 We're actually early Three of that clock is So this is good. Okay, but I'm so committee. I do apologize And everyone in the row. I apologize the L car went over and it was a contentious issue that needed to be resolved before We left and I'm going to ask that happen again because You're seeing an L car and the same time so s185 that was really a discussion and I just wanted to bring the committee up to There's another bill as 225 that looks at Regional Planning Commission planning for health care needs through like an h-rap health resource allocation plan in each individual Regional planning area that's in s 225 that is in another committee and I thought we might consider that while we were looking at 85 so that was the only discussion and I did talk with Katie about it yesterday She didn't know she she didn't she wasn't quite sure yeah, that's okay Well, so it's on our agenda for next week next Thursday morning is going to be devoted a lot to 25 which is the resilience planning through the Regional Planning Commission's That's all that was And I know that Abby is here as an intern at UBM and she's working with me on this issue So I thought it was important just to give her a heads up Okay, so Welcome commissioner. Good morning. Thank you for being here. Of course. You're it's way overdue Seriously, but we know you've been busy speaking with other committees and we welcome you to Talk with us for about an hour great On the mental health 10-year plan. I know how hard you've been working Should I get started please okay For the record Sarah squirrel who struck the Department of Mental Health Pleasure to be here this morning Committee members should have a copy of the presentation On your iPads Through please let me know will pause for any questions that come up And I'll just defer to the chair and kind of the flow of questions and getting to the presentation But essentially the Department of Mental Health Took our charge from the legislature very seriously in terms of doing our due diligence to articulate a comprehensive Vision for a holistic and integrated health care system as I go as we go forward For the past 10 years Vermont has absolutely solidified itself as a leader in health care reform But we still have gaps in our system Fundamentally our mental health and health care systems are separate systems We know that there is no health without mental health So this 10-year plan or allows us to articulate our end state Where do we want to go as a system of care? And what are the short-term mid-term and long-term strategies and actions that will be required to get us there? Everyone have the presentation up in front of them. We do okay great beautiful colors So the next slide is just related to the charge that we did have a legislative charge out of the act 200 section 9 report Where we wanted to really look at this idea of integration of health care and mental health and to work towards integrating mental health in the broader health care system More intentionally It's very important to remember that this process was hinged The fundamental value of stakeholder involvement and engagement and to involve Vermonters And articulating a vision so that includes community members individuals who identify with lived experience peers family members Who have all contributed their voices to the 10-year plan? And again, we feel like this is a very strategic effort on behalf of the department and the agency of human services Because I feel like if we don't know our end state and we don't know our next step We will continue to fall into the trap of relying on band-aids and quick fixes Which actually get in the way of the long-term fundamental solutions that we really need to move our system of care forward So essentially what vision 2030 has achieved is taking vision Into an actionable plan It leads together the health needs of Vermonters and takes policy into practice I do want to talk a little bit about the stakeholder engagement and the process that led to and informed this important work Our vision 2030 plan is the result of a year-long effort We took the charge to involve stakeholders very seriously. We fanned out across the state of Vermont in five locations across the state We had over 300 Vermonters attend those sessions We used appreciative inquiry as a framework. That's a strategic framework Where it kind of moves away from change management 101 systems and people as problems to be solved and move towards what could be And how do we build on the strengths of our current system and move forward to achieve the vision? That we would like to see for Vermonters Once we completed the statewide listening tour We had a vision for about Vermonters wanted to see from the mental health system of care We knew and know that a vision without a plan is hope and we knew that we needed more than hope to move this work forward so we had a Think tank that was comprised of about 25 systems leaders That came together and have the somewhat daunting task of taking the vision of Vermonters those ideals for our tenure Vision for our mental health system of care and to translate that into an actionable plan for the future That we could all come to The think tank met for about five sessions again representative of peers advocates Systems partners representative from our designated mental health agencies and our health care partners that came to the table inclusive of one care Folks from UVM CVMC other hospital partners who all contributed and again have that daunting task of synthesizing the vision into an actionable Blueprint we also had a think tank advisory group which was comprised of additional Individuals who kind of put they provided checks and balances for us as the tenure plan began to evolve They were great thought partners in helping us think about different things how to refine specific action areas That were urgent and important to moving the work forward We also used our adult state standing committees and our children's standing committees to provide input and feedback We opened it up for public comment. I believe we've received over 52 people comments on the tenure plan So we had a work cut out for us in terms of incorporating all of these ideas Into a