 Good morning everyone. This is the House Healthcare Committee this morning. And let me start for committee members to appreciate your flexibility starting at half hour earlier than we had initially scheduled. I think that was done that for several. I think that was today as well. And today's agenda is to look at the follow up on the use of coronavirus relief funds, which were referred to as CRF dollars, will be following up on the use of CRF dollars, particular issues of health disparities, something which this committee had a great interest in June when we were when we were allocating and then appropriating substantial amount of dollars for healthcare related issues. I won't review right now exactly how we got where we were, but we, one of the things that may be helpful is that to understand is that we had made some proposals from the House when it went to the Senate and came back through conference committee, the we were reminded or told that the department, I think we had recommended a million dollars from the House for health disparities. And we had a particular set of issues that we thought should be prioritized. And when we came back, we understood when we came back went through a conferencing process, not a formal committee. We were informed that the Department of Health had a particular grant and maybe Sarah, I think Sarah will be able to maybe remind us of what that is, that would allow for some grants, sub grants to groups around health disparities. And that's part of what we're looking to understand today that I believe as I recall there was to be rough, there was an additional half a million dollars allocated out of staff dollars and there was to be an additional 500,000 or more from a special grant, which hopefully Sarah can fill us in on. And that between those two pots of money that the million dollars would be available for health disparities. So part of what we want to understand today because a lot has happened in the meantime we all do our best at trying to make decisions and proposals. And what we wanna do is first follow up with the Department of Health to understand what they have set in motion to distribute dollars for health disparities. So we'll hear from Sarah who will do me the favor of using her full name and we'll pronounce it properly then. And then after we hear from Sarah we will then turn to Mercedes Avila who is from the Governor's Task Force on Racial Equity. I think I have that right. But again, because there was simultaneous with what we were doing there was the governor had appointed a task force and one of their first tasks was to look at issues of health disparities as it relates to COVID-19 in particular and recommendation. So we're very interested in hearing those recommendations. And then we have time for committee discussion and to consider whether there are further allocations of dollars that we might wish to make given that we were asked by the speaker to determine whether further allocations of any dollars not just for this but across this spectrum should be considered in the budget. And we've done some preliminary language to try to move us along if we need that later in the day or later in the morning. So I think that lays the groundwork. And with that, I'd like to first turn to welcome Sarah from the Department of Health. I apologize Sarah. That's okay. And so if you would, I'd appreciate if you would introduce yourself. And I also wanna say, I appreciate you're making yourself available today. I know that there was a request that we defer this testimony till next week. But given the timeframe, we are charged we and all the other committees of the house because the house starts the budget. We have a much tighter timeframe than the Senate. And we are charged with having any recommendations to the appropriations committee by the end of today. So that really was, that's really for both of you that that really frames what our needs are. And we will do our best to listen and then to think together and have some committee discussion after hearing from both of you. And then I should just say that at the end of where we have two and a half hours stay till 1230 I'm going to some ways reserve the last part of today's Zoom meeting to preview for the committee the issues that we will be taking up starting tomorrow that I previewed in an email that has to do with a proposal from the department of public safety and mental health counselors and where the speaker has asked our committee to take some tests to take testimony and bring a recommendation. And we will be looking at language. We need to, we will create, we have crafted we being the leadership of this committee or representative Dot-A-U, representative Houghton myself have crafted some placeholder language in conjunction with our companions on the appropriations that we will need to put into the budget today in anticipation of future testimony that we will be taking. This is all, it's a lot going on. Let's just say there's a lot going on. So I think I'll take a breath and with that, I would welcome again, Sarah, thank you for joining us today on short notice and I'm inviting you to introduce yourself and then proceed with filling us in where we are with the allocation of dollars for health disparities from the health department. Is that work? Yeah, thanks so much. My name is Sarah Chesbro. I work at the health department and in quote unquote normal times, my role is grant and program manager in the division of maternal and child health. I've been involved in some health equity and community engagement activities at the health department for a few years, just as kind of a professional development opportunity. And during this COVID response, we have mobilized the health operation center. And in late May, I was deployed as the health equity technical advisor. So I'm here today as part of the health department's HSC effort. My role there is to lead a team of five other folks. So there's six of us half time who are dedicated to mitigating health disparities. And that means a lot of things. But one of those things is to allocate funding out to our community partners and folks that can help us build trusting relationships with subpopulations in Vermont that experience health disparities. And I just wanna express gratitude to you and to the entire legislature for appropriating this money for the health department to spend. I think it's obviously a time to invest in this work. It's past time to invest in this work and we have been working toward these ends. And so this contribution to our budget is really appreciated. And thank you for all your work on it. I'm happy to be here with all of you. And I could jump into a long spiel, but maybe I'll ask Chair Lippert or any of you if you have any opening questions for me around the coronavirus relief funding. Well, maybe as an opening question, I could ask you to help us understand the differentiation between what, and I don't have in front of me the name of the grant, but I understood that there was a special grant that the health department had received that has had as a part of its goal allocating some dollars. And we were told perhaps as much as a half a million dollars. Primarily as I remember toward more educational issues, et cetera, but I don't know if we had that wrong. If you could tell us about that grant and then we separately had allocated, I believe, $500,000 for additional distribution, more in line with what this committee's concerns were around actual working with groups that who were impacted disproportionately or were concerned would be impacted disproportionately by the COVID-19 virus. And we were particularly interested in reaching out to groups that could do outreach and group groups which themselves were composed of people affected. I don't know if that's the best way to put it, but yeah. So if you could help us understand those two groups, two amounts of money and how you've proceeded with each, I'm gonna, Representative Donahue has a question I think and she may, is that a question, Ian? Just trying to a little clarity on those two pieces from my, because I re-looked at it just the other day, including the report from the Department of Health. And I think that what happened is that the Department of Health said that the, and I can get the name of it if you need, but that first part of money was already there for doing the educational outreach, getting information that was culturally appropriate. That's here from the Department of Health. Oh, okay, I thought there was a... If I misconstrued it, that's what Sarah tried to sort it out. No, that's great. She's our witness. That's, thank you. That actually was what I would say an introduction. So I think the funding streams referred to are the ELC, so that's the epidemiology and laboratory capacity. Thank you. Yeah, and enhanced detection grant, there's this long acronym. So that's the piece, I can speak more to the coronavirus relief funding, but what I can tell you about the ELC grant is that it has been appropriated to the Health Department, there is an implementation plan. I am not aware that spending from that grant has happened yet, but what I do know that was that $640,000, that was a little more than half million, was set aside for, as you said, Chair Lippert, subgrants to community organizations that work with marginalized people, and especially the education and training for the Health Department on how best to be culturally sensitive, responsive, language access issues. So, and I'm looking right at the language here. We've asked that this money to be spent on providing trainings on racial equity for both folks in our central office and our regional district office staff, and especially to inform the work of the Health Operations Center. So in that pot of money, and Shayla Livingston is probably the person at the Health Department to connect with, and I'm happy to make that connection and get you any answers that I don't have to say. Yeah, she's not available this week. Yeah, she's out this week. But my understanding is that, probably what was expressed was that, we do have this chunk of money, it's to be spent here. The Coronavirus Relief Funding would supplement that money, and I can tell you a little bit about the planned spending of the CRF, if that would be helpful. That would be helpful, that would be helpful. Okay, wonderful. So, Coronavirus Relief Funding is in the amount of $500,000. We have some really great and clear language from the bill, especially around kind of those populations that we know experience adverse outcomes from COVID-19, and what types of activities would be supported through this funding to help them meet their needs, their prevention needs, and education needs. So, we are planning to sub-award to five different entities with this pot of money. Each of the five sub-awards is in some process of near completion. And I know you know the grind of getting grants out the door. So, and one of them is actually to Dr. Avila through Spectrum. And I wanted to talk a little bit about that award first. It's the largest chunk of our award. And the health department has worked with Dr. Avila in a few capacities, mostly through our alcohol and drug abuse programming division. And she has developed a cultural broker model and supports a group of cultural brokers who are members of affected communities, share identities with affected communities and are essentially community health workers and care managers with folks who I think are often kind of left out of broader health department outreach and education because maybe they have limited English proficiency. There's not a great trust relationship built with state government or other entities. And so, we have struggled in the past. The health department has really struggled in the past to know how to accurately message to two different populations. And the cultural brokers will be, excuse me, contracted to help us kind of understand what folks in particular new Americans, refugee and immigrant populations, what they understand about COVID-19 risk prevention. Also, quarantine and isolation and kind of the whole gamut of what to do. We wanna know kind of what people understand and where the gaps are and then what we could do to more specifically, culturally, appropriately target messaging to these populations so that everyone has the same information and access to the same services. So that's just a blip. And I know, Dr. Avila can tell you a ton more about the cultural brokers as well as the health disparities and cultural competency committee that she runs. But that was the first piece we worked on. And so, we're really grateful to continue the work with Dr. Avila that started within ADAP. Dr. Avila also, oh, yes. Can I just jump in here and say that Dr. Avila, if you, I don't wanna cut off, Sarah, but we're fortunate to have you with us. And so in addition to your reporting to us about the task force recommendations, perhaps you would be willing to help us understand more fully the sub-grant that Sarah was just outlining as well. And I don't know, Sarah, would that be helpful to do that briefly now? If Dr. Avila suddenly putting you on the spot, but is that something that would be, you could give us a little more information on in addition to what Sarah said at this time. Absolutely. And the grant is actually sub-awarded to Spectrum Youth and Family Services. They are the grant that has have almost a five-year contract with the Department of Health and ADAP to provide behavioral health screening and outreach to refugee and immigrant communities in the area. So the program has about six to seven cultural brokers from the refugee and immigrant communities that have been extensively trained in providing screening, case management and support to the refugee communities. The model was created based on breast practice models nationally that exists related to addressing health disparities related to community health outreach, community health workers. So it's one of them, it's the only program that we have in the state of Vermont that specifically outreaching to refugee and immigrant communities related to health and behavioral health disparities. In the program has existed for five years and in the five years that the program has been in place we, the cultural brokers have reached out to almost 4,000 refugee and immigrant communities members in the area through screening, case management and providing support specifically around anything that has to do with the social determinants of health and intersecting issues related to social determinants of health. So we believe in any of us and there aren't that many people in Vermont working in health equity, I think I'm one of the few people. So Vermont is a very small state so we're always gonna be intersecting when we talk about health disparities. Those of us working in this field, I've been working in health equity field for almost two decades in Vermont. We strongly believe that we have to work with communities and that work with communities means having community members hired work doing this work through our organizations and making the link between services and communities. I conducted a community needs assessment in 2014 identifying barriers to access to care and that report is available online. I'm happy to share the link later on is a 40 page report with findings. We interviewed more than a hundred refugee and immigrant community members and the findings of the report, one of the main recommendation was to have a cultural brokering program having community members hired in that capacity to make the link between services and organizations. One of the biggest findings of the program was that community members did not know that for example, mental health agencies existed that they were not aware of any program providing services. And if communities don't know that the programs exist how are they gonna access them? So I had several meetings at