think has been absolutely critical and in terms of of really ensuring that outbreaks don't get out of control. One of the things that I would love for us to be able to talk with this legislative group about in a few months is the outbreak response that Vermont has created. And really recently BDH has started crunching some of the numbers and have discovered that the outbreak response the rapid response that Vermont has been able to employ to our long term care facilities has actually prevented more outbreaks than actually occurred, simply because of the structure that we put in place to consult around needs almost immediately. And that staffing pool I think has been a critical component of that. I'm going to turn this back over to Commissioner Squirrel to talk a little bit about the impacts of mental health. Commissioner Squirrel, I want to be very sensitive to the time and the folks that we have lined up coming after you. And is there a way that we can wrap this up within the next five or seven minutes. Yes, of course, we can absolutely do that. Perfect. Thank you. And we will. We are very much aware of the need to have you folks back in. And you keep telling us that and we hear you. Thank you. Unusual for us. Of course so just to continue I did want to highlight while our response has been tremendous across the state. We know that there are going to be ongoing impacts related to coven particularly on our mental health system of care that includes the impact of social distancing and quarantine requirements, specifically for our residential facilities you can only imagine how challenging that has been to manage also decreased capacity just to ensure appropriate social distancing etc within many of our communities. A real focus and attention on remote learning and impact on children and youth, we know any kind of public health emergency will have both short term and long term impacts on children and youth. And this is why fundamentally our efforts to keep our public schools open have been so critical. We worry about the needs of children and youth in terms of their social emotional and behavioral development, and the widening achievement gap that we might see as a result of COVID and school absenteeism. Access gaps are another area we continue to look at we have seen reduced capacity across some areas of our system. So that's something we need to continue to look at co occurring issues. And of course we are continuing to see increases in substance use overdoses, particularly for individuals who are seeking inpatient care. We've also seen some increases related to overdoses and substance use issues with our youth as well so again another area we want to focus on overall well being and wellness we know that across the state across the country. And certainly we worry about just the general mental health needs of our monitors we know that many are reporting the negative impacts on their mental health and well being workforce I want to note two aspects of that availability, and of course the impacts of COVID on our workforce. They have been tremendous. They are tired. We worry about burnout. So again we want to continue to focus on the well being of course service delivery and quality. The only last piece I would note is that we also need to continue to focus on racial and ethnic disparities in access to mental health care and health care in general. We know that racial and ethnic minorities have less access to mental health services are likely to receive poor care. So really making sure that we're looking at cultural competency focusing on our new Americans across the state in Vermont. And our solutions are not just about broadly improving health care access but really tailoring the provision of care to remove any obstacles that minority individuals might face to work with our communities and to really address this as a public health issue. So I will continue just with the opportunities continuing to leverage telehealth which has really expanded access. However, there are limitations to our expansion of telehealth. We have several current federal grants that we are leveraging across the state that we are working on. And we are also anticipating increases in some federal funding particularly for the Department of Mental Health. We anticipate increases to our mental health services block grant increases for suicide prevention and for project aware and I will turn it back over to Modica. And I will talk very fast. So in addition to what Sarah has talked about or Commissioner squirrel sorry I keep doing that. Commissioner squirrel spoken to in terms of mental health which we know impacts the disability community and our older Vermonters. I would just add to that and echo that the isolation has been tremendously impactful across our system we know that ourselves. We know that for our more vulnerable populations. We also know that isolation has a physical impact on and an impact on our physical health, in addition to risks to our emotional health and mental health well being. So really realizing that that's going to be an issue on going. I think that access to necessary services throughout this pandemic has been really challenging. You know we were in the very awkward position of meeting to define what was essential and what was not. That was very challenging and has been challenging for individuals and families throughout so recognizing that that's been an impact and that some people have not received the services that they needed. Maybe they were not considered essential but they were still necessary, and that has been an ongoing issue, limited access to community for as much as we are all isolated sometimes that trip to the grocery stores the one thing that's kind of keeping us going throughout the week and that has been limited for individuals with disabilities and older Vermonters, even more so. So recognizing that that critical connection and just that critical kind of a function hasn't been necessarily as available as we would like it to be tremendous impact to individuals with disabilities and older Vermonters potentially lost the jobs that they had because they couldn't receive the supports, and as we go into an economy that's inherently changed. Because of this I do worry about competitive employment for Vermonters with disabilities and older Vermonters and hope that opportunities will remain there. There are some blindings but certainly there's some great loss, and I spoke earlier to the fact that with all of our long term care residential programs struggling to manage pandemic and the risk of that. There are individuals who ended up stuck in hospital or stuck in nursing home, not able necessarily to transition to a lower level of care, when that's really what they wanted, and what was required for them. There's been a real stickiness in the system that we have had to try to address always opportunities in any kind of a crisis so, in addition to some federal funding opportunities were, which we're still waiting to understand, waiting to get some numbers on to see how they might be helpful. We spoke earlier to the some of the flexibilities that were created in terms of telehealth and telehealth billing. It's been incredibly flexible, Medicare continues to lag behind in that, and I would love to see this pandemic as an opportunity for us to push federally for Medicare to become as fluid as Medicaid is when we talk about telephonic billing. This has created some opportunities for people to receive supports telephonically and through video in ways that they never had before and I don't want us to lose some of what we've learned about how to do things differently. The providers specifically have been incredibly creative, the designated agencies the specialized service agencies are adult day program so senior centers that have really created online communities for people, been able to push out exercise classes and activities that have made people able to connect in ways that they never had before, we don't want to lose the things that have worked well, we want to add them into our service delivery as we go forward. Finally, I know from a Dale perspective our ability to communicate with stakeholders has been enhanced tremendously by moving to online platforms. And while we look forward to seeing people in person again, we don't want to lose the fact that sometimes for people with mobility issues or those telephonic video zoom opportunities, allow people to be engaged in a way that they never had before, and we don't want to go back to a place where we're counting them back out we want to make sure that we enable that to move forward. So I think at that point we're done with our formal presentation. Thank you for your time this morning we greatly appreciate it. Absolutely. Oh well thank you. This is very helpful and I think that probably more than we expected, but I think very much valued, and we do appreciate that especially the new members who are here with us on our various committees. So, we are going to, and, and we also heard loud and clear that we will have you back for greater depth on summer all of this so thank you for that. And I would like to acknowledge that representative Pew chair of human services is here with us and welcome representative Pew. So, we need to move on and I know that we have, we have a great deal of testimony that we want to hear. And so we'll just move right through the, the witness list that we have on our agenda. And the next person up is Julie Tesla and Julie I don't know if you and Mary and Heidi are going to be testifying together or how you're going to do that so I'll just turn it over to you and let you introduce yourselves. Thank you very much. My name is Julie Tesla I work at Vermont care partners that is an association of 16 designated and specialized service agencies that provide developmental mental health and substance use disorder services. I have we put something on to the committee websites that just gives you a link to our website so for those of you who are new. If you want to check it out for all of you will be sending you an annual report it's short easy to look at. And would love the opportunity to speak with any of you at any time and also connect you to your local agencies. I'll be very quick today and give Mary and Heidi are going to really talk more about the topic at hand. I do want to point out that as when I work with the agencies one of the observations today is the wave has yet to crest that the the trauma caused by this pandemic is going to be lasting and it's going to be building it's. It's not like we're all get vaccinated and things will go back to normal. So we're seeing an increase in demand for services, not just our mental health services substance use disorders and even if you go to the people we serve with developmental disabilities the amount of isolation they're experiencing is creating psychiatric distress for them just like it does for the rest of us. So we're able to continue some things like some of the supported employment and time in the community. So it's affecting everyone we serve. I think we've done a really good job in meeting people's needs, maintaining services, keeping people safe, maintaining our staffing levels but it has been challenging not all agencies have been able to maintain all the staffing. And we are really learning from some of the innovative services and Mary will talk about that as we move forward. I want to take this time to thank all legislators who have supported