concrete actionable plan So I'm sorry sir that did include then People who have have been patients or clients of the system and their families. Absolutely So the stakeholder engagement I would say we had an incredible turn out of family members of Individuals with lived experience. We held two sessions So we held one session in the afternoon Where we tended to have more providers if you will that were participating in those sessions and then we also had evening sessions Where more individuals who had experiences receiving services in the system of care Peers family members who came and share their thoughts And quite frankly their powerful stories and what worked for them in the system which we want to know and what didn't work for them One of the things that we wanted to frame and anchor our vision in Is the quadruple aim of health care? So we have organized on slide five. Hopefully my slides align with yours That we have tried to incorporate and frame our work within that quadruple aim Which is that we want to improve client experiences? We want to improve the health of all populations whole health population approach We want to reduce the cost of care and we want to improve health care provider experience When we think about what does holistic mean? It really means and we think about integration Number so you'll probably have to help me orient to the PowerPoint presentation since they don't have it in front of me But essentially when we think about holistic It's about the interconnectedness Between health and mental health which we around this table all agree with and as I mentioned before Fundamentally our systems are still separate And that we have to take into account mental health Also the social determinants of health which we'll also be talking about Is fundamental to this work and we think if we can get this right that the monitors will have improved access to care They'll be healthier happier and if the state will realize significant economic benefits We also look nationally And when you follow the national conversation National trends and practices are moving towards the integration of mental health and physical health care Since the de institutionalization of mental health care began in the 1950s States have naturally been utilizing our community mental health systems more That's a good thing This vision and many models of integration are hinged on our ability to work across sectors as partners That includes mental health that includes health care substance use Working with patients families communities law enforcement and other community partners That are involved in the mental health care of individuals It's also essential that successful implementation of this vision and plan Will require the buy-in and engagement of not just mental health partners coming to the table But our health care partners coming to the table with us aligning and committing to this vision I think we operationalized and saw that commitment in terms of our health care providers participating in the development of this plan if you actually read the report you can see Who the think tank members were how many of them represented health care providers? But if we really want to move this forward that we need to anchor it And have that buy-in from key leadership across the state. So one of our recommendations is that we Have some kind of board or council that will have some kind of oversight related to this work that continue to follow this work to Pay attention to the implementation of the ten-year plan and to continue to look strategically at opportunities that we have across health care and mental health to keep working towards integration and so as you're going to be talking about the board of the council Yes, and it's constituency Yes, we actually have some draft language that we could send to the committee in terms of our recommendations on representation Okay So Kathy maybe you can help me with the slide numbers. These ones are numbered to help me orient to where So the next slide is really a visual related to the social contributors to health aka the social determinants of health And again the creation of this ten-year plan is really grounded in the idea But the health of individuals is improved when we improve the health of communities So you'll see that interwoven into this report that that was a fundamental value That by working towards creating healthy communities For monitors are able to attend to their mental health without concern that includes basic needs Etc that we all know impact overall health and well-being of our monitors the social contributors to health are called out specifically in action areas as Well as woven together throughout the plan The next slide is a visualization of our care continuum when we think of our care continuum We think of promotion prevention early intervention treatment and recovery It is essential to Vermont system of care that we strengthen all aspects of the continuum in order to achieve the best outcomes And we know that there are areas of the continuum that are overlooked and that includes Promotion and prevention so we tend to prioritize treatment And we feel and what is reflected in this plan is equal attention to promotion and prevention efforts That will allow us to get upstream to impact long-term change Down the road as well as continuing to invest in the continuum care So that one individuals require treatment or higher levels of care. They can access it in a timely way So the next slide is the visual of vision 2030 Which essentially has eight action areas that are aligned around that quadruple aim of health care Your slide should have a framework for action listed on it And okay, that's slide number you 11 perfect. Thank you So we'll be walking through each of the action areas to give you a sense of the very specific goals of that action area and we've articulated the short-term mid-term and long-term strategies associated with each of those The eight action areas include number one promoting health and wellness Number two and influencing social contributors to health Number three eliminating stigma and discrimination Action area four is expanding access to community-based care Action area five is enhancing