the time with the Department of Mental Health, the Department of Health and a spectrum stepped up and also created not only supporting the cultural brokering program but they also created the Multicultural Youth Program which is another program specifically working with refugee and immigrant children. So it's a perfect fit for this type of work with refugee and immigrant communities. And I'm happy to answer any more questions you might have after Sara finished presenting. Great, and that's very helpful. And it also helps us helps me I'll say and perhaps others understand the connection or the nexus with spectrum youth and family services which some of us would not have immediately identified with the broader set of initiatives that you're describing. So this is all very helpful information. Can I ask you one? I believe that I've taken in what we're using a term which I think is, well maybe it's jargon but it's just a term that's unique to this discussion a cultural broker and maybe I would welcome either Sara or Dr. Averla to just be certain that we understand as we're having this conversation what the meaning is of using that term. So I'll leave it to the two of you to help us. I think I've absorbed it but let's be specific for those who might be listening because we also have an audience on YouTube and this will be on YouTube and I think it's useful to know. And this is an important question related to understanding this work with the environment we chose the term cultural broker. There are other terms being used nationally community health worker, community outreach worker. There are many different terms that are similar. Community health worker is the most commonly used term. The refugee community in Vermont chose cultural broker as a term because the community health worker was confusing for some of the community. So that was a decision that was made by the community to use that term. Essentially cultural broker means what the term is defining is making that bridge between programs and communities in a way that is culturally and linguistically responsive and sensitive which means that we have community members working for our organizations making the link between services and communities is one of the best practice national models in addressing and eliminating health disparities and it has proven to be effective nationally but also in Vermont. We have been able as I mentioned to reach out to almost 4,000 refugee and immigrant communities and build trust. The other important piece of cultural broker in is that it helps build or rebuild trust in many cases related to addressing health disparities. As most of you know in this committee we have a long history of distrust with healthcare organizations through some historical events like eugenics and ethical medical research. So most often it's effective to have community members explaining and providing that bridge and link and brokering between organizations and communities and at the same time they speak the language of the community so we don't have to have an interpreter that so much is lost also when in interpretation and translation so that's why it's such an effective process and these six members of the community have built trust in such a way that they are the communities reach out to them. The six cultural brokers we have in Vermont currently doing this program they were also essential in ensuring that hundreds of community members went to the testing sites. It wouldn't have happened without that process of having cultural brokers calling families picking them up in their homes going home by home explaining what COVID was and being able to reach out and get the families to the COVID testing sites. The work that the cultural brokers do is no different than case managers at the Association of Africans living in Vermont or the USCRI Vermont chapter they do similar work but the more cultural brokers we have the more trust and the more we're gonna be able to break barriers to access to health care and behavioral health care in the state. Thank you, Sarah, that's very, very helpful and I think it's very useful to have spent a minute or so several minutes just to be as clear as possible because that's I think it intersects with in fact in different ways with some of the thoughts this committee had had and that's terrific. Sarah, is there anything on that front that you would like to add? That was beautiful, Dr. Avila is definitely the expert there. I will just add that this is kind of a new funding model for the health department and something that I am bringing forward pretty aggressively that is really supported is this idea of we recognize that as the health department we're not all things to all people our website is not accessible to lots of folks. There are traditional ways that we have done outreach in the past that we just know are not reaching all of our mentors. So this idea of hiring someone who shares a cultural identity that can more easily make connections to social services health care makes all the sense in the world and is beginning to pick up momentum at the health department. So we're excited about this. So I'm going to, as the chair of the committee I'm kind of the manager of how we move along and I see and I don't know if Sarah and Dr. Avila, you can see but we have, when we are on Zoom there's a process by which members of the committee can raise their hands virtually. And so I see three, well, two committee members have their hands raised. So I think I'm going to pause and hear what their questions are. And then we don't want to sidetrack the completion of your testimony, Sarah but I think this is a very useful addition to the first part of the grant. And maybe when we come back you could actually help us understand the amount of that grant as well. But let me first turn to Representative Cordes has her hand up and then Representative Page has a question as well. Thank you chair and thank you, Sarah and Dr. Avila. Dr. Avila, the work that you are leading is critical and I'm very grateful for your leadership and Sarah for your leadership in the health department. I just have a comment that may or may not be helpful. The cultural brokers program sounds a lot to me like an organization that I've worked alongside in Haiti and partners in health, Paul Farmers group that lifted up the leaders in the community to build their own clinics, build their, provided them support so that the people actually living in the community were leading the efforts. This was partners in health or Sanmi La Santé had been in Haiti for years but I was there after the earthquake. So people that are interested in this model if Dr. Avila, if you think that that's am I correct in saying that that's a similar model and if people are interested in it it might be worth looking at, there's tons of really wonderful writing about that kind of work through partners in health. Absolutely, there are many different models within the United States and globally that show how working directly with the community increases participation in health care and behavioral health care from the community. So I think that's a great example. I think we have many good examples in the United States as well reaching out to historically underserved communities. Thank you for that example. Okay, representative Page, are you, I didn't cut you off, Mari. Okay, representative Page and then I know there's other questions but maybe we'll come up after we've heard the presentation fully but representative Page, you have a question now. Yes, I have a couple of questions. First off. And you need to speak up Woody because yeah, thank you. Let me see if I can adjust my settings. Okay, how's that? Is that better? That's actually better, so thank you. Thank you. Thank you, Chair. With this grant, it's only for COVID education. Is that correct? Nothing else? The way the bill was written is yes, that this is for purposes of emergency planning for because of the COVID pandemic. Okay, and is this state funding or is this something from outside, say like the State Department or UN Refugee Agency? No, this is not connected to any of the latter that you mentioned. I believe it is federal funding that was allocated out to different agencies and departments in Vermont. Okay, so it is federal funding. And regarding the 4,000 in your communities, where are these communities? I'm assuming Burlington, Rutland area, are those the only primary places that you're working with? That's a good question and I should probably let Dr. Avila chime in here. Obviously we know that the majority of the refugee and immigrant population in Vermont is centered in Chittenden County. And so I believe a lot of the cultural broker work happens with families in Chittenden County. There are resettled folks in other parts of the state. And I believe that Dr. Avila's cultural broker model is it can be scaled statewide. It's intended to be a statewide resource but I'll let you jump in if you don't mind, Dr. Avila. And one other issue is the state receiving refugees. Presently, I know there was some talk about stopping that or delaying it or something. Thank you very much. To the best of my knowledge, I actually just was CC'd on an email that there will be a moratorium on receiving any new individuals in October. And I think Dr. Avila probably knows more than I do but we have been accepting refugees and asylum seekers consistently for since gosh, the late 90s. Dr. Avila, would you want to comment on Representative Page's question about the scope of the outreach across the state? And I, yeah, Woody, can I say this in a way that's maybe slightly, Woody's from the Northeast Kingdom. That's not his only, no, in fairness to Woody, that's not his only interest, but I just think it is important because Woody is an advocate for, Woody and others on our committee advocate for making sure that issues are addressed across the state and not just in Chittin'N'Kat. I don't mean that in a demeaning way, Woody, seriously. And I know that, Chair. Okay, so those who are listening may feel like I'm poking at you in a way that's not- Not at all. Okay. And I can share briefly, and I know Sarah can add more about this. The Cultural Brokering Program is one of the several initiatives that are gonna be funded through CRF, reaching many different communities. Refugee and Immigrants is one of the communities that the funding is reaching too, but there are other communities that Sarah can actually speak more because I don't know the other grants that well in that we are reaching in other parts of the states. We are not saying in any way that refugees and immigrants are the only vulnerable population related to health disparities. However, COVID-19 has resurfaced racial disparities across the nation and also in the state of Vermont. We have a very alarming racial disparities. For those of you who are following the data presented by the Department of Health for children who tested positive under nine years old, almost 68%, almost 70% of children under nine years old who tested positive in the state of Vermont were racially diverse children, many of them from refugee and immigrant communities. So that's a very alarming statistic for the second-wide state in the country. So when we look at allocating funding, should be allocated equitably to address the health disparities more imminent that are taking place, especially in a public health issue like a COVID-19 right now. Right, thank you. It's very helpful to just be building more information, which some of which were complete or we're aware but the more we hear it and the more we share it, the better. I don't see any other hands raised at the moment. So I'm going to suggest perhaps, Sarah, that you continue and then we'll, let me just check, Sarah, what is your availability to us this morning? I can be here the whole time. Okay, Dr. Avila, are you available throughout as well? Yes, I am, thank you. Okay, good, I just want, it occurred to me we should check. So this is terrific to be able to go back and forth and we will, I assure you, Dr. Avila, we will be turning to the task force recommendations as well even though we're spending some. But let's move through the other recommendations for grants that the Department of Health is currently doing and then. Wonderful and thanks for these great questions. I think it's helpful for me at least to be in dialogue with people and decision makers about this to know what your questions are. So I can quickly run through the four other subawards that are planned, tell you about the target populations for that work and some of the activities that have been proposed to us. So as Dr. Avila mentioned, we really did know that New Americans, refugee and immigrant communities were a priority for us to serve in a different and better way. So the cultural broker work with Dr. Avila is kind of one part of the agreement, but Dr. Avila will also be training our staff in health equity, cultural and linguistic competence, implicit bias. We continue to welcome trainings like this for our workforce. And she will also be doing focus groups, 10 focus groups to identify areas of need in different refugee populations, especially around messaging and we'll report back to us her findings so that we can do a better job kind of streamlining communication to the different folks we serve. So that's spectrum and Dr. Avila, that's a big part of the work that I'm really excited about. Another population that has come to our attention as potentially not well-served during COVID is migrant workers. And so, and many of you may share the same concern. We do have quite a significant number of migrant farm workers in Vermont, mostly in Addison and Franklin counties, but spread across the state. And as you can imagine, these folks are really at the intersection of a lot of kind of disadvantages and lack of access. When we're talking about a trust relationship that doesn't exist for the most part, with at least with state government, it does exist with our hopeful sub-awardees, which are UVM extension bridges to health and open door clinic in Middlebury. And so these two agencies will be performing similar scopes of work, mostly outreach, education and care management similar to the cultural brokers. Their contracts, at least the scopes are written to be focused around messaging and creating culturally relevant messaging for folks who live and work on farms and actual door-to-door visits or on worksite visits, to be more exact. So these agencies have recommended hiring, outreach, bilingual outreach staff to add to their teams, doing farm-to-farm visits with tangible things like they're saying health kits. So COVID sanitation kits that include gloves, masks, sanitizer and all the good information that we have on flyers and one-pagers, but just aren't reaching these pretty isolated populations. They're also going to be working on facilitating increased access to flu vaccines for the fall and just ensuring that migrant workers have primary care physicians that they know where to access COVID-19 testing and care if needed and that they will be that that liaison kind of between the system and the community. So that's that chunk of it and that's two different sub-awardees. Addison County is served by open door clinic where the majority of folks live, but UVM extension bridges to health is statewide. Well, it's the other 13 counties. So they will have statewide reach. They have outreach workers in each county. So I'll move on unless you have questions there. To- I wanna go through them all and then we'll come back and maybe you can assign dollar amounts. So because at some point, one of the questions we're going to have is should we recommend any additional funding that might be used to supplement what's already being happening or not and it would give us a sense of proportion, et cetera. But why don't we go through it? So the first one was the spectrum, through spectrum youth