 Good morning. Good morning everyone. This is Senate Health and Welfare. It's September 10th and we're having a conversation. Initially we're hearing from folks regarding the public safety mental health issue that we're familiar with and then trying to understand what the recommendation and proposal is currently. I know that there was a bill that went to the house and I believe the house is working on that or has worked on it and I think each person who is here with us today will have something to guide us and help us. So we have Mike Schirling who is first. I'm looking at my agenda. Excuse me. Thank you. Okay. So unless there are any questions from the committee, why don't we just start right in and Secretary, is it commissioner? No, commissioner of public safety. Schirling, why don't you begin and share with us the information. I know you put quite a bit on our webpage so that will be helpful. Yes, good morning. Madam Chair and committee, appreciate the opportunity to weigh in on this. I literally could go on for an entire day on this topic but I only have 26 minutes before I'm scheduled to be in Senate Judiciary. This has been something that we have been talking about in building capacity for in public safety, small p, small s statewide for more than two decades. It strikes me as this conversation has pivoted to where this funding and this type of a program should reside that we have here to for in this conversation skipped over the underlying need. So I want to go there first. Over the last decade or more, we have seen call volumes in public safety and by that I mean to law enforcement, emergency medical services, the fire service and by extension trips to emergency departments and then to correctional facilities that relate to underlying mental health crisis. And often important also to note it's often some kind of a co-occurring event. It's not exclusively mental health, there could be substance abuse, there could be other unmet social service needs. And in many instances, it's not actually someone who's who's suffering from a DSM for diagnosis of some sort, but is altered in their perception of things and their behavior. And it gets lumped in under a quote unquote mental health, but that's not always exactly accurate. Those call volumes have increased exponentially over the years. The number one thing that I hear about as I travel the state meet with public safety leaders pre COVID, there's not as much traveling over the last seven months. The number one concern is the impact of these kinds of calls for service on resources and an inability to have the the correct tool sets deployed at the time these crises are evolving. From the numbers I experienced when I was chief in Burlington, we saw a 400% increase in mental health related calls between 2008 and 2015 when I retired. Our systems in state government are not as accurate in terms of being able to track that, but anecdotally, and based on some statistical information, we believe those numbers are similar, that there have been exponential increases. We have experience with deploying social workers and mental health outreach staff in many different areas of the state directly partnered with public safety professionals at the time that the crisis is emerging. And all of that experience is positive. We I have yet to hear of an instance where the anything ranging from the embedded social worker in bellows falls the two mental health outreach workers we have in barracks to the street outreach teams that are partnered directly with with law enforcement organizations in Chittenden County and others have had a negative experience. If those experiences exist, I'm eager to hear about them. Because both the assessments of the positive impact of creating these partnerships as evidenced by four different reports spanning more than a decade, I think one of those reports dates back to 2009. There are some from 2011, 10, 11, 12, and one from state police experience in one of the barracks dated in 2020 are all positive. And positive in that they are reducing calls for service. They're improving outcomes. They're reducing correctional center visits. They're reducing hospitalizations. And any way you look at this, no matter which lens it's from in terms of the positive impact on the folks that are in crisis or the alleviation of the burdens and the expense on a host of different systems that often are ill equipped to deal with some of these issues, the results are positive. The reality is that for a cross section of the population that finds themself in crisis for one reason or another, again, sometimes it's mental health, sometimes it's substance abuse, oftentimes it's calling or co occurring events. The entry door is 911. It's a public safety answering point. It's not a crisis hotline. There are actually people out there who don't trust the mental health system. There are others that don't trust the law enforcement system. We have to have multiple ways for them to get access to this kind of assistance. We get calls from people who are asking specifically for particular police officers because they have developed a relationship there. We have folks that call and ask for specific mental health workers because they've developed a relationship there. Again, a variety of really compelling positive impacts that have occurred over the years. I would be disingenuous to say I'm anything but a little bit baffled by some of the pushback on this proposal and the specific way in which we frame this to be an expanded partnership with first responders and law enforcement because the experience has been so positive and on a personal note because for two decades I've been in meetings with secretaries of human services, with commissioners of the Department of Mental Health, other commissioners and secretaries in prior administrations asking, literally begging for resources to expand these programs and a trickle of resources has been put forth. We are now in a position where we have put forth a plan to dramatically improve and expand on existing programs and there's pushback now. I don't have any other way to describe it other than baffled at how that can be. You've heard a variety of testimony. I've had an opportunity to read some notes and without going point by point there's a variety of it that is inaccurate. I'll pick on one piece from my friend Robert Appel who described that he has not seen de-escalation occur in any instance and I'm paraphrasing because I may not have this entirely accurate where police officers have arrived at one of these scenes. I can tell you unequivocally and without hesitation that that's not accurate. That's not been my experience. I have gone to literally thousands of calls for service myself and I have supervised hundreds of thousands of calls for service as a law enforcement executive and I can tell you that the overwhelming majority of responses are met with compassion and de-escalation oftentimes by police officers and sometimes when we can deliver those services partnered with a mental health outreach specialist together. Just to give you the 2019 statistics from just the state police, 115,000 calls for service that translates into roughly a quarter million contacts. 183 of those resulted in some escalation that translated into a use of force beyond compliant handcuffing. Let me give you the numbers again 183 out of over 115,000 responses and over a quarter of a million people interacted with. If that is not evidence of de-escalation I don't know what is. From a purely operational perspective and budget perspective there are a number of challenges concept of moving this over to the department of mental health first from a budget perspective like any personnel funding it's commingled into our budget in a way that makes it very difficult to extricate everything from vacancy savings and attrition for these positions to host of other ways that the way the hiring process flows and things of that nature will create a shortfall in our budget if that money is moved. I know that's ancillary to this conversation but you can expect that we will need some kind of a budget adjustment at the end of fiscal 21 if we extricate over a half million dollars and place it with another department. More importantly operationally the expansion of this program is an essential component of the modernization of the way we deliver safety services and a future shift in the way we modernize law enforcement in particular but public safety more broadly. It's best suited to be an extension of the day-to-day emergency response and the day-to-day outreach that's done out of the public safety framework and the public safety answering points. Removing this from that position will hamper the current efforts to expand those services. It will hamper our efforts to modernize the way that we deliver services which in an entirely other committee in 16 minutes we're going to be talking about how we modernize the way we deliver safety services. There is a nationwide call to do this differently. We know how to do it differently. We just need to resource it appropriately. So again a little baffling that we're having these conversations that appear to be going in two completely different directions at the same time. As I mentioned among the most important things is that the primary entry point for literally thousands of people who are in crisis on an annual basis is 9-1-1 and being able to deliver an array of services including mental health response to those folks is an essential component of not only the future of how we deliver the services but the way we do it now. This is already a piece of the delivery models in various places around the state. And I would argue that those tools and resources are a more critical need at that point in the process and in our overall crisis response than anywhere else in the system. That early response can prevent things from deteriorating to a more substantial crisis where force is used or outcomes are poor or a suicide occurs or a protracted hospitalization or incarceration has to occur. So I can't overstress the importance of these resources being placed at exactly the right point in the process. And that's not to say it's the only point. Crisis hotlines, peer support networks and the array of services that the Department of Mental Health, the designated agencies and others deliver are critical components. What we're talking about is expanding a parallel critical component that the importance of can't be understated. I have a variety of additional notes but mindful of the time I think it may make sense to turn to the committee and the chair and ask if there are things that you'd like me to address if there are concerns that you have that I should speak to. Immuted, Senator. Yeah, thank you. Thank you. Been very comprehensive. I think we've heard the underlying tension between what public safety is doing and then additional resources to ensure that there is mental health and behavioral health capacity within the various departments. I would just add Senator, I'm not here to argue against the expansion of other mental health services. If you look at our, in January we put forth a modernization strategy for public safety and this was a piece of it. At the last page of that suite of proposals is an integrated public safety and public health construct where prevention and educations at the base, outreach and intervention comes next and then alternative sanctions and then traditional courts corrections and things of that nature. We're not arguing against expanding those services. What I would suggest is we have to do both and don't short shrift this effort to move resources to something else that we also need investment in. So I think you're, you know, I think this is extremely logical and sensible what you're saying. The concern that we would have is to ensure that the criteria and the standards are in place for any mental health individual or organization working within public safety that we don't all of a sudden see a bifurcation of systems. And in some ways, you know, I'm reminded of and I'm not meaning to give a speech but I think it is important of the healthcare that we see in corrections where there's a the healthcare of corrections is can be considered significantly different from the healthcare that we see out in the rest of the of the state of Vermont. So my concern is doing it and doing it right. So it's important for us to hear from everyone about how that is and can happen. I for one and knowing what has gone on in my district, including Burlington, and then other municipalities, I am keenly aware of the effectiveness of the programs that you're talking about. So I think we all understand. I hope we all understand how effective those programs have been. So okay, questions for Commissioner Shirley. I'm sorry to rant on didn't need to do it. Questions. Okay, we have Commissioner Squirrel from the Department of Mental Health and Commissioner, thank you for being with us and Commissioner Shirley. I want to assure you we get it. We understand the question is how do we do it right. And I think you're asking the same question. For us, we don't appropriate the funds, but we do ensure provide some oversight for the for the standards and the criteria and the people who are involved. So that's our I would just say in in Parting Center, we're talking about replicating the success of existing programs as partnerships with the designated agencies to deliver the services with the folks delivering the services being employees of those designated agencies and healthcare providers. And that's part of why this is a little baffling to me is the programs are successful and we're simply looking to replicate them. And now we're hearing criticism of that. And I just don't understand where that's coming from. Well, you're not hearing the criticism from me what you are hearing is how do we balance the management of that system. So and I think that's that I think that's what we're we're hearing right now. So we understand. Yeah, I will I promise I'll stop talking but I would submit we have achieved that balance we know exactly how to deliver these services. And we've heard no complaints about the way in which they've been delivered. Um, with dozens of people that are delivering them to today in a variety of different locations around the state. So I would just submit if it's not broken, let's not tweak something that has been among the greatest successes in public safety that I can point to in the last two decades. Anyway, I will stop talking. Thank you. Thank you. I know and thank you and and honestly thank you for the work that you've done in this area because I know it's significant. Greatly appreciated. Senator McCormick. Thank you, Madam Chair. Commissioner Sherling, I just want to and I think I speak for the committee on this. I don't think any of us are necessarily arguing with you and saying no, it's not working. But there are people who are saying that. And I think we are at least curious about the possibility that they might be right. And certainly there are instances and maybe there there are exceptions to the rule, but there have been instances where it seems pretty clear that system didn't work right. So I want to figure out, you know, where where what the situation really isn't where we need to go with it, which is not to say that I'm arguing that I hear very much with my personal experience. I'm a white man has been very good with the police, you know, including at a recent protest demonstration where I was wondering what are these police doing here? We're not breaking the law. I realize they were there. They really were there to protect us. There were guys with guns, and that's who they who the police were hovering there. So I have nothing but good experiences with the police. But we're hearing reports that it doesn't always work out so great. And I think we're just we have we owe it to our constituents to look into it. I couldn't agree more, Senator, in that curiosity that you stated about wanting to know what might not be working well. I have the same curiosity specific to these mental health delivery mechanisms. I don't know of any instances where things have not gone well, where we're delivering these mental health outreach specialists. So that's why we want to expand them is because the outcomes are better that so on this specific topic. If folks have anyone listening has instances where this kind of a delivery mechanism has failed or has not achieved a better outcome. I am incredibly interested to hear that so that we can tweak what we're doing to ensure that we're doing it the best way possible. Okay. Thank you. And thank you, Senator, for your comments. Commissioner Squirrel