intervention and discharge planning services to support for monitors in crisis Action area six is ensuring that peer services are accessible at all levels of care Action area seven is ensuring that service delivery is person-led and action area eight is committing to workforce development And payment parity. So those are the eight action areas that we have focused on for our ten-year plan So action area one is related to promoting health and wellness and again getting upstream We all know that the earlier we intervene the better the outcomes And this is an area we need to continue to focus on in our system of care in Vermont Again essential to this commute this idea is the concept of healthy communities We also have to pay attention to caring for the caregivers Ensuring that families are supported that peers and staff that are working in our community mental health agencies in our hospitals Have the support that they need to do their work and to do their work well some of the high-level action area items include having culturally and linguistically appropriate resources and communities That we partner with peers and other statewide programs and initiatives to improve and expand resources We expand insurance coverage for employee wellness programs and support the development of trauma-informed diverse workplaces On your next slide, which is slide 14, thank you We've broken down the action area by theme. So you'll notice on the left. There's three things practice improvement Collaboration and workplace wellness. You'll also see the short-term mid-term and long-term strategies that we've articulated for each of the action areas again We want to create a path for accountability for ourselves as systems partners to really concretely move these pieces forward As we all know around this table. This is a business of small steps But we want to be clear about what those action areas are so we can target our resources appropriately So the themes here in terms of practice improvement collaboration and workplace wellness Practice improvement includes building trauma-informed communities and safe spaces that are person-led At mid-term is continuing to enhance and focus on social and emotional learning in schools This requires partnership with our early care and learning providers the continued work that we are doing in public schools But going even more upstream to ensure that we're focusing on the social and emotional development of young children We all know some of the data that we're looking at in terms of the rate of children under the age of nine Whether they're coming into state's custody increase in access of emergency services across our system of care There is an urgent and important need to attend to the mental health needs of our youngest mothers And that starts with social emotional learning at the youngest ages. We also want to work towards universal screening and also Appropriate referral and same-day access to treatment and care and then long-term we need to look at implementation of all of these areas Including focus on the caregivers and health and wellness and health benefits that any employee needs So and as we're talking about the health benefits and insurance coverage for wellness There also is a significant amount of work that can go on that doesn't include a Premium payment for wellness and that is changing workplace Habits and environment so that people are their needs are more respected. So this would be without And so is there a section there that would include Employers and having them become engaged in providing wellness opportunities of all types Yes, that's exactly right We know that individuals In our workplace in our workforce For those who are providing direct care Who need to ensure that their wellness needs are being met and just broadly across employers in the state We know that many adults Are experiencing Isolation loneliness depression So your employer becomes an opportunity to provide a bit of a safety net for you and to ensure that Your mental health needs can be met that also directly aligns with reducing stigma Because many individuals who would benefit from seeking care don't well So I kind of link the prevention piece here, too So if you're going to have staggered start times so that people can get their kids to school Mm-hmm, and the children feel safer having their parents getting there. I mean there's different ways of looking at employer Practices that might support Yeah Action area to is focusing on influencing the social contributors to health And we are using the language of social contributors, which are also fondly known as social determinants of health Which are conditions in which people are born work live And that impacts a wide range of health function functioning and quality of life outcomes Particularly for children We all know related to ACEs that children are setting long-term health trajectories in their earliest years So this becomes essential that we pay attention to this across the system of care We also want to ensure that for monitors, but basic needs are being met This includes food stability, housing, transportation, affordable and accessible child care Employment and the community that is responsive to their needs Just a few things But I think it is important that when we think about a 10-year plan for mental health and integration that these pieces are Fundamental to that for example, we just Put out our Analysis of residential bed needs which I'm sure we'll be back to report on in more depth to the committee But when we looked at barriers To transitioning individuals out of our inpatient hospitals across the state one of the most significant barriers with simply housing So we look across our continuum of care and we try to expand flow in the system Sometimes we forget about those fundamental aspects that there's an individual in our inpatient many individuals in our inpatient System of care that are ready to go back home and they can't Because they don't have access to housing So I do think it's important as we move forward that we continue to look at all aspects of Basic needs and the housing piece becomes significantly important And then of course this is lifted up in a specific