and family services, but more to the point about cultural brokers and what Dr. Avila has been describing to us. And then the second, a second is the open door clinic and the third is bridges to health or they, so those are three different sub-grants. Yeah, yep. So that's three, yeah, three sub-grants. The fourth and fifth are two Unitedways. So the United Way of Wyndham County and the United Way of Rutland County. Obviously we wanted to make sure that this funding would benefit as much as possible, kind of the equitable distribution statewide. And when we were reviewing the very clear sub-populations of that language in the bill, we really wanted to attend to racial and social justice. This is another kind of new flow of funding from the health department. We recognize that immigrant and new American refugee populations have specific barriers and that we have a lot of work to do to kind of reach them. We also have a lot of people of color in Vermont who are not refugee and immigrant who may also feel isolated. And as Dr. Avila said, have really alarming disparities in rates of infection and death nationally and in Vermont. So what we did was a scan of kind of the racial and social justice advocacy organizations in the state. We recognized a real pocket of activism and action in Wyndham County and approached the United Way as a potential fiscal agent. So again, this is the United Way, kind of like Spectrum is the awardee. And then they plan to sub-award to up to 14 different nonprofit agencies in their community that provide services such as, excuse me, I had them written down here so I could tell you exactly, community and social justice and equity, which is the priority. Also, indigenous affairs, LGBTQ plus inclusion, rural health and general wellness outreach. So they have those kind of categories of service and they are working with those organizations to determine kind of what programming they will roll out. All this funding needs to be spent, as you know, by the end of the calendar year. So their implementation needs to happen immediately and they're prepared to do that. The United Way of Rutland County, we know that, you know, Rutland County has its own specific kind of needs and gaps and services and that they also have a strong community building around racial and social justice. So in the same way, the United Way will act as the fiscal agent. There were a couple of sub-populations named in the bill, older adults and disabled Vermonters, that we found, you know, we weren't actively targeting through these other awards. And so Rutland County is going to award to their council on aging and their specifically meals on wheels program. So to me, the Rutland County agreement is really tangible kind of delivery of meals, delivery of prevention education material for vulnerable and older adults. I'll stop there and see if there are any questions and I can definitely go back to any of this. So two things, one is that I think Representative Rogers has very helpfully provided a copy of your report, the written report in the chat so that if anyone, as you say, Lucy, it's helpful for me sometimes to have a visual as well. I believe there's the report that shows where these grants are being awarded, but not with the detail I think that you're providing here today. And can you remind me, Sarah, I'm going to try to simultaneously pull up the report on my screen. Yes, because I think part of what left us with questions was the United Way, it listed United Way and broadly a general sense, not with the specifics that you're just now talking about. Did when you were listing the specific groups or types of groups, were you talking about both Rutland and Wyndham County or was that specifically to one of the counties? I mentioned the Council on Age, or maybe I didn't, Council on Aging and Meals on Wheels, those are specific to Rutland County. There are many that Wyndham County is hoping to partner with. I could give you some examples. I have a list of like 15 here, but they are organizations such as the AIDS Project of Southern Vermont out in the open, which is an LGBTQ plus advocacy organization. Like the Brooks Memorial Library, the Root Social Justice Center, it's that there are known entities that have been, I think partnered with the United Way for quite a while that are really helping to move these justice efforts forward in their communities, the Women's Freedom Center. And importantly, I want to note the band of Elmew, Abinaki, First Nations people that live in that area, there's been a real gap in terms of, I can just speak for the health department, but I will speak also a lot of other departments in reaching our First Nations community members. And so I'm really, it was really excited that they proposed, they have a working relationship with folks that are tribal leaders in that area. So those are just kind of a few examples of like the end users of the money. And I'm happy to send you a memo later with all of the proposed some wordies. That would actually be very helpful. I think a memo that could be more specific, yeah. So can I just, I don't see any of the hands right now. So those are the grants that are currently being anticipated through the $500,000 of CRF dollars. Is that correct, Sarah? That's right, yes. And would it be fair to say that the other health department grant, the long acronym in which epidemiology and something and something grant, those dollars are more internally focused, those, they're for health disparities, but are more internally focused for training within the health department workforce. Would that be fair to say? Is that right? Well, there's that piece, but I also do wanna say that part of the intent of that money is to subaward to community-based agencies in the same way that you see these kind of CRF decisions being made. What was imagined was that there would be up to eight agencies statewide that we might be able to fund in a similar way, I think, to the cultural brokers, but also our partnerships with the Association of Africans Living in Vermont and USCRI, those folks that can help us connect with disadvantaged community members, help us with language access issues, help us with general healthcare access. So some of that money, I do think the plan is to subaward out. I don't know the exact amounts, but I know that written into there was written into the implementation. And I think that's part of what was suggested to us when we initially had advocated for a million dollars and we're told that there was some dollars in this grant that would do some similar type work, but that work hasn't been articulated fully at this point. It hasn't. Hasn't, okay. Representative Christensen, and then I see a hand up, so I'm going to turn to Representative Christensen and then I think I'm gonna make a couple of comments that I think might help us. And then I wanna turn to Dr. Avila because I do want to hear the recommendations from the task force to get that on the table for us. So Representative Christensen, and then I'll make a couple of comments and then we'll turn to Dr. Avila to hear from the task force recommendations. A quick question. And this is sort of the same as representative Pages comment. You said an answer to him that this money is spread throughout the state. But when I look at the list, it's sort of concentrated in certain areas out from Windsor County. And I see it in Windham County and I see it up in Addison County. Is that because the greatest need is there or are you targeting just a little bit of clarification? Good question. We didn't have time to do a formal needs assessment. What we did do was reach out to our district offices, so the offices of local health in all the regions of Vermont to ask the district directors there and their staff what they saw as funding priorities around disadvantaged and underserved populations. So that was a bit of an informal needs assessment to get back kind of either project ideas or names of organizations, whatever they saw as kind of the greatest need in their county. And so we used that as the basis of our kind of regional scan approach. We also did our own research on the racial and social justice landscape in Vermont. And we did note that the majority of that work is happening in Chittenden County and Windham County. Rutland does have a strong chapter of the NAACP, but we did see that capacity was highest in those areas. And I do think the, I understand the concern about statewide reach. I think it's important to say that UVM bridges to health is a statewide program. And that although these subpopulations that we want to serve in a different way are pretty concentrated in Chittenden County. And then, you know, Windham and Addison County, excuse me, sorry, Windham County, Addison and Franklin for the migrant workers, they will be offering services across the board. So some of this work is definitely statewide and some of it is targeted to need and capacity of service organizations. One quick follow up. I know we want to move on, but is that because those areas when you did your informal survey, maybe have more resources to be activists or advocates for, you know, the population? Is that, and other areas are just not as organized because they don't have the resources either people-wise or money-wise? It's a really good question. I'm hesitant to answer that because I don't want to say that the other regions are under-resourced or, you know, less active in their communities. I will say that, yeah, from our assessment, what we noticed was there was greater capacity because of the number of organizations active in Windham and Chittenden Counties and just the knowledge of the need based on demographics. But I'm not sure I can answer that fully. I don't know, because we didn't really have time to dig into the capacity of all, you know, all areas of Vermont in a way that we would want to. I think some of that is unanswered. Thank you. Yeah, thank you. So, okay, so I see two other hands of race. I want to hear from members' questions and I definitely, we need to hear from Dr. Avila. So I'm trying to figure out how to balance that. Could you represent Rogers and Reverend Smith? Are your questions specific to the health department or would they be appropriate to be held until we heard from Dr. Avila and then open it up for questions as broadly? I can wait, I can wait, chair. Okay, thank you, Brian. Does it work if I just name my question and I'm not sure when it- That'd be great, name your question. Brian, if you want to name your question, but that's not engaged with the questions right now. If you each would do that and then... Okay, Lucy, would you like to name your question? I just raised my hand because it kind of came as a follow-up to Representative Christensen's questions, but I just, at some point today, I really feel that I need to understand more about the process of how it was decided who the grants were awarded to and just to understand more about what outreach took place and how the recipients were determined and I'm not sure where that fits in best, but that's something that would be helpful to know more about. Okay, and let me say before we turn to Dr. Vila, which I'd like to do in a moment, that I think as I'm listening, and this is from where I sit as the chair, from what we're sitting where I'm listening, I think we may have an opportunity here today to add to the resources that are available and to supplement at least what I'm hearing from the health department and I wanna have that in our mind as we listen to Dr. Vila and the task force recommendations because it may turn out that we have an unexpected opportunity here today that may be actually in everyone's interest. So Dr. Vila, let's turn to you. Thank you for your help in understanding this first part, but we'd like to hear from you and if you would frame what the task, I'll turn to you to let you frame what the task force charges, what the task forces charges are and who the task force is and what the recommendations are. I'll turn to you. Thank you. So I will start my formal introduction now after I talk about health disparities. I'm also switching hats as you know, those of us that work in health equity is only a handful of us. So we're always in a million committees and in a million different initiatives across the state. But first I wanted to say thank you, chair Lippert and members of the health care committee. And by the way, what you hear is the F-35 is flying over me but I have no control over them. We're giving me the opportunity to discuss briefly with you the recommendation related to health disparities as well as best practices to addressing and eliminating health disparities. My name is Maria Mercedes Avila. Most of you know me by Mercedes, which is my middle name. I'm a community representative member of the governor's racial equity task force that was newly formed in June, 2020. I'm also an associate professor of pediatrics and the health equity and inclusive excellence liaison for the Lerner College of Medicine at the University of Vermont. Today I'm speaking as a health disparities and health equity expert and sharing evidence and research related to addressing health disparities. However, my views are not necessarily those of the University of Vermont. We have these disclaimers we had to share. I mentioned already the statistics related to children under nine, that almost those who tested positive for COVID-19, almost 70% of them were racially diverse. We also know that black Vermonters have been affected by COVID-19 at particularly higher rates. Hispanic Vermonters have also contracted COVID-19 at higher rates compared to non Hispanics and also to, as all of you know, we live in the second white state in the country making these statistics very alarming. We also know that in Chittenden County, for example, almost 3% of white people live in households with three or more generations compared to more than 11% of non-white families. So we know that when we have a pandemic or an outbreak like the one that happened in Winooski and in Burlington here in our area in Chittenden County, we find that multi-generational housing can affect isolation and quarantine. And those were two key aspects of that connecting onto the outbreak in this area. The recommendations I'm gonna share related to health disparities were drafted by the Racial Equity Task Force and informed by its 12 members. The Racial Equity Task Force is confirmed by 12 members. But we also had more than 24 groups and organizations that provided advice and consultation during the development of these recommendations. Specific to COVID-19 and health disparities, the Racial Equity Task Force drafted 14 recommendations divided into four categories, language access, access to testing, data collection and reporting and economic fallout. As many of you know, the report was submitted to the governor yesterday. So we wanted the governor to have an opportunity to review the report before making the report public and these recommendations. Related to language access, more than 9,000 Vermonters are limited English proficient in the state. During the earliest weeks of COVID-19, limited English proficient populations did not have access to real-time information. Community organizations and members got together to support these refugee and immigrant communities by translating and creating videos in the 10 most commonly spoken languages in Vermont. Eventually, these initiatives received stable funding. However, that did not happen until later on in the spring, almost May 2020. Within language access, the recommendations include mandating that all communications, including educational materials related to COVID-19 response, be translated into Vermont's most commonly spoken languages. Ensuring that all COVID-19 related grants include line items for translation and interpretation services as required by federal and state laws. And also in this section, requiring or