 Okay, this is the house health care committee. It's Thursday, April 1st. It's 3 p.m. And this afternoon we are We've invited the commissioner of public safety and Department of Mental Health and we see we have a deputy commissioner morning Fox with us to follow up on the issue of mental health Practitioners are being embedded in law enforcement Specifically the state police it was an issue that this committee dealt with at the end of last session and Many of us felt they would be useful to get an update as to where the process was of the Department of Public Safety and the Department of Mental Health Working to bring this about Perhaps And I I don't have any Well, I don't make preferences to who speaks first But perhaps someone could first for we have a number of new members of the committee who were not party to the discussions we had last year Perhaps Commissioner Shirley, would you be willing to give a brief Summary of the proposal that came forward and and what we are looking to get an update on And you're on mute Certainly now Thanks, thanks for having us in happy to do a an overview of how we got to this point and then probably kick it over the deputy commissioner to walk you through since he's been Very closely involved in the program development here to give you the status update on this particular initiative. So for the record Michael Shirling commissioner of the Department of Public Safety There are The the genesis of this particular kind of work goes back more than 20 years The first embedded social worker in Vermont was in bellows falls Shortly after that the city of Burlington began a partnership with the Howard Center to deploy What at the time was one mental health clinician on the church Street marketplace to help mitigate the ongoing impact of Of and to folks that suffered from mental illness substance abuse often co-occurring disorders and a variety of other unmet social service needs as they Intersected the businesses and folks that frequented the what is arguably the busiest street and In Vermont in the church Street marketplace. That was a very successful program that Provided great service to folks that were that suffered from a variety of needs and simultaneously decrease the number of Contacts with law enforcement and eventually Rides to the emergency room Intersections with the mental health system, etc Those programs have since grown up in a variety of different ways including two teams that have grown to cover Both Burlington and Chittenden County and not only Doing sort of day-to-day outreach in particular geographic areas, but doing a variety of things including proactive outreach to people who have Made it to the radar of either that the health care or criminal justice systems and have unmet needs and are Not actively engaging otherwise with services Responding sometimes with law enforcement and other first responders to include fire departments and rescue squads and in other instances responding in lieu of Those first response organizations to calls for service that originate people who are Suffering from one or more of the various co-occurring disorders that I mentioned In addition to those initiatives, there are others scattered around Vermont including two pilot projects that have been in place now for several years in Two barracks in both Westminster and St. Alvin's by all accounts these initiatives have been successful through the lens of The clients who are getting services from these folks from the first response agencies that are partnered with them from emergency departments and health care providers in the vicinity and We've done a variety of Both formal and informal studies the last formal study that I'm aware of was actually done by Doug Hoffer when he was at the University of Vermont at the request of the Burlington Police Department when I was there and and his Review of the street outreach team at the time indicated that there were decreases in calls for service for folks that were the most frequent users of services not only to The law enforcement agencies the fire department and the rescue squad visits to the emergency department Intersections with the court and the criminal justice system in a formal way and a host of other decreases in service that were a Result of the success of these these outreach and response initiatives. What we put forward last year was a Request for funding to expand the programs that exist in the two barracks that I mentioned Westminster and St. Alvin's to Six additional barracks to have a total of eight barracks covered and this year we put forward funding to expand that to nine out of the ten barracks And essentially to replicate the work that's being done in those two barracks and in other places statewide and to try to create a unified System of response where we send folks with expertise in Mental health substance abuse and other Social service provision oftentimes again in lieu of the response of law enforcement sometimes in combination with law enforcement And to not only address the the intersections with the criminal justice system, but with a wide array of of other systems as well That was funded Last year and the work began in early November if you remember those the Session was a little fragmented by the time things were signed into law. It was October of last year and So work began in November Together with the Department of Mental Health Deputy Commissioner Fox has taken a lead role in developing these programmatic initiatives and In partnership with the designated agencies and a variety of stakeholders to develop a statewide memorandum of understanding and then a hiring rubric for these folks and that's the the stage we're at now and Stop there for any historic questions and also to turn it over to the deputy commissioner for the the current status Thank you And let me just say let me just step in and say because some of our members Rightly asked like when we take bring folks into testify. Well, are we about to take an action? Do we need to think about taking an action? This is not an action item this afternoon This is for information and follow-up