action area But continuing to build and power and sustain a strong peer network throughout Vermont So action area to Kathy what slide are they on? Great So on the left hand column you'll see basic needs and protective factors the short-term mid-term and long-term strategies to achieve that In the short term we want more public education on health equity and mental health Again looking at social and emotional learning Across the state in our public schools in our early care and learning settings In the midterm we want to continue to expand support for housing transportation and food and continue to build on some of the What I would consider powerful efforts that are already underway Early MTSS early multi-tiered systems of support has been something that our early care and learning partners have been working on That becomes an essential opportunity for us to build on and expand again this 10-year plan Not only articulates areas where we have gaps But areas where we have strengths in the system that we can build on and expand One of the challenges that we have in Vermont. I would call the implementation gap They're what we use. We don't use with fidelity. We don't use it for a long enough time And we don't use it at a scale sufficient to impact the social change that we really want So really homing in on the targeted areas that we want to invest in To move our system forward and then the other area that I think is a challenge for us and an opportunity is how do we start to articulate and track the savings that we achieve by primary prevention efforts That also becomes important for us as a system Action area three is related to eliminating stigma and discrimination We know that many individuals who have benefit from mental health care and treatment simply don't for fear of labeling Prejudice and what we would call discrimination To let eliminate that will require deep understanding of mental health issues within the context of whole health We want our young people to feel empowered and supported And quite frankly, I think our young people are our future when it comes to tolerance When it comes to compassion when it comes to empathy In my spare time I run the water brewery soccer league In my community and there is a story that really Stopped with me. I was under the tent sorting metals getting things ready for the afternoon I think it was snowing on our jamboree, which is pretty difficult for ball soccer And two little boys walked by me and they might have been in third grade And I just overheard their conversation and he was talking to his buddies saying, you know I was talking to my therapist yesterday and she said sometimes I just need to pull the plug and let the anxiety flow out And it was just a normal regular conversation between two young boys walking across the soccer field and that gave me hope Because that's exactly what we need. Is that yeah So and we can work on a bill in here on EMS wellness connection and hearing some really struggling stories from adult males And so they will get the younger kids will now all right into the process of working together And when we speak in public schools, I mean just the compassion and empathy that our young people have Their lack of judgment So again, I think it gives us hope and we do have an opportunity to continue to expand and build on that strength To decrease stigma and discrimination as we go forward So the specific areas under action area three The themes are education social emotional development and wellness Again, continuing to expand initiatives to educate the public on mental health and supports identifying trainings and increasing support for evidence-based and best practices that teach about the social development of children in schools Also our health care partners This was an area that they were really interested in and having more training for their own staff their nursing staff in terms of understanding mental health Decreasing any stigma or discrimination that folks seeking mental health care in our emergency departments in primary care In our health care settings in general was something that they really felt like their staff needed more support around more training and education and Then longer term to fully integrate mental health education in all aspects of education workforce and community partnerships Action area four is expanding access to community-based care We heard time and time again in the listening sessions From Vermonters who are increasingly concerned about access to mental health services and what happens when access is delayed This includes the enhancement of existing programs the exploration of promising practices especially in rural areas When we look across our continuum of care We've made efforts to increase our inpatient capacity in the system of care We're making efforts in terms of our residential system of care We have to continue to attend to our community mental health system of care Ensure that our community mental health system has the resources to do it to work. Well They are essential to the system and that is something that family members brought up over and over again also ensuring that The public understands how to access the mental health system Improving client navigation supports and increasing outreach and education in the communities So we have a bill in here for the Rutland pilot project on the mobile mental health care program and This would fit in with this can set of community activities. I don't know. There are other things going on in other Municipalities, but so and I don't know if you're going to be testifying on that bill or not. Yes So mobile response was actually one of the recommendations of the 10-year plan So it's incredible to be sitting here Having that initiative moving forward as an opportunity to expand expand upstream mobile response Crisis intervention earlier on I'll speak a little bit to that more specifically as we go forward And also do that our community mental health agencies Are just doing incredible work in terms of diverting individuals from even needing to need hospital level of care through their existing programs But I was recently Reporting on some data and house health care related to our FY 21 budget And