working towards having every state agency contracting with and collaborating with refugee and immigrant service-providing organizations to ensure that interpretation and translation services are culturally responsive and appropriate as that's the area of expertise for the organizations that serve and work with them on the ground every day. The next area is access to testing. Lack of access to testing for communities of color happened across the state. Another barrier was transportation. Transportation has proven to be a challenge during summer and spring months and this barrier will worsen as inclement weather approaches. Within access to testing, there are several recommendations. Support and increased infrastructure for homeless Vermonters impacted by COVID-19. Ensure that testing accessibility by collaborating with community organizations that serve marginalized groups and conduct broader testing in prisons in state and out of state where we know a disproportionately high number of people of color are testing positive. The next area is data collection and reporting. Overall, the task force recommends investing in data collection and reporting systems to ensure race and ethnicity data is as effectively tracked across the state. This will allow us to identify racial and health disparities and assess risks, for example, for COVID-19 in communities of color. We acknowledge as a racial equity task force and in my personal view as a health equity scholar is color that collecting race data can pose additional concerns related to distrust with healthcare organizations due to the horrific historical events. Like I mentioned earlier, unethical medical research, the eugenics in Vermon and other events. Within this recommendation, one of the recommendations is to increase resources in COVID-19 test results to ensure that race and ethnicity data collection and analysis are happening effectively. Collaborate with community and health organizations to provide training and education on cultural humility for health service providers that administer COVID-19 tests at testing sites and in healthcare organizations. Finally, the last and fourth section of recommendations is called economic fallout. As you know, many Vermonters have experienced tremendous job losses and job interactions due to COVID-19. Several COVID-19 related funding sources became available to communities. However, not all communities were included in this area. Only in the funding that was available to communities. For example, migrant farm working populations. The main recommendation in this area is to create it. A state-level relief fund, similarly to the one successfully implemented in the state of California, to provide economic relief to those because of their immigration status could not access relief funds. Even though migrant working populations are also Vermont essential workers in our economies, they are most often excluded and forgotten. Health disparities do not happen in isolation. They happen with intersecting problems in our society. The racial equity task force recommendations expand into other intersecting areas like schools, housing, technology accessibility, workplace, and government operations. Most importantly, we need to remember that health disparities are defined as unnecessary, unavoidable, unfair, and unjust. Health disparities are preventable and they represent injustices that continue to affect historically disadvantaged groups in our society. The racial equity task force recommendations I just shared align with national best practice models for addressing and eliminating health disparities. In sum, we need to actively work to address poverty and improve health, housing, and employment. We need to proactively ensure a health equity and justice approach in which all communities have access to quality health care and a fair chance to be as healthy as possible in our society. We need to allocate funding equitably while ensuring our most vulnerable communities have a fair access to opportunities and funding sources. We need state and local leadership committed to dismantling systemic racism and other forms of oppression. This is not a one political party issue. This is not a one leaders responsibility but a social and public health policy issue affecting everyone in our state. We are all responsible to address these issues. We need to ensure our representatives, our workforce, our leaders, reflect the community that we serve. We need to ensure everyone, including our healthcare workforce, understands the root causes of health disparities, the history of this country, and the responsibility that we all have to dismantle systemic racism. We need to work with communities, hear our voices, and advocate for historically disadvantaged groups. Thank you again, and I know this is a lot of information but I welcome any questions you may have and I'm here for as long as you need me to answer those questions. Great. Thank you for so clearly articulating the recommendations from the task force and would I be correct in understanding that there is a written report that would now, since it has been presented to the governor, which now would become available broadly? There is a 20 page report, yes, that was submitted to the governor yesterday. Yesterday, yes. Okay, so I would ask that that report be posted on our house healthcare website and Demis who's the assistant to our committee, if you would secure that link and provide it to all the members of the committee as well as posting it on our website just so we have easy access to it. Okay, well good, let me, so let me take a minute and say, and so I think it's very helpful to have the health department's report in front of us. It's very helpful to hear the task force recommendations which are from the governor's racial equity task force. There's an overlap, they're not the same and there's the racial equity task force has a broader mandate, but it also has a intersection around COVID-19 recommendations as well. I think what I'd like to do, so before I open up for questions, I'm gonna suggest that what we have in front of us today is, as I said at the outset, excuse me, what we have in front of us today is an opportunity to get an update on where the CRF dollars are being allocated around health disparities, including racial health disparities, but not exclusively to that. And we should remember that CRF dollars are unique. I mean, it's a unique opportunity for Vermont, but they come with certain restrictions. They, CRF dollars must be allocated and spent before December 30th, at least at this point, unless the federal government makes some change, which they haven't to this point, but they must be allocated and spent before December 30th, and they must have a nexus to COVID-19 issues specifically, but nevertheless, they provide an opportunity to move some, to assist communities specifically around COVID-19 issues, impacted communities, disproportionately impacted communities. So that's the first piece. The second piece is that I would like to just say as the chair of this committee, at least the chair for now, I have a, and I think this is shared by many members, if not all members of our committee actually, an interest and an ongoing interest around health disparities issues that will go beyond December 30th, and that definitely go beyond December 30th, and, but that today what we can, that we will continue to visit this issue and revisit it as part of our commitment as the healthcare committee to eliminate health disparities in Vermont. But what we have today is particularly to focus on the CRF opportunities that are in front of us. So with that, I'd like to open up the questioning from committee members and then think together about how, and maybe we'll along the way, I'll lay out some more information and we'll think about how we can proceed. So I know that Lucy had put a question on the table. Brian has a question and I see representative Don, he has a question. So actually just a heads up that I sent everyone, I emailed everyone a copy. Again, thanks Lucy for the concept of having it in front of us. I emailed a copy of our, the language that we from our committee put in the bill last June. So it should be in your inbox to have it in front of you if you want. Okay, thank you. And does Demis have that? Is that accessible to Demis to share if that was useful? I sent it on the house health care email. So I think that Demis gets that, yeah. So Demis, I don't know, let's do a little administrative piece here quickly. Demis, if that's, I don't know how easy or difficult it is to actually grab a document like that, that possibly could be shared on the screen at some point if we find that useful. But if you could be looking at that while we hear questions, that would be great. Okay, so I'm going to turn back to the questions that had been raised, the hands that had been raised earlier, first from Representative Rogers and then Representative Smith. So Representative Rogers, do you want to articulate your question again so that we understand it? Well, actually, before we do that, because that was specific to I think the health department, I want to see if there are questions for Dr. Avila based on the presentation that she just made in terms of the Governor's Racial Equity Task Force. I do have. Okay, Representative Smith. Thank you, Dr. for all of your testimony this morning. Appreciate it. I have a question involving the number of COVID cases in Chittenden County, I believe it numbers somewhere 700 or 800 right now, I'm not sure. But do you have an idea of what the percentage of that amount of cases in Chittenden County are of minority members? I don't have the statistics right at hand. If that's probably more a question for the Department of Health. However, we know that African-Americans in Vermont were 11% had an 11% higher chance of testing positive or being infected by COVID-19. That's one of the statistics that was shared recently on VPR. There were two segments specifically about racial disparities and COVID-19, but there are some reports and graphs available through the Department of Health, specifically looking at racial disparities. I don't know if Sarah, you know, more distantly. I'm trying to pull it up right now for you and I'm not finding it. I can certainly insert it into the memo that I send later today. I wanna point out too that we're saying, Vermonters of color are much more likely to be at higher risk for COVID and the percentage of people of color in Vermont is very small. So I think it's less than one and a half percent. So that's the disparity is when we see, you know, that it's not equal, that the rate of infection and death is not equal as a percentage of the population. So that's what's most concerning. And I will, I'm on our website right now. So I'll see if I can find what you're looking for. I think my next question could be answered by either one of you, I believe. When we ask for, or when a group asks for an additional appropriation of either a million or two million or whatever, the money that's appropriated for everyone doesn't a minority have the opportunity to go into the hospital as equally as anyone else in the state does or why do we need to spend additional money when everybody is supposed to be equally treated? Perhaps I could intervene here and make a comment. And I'll let others respond as well. But I think, Brian, we've talked about this before in our committee that when we understand that there are uniquely, highly impacted communities as we discussed around suicide prevention, if you recall. And we talked, and I think you raised a similar question then. And I shared the example, which, and at the time I think it had to do with LGBTQ youth who are, we know, at very high risk for self-harm, including suicide, thoughts, suicidal attempts, et cetera. And I suggested that we also remember that other groups are at high risk, such as veterans as an example. And so that we need to do, so that while, quote, everybody has the chance to go to the hospital together at the same time, there are often unique barriers to subgroups of Vermonters, even if it's a small subgroup, that particularly when we find that they're disproportionately impacted. And so I just want to just on behalf of our witnesses acknowledge that we've had some conversation about this in our committee and that it's important to understand that allocating additional dollars is one way for the state of Vermont to address these disproportionate impacts. But I will let others comment as well. Okay, thank you. And I could be happy to also share a couple of pieces related to health disparities. One of them I mentioned earlier, the history of, there is a history of distrust from historically underserved communities with the healthcare system and anything that has to do with scientific research. And that history of that has to do with in Vermont specifically the eugenic movement that led to forced sterilizations of community members that to this date, that distrust continues to happen. And we define that as historical trauma that has passed down through generations, not being able to trust a provider, the system. I've also heard from community members, especially native people, that sometimes they check a box, they go to see a doctor for example, check a box saying that they are native and the healthcare provider questions, whether they are native or not, because they look white, because many of our Abenaki native people in the state look a specific way. So that distrust of having to explain your heritage, you're trying to regain and reclaim your own identity and that is questioned on a regular basis in a daily life that also connects to historical trauma. The other important piece about accessing healthcare is that healthcare even though it's available not everybody has access to health insurance, not everybody has access to health literacy information and this applies not only to refugees and immigrants but low socioeconomic status communities in Vermont, people living in rural areas. Right now COVID-19 is a perfect example of the health disparities that exist. We're moving for example into telemedicine and telehealth models that in some areas patients don't have access to wifi, they don't have access to a laptop to be able to connect with and even one population as you know that is mostly affected by COVID-19 is the elderly population. The technology used for telehealth and telemedicine was not created with elderly populations in mind. So we can have a telehealth appointment and I know because my mother is here and they send emails with on distractions and she doesn't have two or three of us explaining how to log in into Zoom, how to sign a consent. There are all these barriers that are presented for whether you are a Pacific age group or a Pacific cultural group. And the other important piece about health disparities is that we have many populations in Vermont that are defined as limited English proficient and limited English proficiency means that some communities don't speak English as a first language, but limited English proficiency also includes communities that have a disability, communities that need ASL interpretation and also communities that were born in the United States, they are native English speakers and they cannot read or write in English fluently which is a percentage of our population in Vermont. So when we look at accessing healthcare there are many barriers, transportation is one of them taking time off from work to be able to get to an appointment, being able to understand what the provider is saying to us in a medical appointment and then when somebody doesn't speak English as a first language, there is that additional level of complexity of having to use an interpreter, an iPad, a telephonic piece that also poses other areas. All those pieces are connected to health disparities and inequities. So we might even get to a hospital