welcome and Deputy Commissioner Fox welcome. So I'll turn it over to you. Great. Thank you. Good morning. Nice to see everyone. Thank you, Chair Lyons for the record. Sarah Squirrel, Commissioner of the Department of Mental Health and joined by Deputy Commissioner Morning Fox. So I want to thank the committee for your time and intention to this important policy and programmatic effort on behalf of the state. I also want to thank Commissioner Schirling for his leadership on this and for his vision of modernization of public safety and to further expand the mental health outreach program statewide. I think this is a critical opportunity where we can really strengthen our collaboration between mental health and law enforcement. As Commissioner Schirling noted, a very high number of law enforcement calls are related to mental health and or substance use. And our goal is to ensure that we have an effective and therapeutic community based response when that happens. Across Vermont as Commissioner Schirling has highlighted, there's a continuum of collaboration that exists and we want to continue to build on that. That starts with I think the team two training that many folks may be aware of, where we have comprehensive training between mental health and law enforcement. We have the mental health outreach programs that are happening at Northwest Counseling and Support Services and in Southern Vermont with HCRS. I know George Caragouakis is here. He can speak to the effect of that in his community. And also the community outreach and street outreach programs that we've been able to stand up in Chittenden County. And I think that all of us across the state are eager to build on the success of those programs and to continue to expand them. And I would also note that nationally this is an area of focus. The American Psychological Association clearly recommends increasing mental health professionals working closely with law enforcement. SAMHSA has clearly identified that crisis response partnerships with law enforcement are an essential principle for modern crisis care systems. And we think about our continuum of crisis care across the state of Vermont that has been identified. So DMH fully supports the expansion of the mental health outreach program through collaboration between the Department of Public Safety and our designated community mental health agencies. And the core elements of success that we want to build on are continued inclusive collaboration training and collaboration. I would also just note that it's important to note that individuals with mental health challenges are not more likely than anyone else to commit crime. So I certainly want to make that very, very clear. And in fact, it's 10 times more likely that people with severe mental illness will be the victims of violent crime. This is more about ensuring that when an individual is in the community that that first response is therapeutic and gets them connected to the right services and supports. And if we really want to improve access to care, improve better safety for all, we absolutely have to continue to develop a close working relationship and partnership between law enforcement and our mental health systems. So the mental health outreach program, which is what is being proposed to be expanded across the state, you know, that model is really co response teams. That's really where it's a collaboration when designated mental health agency employees, clinicians and social workers are working side by side with look at law enforcement. It pairs the benefits of having embedded clinicians with community outreach. And again, I think of it as this co responder team out in the community. And also, even as calls are coming in, law enforcement clinicians and dispatchers can really kind of triage and determine what kind of response might be best suited for the situation. And that can look like mobile outreach and response screening and assessment de escalation referral to appropriate services and follow up. And as commissioner has noted, you know, the outcomes have been very positive. Certainly within our system of care, we always have situations that happen in the community that don't go the way that we would like. But all in all, the outcomes that we have related to the work that we've done around this have been powerful. I was just looking at some of the data from the relationship and collaboration between Northwest counseling and support services. And the Vermont State Police and the data that they have this program has been up and running, I believe for since 2017. That troopers are on the scene less than 30 minutes for 65% of the calls that have a mental health outreach worker responding to so you're seeing a decrease in the amount of time that law enforcement is actually on the scene. And the mental health clinicians are able to do that outreach. And 45% of those responses in the community actually resulted in referrals and additional outreach efforts. And from my perspective, that's a good thing. Those are things that we want to continue. I also think there are elements of trust building in communities that are essential. I think that this kind of collaboration can lead to kind of enhance that trust at the community level that also commissioner shirling spoke of. I also think that the embedded model has incredible value by having mental health clinicians working side by side in police barracks. We can kind of optimize the police culture. How do we bring more trauma informed approaches into the barracks? It's very similar to other models that we have in the state. I think about our school based mental health programs that we have statewide where public schools are contracting with the designated agencies to bring mental health and social workers into their schools to support trauma informed care for children. And the cultural impact of that on the schools in terms of having a more trauma informed setting has been one of the greatest outcomes of that work as well. So I just think that those models are somewhat similar. I also want to talk a little bit about implementation because I think this is one of the areas in Vermont where we're a small state but sometimes we struggle to bring things to scale in a way that will actually result in the meaningful social impact that we want to see. So what this program does and what this proposal does is really take to scale something that we think is important that will have better outcomes for Vermonters and a better impact across the state. And like all things Vermont, we want to have a consistent systemic approach but we also want to leave room for that regional innovation community need. And that is exactly what I've seen in these programs but it actually builds collaboration at the community level so that innovation can happen to ensure that the needs of community members are being met. As I've said before, I think trusting relationships and collaboration are at the heart of what has led to success for the implementation in other regions. DMH, the Department of Public Safety will have an MOU that really articulates the collaboration, how the supervision works in terms of the designated community mental health agencies and I think really leads to accountability and quality oversight over the long term. I would also note, as Commissioner Sherling did, at the clinical oversight of the clinicians is held solely by the designated community mental health agencies who will be supporting those clinicians in an ongoing way. I also just want to note that I think it is very important and I think this legislative policy process has brought in stakeholder voice and peers and individuals with lived experience. It is important that we hear their voices and their voices inform the work as we go forward. And as Commissioner Sherling noted, the reality is that in our current system, when somebody in the community sees an individual experiencing a mental health crisis, they call 911. So we want to ensure that the response that they get at the community level has a mental health clinician there that is going to lead to a better outcome. So expanding this program I think is a significant step in the right direction. I also just want to note that I do think we need to take the time to ensure that those who are directly impacted have a voice as we move this important work forward. So part of our implementation plan, part of the MOU, really does need to include how we include the voices of those with lived experience and how they can continue to inform and strengthen this work as we go forward. I think the designated agencies are also well positioned to help us with that as they already have tables that are set for individuals to really provide input on these kinds of programs. I think when I think about this, it is a continuum. In the short term, we want to strengthen and expand our mental health outreach programs. And midterm and long term, as Commissioner Sherling noted, we really want to think about our crisis continuum in the mental health system and continue to try to strengthen that. And I think one of the key transformative elements of our future kind of crisis system in a recovery oriented system of care is to ensure that we are fully engaging peers in this work. The experience capability and compassion of individuals who have experienced a mental health crisis needs to be front and center. I also think that the partnership can further best practices for addressing community and police relationships. In terms of the funding, I support the funding flowing through the Department for Public Safety. I actually think from an implementation science perspective and my training and understanding, it really creates buy-in and engagement on behalf of our public safety partners that they are bringing the funding forward. They are committing to using our community mental health agency to provide the services. And I think that does help us create kind of a platform to advance us and continue to strengthen the collaboration between mental health and law enforcement. So I'll stop there. I do want to pause. Deputy Commissioner Morning Fox has been working for years on these efforts. So I did want him to offer a few comments on some of his reflections on the work to date in Vermont. Thank you. For the record, Morning Fox, Deputy Commissioner Department of Mental Health. As Commissioner Squirrel mentioned, I've been doing a lot of work over the years in my 25-year career in mental health at the intersection of law enforcement and mental health. Having done a lot of work with Burlington Police in my early years as a crisis clinician, working with Matt Young, who originally started the street outreach program there, to being the court liaison in the Costello Courthouse in Chittenden County, to working with the FBI and other folks in law enforcement in many states. And that's what I really kind of wanted to start with is around the many states. As has been mentioned earlier, these types of models, and there are many models, as many words as I can say, there are probably just as many models in collaboration between mental health and law enforcement throughout the country. Most states throughout the country have varying models with the collaboration between mental health and law enforcement, ranging everything from actual police social workers who are a part of the police department and hired and our officers to embedded workers or co-located workers from community mental health centers to actual teams with specialists on teams that can respond to domestic violence, children's needs, homelessness, substance abuse, etc. There are many programs that are that are great models that we can can learn from. But I also agree with the statements of Commissioner Schirling that we have good programs that are out there of various models already. And just trying to expand upon those is a great goal. One of the programs in the state of Michigan has been well touted as a great collaboration between mental health and law enforcement. One of the local advocacy groups in Michigan known as the Michigan's Poor People's Campaign that works towards limiting systemic racism and poverty is a tremendous supporter of the programs in that state. A program in Minnesota over the past two years reports a decrease of about 30 percent of contacts with people who are frequently coming into contact with law enforcement as a result of mental health or substance abuse needs. And by enhancing their collaboration with mental health professionals have been able to work with those individuals and actually decrease the actual amount of contacts. As we all know, less contacts with law enforcement leads to less incarceration and less possible bad outcomes as well. When you don't have any kind of contact, there's no need for a positive or negative outcome when an individual is able to receive the services they need to have the supports they need to be able to maintain safely in the community. As have been mentioned locally we have a lot of those programs here. Many of them working with the state police are you know become a in a sense part of a family. They become accepted within the barracks but one of the main things there is that you have this give and take of information. You have the the positive influence and impact on the culture of the law enforcement agency in Barracks by bringing a mental health professional in with them as well as it creates a much better relationship between the entire agency of the the mental health agency with the law enforcement agency. And we can only have better outcomes when we have better understanding and better collaboration. You know better understanding and better collaboration do not lead to negative outcomes. They can only lead to better outcomes. And so those are some really positive things that are happening you know the folks that that work with you know out of Barracks they are receiving supervision both individual and group by their by their crisis service directors and we're made a part of those teams and receive that that kind of clinical support. And then just just on one last piece the Council on accreditation which is an international independent non-profit accreditor of human and social service providers has kind of a list of several recommendations when setting up a planned connection with law enforcement and mental health professionals two of which I want to just mention which is a jointly evaluating policies and protocols to emergency response and I want to speak to that just for one second. I think that that that joint evaluation of policies and protocols to emergency response is not just the responsibility of the mental health providers and the law enforcement providers but also those with lived experience and those who are who are on the receiving end of how those policies and protocols get enacted and are used. The other is creating memorandas of understanding between the police departments and the providers to better define the roles and expectations around interventions and that's exactly where we're considering and what we're proposing at this point is having those MOUs excuse me developed to ensure that those roles are clear and that those expectations are clear. So and due to due time I want to make sure we have time for other folks or questions but I will leave it with that. Thank you. Thank you for your work on this as well. I mean it's amazing what you've done. Yeah it's terrific. Both you and Commissioner Squirrel have been deeply engaged. I think what we will do I have questions but I'm going to hold those off until after we've heard from other folks because I think that we may hear some comments related to the MOU or other issues that you've touched on so that would be helpful. Okay so we have is it Kareem or Kareem? Kareem Chapman. It's Kareem Chapman. Good morning. Good morning. Welcome. It's nice to have you here. Yes thank you for the opportunity. So yes good morning to all. Kareem Chapman executive director for my psychiatric survivors on behalf of the peer world I just want to say thank you for this opportunity to testify. I just want to briefly start with a quick story a little bit about myself. When I was 14 years old I was on the way to see my dad in New York City and when I got there he was shot and killed by police. I was a very very angry young man stressed out anxiety the way I looked at the world was not a good one. I didn't understand that 14 years old why my dad was killed and it was a mistaken identity at that. To that point I was very angry at law enforcement at systems at the world and it took one person it took one person that came into my life that had some shared experience that understood and could relate to me or what