on work that we did take action on last year. So just to clarify that as well So There may be issues of information and clarification I've welcomed them along the way, but why don't we turn to deputy commissioner morning Fox welcome back More, you know some further update on where things stand and then we'll open it up for for the questions No for the record Morning Fox deputy commissioner Department of Mental Health As commissioner Shirley mentioned this work in earnest began in November of last year and over the course of the last six months. We've had a Rather extensive stakeholder engagement process to really build from the ground up Memorandum of understanding That would be used statewide that can be used by Every designated agency and their local barracks. So that there's fidelity and consistency around expectations Of this work and and the work being provided by the mental health crisis specialists. That's the The term that we're currently using for these folks and that we did not want to Use language such as embedded social worker or counselor or something of that sort Partly because we didn't want to box ourselves into the need for Licensed individuals of any particular Practice and also that folks with lived experience and more practical Experiences as opposed to Book learning and other education backgrounds That it would be open to any of those folks that would be appropriate to make that work In in these in these settings and so we engaged with the designated agencies the statewide State program standing committee local standing committees throughout the state as well as Vermont psychiatric survivors NAMI Different commissions related to domestic violence Victim crime Supports as well as the director of racial equity In the governor's office and so through that that process It's taken us a bit longer than I think we would have liked to have gotten at this point Just but it's been an extensive back-and-forth conversation around the details of the MOU The details of the actual job description and as commissioner sterling said The kind of onboarding and training Of these folks again wanting to try to ensure as best as possible that there's fidelity Across the state and in all this work We are at the place now, it's actually good timing that that you asked for this update as last week the Memorandum of understanding has gone through It's kind of final processes to be signed off on it's gone through the the lens of the not only the The people who may be providing services or supervising these services both from the department public safety and the designated agencies But also from a legal perspective Both the general councils for Department Public Safety Department of Mental Health and through Vermont care partners To basically make sure that everyone was in agreement in the context of the Memorandum of understanding and responsibilities supervision things of that sort as well, so We are now at a final stage of finally having all these documents finalized And and consistent and so it's now In fact, Commissioner Shirley and I spoke earlier Today to just start coming up with the process of now rolling it out bringing the designated agencies together with the barracks and really rolling out the hiring process In getting that started in the coming weeks Okay So just let me just ask several things and then open it up to other members So is it's so remind us? It is the intention that these folks would be hired Through a through what process who would who would be doing the hiring? They as I remember commissioner They would be employees of the Department of Public Safety. Am I correct? They would actually be employees of the designated agencies in part because we want to ensure the correct clinical supervision through the folks that have that expertise And Reminded because I said there were different iterations going around. Yeah, there were and We envision a collaborative hiring process where ultimately the designated agencies doing the hiring But that there are stakeholders and representatives from the Department of Mental Health and the Department of Public Safety is part of that Hiring process and one of the things we spoke about this morning was ensuring that there was Consistency statewide, we don't create 10 different hiring processes around the state and try to do it in a way that Creates well working for different agencies a unified program to the greatest extent possible And just to add to that I think part of that hiring process what we're looking at is that as commissioner said The the final decision is that it's going to be a decision on the designated agency They'll be the one that's employing the individuals But it will be a collaborative process with representatives from Department of Public Safety the designated agency people with lived experience as well as some of the members of the of the small committee that helped put put all these pieces together So we have kind of a consistent hiring throughout the state Okay Well, let me Let's just open it up to further questions at this point. I see several hands represent Peterson then represent Burroughs Yes, thank you The folks you're hiring And I and I might have gotten this Way wrong I'm trying to follow all said here the folks of your hiring are going to deploy with law enforcement to be a Mental health advocate and to diffuse situations And work with law enforcement Everywhere is that what the ultimate goal is that every every barracks every group every Is it the ultimate goal that every? Every time an officer leaves on a patrol or anything that That person would go with them or are they In the in the barracks for a call-out should something happen how how will that that's one question The other question I have is I You talk about folks with lived experience Are they going to be possibly hired for this also? Those are the two questions I have I'll start with the answer to the first question and actually give you a number of fragments of information in response to that The In terms of the service area we envision that it will be statewide eventually Once we have all