but that doesn't mean that we are gonna understand what's happening in a medical interaction. There is a great resource available online by the US Department of Health and Human Services. They explained that every time we go to see a doctor, a mental health clinician, any type of health or healthcare appointment, those appointments generally take 15 to 20 minutes. When a patient leaves the room, they only remember from that interaction 20% of what happened there. So imagine if we add language limitations, health literacy issues, patients don't remember anything of what we say in those interactions. So we need to be investing in expanding time for appointments, expanding resources to be able to ensure that communities understand what's happening with their health and healthcare. So those are some issues related to effective communication and health literacy that are directly linked to ensuring that we address and eliminate health disparities. Thank you. Thank you, that's very helpful to have you articulate that more clearly. Thank you. Again, I'm managing our, we have, so I'm not, you know, actually, I'm not clear who sees our chat notes or if it's just members who are on the Zoom call, I think, but I will just bring to our attention that in Representative Donahue, you added something to the chat and I'm gonna ask you to maybe just comment so that everyone hears it and then we'll turn to Representative Page, Representative Cordes for their questions as well, because I think your comment is timely in terms of Dr. Avila's comments about historic lack of trust with the healthcare system. Thanks, yes, I was just completely agreeing with those comments about, you know, historic trust issues based on trauma and a lot of times systemic depression, racism and discrimination and saying that there isn't the added language barrier, but those issues you brought up are very similar for members of the LBGTQ community and psychiatric survivors who have that same real difficulty accessing healthcare because of fears from past discrimination. So I think there are excellent points and that's part of why we identified those groups as well among our COVID-19 disparity, you know, access to support, housing, food, I think your point about accompanying to doctors' offices and so forth is an excellent additional area. I would just add that for some communities, LGBTQ communities, in fact, just actually sharing that information, sharing that identity is often a question of whether is this a safe space in which to even, when I try to seek healthcare, when I, if I as a gay man or a lesbian woman or someone with another sexual identity, how will I be received and will I in fact get impartial or appropriate treatment? So there's a lot, these are again the examples of barriers and I asked Representative Donahue to comment but I'm guessing the same would be true from any psychiatric survivors as well. Well, particularly in that, I mean, they each have their, each group has their own but psychiatric survivors, it's the huge issue of, now I'm forgetting the medical term, but you know, health concerns being totally dismissed based on the moment somebody knows you have a psychiatric history, everything gets interpreted that in that lens and the diagnosis as a result. So there's a lot of fear and trust around sharing that. Right. And I wanted to add briefly, so I'm an educator. So what I teach my students, especially health and science students and medical students is that we need to move away from blaming the victims for their conditions, for their positions in society, for not accessing healthcare, from not getting to an appointment but we need to look at the social and environmental conditions, the structural conditions that are preventing groups from moving forward and being able to thrive in our society. So I think it's moving away, have that critical thinking lens to be able to see if specific communities are disproportionately being affected by COVID-19, if we have higher suicide rates in the LGBTQ community, if we have higher mental health issues and substance abuse issues in a specific community, it's not because people are choosing those specific conditions but there are social and environmental conditions that are leading communities to those areas. And our responsibility as health equity scholar, US legislators, our responsibilities to address those social determinants of health are defined by healthy people 2020. We need to understand those five areas of social determinants of health and improve those five areas which is housing, employment, education, access to healthcare, exposure to discrimination, neighborhood and built environment. Once we improve those five areas, health outcomes improve by themselves. So our responsibility is to focus on improving social and environmental conditions, structural conditions that are preventing groups from thriving in our communities and moving away from blaming the victims because that hasn't worked in our society and actually continues to perpetuate some of the systemic oppression that happens to this date. Thank you. Thank you. So I'm going to turn to Representative Page. Is your hand still up or is that from previously or you have it up again? Because if you do, that's fine. Have it up again. Okay, that's fine. Let's hear your question then from Representative Cordes. It's, well, I guess it's more of a comment from Ms. Chesborough as well as Dr. Well, it has to do with the grant grants and it also has to do with the recommendations. I know up here in Orleans and Essex and other counties to include Representative Christianson's County, COVID-19 is, I wouldn't say it's non-existent, but it's the numbers are very low, okay? And I think we were getting to this earlier with Representative Lippert's comments as well. We want to keep those numbers low, whether it be in the Orleans County or Essex or Chittington County, I would like to see those grant monies properly distributed because we do have an immigrant community up here that does farm, okay? But I'd like to see those grant monies properly and properly distributed amongst all of our, all of our homeowners. And in addition, Dr. Avila, your recommendations, I'd like to see those also properly distributed and educated, not just in Chittenden County area throughout Vermont. And those are my comments for you, okay? Thank you. Thank you, Representative Page. Let's hear, I see Representative Cordes do you have your hand up? And then I think Representative Rogers had a question that we'll return to. And then after that, I think I'm going to see if we can shift our conversation to a recommendation that we can perhaps all think together about. So Representative Cordes and then Representative Rogers. Thank you, Chair. And again, thank you, Dr. Avila. And I want to clarify, I believe your last name is pronounced Avila, not Avila. It is Avila, yes, like the Spanish city or the Catholic saint. Okay, thank you. I want to amplify what Dr. Avila was saying about, we, especially as the most of us in our committee, not all of us, are members of the white part of our white dominant culture. And as such, if we have not taken the time to listen to what black, indigenous, and people of color have been telling us for generations and generations and generations, then we're going to keep asking those questions about, is this really happening? And there's so much data out there, you could drown in it. So when witnesses like Dr. Avila come to us to share her incredible expertise, but also as someone who has lived experience in that community, I implore us to do a good job of listening. And as a healthcare worker on the front lines, I can say that on a regular basis, the people in the black, indigenous, and people of color community are treated differently and inequitably. And there are very good reasons why many will not go to the emergency department. And this includes people that need psychiatric assistance. It's because of their, and LGBTQ people. It's because of their direct experience with the healthcare system, which continues to systematically support white people at the detriment of everyone else. So I could throw more statistics at you, like the black-white disparity for infant mortality exists at all educational levels. So even people with a master's degree higher, the infant mortality rate for black women is the highest if they have a doctorate or a professional degree. So it doesn't matter what your, it does not matter what your economic status is either. And a topic of research are horrible history of imposing unjust, unethical horrific research on non-white individuals. Even when best intended research is performed, it neglects to fully understand, for example, how heart disease affects and shows itself in women, how heart disease manifests and shows itself in black individuals. So the research is done primarily on getting better, but a lot of the research by which treatments are then, and plans of care are derived from are based on populations that don't look anything like or have any connection to a large segment of our community. So I'm imploring us, calling us all in to do better. Thank you. Thank you. Thank you, Representative Cortes. So I'm going to turn to Representative Rogers' question. And then as I said, I think I want to kind of bring this together toward a discussion of moving forward because I think there is an opportunity in front of us as a committee to make a recommendation, perhaps to add additional resources, at least within the CRF framework that we have available to us at this time. So Lucy, do you want to restate your question? Yeah, I actually have a few questions, Chair Lepert, that are specific to the assessment. Let's hear them and let's go through them and... And the first one is the one that I asked earlier, which is just to help me understand more, was there a public RFP process that was put out? How were the organizations and the recipients of this money identified? What did that process look like? And how were the amounts of the awards determined? Sorry, I had trouble unmuting, but I can definitely speak to that. Representative Rogers, I want to acknowledge too that you did send some questions up through our commissioner's office around this that I don't think came back to you yet. And that was in mid-August. I think that answer was... Yeah, I'm glad. Thank you for bringing it back up. So there was not a public RFP process for this. We determined that we didn't have the time. I think these awards were made available, gosh, maybe late June, early July. And just knowing that that spending timeframe was so quick, we didn't think we had the time to ask for proposals. And so we did submit to the agency of administration the questionnaire that kind of asked those questions about how we will be assessing need. And we were clear that we weren't going to be able to open it up for applications. And then we were wanting to be very attentive to the regional spread of the money. And so that's kind of where we did our informal assessment within our offices of local health. So that looked like a survey to the division, excuse me, the district directors at the offices of local health and an ask for them to collaborate with their staff and community partners and reply to us with kind of their opinions of best ways to spend this money regionally. Our highest funding priority, as you've heard through all of this was refugees and immigrants followed by migrant workers. And so the populations of those populations, excuse me, the percentages of those populations are very high in Chittenden County. Hence the award to Spectrum and the awards to UVM and Open Door Clinic. We also have been following obviously the state and national disparities, racial disparities with COVID-19. And so we really understood the importance of this funding reaching Vermonters of Color and Vermonters with limited English proficiency beyond refugee and immigrant populations, which is why we performed the scan of racial and social justice organizations regional, excuse me, statewide. And our outreach to the United Way was an idea that instead of funding individual nonprofits and breaking this award up into many small awards, which would be kind of administratively burdensome, I think on the receiving end, that we could find a regional fiscal agent. And so we opened up those conversations with United Ways and as you know that that's one of the roles that they serve best, I think. They already have the funding relationships with their partners. We did have a collaborative decision-making process that actually included Susanna Davis and the Racial Equity Task Force. In July, we met with Susanna several times to have her kind of vet our initial thinking and to give us some guidance on underserved populations that perhaps we hadn't thought of. So we did get an informal endorsement, I think from Ms. Davis to proceed with these subpopulations that we had identified. We included lots of decision-makers at the health department too. It was a very collaborative decision-making process. I will say that one of the items in the bill that stood out to me was the fact that our subawardees should be chosen based on previous performance, prior demonstrated work with affected populations and or that they were members of affected populations. So we really kept that as a high priority as we were looking for agencies to fund. The outreach was cold, which was a little bit strange. It was a different process than we have that we normally take with grants that we really kind of did some calls and introduced the idea and the opportunities and it gauge to the responses we got back. So I think we did as best we could in a limited timeframe to assess statewide need and really kind of went where we knew the populations were. I hope that answers that. That's helpful. I think with full understanding of the incredible time pressure the department was under, I think a question I'm left with is just since this whole conversation is framed about populations that may not in the past have had the strongest connections with public health and departments within the administration, I'm kind of left curious if an organization that did not already have a strong connection with a regional health office would have a chance to have known that this money existed or to have reached out and to have known it existed enough to reach out and suggest that they might be a good recipient. And that's kind of the question I'm left with an understanding of the pressures that the department was under. Yeah, that's a really good point. I could give you an example of how that worked in Wyndham County, which was that the United Way did a pretty broad reach out to their partners. And I can inquire about kind of how broad that was but sounded like they did reach out to the smaller organizations like out in the open or some other really small advocacy organizations that aren't usually direct sub-recipients of the health department. There's kind of all those middle layers to engage them in conversation about whether they could use this funding. So I do think at least as an example in Wyndham County that local outreach happened and it did happen with organizations that aren't kind of traditionally funded or are smaller and less visible. I would suggest that we keep moving on because what we have in front of us is possibly an opportunity to add to outreach. So it's helpful to understand what has happened or what hasn't happened. But Lucy, you had some other questions, I believe. Yeah, I was wondering, I know in the language that we passed, the needs were specific to COVID but not specific to healthcare, specific to issues that could include food or housing or kind of emotional support that may be heightened because of COVID. So I'm curious if there's examples of ways that the money is being used beyond public health information. Yes, absolutely. And I wanna say I really loved the inclusion