I was going through. Until then I was drugged I was in facilities that the only solution was that you know we give medication to help your problem. Even as therapists didn't understand how it was to be an African-American male that had just seen his father killed it was no solution it was only medication. So this person was shared experience that really helped me through the situation any other than that I cannot see no no other way out. I was a very angry very violent young man made a lot of bad choices and I didn't understand what was happening to me. When this person came into my life and shared his story and gave me the opportunity to understand that I'm not by myself it made the world of difference and I'm saying this story because the impact that the peer service world has on working with people with mental illnesses is a great one. I mean the evidence is there for two years I've actually worked in a definite agency in Rutland, Vermont where I created a peer program within the crisis team and I worked along the side of clinicians and therapists and it was a great relationship. I've dealt with police officers that I respect and understand their position and role and I want to say this nothing works if we don't have understanding we cannot move forward if we don't understand everybody's role and position the law enforcement officer the peer worker the clinician everybody has a role to play and I think that if the peer voice is not at the table we are we have a disconnect there and process won't be valid or relevant if we're not at the table. So and also for the past two years I've had only one person go back to the ER when I'm sitting on people's couches or taking walks and you know we all know that it's a stigma of mental health and what the community looks at you know there's a fear there and when people are in trouble or having a rough day they really their first their first choice is not to go and call a crisis person you know they want to either figure out their own or law enforcement gets involved. I've been on many calls where I've been a part of the escalating situations well all the person wanted to do is just talk in 10 5 10 minutes it was the escalator and the officer didn't have to do too much so again I just want to really just reiterate and and and they give my testimony that the peer work is very impactful and we have to be at the table. Also we educate in the community I mean I haven't heard anybody say yet how we're educating the community and getting the community involved. I believe I'm knocking on doors I believe in going places where most people won't go those dark places where people are that we need to service and ask them what's happening how can I help. I mean it's great to talk about what we're going to do but what are some of the action steps that we're going to put in place to really make these things happen. So I mean I'm here in front of you saying that I'm living proof I'm a survivor I'm a peer person that knows that it can work out and we have to figure out together not to fight about it but how to figure it out and there is there is room in the way for everybody to play a role and I'm leaving with that at this point and if there any questions I'm willing to ask or to answer but again just we we got to get this right because people are suffering and people need answers and we are in a great position right now to make it happen. Thank you. Thank you and thank you for sharing your very compelling story. I can't imagine going through that and it's it's really terrific to hear your voice and your experience that has brought you to where you are today so thank you and thanks for your comment about having peer support. I think what we'll do is let's keep moving on and then we're going to open it up for questions and discussion generally because I think I think that's starting to coalesce around the questions we need to ask so thank you very much. You're welcome. Wilder White, Wilder welcome back to committee it's good to see you and why don't you introduce yourself and give us your testimony. Thank you it's also nice to see you all of you. My name is Wilder White. I'm listed on the agenda as the Chair of the Mental Health Crisis Response Commission. I chaired that commission during our review of the law enforcement killing of Phil Brennan but today I'm not speaking to you as a as Chair of the Mental Health Crisis Response Commission. The commission has not taken a position on this proposal but I also wear a number of other hats. As many of you may know I am the former Executive Director of Vermont Psychiatric Survivors. I'm also an attorney. I am a psychiatric survivor. I'm a mad activist and I've recently founded an organization called Mad Freedom whose mission is to secure political power to end the discrimination and oppression of people based on mental status and so I'm working with a number of other Vermonters and people across the country in that endeavor and I speak on behalf of that organization today. You've heard from Commissioner Mike Schirling from law enforcement and you'll also hear from law enforcement according to the agenda at the end of this testimony and unfortunately what you're missing are the voices whose gravitas really added to the hearings before the House Health Care Committee and I know that Karim and I cannot adequately convey that testimony and so I hope that you will go back and review that testimony. The time is short and it's really difficult to figure out how to use it but based on what I've heard up until now I think what I'd like to do is talk to you about the impact of this proposal on the Black community. We are opposed to this proposal. This is a proposal whose time has passed. Commissioner Schirling talks about how he was baffled, why anyone could be opposed to it, and I have to express my bafflement at his bafflement. In this post George Floyd, Daniel Prudair, it is imperative to eliminate law enforcement interactions with people with mental health and emotional distress whether they're working with embedded mental health conditions or not except perhaps in situations involving violence to others. Because of institutional racism, embedding mental health conditions with law enforcement is a combustible mix that will work to the detriment and disadvantage of Black and Indigenous people. Currently Black people are disproportionately killed by law enforcement and Black people and Indigenous people are disproportionately diagnosed with mental illnesses by the mental health system. An alliance between law enforcement and the mental health system risks transforming mass incarceration into mass medicalization by turning Black people into mental health patients and subjecting them to yet more marginalization and oppression and furthering the racial caste system that has controlled Black people in this country for more than four centuries. Historically, mental illness and race have a trouble past. In the 1850s, American psychiatrists diagnosed escaped slaves with a mental health condition called drapetomania and it hasn't improved much since then. In 2005, the Washington Post ran a front page story with the headline racial disparities found and pinpointing mental illness. The article detailed a research study that examined the largest registry of psychiatric patient records looking for quote ethnic trends and schizophrenia diagnoses. In the article, the Washington Post described schizophrenia quote as a disorder that often portends years of powerful brain altering drugs, social ostracism and forced hospitalization that has been shown to affect all ethnic groups at the same rate. And yet, in the analysis of 135,000 cases, research revealed that doctors diagnosed schizophrenia and Black patients and particularly Black men four times as often in White patients. According to the study's lead author, doctors overdiagnosed schizophrenia and Black men, even though the research team uncovered no evidence that quote Black patients were sicker than White patients or that patients in either groups were more likely to suffer from drug addiction, poverty, depression, or a host of other variables. According to the lead author of the study, quote, the only factor that was truly important was race. These findings are not unique. There is a large body of research and literature that explores the processes through which American society equates race with mental illness and through which our definitions of both terms change as a result. For example, in his 2009 book, The Protest Psychosis, How Schizophrenia Became a Black Disease, Jonathan Metzl demonstrated how schizophrenia was transformed from a largely White, middle-class, non-menacing disorder to one that is widely perceived as dangerous and threatening precisely at the time of the U.S. civil rights movement. The book shows that fears associated with urban violence and the rise of Black power in the 1960s became an essential part of the very definition of schizophrenia. I can also offer a more recent and personal example of my own travels through the mental health system. In 2013, after I reported to my psychiatrist a traumatic encounter with a law enforcement officer during which he had unlawfully demanded to see my identification, my Harvard educated $300 an hour psychiatrist working in private practice inserted a diagnosis into my medical record which he withheld from me but sent to my insurance company diagnosing me with paranoid personality disorder. He explained the basis of his diagnosis as follows and I'm quoting. She reported to me that she refused to show identification to the police officer because she was concerned that being Black there was a higher chance that the male officer would mistake her for taking out a weapon instead of her identification and consequently that a firearm would be discharged against her preemptively. It should also be noted that here in Vermont, non-white Vermonters are disproportionately represented in the highest levels of involuntary hospitalization. At Vermont psychiatric care hospital, 15% of the patients held there are Black and people of color. Allowing police officers to use their late understanding of mental illness coupled with their implicit racial biases that I want to make clear here that police officers are not the only ones with implicit racial biases we all have them but allowing them to use their late understanding of mental illness coupled with their implicit racial bias will exacerbate the disproportionate rates that Black and Indigenous Vermonters are diagnosed with mental illnesses and perhaps overlook Vermonters who may indeed be in need of assistance. For example several years ago I was confronted by two police officers while I was walking on the Golden Gate Bridge in the middle of the night. The officers had received a call that a person was threatened to jump off the bridge. After talking to me for a few minutes the officers decided to let me go because in the opinion of one of the officers Black women are too strong to kill themselves and my opinion such an attitude likely contributed to the indifference that allowed Sandra Bland to take her own life in that Texas jail cell. Police officers simply ill equipped to determine who to refer for mental health treatment. I also want to I'm going to stop there because of time but obviously I click the lawn but I also want to talk about something I was very troubled with during testimony that Commissioner Shirland gave before the House Health Care Committee. I'm concerned because of the impact of this proposal on the therapeutic alliance and the right to privacy guaranteed by the U.S. Constitution that concern was raised most acutely when Commissioner Shirland was asked by Representative Houghton the following question and I'm quoting. So when you say quote embedded for state police we have in Chittenden County a community outreach team. What is the difference between those two models? And Commissioner Shirland responded. There's not a substantive difference in part because our model is not fully fleshed out yet. I know those teams do have direct access to their law enforcement agencies. They go to roll calls. They do ride alongs and many instances they actually carry radios and that's something I think we would envision as well and have access to our computer generated dispatch and record management systems. That way they can see a call coming in or hear a call coming in. They can say oh I know John Smith I've been working with him. I'm well suited to respond to that. I can take that call instead of sending an officer or they may choose to go with an officer or they may say hey John's been violent a little violent recently. Once you get there and get things settled let me know and I'll come over and I'll work with him. In my opinion and it's my legal opinion as many of you know I am an attorney this scenario described by Commissioner Shirland violates not only HIPAA but an individual's constitutional right to privacy. Here the clinician disclosed that John was their patient and disclosed information they had acquired in the course of their patient-clinician relationship specifically the opinion of the clinician that John had been called a little violent and this disclosure puts that client at risk because now the clinician has primed the responding law enforcement officers to expect violence. And when I look at the Vermont State Police's directive 530 response to persons with mental illness or diminished capacity I instantly cannot trust that this law enforcement agency has any understanding of who people are who carry this label of diagnosis of mental illness. For example I'm quoting from this directive it's entitled maintaining safety when dealing with mentally ill individuals and it reads dealing with individuals in enforcement and related contacts who are known or suspected to be mentally ill carries the potential for violence. Now any interaction with law enforcement carries the potential of violence but to say that it carries more of a potential of violence with people with mental illness is just plain wrong. It goes on to say given the unpredictable and sometimes violent nature of the mentally ill again we're objectified by reference to being called mentally ill and then somehow we're told that we have a nature meaning our constitution by our constitution we are sometimes violent. Both Commissioner Squirrel has already told you that there is no evidence that links mental illness and violence. We are no more likely to commit a crime but this is the attitude from our Vermont State Police which is very very troubling to me particularly when we're going to be have clinicians who are divulging things from their therapeutic relationships that give officers the impression that their clients might be violent and thereby priming them for violence. In fact it's very very scary to me to have law enforcement and these mental health conditions working so closely closely together. And finally I want to say I think a lot of the testimony that was heard at the House Healthcare Committee were alternatives to this proposal that would more address the underlying issue rather than put a band-aid on it because what Commissioner Shirling is actually saying is that our mental health system is inadequate. He's saying they don't have the resources and people are falling through the cracks and as they fall through the cracks they're calling 911 and we are having to deal with it. But instead of trying to fix the mental health system he is trying to apply a band-aid to that system and intercept the problem when they call 911 instead of creating community-based resources that would obviate the need to even call 911. And this is something that I see repeatedly in Vermont in overinvestment overinvestment in crisis in an underinvestment in prevention and maintenance. Well I'm going to ask if you don't mind for you to wrap up I think your testimony has been extremely helpful. I will end there. Thank you and if you have additional comments please do send them into Nellie and we'll post those on our webpage so that we have access. I have reviewed most of the meeting, the house health care committee meeting on this and I'm recommending that my committee also review that testimony as well. So thank you for bringing that in to your testimony. Thank you very much. Thank you. Okay we're going to move on to George Karababakakas. I said it finally. George why don't you introduce yourself for the record and give your testimony. Okay I am George Karabakakas CEO of HCRS and we're the designated community mental health center serving Wyndham and Windsor counties. So it's an honor to be here. Thank you for allowing me to be part of this committee. So I guess I have