the barracks covered and it won't only be Servicing the service area that the barracks covers so for example out of the Rutland barracks if there was a call in Brandon Even though the Brandon Police Department covers that area this these this staff would be available outside of the The service area of the barracks as well In terms of where they deploy from in some instances, they'll be coming from the barracks They may be there doing meetings or gathering information They may be responding from another location They may be responding to calls with a trooper or another police officer They may be responding to a call in lieu of that the response by a law enforcement officer, and they may be out doing proactive Contact with clients to prevent calls from service from happening. So there may be other Sort of operational methodologies that I haven't covered there but Gives you a sense of sort of the the wide scope of things they might be doing In addition to that In an ideal world Let me back up to it one more piece of history that I that I skipped over Many communities have wanted to do this kind of expansion of service for years and oftentimes it has faced Stagnation because we're waiting for a Partner or waiting for the state or waiting for someone to come forward with a fragment of funding to be able to make this all work We finally said last year listen well the ideal scenario is that you've got multiple partners helping to fund this kind of initiative Because there's a benefit to a wide array of stakeholders. Let's just start by the seed funding coming from the state Let's get the program up and running and then we will go out and continue to hopefully expand right now Remember we're we're contemplating just one Employee that covers each of the various barracks area. That's my other question. Okay, it's We have multiple shifts. You might need multiple people per shift And we're gonna get a lot more experience with a statewide footprint as this gets off the ground And the hope is that we partner with hospitals with designated agencies with other health care providers with other first response Organizations maybe with statewide organizations like one care or others all to bring Collaborative funding to the table to expand the footprint based on the efficacy that we demonstrate going forward and on the on the Second half of the question I'll defer to the deputy commissioner Yeah, and just to follow up on some of that some of the Activities of these individuals as the commissioner is speaking about the response You know coming from the barracks or other locations There are also their responses may be going out as follow-ups to prior contacts And trying to help I think the primary goal is to really try to help individuals be connected to the the social service supports that that they need and not and try to Minimize and reduce contacts with law enforcement or Other you know unnecessary emergency room visits things of that sort and trying to get them connected with the social service supports that that they would need Representative Pearson the second half of your question Can you just repeat that again, and just want to make sure I answer it correctly wanted to know is You mentioned people with lived experience and I and I my my question is What? Training have those in the in other words are you just getting some of the lived experience? You're gonna send them out there to deal with people and they don't know how to do I assume you're not gonna but I Want to know where education and training sure and and lived experience Kind of go together. Sure it is a distinct possibility that we'd be hiring individuals with Lived experience and without an advanced degree in in mental health Did the job description actually? We set a standard of having An associate's degree As a level of education The folks doing this work will not be Billing individuals will not be billing Medicaid things of that sort Generally in kind of crisis type response Where you're not seeking, you know insurance information of individuals things of that sort and from the research that that that we've done It really seems to indicate that it's more around the right person with the right attitudes the right mentality the right communication styles To to be able to be effective in this type of role Versus having x y or z degree or licensure after your name And so what we'll be looking for and individuals is just just that Their their ability and comfort levels in in working in an environment where you're working with law enforcement on a regular basis and being able to receive supervision and support from the designated agency and And so it's it's possible that we'll be hiring individuals who do not come in with you know a license or you know advanced degree It's very possible that we will be hiring many individuals with licenses and advanced degrees it's really based on compatibility and ability to Make those connections with individuals in the moment of a crisis Is the idea is that these individuals are not providing therapy For an individual they're really there to try and help manage a crisis and and help get individuals connected with the social service supports that That they need that that are at the root of the cause of that crisis for that day Thank you. Thank you representative for us. Thank you. I just first want to say that I commend you both and all of you who are standing invisibly next to you For this program. This is really exciting and I can't wait to see where it goes Commissioner Sherling you you mentioned that you were shooting for nine out of ten barracks, and I wondered what what happened to the other One that got is getting left out who got the last straw Yeah It's a great question we haven't actually left anyone out and and we've had A number of conversations the money committees this year telegraphing to them what our tentative plan is We actually have two things that we're going to solve for one is that initially the Funding was for really seven of the ten because the two that exist already Westminster and St. Almond's are funded exclusively by the designated