of the provision of emotional support that was such like unique and creative language to see in a bill. And so, yes, we were able to take advantage of that kind of direct aid, that tangible piece that we understood from the language. There are examples in, I will say, the Rutland County proposal to bolster their Meals on Wheels program seems very tangible that we know there are folks who are isolated in their homes that are older with disabilities who lack access to nutritional meals. And so actually that delivery and that I think there's emotional support there, oftentimes those folks, those volunteers are doing more than just dropping off a meal. So anecdotally, we know that that really helps build relationships and trust in the healthcare system. So there were other streams of the CRF money that we knew were going directly to housing, for instance, there was a lot of other departments and agencies were getting money to support homelessness prevention and rehousing. So we did not see that as our priority. We knew that that was kind of being covered by other funds. And similarly, I think there were some, a lot of funds supporting food access, but we really love the language around kind of safely meeting your essential needs. So one other example from Wyndham County, I believe it's through their library, they're offering like an outdoor, distanced yoga for older adults. And this is like a chance for people to come, connect with people they trust, potentially get some care management, but meet their emotional needs through stress relief and enjoying being in a community together. So those are just a couple of examples, but I did really appreciate that, the allowance of those services through the bill language. I can ask one more question and then, I noticed in the report that our committee, report back that our committee received from the Department of Health, that there was a list of priority health disparity groups going forward that the department was looking at. And I noticed the list was somewhat different than the list that we had provided in the bill. And I know we didn't have the most, there are process ever, but we did use past work from the department with health disparities to as part of our process of the groups that we included. So I was just wondering if you could explain a little bit why the shift and where the group, where the list that you came up with came from. And then specifically if there was an intentional reason for the exclusion of anybody from the LGBTQ population or that was an oversight. It was an oversight in that report to you for sure. LGBTQ plus communities are a priority population for us. They're named in our state health improvement program or plan, excuse me. And we've done a lot of work with advocacy organizations. One of the ultimate sub recipients of this money out in the mountains in Wyndham County only serves LGBTQ plus folks. And as well, there are some other kind of supporting organizations in Wyndham County. So I do feel like at least in that region money is flowing directly to an end user who is of the LGBTQ plus community. So the qualitative analysis that we undertook really identified, as I said, refugees, immigrants, migrant workers and for months of color as the highest priority for the health messaging. We do know that LGBTQ plus people experience health disparities at a high rate and have particular vulnerabilities to infection with COVID-19. Those are things like smoking tobacco at a higher rate than heterosexual cisgender peers, higher rates of HIV and cancer. So I'm glad you called that out and we will absolutely include LGBTQ plus individuals in our priority population list moving forward. Yeah, that's helpful. I guess if in one sentence, if you could just be a little bit more specific about when you said your outreach identified that, I guess what I'm trying to understand is what that outreach looked like. It was, you know, there was a lot of listening involved. I don't know if I can sum this up in one sentence. I'm sorry, we were really trying to be responsive to the needs that were expressed to us. And those were- Right, regional health, but often I just like needs that were expressed by- By community members, really, by people who felt not served well. And a lot of that happened in the context of the Whenuski-Berlington outbreak. So whether it was individual people coming forward to say, you know, I didn't feel like I had access to this service or it was advocates or cultural brokers coming to us to say, you know, look, the same language access pieces needs to be quicker. We were really just trying to be responsive to those needs and to try to be quick and immediately funding those needs. So in the, yeah, I'm not sure I'm answering your question, but the outreach that we did really kind of aligned with those populations because we were in such a time crunch. So, yeah, thank you. So we, time crunch seems to be the, unfortunately, the issue that's in front of us over and over both as legislators as well as those who are trying to implement what we put forward. I'm just gonna, I'm gonna suggest that in the light of what we've gotten a lot more information here today. And it's actually, I think it's been very helpful both from the health department and from the task force recommendations. And in anticipation of that and combined with what I explained to our committee members, but I'll explain to our witnesses as well that the speaker of the house had said to each of the chairs of committees who were reviewing the implementation of CRF dollars, again, that need to be used by December 30th and COVID related, asked each of our committees to think about whether any additional recommendations should be brought forward for further allocation of CRF dollars in particular areas. I, full confession in reaching out to myself and the leadership of the committee, but not to the full committee, identified health disparities based on our previous work. And based on what we understood at the time were some of the areas that had been addressed with the health department, but some of the areas that perhaps that were not being addressed in the same manner, some of which we had identified. I should note that there were two separate grants given CRF dollars to Africans living in Vermont, specifically through the work that we did jointly with the Health, with the Human Services Committee. And I believe they received a grant of 300,000 or $350,000. And also a specific grant to the refugee resettlement project, which also received a specific outreach grant. So that should be brought at least into the context of what we're talking about here today. Let me turn off my phone. But in the interest of trying to respond and take advantage of opportunity that was perhaps presented to us, I had asked for some language to be drafted that might allow us to allocate some additional dollars, a CRF dollars perhaps to the health department for further allocation. And one of the questions might be, well, what would the process be? Is that possible? And Dr. Avila, in taking into account some of the recommendations that we've heard today, whether there are recommendations that can be incorporated into the timeframe of between now and December 30th. So I would, and given your close relationship with the Department of Health, I would personally think that there would be close collaboration if we are able to allocate any additional dollars. So I want to just open it. I guess I'm going to dive right in and say, I would like to put on the table that we recommend some additional CRF dollars be allocated in addition to what has already been allocated and that we review some language that has been prepared that would at least begin to articulate some of that and then try to identify that so that we're in a position to see if we, see if the committee can come to a recommendation today to give to our Appropriations Committee. So I'm going to turn, so first, how to proceed. Let me take a breath here for a moment. I guess I'm trying to think what's the best way to proceed. I think I put on the table that we make a recommendation for some additional dollars. I'd like to maybe start with that and just test that with our committee members. And then also then we'll circle around to our witnesses and see if they feel like they, if some additional dollars were allocated, if they could in fact take those dollars and move them out in a timely manner, which I would hope that would be the case if we recommend it. But, Ann, Donahue, did you want to dive in here? You actually ended up referencing it. I just wanted to, you know, I'm sure the legislature threw a lot of overlapping stuff out, but in terms of it was, there was specific additional money, specifically for meals on wheels around the state. And it was 700,000 that went to New Americans refugees and immigrants for language outreach and all of those things. So I think we should, I agree about trying to target some additional funds. I think we may want to target them looking specifically to groups that didn't maybe get a focus in the first round. And also that the focus on the things we were targeting that were not eligible under the ELC, which was for language and so forth, but more some of the other things. So, but mostly I wanted to comment on, and I think that's when as leadership we got together, we were trying to look, some of the feedback has been terrific in terms of what we were trying to look at as potential language. Okay. Which maybe you want to, that's where- I'm just going to suggest that we put, we put in front of the committee, the language, some specific language that's been drafted that is open to modification. And this is, and I don't know- Because I think it'll answer some of what's been discussed and will be a good frame for carrying the discussion on. Right. Do we have that language available to put on the screen? Do you want me to put up? I mean, I can share my screen. If I have permission, if you want. Yes, Jennifer, Jen, not Jennifer, Jen. Yes, that would be great. If you, I don't know how, who has to give you authorization to share a screen or how that works. Demis doesn't, she just did it. So I should be good. Okay. Can you now see my screen? We can. Great. We can, thank you. Short. And we're going to need to depend on you to continue to scroll for us. But if you could scroll up, I think a little bit. And- Keep going. Yes. And I think what we'll find here is that some of this language is similar to what we had put together as a committee initially, but then there's some further language. Do you want to walk us through this, Jen? Just briefly. Sure. Yeah. So Jennifer Carby, Legislative Counsel for the Record. This would appropriate to be determined from some from CRF dollars to the health department as a supplement to the monies that were appropriated in the bill that we had worked on a couple of months ago. It would direct the department to use the funds for grants to community organizations. And there's more coming in that on, on that in subsection B to conduct outreach to isolated individuals at high risk of adverse outcomes. This uses the same language we had used in Act 136. High risk of adverse outcomes from the COVID-19 pandemic based on factors such as race or ethnicity, immigrant status, sexual orientation, gender identity, disability, age, and geographic location in order to assess and identify their needs during the COVID-19 public health and emergency and to identify and address their difficulties and safely meeting essential needs, including food, shelter, healthcare, and emotional support during the public health emergency to help protect themselves and others from the disease. So that's kind of the intro part. And then it has the department determine the community organizations best suited to do that work by soliciting recommendations of organizations that have members who are part of an affected population group, have prior demonstrated work with an affected population group and have the ability to rapidly implement programming in response to unmet needs resulting from the COVID-19 public health emergency from the following. So they're supposed to solicit recommendations from the following, Racial Justice Alliance and LACP, Migrant Justice, Outright Vermont, the Vermont Center for Independent Living, Vermont Psychiatric Survivors, NAMI Vermont, AARP, the Community of Vermont Elders, and other advocacy and service organizations assisting or comprising individuals at high risk of adverse outcomes from the COVID-19 pandemic based on factors such as race or ethnicity, immigrant status, sexual orientation, gender identity, disability, age, and geographic location. We'd have the department in consultation with those organizations, identify population groups that were not served by the sub grants awarded under the prior act or that were only partially served and are still in need of assistance. Then it would direct the department to award grants to the organizations it finds upon recommendation of those listed organizations as those best suited to provide outreach and assistance to the population groups most in need. The department must allocate the grants which could be awarded to one or more of those listed organizations as follows. And then it would put out a to be determined percent among organizations recommended by the Racial Justice Alliance and NAACP and other organizations focused on issues of racial equity, a specific percent among organizations recommended by migrant justice and other organizations focused on migrant workers' rights, a set percent among organizations recommended by outright Vermont and other organizations focused on issues of sexual orientation or gender identity or both. A set percent among organizations recommended by the Vermont Coalition should be Center for Independent Living, Vermont Psychiatric Survivors, NAMI Vermont and other organizations focused on issues affecting individuals with disabilities and finally a set percent among organizations recommended by AARP, COVE and other organizations focused on issues affecting older Vermonters. And that is the end of the lecture. Okay. Take it down for a bit. Sure, yeah, but that's very helpful to put that in front of us and we'll have it available. And again, that's language subject to further, I mean, that was to put something on the table in anticipation of the testimony today that we had not heard and but that we thought we wanted to be prepared to see if we could respond in some way and particularly trying to identify at least preliminarily some of the communities that we felt perhaps were not being fully targeted through that targeted in a good way would not fully responded to. Let me put it that way through the grants that we were made aware of, but we've learned a lot more today. So I'm gonna, again, I'm gonna jump in here and say that I think one of the things that I think is missing from this language would be the geographic dispersion of grants. And I think that issue has been raised by a number of our committee members. And I think if we were to be able to add some language, I think that would at least that would be responsive to some of the questions I've heard here today. And with that, because I think that, anyway, so I'm gonna, I'm going personally to make that suggestion and now I'm gonna turn to questions or comments from committee members, Representative Durfee, then Representative Page and Representative Reed. Thanks, Mr. Chair. Just a couple of things. I'm not clear on the, how the ELC might work in to address some of the issues that have been raised. I'm also wondering about the timing. I guess I'll just say, first of all, or ask first of all, whether this is the timing question, have the grants already been distributed or allocated and what's expected there? Everything has to be spent by December 30th. Does that mean that the sub grantees have to have all been awarded the money