a question how much time do we have because I know we were going to I just just to make sure and I think Lieutenant French was also going to speak to to our program. Right so what I'm going to suggest to our committee because we have a little bit of fluidity today that we're going to go until about 1015 so if you don't mind we have 12 minutes I'm going to share that between you and Anthony French and if we and we'll we will take some time for questions so. Okay great thank you. So I guess I don't have a lot of time I do want to I want to talk about our experience and our programs here in southeastern Vermont. It was in 2003 that we actually started working with the bellows falls police department to develop our police social work program and it was so successful and it made such a difference in the community that we started expanding that we really looked everywhere for every bit of funding that we could patch together to create programs and those programs and we develop police social work liaison programs in Brattleboro bellows falls springfield Windsor we serve Weathersfield Hartford we also as of two and a half years ago uh have a police social work liaison in the Westminster Barracks as well which serves a very large region and more recently we were fortunate enough to get a health resource services administration grant HRSA grant in Wyndham County to address the issue of substance use and it was a community collaborative and so we have a police social work liaison in the Wyndham County Sheriff's Department and the Wilmington and Dover police departments so we've been doing so we've been providing these services for a long time I have to say that uh as we've heard the reality unfortunately the reality is that law enforcement is oftentimes the first stop when there are challenging situations related to mental health and substance use and domestic violence and a whole range of other issues that also include homelessness and uh healthcare issues and social service issues and all the unmet as commissioner squirrel mentioned all the unmet social service needs these are the issues that oftentimes bring folks along for us when having someone who is co-located having someone from our agency that can be that connector can be that uh that person who is working very closely with law enforcement to help people create connections to help people get the services they need to uh sort of connect to all the other social services in our community that's really been uh it's been a great collaboration and a great partnership a lot of it has been about providing de-escalation about establishing rapport about monitoring and assessing individuals needs and doing those conversations in people's homes doing it on the street doing it in the community sitting at their kitchen table and just getting a sense of what are the issues what are the concerns because most likely off it is not getting someone connected to the criminal justice system isn't the answer the answer is getting them support the answer is listening to what those issues are and moving forward our team our staff are first of all i just want to say they are not it is social work in the broad sense but they are not necessarily social workers they might be case managers community outreach staff so i just want to put that out there and they uh they as i think it was deputy commissioner or maybe it was commissioner scurl talked about the supervision they are supervised and work really and both individual and group supervision with our with our crisis coordinators primarily uh many of them uh actually i think pretty much most of our crisis team but and our police social work staff have gone through IPS or intentional peer support training which i think is really critical ensuring that their practices are consistent philosophy with our philosophy of care uh it is uh you know i have to say that it is a work you know it's been 17 years but it continues to be a work in progress i do see this as an incredible opportunity to look at our system to look at what we're doing i absolutely agree and i have to say i really appreciate kareem's kareem your your sharing uh and certainly uh and will then others have share that the voice of the people that are most impacted do need to be part of this process absolutely we have work to do i think throughout our community uh and i think this is absolutely an opportunity to do that i we have a very strong peer support team and services uh at our agency i think we're really proud of the work they do uh and feel that and and know that those peer support services could be and should be very much a part of the response and understanding how to uh move forward um i uh i i think that's you know i'm just cognizant of the time so i'm gonna uh stop there uh and there's i have so much more to say about our program and the details and how it's worked over the years but i will um hold back and uh in uh in the interest of time and and go from there um if it would be very helpful if you could get us something in writing and uh maybe uh there are some specific recommendations that you've made as a result of your experiences so if you can draw down on those experiences and send us your uh you know your recommendations that would be very helpful i'll send it uh i'll send it to nelly right that'd be terrific thank you for that um that the more we have that we can reflect on uh the better our thinking and we're certainly getting a lot to think about today so thank you very much and thanks for your work on that thank you uh lieutenant french um you are up next and we appreciate your patience uh and sitting through this uh and and being able to stay with us and share your information so why don't you go right ahead good morning and thank you for having me i appreciate the opportunity to speak about the uh very successful program that we have here at the west minister barracks i'm lieutenant anthony french i'm the station commander of the west minister barracks uh i've been a trooper for over 22 years now and a little bit of history it's always been frustrating for me as a trooper on the road to see have us respond to calls for social service needs or a person's experiencing mental health crises and not having the adequate services to assist them you know we essentially put a band-aid on the problem in and leave you know there's times where we offer referrals for the or have offered referrals for social services to hopefully get people pointed in the direction they need to go but that usually falls to the cracks and um we really don't have follow through that that we have now so this this position that we have in west minister uh fortunately with a partnership with hcrs started about two and a half years ago um and it is more than a crisis worker that responds to crisis situation it's a person that's a liaison between the police and social services that provides families with the support they really need ranging from mental health homelessness families dealing with dementia domestic violence drug addiction and really the the list goes on a little bit about the operational level our police social worker does work out of the barracks within the barracks she's supervised by hcrs with input from me the station commander uh our local police social worker also meets monthly with other social workers that that are stationed at other police departments in the areas with that collaboration so having the the police social worker in the barracks it really enables the troopers to actively involve her in cases she does have a radio and a computer so she can listen to the calls and see the calls for service that come in if there's a way that she can help and the trooper hasn't reached out she'll reach out to the trooper but we've really come to the point now where the trooper is actively reaching out and trying to involve our police social worker in any way possible i haven't seen and i'm not aware of any incidents where patient information has been given to a trooper from our police social worker the troopers and her are very aware that it's a violation of privacy so that hasn't been an issue i know it was brought up as a concern the troopers also actively seek input on cases so if there's case follow-up they are working on and they can refer it to her or just have the opportunity when there's time available to speak with her about the case that's going on and and find better solutions to deal with people's problems than than we really could do in a law enforcement setting so the our police social worker can respond to calls with the trooper in the cruiser or separately in a personal vehicle it allows for better communication of the current situation so when the call comes in they're able to collaborate and kind of come up with a plan to best approach the situation with this situation they both arrive on scene together it's safer for the social worker and it's also giving the immediate need for mental health on scene at the immediate immediate time so there's no lag time in between this this brings a resource to the rural areas of vermont where it's difficult to get people resources we have 25 towns some people can be an hour away from services that they so desperately need and they're not able to go get those services so this allows us to bring the services to them when our police social worker is involved with a person on the street when we go to a call she's able to give them her card so this keeps them from having to call us directly or having to call the barracks directly for follow-up they now have a contact they have a face with a name a phone number to call the calls for follow-up visits so this is really a large part of what she does is to help people get the services they need to be able to have that relationship with them it's really much more than a you know mental health crisis worker it's a liaison that collaborates with many social services resources in the community to get people the help they need a good example of this is a trooper going to a call where someone was looking needed service and the police social worker asked to join in on their way to the call they knew they'd be traveling to another town where they dealt with a person the day prior who had very limited means and abilities and needed food on the way the trooper and the police social worker stopped by the local food shelf picked up a box of food dropped it off to this person in need on the way so here you have a person in need that had a meeting with a trooper and our police social worker and the follow-up to that was the trooper bringing them a box of food it's an outside the box solution that troopers wouldn't have thought of without input from the police social worker and this is the work towards building relationships between law enforcement and the community serve that we that we really need and it's really the future of policing another example to quickly give you is a family that as many are struggling with an elderly family member with dementia which the person was sometimes combative and instead of the troopers responding and defusing the situation and leaving our police social worker was able to work extensively with the family to get them the resources they needed which obviously led to a safer outcome for all eliminating the calls for law enforcement to respond and really giving the family the support they needed in this situation these daily interactions allow the troopers to really learn better ways to assist people in need we while they're back at the barracks they can debrief incidents it improves the collaboration with other resources that are available in the community when she's not available for immediate calls the troopers can send an email requesting follow-up it's really better than the mobile crisis response team being contacted to respond because the having the police social worker at the barracks it really gives us the opportunity to have that collaboration and the relationship built up we can arrive at cases incidents at the same time and the police social worker is very comfortable with the troopers and there's no hesitation when an idea is developed to interject in the situation to say hey we should do it this way this would be a better idea let's try this so that's really the the unique relationships that we need to build upon and to to move forward as mr Chapman mentioned it's it's these collaborative collaboration and communication between mental health peer support and law enforcement that we need and that's going to help move us forward so I just want to say that having the police social worker at Westminster has been extremely beneficial to the rural communities we serve this collaborations has made tremendous improvement in the utilize utilization of resources to get people the resources they need for long-term solutions and I'm sorry I went over a little bit but thank you for your time no that's just fine thank you very much that that was very helpful and it sounds like what you're doing in Westminster fits with the communities in that area so the the community outreach model that's being utilized in my district also fits with with the municipalities there so there is some diversity in response but we're trying what right now I think the question that our committee is going to have to wrestle with a little bit is on the administration of this and who's involved how they're involved what is in the MOU and I you know I think I want to just bring some closure to the discussion but it will certainly be helpful for us as legislators to know what is involved in the MOU and who's been involved in the development of that and how people are going to be included going forward this is when we're when we're writing a broad state policy that goes beyond the local response we need to get it right so that I think that's where that's where the concerns are I'm hearing those concerns across the board so committee questions that you might have for any of our witnesses up to this point Senator McCormick thanks and I'm not sure who this is for probably for Anthony French uh it seems to me you've got the two fundamentally different functions designed to deal with two fundamentally different kinds of problems on the one hand the underlying problem of somebody you know who is going through a period of stress to the point of you know affecting their judgment and on the one hand which calls for a great deal of compassion patience working it through but on the other hand if that those problems the underlying problem manifests itself in threatening behavior dangerous behavior the imperative is is to make that stop quickly so on the one hand you've got the the police officer as an authority figure who should be imposing his or her will and on the other hand the social worker as a compassionate person addressing the nuances of the the underlying problem there's nothing nuanced about a guy with a gun you got to get the gun out of his hand okay and yet there's underlying all that the reason he's there with a gun is because of bigger problems how do you reconcile these two very different kinds of functions so that was a good question it's um we use our de-escalation skills and training to actively engage the person and you know the troopers that are responding to these cases are you know normal people just like everybody in the community so um you know we are the authoritative figure that is there for safety um and that puts a stop to the violence but that's the last resort we don't want to have to do that we want to use the best solution possible um that's why it's so important to be able to have this police social worker there and available to us to help de-escalate and you know when we're there and we have this other person that's not in uniform that we can kind of push to the forefront as the safety allows and let them control the conversation as we slowly back out um it's really the best scenario possible that there are situations where it doesn't go perfect and we do have to step in and the social worker has to step out um but you know at least we have the resources there at the time and available to try to do the best thing we can uh for the immediate need okay thanks thank you uh i don't think that question invited a definitive final answer those oh that settles it but thank you for your analysis right i mean each and each situation each uh program is going to have a slightly different answer yeah all right so uh we obviously underestimated the time required for us to fully explore this issue but we are at in a stage of the session where we don't have a lot of time what i'm going to suggest is Madam Chair and Senator Cummings had her hand up oh never i was just trying to be nice she said no okay thank you