agency. So we knew going into this. We were creating an unlevel And in an unequal playing field for those da's So what our plan is and not to drag you too far into the money, but what we've telegraphed is Because we are so far into this budget cycle the the hope is that we will plan for Funding all ten barracks going forward for it for this year We will then ask to carry forward some of the money that was appropriated from this year into the coming Fiscal year still be able to fund all ten and then in fiscal 23 come back to you with what we anticipate would be a roughly $200,000 additional funding request to sustain the funding for all ten So in fact the plans I had heard that I mean I had understood that in fact there were all ten barracks We're going to be covered in the budget as proposed. Yes. It was inadvertent That wasn't it wasn't by design But by happenstance because of the timing of all of this it's worked out that way So it's it's positive. It's a silver lining to the to the timeline that carry forward creates the opportunity Okay, so we'll represent a page So it sounds like there might be someone in the Northeast Kingdom Yes, but apart from that you have another question perhaps. Well, I do and I apologize. I came in late and Maybe you've already answered this question. What are the salaries for these individuals that are going to be assisting? The starting all in is estimated in the low 80s Including benefit package So I don't know how much of that is benefits versus salary, but based on the engagement with the designated agencies were anticipating In the low 80s and that is also an adjustment from our initial funding request, which was at 75 For each position. So that's something we'll address also going into to fiscal 23 Well, that's that's much better than I thought you were going to say You know for a salary That's not all salary. Just this be real If I were to guess it's in the you know, low to mid 50s and the rest of it is His benefits, but that's a that's a guess and maybe the deputy commissioner has a better sense of that at this stage. I don't know Yeah, and we we actually engage with the designate agencies and in particular those that are already have these these positions in place and And that's the the salary range and and total total salary package including benefits of those current individuals and so we wanted to remain consistent with With those folks and did not want to come in at a lower range than then where folks are currently at right and I would imagine you're going to find it difficult to find these individuals From you know, since we're we do have a manpower issue on almost everything The state and I will also remind you. Well, we all know it because we've been talking about it These individuals will be state workers. I'm assuming No, they're not. Okay. Very good then. Thank you very much We're also mindful of the pressures on the state budget relative to adding people But the primary reason is the the clinical supervision component Yeah, okay your questions answered represent page. Yep. Okay representative Goldman Well, I'm glad we brought that topic up because and thank you to both of you It sounds like a really excellent program and really good for our population, but oops my dog But we also have been talking a lot about how designated agencies haven't gotten raises It's really hard to like you said representative page to find staff So I feel worried about adding more staff at that level and then not funding it I know you fund it for a couple years, but what happens after that? So I guess I feel worried about the model of adding staff to designated agencies and not Having them be supported in in a state position. I understand about pressures on the state budget as well, but I mean, we can't every so often say we want to add 2% to designated agencies and that's what we've had to do this year So I'm a little I'm concerned and I'm concerned about the ongoing sustainability of this because of that problem Well, there are there's two advantages to what we've done in the initial funding First to begin it is in our base budget in the Department of Public Safety. So it doesn't just go for two years The goal is to sustain this for the long term and again to expand it through partnerships going forward in the future The advantage to it being budgeted using state dollars is that in as The salaries grow over time. So if we're able to Retain people they do get steps in cost of living in much the same way that state workers do We would be coming back to you on an annualized basis to To show those salary increases as part of our base budget since the money is passing through us So there's a an advantage in the consistency of funding With a program that's being co-managed between the Department of Public Safety and the Department of Mental Health Thank you Represent black and then represent Donahue Thank you. And thank you commissioner. Shirley. I I first of all, I think this is very exciting I can't wait to see how how things turn out My question is Are will these individuals receive even cursory training in law enforcement? They will they will get They'll get safety training. They'll get safety briefings. Um, we haven't yet discussed equipment, but I know In burlington the street outreach team actually has radios so that they can both radio for help if they needed it But they can also listen to calls for service and actively intervene if they hear something that maybe they're not dispatched to but Is a client that they're aware of and they may have something to offer they can respond. So My hope is that we're we will eventually be doing something similar to that as well And I would just I would just add that as part of the On-boarding and training. There's a number of different trainings including Different law enforcement trainings around sea management safety management things of that sort as well as Intentional peer support trainings team to training Things like things of those nature as well as well as Even radio training as as the commissioner mentioned And understanding the the computer systems of both