by then? And also just thoughts on what the timeframe between now and December 30th allows for what we're discussing here and visioning for additional funding. Can I answer a couple of those questions? Let's recognize that we have a half hour left and we had some other work to do, but bringing some closure to this today is really important, I think. This is really exciting to thank you for that language. And I think it's really helpful that you've done the work to identify the advocacy agencies that were not met with this funding. To answer your question, Representative Durfee, the timeframe is challenging. I think what the health department wants to do is support agencies that we know can act quickly that have sophisticated administrative processes that can accept an award and get started on programming right away. So that's one thing we look to is to not burden an organization. Sometimes if it's a small organization, hundreds of thousands of dollars in the span of four months is gonna be maybe actually even harmful to their programming. So we just wanna have an eye to that. That said, I think there are a lot of organizations poised right now to act quickly and that this language is specific in places, but broad enough that I think a lot of the direct services that the agencies you identified provide, they're already happening and that we could support and bolster them. I know there are concerns about the timeframe, but I really think that we could work with that. Okay. And do ELC grants at all duplicative or potentially recover if there's any of the concerns here? Yes, and it brings up a issue that I don't think you have time for today, but some questions from me to your committee later or kind of assessing what other coronavirus relief has been allocated to other agencies and departments because we wanna be attentive to not duplicate it. So as you see a one note is the ALV and the AIR I received a $700,000 chunk. Wonderful. We wanna make sure that we're not writing the exact same grant. So I think I need to do a little bit more homework on the ELC. My understanding is that was a two year grant for us and I don't know when it started probably this summer, but let me get more clear on like what the plan is around health equity and community engagement within that language, how much money is appropriated and what exact activities it will support. I think there is potential for over. If I understand that that grant doesn't necessarily operate within the same timeframe restrictions and may very well allow some work that goes beyond the December 30th, there actually might be a way to actually compliment each other. Absolutely. I'm not sure I have all the information either, but you would get us that. You can get us that. Yes, and let me be clear. What I'm trying to achieve here today is some language to pass on to the Appropriations Committee so that, and we can continue to think about refining, but if we have language that's broad enough but specific enough to make some direction and to say this would go into the House recommended budget and then it goes to the Senate. And as we know, things continue to get modified. So perfection is not our goal today, but our goal is to try to see if we can't move something forward that would supplement in a way, and supplement further what we've already, what's already been put in motion and that would continue to be consistent with what this committee's concerns have been. Is that, I think that's clear. Representative Page and Representative Reed. Yes. I have no problems giving additional money, CRF money to the Health Department, okay? Let me be clear on that. Okay. I do have some issues with this bill. If you just speak up, Woody, yeah. I have some issues with this bill and there are some agencies that I'm sorry, but I just cannot support. And I was wondering, is it necessary that we list those agencies? Okay, I think what we're, so I'm gonna. So that's my, that's your question. Yeah. Okay, okay, thank you. Representative Donahue, I see your hand wants to respond to this specific question that Representative Donahue, or Representative Page. Yeah, just to respond. The, these, that list is not the list of people to receive the funding. It is the people who are kind of in touch with some of those groups to ask them to recommend the groups that might be best suited to meet what we wanna have done with the money. So that list of, that list of organizations is not for the purpose of giving them the money, it's to hear the voices of the affected communities in terms of where they think it would be best used for the purposes that we've outlined. So I don't know if that helps. If that's the case, Ann, then the language needs to be maybe a little more clear in the bill if possible. Yep, that's what Jen's here for to listen today, but that, that is the intent just so you know. Okay. Yeah, Representative Reed. So Jen, can you be thinking about that as we continue to? Yes, I'm looking at the language right now to see if I can make it clear. Okay, Representative Reed. So I definitely am supportive of broadening this to include some sort of rural geographic issues. I can't think off the top of my head of an organization that might provide guidance there, maybe VCRD might be one option. But I also- Translate VCRD. For my council on rural development, yes, thank you. Thank you. I just, it wasn't immediately coming to my mind. They may be more of an economic than a healthcare, but it may all tie together. I guess I question whether we actually need a list with percentages that seems a little too prescriptive. And finally, I wonder if there's a way to reference the task force recommendations, even though we haven't seen them formally, based on what we heard today, it may be a nice way to tie that together and may build some additional support for getting the funding. That's it for me. Okay, thank you. And that makes me, that reminds me in terms of the recommendations from the task force to speak to one of the recommendations I believe had to do with establishing a Vermont fund to fund Vermonters who were not made eligible at the federal level for stimulus money. And I believe to just to say, I think maybe everyone is aware, but there is a parallel process happening right now in the House Appropriations Committee. The governor recommended a two or $2.5 million fund. And I believe our House Appropriations Committee, based on what I've heard and been communicated, is looking to increase that to $5 million as part of the House Appropriation Budget recommendation. So I thought we should at least acknowledge that as we looked ahead. But I think maybe Dr. Avila, is it, might it be appropriate to include some language where there's an intersection of the recommendations of the Racial Equity Task Force with the ability to respond using CRF dollars in this timeframe. Would you comment on that if that might, how you see that, if that's appropriate or how that might be useful or not? I think similarly to what Sarah mentioned, my biggest concern as a citizen more than a health equity scholar is the timeframe to spend the funding. That's gonna be tricky if it is by December 31st. During the conversation I've been writing down groups that I think we have gaps in providing services related to health disparities. It's clear that LGBTQI is one group that we need to be focusing on and maybe moving away from naming the organizations and possibly naming the communities and populations that we need to be focusing on can help change that description in the language. Another group is disability. The Racial Equity Task Force did receive a letter from several disability organizations advocating for looking at disability health disparities and intersecting disability and racial disparities because there are enormous health disparities if you are a person of color and have a disability in the state of Vermont and nationally. The other group is migrant farm workers. I think we need to be expanding. I'm glad to hear that that's gonna turn into five million dollars. That was also a letter that we received in the Racial Equity Task Force advocating for that funding. And I don't want to forget the native people and Abenaki people. Absolutely. Generally forget about our native communities and we are all on stolen land. So we need to acknowledge that this is Native American Abenaki land and most often we forget about native communities that have a pretty high risks and needs related to health disparities and even behavioral health disparities. So I think keeping those communities in mind and I would even add elders, whether it's elders at the intersection of racial diversity, disability. There are so many aspects that coronavirus has resurfaced for us as a society that we need to be paying attention more to elders. I mentioned I'm an educator. So when I teach, I always talk about when we allocate funding and when we cut funding at the federal level, we generally cut in early childhood and in elders. And we don't focus on our future and our past. And that's what we're focusing on especially because elders are our fastest growing healthcare population. So I think those are some of the populations that and we have organizations working with all of these groups that are statewide. So that will allow for an equitable distribution of resources. And as all of you mentioned, poverty and rurality of many communities that don't have access to wifi or internet, that's another barrier that is connected to health disparities and access in care. I hope that answers some of the questions related to some of the barriers. I think that your comments are very helpful in terms of articulating. There's an overlap but clearly you further articulated some of the important areas that have not been fully addressed in the current proposals. And I think that there may be a way to reference communities rather than organizations but it also might be helpful to acknowledge some organizations to which there should be specific outreach. And but we're obviously not going to manage this from the house health care committee but I think our concerns were that some of what we are hoped for outcomes were not getting fully realized and that we may have an opportunity here to expand that and to take it further. Representative Donahue? And then if Representative Page, if you have further comment here from you, your hand is still up so just to say. And then I think I have an idea of how to proceed. I hope I do. I agree that was very helpful and it's hard when you don't have the language to keep in front of you but I think the idea of naming the population groups is there that that listed group was just for these are folks to get input from and there's one category that says and others as well. I think the indigenous populations are really critical one that we don't have on that list. So we need quick brainstorming on who would be the right group to name as make sure we outreach specifically to get input on who might provide services because they're clearly a gap. That and geographic are I think the two big gaps because we do have the elders, we do have disabilities, some of the others that you mentioned but we do not have indigenous. So I'm just gonna dive in here for a moment and just say, and this is a little bit coming out of my own background but I think when we talk about sexual orientation and gender identity, that's very important but I think we need to also recognize the LGBT youth whether you want to however, whatever the acronym is you want to use today, LGBTQIA plus or queer trans youth are a particular group within that community within frankly the community I'm a part of that we recognize on every measure is at high risk. And I think that it would be a tremendous mistake if we did not actually try to do something specific in that direction, that's not to exclude LGBTQ elders, et cetera. And I think Dr. Avila's comment that there's an intersection and a cross community issue for many of these groups that you fall within not just one group but in multiple groups. And when you're in multiple groups that are all in groups of disparity, healthcare impacts, it's just amplified. So I'm looking at what we have for time and it's 12.15. I think it's probably not realistic to ask Jen to recraft language, but we've made some, I think some very important and helpful suggestions but I don't think we should try to recraft language between now and 12.30. But I think what we could do and what we can do and still meet our commitment to the House Appropriations Committee and our commitment to this committee is to hear further comments. I'm taking as a, I'm going to operate on a, my sense of the committee as much as I can get a sense of the committee from Zoom but I'm hearing comments from many of you that there's a general sense that we would move forward to making a recommendation for some additional dollars. What we haven't talked about is an amount of dollars but I think that we should, so I'm going to suggest that rather that if there are other comments in terms of ways to articulate the additional need or the additional process, all with, has to happen within the reality of this currently has to be done between now and December 30th that we hear those comments and then try to integrate those and that we then circulate amongst the committee and would then circulate because of our witnesses here today, circulate with them with you as well, the language of a proposal that this committee would then likely take or would be taking to the House Appropriations Committee by the end of today. Not meaning that it can't be further modified we all recognize things change along the way but I think we should try to have something that the majority of committee or everyone in the committee can get behind. Does that, I'm throwing that out to committee members as a process that we hear further comments and try to complete our work through an email exchange throughout the day and would invite our witnesses to review with us the language that we would be proposing as well if you're open to being our assistant, our consultants we, that would be great. Representative Gina and then representative Donahue. Thank you. I don't have an exact amount to propose but I wanted to just propose that when we look at the appropriation that we're making of CRF money to address health disparities that we look at that it's somehow tied to the proportion in the disparities. Like for example, if 1% of Vermonters are BIPOC you know, black indigenous people of color but 11% of COVID cases then does that mean that it's affecting those communities 11 times more? And if so that proportion should be incorporated in the spending. So I'm not saying that it should be that we should spend 11 times more but we should look at that impact when we're spending the money and because I think that there's some significance to that. And include, can I suggest that a way to achieve that Brian might be or representative Gina might be to have some language to reflect proportionality of I mean some type of proportionality language rather than a specific percentage. At one point I think there was some thought of like a percentage for this percentage but like some proportionality language would that address what you're thinking of? That's what I meant and I was using BIPOC as an example but I would suggest we do that for every group we're looking at that we look at the proportionality. Yeah, well without getting lost in I mean we could spend days trying to figure out percentages but I think I hear your concept, yes. And I hope Jen might take that and think about it. Representative Donahue. Well that is perfect segue that's what I wanted to address also I think it was David who was saying this idea of percentages might not be workable. I think we have language about groups that didn't get to pay attention to groups that were sort of left out in the first allocations. And so if we