senator uh does anyone else have a question before i launch off and go forth and begin to commence okay um i think we've we've heard a lot and you know in in past years we've talked about how do we link the uh the district attorneys with uh the local states attorneys with mental health and mental health uh organizations the da's and s s a's and so this is another one of another concern and we all know it's a huge concern and we know that there are racial disparities within the discussion and how to resolve some of those disparities at a local and a statewide level um so this is the beginning of a very long conversation which has um short term implications as we look at the budget we will be looking at the budget as a committee and we will be thinking about how we might influence the direction that's taken um within and it sounds like the MOU is something that um we should we should look at and may talk with Commissioner Squirrel and Commissioner Sherling about that um having said that committee i think what i'd like for the committee to do please is to review the testimony that the house health care committee received it will be similar um but there there is a youtube recording on their webpage and you can find the date i don't know exactly what day it is it's yesterday the day before um not clear and Nellie maybe you can help us find that and send a link out to everyone so please do that and then we will come back for a discussion of this at some point uh probably next week when we're looking at the budget and any senator Cummings you're muted um i'd also be interested in hearing more about this peer support because i don't think we can have a peer in every instance but i think statewide that peer support is an important it's not the same as social work you know having been one of those potential social workers that could have gotten one of these jobs getting out of college um we started out pretty naive too and we learn as we go and i think it's how do you mesh all of that and have a system where you have someone available you can call um in the you know in the instance you have i think the social worker with the police departments is is one thing but then there's other resources that i think we need to look at yeah thank you for that comment and i think pay attention to that as you're looking at the house uh healthcare testimony thank you okay any other comments or questions committee wow okay well we have walked right over our opportunity to dive further into h611 so we're going to postpone our h611 discussion until later this morning with apologies to representatives noise and wood but gen carby cannot be here so it'll be our our committee having a conversation you are welcome to stay with us as is ruby welcome to be here as well ruby baker so um but we are going to move now from this topic to um the covid-19 uh school and public health response and spend a few minutes more on that we have with us ted fisher and then um brina homes will be joining us as well so we'll look at that come back to that issue okay thank you all for being with us on the on this mental health on the mental health public safety issue i know it's uh complex and uh it but we need to get it right and we're going to try to do that so thank you thank you very much okay so ted you are here nally can you remind me what time um brina homes is going to be joining us uh she'll be joining us at 11 yeah so we have a whole hour for this what i'm going to suggest um is that we have heard from ted previously ted you heard some of our questions and concerns last time and in particular with respect to um safety measures being taken for teachers who might be vulnerable uh that was a big question that we had and you had indicated that um that would be a contractual discussion or uh there might be other laws affecting that so maybe you can come back start out with responses to some of the questions that we had the other day i suspect that we will not go we are not going to go until 11 we might revert to a conversation about h611 or h607 so let's let's uh see how far we get hi good morning senators uh can the committee hear me yes terrific awesome um so and i apologize actually i um i'm i would be happy to answer those questions i uh i wanted to sign post that i actually am and have been asked to join your sister committee in the house 11 so i'm sorry that i will not uh overlap with uh dr brina homes who we have enjoyed working very closely with in the house i'm just trying to pull up i sent a response to senator mccormick this morning i also want to note that um senator uh excuse me deputy secretary buchet may be joining us um it looks like she's coming into the meeting right now um so so uh wait you sent senator mccormick a response to a question that he asked during the committee and correct i would be so if you don't mind in the future if you could send those responses to nelly and to the entire committee so that we have it of course my apologies absolutely don't apologize it's understandable so i i figured we would have a chance to chat about it today so i'm just having an issue with my outlook so if you'll bear with me one moment so so this is with regard to the question about um whether or not uh like the state level accommodations for school staff who may have medical concerns that are related to covet i know that secretary french discussed this uh during the all senate uh meeting a few weeks ago i followed up with him the uh the the crux of this comes down to the americans with disabilities act um in terms of providing accommodations um the the the roadblock to providing a sort of a statewide solution is that um the uh work environment of educators looks different depending on both the school and also on what uh what their individual uh needs of the educator might be in terms of what what the health risks might be it's really a case by case uh basis secretary french used an example that he reminded me about um because this uh act of course predates covid if you had a teacher for example who broke their leg and taught on the second floor a accommodation under the americans with disabilities act might be arranging their rearranging their classrooms so that they're on the first floor now that might work for school a which has multiple floors of classrooms in school b an accommodation might not even be needed because um because uh their school b for example may be a single floor right so that teacher may not ever need uh to navigate up a set of stairs so that was that was the sort of the hypothetical example he used this is something that schools deal with and have dealt with since the passage of the ada in terms of coming up with requirements it is a medical you know it's an issue the our guidance the strong and healthy start guidance directs uh school staff to contact their providers to identify their risk um and then and then that then they can work with their school district to make sure that there are accommodations in some of those cases uh in some cases it may be that um working remotely and and and teaching remotely is is the safest and best thing to do in other cases there may be other accommodations that that's really sort of a case by case discussion with a medical provider and with the employer which would be a school district or would also be a um uh possibly an independent school if the educator works in that environment um uh you know one of the things to just note here is that uh we're we're very quickly discovering that there is a very large diversity of schools and there is no one size fits all approach for a lot of these health and safety guidances so that is one one of the potential issues at stake in this conversation and other parts of the health and safety guidance and I will make sure um uh madam chair that that written version I will forward that to to Nellie so the whole committee has it for their records um thank you I do remember when uh secretary french came before the entire senate I asked this question and his response was it's an ADA question however if we look at schools as just one workplace the ADA affects I think literally every workplace the municipal buildings uh restaurants um other businesses and so we have passed public health safety guidelines that has based on the public health um emergency that we're in and we've we've said you know you don't have to go to work I mean you can work remotely and people are protected uh from being exposed to the disease and we know that kids are carriers so um it concerns me just a little bit that we're having uh teachers having to negotiate safety uh in an era of unsafe public health so uh I I give you that question I don't know if you can answer it or perhaps it's a discussion that we have with Dr. Holmes um and I see that you're here Dr. Holmes I don't know if you can join a conversation or not not yet okay so um but so Ted is there is there a response to that uh doesn't this doesn't or oh I see Deputy Secretary Boucher thank you for being here or is it Boucher or Boucher sorry Boucher okay good mix things up I know it's confusing okay did you want to weigh in on this uh topic it's been a topic of concern for some time sure sure and and we definitely recognize that um I think um the intentionality of the guidance was was not meant to leave it solely up to teachers to you know individual teachers I mean they're really supposed to be working in partnership with their doctor and so if their doctor um really believes that the situation is not a safe one for them then that's what they go to um their their local um authorities in terms of HR in terms of the school the district leadership to say hey my doctor you know my doctor agrees I'm in the at-risk group this is not a safe place for me to be um we would certainly want to know if that's happening if that is happening and then there's pushback um because that would actually be we would consider quite problematic um so I do I I think it's a little tweak um Chairwoman Lyons with what you were asking but I do think it's an important piece that we're not just um we're we're not trying to just sort of leave it up to teachers to be kind of battling for their safety that it really you know it really needs to be in partnership with their own health provider who knows them best and can actually make that determination with them I see um Dr. Holmes is on now as well oh good that's great uh welcome welcome to the committee it's good to see you again Dr. Holmes you as well Senator Lyons I have a a document to share with the committee that may be of interest in this arena which was written by the adult infectious disease and primary adult primary care community to guide uh the the shared decision making between educators school staff and their medical homes that which was exactly for this purpose to really make a shared decision based on individual health information that we really couldn't standardize in any kind of a guidance document by way of explanation I think the chair is frozen that's why we're nothing is happening oh that is so helpful senator I thought that I was speaking into a black hole no thank you okay yeah just it felt very odd you would you'd spoken and suddenly everything was silent rich rich are you our vice chair yes I think I am um why don't we wait a minute um um because I suspect Ginny is rushing to get back on oh I I bet it's mayhem intense anxiety if she's not and um two or three minutes we'll pick up and go ahead yeah Nellie are you there I am yes I'm uh I'm emailing her the zoom information again to hopefully get her back on okay I know the instant I go to get another cup of coffee she's going to be back on so she is in fact she's coming back on right now yeah okay I go get one anyway in between people I go and get tea water so you know I'm back I hello madam chair we thought you'd be back I it was my internet um just decided that it didn't want to participate did anybody else go offline or was it just me we were all sitting here saying yes I'm sure uh Dr. Holmes sorry about that um were you going to share on your screen the information that you had or send it to us it it's your what what is your preference I'll it would take me a few minutes to search and find in the mayhem of my inbox uh and then I should just send it I think great no just send it is fine that's all we need to know um and I will say that Senator Ingram is testifying in another committee so that's why she's not here with us well the question that we've been kind of wrestling with is how we have a lot of questions for you uh from the for the Department of Health but the question we've been wrestling with regarding the COVID and public health for teachers is how teachers might recuse themselves or not go to work because they feel they're vulnerable and so Deputy Secretary Boucher indicates that uh there's some there's a medical communication so the physician would make that recommendation based on the patient's status or the teacher status are there other general guidelines from the Department of Health yes so that's what I'll share with you I think the part that is uh most important of interest is this is a shared decision-making experience between a clinician and a teacher uh the list that the CDC produces of chronic conditions which infer some increased risk during a time of COVID is long and extensive and would preclude almost and you know a large proportion of our adult population working so it is really about how well is your chronic condition managed and what is your vulnerability so it has to be done at the in a shared way I don't think that uh adult physicians are um in some situation where they're making the decision they're guiding and uh but it is really important and we'll talk more about this during my presentation schools are a very safe place to work based on all the mitigation strategies and how hard so many people have worked to set them up to be abiding by COVID prevention strategies and I did hear you say Senator Lyons that children carry this virus I think we can certainly address that uh they do uh have the virus in their nose at times and they are known to when tested to have no symptoms and test positive but they do not spread this virus the way adults do they are not the vector of this pandemic the way most viruses are and I think this is getting out in the outside of the medical world but we have to say it all the time to each other almost every virus in our world we get from kids and we're used to as pediatricians and teachers and we're used to the kid with the running nose and then we get it and we're sick for a week and that's not true with COVID children get this virus from adults almost always it's an extraordinary flip of science and we don't know why but it's important in the school conversation this this is Ted from AOE again um it looks like I've lost video um I'm trying to rejoin I just wanted to to note um one thing before we we move on uh in addition to Dr. Holmes's excellent comments and and what the secretary uh deputy secretary Goucher noted um it's important to just I wanted to reinforce what I said earlier that you know the Americans with Disabilities Act is a um you know is an obligation right it preaches COVID-19 obviously but you know working with the provider um if working with the provider uh the teacher and the provider identify an issue that that makes them unsafe working in schools and the schools do have to to work to to accommodate and provide a reasonable accommodation there so that that's why Secretary French has has fallen you know back on that and answers and and why we're providing the answer we are today okay thank you for that this everything is starting to uh the clouds are clearing so this is very helpful um I'm going to ask um Ted you or Deputy Secretary Boucher if you have anything more to add we you have been in to committee previously with some uh testimony so if you have something to add that would be helpful otherwise I think we'll move to Dr. Holmes and listen to her testimony uh and then we'll come back for um questions and discussion with the committee and the group as a whole okay okay hearing nothing further I will turn we'll turn uh to Dr. Holmes good morning everyone I am going to share my screen holding my breath because technology has been uh boy have I learned a lot uh let me pull up as I'm sure you have about technology so I am Dr. Brina Holmes for the record yes I did want to update you on a title change you know you've known me for 10 years as the director of maternal and child health at the Vermont Department of Health uh pre-covid I had made I was starting to make a transition to be on the faculty at the larner college and medicine department of pediatrics on the Vermont child health