the designated agency as well as The computer systems that department public safety uses Uh, what's it's a relatively extensive actually? training Regiment that's that's really set up for all the individuals Is there any concern about? You know sort of overlapping or You know after a sick period of time becoming more embedded as a law enforcement officer as opposed to You know the original intent of the position That's a it's a great question. And you know luckily we've got two decades of experience with this now And we haven't seen that happen They're very much distinct roles and If anything, I think what you see is that the the the clinical approach Um Sort of morphs its way more into the officers who are learning from the clinicians that they're responding with And those skillsets sort of bleed over In a really positive way and and not so much the other way around And I would just add and That you know, I guess as commissioner shirling would will probably agree with me that I think in a lot of cases Many officers and troopers are hesitant or reluctant or concerned about having a quote-unquote civilian Responding and coming out But the experience has been both in the barracks where this is is occurring as well as in other places like the community outreach team comes and That type of work in burlington is that we're actually seeing The other impact where they're having that positive influence on the law enforcement officers and they're seeing the value of Kind of that that more clinical intervention and the skills used there And I think it part of part of this work is also to try to kind of cross pollinate and really create moments of opportunity That uh what I call growth points where individuals can See an experience and then there's kind of on on the job Training and education and so it's not just that these these clinicians or these specialists are are going to be trained Into law enforcement, but that law enforcement also receives kind of that That informal training of oh, so what was how did you get that you know person that conversation? It's like well, that's some motivational interviewing that I was using well That's a really interesting concept. How does that work? And that's some of that cross-pollination that that we've seen in other places that we would expect to continue to see Again, I'm very excited. I know You know the local police department in my town and representative potent's town We share one with surrounding communities and I've heard the chief talk about if we can have our own Individual it would make a world of difference Yeah Yeah, to that point what we hear most frequently is troopers and police officers asking for more Uh of this kind of staff as many as we can deliver. They'll take them Okay Thank you representative down here Thank you. Um, I realized that a lot of the mo you um sure has to do with How do how does the money run? How does the supervision run? I'm wondering? How much is involved in it in talking about? Who responds? How are responses handled? What's the relationship like and if there's any examples of things like that that you can share? I think Commissioner if that's all right, I'll I'll Angie you can go sure But I think one of the major pieces of the of the mo you actually speaks to Um When that co-response happens who's taking the lead? How is that happening things of that sort and We tried not to get this to be too complex of a of a document and try and go into Each and every scenario But the basic concept that that we tried to get across in the mo you is that If there's any kind of clinical decision making, uh, I think this person needs x I think this person needs y that the crisis specialist That's that's their purview and that's their decision making Tree they'll be in there'll be a discussion. There will be conversations, but in the end The the specialist kind of runs that If there's questions around scene safety You know, is there a weapon involved or something of that sort that's law enforcement that that will take kind of the lead In in those circumstances and so that's really how we tried to to divvy that out But you know, we definitely took a strong look at that because I think we want to make sure that when it's coming down to You know, I'll give an example I think this person can follow up with you know We can have the crisis team give them a call later to follow up and we'll get them connected with You know a therapist or intake at x designated agency and the officer may say I don't think so I think they need to be in the hospital, you know, that kind of thing that it's the specialist that's going to make that final decision Versus the the safety situation The crisis specialist I I'm okay. I can go in no Law enforcement may say we know that there might be weapons here We need to make sure the scene is safe first and so they'll take that that lead at that point But that's that's the type of language that we have in the mo you What what about um, you know a 911 call comes in How is that screened in terms of whether it's going to be both or one of the other who responds? It could be screened a number of different ways, but uh, the My experience has been, you know, the mo is Most applicable in the first three to four months and after that there is just a flow to how all this works and it really is a team that is firing on all cylinders and Folks know who's best suited to do various things and if anything these the the folks that we're going to hire are Their phone is going to be ringing, you know three months in it's going to be ringing constantly Both with clients who are calling directly people calling dispatch asking for them and our staff calling and asking for their advice or asking for their help or ask them to respond to things so The performance punishment comes in pretty quickly So the the you know We could script a variety of those different flows, but it really does come down to common sense And everybody listening to the calls that are happening and that's why having them On the radio and present and able to intercede When they hear something going on or to call off