when you look at the trend line of Vermonters accessing emergency services I mean it is incredible how much that has increased and our community mental health partners are Managing within existing resources to meet that need But it's clearly an area that we need to look at comprehensively across the state Great So the specific areas outlined here in the 10-year plan are focused on public education centralized resource local and regional services and evidence-based practices again We've heard about Individuals just trying to navigate the system of care to understand where they need to Where they can access resources our community mental health agencies work very hard to try to educate the public And who they can call where they can go when they can but again I think it's an opportunity for us to continue to look at that To address gaps and evidence-based services for under server for monitors. Where are we missing opportunities and? Continuous improvement on expansions to community-based programming Mobile response is an example of that. There are additional areas Across our community mental health system of care that we need to continue to look at to strengthen and expand So and you're thinking about this Having measurable outcomes becomes really key Yes, and knowing that one of the waiver goals that we have is reduced suicide So the linkage between the the programs that start up Closing the gaps. Yes, and how are we keeping? Data on that. That's something that's a question. We have to ask in here as we're passing bills So any thoughts that you have for us on that going forward while we look at the mobile response team or whatever Would be very helpful. I don't know if you have a broader metric in place So specifically and I think accountability is essential. We need to measure our outcomes Which is exactly why we presented mobile response as a pilot that is what is a pilot is designed to do Where we can implement an approach we can measure it we can find two neck So I believe when Laurel Omland from the Department of Mental Health testified There are over 10 Evaluation metrics that we are looking at specifically for mobile response Of course number one is a reduction in ED utilization in that community And one of the reasons that Rutland was selected was because from a very data-driven approach When you look at their overall ED utilization for children and youth It is the highest in the state. We actually received some data and information from the Vermont Care Partners Network that identified Rutland's data related to when crisis services are delivered in an ED Those numbers were the highest and again The ED might be an appropriate place for some individuals for many individuals if we can triage to that need Earlier and more upstream in a family's home in a school setting that is ideal So those are some of the metrics that we're looking at our suicide prevention array than she is also has significant metrics Associated with each of the areas that we're looking at so action area five And I also just want to note That one of our designated agency CEO's is in the room today George He was also a member of the think tank So just wanted to acknowledge his contributions as a leader And I'm sure could comment on some of these pieces as well Action area five is enhancing intervention and discharge planning services to Vermonters and crisis Again, we are worried That the emergency departments in the state of Vermont are being perceived as the only door to accessing care And that is concerning because the ED door Can quickly become a pathway to higher levels of more restrictive and more expensive care And we want to divert anyone much earlier before they even need to access Services or care in an emergency department, which is not what they're designed to do Or to meet then higher levels of care. There was a national survey that was conducted I believe in 2018 by the National Council on behavioral health Of those who were seeking treatment for their family members for themselves And over 46% didn't even know where to begin So again, it's essential that as we strengthen our community-based systems We also want to ensure that the general public is aware of what additional resources are available to them So that they don't just see the ED as being the only door to accessing care It's also important to remember Vermont has 14 emergency departments across the state We've had more than 10,000 individuals Who walked through the doors of those ED's over half of them were discharged back to the community? So again, just an important data point for us to keep our eye on, you know How are we strengthening that community system of care to prevent individuals from needing to see the ED as their only way to access care? So essentially we have to address I think both the social and fiscal costs of more restrictive and higher levels of care and try to align our resources To prevent that need Which I think will save both resources And create better outcomes for the monitors So again, some of the bullet point points here are clear and consistent messaging that support individuals in crisis Implementing practices that improve an individual's experience while in crisis Education and training for providers and trauma-informed person-led care Continuing to strengthen prevention care coordination and hospital diversion programs and development of alternative options to emergency department places placements We talked a lot in the think tank the group that I was in in particular looking at potential urgent care models That could divert individuals If you have a health care issue many of us access urgent care on a fairly regular basis So that's a resource that we have in our community. It would be nice from a parody perspective That if you're experiencing a mental health challenge that you might be able to access that same kind of urgent care As someone who have those experiencing a health care challenge There's also an exciting Initiative that's happening at the United Counseling Services Or they have implemented an urgent care model for the pediatric population I'm sure they'd be happy to report to the committee on that But again, we continue to move in the right direction