improvement program then the pandemic hit it did not seem like the right time to step away from my beloved colleagues at the health department so after much ado uh Tuesday September 8th I have taken on I'm going to be the medical advisor to the maternal and child health division 40 percent and keep us going in the school and child care work that has been essential from our division and then the 60 percent I'll be joining the department of pediatrics at the Vermont child health improvement program so sorry for those four that's too many sentences but uh in congratulations confusion thank you just congratulations but also condolences to the Department of Health I think it's going to be okay thank you Senator Alliance the um Elisa Stallberg is our beloved deputy director she's become the mch director and really has all the structure budget supervision she's amazing the only piece she didn't have was the medical background so keeping me on in that capacity is going to be I think the right team and I certainly hope to still come before your committee in this meant whenever you need me to because I've enjoyed it and 40 percent is should be enough maybe also you know no one wants to make a transition during a pandemic so can you see my slides has magic occurred yes okay so I have some general remarks I really want to make about this journey because I'm so proud of it and then I really want there to be time for questions so um if you all hold me to if this is beyond the time we have a lot I know I have till 11 so let's see if we can get some of the structural stuff out and then spend the time and more of a conversation I wanted to start with gratitude I you're all working so hard we're all working so hard I have never been more proud to be part of Vermont's uh state system and uh it's a very uncertain time so I also wanted to acknowledge that this virus was not known on the planet until December of 2019 so more than ever in my medical career I've had to go back to a group and say I said something incorrect yesterday or something changed in the way that we have come to know that's something about this virus so please bear with us with I have a lot of humility about information I wanted to put uh the reopening of schools in context because the national story is not the Vermont story and I think it's getting conflated and must be one of the many sources of fear in our state uh the CDC has guidance about reopening schools the American Academy of Pediatrics has guidance and uh we're really proud in Vermont because we had a comprehensive and continued to have a comprehensive and thoughtful approach with a really strong multidisciplinary team which I really don't think any other state has we have tons of physicians we actually have half of our group was from the medical field and the other half were educational leaders we also monitor our data so darn carefully in Vermont that we are going to know and continue to know if safety is in any jeopardy here in the uh opening of schools and then I'm sure you've heard and been following that our pediatric medical community has been one of the uh outstanding leading leaders and champions in the efforts to reopen our schools so no need to make the case to you all with your backgrounds but there are uh kids are not doing well in their isolation and we also have to remind some audiences that schools provide way way way more than traditional learning experiences it's where children connect it's where we uh meet and address social emotional needs it's where children access healthy foods physical activity and kids particularly kids with additional vulnerabilities uh schools are their epicenter okay here's the one slide for you know nine months of science so far this is what we know and agree on despite uh the media picking up on some cases and episodic studies that show something different about children and covid the vast majority of literature supports these four sentences children are less likely to get covid no matter how you slice it where you look around the world where you look around our country this is not a pediatric disease now that doesn't mean kids don't get it but they're less likely they do not get that sick except of course a few kids do we've had no children in the state of vermont hospitalized with covid zero and we're up over 200 uh cases documented since march in kids zero to 19 we also know that the particularly the younger kids don't transmit this virus and we have study after study of little kids who have covid that they got from an adult exposing a classroom setting or exposing a larger household and no one contracts are from that kid and then we really have to look in vermont to the countries with low prevalence of this disease to decide about the success of our opening and how well we're going to do and this was more relevant per force to number eight because here we are but we should not be comparing ourselves to georgia or florida or texas because we have such low prevalence of the disease the two pediatric infectious disease doctors at uvm are nationally known for their work with covid and this happens all the time in vermont we get so lucky with our experts and our pediatric leaders and you know there's a long history of why vermont's pediatric community is so so famous but benly and bill raska are on the national news they write editorials for our national journals and they're the ones that were on our task force to reopen schools so here's who was on it maybe you already know this but we had representation from superintendents principles the independent schools our great school nurses the nea was there we had special educators the vermont's health improvement program the infectious disease doctors we had general pediatricians school psychologists we had our transportation colleagues and uh heather and ted and tons of people from the health department as well including our state epidemiologist we sent the draft this is all that way back in june we sent it to parents we shared it with our vermont after school coalition the vermont raise which is an adolescent health advisory group at uvm through uh the teachers through nea and we also shared it with additional pediatric colleagues for geographic diversity it was published june 16th i'm super proud of that the aoe and the health department partnered beautifully to get this out before school administrators left their buildings or left their the 2019-20 school year and then we revised it august 11th based on new science and information and we're going to revise it again uh not you know every ditzel and not every week but as we learned in our child care experience we need to stay vigilant and meet probably monthly to continue to make the document as accurate and up to date as possible uh it's helpful for folks that are working in in schools or supporting people who work in schools to think about these concepts i'll just highlight the first three the way you prevent uh outbreaks in general in states but in schools would be you got to stop the virus from getting in the building decrease the risk and you do that with staying home when you're sick and health screenings checking temperatures and once you're in the building if the virus gets in which it will we have to stop it from spreading between people and you do that with math almost entirely and cleaning and distancing and then once there's a case in a building you have to contain it and you do that with quick identification testing of close contacts and our contact tracing team which is truly unbelievable and the one of the sources of my greatest pride as a health department employee so we asked for covid coordination all districts have complied with this we have amazing leaders who reach out to us every day to help interpret the guidance it's almost always a school nurse which was our vision and our hope in some communities where they needed their school nurses to focus on other tasks they were able to find other health professionals to play this role there's been a lot of talk about steps i i could talk about this more if you want uh vermont has been in step three which is an epidemiologic step from the cdc since may we were in step three because we have such low prevalence of the virus the schools asked to start in step two which was a very reasonable request because they wanted to get their setup correct in the event that they needed to step back to a more prescriptive situation the primary difference between step two and three as it relates to a school building is the attention to the distancing and the use of the gymnasium and the cafeteria of quick note we did require or recommend that that buses could be right away in step three because six foot distancing is not possible on public on buses so we have a ton to tell you and i don't want to spend too much time but please know that the health department's website has developed specific tools and the aoe shares them as well for schools to be ready for cases because it's inevitable this is not a if situation it's a when and the reason we say that is because we know what to do and we don't want any kind of drift into what i call the limbic system or the part of your brain where you're in um anxiety and fear we want you to know that a case has come and that the health department knows exactly what to do a little bit here all these slides will be available to you for your review but this is where we made a shift in our health screening we're now asking parents to do the symptom screen at home the temperature screen is at first point of contact one of the biggest changes in our society since covid is we have to stay home when we're sick and i will be the first to tell you we botched this before covid my goodness we were letting sick people everywhere including in the health department i would sit in meetings with people coughing and coughing and think you need to go home and schools and child cares were terrible we we were so pressed to have people at work and and kids in their education settings that we forgot really basic public health but it wasn't good to be allowing any of these symptoms pre-covid in our mix so it's been actually an interesting uh somewhat healthy experience since march to have people staying home sick uh we do recognize this is the slide to address what the senator lions mentioned uh we really want the shared decision making between staff and medical homes and i sent nelly the one pager that we wrote to guide health adult doctors infectious disease and primary care to talk with teachers a little bit more about the importance of exclusion for being sick i hate the word exclusion because it means something different in education that's not strength-based but in here in this circumstance it means zero tolerance for sick people in your building we have very good language and school nurses understand deeply what to do with allergy and asthma those kids are not excluded but we need uh conversations with doctors and teams to identify kids with those chronic conditions we've had a lot of good work on children with special health needs we have a separate group of people that have produced some uh guidance and checklists around what to do with special education special health needs heather uh deputy deputy secretary and her team have incredible social emotional learning documents it's been a really powerful partnership between public health and the agency of education and we are really proud of our guidance so i'm not going to go through everything here because you'll have it but just wanted you to see the breadth of what we address in our guidance we address buses we address the drop-off and pickup protocols we've heard from our school since tuesday that they anticipated an hour of entry that it was going to take for drop-off and adequate screening and it's taking about 30 minutes so already we've set nice protocols and expectations in place that it was going to be delayed and we're seeing that folks are really rocking this the conversation about facial coverings is really important uh it's required that everyone wear coverings we have a document coming out this week about the very very rare medical exemption to not wear a mask for children and it's coming from the pediatric subspecialists and i'm talking about respiratory specialists cancer specialists developmental and behavioral specialists psychiatric specialists and there i'll give you a spoiler alert because it's coming out tomorrow there's almost no condition you can't wear a mask so please know when you hear from folks that their child cannot medically wear a mask that that's not lining up with our medical subspecialists that being said there are developmental considerations and in our child care guidance we say it's strongly recommended because three-year-olds are really really working on this but they can't leave them on all day and that's just pure child development and we didn't want to get in a punitive restricted space we have that uh interesting and important public private um mixed delivery for our pre-k so the three and four-year-olds in our public school systems are required to wear masks but we have a line in the guidance that says please give them special consideration in our private pre-k situation they follow the child care guidance which strongly recommend so i'm just calling out that difference it's not my style to have that kind of a difference but it was important and necessary and we can talk more about it we address all sorts of group size and the integrity of the group this is a source of great media attention we have to mix groups in vermont because we're having kids go to child care and out of school time because our schools are hybrid so we couldn't we can't say a same group of kids stay together all day because there's so many different venues in which children are moving we feel this is safe based on all the mitigation strategies and our low prevalence the physical distancing pieces of our work have been extremely interesting the data and the scientists tell us that little kids can be three feet apart with minimal risk so that's why we amended our guidance in august to say pre-k through grade five the kids should be allowed to be between three and six feet that appeared to be somewhat the six foot rule was prohibitive for some schools so we went further in the guidance and said you can be in person now because we gave you the distance and schools have taken that seriously and they're working toward that we're still recommending six feet for kids over from sixth grade and up and then we really want people to understand that in the circumstances where you can't be six feet apart which is a lot of times in education that's when you just you know you hone in on the facial covering child care which has been in my wheelhouse since March there's nobody six feet apart in child care by definition these kids are toddlers and infants and they're in the laps of their caregivers and we have had almost no spread when adults have brought covid into those buildings and covid has come into child-serving settings because adults have had the virus and when they do we contain it we tell the families the kids are quarantined some of them are tested and there's been almost no kids with some cases there were a few out of hundreds of exposures a little bit more about group size on this side we address libraries extracurricular gyms cafeterias fire and safety drills playgrounds and recess we address volunteers field trips and parental visits we spend a ton of time on cleaning we've become environmental health experts on my child care and school team the food service people are heroes of this story i just wanted to call them out because they fed families all summer and they figured out how to do this and also food service folks by design understand infection so this has been a very successful part of our covid response and i just wanted to acknowledge their greatness we have incredible communication information and tools and i also wanted to say that we asked our pediatric community to go find a school to work with and we have more than dozens of examples of pediatricians who have made videos with schools have gone to school boards have partnered up with school nurses and have made sure that this was a community effort to get schools open safely i think you could you probably have already had talks about what to do when there's a case but suffice it to say that we now have documents for school administrators to read ahead of time but the biggest lesson here is to trust our contact tracing process 96 percent of folks that have covid in vermont have been contacted within 24 hours since march i'm not even i can't even tell you how proud i am of that in most