a response to say listen, you know You're sending me to go see john smith. I was there yesterday He was not really in a good way and he was threatening me at the time So why don't we send a trooper or a police officer first and I'll I'll wait and And if he's calm, then I'll go in and talk to him It all just it kind of flows based on that that common sense rubric once things start moving Thank you. Um, I'm gonna just throw in a question here Frankly, it seems to me that individuals who are Are willing to step into these types of roles bring a particular special set of personal qualities and willingness to step into crisis situations, etc and So and I know that's what you'll be, you know assessing for and looking for and hiring It seems like there might also be particular opportunities to have these folks Connect with each other Across the state that they're so that they're not learning and doing this in particular isolation as a part As opposed to just the individual supervision or whatever type of supervision is set up at each da So I'm wondering if you if that's being Contemplated and hoping that it is actually it is There might be particular value to Having them have peers if you will I think that's exactly right and we've had those active conversations already and not just connecting the 10 folks that will work in this in the bubble of this program But having them connected to the folks doing similar work all over the state. So we're really trying to create An array of assets that can leverage each other's experience each other's talents training To provide better service and leverage each other's experience going forward Yeah, and we actually Don't have a right in front of me, but I believe it's actually spelled out In one of the documents that we'd be looking at a monthly kind of peer supervision with these folks Again to share their experiences And and what they've learned Through their experiences so that others can learn from that as opposed to having to learn it for themselves In the moment of a crisis So I know you're exactly right Representative Lippert that Having that that space is is really important. And so we actually look at that is not only the the direct supervision from the mercy service director at the designate agency, but also Regularly scheduled peer supervision meetings as well Representative Peterson perhaps and then representative Goldman Yes, um, you probably mentioned this along the way here, but how long is the training period for these folks? What are we envision as a training period? I assume they're You know, you've mentioned all the things you're going to want to train them on What are we talking? I don't know if there's been a timeline developed yet. I'd ask the deputy deputy commissioner if they have a timeline I could take a shot at you know A ball parking it but they may have a timeline already built. Yeah, we we don't have a specific timeline I think part of it is coordinating all the different trainings as there are some specific prescribed trainings as well as Things that can be trained kind of on the job type training And such like that But we haven't there isn't a schedule For that as delineated in any of our documents yet Commissioner shirling. What's the training period for a state trooper? Yeah It's pretty close to a year From pre-basic through field training Uh, we don't envision anything close to that, you know, assuming I understand coming in I understand but I You know, I maybe I'm looking at the negative here, but you know, I hate to put in a person with Limited training in a in a bad situation. That's all I I assume you're going to pair up if there's any question That's exactly right And and one of the jobs of the the supervisor on duty for the particular barracks is to ensure that we're not placing clinicians in Uh in bad circumstances much like we don't want to put a trooper in a bad circumstance alone either but uh a little different um Little different balancing act there And I would just add similar to what commissioner shirling stated earlier that you know after a few months kind of How the calls go and how they're rooted becomes kind of a well-oiled and just I think at you know, the early outset you'll see a lot more co-responses And then as comfort levels and and other things develop You'll start to then see more separate Responses or you know the clinicians responding to a radio call going. I know, you know, john doe I feel comfortable taking that that call, you know those types of things as well Right. Okay. Thank you And even in the urban uh more urban to the extent we have urban in vermont in the more urban environments where we have These folks operating sometimes those contacts are done by phone to assess um, you know, what somebody's current state is so the the Um, the street outreach team member will call them and get an initial Sort of weather report before they they walk up to the door Represent golden represent done here So it seems you almost have a natural experiment because there have been two Barracks st. Albans and Westminster with these people with many that don't have it So do you have any data comparing like emergency room visits or anything that could sort of demonstrate the Outcomes of this program. I wish we did we don't our current data system is uh old and busted We are getting a new one where it's in progress right now should be up and running by july so perfect timing to begin looking at At the efficacy. Um, we do have that data From other departments, uh that have utilized, uh, this kind of response and it does show definitive Differences in call volumes, especially with folks that are More frequently in contact with the systems that I uh described For for folks that have um You know, there's a variety of different clients that that people interact with sometimes It's just a a one-time thing someone's in a crisis. Uh, they need a crisis response We never see them again. Um But more frequently there's a very small cross-section of people that tend to to utilize services Whether that's emergency department or law enforcement or criminal justice system