us provided the $19.7 million and CRF funding it made a huge difference. And who enabled us to have the flexibilities to meet needs in new ways and to have some flexibilities and staffing and things like that. The Agency of Human Services, the Department of Mental Health, Dale, and the Department of Health have all been so responsive and so supportive it's really been an amazing partnership, especially that first phase those first three months of COVID. It was just amazing how quickly the departments worked with us and the agency worked with us to make sure that we are able to continue services. We also had really wonderful partnerships from other health providers and our community partners, including housing agencies. Together, I think Vermont is doing an amazing job in meeting people's needs and not perfect. But when I listen to other states and the experiences that they're having there I know that Vermont's efforts have really been superior because of our ability to work together. And today, Heidi Hall, who's the Chief Financial Officer at Washington County Mental Health Services is going to give you an overview of the resources that we've been working with. And then Mary Maltin, the Executive Director of Washington County Mental Health Services will give you an example of how those funds were used, what's working, where are some gaps, what we've learned. So thank you for your time today. We hope that we'll have a continuing dialogue with you on this topic. I am Heidi Hall. As Julie mentioned, I am the CFO here at Washington County Mental Health. I am also this year's Chair of the statewide designated Specialized Service Agencies CFO group. And we pulled this information together and I'm really, I'm only going to take a second just because Sarah did a great job talking about the different funding levels so you don't need to hear it from me as well. I also want to point out though that we on the designated agencies receives tremendous support from the state but we also received tremendous support from our local community partners. Everybody really stepped up. We had face mask donations meals delivered water hand sanitizers. The community was absolutely out there and showed and showed why Vermont we're so proud to be Vermonters for sure. We noticed that the designated agencies were able to access for the federally administered cares act. That was a big lift on the PPP some of our smaller agencies agencies that have under 500 employees were able to access the PPP funding which is the payroll protection program. They're still waiting to hear if those are loans or grants but that still was a big lift or big assistance. Sarah Squirrel mentioned that we have other small federal and local grants. One other thing that I'm not sure was mentioned but the Department of Mental Health use the flexibilities afforded to them to case rate our school based services through June of last year to help mitigate the loss due to the fee for service nature of our school based programs and that is huge. That ended in June and they're looking to try to case rate that again. That is somewhat of a gap this year on the agencies will be feeling that tremendously until we are back to working with the kids full time we have the staff. But as you can imagine not being able to work with them the same number of hours that we were face to face hours or even telephone. Hours has will be a gap through pandemic. That said I don't really have much more on that I think we'll just turn it over to Mary who could talk about what we did with those funds. Good morning everyone thank you so much for having us today I'm Mary Moulton I'm the executive director at Washington County Mental Health and actually also serve as the president at Vermont Care which Julie referenced which represents the DA's and SSAs. It's just such a opportunity and Sarah and Monica our commissioners laid this out for us. But the support that we received from our state partner partners was crucial from the beginning we met with them continued to meet with them weekly. I think there's quite a story to be told and how we utilize these dollars and they were absolutely essential to our operations and to upholding the system and the system just could not fail during this time. Because it would have gravely affected the availability of hospital beds potentially that might be needed by COVID patients so when this all started. You know we did not see people going to the emergency rooms and when we began the key for us starting on March 7th at Washington County Mental Health setting up an incident command system was communication and education to clients to home providers. To staff and to to all of our other folks that we were dealing with working with so that we were able to give them the most recent information on safety. This required some purchase of equipment that we didn't have so we used a multi modality approach to communications. Everybody receives information differently we did videos. We did snail mail a lot of it to get that out to our home providers. We have a director of nursing who is just tremendous and let us in this effort. So, in beginning to do that out of the gate. We, we did everything we could to help us particularly we have about 22 residential settings at Washington County Mental Health and so we wanted to be able to continue to serve all of those people hazard pay made a huge difference for us we were able to keep our crisis bed programs open. Psychiatric beds did come offline in some hospitals due to spacing issues, due to staffing issues, due to planning for potential disaster issues. And so we operated at 90% during the pandemic during it with our five crisis bed. beds and in our region, and actually, many of the DA's throughout the state maintained very high levels of census during this period of time so flow through the system was extremely important when we had crisis so it involved conversations on whether someone had to quarantine before they came, whether they need testing before we came, they came, and that involved a lot of collaboration with our community partners. Personal protective equipment which we purchased was key and I'm sure you can imagine how once the market knew how much we needed it. The prices inflated. So we were all spending a lot more money on PPE, then we expected and for our residential facilities which we of course ran face to face every day across the board that involved masks and face shields and foot covers and gowns. If we needed them and we had a presumptive positive case, we needed to quarantine people in that case we're very fortunate up until recently and not having to do any, but probably two or three quarantine situations. And so, you know, that involved going back to the videos on teaching people how to don and doth their gowns so that we did not have further contagion so all parts of the behind the scenes stories. Telehealth we pivoted. And this is where we get into the use of devices and connectivity and the money we spent there. We pivoted within 24 to 48 hours to telehealth and we were able to maintain connection on with those that we were doing therapy with case management with. We needed to get devices into the hands of our clients. We did that through the money that came to us that you that you sent in our direction channeled in our direction, then there were Wi Fi issues around connectivity. So within our residentials for kids that were no longer going to school and staying at home in the residential we have five of those with four kids in each. We had to be making sure that we put in what are called WAPS wireless access devices. So we boost the ability to let them do their schoolwork every day. So other agencies rented spaces for this and they had to do the same thing. So devices connectivity and some of the technology and more expensive improvements that had to go with that. There were other arrangements for transportation so that we could keep people moving in into into their doctor's appointments in the beginning of the pandemic. There were situations where people might need to get to the emergency room we had to transport them so agency spent dollars on protective barriers in vehicles so that we had safety and protecting people and we could get them where they needed to go. In June we were we were moving out of the more telehealth stage and back into face to face because we recognize the importance of face to face contact. People were, we began to see the effects of the isolation, the anxiety that increased and so our workforce. We learned more about COVID and how to stay safe and as we social distance and begin to experience that we were okay and we weren't contracting the virus our staff was feeling more comfortable there. So, so, you know, we did move back into the community and in order to have space and safety. There were agencies that bought tents that got heaters to be able to sit outside if it was cold. And that supported some of the folks particularly on the DS side developmental services side of our agency to be able to come out of those family living situations we did make payments to as Monica commissioners hot mentioned to shared living providers home care providers crisis stipends for family providers we bought supplies to deliver to homes during the time when people were most isolated and delivered those just leaving them outside talking to people from the sidewalk. Everything we can to make that contact was extremely important. What we also saw and I really want to raise and that was a new feature for us all were the amount of people living in hotels. Within our state now our homeless population as I'm sure many of you know, have received vouchers to be safely housed within hotels in Washington County 346 people have vouchers 80 of those are children. One feet one very good positive that came out of that our community providers working together case managers coming together to provide supports to those people that are in hotels. They have significant needs case management needs nursing needs on site support security needed in the hotels, and all of them, all of them have housing needs. So this lies before us as a major challenge, and we did not receive additional dollars for case management, except through a hop grant we had for about eight weeks. Housing opportunity grant and some of that went out to our capstone our community action folks as well. That was very helpful. We stretched our people and they willingly have gone door to door in the hotels to provide services we continue to have the need for a solve their as we come out of the pandemic. I we're going to I'm sure I'll be talking about that and the services that that are needed there. That brings me to what we what we need really as we go into the, we're still in the pandemic, but we're getting vaccines. That's the good news. Those are beginning and so our staff is experiencing that. And we are also beginning to see the explosion in mental health needs so I was on two calls yesterday to date yesterday and today with executive directors and people are pouring through our doors I think covert stress. Let's acknowledge national stress. That hurts our hearts all of us and it embeds itself in our emotions and so we're seeing people come through and referred from private providers because they believe we could give a greater menu of services. So we are seeing the need for more clinicians. We are seeing the need accentuated for more nursing covert really accentuated that for us clinical