But want to make sure we're thinking about skin is effort statewide to have maximum impact The strategies under action area 5 The themes include access transitions and outreach and coordination The implementation of mobile response is a significant action area That we are moving forward as part of the recommendation of the 10-year plan As you heard in testimony Mobile response allows us to respond more proactively to a child youth or family Before something becomes such a crisis that it might require you to go to the ED When we look at the trends in children under the age of nine Who are accessing emergency services overall the pressure on our emergency services systems within our community mental health agencies? This funding will allow Rutland as the pilot site to implement the mobile response team, which will be able to respond Face-to-face with children and families in their homes to provide that level of care Myself and the previous secretary convened a meeting Related to our overall concern as a state about the amount of children who are waiting in EDs for days at a time And we had family members there Who all reflected on the need and their desire if only I could have called someone and they could have come to my home and Helped myself and my family in that moment And one family even reflected on you know ten years ago. They felt like they were able to receive That kind of response But because of the pressure on the system the increased need It's an area that we need to continue to attend to we work very closely with the Vermont Federation for families on this Who also work directly with families across the state and this is something they have closed time and time again That they want and need Again continuing to also look at Urgent care as an opportunity for our mental health system of care There's approaches such as the living room model, which is an alternative to emergency departments And access accessing hospital diversion programs across the state We've been a good job in expanding some of our hospital diversion programs through Northeast Family Institute, NFI Continuing to focus on hospital diversion programs for adults as well And ensuring that folks are aware of crisis supports and services that are available in their community Including the crisis that's available through our visited community mental health agencies Action area six is related to peer services and ensuring that they are accessible at all levels One of the things that we know is expanding peer services across our system of care Have shown impressive potential and outcomes in other states And we think we can do better in Vermont Other states who have implemented peer services, whether it's access and emergency departments At other points of care Peer intervention and support can be incredibly powerful For individuals who might be experiencing a mental health crisis They're a valued Component and a critical component of our mental health system of care And we'd like to continue to expand on that work in Vermont We also need to understand How our peer workforce how peers Also fit in from a credentialing standpoint from a billing standpoint And Medicaid reimbursement. There has actually been some debate And I think folks involved in this peer work about whether or not They should be billing What that could look like what that credentialing should look could look like But if we were able to do that successfully it could open doors To potential funding of peer services that we think are urgent and important So one of our recommendations is that there is a peer led work group That can help us think comprehensively as a state of what those opportunities are What that credentialing could or could not look like to make recommendations as we go forward We also have areas and bright spots in the state that we want to expand upon We have a two bed peer respite program that makes peer supports available to individuals We have the satiria house Which is also considered hospital diversion or utilized as step down from any patient level of care that is all peer run We've seen on the substance abuse side of the system They're great success in implementing Peers and peer recovery coaches in emergency departments across the state of vermont We think it would be powerful to think about the integration Of peers related to mental health supports across our emergency departments as well So This idea of looking at peer navigators etc. This is something that The think tank and burglars really felt was important In terms of the action areas They're broken down into three main themes Which are standards and guidance informing programming and strategic placement As I mentioned establishing this peer work group that can look at credentialing and aligning aligning standards Opportunity for federal reimbursement of peer services Feels like a significant opportunity and level for us potentially But again, we have to have the credentialing and standards somewhat articulated before we can do that And more guidance and educational opportunities for community providers Related to the opportunities for inclusion of peers And what that can mean for those individuals We'd like that peer work group to advise the department of mental health on a regular basis So that we can continue to move this forward Action area seven Is ensuring that service delivery is person led This is a fundamental value That vermont has long held related to our mental health system of care It's building a culture of care that treats individuals with dignity and respect Supporting individuals in their own path towards recovery and recovery goals Person led systems provide expertise and resource that support and individuals goals That includes their needs their values their cultural identity and interests Even when the care is provided to folks who are on an involuntary status So this is something it's essential to recovery best practices Something we need to continue to pay attention to in the state of vermont We want to ensure that same-day access access solution focused intervention Also reshaping practices that can include advanced directives So that individuals can articulate and lead their own care When they're they're in