states it's 60 and it's just diligence and great leadership and really really committed vermonters the decision to close the school is going to be made with agency of ed superintendents and the health department we're not going to close schools we will close a classroom if we need to and one of the most interesting parts about covid is when you go through close contact and you find yourself trying to make a list of who needs to quarantine it's never as long as you think so if a teacher gets covid i doubt the classroom is going to all be considered close contact because you have to have prolonged exposure with pretty close up and i can't speak more to it because it's individualized based on the symptoms of the person with covid when they were symptomatic and it's too hard to make a blanket statement but in childcare when we get the call on a sunday that a teacher has covid we all our heart sinks for a sec because it's you know we want success so deeply and then the next day we find out there were only two kids that were considered close contact and were just so relieved so please know that this piece is our strongest and this is just some more slides for you all on what is contact tracing it's so easy in schools because schools keep attendance and it'll be just a little shout out to uh well a reminder to all of us what the health commissioner says we as citizens need to know where we've been the last 14 days in our behavior and our movement and when we contact trace we realize people don't know where they were but schools know where the kids were so this is going to be easy including buses we know where kids sit on buses we know where kids are in a school building and i did want you to know that all summer all spring and summer we've had four public health nurses on the phone with our school and childcare and summer program uh administrators answering questions we now have eight humans i'm so proud of this as well because we asked our emergency operations team for to double our staff so that we could answer all questions all day long as small medium and large as they need to be to keep schools uh moving forward i'm sure you found our website i'm also very proud of that and i'm going to leave it there senator lions and see what questions have come up and i probably weigh past oh no i have to 11 30 i do pretty well now you did great uh this is this has been uh uh obviously our committee has a significant uh role to play in understanding this and you have just brought us some understanding and we greatly appreciate it thank you thanks for your work um before i ask questions i want would like to ask the deputy secretary to introduce yourself for the record yes thank you madam chair heather boucher uh deputy secretary for the agency of education thank you for the record oh good now now we're all good we're now here for the record you're all official thank you um dr homes thank you very much for that um i did i did uh understand in conversations with dr first at the uh at the medical center understand that k through five kids or probably more able to attend school for the entire day is that is that was that a consideration that was given during um the discussion about how to open schools i know the concerns about um teachers and kids and so on um and you've clarified that a little bit but are k through five schools opening up completely or are there still remote uh learning and i guess that's a question for both you and dr boucher yeah i'll answer the health piece and then i'll let the deputy secretary so um yes so that's exactly what happened between june and august so the first iteration of our guidance uh used a lot of sort of cdc words like stay six feet apart when possible and we heard right away from superintendents that in order to meet the standard and try to get everybody six feet apart they were not going to be able to have everybody in the school building regardless of age so we spent the month of august with the task force bringing the scientists back in infectious disease doctors to say here's what the science really says you can be closer than six feet if you're in a younger age group because they're not transmitting this virus so we brought that to the task force the task force heard the evidence and agreed that our new guy our revision which was august 11 would state very strongly that the science has shown pre-k through grade five which people call me out for being arbitrary of course it's arbitrary right you have to pick a cut off the science studies kids zero to nine zero to ten zero to eleven but the consensus was that in those grades the distance should not be prohibitive and that we really recommended in-person learning and that being said we also really admire our district school leadership where they said okay we're going to work toward that but we have to start in a place where we can get the logistics right and I'll turn it over to deputy secretary to talk about that so it's not a yes it it's not a once we said it everybody just opened elementary schools full-time that is our vision but there's it's iterative sure and I would definitely echo what dr. Holmes said a couple of things that's exactly right so the committee that worked on the guidance definitely heard from the education folks and it made logical sense that we would start in step two at a more restrictive level in terms of precautions so that should we should a particular school or classroom have to move back to a more restrictive set of a set of practices that they would be ready to do that we know that right now about 80 percent of our districts are have adopted a hybrid model where in some kind of pattern students are doing both remote learning and in-person learning there's a small percentage of districts and schools that are doing solely in person and similarly a small percentage that are doing solely all remote it was important for us to allow that flexibility especially as we first started out because each district had to think about their own set of schools and what the physical distancing might look like in those schools as we all know they're they're very different across the state they also had to navigate different community factors so for some of the districts there was a real push from parents that they they did not want to send their students back to school so I think those are places that have a heavier remote component in other communities many more parents were of the opposite standpoint saying I need to get to work myself so I need the schools to be open so I know there's been a lot of discussion about the fact that there there hasn't been kind of a top down one size everyone everyone do the same thing and I think I just wanted to clarify that that those are the reasons that that there are really different factors both in terms of the physical logistics of different schools across the state and then also what works best for for each community I do want to also note and we'd be happy to come back in and talk further with the committee that the agency of ed is actually developing a new collection data collection tool so that we will actually be monitoring exactly how many elementary schools how many middle schools how many high schools are in these different dispositions are in fully remote are in fully in person are in a hybrid model as we move forward and the piece about the hybrid model that I said it's it's it's a big catch all because some some districts have students in for two days in person usually a shortened time frame couple two to three hours some have students in for five hour five days of mornings or five days of afternoons they really are quite idiosyncratic to the local need we would we would state and actually agree with that approach again we're working with a pandemic and we needed to make the situation so that our local entities could figure out what worked best for them there was another piece that I was thinking of but it will come back to me okay I hope I answered madam chair no that's that's very helpful we understand the the question I think that our committee has had from the beginning really was the overarching public health guidelines and guidance that would help regardless of the school or district involved so right and and I and I think we're getting that answer this has been very helpful I do have a question and then I'll I have two questions one is on the criteria that Department of Health is going to be using for and you've you have dressed this uh Dr. Holm so it's it's not that you haven't addressed it but there are times when a school might be closed down completely we saw that uh in the spring time when schools were just shut down categorically because of the immensity of the pandemic um what criteria does the Department of Health have a set criteria or criterion for closing down schools you talked about closing down classrooms and the contact tracing that that's all very helpful but are there sort of risk levels that you're looking at that would suggest uh that we should be either shutting down a school a district or the state again how's that being looked at anticipating the possibility a couple of really important concepts here um we didn't know what we were doing in March right we had no testing we had no contact tracing we had never lived through a pandemic so that feeling that we're all still carrying of like we got to close is is not anywhere where we are now and I and I really don't anticipate being there you know we uh we will know when we have a case and then we will know who that person was in contact with and all of those people will be advised to quarantine and then the the school will continue business as usual and that we've had so much experience with that with child care summer camps other work sites long-term care facilities even our correction system so I just I just really don't see it coming that being said the secretary of education and the commissioner of health talk about this a lot we don't think we're the kind of state that sets some arbitrary number because it we're so easily able to have the conversation of what is the unique experience and we know how to define an outbreak and we will and we're not we the minute we have an outbreak we call it an outbreak you know we're not afraid of the word it's I hate the word but and then we uh we get the public to understand and then we move forward so to me saying sick you know you have to always know your denominator before you make a numerator and we wouldn't be able to say six cases in a school means closing because for one school that could be the whole kindergarten or for another it could be 0.5 of the population so please know I mean one of my there are silver lining I don't know what the term is of the some of the small gifts in this terrible time but the way that the health department and the agency of education working together right now is fabulous we talk every day and my team meets with Ted's team every Friday and we we make all our tools together and and as deputy secretary said we're gonna we're looking at the data together we're gonna report the data together uh I just don't think you're gonna get an arbitrary number out in the public that says what would warrant a change I will tell you what I know from other states the school is just a mirror of the community so if a community is experienced an uptick in the virus then we're going to start to see it in our school systems so the the lesson here is for the community to continue all of the great efforts to keep the virus down so that our schools can do their thing I did want to say one other thing while I'm unmuted because my my so John Hopkins did this amazing analysis of school reopening plans and they gave Vermont a 10 out of 12 which put us in the top five percent and the only reason we didn't get a 12 and please forgive my perfection is they included parental choice and teacher choice as metrics in their health guidance analysis which we in Vermont have opted to have these separate aspects of our school reopening conversation so as deputy secretary will has probably explained to you like there's guidance about hybrid or educational models there's guidance about social emotional learning the the health guidance itself contained itself with it in its lane as we said and so we didn't address teacher or parental choice by on purpose because it's addressed elsewhere so so we got a 10 out of 12 with an asterix which to me is a 12 out of 12 so please know that we are very uh the plan had all the right people in it and it has been well regarded when reviewed independently so I'm just super proud of it and I I wanted to make sure you I'm sure you hear a lot of uh dissent but in terms of the and I do also echo deputy secretary said which is we have too much uh we just really love the way our school districts function in their uniqueness and to say this is the plan and everybody has to do exactly what that didn't make any sense and and when people started wishing for it it didn't make sense to me as the leader of the task force so stop there okay thank you that's very helpful I think it does make sense to have clear public health information and then that can help guide local decisions and that's what I'm hearing you say both of you okay one one last question and it's a comment and a question and that is as you may or may not know one of my concerns has always been having adequate uh nurses uh in school school nurses and the adequacy has for me has always been very there's been a shortcoming in that area to say that you've increased the number of public health nurses from four to eight is reassuring but are we seeing uh adequate um healthcare personnel in our schools are we seeing nurses available to do the testing and the temperature measuring uh on a daily basis so I know that the nurse doesn't have to be there to take the temperature in the morning but having a nurse available for faculty and children does seem important during the day can either or both of you comment on on that sure I'll start by saying um maybe some of you know I wrote the national policy statement for the american academy pediatrics on the rule of school nurses so we are very clear you need a nurse in every building from a health perspective and vermont gets uh part of the way there and it does better than most states but we don't have a nurse in every building that being said almost every school district commits to a nurse in every building and then has trouble with the workforce it's actually hard to find folks to do the work so when you hear there isn't a nurse in a school don't I don't want folks to assume it's because it wasn't budgeted or it wasn't part of the mission or the wish sometimes it's a workforce and that being said because we know that there's not always enough nurses in any part of healthcare we created a school nurse leader model years ago I feel like maybe we've talked to this committee about it but it we're really proud of it and it's the idea that it you you put your very very best amazing well trained school nurse at the administrative table to look at the schools in your district and say gosh I'm worried about this small elementary school because there's two kids with diabetes and we really need to adequately stop that school and you make those decisions in the summer based on leadership so that system has helped us enormously in covid that we have school nurse leaders who are very uh in close contact with their superintendents and principals that being said we need more we have had some options to use the medical reserve core which has turned out to be a little problematic from a licensure perspective but we are using the medical reserve core folks with some independent schools that don't have nurses and also for the temp checks as you noted those do not have to be health professionals uh in fact most schools are not using health professionals because we like to save that expertise for the kids that are sick or need to be excluded or some of the clinical decision making so in all with this being my whole career passion I'm feeling another silver lining of covid is the leadership of school nurses uh and that there are tighter connections with school administrators because no one thought or tried to open schools without their school nurses at their hip so I'm feeling actually quite hopeful I'm interested to see what deputy deputy secretary think yeah and I had raised my hand um just to to not be rude and jump in um yeah I agree with everything that Dr. Holmes said I do um and I think um Dr. Holmes I would ask for a little clarification um on this because of course you are the expert on this area one of the things that I think about though is that we sometimes confuse a full-time