needs for our developmental services. We're we do a lot of support but people as has been mentioned with isolation are now having the addition of mental health needs through anxiety, depression, and so we definitely are going to want to talk more about with our department. Commissioner squirrel is mentioned this about the capacity needs for children and adults that are going to be increasing. And we, we hope to keep you apprised of that and of course in order to meet that capacity. There is an implicit match of market rate salaries that has to be considered and we're learning that, although we have people coming through the doors they are for staff potentially, they're refusing jobs because of the pay so we'll need to tackle all of that as we go forward in in the post pandemic surge of mental health need. But I think we just really want to conclude by expressing our gratitude to our state partners and to all of you on how this was managed thus far, and how we will continue to do that going forward together so thank you so much. Wow, thank you. Thank you Heidi, Julie and Mary. It seems to me it's two steps forward and one step backward and we're going to solve this problem. I look forward to hearing from you as we tackle the, the salary issue, the workforce issue, and all the needs that are out in our communities. We're all feeling it, and we appreciate the work that you're doing on this. So thank you. Thank you. Thank you. We're just going to move ahead. It's not because it's on your, there aren't 1000 questions, but we want to hear from everyone so we're going to move right along to Jill Mazza Olson and Jill, you are here, I know we let you in a minute ago, or a little while ago. Yes, can you hear me. Yes, we can and thank you for being here. Thank you for having me. Good morning. I'm Jill Mazza Olson and I am the executive director of the VNAs of Vermont so I represent home health and hospice agencies. So I'm going to try to give you back a little bit of your time because I know you have lots of witnesses. I just want to echo what some of the speakers before me had said about the just our gratitude for all the partnership in Vermont across administration providers and the legislature I think it's our successes in Vermont relative to other places on this crisis are not an accident and really due to that, to that capacity for collaboration. In terms of home health agencies. I always like to especially since there are new legislators just remind people what we do. Before I launch in, because I find that people either know all about us or don't know anything. It seems to be kind of a one or the other. We provide several really critical buckets of services. So we provide health care at home. That's nurses physical therapists occupational therapists at home for people either coming out of the hospital or who have needs that are identified by their physicians. So that's clinical care, skilled care in in the home where people most people really prefer it, where it's possible. The second really big bucket is long term care at home. So people who would otherwise be in nursing homes are able to receive personal services at home, help with nutrition with bathing dressing those kinds of things. So it's not skilled care it's not generally provided by nurses, but it is provided in the home and keeps lots of people independent at home. We have about half of our long term care Medicaid population is actually at home being served by by either agencies or by individual providers. Then we provide hospice services so end of life services. And I always say hospice is a service not a place. So hospice services are provided at home that they're provided in hospitals, they're provided in nursing homes. So we provide hospice services in in many, many settings. And then we also provide maternal child health is the other sort of really large bucket. So just a reminder of who we are and what we do. In terms of our coronavirus relief funds, home health agencies, about 60% of their revenue comes from Medicare. And so as a result, we actually did get some allocations from directly from the federal government. Which I, it looks to me from just looking at Sarah's data like the result may have been that none of my agencies in the end qualified for the state funds I didn't actually see home health listed as recipients. Frankly Sarah would know better than I would I did not collect that data knowing that ahs would know more about that than than I ever ever could. But we certainly received federal dollars. As commissioner hot said we actually didn't really slow down that much for other unlike other providers so the services we provide really don't stop for almost anything and so most things kept going. Certainly some exceptions. And certainly when hospitals stopped doing elective surgeries there was then a. You know that that sort of flowed through the system where there were fewer people coming out of hospitals who needed our services. At the same time, as hospitals closed down things like outpatient physical therapy, some of that shifted home. So, in the end, a lot of my members are actually reporting higher census, then both than the sense before the pandemic started I'm actually collecting their, their data to see just what that looks like. But we did not have that concern that many providers experienced of loss of revenue from not providing care. We did have lots of revenue from fundraising events that were all canceled. And for home health, many agencies plan to lose money on patient care and make up the difference on fundraising so that is not a small thing for the fundraising to go away. It appears that the federal dollars now are allowed to replace lost fundraising revenue. That's new. So, the rules just keep changing. So, it's really hard to know. In terms of how we use the federal dollars we received. Really, it was, I mean, they're only allowed to do two things, expenses related to coronavirus or lost revenue. So, for us as others, it's largely PPE was the was the really new big expense. In terms of what I want you to just know about going forward. The first is that Medicare is penalizing home health agencies when we provide some of our services by a telehealth. So, I would have to explain to you more than you ever wanted to know about how our federal payments work to give you the details which I'm not going to do today. But suffice it to say, if we provide, we provide care in episodes so we take care of people for 30 days no matter how many visits they need that's how we get paid. If some of them are telehealth, it substantially reduces the total payment. So, it's really we view it as a penalty for providing some of those services by telehealth and some of them can be provided that way, especially for a subsequent PT visit you might be able to do some that way. So that's a federal problem. We're trying to solve it federally and of course we have a very supportive delegation behind us to to assist. As others have said, this crisis has created a workforce crisis on top of a workforce crisis. So we started with a workforce crisis across all areas of our service, long term care and skilled services, and it is worse. In some places substantially worse any agency that was relying on contracted traveling nurses from those kinds of programs. They're, they're already very expensive, but now they're not even available there and they've been deployed all over the country. So that has created really substantial workforce challenges in the nursing arena for some of my agencies. So that you know when I think about what's keeping us up at night. You know I mean other than the global pandemic, it's, it's, it's workforce, and it is, it's always workforce but it's even that much more challenging. So that's our top priority in terms of, you know where we were going to need additional help moving forward. I think that covers the primary comments that I thought might be helpful to you today. Thank you that that is very helpful and we will be following through with some of the issues that you've talked about I'm sure so we we greatly appreciate your time. Thank you. Thank you very much. Okay, and so we're going to move right along and we'll move right on to John sales who is here from the Vermont food bank and john. Thank you for being here. I'll just unmute myself so people won't have to say you're muted. Hi everybody thank you for having me and I appreciate the time today for the record I'm john sales I'm CEO at the Vermont food bank. As I said thank you for really the, the incredible work above and beyond that the, the legislature and the, the administration and you know all of our partners in the community have done to address the pandemic and the economic implications. We've been really grateful for the support and policies and funding to help our neighbors facing hunger. The food bank plans for the year ahead we know that the hunger crisis were facing is not going away, as Julie Tesla said this wave has yet to crest. One in three Vermonters right now have faced hunger food insecurity since the pandemic began. And, you know, as we know this is far from over addressing the increased need with so much help from so many places the food bank has doubled our distribution since March, dramatically increasing purchasing from local farms, providing funding to support community partners throughout the state. And all the while taking all the measures necessary to make sure that that staff and volunteers and the people we serve remain safe and healthy. I just on the on the cares act funding. Huge appreciation the legislature the administration supported $4.7 million in funding to the Vermont food bank, and all of that has been spent and we have been doing reimbursement up through the end of November so far and so still calculating the December numbers. And well, great working with the agency of human services they've been a great partner in this to make this all move smoothly. Just, just in really broad strokes how that money was spent about 632,000 of that was spent on salaries. Including including the purchase of food, about 3 million of that 4.7 about 2.6 million was spent on food and other necessities things like diapers and cleaning supplies. grants to our network partners the food shelves and meal sites right in all of your communities. And in addition to some other, some other groups, folks like the diaper bank and no for Vermont for their low income CSA program was about $580,000. And then miscellaneous kind of indirect of about 400,000. And, you know, just one example of of the impact of the coronavirus that we got an email or there was a front porch forum post from the Worcester food shelf here in central Vermont. In the first quarter of 19 January February March they served 83 families, and that was 212 people individuals. By that last quarter of 19, they were serving 513 families and 1160 people. And, you know, this is in addition to the farmers to families food box program and the, you know, all the other food assistance that's happening your local food shelves and your communities are responding in an amazing way. And we're really proud to to be a partner in their network, as well as with so many other partners in the community. Really we want to keep people ready to bounce back from this and not to have to dig out. And in order to help accomplish that in foreshadowing what representative leopard said earlier. I'd like to just talk about some different ways that the state can continue to provide