um in a in a very disproportionate way and that's where a lot of the Um really successful interventions are in reducing excessive call volumes By a cross a small cross-section of individuals to a much smaller level And then moving on to the next sort of cohort of folks that um that could use services I have unmet needs and trying to address those the analogy is If you've read uh Malcolm Gladwell's million dollar Murray, it's it's pretty old now is the 80s he wrote a uh an article around a A gentleman who had a variety of needs in new york city and then assessed what the cost of A year's worth of services to that person was and and the moniker was million dollar Murray because even back in the 80s He was consuming a million dollars plus in resources across health care systems criminal justice services, etc When we did an initial assessment, um when we deployed the first city-wide street outreach team in burlington We had a number of million dollar Murray's and they were able to successfully um Provide a level of service that those folks had not previously enjoyed and as a result of that going to them instead of Relying on them keeping appointments as they suffered from various types of crises Their visits to the emergency department their rides in the back of a police car Their rides in an ambulance all went down dramatically So their quality of life improved the cost of the various services um improved and it was just a I can't overstate how um How useful in so many different ways these kinds of response initiatives are So chair, uh, mr. Chair if I may follow up Sure I'm just wondering if in the if if i'm not sure where the appropriate place would be but it would it be in the MOU or you say you're going towards collecting data Have you talked about a process? Would it be in the MOU? Would it where would it live? I know your data collection is all terrible But I think in order to prove that this has value. I I understand about million dollar Murray Yeah, but it's anecdotal. So how do we understand statewide the impact of this program? so we the the the Components of the information technology system already exist because the system we chose is already in use and roughly 50% of the agencies in Vermont including most of chitin and county which has been tracking this for some time so It's embedded in that system. So once we get to july we will be able to Much more clearly track the impact of a variety of different kinds of social service needs and and call types And how they Change over time based on different kinds of strategies And I would I would just add in in the MOU itself We there are probably close to two dozen different data points That will be collected everything from age You know kind of general demographic type information Where calls came in nature of the call mental health related substance use related other, you know on down You know quite an extensive list of of data because that's just it You know, we know that we need to come back and show the efficacy of the program in order to be able to say We want to keep getting funding and keep this a part of the base budget and and such like that And so anecdotal data does not equate to you know the receiving funding and so We that's baked into the MOU The data points and even though as the commissioner said we didn't have kind of that the data to show the efficacy of the two kind of current embedded workers those workers were a part of This development of the MOU and and working with us in the job description and the training Based on what they went through the the good things that that happened for them the The hiccups and hurdles and and roadblocks that that happened for them and you know so that we could Basically pave the road for the next round of folks coming in to have As good and even a better experience In the in the training and what data they're collecting and it's based off a lot of what data they're already collecting and Monitoring as well so So one more question if I may um the two people that have been embedded It sounds like they were for a long time. Um, do you have any sense of what the turnover is in that position? It's been about two years. I don't believe there's been turnover Uh, I could be wrong, but I'm not aware of any turnover so far No, I think that the worker out of west minster. I know has been there at least two or three years and St. Albans as well has been there for several years And the only the only worker I've ever known there. Uh, okay, that's great. Thank you. Yeah Is that done here representative Peterson? Yes, thank you. I think um, the only thing that's um, that's a little bit uh disparaging About this is when you think back if you imagine what most people thought and maybe once was the goals and vision and type of work that That are crisis teams around the state were intended to do and a lot of the description of this work is Exactly what our our crisis teams were envisioned of as and even in terms of close working relationships with law enforcement and Spawn with them and assist Was uh, what was called team to training to help make those communications work And having attended some of them. I know one of the law enforcement responses to that was Gee, you know great training about How to reach out and get crisis team response? Response, but they never respond because they're never available Because they're either under staff for you know lack of Being able to compensate or even more frequently simply tied up sitting in emergency rooms Doing screening which results in a lot of people not wanting to call them in a crisis because they know calling the crisis team means Being evaluated for whether you're going to be involuntarily hospitalized so It sort of feels in a lot of ways like You know starting over with something that that could have been there But we we didn't fund and didn't support and Therefore has kind of been diverted but The thing that started me thinking about that actually thinking about it in terms of the Kind of crisis team response function that they play Is the fact that we just heard earlier today that That there's a