combine that with proportionality I think we meet what the percentages might have been focused on without making it too restrictive. Okay. I see some other hands. Representative Chien, is your hand still? No, Representative Christensen I'm gonna turn to you. Okay, when we talk about proportions we're talking about geographic and as well as older Vermonters. That's a very good question. And if I can chime in I just I think that we would obviously need to have the data to support that. And so I wanna check with our data team we obviously have race and ethnicity but some of these sub-populations in terms of when folks are getting tested or admitted we don't ask for instance sexual orientation or so some of this may be kind of like no. Not gonna be able to do. Right. In terms of that direct proportionality. Right. But I also I'm wanting to I don't know if Woody your hand is still up but it is okay well can I make can I pick up on a comment you made earlier first and then we'll hear from you that I think there's something to be said for also some outreach and perhaps grants as Representative Page said we don't want this to get worse where we are. And so to have the only measure of outreach be that there is current significant impact. I mean there's different ways to measure importance of reaching out and I think that you begin to it's a little bit like the question I think that Representative Christensen asked at one point well were things distributed because there were already resources there because of chicken and an egg thing is like oh well or I don't know if chicken and egg is the right metaphor but where there's resources oh we'll give more people because they have resources to do it and therefore you don't get resources. It's like that's so I think it's similarly or there's somewhat similar issue of if there's not an impact in certain parts of the state now we want to keep it that way and that and that there's something to be said for understanding that as well rather than just looking at the COVID-19 testing data as what drives this. So Woody I'm sorry I just kind of was picking up on something you said earlier but. Thank you Chair. But just a quick item just a quick item and perhaps the Education Department is handling this but is there a need for recognition of foreign students? We talked about LGBTQ youth. Is there a need to recognize foreign students or foreign youth? We've mentioned our elders and I'm just throwing that out. Students who are here for educational purposes in Vermont but from different cultures. Right it could be college it could be I don't know whether we have any private schools or public schools where some of these students are here. Well we do in fact and I can think immediately of St. John'sbury Academy. Well that's true yes thank you. Where St. John'sbury Academy often draws students from other countries and other cultures. I mean that's the one that comes to my mind is a private but public high school both. So we may want to include that I don't use it. Make some allowance for that yep. Okay so I'm just gonna go out on the limb here and put a dollar amount on the table. What if I was thinking about a million dollars that would then allow this process to move forward but recognize that that's a figure that could change along the way clearly but it was a figure that we started with as a committee. We hear that there's a lot of outreach that's been done and but we also hear that there's a tremendous need and a tremendous unmet need and that the dollars have actually been a restriction in terms of being able to do as much outreach as possible. Whether we would end up with that dollar amount at the end of the day I can't say but I would like to at least say that I think if we put a million dollars on the table right now from our committee that that would then position us to be able to begin to respond in a more significant way and that we would advocate for that. I would recommend that we consider advocating for that dollar amount to our House Appropriations Committee and then see where the process takes us. And this as I say this is an opportunity. Representative Cortes and Representative Smith. If we're thinking we would prefer to end up with at least one million would it be better to act like we're negotiating and start with two or three million? I know a propes we'll see right through that probably but I know I think we do want to give more than a million but I wouldn't want to start out being shy. I think a million is not being too shy. But perhaps we can have some continued conversation about a dollar amount. Representative Smith and Representative Christensen. A million dollars is a good number to start with and like Representative Cortes is just saying we're not trying to buy a car. So appropriations is going to know if we ask for a million that that's what we want but would you want to take that million dollars and divide it by 14? There's 14 counties in the state of Vermont. That's one quick and dirty way to do it. That's one way to approach it but I one would question. I sure if we doubt that would happen. I think that's right. I just wanted to mention that that's all. Okay we hear you. We hear you. Representative Christensen. In a weird sort of way. If piggyback Representative Smith's comment. Can we be sure that the tried and true you know the people who do get the money don't get more money and still have the geographic location being left out because there's no advocates because often what I hear when I hear of grants I send them to appropriate places saying hey apply for these grants are great. And people will say we just do not have the people to apply for the grants in this deadline. Or the capacity. Yeah and that's my main question but the other one is will you be able to spend a million dollars by the end of the year and get it out the door or is some going to be just left on the table December 30th? Can I just say that without having the health department have to answer that specifically right now that is the case all across the CRF dollars in the state and there's a provision in every application that first of all that the dollars have to meet the conditions of the COVID front. CRF dollars has to be COVID related has to be auditable. The state has a process of trying to ensure that the work that's being suggested or contracted for is meets the guidelines. But that also if the money is not able to be allocated or used in the period prior to December 30th that there is a reversion process that I believe the Joint Fiscal Committee or some other combination will be responsible for trying to see if there's a reallocation so that we don't leave dollars on the table that we can avoid because there may be a greater need in one area. And that it can't as an example I've heard and we don't need to go into examples now but I know that some departments of state government were allocated some dollars and they've said we can't use it. And so that this is part of what the government this is part of what the speaker is trying to do right now is to say we know that some areas have said they can't use their money. Is there a new are there new dollars that could be allocated and should be allocated elsewhere and that's what we're that's what we're making the case for around health disparities. That's what we would be doing. And I would like to add briefly from a health equity perspective when we allocate funding I think the idea of county is important but it has to be based on population density and also need within those populations. Another health equity perspective for allocating funding is looking at history of allocation of funding for specific communities compared to other communities. And the third piece specifically during a pandemic is looking at higher risk populations related to be proactive and work on prevention to be able to prevent any outbreak from happening again. So those are some of the pieces looking at history of allocation of funding. Sometimes people look at ALB, USRI receiving $700,000 some people think that's a lot of money. It's not a lot of money we have never allocated funding to those organizations for the longest time in Vermont. So I think we need to look at the history of allocation how much funding compared to the rate of the population that is gonna be served and then the high risk or risk for being able to be more vulnerable in these times. Thank you. Thank you. Well... Lord glory. Where's the phone? Yep. Sorry, I just wanted to say that I found this conversation very, very uplifting in a time in the world where not many things are and I wanna thank our witnesses and then Representative Lippert and Donnie Hu for their leadership on this. I think that the thing that I most wanna make sure remember is that this doesn't stop on December 30th and someone else mentioned, I forget which witness I apologize about the social determinants of health. And I would hope when hopefully we're all around the table again next year that we can continue this and not just have a beat COVID focused. Thanks. Thank you. I heartily agree and second your comments. So I think this has been a productive process from what I can see. And I'm going to suggest that given our time we're gonna run out, we're running out of our time that we, I'll say I, that I work with Representative Donnie Hu, Representative Houghton as the leadership of the committee to work with Jen Carby to recraft the language in a way that takes the feedback that we've heard here today, tries to recraft it in a manner that allows us to move forward that we distribute that language throughout the day through our own email to our committee members that we try to come to some closure and consensus in that process that we share it also with our witnesses and that we then with the goal that by the end of today we have a proposal that we would then submit to the house appropriations committee as our healthcare committee recommendations for additional CRF dollars to be allocated contique specifically now around health disparities and COVID. That sounds excellent. Representative Rogers. Yeah, I just had a quick thought in just thinking about the discussion around geographic disparities and I feel it gets a little unresolved as to what we would recommend on that but just thinking through my own because I've been following this closely over the last few months. One of the big issues that comes up for me with geographic disparities is the way that testing is accessible differently to people in Chittenden County or near a UVM network hospital versus other areas of the state. And so I, which isn't necessarily so much a money question but it is a department of health question. And so I'm wondering if there might be room for some language as opposed to dollar appropriations but language surrounding insurance that testing is more equitable for people who are essentially in Chittenden County and a few other locations versus in the more rural areas of the state. All right, I mean, I have to stop and I want to reflect on that for a minute but I don't see any reason why that couldn't be reflected in some way. And I think that would be consistent both with the health disparities recommendations and the task force and the geographic issues that you're raising as well. And Representative Donahue, did you have your hand up? Yes, because we're out of time, I just wanted to remind or ask, do you want to say 30 seconds on the fact that we need to get placeholder language elsewhere that is sold as placeholder? I think I'm going to just say this. We, I have, I've had crafted some placeholder language around what we're taking up tomorrow, which has to do with the Department of Public Safety proposal around adding mental health counselors to law enforcement. And as I said in my email memo to committee members, that is something in which the speaker has asked our committee to take the lead on. We will begin that tomorrow by hearing from the commissioners of Department of Public Safety, Public Health, and then from Representative Christie from the Social Equity Caucus and the Judiciary Committee from their work of hearings in the survey that has been done. And the placeholder language is simply going to suggest that the dollar amount as determined by the Appropriations Committee, this is not for us to choose at this point, but the dollar amount that they determined would have been in the Department of Public Safety proposal be the place language placeholder language would simply say that that dollar amount would be allocated to the Department of Mental Health for further distribution to address additional mental health crisis response in communities in a manner that would be of assistance to law enforcement. And that that language would allow the budget to move forward holding those dollar amounts, holding those dollar amounts for a further proposal that would then come from our committee after our tomorrow and next week's testimony that we would then forward to the House Appropriations Committee to take into their conferencing with the Senate. And I will distribute that language. I don't think it's language that's, I think, well, that's what needs to happen at this point. And just for background, let people know the language is mostly drawn from the specific proposal that DPS had put forward. But I think it's very important to understand as well it's language which the speaker has re-crafted that the speaker of the House has said and directing our committee to take the lead has said we, this is because of concerns around law enforcement and mental health, this is money to be allocated and distributed to support communities around crisis where law enforcement may likely be engaged and it's to support crisis response within communities around mental health issues. It's not monies to be allocated to law enforcement for them then to allocate. And that's a difference in framing. Is that fair to say, Anne? Mm-hmm. Okay, so I'll distribute that language and we can, we're then gonna be hearing testimony tomorrow and having committee discussion and then we're gonna have further testimony. And I realize we're running over, but Demis, did you, one of the other things that I concluded is that we needed to have an additional committee meeting next week. Did that get communicated to committee members at this point? Yes, I sent an- I mean, honestly, there's been a flurry of activity and thank you, I just didn't confirm that. So if you haven't checked committee members, we have, I have asked and we have been granted the ability to have a third meeting next week that includes a meeting, I believe on Tuesday between 3.30 and five, I think it is. But check, Demis has communicated that to everyone. Okay. Well, with that, we've run over, but I wanna really express my deep appreciation to Sarah Chesbro from the Department of Health. You've been very helpful in responding to our questions and to Dr. Avila for your deep expertise and help in understanding both the task force recommendations but equally important to understanding some of the deeply important dynamics involved in health disparities. And I look forward to, and I think we as a committee look forward to working with you significantly beyond December 30th. And in the meantime, so with that, I think I'm gonna suggest we bring this to a close and that we will then distribute, we'll look at some crafted and recrafted language and see if we can't come to some, I think I'm confident we'll come to some closure by the end of the day. Okay. Okay, you're ready to go off live stream? Let me do one last thing. I realized I had been not monitoring the chat closely and see if there's anything that, thank you and thank you, Dr. Avila. Yes, there's a number of recommendations that you made in the chat and we will be, and I think others have some thoughts there too. So thank you all. I think with that, we'll conclude our meeting for now. Thank you. Thank you. Bye.