support around food for people in the community, heading into 2021. And one request there's three is to allocate 1.5 million of the remaining cares act funding to the extent that there's funding remaining to support the Vermont farmers to families food box program which the food bank has, along with the Abbey group has implemented it's working right now we'll be doing eight weeks of of boxes five 500 boxes a day, five days a week for eight weeks, and those contain more than half Vermont product. It will allow us to bridge the gap and compliment the USDA program which is starting up again in February. The second is is will be before the legislature asking again this year for a $500,000 appropriation annual appropriation for Vermonters feeding Vermonters, where the program purchases the local food from Vermont farmers and growers and distributes that to our neighbors who wouldn't otherwise be able to support that food. Because of the cares act funding the food bank had had a budget of $200,000 for purchasing local foods in this last year. We were able to spend $975,000 supporting local Vermont farms all over the state. We did submit testimony and some materials and includes a map that shows where all those farms are so you can see where they are in your communities. But more federal funding become available to the state to allocate out the food bank does have a budget of about $7 million for for additional costs that that we project will be incurring in the fiscal year 2021 for the food bank that includes that 1.5 million that I mentioned earlier. We know that nor funds are not available yet but and we're ready to to come in when that process begins and and have further conversations and kind of break that down for you. Thank you sincerely for for all the work you're doing under really incredible stress and really difficult circumstances and I'm so proud as others have said about the partnerships that have. been there but really, really have taken off all across the state. And my one hope for our learning through this, this time is that is that we don't let that go away that those silos don't get built back up and that we continue to really support each other through this and into the future. Thank you. And thank you. We, we do know how committed you are to avoiding food insecurity in our state and we really appreciate the work that you've done. I can't thank everyone enough, everyone who's on the call today for the work that they're doing. I do. Here's, here's something that we need we are under a lot of stress. So I think two things first, we will go until 1130 I've talked with communicated with both chairs and that seems to fit with committee schedules, but if we're going to do that I think that we need to take a five minute break. And we're doing that right now with, and I don't apologize to the witnesses because I'll bet you all need a little break to so we'll be back here at 1042. Thank you. Nellie you can put the screen up for about five minutes. And are you there. I'm sorry I didn't realize. Yeah, no, we were we were off video I just want to bring us back. Yes. Oh terrific. Okay, now Nellie boss back good I was talking before and I was on mute. I didn't know I wasn't going to get any responses. So listen thank you all for coming back in together and we'll, we'll continue on with our testimony and we have Ali Richards who is chief executive officer for let's grow kids. And certainly an area of concern during coven so Ali why don't you go ahead with your testimony. Thank you so much Senator and for the record Ali Richards CEO of let's her kids and again an honor to be here and I appreciate you asking for an overview from our perspective and it just stunning to hear the response from everyone so far unbelievable. And I like everyone else will start with gratitude. I also submitted testimony, and we also submitted a summary of where the CRF dollars went for childcare so if that's of help for folks to go into detail. A reminder and for those who are new let's grow kids is a campaign for high quality, affordable childcare for all who need it for month by 2025 and we really act as a facilitator. So I'm here in that vein today to give you an overview. Well we don't do direct service we do work directly with the field of early educators and childcare programs. So I'm here to give you a quick overview of how the CRF dollar response went in that regard, and like everyone else. The punchline is truly remarkable, truly remarkable. I think you all know you said a national standard for how to respond in this crisis, specifically for childcare. And in what I submitted to you all are sort of the details of where those dollars went $50 million in relation to childcare and early childhood education in some manner. So, again, what I think we need to really emphasize and I don't think I'm putting too strong terms, the support, the swiftness and thoughtfulness and target targeted support really avoided utter disaster for the childcare industry. We are in a much stronger position for this essential but fragile industry than almost any other state because of the support. Specifically, the, the, the targeted monies went to early childhood education programs. First, as you'll remember the stabilization program, which helped childcare programs implement health and safety guidelines during the very early days of the pandemic, ensure that programs will be able to reopen, since they weren't going to go financially bankrupt once this closure period was over. They also went to restart stipends that allowed programs to prepare to welcome children families back into their care after the closure period, responsibly at their own pace to source PPE that they needed cleaning supplies, and other elements like that. Additionally, the supports for early childhood education programs included the operational relief grants. Those helped programs account for lost income due to the small class sizes with the public health guidelines, increased staffing needs for the protocols, additional supplies and other increased expenses to do this already very difficult task within the context of a pandemic. So those were the targeted supports that went to the early education programs. Similarly, you really helped families directly through the support. Essential workers were able to access emergency care during the closure period, because some programs were supported to stay open for essential workers children. The childcare financial assistance program continued to pay programs when children were not attending so paid upon enrollment and not attendance. That was very significant in allowing families who weren't able to pay remaining tuition, able to access support from the state and continue to hold their childcare space. And also the temporary childcare hubs, which allowed families with school age children to access access care during the remote learning days. So again, a span of things that really targeted supports to families when they needed the most. Finally, early childhood educators got directed supports through this through mostly the frontline workers hazard pay program and the workforce stabilization program which provided one time financial support and recognition of the difficult work that these early educators are doing. And many of them were working since the beginning of the pandemic, you know, for quite small pay and no benefit so this was an unbelievable part of the response. Early educators were receiving literal wage supports at the end of the year to help them carry on, you know, keep doing this work keep showing up for their kids and families in some cases pay for their health care, since some don't have that benefit during the crisis so those were the supports they're summarized in the documents that I sent, you know, I want to be clear. This was an unbelievable response. The field is incredibly grateful from our discussions with them. I don't want to make too too rosy picture so it doesn't seem unrealistic. Yes, there were a few bumps along the road but they were very relatively modest and minor considering the scope of this response. As you heard from Sarah Clark it's just really unbelievable, the amount of detail that had money that went out the door here. Almost all the bumps were related to process, just some prolonged timelines waiting to hear on some details. Some were just, frankly, the level of detail needed. And almost all of that was due to federal guidelines that we had to meet. So it was quite understandable. These were really relatively modest concerns that that happened and I will also say a lot of them directly relate back to a very antiquated it system, having that really did, you know, tie one hand behind our backs for the response. And I think a lot of folks are committed to really fixing that moving forward. So I'll just add relative to very, very short additional notes. As we sit here, as you heard from so many folks already on this call, we are in the middle still of a crisis that is unembedded at the moment, although we have light at the end of the tunnel. A lot of these supports have run out and childcare continues to show up every day for these kids and families in this essential way. We have the $12.5 million additional from the feds and we're very excited and awaiting next steps and details from the feds on that, and very much looking forward to working together with you all as the next wave here with that $12.5 million and how to target that. And also, as we know we risk going back as we come out of this acute crisis to an unsustainable and equitable system. We know everyone is working together collectively and committed to the future and I feel quite optimistic about this, you know, really tackling together as we move forward access, affordability and quality, these structural issues that we must address. As we know we won't fix any of these without really diving into them together so that's the IT infrastructure, continuing to make progress on CCF AP and supports for the early education workforce. So, I really do want to end by saying this is again a brief overview to give you a sense of a truly remarkable and national leader response for childcare in Vermont. The field feels incredibly grateful on balance of how this all went but these were very targeted and they frankly made a huge difference in allowing this fragile and central industry to stay as it needed to. Thank you very much. So, we do have your written comments and the data of financial data so we very much appreciate that are our committees the human services and health and welfare in the Senate will be working. House human services will be working together on childcare issues. So it will be important for us to have this feedback. Okay. And I want, I want to keep moving along and I'm going to need help from Jacob and I don't know how to pronounce your name thought is it thought though or. I'm going to ask you to pronounce your name for me please so I don't make a mess of it and are you two testifying together or separately. Thank you so much for having us and I will be testifying together is the associate director of the association of African sleeping in Vermont. And would you like to introduce yourself as well. My name is Jacob and I am the executive director of the association of African sleeping in Vermont. Good morning. My name is Tato and I'm the associate director. I'm very pleased to be here. Thank you for having us. Well, we're pleased to have you here. And why don't we allow for you