position with with you know a nurse being in the building and so my understanding for instance is that all of our districts have a nurse pretty much a full-time nurse it might be though that the nurse is not that that every school does not have a full-time nurse and what that would look like my understanding is in a situation where there were a case detected is there would be a nurse readily available who would who would zoom over to that school even if they weren't there that day and would would start you know doing the contact tracing and and well doing the liaising with the Department of Health so I I have noticed that folks um it when I've talked with folks kind of in the field they were conflating that full-time piece which we all know is the best model we all want a full-time nurse in every school but if there isn't a full-time nurse that doesn't mean there's no nurse available and sometimes I think that that gets conflated a little so that's all I wanted to add brina if you wanted to maybe chat about that a little more because again this is your area and you know more about that staffing piece than I do no that's correct I think I think adequately staffing is really the school nurse leader's role and I I do think some schools need more nursing support than others based on the needs of their students but and also utopia is a school nursing full-time in every school so it's a fun you know yes and conversation because I actually think people are doing the school leadership really gets it and they get it even more now and it's it's actually kind of heartening the other thing I'm so excited about is what we call team-based care which it's always been best for students and parents if pediatricians and school nurses are in constant contact about kids and some schools do this beautifully some school nurses meet you know weekly with care coordinators and medical homes and we we're elevating those models to share with other communities to say this is how you're going to get kids back to school who have symptoms and they don't have of it or you know recovering from covid whatever's ahead I know for sure needs a team and special educators need to be on that team and to me it's it's a great model that we're going to just elevate because of a pandemic which and then we're never going back that's the beauty of some of the gifts which again strength base just trying to stay positive I'm so sorry I have to go at 1130 and it's now we're we've gone over your time to break I'm going to let Senator McCormick ask his question and then we'll we're going to switch gears so thanks thank you very very briefly I want to thank you for the good work you've done I have argued for a higher level of caution than we've actually exercised and on the question of whether or not to open the schools as this is not the first time my colleagues have not found my efforts at persuasion to be persuasive and that train has left the station and the schools are open so that being the case the best I or anyone else can hope for is that if we're going to do it that we do it safely and I think you're probably you're doing it as well as it can be done so thank you for your good work let me ask you this do you think it's time to reopen the legislature in the state house using the same safety protocols well now there's an interesting question I guess I would need to know more about how well you feel you're functioning no honestly because this gets asked a lot the governor gets asked this a lot at press conferences why are you opening schools but but this agency human services is still remote right and the answer is that we have figured out a way to do our job and if we keep our community safer the schools are going to be safer do you see what I'm saying so if you guys see if you all feel that you have achieved a high level of function in zoom uh then it probably is it keeps the community safer if there's less humans getting together yeah because we want our schools to do you know it's the same with healthcare and schools people need to do these things in person and so the rest of us that's just one person's opinion though please don't take that as any official no I'll ask Dr. Levine as I say at this point that train has left the station and I hope we do it well I hope the reopening of the schools is successful I would take no pleasure in saying I told you so I really and I mean that sincerely I think you're doing as good a job as it can be done thanks so thank you thank you thank you senator I know that's a question you've been asking or at least a position you've been supporting for a while and I'm sure that I know that that discussion is going on in various legislative committees so we will we I'm sure we'll return to that one I want to switch gears unless there are other questions for Dr. Holmes or Deputy Secretary Boucher all right thank you thank you both for being here thank you all very helpful thank you thank you all right all right so I see that Katie is here and I also see that Ruby Baker is here and those represent two different issues H611 which we have not gotten to but we're we definitely have on our agenda for tomorrow so we will be spending some time on that I'm going to elevate that to number one for us I do have a question for Katie going back to the public safety mental health issue and Katie I don't know whether or not an MOU has been a draft MOU has been shared at any point with legislative committees the the health care committee in the house I'm not sure that I've personally seen it but I can check their website to see if they have that posted yeah I haven't done that yet either um what I'm going to suggest to the committee is I mean there was a lot of questions that were raised as we heard testimony about how to move forward on this my concerns really are I really am concerned about having the public safety become a separate parallel mental health organization and not wanting that to to run rampant and to allow for the Department of Health and the DAs to be have the oversight necessary so that we we know that this is done appropriately I don't know Katie if there's anything that you can offer at this point as to the steps that are going on in the house and in particular with respect to the budget I haven't looked at that yet sure um the house committee has met several times on this issue most recently yesterday but I think they've met at least two other times and they're being in a few minutes again to have some committee instruction and after today's meeting I'll probably have more of a sense of what direction they're going in okay I think that's helpful I think we'll we're by virtue of the timing that we're in we're going to have to hold off and see what their recommendations are and then we'll we'll be in a responsive position but we we need to do that so we'll I think we'll take it up this will be part of the budget is that your sense we're not going to get a bill on this my sense is that it will be part of the budget yes yeah so that'll give us an opportunity next week to go through the budget and then to consider what policy recommendations are being made okay just thank you for keeping us up to date any way you can that's very helpful committee questions for katie on this one okay we're good again review the testimony that the as much as you can I know there's a lot but at least look at their witness list and maybe some of the testimony that's been submitted would be helpful all right I want to move over to first is there is this anyone wish to make a motion on age 607 which is the nurse and primary care workforce bill I the bill will be going to appropriations there's no question about it but I think we heard yesterday that the the money is there there's a million dollars more or less being appropriated for scholarships for nurses and for medical students with an incentive of going into primary care with a payback of time two years per year of support the other money has not been spent on mental health and I think if we let it sit there too long it's not going to be spent on anything my my my thinking is we did make a recommendation about having more mental health counselors supported and incentivized I think we have a we have an actionable proposal in the form of age 607 and I would consider tomorrow having a proposal or a motion to move that bill the only I think the only outstanding question is whether or not naturopathic is included in the initial definition certainly it can't be in the in the award because we don't have a naturopathic school in our state so tomorrow okay with that one senator comings so touchscreen on this computer I thought the naturopaths wanted to be on the advisory board that's it thank you yeah okay yeah brain cramp uh so it would be on my brain is very cramped at the moment so I know we all are so listen consider that and if you want to have that included let me know or let Jen let me know and copy Jen on that uh and it would it has to be a committed decision to include them on the advisory board that's for strategic planning going you know so maybe useful to have that okay and tomorrow we have 607 and 611 and 795 up for discussion on 611 there we are and ruby you're here um and I'm glad you're here thank you for for joining us again I actually I want to ask you uh if you have any recommendations for improvements to the bill as it's come to us from the house um the recommendations that I primarily have you have any testimony in written form which might make your life a little easier um but I can go back over sort of the highlights if that helps can you do that for just in just a few minutes and that'll that'll refresh our our memories yeah the the sort of primary recommendations that that I gave in testimony were about reintroducing language to to put a funding mechanism in rather than just a rate study we we know that home and community based services are underfunded this is we don't need a study to tell us that and um the original language in the bill um was was about creating that mechanism now and to um I think this committee has made the point several times uh about the opposing benefits of studies versus making a difference right now and especially during COVID these home and community based services are the reason that people are able to stay in their homes in a safe environment and still get the support that they need and we need to we need to support those services we've seen it with adult days some of them have had to close we've seen um our senior centers and all of our service providers really are struggling to make ends meet and to deliver those services and they're doing a phenomenal job so I think they they deserve that support um the other recommendation that I made and it and it is in a specific language recommendation but really something for discussion and thought with this committee so this might be a good moment to just touch on it is how are we including senior centers in this system um you heard testimony from Deanna last week and I would just say that um one of the points that I've heard made specifically about home delivered meals is that um home delivered meals or meals on wheels is one of the only recommendations that um that someone might get when they are leaving the hospital uh in terms of like rehabilitation and recovery it's one of the only recommendations that actually isn't billable under insurance and um so I guess the recognition there is that our doctors our primary care providers all recognize that this is part of health care and nutrition is part of health care and wellness and long-term survival of humans so um where that recognition falls in in this bill is um in my personal opinion we could talk about that a little further and and how vital and integral to our health and wellness system senior centers are not just to our social interaction and how how older adults have fun in the community it's really part of the health care system so um that's a discussion that I think deserves a little more consideration and then lastly is our our safety and protections um I sit on the adult protective services subcommittee and cove was part of the um the lawsuit there a while ago and I just think that putting all of our eggs in the APS basket is foolish not all older adults are vulnerable the statutory definition there is very narrow it's an old statute and so what is a more comprehensive approach to safety for older adults and what does coordination with law enforcement and mental health and I heard some of the testimony this morning about that as well um how does that spread over into older adults so you know that's my large nutshell so you brought to us some very large nuts to crack um and I think they're all really the each one of your suggestions is um admirable and and exciting for us to think about um so given the time that we have committee uh our goal is to make sure that we can pass a bill that then the house is going to concur and I will I'll run some of the ideas that might generally be generated out of what you are saying I think the meals on wheels piece is really important and ensuring that seniors have access to adequate food especially when they're coming out of the hospital um we we know how difficult that is so even when they're going home and they have someone at home they don't always have the care and the nutrition that they need I think um senior centers yes ma'am sorry um no last year there was I believe a proposal to um to create a mechanism for billing meals on wheels to insurance you might want to talk with um representative noise about that I think yes I I get that I know that and but here here's where we are we're not at a place where we can take up something that is going to require testimony a significant testimony I think that is a really good bill for us to consider going forward just as I think adding uh senior centers into the uh system of care is a really good issue for us to take up and how do we do that that's important uh the beauty of um the bill that we have in front of us is it establishes the principles upon which we can build it's like putting in greenhouse gas reduction goals and then the next thing you do is you pass some bill that actually gets you there um so but I'm I'm hearing you um committee thoughts about um some of the directions that uh Ruby Baker has uh suggested any comments okay uh here's my suggestion read through h611 I know you're doing that already for tomorrow I would like for us if there is language that we can add that would project additional policies in in the areas that Ruby has brought up because I think they're they're important ones um maybe there's some language we can add maybe there's an amendment we can add related to any one of these but we will be going through the second half of the bill tomorrow we got to the end of the Old River Monner's uh information yesterday and then tomorrow we'll go through the rest of the bill and we'll try to do some markup on that bill that's tomorrow after we've had our joint meeting with um DFR and then we'll be also looking at 607 so any any um amendments that you'd like to place on 607 please bring those in as well including the one we mentioned on naturopathic and then we'll look at the amendment h795 that will probably be the last bill that we deal with and that may not be until you know next week but we want to try to complete our work on these bills we're just getting to a place where we have an understanding of what's there and what's not there and that's probably important questions I sent a memo out to you from DFR that helps explain what we're discussing tomorrow with house health care uh I know we have an hour and 15 minutes scheduled for that discussion I'm hoping we can go through it um efficiently okay representative wood I think we've gotten to a place of closure we'll be taking up 611 tomorrow as well as 607 and trying to finish our work on those two bills committee comments suggestions need for therapy at this point after this day we've been through a lot the ringer has gotten us talk about mental health counseling here we are some days this committee is depressing say don't don't be depressed I'm energized there's so much we can do think about all the problems we can solve going forward that's the good news all right listen I'm gonna I'm gonna give us uh nine minutes off we deserve it after today and uh Ruby thank you again for being with us and bringing your comments again greatly appreciated my pleasure so committee I'll see you at one o'clock uh 967 has been approved by rules so that will be on notice today and I don't know whether we're gonna take it up or not but I'll be ready to offer comments on it all right thank you all take care Nellie we can leave thanks