more of a position of wellness versus at a point of being in mental health crisis thinking of O and H Do you think orders of hospitalization and orders of non hospitalization among other things? I think how Advanced directions directives could inform orders of non hospitalization and ensuring that the care management that we're providing for individuals Is really aligned with their own goals for treatment and recovery Not an easy area not an easy area But it was an area that both Vermonters And the think tank felt warranted additional attention The specific areas of this are related to services and workforce Again, we have an opportunity to continue to educate our staff on what person led treatment really is That's in our inpatient facilities across our designated community mental health agencies I think there are areas where this is happening And it's something we have to continue to attend to that's one of the maintenance of practice improvement and continuous quality improvement That we have to continue to train our staff In these best practices Ensuring that advanced directives are offered And that person led treatment is truly implemented across the state of Vermont across all of our providers Finally action area eight Is committing to workforce development and payment parity We all know that workforce development is absolutely essential to achieving vision 2030 Without offering the resources tools and employee benefits Our dedicated community care providers need We can't meet the urgent health needs of our vulnerable populations without supporting our workforce workforce development and payment parity We think underpin a strong system that can deliver high quality services and supports And when we think of payment parity, we think specifically of equal rates of payments for the same services when provided by mental health professionals As compared to health professionals So this is something we need to continue to look at across the state of Vermont Some of the high level bullet areas that we want to focus on our implementation of approaches From the mental health developmental disabilities and substance use disorder workforce report Looking at other aspects of our workforce in terms of community health workers and peers Ensuring that our workforce is well trained having payment parity across health care providers Feels like a big area that we need to continue to tackle And expanding coverages for all services for vermaners Regardless of their insurance So these are areas that the think tanks we had a very specific group that was focused on this And again, just these are high level action areas kind of summary for the committee The report itself is much more detailed in terms of the specific next steps that we would be taking So and as you're going through some of so obviously the payment parity issue is one that We're also very concerned about and Trying to Improve access for folks in communities and community services Relates directly to this and how private insurers incorporate payment for Counseling sessions and peer group sessions. I mean, there's a lot this is just It isn't a simply mental health that we're talking about here. Well, as you said it's substance use disorder, but it's also other Other areas That really cry out for payment parity help Yes, yeah And one specific example too is we when we convened that meeting with you know, individuals waiting in eds as we move forward with mobile response You know one of the Concrete action staffs was meetings with blue cross blue shield For example to talk about can these home based services also be reimbursed For family numbers. So these are the kinds of conversations that we need to have Regardless of what your insurance is To ensure that you can access the resources that you need and knowing that medicaid does pay for this. That's correct Pits the burden on the state Okay The Specific themes under this action area are capacity quality training and diversity and inclusion Again, this continues to look at initiating workforce recruitment strategies Training improving working conditions in support We're all grappling with significant workforce challenges across the state of vermont health care and mental health partners Working towards parity and reimbursement rates again. We do this in pockets How do we have a more comprehensive approach to addressing that? And again ensuring that our workforce has the appropriate supports education and training to support their day-to-day work And to encourage their professional development So this is Not the end. This is just the beginning from the department's perspective We felt it was an urgent and important opportunity for us to articulate a 10-year vision That very strategically outlined the short-term mid-term and long-term actions and strategies to get us there It creates a framework by which decision making Can be held within To ensure that our investments and opportunities that we're looking at are aligned with our 10-year vision And that there are very specific action areas that the department will be taking Upon submission of the report that we are beginning to work on Implementation is critical. We have a policy team with the department of mental health We'll be continuing to provide leadership on this Again, as I mentioned earlier on in the presentation We really want to engage you as legislators in the creation of an appropriate structure such as a council or board That would have the authority to oversee and guide strategies in this plan That would require commitments to a common vision that would bring healthcare and mental health partners together To achieve that vision As I mentioned, we do have some specific language Related to what that council or board could look like We are proposing That this would be chaired by the commissioner of mental health That some of those representatives would include folks from the green mountain care board The agency of education A key leadership from one care Representatives in the Vermont medical society the Vermont association of hospitals Vermont care partners by state The university of Vermont medical school Also other representatives from our hospital partners Commercial payers including