to testify. Please go right ahead. Thank you so much for having us and giving us the opportunity to share about the work we did over the past few months. It has been very difficult for not our organization but our communities but also as a community here in Vermont. We were fortunate enough to have the support of legislatures by you. And in mid July, when Mary Beth reached out to inquire about what we are we are doing also how we would like to see the legislature support our work really. We would like to hear that help is on the way. And what I'm going to cover is talking more about what we receive from the legislature here. Our organization received 350,000. So we'll talk about what we did with this funding. And a little bit about our organization and the core services we are offering and also look at ways of some of the needs that are not met. With me that would also share some of the slides that we are going to talk about. On that note, I will let us start with the overview of our core services and also I will continue with the rest of the presentation. You were muted. We thought we could start by giving you an overview of what the organization does for the benefit of people who may be not familiar with our work. So the organization says refugees and immigrants who have come to the state of Vermont after their initial stages of resettlement so we provide services from whenever folks come into our doors until people feel self sufficient. Our model of service is to work with the community to empower them to eventually have the ability to access other services without our hand holding that varies depending on family situations depending on individual situations. So we provide what we call the wraparound case management services where people come in and we figure out what they need help with it goes anywhere from figuring out the mail primarily from state to understand how systems work where people can access services. We also provide the interpreter and translation services. So with interpreter and translation services, our partners, they submit a request and then we train and launch interpreters out to help with communication in other settings. We also have the health and behavior programs where we do primarily education around substance abuse, sexual education for young people. We also have support groups for women who were primarily sexually abused while they were in refugee camps or while they were running from one refugee camp to the next or trying to find safety. We call those groups community cafes. We also have legal services that provides primarily immigration legal services. So when refugees come here they are technically a permanent residence but at some point you have to apply for a green card and as well as apply to be naturalized as a citizen after five years if you choose to do so, we provide all these services for free. We have work for development where we work with folks to look for work. We do training in terms of how to work in the US and then we work with companies locally to help folks look for work. We have our guidance program called the new firms for new Americans. A lot of folks grow food in the summer for primarily home consumption. It's one of the popular programs among the community because people come from agriculture background so it's been wonderful to have the space to be able to grow our home food so if you ever have the time during the summer and want to see a variety of crops. Please do visit these new firms for new Americans. We have the youth development program that has grown tremendously and over this, this pandemic actually it proved to be such a great need where kids came in the office and we continued to support their education efforts by providing tutoring and helping them understand the education system because parents were not in a position to do so. We also have the rich up case management program which is supported by the state. I said all this very quickly. I'm sure I'm leaving one or two things but I just wanted to give you that quick over. Thank you. Thank you. When we reach out to the state, our hope was to provide with our grants. The following work communicate with our community and provide linguistically appropriate health and hygiene information related COVID related to COVID-19 deliver care packages to families that are in need of support. Provide a case management and also ensure that new Americans can continue to access services safely within our organization and also get the right referral to programs or support the need if we cannot do that in-house. The next slide you have here give you a breakdown of what we did over the past six months. It's somehow small but one of the things that is at the top is social security. Some of our participants receive SSI benefits because they are elderly or they are disabled. As you know some of these require continuous updates or feeling more paperwork and sometimes when folks get into this country they could be eligible for SSI but they need to adjust or become citizen within the first seven years of arrival in the United States. So for individuals who are eligible to apply for citizenship, we work closely with them and the medical providers to make sure that they can get the medical waiver and assist with the citizenship application so they don't lose this benefit that is crucial to supporting their need. One of the things we also help over the past summer is employment. Between March and July we have seen a lot of clients coming here because they lost their job. So they needed help navigating the Department of Labor system filing for unemployment or looking for employment opportunity. In our case we work closely with employers to first ensure that clients could go back to work if they were given the opportunity once the employers reopen their workplace. And now on a weekly basis we're filing about 158th application for unemployment, reaching out to the Department of Labor just to make sure that folks are getting their benefits and also troubleshooting if information were missing. And now we're really grateful with our Department of Labor here because they were able to triage, give us a portal where we could just upload information of clients who are struggling to access their benefit. And this help us cut down on the wait time over the phone or making sure that folks are not missing on their benefits. And this has been really helpful until the end of the year we continue this system. So one of the biggest things also pertain to navigating health care and also assisting clients access services, mainly general assistance and legal assistance. One of the things we ran into earlier is folks being asked to pay back because there were claims that were not found to be legitimate. So we work closely with the Vermont legal aid and the Sartre-Anton legal clinic to triage clients who were receiving notices to pay back so they can help us navigate this system of the Department of Labor. By the end of the year we refer the 12 cases to the Department of Labor and three of them were waived. So clients were able to see 32,375 waived for these three participants. Because the employer were refusing to acknowledge that the workplace has closed and sometimes they were pretending that they reached out to employees to come back and they refused to come back. And the rest of the cases are still pending and we are hopeful that with the support of Vermont legal aid and the Sartre-Anton legal clinic will be able to help our clients make their case and avoid paying the fees and the penalties. And the rest of the services are here. You will see one of the things that pertains to the women group. One of the activity we did in this summer is to run focus group to help understand the needs of the community and also see how we can be proactive. Between March and July we were completely closed, providing services online. But this was proven to be difficult because sometimes clients would work to case managers' house and wait outside for services. So as of July 6 we reopened for in-person meeting in the office and we did so until the end of the year. That's okay. Let me move to the next slide please. And on this slide you will see the number of clients we met with per month. At the beginning of the program in July, about 273, we saw a deep in August. Usually during the summer month and during this time also we were fully open and services were more accessible. Many folks were able to go back to work. So we have seen a deep in the number of clients we assisted. But such in September the number again went up after the holiday period. On December 2328 in September, October we saw a decline of 278, November 242, and December we were at 395 clients we met with during this period. We closed our office mid-December to give some time to our staff to rest because folks have been working non-sub-between March and December and we were so burned. So we decided to close for these two weeks so people can rest and come back in January. We wanted to share some of the numbers we, some of the cases we worked on during this pandemic. Weekly we filed 158 unemployment insurance claim for the Department of Labor. These were case managers helping clients who were on unemployment call weekly to file their claims. And usually staff would start Sunday through Thursday to make sure that everyone claims is filed. We were able to submit 74 application for the rental stabilization program. 103 for the utility assistance program and 38 individuals were referred to other agencies. These are folks or services that we could not provide in house. So some of them pertain to domestic violence situation, mental health, homelessness, and as I said earlier, appealing some of the decision from the Department of Labor asking to pay when there were some mistakes on their payment. And with our partner here in the building, the family room, we work closely to make sure that we do not duplicate services because sometimes some of the clients who attend the family room programs are the same coming to ALV. So what we did is working with them to provide food assistance to the clients and also care packages. So the family room. And as work closely with some of the farmers and the local stores to collect donated goods and food, and we pay the care packages ranging from diapers to toiletries. So we would make boxes and bring that to families that are in need and usually would identify families the week before. So the following week we can have them on our list and do the delivery when they were asking for assistance. So between July and September, 26 individual came to our office for employment assistance, and we were able to help 24 of them find a job at 13.75 hours. And the numbers seem low, but to remember that not everyone who was laid off was had to look for job because some of them were able to go back when the employers reopened their workplace. We kept in touch with most of the employer just to make sure that we understand when they were opening and also what are some of the needs so we can communicate that back to the fans we were working with them and make sure that they can safely return back to work and follow some of the guidance that the employers were was sharing with them. And the following quarter also October to December, the number went up to 52 and 42 were able to find a job at a reduced rate this time 72.75 dollars per hour. So we are still continuing as of December and the beginning of this year, the number of folks are being