whole batch of ARPA money specifically designated for crisis team ball string So i'm just wondering in terms of this model if this is what we're Where we're going now with with sustainable funding for crisis response If that could could be a source for for funding for expansion here That's a great question. We haven't gotten that far into Exploring that particular funding option, but as you observe I remember responding in the late 80s and early 90s with the Howard Center's mobile crisis team and You know learned a lot about I guess to some extent how to form these programs by By the work we did on the street way back then And an interesting Sort of offshoot the observation you made about people's willingness to call based on their perception of what might happen we get We get calls where people are requesting in some cases the street outreach worker by name And in other instances they're calling asking for particular police officers because for some reason they didn't like what the what the The street outreach worker told them so instead they want to talk to officer smith And they don't really want to talk to Justin so they want to talk to him. So it people begin to kind of shop for Um, the service they want which is fine because the goal is to get them to engage in the problem solving process So either one is is actually a positive outcome I I did I did extensive street outreach in uh, new york city in the in the 80s. So I'm very familiar with the That whole phenomenon and I would And you know, I I was at the Howard centers, uh, their mobile crisis team in the mid 90s And if a program like this existed, I would have jumped at that opportunity I that was back in the day when most of our outreaches were in the community not to the emergency room as as you see more often now And uh You know just to your to your point representative donahue around, uh concerns of of individuals because of The concern of of how our responder may may respond And you know, uh We took particular note of that and made sure that Part of the the understanding is that these crisis specialists Uh would Receive the training that a qualified mental health professional receives for their understanding and knowledge of the laws Uh, but that they would not be designated as qualified mental health professionals Uh in that we don't want that to be a barrier We don't want people to think if if I am in contact with Uh these folks, uh with you know a mental health crisis specialist through through the police that They may seek to you know involuntarily hospitalize me Maybe for yeah for background for new folks What does that title mean? What's qualified mental health professional? So qual qualified mental health professional Are the individuals that uh, the department provides training for at the designated agencies And it's a two-year designation every two years people would have to go through The qualified mental health professional training and it's all about The laws around involuntary hospitalization and basically with with Completion of that training the individuals at the designated agencies in the emergency services would have the capacity to engage in The involuntary hospitalization process they would generally do the Basically the first part of the emergency exam if you will or the ability to Work with a judge to write a warrant To bring someone to a hospital for an emergency exam For to commence the the process for involuntary hospitalization. Oh, this is uh Actually filled us in with a lot of information. Um Actually, I have one one other question that occurs to me because very late very very late in the negotiations that resulted in this becoming law domestic violence was added Very late in the negotiations if you remember commissioner shirling and we were all very late in the night doing this There Well, I'm just saying uh, that is part of the statute now and I did hear it referenced in the in the app in the Stakeholders involvement and so I'm I'm just interested just To learn if there's anything To learn about the inclusion of that and what that might mean I don't know that we've got a um a specific lane of travel for that yet, uh other than um in that array of training that is uh um going to be important early on uh awareness training around um how to recognize and what the impacts of domestic violence are and how uh someone that may be um subject to a cycle of violence um may uh present differently or um what the uh areas of concern might be if you're uh If you're interacting with somebody who you're you're trying to uh assist that's in that uh type of a crisis And I think the the the direction that we took and in receiving feedback From from those folks was to be clear about the lanes and and and the work and that These individuals are not to take over uh For those those supports, uh, but to be able to help identify and appropriately refer to those types of supports Or to to engage in emergent situations around safety, but really not to supplant or replace any of the domestic violence supports that are that are currently out there in the state Sounds like you've found a good accommodation perhaps for the change in statutory language Great, I think um I think maybe we're at the point where it makes sense for us to Bring us to a close for the afternoon. Again. Thank you commissioner. Sherling. This has been very informative and uh deputy commissioner fox And I have to say that you know, you know, this isn't this is an example, you know, like we work hard we Bring our different points of view together trying to move something forward as the legislature and then we move forward with uh turning it over to the executive branch to implement and uh and this is This is a very helpful update and um and very hopeful update given all that all that uh can happen here So we look forward to staying staying apprised of this work and uh look forward to hearing from you again another point in time Thanks for having us in. Thanks for the support. Okay. Thank you very much. Thank you. Bye Thank you Okay, um So I think that brings us to a close for the day we can go off you too