blue cross blue shield and mvp and other Education centers across the state so we can provide this specific language That would be helpful. We do have a placeholder up there for the 10-year plan right and So we'll have some time to look at this. If not next week when we get back after Town meeting excellent, so It'll be a start I understand that and I I don't think that the house is passing us anything related to The 10-year plan at this time. I will be re-communicating with bill leper about that, but It does give us an opportunity to go forward a little bit The other So I think that's probably the best option and the other option is to put it in with a ruttland mobile mobile unit, but Probably doesn't And the other piece in order again to create Accountability and commitment to this 10-year plan and the integration of mental health within health care We also want some benchmarks in terms of us needing to report back To the legislature related to our progress and implementation So creating those structures of accountability from my perspective feel important So that we can continue to move this work forward in a meaningful way. That's also included. Okay Are these specific goals? Or chart the chart to that commission included in there because I could see it growing like gangbusters I don't know if it's as specific as what you're asking for so we could certainly suggest some areas in terms of the specific charge That the council would be focused on. Okay If you can get that to us, then that'll give us an opportunity to We'll put it up on our webpage and then Members of the committee can look at it and we can make recommendations for For the legislation Other short-term strategies that the department will be taking on is to conduct an inventory and analysis short-term actions And the resource assets that we currently have that we can build upon in a more targeted way Again, some of this is you know building on the strengths of the system that we already have So the department of mental health has actually already begun that work Also to try to convene tables and forums That are maybe beyond the traditional scope of the department of mental health again as an effort to engage stakeholders and healthcare providers In these conversations That we will be finalizing the department of mental health's state system of care plan using information and strategies from the tenure plan We will also be including this in our input according on act 79 And we'll be creating an evaluation framework for the monitoring and measuring of the success of this plan Can I ask a question? I'm looking at the the vision 2030 short-term stakeholder activities That slide okay with the with Are you you're not there yet? I won't go Um Which slide and where is that? 30 I don't want to go there if you're not ready to go there Is that this one? Oh, no, no, it's You keep going you keep going. I'll I'll I'll remember what I was going to ask Okay, so I this what this slide articulates Is that inventory and analysis of some of the short-term actions and resources that we have? So it's very small. I apologize I think this was really just to demonstrate where we felt like we had some assets that we could build upon What are you talking about now the one that I was on it? Yes. Yes, exactly. I want to look through Her Yeah, so I'm looking at action areas and I see one is actually the council Right. So then would that mean that the goals for number one would be to Develop analyze make recommendations about all the take all the ones that are there We want them to work further. I'm just thinking about the legislation Yeah, let me think about that a little bit and how you know what we've done in terms of our analysis of short-term assets Could inform the charge of the council to ensure that their work is very targeted and focused Okay, and again very specifically In terms of how our overall f y 21 budget this year interacts with this 10-year plan Which is important? Mobile response is a specific action area that was lifted up in the 10-year plan that we are moving forward Suicide prevention was also a specific action area in the 10-year plan We've put forward a comprehensive approach to suicide prevention in vermont Which includes the expansion of zero suicide the national lifeline And the expansion of our elder care clinician program We are also looking to expand our community and street outreach programs across vermont Again, this is kind of pairing law enforcement with mental health social workers That was also embedded within the 10-year plan That is something that we are moving forward with expanding in the washington county area, which we're very excited about And also we did just put out an rfp for a peer workforce development grant Which we they will be essential in moving forward with that action area related to peer credentialing And how we think about potential Medicaid reimbursement down the road So just wanted to make sure the committee was aware of some of the things we've already put in place That are reflective of the 10-year plan and vision Questions I apologize for stepping out. I had 48th graders and I took a little longer than I thought No problem. Thank you 45 minutes You've done a lot. I know that I know that your presentation and other committees has lasted a little bit longer and more in depth But we're we will look at the report You know the 10-year plan, right? I've already looked at it. And I just think it's a significant It's a significant document. There's a lot of work to do. It could be overwhelming But I think a lot of the things that you've been doing and we've been doing Have are leading us in these directions Well, thank you for your time this morning. I really appreciate it. Thank you. I know that you'll you'll get this Email this to the committee If you send it to dory and then we'll get it up on our page and then any other thoughts you have about that last Table and then how to build a charge. I think we may want to refine whatever it is you have. Of course we're senators Maybe we won't no, we'll say Great. Thank you again for your time this morning. Thank you very much. It's been terrific. Good work. Thank you I know how hard you've been working. Thank you