laid off is increasing. So this is our hope that we will be able to assist them as much as we can, and also get back to the employer to see if they would be willing to take them when they reopen soon. Thanks Jacob. Before we end our presentation we also just wanted to talk a little bit about the positive out of the crisis that we are in. So we tend to take the positive outlook from every crisis that we go through within our building. When COVID-19 hit in March, we knew that it was going to be very challenging, especially for folks with limited English proficiency. The anxiety went up right away. We had to quickly think on our feet on what's the best way to reach out to folks so they know that we are still available. Technology use is definitely a challenge and we were worried about that. However, we're able to adapt very quickly to a service called WhatsApp that I think now most providers in Vermont are learning about because they have to serve the refugee population. And so everybody sort of moved to that. We had existing groups for WhatsApp that we tend to do, we tend to broadcast message through that application. We got in touch with clients where we explained what was going on. We pushed the message to educate people about COVID-19 because there was so much information that was in accurate coming from our home countries, coming from other refugee camps. So we wanted to make sure that in fact, Vermonters here at the LEP community knew the same information that everyone else knew. So the collaboration between USCRI, otherwise known as VRRP, the Spectrum Youth and Family Services. We quickly got together and formed a multi-lingual taskforce where we create messages where we translated the Vermonters, the governance messages as they were going on to distribute to the community just to make sure that everybody was in the loop. The multi-lingual taskforce continues under the support of the Department of Health. So we are really grateful for that support. We also got into a contract right away with the state for the mass feeding. Most of our folks started testing positive for COVID. And as you may be aware that families live in small houses. So we were worried about the quarantine. We knew that isolation will be a challenge, but at least we wanted to make sure that the quarantine rules were understood and we could provide support. We formed a partnership where the state of Vermont will give us details about who needed help with food. As soon as we got the information, we went to do food purchasing, we deliver the food. The service continues today. It's a logistical nightmare, but the one that I think we have perfected now. So folks can adequately quarantine and still have food in the home because that was the most worry for parents that if we have to stay for 14 days, how are we kids going to eat? So we also really, I think, strengthened collaboration out of this. Everybody has been saying this. I always say that Vermont is my home away from home. We got phone calls. People were saying, what is it that we can do to support you? We have plenty of masks. Because we opened services in full, people were coming into the office, it was crucial that we make sure that we were safe in the office. And we're keeping everyone safe. We had the masks, sanitizers were donated, food donations, volunteers came in when people became homeless, and then we found housing, we had to move them. People were willing to literally volunteer and help us move families in their new homes. So that was really uplifting for us. It was one of the times where we said, we are in the right place. Vermont is the place to live. So we are very, very grateful for that. And I'll just touch for a couple minutes on the gaps, existing gaps that we continue to see. I don't know how to remove my slide. If I can get some help doing so, that will be great. I think, hang on, maybe I can do it. I can stop the share. There you go. That's it. Thank you so much. I just wanted to highlight a few gaps that continue to exist. I talk about the gaps, but I also really want to let all of you know that without the support that you gave us, we could have lost their stuff at AELV. Our situation could have looked very different. So the CRF funding really came at the right time for us to have the ability to continue supporting services to folks who would otherwise really struggle accessing services in general. So we are very grateful for that gesture. It was timely. We just cannot say thank you enough. Our major source of income is one of the programs that I mentioned the interpreting services. As soon as COVID hit, we saw a decline in the requests. So that meant that 27% of our income, which is more operational income. So our interpreter services supplements all our salaries, Jacob, myself, everyone else. So we had to make some adjustment as soon as that happened. Fortunately for us, we have incredibly dedicated staff. Everyone was ready to continue working regardless. So that created a gap in terms of our ability to increase the staff. However, what we're able to do with the support that we got was to have an additional staff member who was able to reach out to the other community, the Bemis community. We have had a gap in providing services to the Bemis community because we couldn't afford to add one more body. So we are able to achieve that and be able to do home outreach for the community. So that was very helpful. So the gaps that continue to exist really is the ability to operate at the same level as we would like to. Because long term, without the staff in resource, we cannot afford to provide services at the level that we are doing right now. The staff is fatigued. We gave everyone time at Christmas. Jacob and I had to work. We can never, ever close the office completely. So I cannot wait for a week where I can take vacation. I'm ready for that. And I know that it will happen because we have incredible collaborators around this state. I think one of the things that we see as an opportunity is a gap, but also an opportunity. It's really this idea that we now are at a place where we are collaborating as organizations. We want to learn the cultural brokers, USCRI. We see this as an opportunity for us to continue growing and working together to leverage the already limited resources that we have in the state. That also requires a lot of cross training. We see ALV as an opportunity to work together to cross train so that we can empower each other as organizations with knowledge, because we bring something we can learn something from other organizations as well. So we are working with the intentions to provide adequate services to our communities. So we hope that, you know, with further support, we can have an opportunity to, to cross train, to increase our staffing, as well as one of the most accessible access to stable housing. There is just not enough housing environment and then folks are struggling to pay the housing is very expensive. So that remains a gap. Access to the court system was such a challenge is still a challenge during COVID-19. We have domestic violence cases. Unfortunately, we were worried as soon as COVID-19 happened that how are we going to deal with this. So our hope is that we can increase our collaboration with the courts and then train internally to know how we can continue to support folks while the court system is still figuring out how we can access the court safely so people can get the services that they need. I had quite a lot to say, but I realize also that the time has moved a little faster. But we just also wanted to really say thank you again for for your support. We look forward to the continued collaboration we appreciate your acknowledgement and recognition of the hard work that our team I always say is our team doing the ground work that do all their time to support the new average to feel like that we are all home away from our original homes. Thank you. Thank you. And thank you both for being here. I was muted. I'm sorry. I just want to say thank you and thank you both for being here and being so thorough in your presentation. You've touched on a lot of issues that are recurrence and relate to other organizations. So that's very helpful. And I'm sure we'll be hearing from you again. I would I would like to move on now we've got, we do have some solid. We have three or four other folks we want to hear from. So we'll we'll turn to Holly more house of Vermont after school then we'll go to the parent child centers, and then to the coalition of disability rights. And I'm going to ask each of the groups that are remaining to be pretty concise, and if you have anything in writing will will refer to that, rather than take up another hour, we could spend another three or four days on what we're hearing so thank you and thank you thank everyone for being so patient with us where we want to learn as much as we can and we do appreciate your providing information. So let's move on Holly. Welcome. Good morning. I'm Holly more house of Vermont after school. We are statewide nonprofit that provides professional development training, technical assistance, partnership building and networking for any organizations after school program summer programs working with children and youth outside the school day and over the summer. This morning I'm going to report on a very specific initiative as the school age childcare hubs initiative I did submit a report. As you have in that report detailed information on how we ran the process. There is a link to a map of where the hubs were located there are quotes from staff parents and children who attended the hubs, and they are for their details on where the gaps, or in the program and the recommendations that I think that we can draw on from these lessons learned over the last few months, as we move into 2021 and 2022. A brief context if you remember late summer early fall. Vermont was facing a potential crisis for working families and young children where the Department of Health felt it was safe for children elementary school age children to be in school in person but yet not all of our schools were able to open their doors and do in person classrooms. The parents were. We're in crisis thinking about how to return to work and meet the childcare needs. And we also felt that children young children really needed to be back with caring adults and in supervised and active engaging settings. And that is where Governor Scott's initiative and with support from the General Assembly, with forward the hubs, about $6.9 million were allocated for the hubs went through the department for children and families the child development division of Vermont after school was the state lead partner on that and we worked extremely closely together through every step of the way. The hub grants did garner national attention this initiative, partly because it happened so quickly. And it was just a matter of I think seven or 10 days from when it was announced to only have the first hub doors open. It is a time where I think we another spot in this morning where we can take stock and be proud of what Vermont has accomplished since March. We'll say, in looking at why what worked well. There's three things that I'll really point to one it was building on the existing infrastructure. The hubs initiative called on after school providers recreation departments, private childcare providers early childcare providers to really step into the space that allowed us to move more quickly it allowed us to create a system that could not draw down on those existing networks and actually ended up with stronger supports across our state than when we started. The second was the strong collaboration with Department for Children and Families, Child Development Division, a number of state agencies, the dedicated resources that moved in this space to make things happen quickly. It was truly amazing and something that I was really, really proud of for our state. And the third piece was that around opening the hubs it was not about just opening spaces and where having housing children. It was about finding qualified providers who already had experience working with children and families following the health and safety guidelines provided by the Department of Health. We had a statewide staff hiring campaign to bring new people to the field. We had extensive training available for staff we had ongoing coaching and technical assistance, because whenever you open a program for children and youth, it needs to be a quality program. So, where we saw some of the gaps, the hubs were set up for remote learning days, however, many programs across the state offered extended hours, even though their schools were in session so elementary school might be in session until 11 or one on a given day, and an after school program had to step in and provide that extended programming there was no funding through this initiative to go to those areas they had to be on remote learning days. And then grants allowed for startup and operating costs for the first month but did not cover ongoing tuition or fees. So there was a heavy burden placed on families who were now in the position of providing six to 30 additional hours of childcare for their school-aged children without sufficient support. The hub program ended at sixth grade we heard from another fan number of families looking for support for middle schoolers and seventh and eighth grade. And we also are faced with the hub program only ran through the end of December. So there are a number of schools and communities that were later into the game and didn't have time to apply for hubs, and the funding ended in December and we are still looking at the schedules remote learning days and there is no support continuing in those areas. We do know the demand is great there's about 26,000 children and youth who would be in programs today if more were available and affordable. We ran a small grant competition with after school for all funds in December to try to help meet this need for winter and spring. We had $110,000. Some of that was state dollars and some of that was from the Vermont administration. We received 84 proposals with requests totaling over $900,000. So the demand continues to be heavy in our state for programs serving children and youth outside the school day and communities are ready to do so. For recommendations I think our biggest lessons learned are three. When we talk about childcare in our state, we need to talk about not just zero to five but we also need to pay attention to school age so I would say elementary school and middle school need places to be when parents are working. Any supports that we provide for childcare field, we need to have parity for after school programs and staff. I would also include in that COVID testing and vaccination schedules so that childcare providers and after school programs can meet the needs of children and families. Secondly, which I briefly addressed was the idea of fees who pays for this it's a heavy heavy burden on families to pick up the additional childcare time. So anyway that we can use state and federal recovery dollars and in the report I point to three different sources of some of the federal dollars that can be used for after school and summer learning, which brings me to my third point. When schools had to close their doors in the spring it was after school providers and early childcare workers who provided that essential care when schools cannot open the doors in the summer or run summer programming it was after school programs and provided summer programming. When schools cannot open in the fall it was after school programs and new serving organizations that provided the child care hubs on remote learning days. Now when I look at plans coming from schools on how to support students in the spring and through the summer, I would love to see after school summer programs community, energy serving organizations written into every single one of those plans. We are looking at significant learning loss for students and we are also looking at significant emotional social emotional learning connection loneliness, and youth engagement needs and after school positions programs are well positioned to support those. Thank you for your time. Thank you for your support. And I will pass back, Mike. Well, we know that we know that our committees will be working on childcare issues and this fits directly in with that and I know that the so it'll be a will be seeing you again Holly and thank you very much for the work that you did and for all the information that we now have on on our web pages. So we're going to we're going to switch over to parent child centers and Amy Schoenberger has asked some folks to testify for us and I what I'm going to ask actually is that we have both Donna Bailey and Mary Feldman and if there's a way that are you folks testifying together. Or were you. I'm sorry I didn't hear you. I think we're testifying separately. Okay, and just so you know that we're our goals to finish up within 10 or 15 minutes so our time is very precious, and we do have Vermont disability rights who we also want to hear from. And if we if we miss something and we'll we're sure to have you back know where we don't want to miss the testimony that you have prepared for us so thank you. So am I going. Yes, go right ahead. So hi and thank you for hanging in there this long. I appreciate the extra time I promise you I will be under four minutes. So it's always good to know how long you're going to deal with somebody. My name is Mary Feldman and I'm the executive director of the Rutland County parent child center. And I really do appreciate this opportunity to share with you the good news of the work that you have accomplished as a state legislature through the through the agencies that you have supported. We have been able to use those funds to respond to the needs of Vermont families who utilize the extensive services provided by the statewide network of parent child centers. We're grateful for the specific amount of $1,621,000 and one cents. So thank you. It's a great opportunity that we've come through tough and unprecedented times. And yet with the resilience of the human spirit you have responded. The parent child centers have responded and our communities have felt their needs acknowledged during very scary times. The end in sight feels to some of us quite a ways away, especially when returned to normal. There will be a big cleanup. So again, thank you for your work which helped us to respond to the individual parent child center community needs across the state. We've added a new landscape for the work we do. I'm sure you can relate. It might be hard to imagine how life changed for the ordinary community citizen in person, suddenly food shopping was both unaffordable and inaccessible parent child centers responded with food for children and families who were suddenly unemployed and suddenly unable to take care of the immediate needs of their families food insecurity is a very humbling concept. A very stressful experience was mitigated by the funding provided by the state through parent child centers. Rutland County parent child center mobilized its forces and was able to provide food on level with what we at our agency consider to be our own little National Garden Rutland on an ongoing basis. 45,000 meal equivalents have been delivered to Rutland County families on a monthly basis. Your funding provided the refrigeration and freezer units to provide these foods safely. And the new tents help this to be accomplished in a warm and safe environment for staff and recipients alike. Many parent child centers across the state were able to provide food because of CRF funding for many folks cove it has been about isolation. And these are individuals previous to cove it who experienced isolation of raising young children alone, children with extreme developmental needs and parents, many of whom who don't have skills and understanding the needs of children to cope. Parents who face the constant struggle of simply surviving with the funds that you provided for technology, as common for some of us, as this is is having electricity for others, it's a pure luxury item. So they taught us that technology can unify this and franchise people and provide a strong connection through parenting classes early childhood education, children's integrated services who are supporting our youngest kiddos behind the starting gate parents who want to continue their high school education and our learning together program and have to do so from home, and additionally helping parents who face the isolation of addiction. The technology provided a link from person to person without the dangers of exposure. The Sierra funds made it all possible and prevented I believe personally a lot of folks losing their grip and staying focused during this time. I also believe it kept children safe. Technology allowed all of our services to be continued seamlessly. In fact, parent child centers did not decrease center services like many other agencies. That increased our accessibility during this time, and we're on the front lines. Technology does not put gas in the car or electricity doesn't keep it on the Sierra funding extended to providing concrete financial supports to families at this time, which included gas cards, food, phone cards, Wi Fi for connectivity winter clothing, and for our staff internet because they were shoulder and expensive working from home. To contain the virus, folks need to stay home in order for some people to stay home the parent child center staff had to operate directly on the front lines. Put it in the spending of the CRF money was hazard pay that honored directly, many staff who are among the lowest paid in the state for their incredible work in early childhood education. Additionally, there were money spent on protective gear cleaning supplies structural changes that enabled opportunities for staff to interact safely with families in need, because of the CRF funding safety was able to be our priority. A large part of the work parent child centers accomplished focused on our youngest community members. The CRF funding was able to provide families with activity bags, the technology to connect over those activity bags and outdoor gear for families to get outside and play, consequently fostering really positive and safe interactions with parents and children, children's integrated services, which my center operates at an extraordinary deficit was able to provide developmentally appropriate materials that remained in the home. Additionally, some early childhood education daycare centers were able to provide outdoor equipment that decreased contact and possible spread of COVID among children and daycare settings. The parent child centers have a reputation for delivering high quality early childhood education across the state. These centers are not only important for helping parents to return to work and jump starting our economy, but they impact long term outcomes for Vermont's children. Research has indicated that COVID COVID's impact on low income, minority and learning disabled children is devastating parent child centers have worked hard to mitigate the impact of these one year of learning loss for a child positive to lifetime loss of $80,000 in income. The, and that's one year the economic impact that children's learning loss for at the national level is $98 billion. So children's learning loss is everyone's problem. The impact on the local level will be felt in the healthcare industry over time and increased crime incarceration and political participation of these children when they grow up. CRF funding that supports continuation of early childhood education, our after school program loss revenue and school age programs are critical to us and mitigating the impact of this in Vermont over time. The child development division had requirements for reopening childcare centers and consequently reopening the economy parent child centers which operate at a 30% structural deficit, simply did not have the money to make these renovations. And at the same time, the revenue that supports continuation of services, providing opportunities to us to compensate for some of our revenue loss kept us in the playing field, we were so grateful. There will be a time when COVID is a thing of the past thankfully. However, we're nowhere near that yet parent child centers have historically been the trusted support system for Vermont families. The loss revenue is critical as we continue to navigate COVID and as we look forward to rebuilding our lives our communities and our economy and paving way forward for more information specifically on how this money played out across the parent child center. Please refer to the document that's provided by action circles on the CRF funding parent child center. Thank you for hanging in there with me for your time and for all you have done with done for us. And thank you for considering ongoing funding, ensuring that parent child centers will be able to continue to work with Vermont families when all of the one the mess actually is bigger at the end of all this. Thank you for your time. I go ahead. Yes. Thank you very much. But I do want to encourage consolidation of testimony. If you're repeating anything that Mary said if you could. Okay, I'm not well there you go. Okay. Thank you Donna. Thank you. Hi, I'm Donna Bailey and I am the co chair of the parent child center network and I'm the director of the Addison County parent child center. I will say thank you a million times I know you've all heard it but so I will move on but thank you so much for the allocation of funds and thinking so thoughtfully, I have never been more proud to be a Vermonter than during this crisis. I think we're all pulling together and doing the best we can. That said, I think as we're looking at funding moving forward, we really need to think about to look forward and think about as organizations about long term planning and as a state to think about what we need to do to help families and our most vulnerable Vermonters many of them being young children. So, you know, parent child centers operate on shooting budgets already before COVID while we were able to get funding for the, for the specifics already addressed. It's really important that the that funding and the situation we're in around ever increasing ever increasing demands for our services with no new resources is not sustainable. So we come to you, you know, looking at losses of funding trying to find new ways to support families in this world. We do not know the impacts of COVID in the long term on children and families so we do not know that so we want to be here and be available and be learning and be on top of that so I come to you with a specific request for the parent child center network of $3 million that would give $200,000 to each parent child center in order to have some flexibility to provide the needs for families as as we see fit and as are appropriate for these funds. As you know, we've been we've used COVID money to date for very concrete basic needs, making sure that families stay safe during these hard times there's a breadth and depth to the work that we do on a daily basis. It's multi generational approach services are broad, and we have, you know, work with multiple other agencies and issues including homelessness, helping our families finding jobs education providing guidance and counseling as well as helping families with new babies. The broader vision that I've seen and we've all seen here in Vermont and for families for our families and I want to say, as someone who also runs an organization of staff we have 32 staff on our own in our own parent child center but for hundreds of parent child center folks across the country. These have been tough times and living on the edge and as people move to working remotely and from home base, we realize that access to the internet and broadband services is crucial to this work, not only is it crucial for children and being able to communicate for schools and education and care and for health and telecommunication telecommunication has been critical. You know really important for for our staff to be able to do their work from home and that's not just the case for us as you all well know. But what I want to talk about is universal access and ask for us to think about universal access to broadband services families need this in Vermont, and it's not just about where there are no services it's also about affordability. We need access and affordability for all Vermonters to be able to move forward in an equitable way. I also think that this time has made it clear that that's true for health care as well. Many Vermonters are without health care don't know where they're going to get vaccines much less care for COVID and other situations so I think we that this, this pandemic has highlighted that, and I hope that we can really move forward in Vermont towards that goal of making sure that every Vermonter is covered so and that's a right and accessibility for all of us. Thank you for your support. The parent child center network is working also working with senators right now to have legislation introduced this year which updates our statutes and finance adds financial supports and while that's not why we're here today I just wanted to say that out loud, because I think our ongoing support helps all vulnerable Vermonters. Thank you. Thank you. Good job. You did it effectively. So, last but not least and Sarah, I just want to apologize but say you are extremely patient and we appreciate that. And we look forward to your testimony so why don't you go ahead for disability rights Vermont. Thanks so much. Can you all hear me. Hi, so I'm Sarah Launderville and I'm the executive director of the Vermont Center for independent living but I'm also the president of Vermont coalition for disability rights and I'm just going to highlight. You have written testimony from me and a bunch of other documents that has been posted. Thank you everyone else I want to say thank you for the hard work in response to this pandemic. And I appreciate the opportunity to testify today our member organizations are hoping also that the committees will also hear directly from individuals with disabilities directly about some of the experiences that they've had during the pandemic. The association for the blind and visually impaired received $100,000 to provide training on various devices such as iPhones iPads and helping folks connect with family friends and doctors. They're funding expired in December but they're still the 78 people in the program and so they're hoping that that will continue as time goes on. There's a quarterly report that's in your packet that will help show the numbers of all of the work that they've done. The Vermont family network has seen an increase in number of calls that have been coming in, especially related to special education and concerns and the complications with schools and parents to EPS. Now that we're in this remote and hybrid environment, and they're also working really hard to connect parents with other parents as they have seen increased struggles and isolation food insecurity all the things that folks have mentioned here today. I also know that very low income people with disabilities such as those on reach up have not received the same level of support that folks on the enhanced unemployment or others who got stimulus checks and reach up families with an adult on SSI are still having a percentage of that count against their benefits so any extra costs from COVID way more heavily on those families. As Commissioner Hutt said earlier, Vermont Center for Independent Living received over $900,000 as part of the federal cares relief bill. You can see in the testimony that we've spent some of that money on our Meals on Wheels program where we partner with senior centers and expanded the reach of who could get meals as well. And we also created a way for people with disabilities to access funding to help pay for unique circumstances. It's called our RISE program and folks with disabilities can access up to $2,500 in funding. I've included a story of a person who was able to access oxygen from that fund because of the complications that health insurance have been experiencing the way that they administer programs we were able to sort of break through that bureaucracy and help pay for oxygen so I encourage you to take a look at that. And I've also included a report on some of the surveys that we, one of the surveys that we completed around grocery stores and access to food. It has some information it highlights experiences of folks with disabilities the types of foods that they're accessing the issues they've experienced with some of the food that they've received although they're grateful. Some of the food has been expired or almost expiring. And it also highlights the ongoing issue that if you need grocery delivery you can't use your EBT benefit online for most stores. I will stop there I really appreciate your support and happy to answer any questions and offline. Thank you. Thank you very much and some of the things that you said are maybe critical issues that we'll have to look at I suspect that the CBT card issue might be at a federal level, but certainly something for us to consider as we continue our work. Next week on looking at new CRF and new guidelines and keeping our fingers crossed that we can continue to can continue to support all of you who are here today. We greatly appreciate the outstanding work that you have done. And in particular, I'm always impressed with how important volunteers are in our state. And so I just want to say thank you back to all of you. We can keep working together. And you know that I don't think there's a much more to say, but to everyone here thanks. Committees, you, you've been outstanding today in, in perseverance and patience and everything else. We always put too much on our agendas, but this is a good start and I think it's been a great overview of the work that you all have done. And so thank you. I think we all need to do that. So I'm going to, I'm going to sign off right now. I think our meeting is complete. I know that Bill Lippert and Anne Pugh might want to say goodbye or say something, but I think we should just. We've, we've done, we've done yeoman's work today. Take care. Take care. Take care. Take care.